In this 45‑minute podcast Dr. Paul Anderson explains what post‑COVID syndrome (long COVID) is, why its presentation is wildly heterogeneous, and how the underlying biology of SARS‑CoV‑2 interacts with each individual’s immune, hormonal, and metabolic landscape to produce a spectrum of lingering symptoms. He frames post‑COVID as a classic post‑viral illness, then dives into direct pathophysiologic pathways (e.g., clotting, organ‑specific damage) and indirect cascades (e.g., hormonal dysregulation, electrolyte shifts, toxin unmasking, mitochondrial dysfunction, blood‑brain‑barrier breakdown). The episode outlines key mechanistic players such as the viral furin cleavage site and the bradykinin system, and links them to clinical manifestations ranging from fatigue, pain, and respiratory compromise to neuro‑psychiatric disorders. Dr. Anderson stresses that treating only symptoms is insufficient; clinicians must assess underlying drivers using a stepwise work‑up guided by the K‑L‑O‑K severity scale, basic labs, endocrine panels, toxin screens, and mitochondrial/antioxidant markers. He recommends a pragmatic blend of symptomatic relief, cause‑oriented interventions, and, when needed, referral to functional‑medicine or specialist care. The podcast also promotes his CE presentation, a forthcoming newsletter, and social‑media resources for patients and providers.
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Empower the listener to gain access to the best healthcare possible. Good day and welcome to Medicine Health with Dr. Paul Anderson. That's me, I'm Dr. Paul, and today we are going to talk about something that we hear about seemingly multiple times a day now, and that's post-COVID syndrome. It's also been known as being a COVID long hauler, or long COVID is a more common term used in the last month or two. But whatever you call it, it certainly is happening. It's something that is both common and also complex, and things that are complex kind of defy simple answers. And so there's a lot of confusion around what it is and, you know, how it comes about, etc. The other thing that I think lends to some confusion around it is there's this big variety of the way that people experience post-COVID syndrome, because you have some people that have none at all. You have some people, it's rather short and, you know, kind of like a post-flu syndrome where you just don't feel very good and they come out of it. And then you have other people that, you know, I personally know people, you know, who 6, 7 months in still have quite a bit of trouble. And things like that, when you have seemingly one infectious process and yet a lot of different experiences with it, same as we see with COVID as an infection. And then you can have people who have rather, you know, moderate to severe infection and they don't get follow-up symptoms. And then you have people that have moderate to severe and have, you know, extreme follow-up symptoms with COVID So it's frustrating in that sense because there's not a lot of straight lines that you can draw. So we've talked about COVID itself, the infection, which of course is bad enough if you have significant symptoms with it. And we talked about how that's part of COVID We have people who are, you know, infected seemingly but asymptomatic, and we You have people who are infected and extremely symptomatic and everything in between. Now with post-COVID syndrome, it's a similar bag, a bag of tricks, if you will. And so what I wanted to do today was to take the podcast and break down the way that you can create a post-viral illness, because this is already, this is a very well-known thing in medicine, post-viral illnesses. And then what I really wanna do is talk about not only, you know, what is this post-COVID thing and where can we get help and, you know, what can we do about it, but also why would COVID as an infectious process create such a variety of responses amongst people? Mm-hmm. Because we literally have people who are, you know, debilitated and still having problems months and months out. And then we have other people, you know, Right next door to them that had no post-COVID experience at all. And you can look at some basic factors that sometimes help to draw lines between them, but even some of those basic things we think about don't really pan out every time. So really want to just go through that and dig down into it. Now, there's 2 other things that, that I've done that you can look at if you like. One is for healthcare practitioners. I have a 2-hour presentation, it's a CE presentation on post-COVID illness and how to think about it and where the pathology comes from and more from the healthcare provider, how to manage it. And that's on my healthcare provider website, consultdranderson.com. And that's got that there in the CE section. And I'm finishing a follow-up to this particular podcast, which will be a newsletter. So for those who actually like to see where all the references are and see the citations and, you know, kind of be able to slow down and read through things instead of hearing it, the newsletters are a hit in that respect. People that— if you're not into reading, then the podcasts are probably a little bit easier. But we should have that newsletter out next week. It's still having some work I'm doing on it. There's some publications that are just coming out like right now that I want to make sure that I get in there. And in order to do it, do it justice, do the topic justice, it's going to take a little bit of time to get that done, but probably next week. And it'll just be entitled Post-COVID Syndrome. And you can get that with all the other newsletters. So people have asked, what's the easiest way to find links to, to my stuff. If you're on Instagram, it's just DRA, DRA like Dr. A, DRA Online, O-N-L-I-N-E. If you're on Facebook, it's DR.A Online, so it's almost the same as the Instagram handle. And both of those places have a lot of links. The Instagram has a Linktree with links to all of these, all these things. But let's start out with what is post-COVID syndrome, or otherwise known