A Complete Breakdown of Long Covid Treatment | With Evan Hirsch MD

hey everybody welcome back to the energy MD podcast I'm so glad that you're here with me today so today we're going to be speaking with Jess medinger let's talk about the live active virus Theory it's it's something you know this idea that people who have long covets still have live active virus this is something that we've seen in our practice where when we start using antivirals and whatnot we do notice that people get better or they get die off they start killing the infection they may get a little bit worse before they get better what are your thoughts what's the research that you've seen on this theory about that it's actually the virus is persisting so we currently have just for context um sort of received wisdom at the moment suggests there are seven possible causes of long covid now I suspect that we're probably going to find that actually a number of these are implicated more than necessarily just one although it might be a you know a tree with one of them at the top which could be viral viral persistence let me just run through those seven for context so we have uh direct tissue damage so organ damage results of the virus uh autoimmunity um immune dysregulation uh disruption of the microbiome reactivated latent viruses like EBV for example um viral debris and then finally viral persistence um so when it comes to viral persistence uh we've got it's if you think of it like a game of Cluedo we've kind of got all of these Clues but you know it's all kind of pointing towards Colonel Mustard in the billiard billiard room but we don't have the Smoking Gun just yet you know so we've got things like viral DNA being shared um for X number of months uh in a certain proportion of you know stool samples we've got uh we've got viral RNA being detected in gut biopsies we've got subjects uh we've got um recent papers like Akiko usaki and David petrino's one finding T-cell exhaustion you know in T-cell exhaustion um is sort of a bit of circumstantial evidence suggesting that well why are they exhausted because we've still got persistent virus you know so there's all of these things kicking around which all seem to suggest that and that's just three of dozens of bits of circumstantial evidence which all seem to suggest that there may be persistent virus in the body but right now we don't know where it is exactly it could be in a number of different places I mean the obvious places to start looking would be the guts uh the lungs um things like the appendix um and then there may also be immune privileged sites as well we just don't know if they're like in the eyeball or the testes you know and until we start or even you know potentially even in um cerebrospinal fluid you know so until we have I mean the way to do it unfortunately this isn't going to pass any ethics and it's never going to happen because you can't do it but if you suddenly had 20 long haulers die and you could just do full autopsy workouts the problem is is that these biopsies you need to actually find The Smoking Gun you can't do on live patients um so it's very very difficult we're only looking at what we've got in hamsters or what we've got in hospitalized people who subsequently die and then have autopsies or what we might get from stool samples and things like that from living patients so it's it's really really difficult but we're starting to get increasing amounts of evidence that points towards the fact that there is some remaining virus in the body somewhere but we don't know exactly where it is yet yeah and that would explain a lot of those other studies and you know triggering this aspect of the immune system causing hormonal dysfunction or whatever yeah yeah absolutely it would explain if if there were to be viral persistence everything would fall into place yeah yeah so then let's talk about current thinking around treatments um what are people I mean I'm practicing functional medicine I'm kind of doing stuff over here and experimenting with the folks that I'm working with but what is what does the data say what have you gleaned from some of the uh the data from the patient groups so there's a wide range of different kinds of treatments so if we start off with the ones that your doctor might give you um then we can start off with something relatively simple like antihistamines so H1 and H2 antihistamines um do seem to be helpful for a large number of people and there is some evidence to back this up we've got a couple of small trials which have been published showing that they are effective with people with long covid for people who have pots so postural orthostatic tachycardia syndrome which is a form of dysautonomia then there is a medication that can help a huge amount with that so things like you know beta blockers I've abridine midadrine things like that your dots can prescribe that can make a big difference you may also find that if your symptoms flare and so for me I had a horrific skin inflammation at one point in my long covid and I was given some steroids course steroids and again that helps significantly bring that flare down there's an argument for trialling low-dose steroids in long covid um I'd like to see that trial but they'll need to be done properly there's also questions around you know long-term use of steroids even at a low dose too so you know not not ideal um then we've also got all sorts of things that might be prescribed for symptomatic relief for whatever your symptom constellation is because there will be various different things for headaches or for you know itching pruritis or anything like that that can help you um so your doctor can help you with this stuff there may not be a magic pill for long covid but you may find your doctor can significantly help you um you've also got things like conservative measures that your doctor might prescribe so this would include things like um uh increase your fluid intake um if you're this autonomic and especially if you're potsy that can help a lot increase your salt intake um again that can help a lot if your blood pressure is all over the place and you've you know your heart rate's rocketing when you stand up um if your doctor is so there are some doctors who are also going a little bit further than this so we've got someone who your American audience will probably be familiar with called Dr Bruce Patterson so he does a workup on your blood and looks at which of your cytokines are elevated which are inflammatory markers of the immune system um and then one of the drugs that he often prescribed is maravaroc um and there's another hugely prescribes a Statin like pravastatin as well um some doctors will prescribe LDN which is low-dose Naltrexone um so this is a drug that would normally be done for uh opiates and