Being a functional medicine provider has been rewarding in so many ways but it’s always nice to see when the conclusions I arrived with listening, observation and simply thinking is backed up by scientific studies. This is one of the biggest differences between traditional medicine and functional medicine. Traditional medicine waits for the large, controlled study before arriving on a conclusion and more importantly before really taking action (not all, I know there are many exceptions to this). Functional medicine meets the challenge where it is and starts taking action with what we know at that moment or suspect using prior scientific studies and diving into the underlying mechanisms. COVID has shaken the world and definitely shaken medicine in general. Even the CDC came out this past week with a new restructuring idea because they realized they aren’t flexible enough to spring into action when the needs arise.
My theory based on what I have been seeing and how patients have been responding is that there are three main mechanisms involving long-haul covid symptoms. A person can have activation in one or all three which creates exponential symptoms when combined. READ ON as I walk you thru my theories and now the science that supports them….
I believe that covid activates many different systems and depending on what you were already pre-disposed to might lead it down a different path than your friend or neighbor who also had covid. The three areas are:
- Activated histamine system
- Activated inflammatory response
- Re-activating viruses -specifically EBV (Epstein barr virus) and other herpes viruses
Any one of these can flip our parasympathetic/sympathetic system upside down so our fight-or-flight system goes haywire. Studies are suggesting low cortisol in the morning which is one cause of extreme fatigue that is not responding to steroids which in typical cases helps this problem. High glutamate has also been implicated which is very neurotoxic and can create all sorts of anxiety, brain “zingers” and uneasiness. Other symptoms of this flip include sleep issues. Instead of being in a calm parasympathetic state at night the sympathetic system is being activated causing more sleep disturbances that seem to defy any medication. The mere fact that the traditional treatments for these symptoms aren’t working tells you there is another underlying cause that is being missed. Let’s circle back around to my three theories.
1. Histamine: I have been evaluating and addressing the histamine system for years. I am a firm believer that when our gut microbiome gets off kilter then we are more prone to having more food sensitivities which can create more and more histamine issues. Many things contribute to the dysbiosis: toxins, medications, antibiotics, parasites, mold just to name a few. Many people have no idea their histamine system is activated but you might be familiar with some common symptoms like persistent nasal drip, drainage, clogged ears, asthma, sneezing, any type of gut issue from diarrhea to gas to bloating, intermittent swelling in the hands or feet, significant headaches just to name a few. COVID seems to kick up more histamine release in the body. When you get too much histamine then many other symptoms can start to occur including anxiety, insomnia, mood swings in addition to the ones I mentioned before. I am using many different approaches for addressing these imbalances starting with simple things like an anti-histamine, supplements that help with histamine like quercetin and then progressing into more involved protocols using medications that are histamine stabilizers. Many times multiple things have to be combined for any effect at all.
2. Inflammation: This one is not a surprise as even the very early cases of severe COVID implicated an inflammatory response like no other. However, it was thought if you had a mild case then you dodged this. Unfortunately, this is not true. Many different inflammatory cascades have been shown to be activated and these are usually missed on routine blood work. The heart inflammation and what I am going to very loosely call brain inflammation are two of the most concerning issues that can occur. Recent studies are also proving this low grade inflammation.
Heart inflammation can present with very subtle symptoms including slight pressure that is present most of the time, trouble with exercise and difficulty with heart rate. Always make sure you do your due diligence and get the necessary tests to make sure you aren’t having a heart attack but if that is all normal then you might have low grade inflammation. I had a young man several months ago in this exact situation. His heart had checked out as fine but he was convinced that something was wrong and he was right. His routine blood work was completely normal but since he was having this consistent chest pressure I looked at a special inflammatory marker which is an early precursor of inflammation in the blood vessels and it was markedly elevated. We did some natural supplements for this and his symptoms and levels returned to normal! Trust your body – it is telling you something.
Brain inflammation can manifest as headaches which is what I am seeing primarily and most testing seems to be normal so you just have to have the suspicion it is COVID related especially when you didn’t have headaches prior to getting COVID. Because the blood-brain barrier is so good at protecting everything inside it takes longer to see results when addressing this so you have to be diligent.
3. Awakening a sleeping giant – cue other viruses. I have a lot of patients who already had reactivated EBV (which is mono) and I noticed very early on these patients were having the hardest time with COVID and post-COVID. I started treating them aggressively for the EBV and the long-haul covid symptoms improved. Since then I always think of EBV and other herpes viruses when I am working with a long-haul COVID case even if the labs are normal! I think we don’t have adequate testing available for many of the different herpes strains and other viruses and am hoping new modalities of evaluation are coming! If you are having what I call “flares” then you most likely have a virus that is being reactivated. EBV is probably not the only one as there are many other viruses that we have no idea even exists let alone test for! If you are feeling ok but then start to feel achy, feel like you are coming down with the flu, feel like you have a fever but you don’t and have general malaise that lasts for a few days and then resolves then you are having a flare. Many anti-viral supplements can really help in these instances as well as prescription anti-virals. A recent study just proved that EBV is being reactivated with COVID so there will be more attention paid to this cause of long-haul COVID!
If you are having long-haul COVID and are struggling then find a provider who can walk you thru the many different causes and just keep trying things. Every one if different and unfortunately in many instances we have to try many different approaches to get things back on track. Hang in there…you are not the only one!
To your health,