In this episode, I am speaking with Evan Hirsch, MD – who is a world-renowned fatigue expert and is the founder and CEO of the International Center for Fatigue. Recently, Dr. Hirsch has taken a deep-dive into the science on “COVID long haulers” which we will discuss in more detail.
Table of Contents
In this podcast, Dr. Hirsch and I will discuss:
- What is Long COVID?
- The role the media plays in this pandemic
- Who is at risk of getting long COVID
- How to find out if you have long COVID (And how to recover from it)
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Listen outside iTunes
Transcript
Ari: Hey there. This is Ari. Welcome back to the Energy Blueprint podcast. With me now for the third time is my friend, Dr. Evan Hirsch, who is a specialist in chronic fatigue. He’s a world-renowned fatigue expert and is the founder and CEO of the International Center for Fatigue. Through his best-selling book, podcasts, and online programs, he’s helped thousands of people around the world optimize their energy naturally and he’s on a mission to help 1 million more people. Welcome to the show for the third time, Dr. Hirsch, such a pleasure to have you.
Dr. Hirsch: Hey Ari, thanks so much for having me back. It’s always a great time with you.
What is Long Covid?
Ari: Let’s talk about long COVID. I know that you’ve done a lot of deep dives into this. You have quite a lot of patients with long COVID. I would love, and I’m sure all of our listeners would love to hear about everything that you know about long COVID. First of all, what is long COVID or post-COVID-19 syndrome?
Dr. Hirsch: It’s got a lot of names. There’s post-acute COVID-19 syndrome, there’s post-COVID syndrome, post-COVID-19 syndrome, long COVID, which is what they’re calling it colloquially in the UK and beyond, and then long haulers, which is more stateside what they’re calling it.
Ari: I think I’m going with long COVID just by having to deal with all the different names.
Dr. Hirsch: Yes, that’s true. We can call it whatever we want to. It’s the persistence of symptoms that people acquire from COVID-19 so they get infected. Generally, a majority of people are going to have relief by three weeks and these are people who persist past four weeks. There’s no official diagnosis right now of exactly when that line is, but it’s generally around four weeks.
Ari: Got it. What kinds of symptoms are we talking about here?
Dr. Hirsch: What’s really interesting, as we’re seeing with COVID, is that the symptoms really depend on the individual. A lot of that has to do with the fact that COVID travels in the blood. Wherever the blood goes, you can potentially have symptoms. They can present in pretty much any organ, but oftentimes some of the weird ones are loss of smell, loss of taste, hair loss, which is always a surprising one for folks, especially the younger generation. Then you’re also seeing things like headaches, muscle pain, weakness, obviously fatigue, which is one of the number one that’s like 90% of everybody who’s experiencing. It’s very high number for those folks.
Then we’re also seeing a lot of gastrointestinal issues, but it really depends on the person and interestingly enough, it seems like the more mild your case is initially, the more likely you are to have long COVID. It seems like the infection shows itself and then disappears very quickly, burrows deeper into the body, into the biofilm, wherever, and then it’s able to avert the immune system, and then it comes out later once it thinks that things are safe and it’s tricked the immune system in some way.
Ari: How do you think that this compares to, let’s say, Epstein-Barr virus and mononucleosis and a lot of– well, I guess for context when we’re talking about COVID we know that the research is quite clear that young person, in general, have very low risk of severe COVID or dying from COVID. It tends to affect the elderly, it tends to affect people with pre-existing conditions as well. But we also know that something like Epstein-Barr virus, mono or glandular fever or the kissing disease as it’s called in different places around the world, affects young healthy people in their teens, in their 20s, and they can get very severe illness.
I know from experience, I got it in my early 20s and I had long mano, you could say because I had severe symptoms for about six months and I had symptoms that went out to a year. If I think of, maybe just minor fatigue or my immune system not being particularly robust, maybe I could even track that out to five years or something. How do you think that what’s going on with COVID and long COVID compares to that? Is it a reasonable comparison? Do you think it’s much more severe than long mono, let’s call it? What’s your take on that?
Dr. Hirsch: Yes, a great question. I do think that they are very similar in the fact that they’re viruses and in some of the ways that they’re affecting the immune system, but I do think that long COVID is going to turn out to be more severe. I think a lot of that really has to do with the conglomeration of symptoms that people are experiencing and this rotation of symptoms that they go through. Some of the symptoms that they may have had initially if they’re a couple of months out, they may say, yes, I no longer have those initial symptoms. Now, I have new symptoms and these new symptoms get worse. Then they rotate where those symptoms go away and then you get new symptoms and then those symptoms get worse.