as being a COVID long hauler, or long COVID is kind of a common thing they're talking about now, and it's just different ways to talk about the same thing. Post-COVID syndrome is a post-viral illness. That means that your viremia, your disease with SARS-CoV-2, the infection is Done, and now you have lingering symptoms that are either stable and not going away or are very slowly going away, but they are not directly related to the ongoing viral infection. So symptoms you have during the viral infection, whether it's influenza or COVID, etc., are Are viral-related symptoms, and sometimes they're the same as the post-viral symptoms. Post-viral symptoms, post-COVID symptoms, are when you technically aren't dealing with the infection anymore. Your immune system has cleared it. Now, it— another frustrating thing about post-COVID syndrome is it can be a list of things all the way from generalized fatigue. Neurological symptoms like anxiety, depression, sleep disorder, a number of other neurological neuropsychiatric symptoms, chronic headaches, chronic body-wide pain. We've had people who have chronic lung issues. A lot of times they'll have to be on residual oxygen periodically because of low ability to move oxygen. A number of other things there. We even have people who have derangements in their blood mineral levels, especially sodium and potassium. And we'll talk about that in just a minute and a host of other things. So you look at it and it's like, as I said, it's a lot like with COVID Why does one person, you know, get more lung symptoms and then sort of a viral fatigue and they kind of work their way out of it? Other people lose their sense of smell or taste or both, and then they get maybe some abnormal clotting, or they get some brain problems. How can you have one disease do all of this? Well, whenever you have one disease that does all of that, the post-illness from that disease will be very broad. Because if you think about it, what happens is when you dig down to why would an infection like SARS-CoV-2, which is— of course, different than SARS-CoV-1, and we'll talk about one of its little tricks that makes it maybe a little more likely to do this and be more infectious. But when you have something like SARS-CoV-2 that can do all of these different things, what happens is that when the virus gets in, part of its ability to infect you, so its pathogenicity, is that it can— well, it possesses different types of ways to dock with the cells in our respiratory system. And those tricks that it has biologically for docking and replicating lead to other problems inside of you as a human. And instead of just being, you know, in one location, such as, say, your lungs, and then getting in the lung and then, you know, replicating around the body and creating a viremia. That's the viral part of it, but the other chemistry around it is very complex, and what it does is it causes a cascade downstream of things like pro-inflammatory chemistry and other chemistry that is associated both with viral infections generally and also your immune system fighting back. So just like we talked about, we talked about COVID all those times, When you get the immune system pushing back and fighting, you can now have double the amount of pro-inflammatory and other kind of immunologic chemistry going on that creates downstream effects. So it's no longer just about the virus meeting your cells and replicating, it's now about damage to your cells And then a derangement of the normal immune response. So when you have that, it's sort of like if you were to take and roll, you know, let's say you had a road, you know, driveway that was sloped downhill. And you, you know, you could roll a basketball down that driveway and You know, roll it into the side of the garage, right? Well, if the driveway is perfect and not slanted to side to side or doesn't have holes in it or whatever, you roll the ball down there from the center 100 times, you're going to hit somewhere near the center of the garage door. But if you take that ball and you go to a driveway that's slanted to the left and you roll it the same way, it's going to go to the left most of the time. Take it to a driveway slanted to the right, it's gonna go to the right. Take it to a driveway with a big giant hole in the middle, it might fall in the hole and never get there. Take it to a driveway with a bunch of little holes all over it, and it's gonna have this random pattern of going right, left, center, and all over. What does that relate to? Well, it's the same. So the human, you, are like the driveway. And some people, their immune system is pretty well balanced. They weren't terribly sick before. They didn't, you know, all this other stuff. And there's a lot of genetic things. So saying you weren't sick before is not a get-out-of-jail-free card. Some of the most sick people I know with post-COVID syndrome were totally quote-unquote healthy before. They had absolutely no underlying problems. They were young. They didn't have any of the signs that would say, gee, we should worry about you. And they have some of the worst post-COVID. So being healthy from the outside is sort of a misnomer, but let's just say you are. If you're healthy, it's sort of like having that nice flat driveway. You know, you're going to get a predictable outcome. And the other good thing about that is if you get COVID, you're going to have a predictable response and then probably predictable post-COVID if you get it. But if you have things on the inside that you do or don't know about, and most of these things we don't know about, they're not things that we screen people for regularly. The ball may start rolling downhill and you think it's going to go fine and you might hit a whole bunch of little pockets in the first roll. It may go A little veering off to the left and the next roll to the right. Well, those little pockets that might cause that deviation can be things inside of the human that would be things that would trigger maybe an up or a down regulation in some of this immune chemistry that goes on. And that chemistry can