opiate addiction but it does have a surprise well it seems like there's a proportion of long-haulers who respond very well to it to low dose in terms of it calming calming everything down essentially um and then another thing as well if you have a very sympathetic prescriber they might put you on anticoagulation particularly if you've had blood slides done up that show some form of clotting but again this whole subject to microclassing is a huge huge thing that the patients are very excited about but amongst the medical community there has yet to be widespread consensus on what's going on on this sort of microclotting side of things or indeed thrombotic stuff generally in long covid but anticoagulation does seem to help a number of patients too um beyond that it's a long answer but there's a lot right because everybody has tried everything um you've got the invasive therapies so things like aphoresis so this is happening in Germany either plasma aphoresis or helperesis people are also having NAD infusions so NAD is one of the precursors of ATP which is our body's sort of fundamental unit of energy so people having infusions of NAD um monoclonal antibodies as well um some people are reporting positive results from those and then you've got a whole world of holistic stuff so everything from Cold Water Swimming to acupuncture to intermittent fasting to lymphatic massage um you know and onwards Reiki and homeopathy so it's it's a it's a huge subject when it comes to treatments and in terms of what have we got data for well not a lot right now um antihistamines are something we do updated for I have a little bit of data too for a survey I did last year and I looked at how long haulers responded to um three different interventions that they had changed in the last month so that either started taking supplements or they'd started taking um uh niacin vitamin B3 or they'd started taking uh well started adopting a low or no histamine diet and sometimes some of those groups coincided so some of the people were taking niacin as well as starting a low histamine diets um what came out of this was the the low histamine diet was by far and away the most effective of these things supplements were no different from the control group so like we would sort of expect it's a bit of a lottery with supplements unless you manage to plug an existing deficiency that you didn't know you had um uh but the low histamine diet made a huge difference and this would work for the same reason the antihistamines work which would be calming down this Mast Cell reaction that is one of the things that seems to be going on in Long covid why would niacin help well again this ties back into the metabolic side of things um so nicotinic acid which is what niacin is is one of the central precursors to make NAD plus which is how we generate ATP which is energy so there's a pretty strong Theory I think that was published about a year ago now from some South African doctors suggesting that some of the metabolic pathways that would normally happen you know normally work in our body have been hijacked and we end up using the wrong metabolic pathways and that has all sorts of consequences on us and we can start to compensate for some of that by supplementing with certain things and the most important of those nicotinic acid so yes that the knit sorry nicotinic acid uh I looked at sort of P values for statistical significance for both the low histamine diet and niacin and they were both statistically significant with naught Point naught I had to do some memory it's about 0.0 one I think for the niacin and 0.0 naught one for the low histamine diet so well below that 0.05 threshold so very long answer I I tried to cover the whole enormous topic of long covered treatment there you did great thanks you know the the challenges that I have and I think that a lot of patients have with the treatments that are available right now is that essentially they're Band-Aids you know if the immune system is dysfunctional because of virus and leftover virus and immune dysfunction or whatever it is right you're you're taking these these either their supplements or their medications or whatever and they can mitigate symptoms and they can potentially allow you to get back to somewhat of a normal life but the challenge is is that it's not causing resolution right so it's like whack-a-mole all of these treatments are whack-a-mole and you're not fundamentally taking the batteries out of the game that's the problem and the and the the treatments that I would say haven't been addressed or aren't being talked about in the mainstream media that a lot of me and my functional medicine colleagues are talking about is going you know directly after the virus or is also looking at what are some of the other toxins that are present you know oftentimes we're seeing people who have mold people who've had another virus like you were talking about when you had glandular fever you know one of the studies as you're aware of 73 of people who have long covet in one study also had Epstein-Barr virus right so what what else is going on that's causing the immune system to be dysfunctional so that it actually can't take care of long coven right what is what is actually happening there so I would just kind of throw that in for people yeah um to think about does that make sense would that be a potential Theory hugely and mold is a massive one too so what we're often finding is that any sort of slight intolerance or slight allergy or slight issue that you had before is just suddenly multiplied a hundred times by Kevin so you may have been a little bit reactive to mold before but it's never been a big problem but now that tiny bit of mold in your house is destroying you you know and it's not beside and you wouldn't have connected the two because like I've always been here before I'm you know so I haven't moved so what's changed well what's changed is long covered and now suddenly everything that wasn't a problem before is a problem yeah and we're even seeing people who lived in mold before and now they're in a current home where they don't have mold exposure but then all of a sudden now they've got a mold problem so tell us before we adjourn here tell us about the long covet handbook that's coming out in a month so this is quite exciting so one of the issues I think that faces somebody who's developing long covered now or has developed it recently and they're suddenly hit with this what the hell is this what's going wrong with me what can I take what can I do what shouldn't I do how do I get help from my doctor you know you'll you will have all of these questions and you can put them into Google and see what the internet throws back at you but you will get a whole world of conflicting advice and it seems that