How to Treat Dysautonomia in Long Covid | With Ashok Gupta and Dr Tamsin Lewis

in this film i'm going to talk to ashok gupta and dr tamzin lewis about the role of the autonomic system in chronic illness with a particular focus on long covid is it just one part of the puzzle or could it actually be responsible for all of it stick around and we'll go through it in depth [Music] if you've been following my content on this channel for a while you'll be aware that i've highlighted a few areas of investigation for causes of symptom and hence treatment for long covid as time has gone on i've begun to see it as a bit of a jigsaw puzzle the complicated part though is that the conditions heterogeneity means that the puzzle is different for everyone so despite sharing many of the same pieces some of them are much bigger in some people's puzzles than others and what are the pieces well we're looking at things like potential viral persistence or viral debris mast cell activation nad plus deficiency organ damage or inflammation auto antibodies and dysautonomia pots you might be able to treat one of these and see some improvement but it can only get you so far until you resolve the rest of the puzzle one of these pieces i've not yet discussed at length on the channel is dysautonomia and the more i think about it the more this could be the keystone in the long covered arch potentially even responsible for all the other pieces in the puzzle i asked dr tamzin lewis about dysautonomia in the context of long covid could you tell me what biologically is going on um with dysautonomia it's a good question because a lot of people have been banding around this term dysautonomia without with really out without really understanding what it means and essentially it means a dysfunction of your autonomic nervous system and the autonomic nervous system as we know is this kind of binary distinction between fight and flight which is just sympathetic that's your that's your sweaty palms that's your racing heart that's your nausea your stomach upset that's getting you ready to fight and then you've got the parasympathetic which is your recovery cells cov2 virus in some people seems to be very adept at triggering a huge sympathetic nervous system reaction now this seems to happen not even just in the acute phase but also in the subsequent phases so you know you and i were discussing that you know our heart rate didn't really fly off the handle too much initially although body temperature did but then you know it seems that the inflammation that persists in long covid can cause this dysregulation of the of the um of the nervous system which is what we perceive as dysautonomia and you've discussed you know extensively what is what are the symptoms of dysautonomia because a lot of people are presenting with um the ray's resting heart rate um fluttering sensation in the chest um that inability to relax you know we're all told we should rest we should sleep we should recuperate but you know really we're lying there in bed going you know we're developing this fear of sleep which is um which is problematic because then if we don't sleep we don't recover etc so dysautonomia is um essentially you know that the the balance has shifted towards the sympathetic the stress state the oxidative stress the inflammation etc um and those are the symptoms that we've we've discussed like like i said we don't really know why kovi the styles kov2 virus is very good at doing that but um and it doesn't appear to do it in everyone you know it seems that there is you know as you you've already alluded to there's all there's a genetic component here for sure there's a lifestyle component for sure you know your history of stress your ability to buffer stress your stress bucket etc may make you prone to these symptoms but they can be very disabling um and but there is hope you know we do know how to treat it now many people are put on you know sympathetic nervous system blockers like propanol which block adrenaline and related components which drive that process there are things like breath work which we discussed before which can really activate the parasympathetic branch so if dysautonomia is implicated in long covid what are the implications for treatment well dr tina pierce has previously been recommending the gupta program to her patients so i spoke to the founder ashok gupta to try and find out some more about it ashok gupta describes his program as a brain retraining neuroplasticity tool and it's all based upon a working hypothesis for how a number of chronic conditions uh from me and fibromyalgia to long covid affect the body so could you describe some of the bio biological mechanisms which are actually going on that is creating what is behind the symptoms we find in these chronic conditions generally these conditions and let's take longhaul covid people may have had a viral trigger in this case cov19 in the case of fibromyalgia it might be a pain syndrome in the case of any cfs it could be flu or stomach bug some kind of physical trigger combined with some kind of chronic or acute stress now the chronic or acute stress isn't always there in every patient but we generally find in a lot of patients for about 60 to 70 of patients there's some kind of severe stress going on and a combination of those two things combined with a genetic predisposition mean there's what we call a conditioning event that occurs in the brain and what we mean by conditioning event is there's some neurological learning that occurs that essentially because the body was in a weakened state as a result of that stress chronic or acute the brain thinks i actually may not survive this particular condition and this is directly analogous to covid19 which is a life-threatening condition and especially when we the body