I think it’s just a lot more challenging to treat an infection when you have that sort of situation. The other thing too is that when you look at SARS-CoV-1, so comparing it with other coronaviruses, the numbers are quite high, 30%, 40% of people three to five years later who had SARS-CoV-1 and then ended up persisting with ME/CFS or some chronic fatigue syndrome. The numbers aren’t that high for Epstein-Barr virus. I don’t remember them offhand, but I think they’re more along the lines of if you have mono, and what persists is more along the lines of 5%, 10%. Just not as bad as the COVID-19 and what I believe is going to be this persisting disease, unfortunately.
Ari: The numbers you were just saying was that star SARS-CoV-1?
Dr. Hirsch: Yes. We can talk about the numbers that we’re seeing right now for SARS-CoV-2, but SARS-CoV-1, the studies that were done at three to five years after that they saw 30% to 40% who still had ME/CFS or chronic fatigue syndrome that was persisting. A lot of that was in healthcare workers, unfortunately. Go ahead.
Ari: I think to be fair, even though you can talk about the genetic similarity of the viruses, but the initial SARS was a very severe infection that had a mortality rate of 8% to 10% if I remember correctly, something like that, as opposed to SARS-CoV-2, which has a mortality rate of 0.2% to 2.3% in most people, and then higher in elderly people with pre-existing conditions, certainly. It seems to be a few orders of magnitude less severe based on the mortality rates figure, granted that’s not a perfect metric for translating into long COVID necessarily. Anyway, I guess I’m just trying to say I don’t think you could take the percentages from SARS-1 and say, hey, we’re going to see similar numbers for SARS-2.
Dr. Hirsch: Yes. I would also say that I think that when you’re looking at acute versus chronic like you said, we don’t know. The numbers that we’re seeing right now, we can jump into that, which is really interesting is, there are some studies that are showing like 70% of people who get acute COVID are ending up with post-COVID syndrome, and then there are stats that are showing 25%.
There was even one that was in the UK that was done on 250,000 people that was showing more along the lines of like 20%. It’s still running the range, but it’s still pretty high. Some of this is because we’re seeing, there was one study that was done a small number of people, but half of the– so they took people four months after they had acute COVID whether by symptoms or by PCR diagnosis, they were asymptomatic at the time that they did this evaluation. Four months later, no symptoms and they did intestinal biopsies.
Now, first off, how did they get these people to volunteer their intestines? I don’t know, [laughs] but they did intestinal biopsies and they found that half of them, so 50% had live COVID-19 virus in them, in these intestinal biopsies. That’s for asymptomatic people. Studies haven’t been done on people who have long COVID, but I would imagine that there would be a higher percent. There’s this persistence that’s happening from the infection that’s really interesting.
Ari: When I hear these numbers, here’s the issue that I have with it. I’m not in any way suggesting that long COVID isn’t a thing, but I think the numbers and how we’re reporting this are somewhat flawed just based on the different methodologies of the studies and how they’re defining it. I’ll give you an example. I still think that I actually got COVID last January just as it was starting to pick up steam in the US. I got the worst infection that I’ve ever gotten in my life. I had a very severe cough, a dry cough that the cough itself lasted three to four weeks.
I was so fatigued from that illness that I was not able to work out, not able to exercise or surf or rock climb, or do any of my stuff for four to five weeks which has never happened to me before. Normally, a common cold or flu, I might be out of commission for anywhere from 3 to 10 days but I was technically out for four to five weeks. Then if you continue to track me out to six and seven and eight weeks, I probably still wouldn’t have been at normal levels of energy. I might have still reported some degree of fatigue, maybe a bit of coughing, something like that. Maybe a few other symptoms, post-exertional malaise, things like that.
Based on some of the methodologies of how people are reporting long COVID symptoms and how they’re saying if you have one symptom that lasts more than three weeks you have long COVID, I would have technically had long COVID based on that. If you ask me, do I think that I have long COVID or would I have classified myself as long COVID? I would say no. I just had a couple of minor symptoms that lasted more than four weeks, but nothing that I would classify myself as having some serious condition. Do you know what I mean?
Dr. Hirsch: Oh, yes. I think that part of the problem also is that some of these samples are coming from post-COVID or COVID clinics, or they’re coming from long-haul Facebook support groups.
Ari: Right.
Dr. Hirsch: There’s inherent bias.
Ari: Right.
Dr. Hirsch: Yes, it’s definitely challenging. That’s why I think that maybe the King’s College study in the UK might be the best at 10% to 20%. It’ll be really interesting to see how it plays out but regardless, people are suffering. It’s so interesting how a lot of it is with people who are working out actively. I think some of that plays into the hormesis that you talk about, plays into mitochondrial function. I’m not entirely sure why that’s happening. I’d be curious if you have any ideas, but I think it’s just a really interesting phenomenon that a lot of people get pushed into it by starting to exercise too soon after they have acute COVID.
