191 - The Viral Aftermath: A Web of Healing with Dr. Galland

This episode welcomes Dr. Leo Galland, Internal Medicine Specialist with over 40 years of experience working with complex conditions, which now includes Long Covid and of course ME/CFS. 

In this episode:

• Comprehensive exploration of Long Covid's complex nature
• Introduction to the "Web of Long Covid" concept
• Insights into post-viral illness from a 40-year medical perspective
• Long covid follows patterns of previous post-viral illnesses & similarities with chronic fatigue syndrome and post-infectious disorders
• Some unique characteristics of SARS-CoV-2 virus impact
• The Web of Long Covid - 10 interconnected strands explaining illness mechanisms
• Central components: ACE2 enzyme damage and mitochondrial dysfunction
• Treatment Approach, importance of individualized, multi-step treatment protocols and the importance of understanding individual health history

Links:

• Dr. Galland's "Long COVID Prevention and Treatment" document, available on website: dr.galland.com 

For more information about Long Covid Breathing courses & workshops, please check out LongCovidBreathing.com

(music credit - Brock Hewitt, Rule of Life)

Transcript

Jackie Baxter  
Hello and welcome to this episode of the long covid Podcast. I am so excited to be joined today by Dr Leo Galland, who is here to talk about all sorts of things around long covid, the two tier model, the web of long covid, and I'm sure, loads of other stuff that we're going to get into. So a very warm welcome to the podcast today. I'm so excited to see where we end up today. Great.

Dr Leo Galland  
I'm really glad to be going over this with you.

Jackie Baxter  
Jackie, so before we get into more complicated things, would you just say a little bit about yourself and what it is that you do?

Dr Leo Galland  
Well, I have training in internal medicine, and what I've been doing for, oh, I don't know, over 40 years now, is working with patients who have complex chronic illness, basically people who are not getting the answers that they need to get better and and trying to help them navigate the difficulties of that. And I it, it kind of feels like what I'm doing is looking at areas that other doctors they've seen haven't paid attention to to try and find solutions for their problems, and along the way, I've done a lot of work with nutrition. I've looked at the impact of the gut microbiome and concepts like intestinal permeability and how those impact systemic health. And I've done a lot of work with patients who have post infectious disorders, or so called post infectious disorders, that is, they've been sick with some kind of infection, but they don't really recover. And how do you how do you help somebody get back to their pre illness, state of health or better? I mean, sometimes, sometimes, when people start paying attention to their health, they actually wind up being healthier than before they got sick.

Jackie Baxter  
Yeah, and I can definitely say that's what happened to me, that I am healthier now than I was. So I love that. That's something that you have seen in your work as well. And you know, you said that, what was the term you used? You know, the sort of post infectious illnesses and the sort of chronic conditions, all of these sorts of umbrellas that get sort of tossed around, and all of these things existed long before covid came along, of course. But certainly my attention was drawn to it with with long covid, because that was when I became unwell. And I think that was the case for many, many people. And suddenly we became aware that, oh, this has happened before with other stuff. You know that a lot of us didn't really have that much awareness around it, but it sounds like you've been working in this area for a long time. Before long, covid came along.

Speaker 1  
Yeah, oh yes, yeah. I mean, I've been doing this kind of work for over 40 years, when five years ago, a little over five years now, about five and a half years ago, when I realized that something big was happening, I set about to start studying on this virus, the SARS cov two virus, and looking at its precursors, SARS and MERS, to try and understand what happens in these disorders. And it had become pretty clear by April of 2020 that there were people who are not recovering, these were mostly hospitalized patients. Within a year of the onset, it was clear that there were people who had fairly mild illness and not only didn't recover, but sometimes got worse. That is the sequela was worse than the actual illness for certain people, these were many of them were relatively young and had been in pretty good shape before they got covid and and so one of the things that emerged, and it emerged very early on, actually, was a recognition that there's something very different about this virus. In fact, I remember, I mean, one of the first things that became obvious is that this looks like a respiratory infection, but it's far more than that. This virus attacks blood vessels. Yes, and I remember in March of 2020 talking to a hospital hospitalist who was in Seattle, Washington, which had become the US Epicenter before New York. And he said, The crazy thing is, the people that are dying in the hospital are dying from cardiovascular complications, not pneumonia.