there was a real need to have a singular resource that brought together everything that we had learned in the last two and a half years about long covid into one place so this combines everything that we've learned from the published science whether that's you know in nature and cell and Jammer or whether it's my patient-led research which look comes to it from a different kind of angle um and we've also got the perspective so I write it I co-write it with Professor Danny Altman who's a professor of Immunology at Imperial College London and between us we sort of cover the the clinical and academic side and then from my side the you know the patient-led side um to sort of try and cover every aspect of the condition from the hard science about what we think might be causing it to how you deal with your mental health when you're suffering with long covid and how you deal with your relationships and and what the emotional journey is like when you when you are suffering with long covid because that first 12 months is going to be a roller coaster with more Downs than UPS um in terms of the way that it affects every part of your life in a way that people just don't really understand and this is one of the hardest things is how to how do you get people around you to understand because unless you've experienced a condition like this it's very difficult so I broke my pelvis um about 18 months ago and people immediately understood it was a motorbike accident you know 70 miles an hour broken pelvis oh my God are you okay what can we do it's a week in hospital you know it must be so awful I'm like yeah it's pretty bad but long covert is 10 times worse you know I'd break my pelvis every six weeks on repeat rather than have long covet continually because breaking my pelvis doesn't stop me drinking coffee or drinking tea it doesn't mean that I can only eat like three foods it doesn't stop me having a conversation with someone for more than three minutes because my brain goes to hell it doesn't stop me writing an email or being able to read or being able to watch TV all of this stuff with long covid poof out the window at every one of your faculties is affected and unless people have had a condition like this it's very difficult you know knowing what it's like so one of the things the book also does is help you to help the people and around you understand to give you the support you need um and that's why also the patient perspective in a book about lawn care but is so important because you know as as essential as the clinicians and the academics are in terms of pushing the boundaries forwards research when it's done properly takes time and in the meantime you kind of need to have that sort of patient perspective if people have gone through it to help you know how you can get through it too so yeah that's the purpose of the book um I'm very excited to share with everyone yeah I'm excited to read it I think that what you were talking about with like the mental health component is so incredibly important you know we have people go through our programs you know we've got a mindset practice so what do you do personally in order to be able to um to deal with some of the mental emotional stuff of this so one of the things I found is that in the same way that your autonomic system is like smashed like I've been sort of sending it into the red the whole time before covid then covered came along and suddenly it just it's like the whole engine basically just breaks right and suddenly the cogs are all just grinding and everything's a mess and it's sort of you know you've over revved in it's exploded well the same thing's kind of true for your emotional state as well so a lot of people say the same thing and certainly my experience is that you are just all over the place emotionally so you're you are tipped over the edge into sort of that sort of emotional distress by things that wouldn't normally be that distressing um you are perpetually I sort of look at my sort of emotions as like a pint glass right and normally you know sort of you've only got a little bit in there and you can see you can fill that pint up with like quite a pint glass up with quite a lot of stuff before it overflows and you know and you get overwhelmed but actually when you're suffering on Covert it's like it's perpetually about to overflow and it doesn't take much so trying to actually just manage your emotions in that sense when you're like that is really difficult and for me I find letting that emotion out to be absolutely key so uh breath work in particular guided meditation I find incredibly helpful for me on a couple of different levels the first of which is that it's really good for coming down the autonomic system and the second of which is that often it'll cue basically like 10 minutes of crying and I'll just cry for 10 minutes and I'll just SOB in this emotional just pour out of me and a lot of it is grief and loss and frustration and anger and pain from not just prior trauma in the rest of my life but also my health and the life I no longer have right you kind of have to grieve that and if you don't then you're just bottled up the whole time so actually finding some way of releasing all of that emotion is hugely important and after every time I've had one of those 10-minute sobs it's horrible whilst you're doing it it feels like you know vomiting when you're sick or something it's horrible but you feel better afterwards it's cathartic and it's that's certainly been my experience and the experience of other people I know with long covid who have found whatever is right for them to be able to find that degree of emotional release um and that's been my best way of managing my mental health because if I don't do that I just get worse and worse you know and and you know I suffered with depression before and oh my God there's long covered like make that hard to deal with you know turbo charges any depression you might have had kicking around the system so you kind of really you need to be on top of that and whatever way you can because this sort of connection between mind and body if you know I'm sure you will understand this too practicing functional medicine it is real um and if you are in emotional distress to that level it will not be doing your health any good and it won't be doing your autonomic system any good either so it is something that you have to deal with as part of looking after yourself physically too for long covered thank you so much for the beautiful vulnerability and sharing that with us cheers thanks so much for joining me today thank you so much for your time thank you Evan

Channel: Gez Medinger

Views: 73,236

Keywords: pasc, psca, long haul, long haulers, corona

Id: 7rX5i07eAJ4

Length: 19min 26sec (1166 seconds)

Published: Wed Oct 26 2022