How Stress Affects Your Immune System
Ari: Well, I do have some thoughts on that. This is counterintuitive for most people. It used to be counterintuitive for me until I read the research, and experienced it myself firsthand. People who are highly physically active, for example, professional athletes, and even recreational athletes who are just super, super physically active, actually get sick more often, not less often. They’re actually more prone to getting respiratory tract infections, common colds, and flus.
We have this picture of the healthiest person is the one who never catches anything. We have ideas like that. We also have an idea that if you’re a young person who’s doing lots of exercise, you should be one of those healthiest people who never catches anything. The reality of what we know is that people who exercise a lot, often actually over exercise and run down their immune function a bit and can catch them. I spent years overtraining myself and know this very well firsthand because I used to get colds very often.
I used to have my parents say, “Why are you catching colds three, four times a year?” It’s like, “You’re supposed to be the picture of health. You’re doing all this crazy exercise and surfing big waves and rock climbing and lifting heavy weights, and you can do all these physical things, and yet you catch colds.” They’re actually linked in a more obvious way than you might imagine, which is just if you do too much training, too much exercise, you run down your immune function, and you’re more likely to catch them.
Dr. Hirsch: Yes, that makes really good sense. The more stress you have on the body, whether it’s good stress or bad stress, the more it’s going to affect the immune system for sure.
Ari: You think the best percentages are somewhere in the neighborhood of 10% to 20%? Is that accurate?
Dr. Hirsch: Yes.
Ari: What do you think are the main differentiating factors? You mentioned that people with more mild infections are the ones that are more likely to experience long COVID as opposed to severe infections. That’s counterintuitive for me, but what do you feel is an explanation for that?
Dr. Hirsch: Absolutely, yes. Well, I’ll tell you first, there was a study that was done 1,600 people. There was some ecology group on Slack plus Facebook, long-haulers groups, and stuff like that, that’s where that data came out of that I saw. The reason for that, I think has to do with a very smart infection. An infection that’s able to really dive into the biofilm and hide itself very quickly.
I think the faster that it hides itself, the symptoms resolve. The immune system thinks it’s gotten rid of it and that’s when the infection can really spread, and then pop up in different areas hidden so that in different organs, immune system doesn’t see it, or then when it does see it, then it starts going after the infection and that’s when you get symptoms. You get inflammation. You get pain and dysfunction.
Ari: Got it. I actually don’t know the answer to this. Do all viruses stay in our body and stay latent like let’s say herpes zoster or Epstein-Barr virus, or are there some viruses that are basically cleared from the body?
Dr. Hirsch: They’re never really cleared. My understanding is that most of these infections that we have if not all of them, take up shop and we create a homeostasis or a balance. We’re 90% bug cells and 10% human cells. It’s really more about balance than anything. Oftentimes, we have these infections. We acquire them most of the time actually through mom’s placenta, Moms dumping all their good stuff and all their other stuff into their babies.
Then, of course, anything that we acquire along the way. We’re kissing this person, or having an exposure here, or whatever it is, and they just build up in the body and the immune system creates this balance until it gets overwhelmed by a number of things, and then there’s a problem. The classic example is what you’re talking about with shingles, where you get chickenpox. Herpes zoster lives in the dorsal ganglia, and then it comes out during times of stress. Whether you have a breakup or a divorce in your 20s and then all of a sudden, you get shingles, or whether it’s when you’re 70 years old. That’s what I’ve seen and that’s what I’ve read.
Ari: There are some indications from looking at different people who have gotten COVID, and the severity of the infection. For example, we know that kids generally do not have severe infections, do not have severe symptoms. We have these different layers of the immune system. We have mucosal barriers, we have mucosal immunity and IgA antibodies, and we have the innate immune system. Those things are first lines of defenses. We have T cells, and then we have the adaptive immune system and the antibodies that are created.
Dr. Hirsch: Right.
Ari: One of the things that’s interesting is that we know that people with more severe infections, let’s say older people with pre-existing conditions who have a really severe infection, have a very robust, very large antibody response. Whereas, if you look at kids who have very mild symptoms, or who are asymptomatic, they have very little antibody response often.
Dr. Hirsch: It’s more innate.
Ari: Yes. What seems to be happening is that there seems to be in the younger, healthier part of the population, the mucosal immunity, the innate immunity, the T cell immunity seems to be predominant and be able to control the virus and you don’t need the adaptive immune system and the antibodies to kick on as much. I wonder if that somehow factors into this situation with the virus burying itself somewhere and hiding in the biofilms and so on and then coming out later during times of stress.