be all the way from the virus docking all the way over to just how your immune system responds to it. So because we don't know the underlying terrain of this driveway, you the driveway, As the ball is rolling down, we have a theoretical model which should predict how it goes, and that would be the nice flat straight perfect driveway, and none of those exist. And then we have the realistic model, which is we add you and your biology into it, and now the virus interacts with your biology, including your genetics and the epigenetic signals and everything else going on, and now you create your own pathology and your own post-COVID pathology. That's why you can have 10 people and there's 10 different experiences, and even if you have post-COVID syndrome, you have 10 different experiences of post-COVID syndrome. So human variety is the big wild card here. Now why is that important long term in doing something about this? Because if I just told you the story that which I have been, that, you know, this is a very random disease. It is something that sometimes follows the rules, sometimes doesn't appear to follow the rules. It's really following rules. We just don't see all the players in the game. And then I ended there, it would be kind of a, you know, just sort of a downer as a story. But what I can tell you from a lot of years of dealing with people with Post-illness syndromes. Okay. Post-illness syndromes can be things like post-chemotherapy syndromes, post-radiation syndromes, but also the most common are post-viral syndromes because we have a lot of data from, you know, the past and we know people would get sick and then they wouldn't recover appropriately. So when we look at that and we look at post-illness syndromes, there are some things that we can bring forward from it, even though, you know, it's— yes, post-COVID syndrome has only existed in time we've had COVID. Okay. But post-viral syndromes and other post-illness syndromes have existed forever, and we have a lot of information on them, and doctors like myself have treated a lot of people with these things. So why don't we look at those concepts and see if there's not a roadmap towards a better understanding of post-COVID syndrome and a better way to assess and treat the people who have it? And so one of the things I want to say at that juncture with respect to, you know, why is it so varied and, you know, why do we literally have 10 people and 10 totally different seeming diseases or disorders, is that in medicine what happens a lot of times is when there's these multifactorial things. So a non-multifactorial event would be a perfect driveway. One ball rolling down one hill into one garage door, you're going to get a fairly predictable outcome. Okay, multifactorial are the driveway looks normal, but it has a lot of waves and bumps and lumps in it. So every time I roll the ball downhill, I'm going to get a different outcome with the ball. Well, that's what people are really like. They are multifactorial beings. And then when you put multifactorial beings and a virus that can create multifactorial immunochemical effects, you get not one outcome, you get a lot of outcomes. Well, in medicine, what we like to do is we like to call those things syndromes, and that's nice because it puts them all in it. Okay, it's, it's not one thing, but it's a bunch of stuff. But in the way that modern North American medicine is practiced anyway, we don't really like to treat syndromes because medicine is mostly set up to have a one-shot, one-kill sort of effect. If you, you know, have a bacterial infection, We give you an antibiotic that kills that bacteria, hope it kills the bacteria. If you break your arm, you know, we set your arm and put it in the cast and it heals up. Those are great. Those work really well. But when you have something that has a bunch of positive potential inputs and a bunch of potential outcomes and they don't always match up, that is not a linear equation and that creates a lot of trouble. So what tends to happen is a syndrome is talked about, it is named, and then medicine kind of goes to the other end of it and says, well, what can we do to treat the symptoms? At least because we'd like you not to be, you know, in pain, or we'd like you not to be fatigued or whatever. And there's nothing wrong with treating the symptoms, but the problem that I've seen with these complex post-viral things is if you don't sometimes work your way back towards what went wrong in the middle, Where was the driveway messed up and how did the chemistry get, you know, imbalanced? You can have people who still don't get better. Okay, so there's nothing wrong with treating the symptoms on the other side of the problem, but if you are not getting better in post-COVID syndrome, then you need to back up and think what else could have gone awry between end of infection And where I am now. And that's where this uneven driveway idea comes about, and you are the uneven driveway. So when we think about this, if you think about, well, you've got the mechanism of the infection creating all these varied problems from brain problems and clotting and lung issues and every other thing in the world. Yeah. And then you've got the immune system either accentuating or aggravating all of those causes. Then the next thing you have to think of is where would those causes go? Let's say we could pause them right here in the middle. Where would they go moving forward that would give me all these symptoms of post-COVID syndrome, like I said, which are all over the body? Well, there's a couple of things that I want to bring up and have you just think about while we work through this. The first one is there are direct problems that can come about, and the second is there are indirect problems that can come about. So a direct problem example would be, let's say you don't know it, but somewhere in your uneven driveway you have a tendency towards clotting, and it hasn't been a problem before because you've been otherwise healthy, and so, you know, no harm, no foul, everything's looking good. Then you get this