Unknown Speaker  
And so as time went on, it became clear that

Speaker 1  
damage to blood vessels and the resulting blood clotting that occurs is an important part of the pathology of covid 19. It doesn't go away just because someone gets over covid. It can linger for weeks or months, and it plays a role in creating long covid, or what's sometimes called the post covid condition, and above and beyond the long covid syndrome itself, there are a whole lot of illnesses. There are a whole lot of illnesses that have been identified to occur in greater frequency after covid, diabetes, high blood pressure, elevated blood lipids, cholesterol, heart attacks, strokes, seizures, conditions like that. They're not generally called Long covid Because they're their own discrete illnesses. But it is very clear that covid 19 increases the incidence of those occurrences during the year after infection, and a lot of that has to do with the damage to blood vessels that this virus creates. The other things that became clear were that the virus produces damage to cells, to the metabolism of cells, especially damaging mitochondria, which are the tiny powerhouses that generate about 90% of our body's energy, and that it also impacted the brain in a variety of ways that could not have been anticipated, that it has a range of effects on the immune system, and that it also impacts very early on, The microbes living in the gut, the gut microbiome. Now, there, before there was ever long covid, there were conditions like CFS me, you know, chronic fatigue syndrome, myalgic encephalomyelitis, that name was first applied in the UK back around 1950 but there's been an awareness of post viral illness going back as long as we've known about viruses, to the 1890s I mean, this is just historical, you know, tidbits, but The original post viral illness was called the Russian flu, and it became notorious because it impacted the British ruling classes. There was a flu in the winter of, I think it was 1890 that started in St Petersburg, spread across Europe and really decimated people. But a lot of the royalty and the upper echelons of government in the UK were impacted by it. And during the decade that followed, there was a recurrent illness that occurred in these people who had had the flu, where they might seem to be functioning pretty well, and then they would just totally crash and be incapacitated. Similar types of illness occurred after the pandemic of 1918 and again, lasted for about 10 years after the end of the pandemic, and then in the 1950s it became, there were, there was attention plate paid to various episodes of a stereotypical illness with fatigue, flu, like feelings, malaise, low grade fever might be part of it. Brain fog was an important part of it, pain. And this was given different names. The initial name was Royal Free disease because it was first described at Royal Free Hospital in England, and then there was a. There was an outbreak in Iceland it was called Icelandic disease, and it soon became pretty clear that these were all probably part of the same phenomenon, but the exact cause wasn't clear. So there's an aspect of long covid That fits into that the differences in my experience is that it's much more frequent after covid than after other kinds of viral infections. Um, especially among people who are young and healthy, or thought they were young enough. They knew they were young. They thought they were healthy and fit before they got sick, and it comes on much faster. That is, we're seeing it evolve in real time. Now, in the past, someone would be ill for a long period of time, and they see a doctor, and then you'd have to retrospectively look back and say, Oh yeah, maybe this is a result of this condition that you had. Now, in my experience with this, I found that there were a lot of people who actually were still infected. This was not especially dealing with Lyme disease or other tick borne infections, bacterial or parasitic or intestinal parasites that they're actually this was not really a post infectious state. There was an ongoing infection that needed to be treated. Treating the infection was essential, but it was not, often not adequate, because there had been so much damage done, and sometimes the drugs that you had to use to treat the problem created their own problems. So it's always been a multi step, complex process that would vary from person to person. Sometimes it would be relatively easy to treat, and sometimes there's just layer after layer. And I describe this process in a book that I wrote in 1996 so that's when it was published, which is called Power healing, and it's a process of recognizing that each individual has a unique illness and that to try and help them get through it or recover from it, you need to Look at factors that I call mediators, antecedents and triggers. What are, what are the triggers in this person that create illness? It could be food, it could be an infection. It could be something in the environment, mold, for example, which is a big problem in Scotland. And it could be a medication that they're taking or some toxins that they're exposed to. And so you need to really try and sort all those out. Mediators are, are things, some of them are chemicals, and some of them are social that that create illness, um, where there's been a lot of attention focused on free radicals in the body and inflammatory proteins, and those are mediators, but, um, the feedback, that you get from the people around you when you're ill that can also be a mediator. So mediators range from actually subatomic to societal and understanding all of them is really important if you're going to help trying to help someone with a complex chronic illness get totally well. Antecedents are those factors in their life prior to the illness that set up the situation in which this person now does not get better in the way that they we would expect them to, um, and so when I talk to patients, I generally go through their whole life history. Because what I think it's really important to understand is this is not just about a disease. This is we have to who we I want. I want to start understanding who is the person that this happened to, and so that I can then apply that in that knowledge to trying to come up with treatment protocols at work. And this is not about in any way, psychologizing a known. Us. But, I mean, we're all psychological beings. We exist. We have this, you know, we think we feel, we have social interactions. So the whole universe of a person needs to be taken into account.

