Post-COVID Syndrome (Long-COVID) What do we know / What can we do?

Good day and welcome to Medicine Health with Dr. Paul Anderson. That's me, I'm Dr. Paul. And today we are jumping right in with post-COVID or long COVID, post-COVID syndrome. Got a lot of questions from people about, do we know anything new? Is there any help for it? What's going on with long COVID? And a lot of people just really confused because there's a lot of different, not only opinions about long COVID, but different ideas about who gets it, how bad it is, what they're doing. And, you know, is there any hope? Because if you're like me, even, even if you're not treating people, but you're just in the, in your community, you probably know somebody or a number of people who are dealing with it. So what I want to do today is move into that. Now, I usually say this at the top, we're doing this live on ContactTalk Radio, which is my home for the podcast. We're live streaming it to Facebook. So when I reference things like in the description box or the references, etc., keep in mind those don't go anywhere in reality. They exist right now, but they don't go anywhere. In reality, till we put them up on YouTube. So when this gets moved over to YouTube, usually by tomorrow, I put a promo out for that. And in the description box, you'll find the links that I'm referring to. Where's the description box on YouTube? So don't go looking for it on Facebook or on CTR. The description box, if you're on your device like a phone, is below the picture on the right-hand side. There's a little down arrow or a little chevron. Click on that. It'll open up the box. If you're on your laptop or some other type of computer, it's on the left-hand side and it says show more. So you want to go there. And by the way, if you are on one of the pod burners that we put this out to, or you're on YouTube, please like, share, subscribe, do notifications. It really helps. The channel's growing really well. And we're even using a new high-speed camera today. So I don't know if that helps you or not, but there you go. If you, if you're listening on PodBurner, you're spared from my wardrobe or anything. So, uh, in, in the notes when I put them up, uh, I— the first link is actually going to be an update. It's not so much about post-COVID, but it's a really great study, uh, that came out about vitamin D levels and the severity of COVID This is an Israeli study. They started with about 1,200 patients and they whittled it down to people that they had vitamin D levels on prior to them getting COVID. Now, why is prior important? Because a lot of the constructive criticism of past studies around vitamin D and COVID was, well, we know that vitamin D levels go down when you're sick. If we just check people during COVID we're probably going to find that they have low vitamin D. So it's hard to make like these associations. But this was, who did we have vitamin D levels on prior? And so when they looked at that, and they looked at— they found about 253 of them where they had a pre-COVID vitamin D blood draw. And the bottom line was that if the vitamin D was deficient, so it was below 20 nanograms per milliliter, they were 14 times more likely to have severe or critical disease than patients who were over 40 nanograms per milliliter. And so if you look at a lot of the recommendations, usually you're trying to get people— the most conservative ones are trying to get people over 30 to 40, which kind of fits this. Normally in, in our practice, we're trying to get people certainly over 50 or 60, which is a very safe place to be, and it's not, you know, over-supplemented. So just want to to, you know, update that little bit of data on vitamin D because that was brand new. That'll be the very first link, and that'll be— now, where do the links go? The links go in the description box on YouTube. So when we get this over to YouTube, that's where you find that. So next, taking a look at, uh, so what is long COVID? What is post-COVID? Just an overview. It's, it's described basically as anything That are lingering symptoms that last more than 3 to 4 weeks after your diagnosis of COVID Now, having had COVID recently, I can say that, you know, especially with Omicron, which is what I had, you've got a pretty rough first few days. Then depending on how your disease goes, you may have, you know, 3, 4, 5 days that are bad. Some people it was 1, Some people it was 10, so it's a big spread. But usually by the end of the second week, although you may not feel fully back to, you know, 100%, usually by the next week you're moving on to starting to recover and feel better. So what they have decided is if it's something that goes on 3 or 4 weeks or longer, they call it post-COVID syndrome or long COVID long haul. So, um, a big question that I got on feedback was, now I'm a few months post my COVID, uh, did I get any post-COVID? And basically the answer is no. Um, I did a whole 2 programs on my COVID experience. You can go back there and look at those either in the podcast or on CTR or on YouTube, whichever place you like to do that. But, uh, no, I, I didn't have any post-COVID. But if you recall, I treated my— COVID and then the co-infections pretty aggressively. So that, I believe, made a difference, and we'll get into that. So that's kind of a general overview. Now I'm going to get into a couple of papers that I'm going to give you the links for, but I want to just give you an idea of what the more recent science is saying post-COVID or COVID long haul is. And I'm doing this to show you that there's not Total agreement, but they're kind of closing in on this idea of what is it, where does it come from, and what we really want to talk about here today is from a broader perspective, what can you do about it? Where, you know, where does it come from biologically, and then what can we do physically to help out? What kind of healthcare providers should you be looking for to seek out and all of that? So the first paper, and this will be under the subheading of