disease that triggers a lot of abnormal inflammatory clotting activity. And so you have the trigger of the abnormal inflammatory clotting activity, and now all of a sudden, unfortunately, you have some clots that go in places that they shouldn't— maybe your kidneys, maybe your lungs, maybe your brain, elsewhere. Okay, so that's a linear example of a problem. Nobody wants that, but that's part of post-COVID syndrome, would be abnormal clotting. But there's a kind of direct relationship between what caused it, and it's a clot creating a problem, embolizing somewhere, etc. The other thing that can happen in that line is maybe, you know, thankfully don't have a clot form, but your, your blood gets very thick, very hypercoagulable, and if it doesn't stop being that way, you will clot, but that can create other problems also all throughout your body. Okay, so that's an example of a direct problem. Then there's the indirect problems. These are the ones that I, uh, I see when I'm, you know, talking to clinicians and, uh, you know, they're brainstorming about what to do with the patient. These are the ones that aren't always, uh, first of mind. Okay, so you can have— if you think that this goes in and creates, you know, all of these many, many immunologic changes, That means that inside of you as the human, anything that was or was not a problem before now suddenly can have a disease pathology start. So the easy ones are in these secondary problems. What if you, before all this started, had a hormonal problem? Like let's say you're, uh, you had the most common low thyroid, Hashimoto's thyroiditis, Well, when you get these inflammatory cascades going on, sometimes that can aggravate something like a Hashimoto's thyroiditis, hypothyroidism, and you could on the other side of the illness be more hypothyroid than you were when you started. So you might already be taking thyroid medication for your thyroid problem, but you might actually need more or less on the other side. Now that's a direct problem, but it's not normally thought of as having something to do with A viral infection, although we do see that a lot, but it's not the first thing on your mind when you're thinking of a patient. But think about it, if that happened, just that one thing, then what would it aggravate? Well, if your thyroid went a little lower than it normally was in the post-COVID time period, you would have more hypothyroid symptoms. So you could be more fatigued, you could have more mental sluggishness, et cetera, et cetera. You can have other hormonal things that will go on because your cortisol system, your adrenals, hormones are in the corticoid family, at least the steroid ones are. They respond a lot when you get sick with anything, but especially infection. So they can sometimes go higher or lower in the post-COVID time period, and then you can wind up having you know, some unusual things that you weren't experiencing before. You can have shifts in the way your minerals in your blood rebalance out. You can have shifts in the things that the cortisol family does for you, which is— there's many, many things there, whether it goes high or it goes low. Now, thankfully, we don't, at least up to this point, see people going into disease states of low cortisol or high cortisol, like Cushing's or Addison's. But we do see people, if we track them, going low normal or or high normal, meaning that they're having a response that's sort of worn out the system a little bit. A really nice thing with your adrenal glands, which is different than your thyroid, is the adrenals can recover if they're taken care of, and they often do. But here's the thing, if they're taking 3, 4, 5 months to recover and no one's looked to see that they're low or high, that will definitely aggravate all of your symptoms, whatever they are. Because the adrenal hormones, we think of cortisol, but there's other ones that are related to cortisol are very important that happen in your body every day. And they help you with many, many, many balancing things, physiological and mental and all sorts of other things. So these are secondary things. And then there's a whole bunch of other things that can happen. One of them is that another secondary effect is, is that you had something going on before that was what we— excuse me— what we would call subthreshold. So it was not at a disease state. Maybe levels weren't quite what they ought to be, but it wasn't a big deal. Okay, you were living, it was fine. But then you do all of this COVID business in the middle and it just beats your system up. And it could— same thing could happen with influenza or any other protracted lung illness. You come out the other side of the infection and what was subthreshold is now frankly low. Or frankly high, whichever direction it was headed. This we've seen happen with people. And again, it's not the first thing that you think about because now you've got this person and they've got fatigue and pain and whatever the other symptoms are. And you don't normally think of, well, you probably didn't even know what was subthreshold before because they felt okay. They were fairly normal. So what would that mean? It would mean that whatever the subthreshold problem you had prior, That probably wasn't on your radar, and there was no reason for it to be on your radar, is now in the mix behind the scenes, making your experience with post-COVID syndrome more exaggerated and more of a problem. Okay. Now, the other thing is you can have an effector on your body, something that's external that's affecting your body. That's like a subthreshold disorder. And yet it is not, uh, something that, you know, you knew was bothering you at all prior. And it's also not like, uh, you know, like a blood sugar problem or a thyroid problem or anemia or something like that. So we have seen this with people who had, um, maybe low to moderate levels of external influence that they did or didn't know about before. You can see this with things like mold. Yeah. mycotoxin influences or other toxic influences, et cetera. And, uh, and it could be many other things