Speaker 1  
Getting back to covid and long covid, so about three years ago, when I looked at all of the different factors that had been described in people who had long covid or had not really recovered, or whose lives had been altered by covid, I put together a graphic that I called the web of long covid. And I did it basically as a teaching tool, but also because it helped me to understand what I was looking at and when each new piece of research would come out. I would try to place that piece in the web of long covid, which helped me understand it better. Because, I mean, there have been 1000s and 1000s of studies done on the impact of covid on the body and how it changes the body for months or longer, and you can really get lost in the data. This is a way for me to under, to organize it and understand it, and it's posted on my website, dr, gallon.com, we can talk about it, but, I mean, there are 10 components. There could be more. But basically, when I set out to create a visual of the web, I looked on Google for where's a good web? And, oh, there was a web with eight strands. That's good, but I need a couple at the center, you know. So I just had my son edit that. Um, there would be, I could probably come up with 20 strands. But I think, I think the the 10 strands of this web pretty much describe, they describe most of what's going on, almost all of it. And it stood the test of time because it everything that I described still applies. At the center of that web there's damage to an essential critical enzyme called ACE two, which is the entryway by which this virus gets into most cells. And the treatment protocol that I put together in March of 2020. Was based on recognizing that a lot of the illness in acute covid comes from damage to ace two when the virus enters the cells. So it was basically, how do we restore ace two activity, which with natural products vitamin D curcumin, which is found in the spice turmeric, resveratrol, well known as an anti aging supplement, found in red wine and a few other supplements like that that help the body restore ace two after it's been damaged. And my personal experience is that of the patients that I've treated from the beginning of their covid because they were my patients over the past five years, almost none went on to develop long covid really well. I mean, hardly anybody, and you know, and I would track and follow them. So I do think that ace two restoration was important, the second central part of the web is mitochondrial damage. We know that this virus damages mitochondria. Now any kind of inflammation may do that, but this virus does it beyond the effects of inflammation and infection. It directly damages it and it impairs the ability of mitochondria to regenerate themselves. Mitochondria use a lot of oxygen. They're a very high risk particle, tiny organelles, and in order to work well, they have to be broken down and rebuilt constantly. And it was shown very early on that the what this virus does, and it's due to the viral proteins themselves directly in. Is to impair that process called mitophagy and biogenesis that's impaired, in addition to the other types of damage that are done, the levels and mitochondrial damage has a huge impact on the post covid state, especially when there's fatigue involved, sometimes shortness of breath. The other strands of the width that go out from that include the damage to blood vessels and the microscopic blood clots and then and also the disturbances in the gut microbiome, which are direct result of what this virus does in the GI tract. They're not studies done with chronic fatigue syndrome and with CFS me have shown that people who have been sick with CFS me develop a dysbiosis in the gut, with a leaky gut. This happens right away with covid. It doesn't take a year of sickness or, you know, two years. Or it happens immediately in people who get covid. And so the the issue there is to restore the microbiome as quickly as possible. Part of that involves restoring ace two, because ace two in the gut is important for immune responses there that rate and these immune responses regulate the microbiome. But part of it is, part of it is that you just have to restore a healthy gut bacterial population, because the virus, and this has been demonstrated following people, the virus devastates one of the most important bacterial species that's kind of a keystone species, and supports a lot of other species. And that's most people have never heard of this. It's it has a hard to pronounce name fecal of bacterium, prazits. You can't buy supplements of this, but it supports the growth and activity of bifidobacteria that then secondarily get depleted. So restoring the gut microbiome is a second after ace two and probably, and the probably the second most important thing, and there, there actually are probiotics that have been shown to help with covid 19, so there's one that have my that we get through a pharmacy, I think in London, it's, but it's made in Spain on called AB 21 that, in a controlled trial, was shown to help people with acute covid recover faster and better. It's, it's based on a type of organism called Lactobacillus plantarum. Now, lactobacillus plantarum, as its name implies, it's it's like an acidophilus. It's a lactobacillus, and it grows on plants. It's found in sauerkraut and kimchi. There's specific strains that are used, but fermented foods can be helpful in that area. And then there's the issue of viral persistence. There's so many studies that have indicated that after covid 19, this virus does not leave your body. The unresolved question is, are we just dealing with viral debris that is still in the cells of the body, or is there live replicating virus? And there's research that needs to be done in that area, because the approach would be somewhat different. If there's live, replicating virus, you may need to be able to kill it, and so all of those strands then leave us with the remaining strands of the web, which involve disturbances in immune function.