post-COVID data updates, so it'd be, I think, 1, 2, 3, 3 links there. Okay. So the first one comes from a cardiology journal because certainly there's a lot of— we hear about clotting, we hear about, you know, pericarditis, myocarditis, all sorts of other things, and In this summary, in this cardiology journal, they say the general recurrent symptoms include fatigue, breathlessness, myalgia, which is muscle pain, headache, loss of memory, impaired concentration. So a lot of central nervous system sorts of things, cardiovascular things like palpitations, chest pain, and then thankfully less likely thromboembolism. So that's where you have some inflammation in the blood vessel and you have a clot, which nobody needs or wants. Episodes of heart failure, stroke, or transient ischemic attack, and then inflammation in and around the heart. So that's from the cardiologist's point of view. The next paper is a bigger overview, and I think if you want a really nice overview, the second and the third link are going to be the ones you want to go to. And again, I put in direct links. So the link that you have will go to the full text of the paper, so you can just read it if, if you're into that sort of thing. But in the second, third one, where they really borrowed data from one another so the numbers kind of sync up, post-COVID incidence is all over the map. So post-COVID generally is 10 to 35% of people who have had COVID, but If you were hospitalized, it can get up to 85%. So this goes to one of the things that a lot of people have talked about, which is what impact does it have, like how bad my COVID was, to how bad my post-COVID might be, or how likely I am to get post-COVID? So the idea that 10 to 35% sort of is the global average, but 85% if you've been hospitalized, up to 85%, there's a big span in there. Then, you know, that's pretty telling, I would think. Now, you can find stories, and certainly we don't have all of the data on everybody. We never will. But you find stories all over the map where people say, well, I didn't have that big of a problem having COVID, but man, the post-COVID really, you know, knocked me over. Or you got people that say, I was in the hospital and I really didn't have any post-COVID. So just like with everything else with COVID these are averages and these are numbers, et cetera. So what Does the second paper say the symptoms are fatigue is the most common, and you see this universally. And then you've got residual breathing problems, mental problems, and that's how they said it. That could be things such as, you know, brain fog and, you know, word finding and other issues that we're going to talk about. Chest pain, loss of smell and taste, as we've talked about before. And then they do point out that a third of the people with post-COVID syndrome also have those pre-existing conditions that usually make COVID worse, like hypertension, diabetes, high BMI, you know, overweight, etc. And then the next paper is just a— is a review of like 200+ articles, and they whittled it down to 145 that met their criteria. And so when they looked at the spread of the most common symptoms, about 21% were abnormal lung function. 24% were again complaints with smell and taste, which we hear a lot about, and then 55% were things like chronic fatigue and pain. And then the last one on the list that you'll see there is again persisting for more than 3 weeks after diagnosis, 10 to 35% again. And this one I just put in because they have a little bit more about cause. So when they get to cause, what they're talking about is it's multifactorial, which just means— we're going to get into that— but every part of your body can be involved and often is. And so you have inflammatory activity across the spectrum of your body. You get nervous system dysfunction. You get lining of the blood vessel damage, inflammation, maybe even clotting, and then everything sort of filters down from that perspective. So that's kind of the what's published out there, but what I want to talk about today is to kind of make sense of that, because if you're gonna, you know, our trajectory here is we're going to talk about Not just what's in the data as far as causes and percents, but what does that really mean? And, and the reason we want to talk about what that really means is that that then leads us to how are ways that we can access the body to try and clean up the long haul or the post-COVID syndrome. Now, at some point, I do expect that people will start writing about what we're about to talk about. But they aren't right now, so I'm just going to talk about it. And one way to think about it is there's this spectrum, because you, you say to yourself when you're— especially, especially if you have long-haul COVID— how in the world is a virus, and now 1 month, 6 months, 1 year later, I'm sitting here with all these weird symptoms that know, I may not have even had when I had the virus. How does a virus do that? And if you boil this down, you get down to a spectrum I like to look at. And on one end, you want to think about these, like the paper said, an inflammatory trigger. And we know, and if you go back and look at the other many, many, uh, podcasts I've done on COVID, What's the unifying, you know, thing on the entry point for COVID? It's your immune system gets activated. Activation of your immune system requires that you become a bit inflamed. And so then when you wind up activating your immune system and becoming a bit inflamed, if there's not counter-regulation, which doesn't happen with some viruses and other infection, then you can become more and more inflamed, or the inflammation can kind of spread. Right. through your whole body. So on the inflammatory side of the problem, you have this— you, you can just think of it sort of like a mist that goes all over through your body. Well, then the other thing about COVID which is not unique to COVID, but it's a thing, and it's something that COVID does very well, is something that I like to call opening a lot of doors that you