too, poor diet, just any external thing. And it wasn't such a big deal. Probably you were getting symptoms, but you know, you didn't notice it before. Then you go in and your body gets completely dysregulated by this viral illness. You get very, very sick. And when you take away all of the normal compensatory mechanisms from your body, which make us feel sort of normal throughout every day, then you wind up with these previous exposures of whatever it is externally being a bigger deal when you get to the post— to the post-infectious illness place. And with COVID that's much more aggravated. Now, there's a couple of— and I'll— next week, hopefully when the newsletter is done and and get all the references tidied up and all that. What we will look at is there's some— what are these triggers on the inside and why would maybe something like SARS-CoV-2, the COVID agent as we're calling it, there's a couple other names now, but we'll stick with SARS-CoV-2, that's classic. There's a couple of things that you hear about in the news, and I decided to talk briefly about them for a moment. Because if you think about them, I've been describing generally this idea that you get this immune dysregulation. So you get the effect of the virus docking and changing things, then you get the immune reaction, which can be small, medium, or large. And then you get this unknown output from those 2 things into your body. And we don't— and that's, you know, the ball rolling down the hill. We don't know how many bumps and lumps there are on the road. So what are the things that, you know, are common to infectious processes but are maybe a bigger deal or, you know, a mutational advantage with SARS-CoV-2. One of them are the effect of something called furin, starts with an F, furin, which is an enzyme, it's a protease enzyme. And in SARS-CoV-2 on the spike protein, the infamous spike protein that we hear so much about, There's a furin place, a furin domain. They call it a furin cleavage site. And one of the things that's sort of interesting is this is unlike the previous SARS-CoV, SARS-CoV-1, so the original SARS, right, in that it didn't have this. And so the previous, what we call beta coronaviridae in this family, didn't have this. So what this is actually is this is one of those natural gain-of-function domains inside of a virus. Now viruses are, you know, not considered alive, but they're— you could think of them as smart in the way they operate. Okay, they're little machines. And their job is to mutate over time and to travel between, usually between species, and to mutate between species. There's also viruses in plants and all kinds of other stuff. So one of the things that you do if you're a good virus over time is you pick up new tricks to interact and have a host like people replicate you better. Because see, you don't really care about the people, you care about you as the virus replicating, right? Now I know they're not supposed to be sentient beings, but sometimes it's good to think of them this way. So this gain of function that you see with the furin or furin-like cleavage site is basically a way to have the virus dock better in you as the human, so it can get into your cells faster and replicate faster. Now, the other thing is that if you have a lot of furin already in your body, it appears that we have more downstream ability of the virus to infect faster. So who do we know from science that would have more furin? Well, people with heart disease, people who are overweight, people with diabetes, and there's a few others. Now, this doesn't explain everybody who gets a bad infection, but that would probably tell us why a lot of the people that we see that get to the hospital and, you know, get into ICUs and things often have those other things. It's not the only reason, But it's a good one, and it's a common one. That's because of this domain gain-of-function mutation, right? Well, the thing to consider along the way then is that this, this one little thing we know, and there's many of these things that we know, as the virus is mutated, it's gained a function. Now it gets into people better, and it can do it in anybody this way because we all have these time-binding domains, but in people with more, chronically ill people, etc., you're going to have more of that go on. Now, why would that relate then over to post-COVID problems? Well, there are a group of— now, I told you that some of the people with the worst post-COVID I've seen don't look unhealthy on the outside, and they don't, they don't have diabetes or heart disease or whatever, but there are a lot of people who have, you know, diabetes, hypertension, And obesity, etc., and they do have, you know, a lot of post-COVID. Well, one of the problems that goes on is if you have these gain-of-function things that allow you to get more infected, you are going to have more viremia, and that means more systems in your body are going to become involved, whether through infection or response to the infection. That means when you're in the post-COVID recovery time, these direct and indirect things I was just telling you about become a bigger deal. So direct things such as, you know, things like clotting and breathing problems and stuff like that, and then indirect things like hormonal problems and nutrient problems and toxic problems and all this other stuff, whether it's direct or indirect, it can be a bigger deal the broader your viremia was. Okay, so that's a really important thing to consider. Now the other thing that may, you know, at least mechanistically explain some of the more broad-reaching effects, so again, we go back to this idea where I was saying, you know, you get virus comes in, virus has all of these ways to infect you, which are chemical, you know, gambits. And then you have your immune system with its chemical gambits, and together sometimes they overdo stuff and get a lot of inflammation and other unfortunate immunochemistry. Well, another one that's, you know, common to all infectious responses is something called bradykinin. Kinins are a part of the immune chemistry