I wonder if maybe younger and healthier people who have a light infection or very mild or asymptomatic infections, maybe since they don’t have a robust antibody response and never really got exposed systemically, maybe they’re more prone to re-emergence of the virus and symptoms. Do you think that’s a reasonable line of thought?
Dr. Hirsch: Absolutely, yes. I hadn’t thought of it that way but yes, I think that that’s a really good line of thought. I think also, what’s interesting about that and the innate immune system is that when we look at autoimmunity, we’re generally looking at whether or not there’s over-activation of Th1 or Th2, T helper cell 1, or T helper cell 2. What we’re seeing is that a lot of these people are presenting with almost mast cell activation syndrome, which is the hype and autoimmunity. We’re seeing also that people who had fatigue and had autoimmunity are more likely to get long COVID.
I think that there definitely is something there, and I think a lot of it probably has to do not just with age, but also that relationship with the virus and whether it’s the innate or the adaptive immune system, how it’s able to hide. Perhaps with the vaccinations, which are focused more on the adaptive immune system, we’re going to have some more knowledge around that.
Ari: Yes, actually that’s interesting to me. I’m glad you brought up the vaccines, but one of the things that has jumped out to me is it seems to me to make a lot more sense intuitively to create an oral or a nasal vaccine rather than an injectable vaccine. Those technologies do exist. There have been some vaccines already that are created that are nasal spray vaccines or things that you hold in the mucus membranes in your mouth.
That intuitively makes way more sense to me because you’re mimicking the natural way that your immune system would actually interact with the pathogen, with the actual virus where the virus isn’t just injected into your bloodstream. It actually interacts with the mucus membranes and with the immune system at the mucus membranes and with the innate immune system before you ever get the antibody response that’s kicking in. I’m just wondering if you have any thoughts on that subject.
Dr. Hirsch: Yes, I think the question is, and I don’t have an answer to this, how fast does the virus get into the bloodstream or how fast does it trigger the innate, and then the adaptive? If you see symptoms go away in a week, then it’s pretty darn quick, and so then the question is if you’re using an intra-nasal vaccine of sorts, is that going to be as well absorbed as an injection? If it’s already bypassed that mucosal immunity like you’re talking about, then do you need to go for something more global that’s going to be better absorbed by giving an intramuscular injection, and I don’t know the answer.
How Stress Affects Your Immune System
Ari: Well, I do have some thoughts on that. This is counterintuitive for most people. It used to be counterintuitive for me until I read the research, and experienced it myself firsthand. People who are highly physically active, for example, professional athletes, and even recreational athletes who are just super, super physically active, actually get sick more often, not less often. They’re actually more prone to getting respiratory tract infections, common colds, and flus.
We have this picture of the healthiest person is the one who never catches anything. We have ideas like that. We also have an idea that if you’re a young person who’s doing lots of exercise, you should be one of those healthiest people who never catches anything. The reality of what we know is that people who exercise a lot, often actually over exercise and run down their immune function a bit and can catch them. I spent years overtraining myself and know this very well firsthand because I used to get colds very often.
I used to have my parents say, “Why are you catching colds three, four times a year?” It’s like, “You’re supposed to be the picture of health. You’re doing all this crazy exercise and surfing big waves and rock climbing and lifting heavy weights, and you can do all these physical things, and yet you catch colds.” They’re actually linked in a more obvious way than you might imagine, which is just if you do too much training, too much exercise, you run down your immune function, and you’re more likely to catch them.
Dr. Hirsch: Yes, that makes really good sense. The more stress you have on the body, whether it’s good stress or bad stress, the more it’s going to affect the immune system for sure.
Ari: You think the best percentages are somewhere in the neighborhood of 10% to 20%? Is that accurate?
Dr. Hirsch: Yes.
Ari: What do you think are the main differentiating factors? You mentioned that people with more mild infections are the ones that are more likely to experience long COVID as opposed to severe infections. That’s counterintuitive for me, but what do you feel is an explanation for that?
Dr. Hirsch: Absolutely, yes. Well, I’ll tell you first, there was a study that was done 1,600 people. There was some ecology group on Slack plus Facebook, long-haulers groups, and stuff like that, that’s where that data came out of that I saw. The reason for that, I think has to do with a very smart infection. An infection that’s able to really dive into the biofilm and hide itself very quickly.