don't want opened. Hmm. And largely this is because of the inflammatory process. There's actually a fair amount of science behind this idea of opening pathologic doors that are hard to shut. And, and that leads to a lot of the symptoms and signs of the long haul or post-COVID. So on the inflammatory side, we see very clearly in the research Inflammation in and around the brain, the heart, the kidneys, the blood vessels, the lungs, your muscles, your joints, your digestive tract, pretty much every organ system that you have. But if you think about inflammation in and around your brain, and I just did an update for healthcare providers that was— took about 3 hours to get through. where we looked at a large number of publications just in the last year and a half, really, about COVID's effect on the nervous system, because so many of the really, really troublesome side effects of COVID and long-haul effects of COVID are due to nervous system involvement. So we wanted to look at, well, what does the science say about the cause? And then what can we infer as far as treatment? So what the science was basically saying is that In COVID, and then especially in long haul, you wind up having a, uh, an opening up of the membranes that go around your brain, the blood-brain barrier that is supposed to protect your brain. And so the blood-brain barrier, to make it real simple, is a set of connections that basically don't allow things in or out of the brain. uh, without some sort of gating or some sort of monitoring. So for example, your brain goes to all this trouble to make neurotransmitters so that you can think and remember and all that. And if the blood-brain barrier gets open, the neurotransmitters may not stay in the brain, they may go out. Okay, now you make neurotransmitters elsewhere too, like your gut, but really we're supposed to be operating, you know, in the local area, not globally with those things for the most part. The other thing the blood-brain barrier does is help regulate inflammation in the brain. It does a ton of other things. So one of the core issues in long haul where the nervous system is concerned is the blood-brain barrier gets opened up and becomes porous. So stuff goes in and out when it shouldn't, and it's hard to get the genie back in the bottle. So healing the blood-brain barrier becomes a big target that we should be thinking about. So we get to part 3 there talking about what do we do about this. We're going to talk about that. But what would a leaky blood-brain barrier and an inflamed brain leave me with? Well, stuff that it can leave you with would be things like central pain syndromes. Okay, central pain is from your sensory apparatus in your brain that are supposed to keep track of pain. But instead of thinking about peripheral pain, which is, you know, I slam my hand in a door or something, well, that's peripheral pain. The central part of your brain communicating with parts, deep, deep parts of your brain light up like you're in pain, but you're really not. So now you have central pain. So you have a sense of pain from your brain, uh, that is feeling pain and giving you a perception of pain that's really not there. So it's not really like phantom pain, although you could think of that like if you, you know, lose a limb or something. But it is a pain that's generated from your brain that comes from leaky blood-brain barrier. The other thing that happens is you can increase peripheral pain and/or abnormal signals, like they talk about changes in smell and taste. Those are peripheral nerves that do that. So things to think about there are you've got now pain, but then what else can be centrally mediated because the brain isn't well regulated? Fatigue. You look at all those papers, you know, fatigue is like at the top of the list. Fatigue and then nerve problems and then headaches and all these other things. Brain fog, you know, so literally feeling muddled and can't think right, can't think straight. So you're not only fatigued, but maybe you can't find words or you can't remember stuff that you normally remember, etc. The other thing that they're writing more about, if you, if you have it, you already know what this is, but they call them dysautonomias. One of the dysautonomias is, uh, POTS. So postural, uh, changes that, uh, will make you feel, you know, dizzy and pass out and all this other stuff. And people who didn't have POTS before COVID now suddenly have it after. People who had it before, it's now worse. Uh, but these dysautonomias— so your autonomic nervous system is the 2 sides, I think of them like the yin and the yang of your nervous system that you're not thinking about. So you have a sympathetic side that's for fight or flight, and you have parasympathetic side that is for resting, relaxing, digesting. And if those things aren't balanced, we call it a dysautonomia, and it can create a lot of weird signals that you get. So again, you know, you might stand up and fall right back down, or you may get dizzy easily, or many other things. The other thing, and it was sort of spoke to in one of them where they said mental problems, which I don't know why they use that phrase, but I guess whatever. Um, but the whole world of the neuro— neuropsychiatric symptoms. So if you think about it, you know, your brain does everything from a control point of view. And one of the things when the brain gets inflamed is wherever its weakest link is, usually that will light up. Okay, so if you tend to struggle with pain, you'll struggle with more pain. If you tend to struggle with, uh, you know, some of these peripheral nerve things, you might struggle with more of that. If, on the other hand, you tend to struggle maybe with a little bit of anxiety or depression or whatever, you might have a lot more. There have been reports of, you know, people, uh, you know, who really didn't have a whole lot of trouble, you know, say in maybe the bipolar area, uh, you know, where there's highs and lows, suddenly after COVID they get exacerbations of their