knows that thousands of people are dying from this every day across the planet um the uh the resistance to it the defensive structure systems such as the immune system and nervous system will over respond and we know with covid19 many people are passing away and dying not from the actual disease itself but from the overreaction of our cytokine storms and various other things so this idea these ideas have uh you know a premise in mainstream science as well so the body is trying to fight off covid19 but is in this weakened state for whatever reason and at that point in time the brain makes a decision i may not survive this therefore i must now go into extreme survival mode overstimulate all the defensive resources and what happens is when the brain is in that neurological state and there is uh quite a lot of research on this the amygdala especially and the insulin they are prone to learning new defensive uh processes to keep us alive so in that moment um the brain is overresponding the original virus goes so we may not test positive for the original virus anymore but our bodies are now in this altered state so that anything that reminds the brain that we may still have the presence of the virus for instance symptoms in the body itself so fatigue extreme exhaustion the breathing problems even the breathing problems can be a conditioned trigger that then trigger the immune system and nervous system to say we are still in danger the virus is still present we must continue to elicit these defensive inflammatory responses so the brain then triggers widespread inflammation in the body and in the brain there can be ongoing stomach challenges from tightness in the gut and shut down of digestive systems which then change the balance of good and bad bacteria muscle tension and fatigue pain in the body the breathlessness that occurs as a result of sympathetic overactivity and some of the damage that may have occurred in the lungs all of this can create the symptoms in the body these symptoms then loop back to a hypersensitized brain that believes we're in danger the brain says i knew it i knew we were still in danger once again we believe these processes occur in the media and the insular but it's not just those two brain structures it's the entire brain working together stimulate the nervous system immune system create symptoms loop back to the brain and we create this vicious cycle and in mathematics physics as we know uh ups and downs or a cycle a waveform occur when the inputs and the outputs of the system are connected and that's how we get waveforms and in the same way people have good days bad days good moments bad moments which reflect how vicious the cycle has become and how many symptoms have been created so in a nutshell that's the hypothesis so when for example i have a day and i do too much in that day whether it's cognitive or whether it's physical um and those limits are now extremely low from where they were before i had covered uh at some point whether it's um possibly within minutes but more often within sort of 12 to 24 hours um i get post-exertional malaise which for me is a really sort of banging frontal headache and a complete and utter exhaustion what what's physically happened there what's the link between that level of activity and the reaction yeah so personally post-exertional malaise has been obviously studied in me and chronic fatigue syndrome type scientific studies for many many years and you know in my view the very simple reason for that is if you continually in the background stimulate your sympathetic nervous system and your immune system that is using up resources so it's using up uh neurotransmitters it's using up some of those stress hormones and even the neurotransmitters which means that when you do then go to do an activity physically mentally emotionally there aren't enough resources for the body to be able to cope with that situation it's already exhausted at a kind of conceptual level and therefore when you do those activities you're pushing the body beyond its boundaries of what it can manage in terms of the resources required and we know that with mecfs there's downgrading of the hpa axis the hypothalamus pituitary adrenal axis so the body isn't able to stimulate enough cortisol enough adrenaline to deal with a physical exertion and then there can be delayed reactions because when we exert ourselves normally there's a sympathetic response and then a corresponding parasympathetic response which is the rest heal and digest response so the muscles get repaired whatever damage has occurred as a result of exertion uh hormones and neurotransmitters are replenished and we get back to balance again but in this situation we know that that's not occurring we're stuck in that sympathetic mode and therefore 24 to 48 hours later sometimes the real effects of that exertion start manifesting even more severely um it's interesting what you say about the hpa axis and the deficient adrenals and the lack of cortisol and the rest of it um i respond extremely well to corticosteroids with long covered whilst i'm having them the fatigue lifts my head is clearer everything's fine i'm much more activity tolerance i can do things that i wouldn't be able to do and not suffer normally and not suffer post-social malaise and i mean this does seem to in my opinion it takes a lot of boxes in terms of what we're seeing fundamentally yes and it's the brain's logical decision to downgrade the hpa axis so it's the idea of you know if you keep punching a system to stimulate it will downgrade its responses to cry try and create homeostasis in the system because i said i'm getting too many signals but in that downgrading when you do need your energy it's not able to give it so when you're getting those supplements you are artificially