I think the faster that it hides itself, the symptoms resolve. The immune system thinks it’s gotten rid of it and that’s when the infection can really spread, and then pop up in different areas hidden so that in different organs, immune system doesn’t see it, or then when it does see it, then it starts going after the infection and that’s when you get symptoms. You get inflammation. You get pain and dysfunction.
Ari: Got it. I actually don’t know the answer to this. Do all viruses stay in our body and stay latent like let’s say herpes zoster or Epstein-Barr virus, or are there some viruses that are basically cleared from the body?
Dr. Hirsch: They’re never really cleared. My understanding is that most of these infections that we have if not all of them, take up shop and we create a homeostasis or a balance. We’re 90% bug cells and 10% human cells. It’s really more about balance than anything. Oftentimes, we have these infections. We acquire them most of the time actually through mom’s placenta, Moms dumping all their good stuff and all their other stuff into their babies.
Then, of course, anything that we acquire along the way. We’re kissing this person, or having an exposure here, or whatever it is, and they just build up in the body and the immune system creates this balance until it gets overwhelmed by a number of things, and then there’s a problem. The classic example is what you’re talking about with shingles, where you get chickenpox. Herpes zoster lives in the dorsal ganglia, and then it comes out during times of stress. Whether you have a breakup or a divorce in your 20s and then all of a sudden, you get shingles, or whether it’s when you’re 70 years old. That’s what I’ve seen and that’s what I’ve read.
Ari: There are some indications from looking at different people who have gotten COVID, and the severity of the infection. For example, we know that kids generally do not have severe infections, do not have severe symptoms. We have these different layers of the immune system. We have mucosal barriers, we have mucosal immunity and IgA antibodies, and we have the innate immune system. Those things are first lines of defenses. We have T cells, and then we have the adaptive immune system and the antibodies that are created.
Dr. Hirsch: Right.
Ari: One of the things that’s interesting is that we know that people with more severe infections, let’s say older people with pre-existing conditions who have a really severe infection, have a very robust, very large antibody response. Whereas, if you look at kids who have very mild symptoms, or who are asymptomatic, they have very little antibody response often.
Dr. Hirsch: It’s more innate.
Ari: Yes. What seems to be happening is that there seems to be in the younger, healthier part of the population, the mucosal immunity, the innate immunity, the T cell immunity seems to be predominant and be able to control the virus and you don’t need the adaptive immune system and the antibodies to kick on as much. I wonder if that somehow factors into this situation with the virus burying itself somewhere and hiding in the biofilms and so on and then coming out later during times of stress.
I wonder if maybe younger and healthier people who have a light infection or very mild or asymptomatic infections, maybe since they don’t have a robust antibody response and never really got exposed systemically, maybe they’re more prone to re-emergence of the virus and symptoms. Do you think that’s a reasonable line of thought?
Dr. Hirsch: Absolutely, yes. I hadn’t thought of it that way but yes, I think that that’s a really good line of thought. I think also, what’s interesting about that and the innate immune system is that when we look at autoimmunity, we’re generally looking at whether or not there’s over-activation of Th1 or Th2, T helper cell 1, or T helper cell 2. What we’re seeing is that a lot of these people are presenting with almost mast cell activation syndrome, which is the hype and autoimmunity. We’re seeing also that people who had fatigue and had autoimmunity are more likely to get long COVID.
I think that there definitely is something there, and I think a lot of it probably has to do not just with age, but also that relationship with the virus and whether it’s the innate or the adaptive immune system, how it’s able to hide. Perhaps with the vaccinations, which are focused more on the adaptive immune system, we’re going to have some more knowledge around that.
Ari: Yes, actually that’s interesting to me. I’m glad you brought up the vaccines, but one of the things that has jumped out to me is it seems to me to make a lot more sense intuitively to create an oral or a nasal vaccine rather than an injectable vaccine. Those technologies do exist. There have been some vaccines already that are created that are nasal spray vaccines or things that you hold in the mucus membranes in your mouth.
That intuitively makes way more sense to me because you’re mimicking the natural way that your immune system would actually interact with the pathogen, with the actual virus where the virus isn’t just injected into your bloodstream. It actually interacts with the mucus membranes and with the immune system at the mucus membranes and with the innate immune system before you ever get the antibody response that’s kicking in. I’m just wondering if you have any thoughts on that subject.
Dr. Hirsch: Yes, I think the question is, and I don’t have an answer to this, how fast does the virus get into the bloodstream or how fast does it trigger the innate, and then the adaptive? If you see symptoms go away in a week, then it’s pretty darn quick, and so then the question is if you’re using an intra-nasal vaccine of sorts, is that going to be as well absorbed as an injection? If it’s already bypassed that mucosal immunity like you’re talking about, then do you need to go for something more global that’s going to be better absorbed by giving an intramuscular injection, and I don’t know the answer.