mania or their depression, etc. So one of the things that, that's hard, and it's very hard for doctors to wrap their heads around, is as opposed to regular neurological problems where you're trying to trace down, okay, is the headache, you know, because of a brain tumor or dehydration or this or that or the other thing, in the case of long COVID or post-COVID, All these neurological symptoms come from inflammation and then the brain dysfunction that follows it. So if you don't treat the inflammation, the blood-brain barrier dysfunction, uh, you can't get to these problems. Okay, so that's a big thing there. Now I said it's inflammation on one end of the spectrum and then doors open to pathology on the other end of the spectrum. So what are the doors that open and— What might we be watching for there? Well, things that I've seen with the long haulers, and this is coming out in research as well. In fact, another thing I've been sharing with, you know, the healthcare practitioners is how much research there is coming out about, you know, some of these things that go wrong. So one of the big ones that changes and can be a real problem during and after COVID are hormone changes. So we call it the endocrine system. Your endocrine system is set up to keep you kind of on an even keel. So your hormones respond to stuff. When you get sick and you're having this upregulation in your inflammatory activity, your hormonal system is trying to constantly adjust and respond to that. In fact, parts of your hormonal system are the ones that are supposed to keep you from having too much inflammation. Okay, so it's not that far of a stretch to think that after 1, 2, 3, 4 weeks of COVID and then into long COVID, that your hormonal system might be a little overtaxed. And that indeed is true. Okay. So what happens then is you come out the other side, and just like the brain stuff, you could have no problems before and now I've got COVID, and then after COVID I've got all these problems. The same thing happens in the hormonal system. I've seen people where their adrenal hormones were unregulated or dysregulated, their thyroid had kind of over-responded and got a little bit tired out, their balance between testosterone and estrogen and progesterone get kind of thrown out the window. And if you think about that, If that's a big area of cause, and now there are publications that show, uh, you know, direct links to the damage during COVID and then the hormone system being messed up, the different organs of the hormone system, uh, being messed up, then you— it's not that far of a stretch to think, well, some of post-COVID might have a hormonal milieu to it. Now, here's the thing you have to remember. All this stuff we're going to talk about doesn't have to happen. It's looking for what doors got open that create the pathology beyond the inflammation that is really the important part of long-haul or post-COVID. So if you're getting somewhere with post-COVID treatment— and again, that's part 3 we'll talk about— Great. continue to get somewhere with it, you're probably on the right track. But when we get people who are, you know, like a— I got a message from a doctor consulting about somebody who's a year out now. You hit a year out and you're doing all the kind of basics, there's other stuff that's not going right. Okay, so hormones are one. So areas that I recommend healthcare providers look at are certainly the thyroid. And, and we've had people where they developed auto— autoimmune thyroiditis after COVID, thyroid resistance, etc. So that's a big area. Inflammation in your central and peripheral nervous system, we talked about that. That's a door that gets opened. Dysfunction in your digestive tract, and sometimes that's pretty obvious and sometimes it's, it's not really that obvious because people feel like they have to have like bad digestive symptoms in order to have a digestive problem. Well, the simple act of being that inflamed can throw your digestive tract off. And, you know, a nice thing is if your digestive tract wasn't that far out in the beginning, uh, it's usually not that hard to heal up. But if your digestive tract was kind of inflamed and messed up, and then you got COVID, you may have a bigger problem. And if you go back and listen to the old podcasts about digestive health and all of that, you'll see that, you know, the digestive system has its own nervous system, its own immune system. And so if we throw that off, not only are we not going to digest well, but we're not going to absorb our nutrients well. We're not going to have all this crosstalk with our immune system, the different parts of the immune system, and even Neurological things can go on. Another one that really throws folks off is the idea that you can have a couple of things around infections. Okay, so I've seen people who have post COVID, and you hear. you know, 5 years ago, 10 years ago, I had some kind of chronic infectious problem, but I got it fixed and I'm all better now. And it turns out that COVID sort of reactivates old chronic infectious things. So the way chronic infections work is normally your immune system, if you've gotten past the infection, marginalizes the chronic infectious agent and keeps it at bay and keeps it kind of jailed up, right? Well, if you thought you were better and all this is going on, your immune system's probably taking care of it. You get COVID, all the inflammation goes on, and these chronic infectious agents say, well, the immune system's focused on COVID over here, I'm going to go out and reproduce and become a problem again. So certainly if a person has a history of chronic infections, we look at those. But here's the other thing. All humans are exposed to these chronic infectious agents all the time, and it's only because of our immune system that we don't react to them. So what happens with COVID is, because COVID again decreases your immune activity because it's focused on your COVID, we get naturally exposed to a lot of these chronic infectious agents daily. Or