and temporarily supplementing the body's responses but what we're trying to do is go to the root course and rebalance the entire system so you wouldn't need those yeah of course um so can you tell us how the gupta program actually treats uh long covert for example uh yes so the way that gupta program works is it's 15 interactive video sessions and about 20 audio sessions which are all available online or on a usb stick if people don't use online and it comes with a book as well and people work through the videos we we hold people's hands through the process so it's even if people got a lot of brain fog or not a lot of energy they can take it very slowly step by step in their own time which is very important and we start off with the three r's of the program so retraining the brain most importantly relaxing the nervous system the supportive techniques and thirdly re-engaging with joy and the core of it is understanding the unconscious signaling from the limbic system and from the insulin which are telling us that we are in danger and once again we're very clear to say these aren't psychological techniques yeah although we're not using drugs or surgery these are what we call brain rehabilitation or brain retraining type techniques um taking advantage of neuroplasticity and so a patient understands and learns what those signaling what that signaling represents and then does something different as a seven step process to retrain the brain and we have other brain re-training techniques and they're supported by things like meditation and breathing which we know increase neuroplasticity so that's the reason for those supportive type techniques and there's obviously holistic health practices like good sleep hygiene a good general anti-inflammatory diet those kinds of things which support uh the brain retraining there's no point retraining your brain if you're drinking 15 cups of coffee a day that's not going to have the impact that we require um so that's the core of the retraining and we also have 30 or 40 you know 30 trained coaches around the world that can support people one-on-one and there's also weekly webinars with myself where people can ask me questions and work through it so that's how it works now if you know me you'll know that i come at every subject from the side of science so i asked dr lewis about her take on the fundamental principle of neuroplasticity and as a psychiatrist by sort of training in practice um what's your perspective on neuroplasticity as a concept the idea of it is is that your neuronal connections which can be brain or your nervous system aren't hardwired right they don't come together and then meet there and then you know that's that's determined there is this growth concept where you we are dynamic with our environment a bit more that our brains and our nervous systems are more reactive to the environment more plastic more moldable that's where plasticity comes from is this concept of being moldable and that's exciting because it means you know diseases that we thought of as potentially fatalistic you know like alzheimer's parkinson's neurodegenerative disorders potentially more modifiable than we otherwise thought depression anxiety other mental health conditions also i then asked ashok gupta about the responses he's seen from long covered sufferers who've joined his program so far so i can give you some case studies which really bring uh some color to it so one of the first coveted patients that we treated uh summer last year was a lady called sandrine and her story is in fact on her website so she contracted uh kovid in march 2020 and she was essentially bed bound so she she really couldn't do anything and right until july she started our program and within i think four to six weeks she was going from bed bound to be able to walk um about four to six kilometers a day um and she so she got up to about 80 recovery in four to six weeks there's a lady called um alison who's recently contacted us um is happy to share her story uh so she started the program towards the end of february um she was severely affected she's an occupational therapist and within i think 10 weeks 10 days to two weeks she got up to 90 recovery and has gone back to work now inevitably she's gone back to work and we don't want people to be complacent um some of the stresses and strains begins to trigger some of the mild symptoms again and so a lot of our program is teaching people not just to get well and retrain their brains but to stay well to make sure that their bodies don't go back into this altered state then we have a another lady in florida uh once again she's up to 95 uh recovery uh within months within a couple of months of starting the program um and in a given day what might i need to do if i want to be you know is it am i spending four hours sitting there going or is it how do people integrate the actual needs of the program into their lives is what i'm trying to say yes so the minimum requirement that we have is a minimum of 30 minutes a day which i'm sure everyone can manage if they are living with a chronic condition that they want to change and secondly there are techniques that people conduct throughout the day and it easily fits into whatever lifestyle people are experiencing so we've had people from being bed-bound or people working full-time or part-time who are still able to integrate the gupta program into their lives so there's a lot of flexibility built in there now obviously with any program the more effort and the more commitment you make to it the better the results that will come and the most common problem we have is people retraining and having that commitment then they get to 70 80 recovery and they think great i've done it you know i'm there and then they too quickly go back into a rushed life a busy