response. Bradykinins are a particular type. And, you know, it's a family. So this is just talking about families here, but it's very common that we have these kinin responses as a normal part of our immune response. But one of the things that probably makes in SARS-CoV-2, where we have a lot more entry to the body of inflammatory things, unfortunate chemistry that is a— it's for a good purpose, but it overdoes, is that when we get a lot of bradykinin release, you think about the normal response to to infection for your body, what you want to do is you want to open up your blood vessels a little bit and let immune cells get out and go kill the bugs, right? Well, if you have something that's all over your body and you have a lot of vascular opening and vascular leakage, the other thing that kind of can keep on going is you get infiltration in your body of inflammatory cells. And it doesn't, you know, take a PhD in anything to understand that if you have a lot of inflammatory cells in your body, you are likely then to not only have the initial insult of the infection, but now you've got a big downstream, you know, think of it, the initial insult times a million or a billion all throughout your body where you've got all these inflammatory cells out there. Now they're trying to do a good job and go and create immune response and heal you up. Yeah. But again, whether it's a direct or indirect predicate cause, you now have inflammatory cells suddenly turning on and think of them, you know, like little gremlins with sticks poking away at wherever you're weak. Okay. Now those can be kind of obvious direct things like we were talking about, you know, maybe thyroid problems or adrenal output problems or neurological neurochemistry problems, or they can be other things that are a little bit more global, global inflammation caused causes kind of body-wide responses, right? Well, those body-wide responses can keep the inflammation going, and that's not always great. Okay. Now, bradykinins have some specific targets, which kind of explains some of the more common post-COVID issues. One of them I've mentioned, you know, is with some of the hormones that the adrenal glands make. We have You know, shifts in sodium and potassium and other stuff. Well, another thing that we see is that we have bradykinins, if they keep triggering their receptors downstream, you'll wind up with a shift where your potassium levels will go down. And that can cause arrhythmias, even heart attacks, and all sorts of other things. But in addition to that, derangements in potassium and other other roles. It can cause a lot of neurological hyperactivity or aberrant activity, as we said, cardiac, but also pain, muscle problems, et cetera. I mean, your whole body responds. We talked about the blood vessels being more permeable, which short-term is fine, long-term is not a great thing. You can get a lot of pulmonary inflammation and edema. Now, the Bradykinin receptors are huge in your lungs. And we believe that in a lot of the people where we see COVID syndrome going into them needing oxygen on and off and having trouble breathing and recovering their breathing, the vascular permeability and the pulmonary edema are probably a big bit behind that. Because if you think about the way your lungs work to move— And CO2, you get down at the end of your alveoli, it's just one cell thick for the most part. And then there's some cells that produce some fluids and immune stuff around there. And so on the venous side, on the outside of your alveolus, there's a lot of carbon dioxide in a few different forms. And on the inside, on the arterial— the pulmonary artery side, you are going to be moving the oxygen-carbon dioxide across this little membrane. Now, the upside is carbon dioxide and oxygen go against Downhill, down their gradients, right? And so if there's less carbon dioxide on the inside, more on the outside, it's gonna get carbon dioxide in, and then the oxygen is going to naturally trade and go over to the other side, and you oxygenate your blood. That's the upside. That's what's supposed to happen. Part of what makes that happen is the alveolus is very thin. It's, you know, it's made for moving gases around. Well, if you have water in there— now there's always a little bit of immune fluid and obviously water and some other stuff— but if you get more and more edema where things swell up, the more you swell that membrane system, the slower it is to get the oxygen in, the carbon dioxide out. And pulmonary edema is a reason people get low oxygen, hypoxic. It's a reason why people die. It's, it's one of the reasons why people with influenza-triggered pneumonias will die and many other things. So it's very serious, right? Well, it turns out that the bradykinin receptors are heavily, you know, heavily represented in the lung tissues and they create this pulmonary edema. So it takes— once you turn that on, it takes a while to get away. Another one that we're hearing a lot more about, some of the newer papers I just downloaded this morning around neurological neuropsychiatric effects of post-COVID syndrome, our, you know, brain. Well, what it turns out is there's a plethora of things that happen in the brain that are triggered by these bradykinin receptor assaults and then all the other chemistry that goes on afterwards. One of them is that there's a barrier around your brain And I knocked my headset off here, excited about this. The barrier around your brain called the blood-brain barrier, named really well. And it's not like people think of something, you know, like the Great Wall of China idea of the blood-brain barrier. It's not really that tight. But what it does is it helps to regulate your central nervous system and keep it from losing stuff that it needs to keep locally. Yeah. Your brain uses a lot of glucose. It needs that primarily for energy. Your brain has neurotransmitters and it would prefer to keep most of them next to the brain and not have them running out and going to the rest of your body. Now you have all this stuff elsewhere in your body too, but the blood-brain