they're around us. And so while our immune system is busy somewhere else, they flare up, or they might come in when they weren't in there before. So infectious things are things that we need to look at in people like that. And then the other one that has kind of two sides to it, as far as doors that get open that we don't need open, is various types of toxicity. So it turns out there's kind of two sides to the coin. One is if having COVID itself weakened you to the point where, you know, you get exposed to something or you're around something or whatever, residual toxicity can be a problem. But the other thing is, is that The inflammation from COVID can change your threshold for responding to toxicity. So one example of this that makes some sense if you think about it is there, you know, especially if you're in like the Northwest where I am, or the Northeast, there's a lot of mold and mycotoxins. Mycotoxins can be deadly, but they can be really, really health disrupting. And they actually are usually immune inhibitive, right? Most people can be around some level of mycotoxin and not really have a whole lot of health effect from it. But as soon as your threshold lowers, and that's usually anything that makes you sick and makes you either acutely or chronically ill, COVID can lower your threshold. So suddenly you start responding to things that were always there. So that could be chemical toxins, mycotoxins from molds, you know, even metals, heavy metals, and other things like that. So toxicity is something either direct action or lowering your threshold to the toxicity. So just to kind of put a point on that, if we're thinking about this spectrum, we want to think about inflammation and all that. So that's Your whole body can be affected, but usually it's sort of like you know you if you pour water on the ground when it's dry, if there's cracks in the ground, it's going to go into the deepest place, going to go into the cracks first. If you pour the inflammatory activity of fighting COVID into your body, it's going to find the weak links, and you may not have known what those were. You might have been feeling fine before, and and then you know suddenly you develop maybe some hormonal things or infectious or. Toxic or whatever. And if you had that problem before, it makes a little bit more sense to people. But it's the robustly healthy people, you know, who we see who are months or years now into post-COVID, where you have to start doing some detective work and looking at these other areas. Because the inflammation then leads to COVID, the great door opener. And COVID opens these doors of nastiness that if you don't look for the problem, you won't find it. And pretty much without exception, if you look in, in the research, um, there are, uh, research that show, you know, definitely the hormonal things, uh, definitely connections for the neurological inflammation, definitely the connections to like other infections and chronic infections. And they're starting to show some connections with this toxicity especially with the threshold of toxicity, which I think is the real critical part. Now, one of the things that we don't have a ton of data on— I hope we do someday— is does early treatment help? Okay, and we know, at least anecdotally from clinical practice, that early treatment of COVID decreases the length of time and the severity of COVID What I will say, and you've heard me talk about this before, I'm in a group that shares information about patients that we've done early treatment on, so it's not just my numbers, but it's basically just sharing large numbers of cases. This group is probably somewhere in the 2,500 to 3,000 patients at this point because people all over the world really. And when people get appropriate early treatment, uh, the incidence of hospitalization and death is almost zero, and the incidence of post-COVID is extremely low. So we look at these data that say, you know, 10 to 30% or something get post-COVID, hospitalized people up to 85%. Um, you know, we're looking at significantly lower numbers, like low single digits of people who actually get post-COVID. Some of the groups where they've, you know, they're looking at 700 to 1,000 patients at a crack that they've had in the last 2 years, um, are reporting, you know, out of let's say 700, you know, they got 1 person with post-COVID, and that's due to early treatment. Now, why is early treatment sort of a weird topic? Uh, you know, it used to be a dangerous topic to talk about. And why do people not do it? Well, there's a couple of things you want to think about. One of them is that if you look at the number of— now this is changing now in the, in the world of Omicron and, and COVID for 2 years and all of that— but if you look across like the US, the people actually treating COVID tend to be people in large you know, in the hospitals or large medical centers, tends to be specialists. And the treatment of COVID has largely not been in the hands of the primary care doctors, who are the lion's share of the doctors out there in the world. Now that is changing, okay? And we've talked before about like oral COVID treatments and, you know, the kind of the standard approaches. Well, now that we have, you know, these, uh, like the Pfizer pill Um, there's a Moderna pill, you know, and all this stuff. But now that we have these things, you know, we could give that early. Uh, there was even a thing on the State of the Union address, uh, where the president, I believe, said they, they are trying to pass a bill where you go, you got COVID symptoms, you go into the pharmacy. If you test positive, the pharmacist, with no, no trip to the doctor, just gives you the, you know, the The Pfizer pill. Well, is that early treatment? Yeah, that's sort of early treatment. But what are, you know, all these 2,500 to 3,000 patients I'm talking about in my group? What's early treatment there? Because we're certainly doing this long before, long before the Pfizer pill was available, et cetera. Well, early