life part of our modern existence and they push themselves too hard whereas we say get up to that 1890 95 recovery and then slowly ease yourself back into those work situations yeah um can you tell me a little bit about some of the clinical uh research uh demonstrating you know the efficacy of the program uh yes so we very much want to go down the scientific road of proving this rather than just saying this works and so we're very pleased that late last year we published a randomized control trial on our treatments specifically for fibromyalgia patients and the study was essentially an eight-week intervention which is very short because normally we say a minimum of six months intervention it's an eight-week intervention and the control group was relaxation techniques and an equivalent amount of uh practitioner time and this was just published in the journal of clinical medicine and it showed that in the control group there was no impact on fibromyalgia scores or the fiq scores but in the active gupta program group there was close to a 40 reduction in fibro scores within eight weeks there was a halving of anxiety and depression there was a halving of pain and a 50 increase in functional capacity and the control group was about i think it was about five or ten percent increase in functional capacity but now group are approaching 50 increase so far more effective so this is a groundbreaking result really for uh this type of treatment we are the first neuroplasticity brain re-training program to actually have a randomized control trial published and we're pursuing phase three trials now with several centers around the world to finally prove this on a larger scale and that's really for any chronic fatigue syndrome which is where we started fibromyalgia but it's also been shown to be highly effective for some of those mold and chemical sensitivities that people experience and obviously long-haul covert now we're just kicking off a long-haul covert study in the u.s with around 200 patients and that'll be a three-month intervention study and let's see you know so for us once again it's let's go down the scientific route let's prove this and um let's see what the results are with patients can you tell me a little bit about your background because you're not a doctor um but i know we've spoken before and you came from having had an experience of emmy yourself and recovering from that so can you tell me a little about your background and how you came to develop the guts program actually develop some of the techniques and learn what you needed to learn in order to actually put this thing together uh yes of course so i was studying as an undergrad at cambridge and it was my second year um like most students i was burning the candle at both ends pushing my body far too hard and i went to india on a holiday and i contracted some kind of very severe stomach book and i came back to the uk the stomach bugs seemed to reside but these intense symptoms of having an infection continued and they got worse and worse and worse to the point at which i was often housebound i found it difficult to get out of bed i couldn't focus or concentrate on a book even reading something couldn't take anything in and obviously had to then you know abandon my studies at that point in time for that year and that really started my quest to say i really want to understand what it is because i went to doctors i went to experts and they said look there's nothing much we can do you probably have this thing called mecfs you know look after yourself eat well pace yourself but that's pretty much all that we can do for you and i said to myself if i can find out what is causing this if i can get better i will spend the rest of my life helping others i made this kind of contract with the universe that you know that's what going to make what i dedicate my life to and so i researched a lot of brain neurology um read a lot of medical papers uh various books on chronic fatigue and these associated conditions and i especially studied the work of professor joseph ledoux who at the time was a real expert in the amygdala and its responses and i came up with a hypothesis of what i believed caused a condition and randomly and ad hoc invested in certain ideas certain ways of retraining my brain managed to get myself better it was very up and down process and then wrote my medical paper in 1999 which was then published in the journal medical hypotheses in 2002 and then i set up a clinic in 2001 to treat other patients and obviously there's a big difference between working on yourself and working with other patients so it took me many years to really refine these tools and techniques to find what worked for most people most of the time and in 2007 we published the first neuroplasticity training program which was a dvd program at that time and then in 2010 we published our clinical audit so that didn't have a control but that was following 33 patients for a year using our treatment and we found two-thirds of patients reached an 80-100 recovery within a year and that was a published piece of research and um after that there were obviously many other types of retraining programs that appeared um afterwards and then we revamped our program in 2019 and obviously published our research then in 2020 so that's been our journey and as you know it's very difficult to get studies in this particular area because it's seen as complementary or alternative but i really hope that we can partner with the mainstream medical profession to say this is no longer an alternative treatment because these types of ways of working are already used in certain areas of medicine and i give the example of phantom limb pain using novel retraining techniques they're able to train the brain to no longer believe there is a leg