Speaker 1  
And there are many different types of immune cells that are impacted by the strands that I've just described, um. There are T lymphocytes and B lymphocytes and monocytes and macrophages and um and mast cells. Disease, and for many people who are really stuck and really sick with long covid, mast cells are the 800 pound gorilla in the room you have to and they're mechanisms by which mast cell activation occurs after covid that you can trace to what the virus is doing in the body, directly or indirectly.

Unknown Speaker  
And I would say that of the people who are most

Speaker 1  
have their lives up ended, the most mast cell activation is one of the factors that really needs to be dealt with, and there's a certain association between mass cell activation and two other things that are pretty common in long covid One is autonomic nervous system dysfunction, especially this condition called pots, which stands for Postural Orthostatic Tachycardia Syndrome, that is associated with mass cell activation. And for some and there's some studies indicating that the mass cells may actually be producing it for some people, because when you block mast cells, you can diminish the symptoms. Not for everybody, though, pots itself, there are three different types of pots, it's and there are other types of autonomic dysfunction that are mistaken for pots that may occur but, but but that's a major complicating factor. And and also related to mast cell activation, is damage to connective tissue. And so there's this other association of mast cell activation that's getting some attention, which is the association with joint hypermobility. And what has been striking to me, even before the pandemic, when I was dealing with people who had post Lyme syndromes, was the large number of large percentage of them that had hypermobility syndromes, and that's become even clearer now. I hadn't seen that with CFS me before, maybe because I wasn't looking for it, but nobody was reporting that there were reports of autonomic dysfunction with CFS me, but it was a different type than pots. It was something called neurally mediated hypotension, and researchers at Johns Hopkins in the US at first described it where there'd be a drop in blood pressure on standing with an in with a lack of an appropriate heart rate response. So this was different from pots. I started seeing a lot of pots and a lot of hypermobility in patients who had not recovered well from Lyme disease. So there was clearly something about those conditions that was predisposed, maybe predisposing to the influence the post Lyme influ inflammation, but it's it's coming out even more so in the long covid population. That may also be that we have a much larger population now, because there are probably 400 million people around the world with with long covid or post covid syndrome, and so, you know, so we're those of us who see the patients who are not getting better, are going To see way more of this combination of factors. So I've tried, what I have done over the years is to try and put together protocols for dealing with each strand of the web. And you know, sometimes they work great, and sometimes they don't, and which I think is the unfortunate experience in dealing with this, with this disorder, what is absolutely emerged as the most troubling and debilitating component is something called PEM, post exertional malaise. I think PEM is a totally inappropriate name. This is not post exertional malaise. This is post exertional agony. So post exertional symptom exacerbation or peace is probably a more reasonable. Total term for it, and it can and, I mean, this is one of the hallmarks of CFS me, it is so much worse in long covid than I ever saw in CFS. Me, um, I mean, it's at a level of intensity that is much greater than I'd seen. And also, there are people in whom too much cognitive activity will produce physical fatigue. Now the crash may be physical after just mental activity. I didn't really seen that before with CFS me, but I see it a lot in the post covid patients or the physical