barrier is there to allow nutrients to go in and toxic stuff to go out, but kind of keep all the goodies around for the brain. So it doesn't keep it all in or all out, but it's, it does a pretty good job. What happens when that breaks down? When that breaks down, you start to get— it's sort of like the story with your lungs and pulmonary edema, but instead of in the brain, you get neuroinflammation. And blood-brain barrier breaking down is the beginning of a cascade of very much badness, right? Bad, bad things that trigger a lot of neurological issues. Now, for some people, it's just pain. Or headaches. Okay. Now back with some of the encephalitis diseases 15 years ago or so, you know, I had patients with equine encephalitis and their virus is gone, but they have these severe headaches that last for months and months. Well, it's stuff like that that goes on. The problem is with post-COVID, you've had so much of both the bradykinin receptor activation at the blood-brain barrier, and then a lot of other things that go on that we're not even getting into, that they— it just makes the blood-brain barrier more open, but more globally open. So now you not only have things like headaches and pain, you now can develop significant sleep disorders, anxiety, depression, and a number of other things. There's a big paper that was just published about post-COVID anhedonia. So you just, you just don't feel like doing anything. Nothing is enjoyable. It's, you just sort of blah, right? Well, that's because the brain is so globally inflamed and the brain, like the whole rest of the body, has stronger and weaker areas. That's how we all are, right? So if I really inflame the brain and then I take the blood-brain barrier and I make it more disordered, wherever you have not as balanced areas in your brain are likely to get aggravated. Yeah. And so there's a lot of, as I said, neuropsychiatric things that are in the post-COVID repertoire when you look at post-COVID syndromes. And it really starts here where you get a dysfunction of the primary regulatory system that, you know, really tries to keep the biology of your brain and the rest of the body working in 2 separate camps at the same time. Now, you can also develop, in more rare cases, encephalopathy, an actual inflammation of the brain. And we do see this in a number of illnesses, but that can happen as well. But mostly it's these other things, these more functional and, you know, neurological things like pain and inflammation, etc., and downstream dysfunction. And then You know, the neuropsychiatric things, whether it's sleep issues, depression, anxiety, anhedonia, etc., etc. So those are very, very common. The other place where there's a lot of bradykinin receptors actually are in the muscles. And if you think about it, your skeletal muscle is what moves your body around. And then you've got muscles in your digestive tract, the smooth muscles, cardiac muscle. So you got muscle all over the place. Well, The bulk of your body has muscle cells in it in one way or another. And so if I have a lot of bradykinin activation at these receptors in most of my body, that is going to affect my energy-producing apparatus. And so not only will I have maybe body-wide pain, but I may be— I may have exertional intolerance. I may not be able to, you know, be as strong or as much, you know, as much persistence of energy, etc. As I go along. So that's another thing to keep in mind. And then there's a very important final thing that goes on all over the body, and that is mitochondrial dysfunction. So we've talked a lot about mitochondria, but basically if you go inside of cells, they are the little organelles. There's a number of them in cells. There's different types in different cells. They are there to make energy. They make ATP. And so they're sort of like their own little cellular thing on the inside. Yeah. And they take in nutrients and oxygen and substrates, and they put them through this little system, and then out comes ATP molecules, energy. And then they also put out their waste products and toxins to get rid of. Then the cell is around them, and the cell then has different uses for ATP, and everyone's happy. Well, if we take these mitochondria and let's, let's take the worst-case scenario. Let's say that we, you know, give you something Like, let's say a really good poison, you know, one of the ones you see in the movies where a person takes it and they're dead very quickly, or they're dead within, you know, a couple hours or something like that. Many, many of those attack the mitochondria and they stop it from doing its business. Well, if you stop the mitochondria from doing their business, you will die. That's how that works. Yeah. Well, thankfully, in the case of post-infectious and post-other illnesses and post-COVID illness, what we have is not usually the death because of mitochondria, but we have a dysfunction. And it's a multi-step process where virus gets in a cell, and then the virus puts its viral RNA into the cell, and then the viral RNA starts to manipulate The cell's mitochondria. And then the mitochondria normally have this mitochondrial DNA that they use to help maintain themselves, et cetera. And that gets dysfunctional. And then the mitochondria basically become very fragile and they can break down. And so let's say you used to have, you know, 200 mitochondria in a cell working. They may all be working at low speed, or there might be a certain percentage working and some that aren't. Well, if you multiply that by trillions, that's your whole body, your cells are not going to feel good and work well. And so, you know, we go on and on and on about all of these different sorts of problems, but you kind of get the point. You're putting in one input, and if you have the wrong cracks in the system, the wrong little bumps and lumps in the driveway, as we were talking about, You get an output that can be body-wide. It can be, and then trigger direct and indirect problems. So you had a problem before, now it's a bigger problem. You didn't know you had a problem before, now it's a