there and stop the pain signals yeah now that isn't psychological that isn't something alternative there is a very there's a deep scientific basis as to why that works and how that works now we're still different to that but the same principles uh occur which is through repetition through then that is what retraining is repetition we learn anything new through repetition through repetition we are able to train the brain to no longer be in this altered state now the reason we can't do it overnight is because you are retraining a survival response which is the equivalent of you putting your hand on a i don't know hot stove and training your brain not to move the hand off because actually it's cold so you're you're training your brain to do something it's not used to doing but it can be done many people have done it and then we find that gradually the system comes back to balance and often people are on supplements they're on this that and the other and actually when they retrain they come off all those supplements and they don't need them anymore because the body itself when it's in its optimal state can provide whatever it needs it can detoxify the way that it needs it doesn't need external support can you tell me um a little bit about your goal in a sense for the future with um with this i mean when we spoke on the phone you mentioned a little bit like you're not that fussed about you know holding on to the ip you know in five years would you say be happy if the nhs was using these tools to treat people and suddenly you know this wave of a million people have long covered in the uk alone let alone the world like what's your vision for the work that you've done the vision for me is to first of all get the phase three trials to prove it works just like we have with you know vaccines and everything like that to really objectively show this works because we're not going to have any luck with the medical profession until we have that and we've already got some studies but we need larger studies that's the first step once we have that our aim as i said is not to hold on to this and say right this is only the gupta program this is about really delivering this to as many patients as possible as quickly as possible so our team would love to train existing therapists and coaches and practitioners who are seeing patients within the nhs and global health systems train them how to support patients through using these tools and techniques and get this out there as quickly as possible because yes although we don't like to tell our patients this because it creates a resistance the sooner that we can get to this the better the outcome so definitely within the first year we find with patients if we can get to them early there's less entrenchment in the brain and it's a quicker and a quicker and easier a process of getting better um so that is our aim is to to get this out there train as many people who are interested in delivering this as possible and make it a mainstream treatment and if we get a phase free trial it shows the same results as our pilot trial you know 40 50 changes in many different parameters within two months of course the nhs of course mainstream media medicine is going to want to take this on and roll it out because it's the ethical thing to do i wanted to get dr lewis's take on this where does the medical establishment sit regarding um you know let's say you know the neuroplasticity programs like the gupta program as treatments for chronic conditions i think alternative medicine as a whole in the nhs is being more um embraced because you know we're seeing the model of chronic disease being treated by the nhs as failing essentially because of the time burden and that we know that behavior change is massively important in determining chronic health outcomes so i think there's a general shift to to include it more um but there's also a hesitance to use that word around quality of care you know the the the spectrum of practitioners that um are alternative um and that kind of um the the framework there the sort of the paradigm of evidence-based medicine it's very difficult to to prove um interventions essentially a lot of the time and i think that's what someone like ashok gupta has done well you know he's because he's you know an economist by background and he's very smart guy he's got the data and he's proved his intervention has favorable outcomes and that that's great because as soon as they do that you know i have my professor friends in seattle saying oh have you seen this dynamic neural retraining works and you're like well it's been coated in a different layer of what it is and then and you know someone very organizes put it together um so i do think these things can really benefit some people but as you've learned as i've learned with long covid and you know our histories and athletes probably help a bit with this is that consistency of behaviors over time really do impact how you feel and function but you need to almost devote your life to being better and to being well um and you know with an athlete history used to do this used to put the training stimulus in and then you have the recovery period and this is it with life now you know you have to wake you have to look at what you're eating you have to look at your morning sun exposure you have to do a number of things in the day to work on your well-being and it's not a nice fluffy self-care well-being to have it's a it's mandatory and and that is frustrating for a lot of people because we're still looking for a long covered cure and you know i i really don't think there will want there will be one thing one tablet one anything that cures it because the systems in our body has gone away um and i think that what the gupta program just to go back to that using i mean he