How to know if you have Long COVID
Ari: Got it. How does someone know if they have long COVID or post-COVID syndrome?
Dr. Hirsch: It’s really this persistence whether it was by symptoms, where they were having a number of these weird symptoms during the last year, or whether it was by an actual laboratory diagnosis plus symptoms. I think in order to support any laboratory diagnosis, PCR, or serology, or whatever, you have to combine it with the symptoms, but anything that started that way and that has persisted over time and that the symptoms have rotated or changed over time. You can have long COVID and it can resolve on its own, of course, but at this point a lot of the people who still have it, there’s no end in sight, and so the question is, how long is this going to persist?
Is this a 12 month, 18 months, a couple of year process that’s going to just resolve on its own, or is it going to persist, and then resolve on its own without treatment, or are we going to need some treatment in order to resolve it? I would say having those persistent weird symptoms, for lack of a better technical term, that’s lasting longer than four weeks, and in your case, it was you had them past four weeks but they didn’t persist for longer than that. Maybe the criteria is going to be eight weeks or maybe it’s going to be 90 days. It’s hard to know.
Ari: I certainly don’t want to offend anybody by even voicing this because I’m sure that there is a portion of the population that genuinely has a very severe set of symptoms that last a very long time, and that are genuinely very abnormal, but I also worry about how much we’re creating a nocebo effect because of the 24/7 fear-mongering on the media, and then fear-mongering since the beginning around post-COVID syndrome. How much concern and hyper-awareness is there around experiencing any degree of symptoms more than three weeks after getting the infection and then pathologizing it as this condition, whereas if you didn’t have any of these circumstances, there was no media attention on a pandemic?
For example, was the case for me in January of 2020, before there was much media attention on this whole thing. Would you just say, “Hey, I got an infection and it lasted a bit longer than normal, but that’s it?” Whereas now it’s like, “I’m a long hauler. I have long COVID syndrome.” How much of the psychological identification with this disease, this condition, is that a problem in any way? Do you think that there’s any legitimacy to this line of thinking, or if you think I’m just crazy and that we shouldn’t even be thinking such thoughts, then you can say that too?
Dr. Hirsch: [laughs] Well, I respect you too much to say that. It’s an interesting idea, but most people don’t want to be sick. There’s obviously some psychology around that, where there can be some pathologic relationships, or there can be a need that’s being fed in some particular way. The studies that I have seen around this, whether it’s with chronic fatigue or other issues, people just don’t want to go to the doctor. This is oftentimes a concern in socialized countries where they’re like– and the US says this all the time, if we get socialized medicine, then people are going to be going to the doctor all the time, and that’s actually not the case.
Humans don’t want to have to go to the doctor. They don’t want to be sick. They want to pay attention to their lives. I don’t think that it’s really an issue. I think that maybe what may be more helpful– and most of these studies are being done at four months, they’re being done at six months, they’re being done at eight months. Maybe I am wrong to say it’s longer than four weeks because you’ve thrown up a lot of stuff that’s like, yes, four weeks seems like it’s way too soon now.
Maybe it needs to be three or four months because, at that point, I think there’s very little to no doubt that is abnormal. That’s probably, and thank you for helping me clarify this because there is no standard out there, but I think that saying, “Yes, 90 days out, if you’re still exhibiting these symptoms, then that’s a problem.” Now with ME/CFS or you’re looking at the Institute of Medicine, they’re talking about like six months out, you need to be having these criteria, and I think that’s way too long.
Obviously, the sooner that you address something, the better off people are going to be, and so the question is when do we do that? Is that at two months? Is that at three months? I don’t know. My recommendations are always the sooner the better if you’re not noticing the things that are going back to baseline after a period of time, and so we just have to figure out what that is. What’s reasonable for that.
How to recover from Long COVID
Ari: To that point, just extending that line of logic, how much does the treatment for post-COVID syndrome or long COVID differ from if you actually have COVID? Is there a whole different set of things that you do, let’s say, if you were treating a patient with active COVID who’s in the middle of the first 14 days of their infection versus someone who has persisting symptoms six weeks later, let’s say? What would be the differences in what you do for those two individuals if any?
Dr. Hirsch: Yes. I think first we’d have to determine what the standard of care is because people are obviously using different things, whether they’re conventional or natural or functional medicine, and then being able to determine– I’ll speak from my experience but I’m just saying big picture, and then being able to determine, okay, what’s the difference in terms of the treatment from the acute to long COVID? I would say that when we’re looking at it and part of this has to do with the reason why it persists, is because it’s never just COVID.