activity. It crosses over. In other words, you do too much in one area and it crosses over. It affects the other major area of functioning, if we separate physical from mental functioning. And again, that's very variable. I've there's I have some patients who can handle cognitive activity if they're lying down, and others who can only handle a social interaction for like 30 minutes, and then they need to take a break. It is possible to recover. I have had patients who, when I first spoke to them, I had to actually speak to their partner. They weren't able to directly communicate. They'd be lying down in bed, and some of them now are, would I say they're 100% Well, no, but they're getting about their lives. They are no longer. They move from being bedridden to being house ridden to being able to interact outside, to start work, to go back to school, there's always it's a long, multi step process. It is possible to recover substantially no matter how bad the situation is, but I think you have to deal with every part of the web and maybe even some factors that are outside the web.

Jackie Baxter  
Yeah, I mean, that does seem to be the pattern that I've seen myself and that I've seen in others that are recovered. It's it doesn't always look the same for everybody, because, as you said, everyone's life beforehand was different. They came in different. Their presentation of the illness looked different, and their presentation of long covid itself looked different. But, you know, everyone finds their own way through it. And you know, there's a lot of commonalities, I'm sure, between a lot of people's journeys, but they're all going to be subtly different. And you know that that's what makes it so difficult, isn't it, as a patient, and I'm sure as a practitioner as well, is that every patient is different, but that's also why it's so important to be able to look at each individual patient as an individual patient, rather than, you know, one of many, and, oh, you just do this, and then this, and then this, and then you'll be fine. It's, you know, it's just not that simple, is it, you know? And having all of those strands of the web, right?

Speaker 1  
And that's what's very disturbing about what's on the internet is your people claiming, oh, yeah, just do this. This is what you need to do. And, and, well, look, people have been before there was an internet people were bringing me. Patients would bring me ideas, what about this and what about that? And, okay, well, let's try it. Let's see if the first question is, is this rational? Does it make sense? What do your gut instincts tell you about how this might apply to you? Are you in? Do you want to pursue this? If you do, and I think it's rational and reasonable, I'll go out on that limb with you. I'll go down that path and try to guide you so that you know, what are the potential problems you might get into, you know, aside from that, now you're going to put your energy into this instead of something else. The there's just a lot of that out there now, you know, and some of it is valid for will work for some people. I mean, my general rule is, if something's a one off, I'm not that interested in it, if I first want to know that it helps a patient that I know, so that I feel that I really have the full picture. Because a lot. Reports that are out there, you know, circulating. You don't really know the whole picture. You get a little snippet, and that's not enough. And then the second question is, does it work for more than one person? You know, how many people and how and once you've done it, how long do the benefits last? And what, what? What are the areas that benefit? And I mean, there just simply is no one treatment that works for everybody. It's, I wish there were would make life a lot easier. You know, who were just a question of, well, there's really a chronic viral infection, and all you have to do is treat it, you know, find the right antiviral drug and treat it. Yeah, that would be that would make life much simpler. There's just no evidence that that's the case. Yeah.