treatment really in that group is more of a kind of a 360-degree look at the patient and then treating what you see and what you find. So in the acute phase of COVID early treatment is a lot about like immunity, immune system stuff, nutrient support, physical support, lung support if needed, which early sort of things, etc. But early treatment sort of got a kind of a negative rap because when they were working up to try and get the vaccines approved on emergency use authorization. Part of EUA for the FDA's rules is you can't have any other treatments available. So if you called something early treatment, and then that kind of caught on, you wouldn't be able to get your EUA on the vaccine. So it was one of these balancing acts, which is really— that's, that's a political problem in medicine, and approvals and all that. So this terminology of, well, don't say early treatment. So we just went about about treating people early and called it helping people with COVID Nowadays, you know, they're going to morph now that there's drugs they're trying to get emergency use, things like the Pfizer and Moderna ones, etc. And they're going to call that early treatment, which is fine. It's just the toolbox needs to be a lot bigger. So what do you do? Well, the first thing is, Remember, I'm a doctor, but I'm not your doctor. This is just information. I'm giving no medical advice. And if you take medical advice from people on video apps or on podcasts, it's kind of dumb anyway, because you really need a relationship with a practitioner or practitioners. I always say that because it's true. So the first thing is finding a competent practitioner who's Treating post-COVID. Now, there's a couple of ways of thinking about treating post-COVID. If you go to most, uh, say, primary care doctors and they even want to engage you to treat your post-COVID, they're going to do kind of the standard North American treatment approach, which is to treat the symptoms you're having. So if you're having fatigue, they may give you drugs that reportedly help with fatigue. If you're having, um, you know, neuropsychiatric things, they might give you, say, anxiety medicine or depression medicine or something like that. So it can be treated symptomatic. Nothing wrong with that. Okay, but what we have found works better is if you treat the symptoms, you know, to control them, because we don't want people uncomfortable You know, there's pain and there's all these other things, but then try and get underneath it. You can kind of build from the ground up. Now, if you think about it, one of the tools that there is out there, but very few people in North America certainly are using it, I've been promoting to doctors as they deal with post-COVID, is there's something called the CLOCK scale. Now, it's Kloch with a K because it's actually the doctor's name. Kloch et al. wrote this paper. I'll put it in there. And they basically came up with a grade 0 through 4 post-COVID disability. Now the purpose of that isn't so much that having a number for your post-COVID disability is super helpful, but it's helpful from the point of view of if you're a low grade like a 0 or a 1, You probably don't need a whole bunch of intervention. If you're a 3 or a 4, you probably need a lot of looks into those open doors that we talked about. So the first thing is to put— to kind of scale it. And as I said, that'll be in the notes down there in the description box. And you gotta remember, if you're on your device like your phone, lower right-hand corner below the picture, And there's a little down arrow. If you're on your computer, it's the left-hand side. It says see more, and that's on YouTube. That's where we put all this stuff. So the first thing is to kind of put a scale on it and then decide, is it a small, medium, or large problem? The lower the grade, the more general treatment you can be. Sort of think of first-tier treatments that we're going to get to next. If the higher the grade, the more doors you want to open from a diagnostic point of view. So if you've got someone who's a grade 3 or 4, you're going to be checking a lot of stuff, you know, their hormonal system in labs. You're going to be checking inflammatory markers, clotting markers. You're going to be checking for infections, you know, these chronic infections that come up and maybe even some of the toxic things. Now, the other axis, if you will, of how bad is it is how long have you been sick? So if we go into the first layer of things that I'm going to talk about and you've been doing all of those and you're still sick, 1 month, 6 months, 1 year, 2 years later, you got to kick it up a notch. Okay, so let's say you're still able to go to work so that your clock scale would be, you know, kind of maybe a 1 or something, or maybe a 2, but you've been sick for 6 months or a year or 2 years. Um, you're gonna have to broaden out the net. Okay, is the where to look. But what's the first layer that we should all be thinking about and doing? So the first thing would be the basics. Sleep. Are you getting enough sleep? One of the biggest problems is sleep disruption due to the brain inflammation. If you're not sleeping, you're not healing. Okay, so that's pretty probably obvious. Movement. Now we got a whole other programs on movement, what that means, but the bottom line is you don't have to go out and run marathons, but your body should be moving some. The more that we have muscle metabolism, the faster we heal. Now, the problem is if you have post-COVID and the number one symptom is fatigue, that's not going to feel very good. So we do what we've talked about in other venues and other podcasts, graded exercise tolerance. So if you're doing zero movement, you do just a little bit more and you don't ratchet it up like you're going out for a new sport. If literally walking up and down your stairs once a day is exercise for you, do that. Do that for 3 or 4 weeks and then add on to it. And as your reserve builds up, you do more. So movement doesn't mean starting a new exercise