It’s the other things that are affected by COVID, the other things that have built up in the body that create a tipping point where COVID all of a sudden becomes the straw that broke the camel’s back. It’s the stress on the hormones, adrenals thyroid. This is one of the reasons why people’s hair has fallen out and they’re 25 years old. Sex hormones, mitochondrial function, nutrient deficiencies, lifestyle habits, all of a sudden they got to get really, really good on their lifestyle habits and they can’t overwork out. Otherwise, they’re going to be paying the price.
Then there’s oftentimes these people are also having heavy metals, chemicals, molds, and sometimes other infections that the COVID-19 seems to be unmasking. Treatment is going to be very different when you’re looking at, okay, this is acute COVID, and so from a natural or functional medicine perspective, you’re talking about things that you want to boost the immune system, potentially kill the virus with herbs and whatnot. That’s going to be very different than removing all of the toxicities and boosting all the deficiencies and whatever in addition to optimizing the immune system and then removing the COVID-19 infection.
Ari: Got it. What is your process for helping people recover from post-COVID syndrome look like? I know you have a four-step process. Can you take us through that?
Dr. Hirsch: Yes, absolutely. The first step of the process is to assess which of these causes that they have. Now, most of these can be determined by their symptoms. It always helps if we have labs but oftentimes, we can see that there are dysfunctions for pretty much everybody in this process in adrenal gland function as well as mitochondrial function and then sometimes there’s thyroid dysfunction as well, I call those the big three. Oftentimes, we’re going to be optimizing those initially in step 1. We’re going to be assessing those initially and determining whether or not there’s any other ones, but most important are those.
Then step 2, that’s where we’re starting to replace these. Then step 3, we’re getting ready for removing the other toxicities that are present, that set the stage for this as well as removing the COVID-19. The reason why this is important is because anytime you’re removing an infection or other toxicity from the body, it’s just very stressful on the body. We’re seeing people who are getting certain treatments for COVID-19 and yes, oftentimes, it’s getting rid of it depending on what the treatment is but they’re taking a longer time to recover.
Is that from the actual COVID-19 or is that from the consequences of the treatment? We don’t know, because we know that a lot of those treatments are also damaging mitochondria and hormones. Step 2 is opening up detoxification pathways, phase 1, phase 2, phase 3, making sure people are going to the bathroom, lymph, kidney, liver, all that sort of stuff, so that we can go into step four, and then we can have some targeted figuring out exactly which causes or which toxicity somebody has, in addition to the COVID-19 removing those.
Ari: I think you might have skipped step 3, or I missed it there. Take me through one to two real quick.
Dr. Hirsch: Sorry. One was, assess the causes, two is, replace the deficiencies, that’s thyroid, mitochondrial hormones, three is opening up the detoxification pathways, and then four is removing the COVID and other exacerbating factors.
Ari: Got it. What does step 4 look like? What kind of things are you doing?
Dr. Hirsch: What’s really interesting about treatment right now, is that you want to make sure that you’re not necessarily doing immune-boosting supplements. This is one of those things where do you want to boost an immune system that’s already hyperactive. Some of the treatments that we’re seeing to be successful are actually ones that are typically targeted for mast cell activation syndrome. Where mast cells which release histamine and other aspects of the immune system are hyperactive, so they’re reacting to a lot of different things and causing a lot of different inflammation.
If you’re going to boost the immune system, you can potentially be making things worse. What you’re looking for is more immune-modulating things, things that are going to activate T regulatory helper cell, which balances out the Th1 and the Th2, those two markers that we talked about for autoimmunity. We’re looking at things like glutathione, we’re looking at things like vitamin D, things like zinc. I’m not a fan of using medicinal mushrooms for this very reason. Melatonin has been shown to be helpful.
Ari: Are we talking about a specific population of people with autoimmunity or are you saying that everybody with post-COVID syndrome has an overactive immune system?
Dr. Hirsch: I would say so, just like I would say everybody with chronic fatigue, ME, or autoimmunity, they all have an overactive immune system. It’s the spectrum of whether or not you have an allergy or whether or not you have cancer. Autoimmunity and chronic fatigue syndrome and all of these things are indicating that the immune system is just reacting to something. If we step back from symptoms– so anybody who has a symptom means that they’re having pain and/or dysfunction from inflammation. Inflammation is immune system reacting to something.
Inflammation is normal if you break a leg, you scratch yourself or whatever, sends a bunch of healing cells to the area, and then it resolves, but if you’re getting a chronic inflammatory response, that’s what we’re looking at where the immune system is overreactive. There’s a lot of people who will come into my program, they’ll say, “I can only eat five foods,” because they’re hyper-reactive to a lot of these different foods. Then we remove, whether it’s heavy metals, chemicals, molds, or infections, or a combination they’re in, and all of a sudden, they can eat whatever they want. Hopefully, they don’t eat gluten or dairy or whatever but the immune system is a lot less reactive.