Jackie Baxter  
So it comes back to this jigsaw puzzle, or the web, as you've described it. You know, the the different bits for different people, and addressing different strands of your web is going to have more impact on some people, and other strands are going to have more an impact on others. And I suppose that's why you have, you know, a number of different things, isn't it? Because you can work out, okay, where are we going to start? Where are you going to get the biggest bang for your buck? What else is going on? What actually is going to work for this individual person? Because it might be that, you know, certainly my experience, some of the things that helped me later on in my recovery wouldn't have worked at the start, because I wouldn't have been able to tolerate them, but they worked absolute wonders. Were further down the line. So, you know, I think certainly for a lot of people that I've spoken to, it's finding the starting point and then allowing yourself to kind of build from there. And that is going to be very different for different people. I think I want to go back to where you were talking about the ACE two, because, you know, you said in the center of your web, you have the ACE two, and you have the mitochondria. And I think a lot of people have heard about mitochondria. You know mitochondria, they're the powerhouse of your cell. Going back to my GCSE biology, you know, and we know a little bit about them, I think most people understand certainly in some part, the role of the mitochondria, but the aids to being right in the middle, they're obviously incredibly important. So what are they and and, how do we go about restoring the ACE two?

Speaker 1  
Okay, right. So let me, and I want to say more about mitochondria, also, they are incredibly complex. So ace two is an enzyme that is present in many different cells, and it mostly is involved in restoring balance after there's been injury or inflammation. It's this kind of corrective response that is the body has a response to injury and infection and attack, but that correct that response has to be brought under control, because otherwise you're going to wind up doing more damage to yourself than the infection alone might have done. So ace two is a part of that corrected response, and it's important in the brain. It's very important in blood vessels and on cells of the immune system and in the kidneys and the heart a lot of the complications of acute covid 19 can be traced to damage to ace two done by the infection and the earliest days of the pandemic, there was this notion that, well, Ace two is bad because it's letting the virus into cells, And so we have to try and block ace two. And that was, in fact, my thought when I first was reading about it was, hmm, okay, well, what are the things that would block ace two? But then I looked at the experience in SARS, which also uses ace two to get into cells, and it became very clear that ace two is the victim, not the cause, and what you really need to do is to strengthen it, to help recovery. So there are dietary effects, but I would say the easiest thing to do, vitamin D definitely increases. Ace too. I'd mentioned curcumin and resveratrol. There are just a number of herbs and spices that will do this as well. In in general, let's just say, eating a diet that is rich in fruits and vegetables and doing the stuff that everybody knows you should do that helps ace too. Exercise tends to help ace too, but exercise very that's a very dangerous thing in the setting of covid 19. It really is a two edged sword. Yes, you want to avoid deconditioning, and you want to maintain strength and stamina, but I have seen so many people who totally crashed after a judicious amount of exercise. I mean, sometimes they overdid it, but generally it's they weren't overdoing it, they or they didn't think they were overdoing it, but it really brought them down and and it could take weeks or months or longer for recovery. So I have a theory about that phenomenon that I developed, which relates to mitochondria, actually. So okay, so we'll move over to mitochondria. Mitochondria do a lot of different things, part of which is to generate energy. And they generate energy by through two different complexes, enzyme complexes. One is a set of enzymes called the Krebs cycle, which probably most people heard about at some point in school, and the other is something called the electron transport chain. This is where the ATP is generated. And the electron transport chain, frankly, is not easy to understand. I mean, I just spend a lot of time trying to figure it out. I don't, I mean, you know, my medical education did not really end the biochemistry that you have to take in college to go to medical school, not, you know, none of that really allows you to understand the electron transport chain, because it involves physics. But in this whole process of what goes on between the Krebs cycle creates certain products that are needed by the electron transport chain, okay, to generate ATP and but there are fuels that have to drive the Krebs cycle, and those fuels come mostly in the form of sugars, or the breakdown products of sugars, like pyruvic, acid, pyruvate, you know that they