plan. It just means moving more in the beginning. Diet. Pretty much everybody agrees who's written about it or published that you want to have— because there's a zillion ideas about diet— you want to have a low glycemic diet. So little to no simple sugars, a lot of complex carbohydrates like you get from vegetables, good clean sources of protein and fat that are balanced. And then from there you can work your way out. But diet is very, very important. Nutrients. I'll go through a list of nutrients. I will also in the, in the description box put in a link to a newsletter I wrote that goes into COVID-researched nutrients. We'll talk about them coming up. And then, you know, like I said, symptomatic treatment. So, you know, for some in the beginning, if that means something for their anxiety or depression or their pain or their sleep or whatever the symptom is, or certainly if you're having signs and symptoms, you know, clotting and other things, you need to be dealing with a doctor for that. But that stuff needs to be treated. Okay, so that's very important there on the thing. So I'm not going to get into like a lot of doses and things, but if you're looking at beyond your diet, what nutrients would we think about? We've talked a lot about vitamin C and COVID. That's still a good idea, and you can read the newsletter for that. You got your fat-soluble vitamins that become important, but the dosing needs to be monitored. So those are vitamin A, vitamin D, and K. Usually we take those together. And then vitamin E. So you want to really long-term take in those fat solubles. You want to work with somebody about that. Then minerals, normally beyond your diet, what I recommend people do more than just taking a bunch of one mineral is to get a good multimineral. And you can get them with and without iron. If you don't need iron, you don't need to take extra iron usually. Certainly if you're anemic, you'd be taking extra iron. But for instance, the multimineral I take, I have plenty of iron. It's no iron in it. But the idea with the multimineral is going to give you stuff, uh, like zinc that you've read about, but also, um, you're gonna have chromium and selenium and some of the other things very, very important for your immune system. Now there's another thing that we've talked a fair amount in the past about, and that's glutathione, or things that support glutathione like alpha-lipoic acid or N-acetylcysteine. There's actually research on N-acetylcysteine And COVID, so want to think about that. And then we get to some specific things. So, and this would be something you'd work with a healthcare practitioner on things like phospholipids, like phosphatidylcholine. They tend to start with phosph here. That those are very good for repairing your cells when they've been inflamed, etc. There is. And I have absolutely no financial connection to this. I just use it a lot with patients. And it's, it's kind of nice because it's got a bunch of the things that heal the brain membrane, but they also actually help with energy and other stuff. Uh, it's— and it's, uh, it actually kind of tastes good. It's a sort of a gel that comes in a pack. You take 1 or 2 packs a day. It's called Cover-3. It's for brain repairs, originally designed for people with brain injuries. And again, I have no financial interest in it, but it's just, it's one thing that's worked because it's like all-in-one supplement and it's got anti-inflammatory and cell support and all stuff in it. And it's just coverthree spelled out, C-O-V-E-R-T-H-R-E-E.com. I will get nothing if you go to their website, but the stuff just works really well. You can give it to— you can go on their website and see any, any age pretty much can take it. Now, you might say, well, is there any, you know, like silver bullet things that they've researched with regard to, you know, can we just get a drug that fixes all of this? Well, they came up with an idea that this inflammatory trigger— remember I said inflammation leads to opening the doors you don't want opened, and then you've got this mess of pathology? Well, they said, well, you know, mechanistically, there's this process, especially in your blood vessels, that involves these things called G proteins, and then they relate to your nitric oxide balance and function. Now, we hear about nitric oxide. Sometimes you think about it with respect to blood vessel pliability, you know, and hypertension. We think you hear about nitrous oxide as a gas used to calm your brain down during dental surgery. So it's nitrates in that area. So this— and I'll put the— mostly for, uh, just for your own interest if you want, I'll put the paper in. But there was an experimental— it's still available— autoantibody, and it targeted this G-protein system and the nitrate system in the body. And they said, well, what if we block that and, uh, then, uh, return the inflamed blood vessels back to their non-inflamed state? And indeed, with this, with this experimental autoantibody, you can, you know, shut off and basically turn off the system. And in one per— it's a case report— so in one person, it actually took away their post-COVID symptoms. Well, why would it do that? Well, we do that largely because the vessel inflammation is so pervasive. We've got vessels everywhere. If you slow that down and get the vessel working again, you might feel better with your post-COVID. But then I was reading it And they come up for— so this isn't a drug yet, it's a research product, it's an autoantibody. They named it— this is a research name— BC007. So there's this, there's this research drug called BC007. I can't stop laughing about it. If any drug ought to work, it ought to be the 007 molecule, right? Well, then if you think about it though, Are there easier ways, or maybe not easier, but less costly ways to target the nitrate system? Indeed, and I will put these research papers in there, many other people have said, well, we could just give people the amino acid arginine because that is how we make nitric oxide and affect