bigger problem. So what does that lead us to? That leads us to then we can't just treat one thing when you're looking at it. Now, yes, symptomatically, you can do symptomatic treatments. That's fairly simple. You know, there are pain things and there are sleep things and whatever, but in the middle, there are cause-oriented treatments. So one of the things that I think is really important is we should have a way to grade how bad your post-COVID syndrome is. There is a scale that's been published, which I am a big fan of. It's called the KLOK scale, K-L-O-K, that's the author. And they have grades from 0 to 4. So in practitioner training, what I teach people to do is look at the KLOK scale. So it's, you know, I'm not affected is a 0, and I can't do most of my own activities is a 4, right? And everything in between. Yeah. Then the next thing that we want to do is we want to think about the middle stuff. So whatever you need symptomatically, you need symptomatically. Okay, whatever. That's whether it's oxygen or, you know, pain medicine or whatever it is you need, that symptomatic treatment. But in the middle, if you have lower dysfunction, let's see your clock, grade 0, 1, 2, you know, you should still have some basic things looked at because like I said, it's the direct and indirect stuff that gets triggered that creates post-COVID problems. So generally speaking, you know, you should have things like your, um, you know, not just your blood counts and your electrolytes and all of those things taken care of, but should also be looking into, even if you didn't have trouble with your thyroid before, or your adrenal output, or your blood sugar, or, you know, anemia or whatever, those basics should be retested. Okay. Even if you're feeling okay, because what if you're feeling okay, but your thyroid suddenly slipped into being hypothyroid, no one catches it and treats it, you're not going to get better faster. Okay, if your adrenals are hyper-functioning, they're pumping out too much cortisol, you have to work on that. The other thing then, if you get to a higher scale where you have more dysfunction and you've had post-COVID longer, I'm recommending that people then start adding in some screening. You can do urine testing to screen for heavy metals and other Chemical toxins. You can screen for mycotoxins, the mold toxins, which are ubiquitous in some areas. So screening for external toxins, very important. You should definitely have basic things checked that are related to nutrient function, such as your vitamin D levels. And there are ways to look at glutathione levels and functioning. There's ways to look at, you know, numbers of these things. Very, very important. And so the point of it is, is that we have to understand this part in the middle in order to understand where to step back and look. And the problem that comes, and I know this from talking to, you know, a lot of healthcare providers, is you look at a person and they're complaining they have sleep disorder, pain, and, you know, some digestive disturbance and a little bit of air hunger. Yeah. Well, you kind of look at treating those things. You don't always think, well, did the disease itself trigger either subthreshold new diseases, or did it allow external influences like toxins, et cetera, to become a bigger problem? Or did it burn up all of the antioxidant reserves that we had? So we need to replenish those. Those are not often thoughts that doctors have when they get over there at the other side. And so what I've counseled most people is, if you are getting better, you have some post-COVID issues, but they're getting better rather rapidly, and statistically rapidly sort of means if in 2 to 4 weeks you're feeling yourself again, there's probably not a whole— and I would still check the basics, but probably not a whole lot to But if you've gone past 4 or 5 weeks with post-COVID symptoms and you haven't been in to have some of these things checked out, sooner is probably better. And I would take a step back. And there's a stepwise approach to increasing the amount of things that you check. But let's say you're getting along okay, but you've got residual sleep issues and anxiety, and you've got residual body-wide pain and some residual other things. Get the basics checked out. into rechecking hormonal parameters. If you're still not getting better, I would expand it then to things like toxins and, you know, these other things that we talk about. Again, I'll have a lot more about this in the newsletter coming up. And certainly, if unfortunately you haven't gotten in and gotten anything checked out and you're, you know, at 2 months or 6 months out and you're still having trouble, you really ought to go and have have a much broader workup done. Now, you might be able to talk your normal healthcare provider into doing some of these things. Sometimes they will because post-COVID is new for everybody. And, you know, most providers are trying to help you get better. You can also consider looking at a functional medicine provider or some other provider if they have a lot of experience with this sort of thing. But the biggest thing is, is if the symptomatic treatments aren't working and you're in a post- COVID pattern and you're really not getting better, you have to have somebody step back and do some detective work to look for this. The other thing that's really common are chronic infectious things. Usually people know they have those, but if you did and they were better and now they're not, you need to have those checked. And there's other things too. So take a look next week on Instagram, Facebook. I'll be posting the the newsletter version of this. It's a little bit more linear laid out with the preferences, have some more kind of lists of ideas of what to do, and we'll get that in there. But right now I have to get off of the air and make room for the next folks. It's Dr. Paul Anderson with Medicine Health with Dr. Paul Anderson. We've been talking about post-COVID syndrome, and I will see you all on the radio next week, and I'll see you online all the time. Thank you.