come from sugar or fats and the and The simplest of fats, the breakdown products of fats. Now, I mean, we could say a lot about that, the idea that, Oh, we're just going to go and we're just going to use a mitochondrial support product, well, maybe that's going to work. Maybe it isn't. Maybe it's going to make it worse. There was a team at the University of Pennsylvania that developed a mitochondrial support product that worked in mice when they first had covid 19, they injected the mice with this, and the mice that got it had a better outcome than the mice that didn't, which is impressive. I got a pharmacy in New York to put that together, but that's for acute covid, when you're dealing with long covid, maybe that's going to work. Maybe it isn't. When there's post exertional malaise, that's where the real issue comes up. There's a lot of evidence that what underlies post exertional malaise is first, the circulatory impairment that is part of long covid. So there is not enough blood getting to certain tissues because of the damage to blood vessels, the capillaries, in particular, that have been done by covid. You can't see this. You don't directly. It's very hard to measure it directly, but there's all this, these microscopic clots and clots and these damaged capillaries. So then you stimulate the tissue. Either you try to exercise and your muscle needs more blood, or you're using your brain and your brain needs more blood. It's not getting everything that it needs. So it creates a state in which you're working without quite enough oxygen and perfusion of blood to the tissues that need it. This creates a condition that I call relative hypoxia. Or relative ischemia. Hypoxia is lack of oxygen. Ischemia is lack of circular blood. When that happens, the mitochondria that have to work hard, start doing screwy really screwy things. Some of the enzymes go backwards instead of the Krebs cycle going in the direction it's supposed to go, it starts running backwards. This generates further damage to the mitochondria. So it's not so what we need is a treatment protocol that can help prevent the damage caused by the fact that the that the mitochondria run backwards, not just mitochondrial support. We also need to a treatment protocol that's going to improve the oxygen delivery to tissues. So you have to address the blood vessel damage and the microscopic blood clots, that's essential. Then if the person has post exertional crashes, then you really need you can't just do a general mitochondrial support, which frankly might even make things worse, because it may stimulate mitochondria in the wrong way. You need a very carefully scripted approach to improving mitochondrial function. I describe what I've worked out. It's a work in progress in this document on my website called Long covid prevention and treatment, and it's, I'm just putting it out there for people to see. And sometimes what you need isn't even a substance. It might be red light therapy. At the right frequencies. The wrong sequence frequencies can make things worse. You need the right frequencies. And this is not so easy to arrange. It might be what's called hydrogen water, which is water that has a high hydrogen content. They're fairly easy ways to produce that. So I would say that that's been in terms of a research focus for

Speaker 1  
me, that's been what I've been focusing on, that aspect of things over the past year or so, which is, how can you put a protocol together that is not going to make the post exertional malaise worse, but can actually allow people to slowly begin to increase their activity and recondition themselves.

Jackie Baxter  
Yeah, and I'll make sure that I link that document on your website in the show notes as well. So if anybody does want to go and read through that, although I don't know cognitively if everyone will be able to do it, but it's there, you know, right?

Speaker 1  
There's supposed to be an AI component, and I'm going to try to expand that, just to make it easier. In fact, the first version of this, some of the feedback I got was, well, if you have long covid, there's no way you can understand this. I mean, it is about 90 pages, but so in the second version that went up a few months ago, I tried to address that. We tried to address that by having different tiers. So there's a simple, you know, like, this is the simple approach, and this is the more granular approach that maybe you know you need to discuss with somebody else. But on the other hand, I've had not everybody with long covid lacks cognitive, you know, lacks the ability to maintain cognitive activity. It's really the it's the stamina. You know, you're good for 15 minutes, but you just run out of gas after that. And there are researchers at Yale actually, who have attempted to address that with medication and supplements. The problem is, it's, I mean, I've looked for drugs that would be kind of like magic bullets, and they just don't seem to really work. Um, they have side effects or reasons why they can't be used occasionally. You know, maybe one patient out of 20. There's these drugs actually do make a difference, but they're just, you know, there's just been nothing that, oh, this works for everybody.