the G proteins inside of our body anyway. We give people with reactive airway disease and blood pressure problems and all sorts of stuff, you know, the amino acid arginine therapeutically. And there actually were studies done that showed that people with acute COVID in the hospital, they could get them out of the hospital faster if they just added arginine to what they were taking. Well, in the post-COVID scenario, like in that case with the 007 molecule, literally that's what they called it, arginine also works. And there's some data here to talk about that. So arginine, again, you know, this is an amino acid that, that people take, and I'm not giving you advice to take it. I'm just saying it's in the research and you— the links are there. You might talk to your doctor about it or read the research, whatever you need to do there. There's another one that's really important that's also in that brain supplement, that Cover-3 stuff, called acetyl-L-carnitine. Carnitine is basically an amino acid. It's category is sort of on the side, but it's an amino-like acid. And carnitine is involved in brain and nerve function and healing, energy production in the body, tons of stuff that's really, really important. So carnitine and arginine are some of the other amino acids that we kind of think about there. Now beyond these things like this special, you know, kind of brain healing stuff. Now why is brain healing so important? Because so many of these problems come downstream from the inflammation in the blood-brain barrier. So healing that up is a really good first step. The arginine angle and healing up the, you know, the systemic vascular inflammation, another really good step. Now, as I said, work with a competent practitioner. So if you've been sick a long time, you got to open other doors. You got to look at the hormonal system, infections, and maybe some toxicity, etc. And that gets you down to the underlying problems. Now, there are some other therapies if you're really sick a long time, really having a bad time, other stuff's going on, um, and those are things that you would have to go and find a practitioner to help you with. But things that I have seen help the more Tough-to-treat cases or the real bad cases are things like hyperbaric oxygen therapy, which is a whole topic unto itself, but you can find practitioners who specialize in that. We've talked on this program a lot about intravenous vitamin C. So we always, you know, recommend oral vitamin C, but intravenous vitamin C and other intravenous nutrient therapies be very, very helpful as you go along. Um, I talked in the COVID and Me, I call it, those 2 sessions about using a nebulizer. And, and I used a very standard drug, N-acetylcysteine, uh, used to be called Mucamist, which is a nebulizer drug. I use that. Uh, we prescribe that to a lot of people. So nebulized, uh, N-acetylcysteine can be very helpful even in your post-COVID. Remember, there's still a lot of residual respiratory problems in the post-COVID people. So I want to just leave you with this idea that the causes— and I'll, I'll put the links in the description— but the causes are inflammation leading to open doors that let other pathologies in, which is why it's such a shotgun disorder syndrome. If you get the genie back in the bottle by getting the inflammation under control, and your 2 initial targets need to be the brain inflammation And then the systemic vascular inflammation and everything leads down from that. And then if you're still sick and you start to open and look behind the doors, whether it's hormonal or infectious, inflammatory, toxic, cardiovascular, look in those areas, especially if you're not getting better. And then, as I said, kind of build your way up. So if you're not that, you know, bad, but it's just, it won't go away, Think about the basics, you know, sleep, movement, diet, extra nutrients, and symptomatic treatments as they're needed. Then on top of that, you're going to take a look at those things like maybe hormonal issues, maybe infectious, maybe other stuff. And, you know, then you're going to get specific with nutrient supports. So you got the brain nutrient like Cover-3. You've got these amino acid therapies that many of them are starting to be researched, but they make total sense. And all of that can be, you know, pretty easily managed. And if you get somebody kind of quarterbacking for you, so obviously you need somebody to order labs for you and all that stuff. And so that's usually in the purview of some healthcare provider somewhere. Now, at the end of the references, I also put in some references because I got questioned about Well, is there, is there something like, you know, post-vaccine syndrome or whatever? I've got some references in there about that. We're out of time today for it. And, you know, I always, I always get feedback kind of from— as you may have noticed, there's a lot of opinions on both sides of the vaccine question. And I am not giving any advice about anything. Remember, go talk to your healthcare providers. Same thing with vaccines. That's a discussion for you and your Healthcare providers. But we do see now, especially where, you know, I'm involved with talking to lots of healthcare providers, we see people who have real similar problems if they have a vaccine reaction to post-COVID. Now, it's not everybody, just like with post-COVID, but I got some research papers in there at the very end. But it's time for us to end today. We're gonna get the electronic hook, so it's time to wrap up this podcast. Please check us out on Contact Doc Radio. You can also check us out. There's a live stream on Facebook, and then we'll move it over to the Pod Burners, Every Pod Burner, and YouTube. If you're on YouTube or a Pod Burner, please like, share, subscribe. It's really helping out. We've got really good viewership, and so thank you. Keep that up. All right, I'm Dr. Paul Anderson from Medicine and Health, and I'll see you all on the radio next week. You've been listening to Medicine and