Ari: Question. Is it that the fundamental problem in that situation is that just that person has an excessively overactive immune system or is it better framed as that person has heavy metal toxicity, or mold exposure toxicity or leaky gut and lipopolysaccharides toxins leaking into their bloodstream that way, and therefore, the immune system is responding appropriately to what is an excessive amount of sources of environmental toxins and stress?
Dr. Hirsch: Yes. The immune system is reacting appropriately, the problem is it can’t get rid of that thing that it’s trying to get rid of. Normally, the reason why you resolve a cold in 7 to 10 days is because the immune system takes care of it, wraps it up, gets it out of the body, and then everything’s quiet. Then it’s got that memory and those antibodies that we talked about before. It’s when the immune system is trying to get rid of something and can’t because it’s hidden somewhere or maybe it’s molecular mimicry or whatever. It’s hard to know exactly why.
My feeling is that there’s something that’s in a particular cell, and in order to get it out of that cell, the immune system has to destroy the cell. That’s where the autoimmunity/inflammation is happening.
[crosstalk]
Sorry, real quick, just to answer your question that you said before. Yes, I would say long COVID, pretty much everybody is going to have some sort of autoimmunity or hyperreactivity.
Ari: Do you have any final thoughts? I know you have to run in a few minutes here. Do you have any final thoughts or tips that you want to share with people on either preventing themselves if they haven’t had COVID yet, how to avoid having long COVID? Or what they should do if they have?
Dr. Hirsch: I think there’s a lot of behavioral modifications that people can do. We talked about not stressing the body, making sure you’re getting enough sleep, you’re drinking enough water, you’re actually resting if and when you get this infection. You’re not trying to work through it or whatever it is. That’s the first thing. If you do end up getting long COVID or if it’s not resolving, don’t wait.
If you’re a month, two months, three months out, whatever it is that we’re going to decide is actually that cutoff, you want to make sure that you’re going to be working on it so that you don’t end up like some of these people 8, 9, 10 months out. In one of these studies, it’s 93% of people have not resumed normal work so some of them have gone back to work in a part-time format, or whatever. That was a number of people who were already they were long haulers and they identified as long haulers. We want to make sure that you’re getting help.
We’re launching a long-haulers group program right now and so if people have interest, I can give you that link and we can drop it below this video. We haven’t launched it yet but if you’re interested, you can always fill out that form. You just have to make sure that you’re looking for solutions, because unfortunately, I think that this is probably a multi-year thing or some people that we see, obviously, with ME/CFS, if you do nothing, you end up having it for the rest of your life. You have to do something.
It’s whatever you believe in whether you’re going to go conventional, natural, functional medicine, but you need to look for obviously, what’s the best research, what’s the best success that’s been done in lots of people with testimonials. If you don’t have the research on it, but you want to get in early– a lot of this with supplements right now is trial and error, we don’t have steadfast protocols, we don’t have a lot of the research that we need, but you do have to try something that makes sense, that’s your best-educated guess in order to get your life back on track.
Ari: Excellent. For everybody listening, we’ll have a link to Evan’s new program at the page for this podcast, which will be at the energyblueprint.com/longcovid. Evan, thank you so much. This has been a pleasure. Do you want to just have any final words on what’s going to be in that program to help people? Is it going to take people through the specific four steps of how to identify their unique factors that are contributing to those symptoms, and how to fix it?
Dr. Hirsch: Exactly. I’ve got a limited number of people that I practice this on, several dozen, but with them one-on-one, and I’m just translating it into the group program. It’s like, what are we seeing in that four-step process, the deficiencies and the toxicities that we have? How do we help people find their individual deficiencies and toxicities and take them through that process with the guidance that they need? I am there with them for daily questions or every other week group questions, whatever it is in order to support them so that they can achieve their success. Hopefully, we can get more knowledge around this, and we can actually create some protocols that we know are working on a larger population.
Ari: Awesome. Thank you so much, my friend. This has been a pleasure connecting with you, as always. Thank you for the work that you’re doing, helping people with long COVID.
Dr. Hirsch: Thanks, Ari. It’s always a great time with you.
Ari: Yes, likewise. Talk to you soon.
Show Notes
What is Long Covid? (3:58)
How Stress Affects Your Immune System (15:45)
How to know if you have Long COVID (25:55)
How to recover from Long COVID (31:05)
Links
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