uses a lot of very powerful meditations breath work illness reframing you know because we're all kind of not all of us but you know it is because of the groups because of the communities we are identifying with the illness and therefore we become almost you know a self-fulfilling prophecy of if i go for you know 10 a 10 minute walk i'm going to be tired or 10 miles whatever that number is so it's trying to slowly challenge and bring safety cell safety back to to our to our self to our being um so the way i've been looking at um long covered recently is that it's a um a puzzle with a number of pieces in it which you know include things like you know is there viral debris bruce patterson has recently been uh hinting that he's found evidence of viral debris is there viral persistence and to what degree is mass activation involved or not plus deficiency or dysautonomia and all of these things are sort of floating around in this puzzle i spoke to ashok and he seemed to suggest that this overstimulated amygdala that was you know uh propagating the sympathetic nervous system was upstream of all of these and all of these issues uh were sort of downstream of that so if you can actually you know resolve that um over active amygdala i mean that's not probably the right way to describe it but if you can resolve that problem at the top then the rest of the stuff resolves with it what's your instinct on that what's your instinct to tell you um about that puzzle and about this kind of work and the effects it could potentially have for people with long covered i think it's um i think what you said though is is interesting because when we talk about the image we talk about a brain region but i still think people are going to take away from it that it's in your head as in this illness is in your head um and and let's still be this binary sort of cut off at the neck when actually at this word dynamics you know we are constantly dynamic you know our brain is a center for not just emotional control psychiatric control behavioral control all functions of our body come from our nervous system so for sure the amygdala plays a central processing role and that amygdala is impacted by your history you know any previous trauma um any previous infections anything that's previously been traumatic or scary to the body will prime that amygdala so there is definitely something in reprogramming those that interplay but it's dynamic right they're still coming up from you which is you know there's some clotting stuff going on here there's some really nasty cytokines flying around um and the brain is so one of the things one of the ways i think my antihistamines are working in this and the mast cell stabilizes and and are by sort of suffusing that mediator to stop them going and being sensed by the amygdala and therefore your body kind of goes ah you know i'm safer i'm safer and safer and i i really think that that is playing a role for sure um and you know the more that we can get tests out that measure and and i think it's the same person that you mentioned bruce looking at different inflammatory cytokines as a sort of signature pattern for long cover because we're not there yet people are fed up with the test being normal um we you know we'll be able to track um how these various interventions um can can impact but you know um we also need to be more objective about our symptoms i know some people are using tina's recommendation the people with that can be quite interesting to objectify your symptoms etc [Music] so i do have to point out that the gupta program is a paid service although there is a 28-day free trial it makes me a bit uncomfortable to recommend things that people have to pay for especially when so many long-haulers have found their incomes massively impacted by their illness so i can't say you know do this it'll definitely work but i can let the evidence that's out there speak for itself and you can make the right decision for you let's say you don't want or can't afford to sign up what else could you do if this hypothesis has anything going for it and personally i think it does so essentially anything that you can do to calm down the sympathetic nervous system and promote the parasympathetic nervous system is worth doing so breath work meditation yoga are all very positive things to be doing and dare i say it but paul garner's favorite positive thinking it's very easy to get stuck in negative feedback loops when you're suffering with chronic illness so anything you can do to interrupt those is worth doing as for what is breath work well try doing 10 minutes of slow breathing in the morning in for four out for six and repeat and then in the evening what i personally do is in for four hold for four out for six hold for four and that's basically an extended out breath version of what's known as box breathing and then any time you feel anxious stressed or like you've been on the go too long try and find a few minutes to sit down and do it again i've been doing this for a couple of weeks now along with some of the meditations from the gupta program and it has 100 percent uh helped me drop my resting heart rate from what was tachycardia essentially at 80 or 90 back down to about 60th which is where i'd expect it to be so it's definitely been a positive experience for me but as for the big question is dysautonomia sitting at the top of the symptom tree raining down coconuts on all of our systems in our body well i can't answer that just yet but on the chance that it just might be it's probably worth all of us trying to do something about it until next time

Channel: Gez Medinger

Views: 41,718

Keywords: coivd, covid, post covid, pacs, syndrome, mcas, long ocvid, long covid

Id: z04DzTQrgWQ

Length: 35min 55sec (2155 seconds)

Published: Thu Apr 22 2021