Jackie Baxter  
So it comes back to that model of piecing it together, doesn't it? Yeah, and you know what you were saying as well about with the mitochondrial supplements. Actually, the. Quite apart from not helping, it might actually make things worse. You know, I think this is a word of warning for people who are taking supplements to make sure it's directed, rather than the scatter gun approach.

Speaker 1  
This one example like Coenzyme Q 10. I When people have fatigue with acute covid. I really like Coenzyme Q 10. A lot of people respond well to it doses, you know, from anywhere from 100 milligrams to six or 600 milligrams in a day. There are two different forms of CO Q, 10, um, there's, there's the oxidized form called ubiquinone, which was the original supplement, and then there's this, so the reduced form called Ubiquinol, or CO Qh, now there's a lot of which is much more expensive. So there's this idea that, well, co q8 is a much better form the Ubiquinol. It's not really true. If you have too much CoQ, too much Ubiquinol, it actually screws up the electron transport chain. The ratio of ubiquinone to Ubiquinol is very important for the beginning of the electron transport chain. So I tend not to jump in with that unless I can identify certain problems in certain areas. And similarly, the NAD a form of vitamin b3 has gotten a lot of attention. Well, just giving people NAD is not necessarily the solution to the energy problem, and it could make it worse, because if you start and there, it's a big trend in the US, people are getting injections and infusions of NAD, very expensive, but especially big in Hollywood, if you start giving people lots of NAD, the rate at which their cells break down NAD increases. So you actually can create a dependency on it by using very high doses and certain, certain cells in the immune system and in the brain, they don't really even respond to external NAD. They need to be able to make their own um. And so what are really needed are the precursors of NAD. But they don't necessarily get where you want them to get. So it's not, you know. So there's a lot of hype out there about, oh, this is the treatment. Well, yeah, there may be something to it. There may even be some science to it, but you really have to apply it in a thoughtful and judicious way. And I try to help people do that with this document.

Jackie Baxter  
So yeah, it comes down to, you know, there being so many things out there and being targeted and knowledgeable and trying things, but also understanding the sort of benefit versus whatever the opposite of a benefit is.

Speaker 1  
Then you have the people who have a kind of political point they want to make, like they say, it's all about the spike protein. See, if you make covid Long covid a spicopathy, as they say, well, then you know that fits right into the anti vaccine politics, because it's all the spike protein. It isn't all the spike protein that's been very well established the other proteins from the virus, or can actually be more toxic than the spike. Maybe that's a component. You can go with that. But it is not all about the spike.

Jackie Baxter  
Yeah, and, you know, it's not all about anything, is it? You know? I mean, that's kind of where we started this conversation, and we've now come up kind of full circle all the way around. You know, there may be similar things at the root of it, but what that presentation looks like is going to be different in each person, and which means that it's not all about anything. It's piecing together that puzzle or those strands, whatever your particular visual. I'm a visual person as well. So I love the this, the strands and the web and things my my brain has a bit of a flow chart rather than a web. So that's, that's what's going on up here. But, yeah, it's piece piecing that together. Yeah. Well, thank you so much. I feel like I need to go and like, draw it out somewhere to make more sense of everything.

Unknown Speaker  
Well, send me your flow chart.

Jackie Baxter  
Yes, I will, and I'll make sure that those links that you mentioned go into the show notes. So yeah, thank you so much for giving up your time today. It's been fascinating. Yeah.