Category Archives: COVID19

Long Haulers, Brain Fog and Post Exertional Malaise

An excellent article recently published in the Atlantic was so well written that I have cut and pasted important snippets to help create this post. The review confirms many findings uncovered in my reading of several scientific publications.

You can read the full article here:

The crushing fog of long COVID

20 to 30 percent of patients report brain fog three months after their initial infection, as do 65 to 85 percent of the long-haulers who stay sick for much longer.

Of long COVID’s many possible symptoms, brain fog “is by far one of the most disabling and destructive,”

It is more profound than the clouded thinking that accompanies hangovers, stress, or fatigue.

It is not a mood disorder.

It is almost always a disorder of “executive function”—the set of mental abilities that includes:

  1. focusing attention,
  2. holding information in mind, and
  3. blocking out distractions.

Patients state they often lose focus mid-sentence.

Difficulty with simple tasks impairs activities of daily living.

“I couldn’t unload a dishwasher, because identifying an object, remembering where it should go, and putting it there was too complicated.”

The memories are there, but with impaired executive function, the brain neither chooses the important things to store nor retrieves that information efficiently.

Most people with brain fog are not so severely affected, and gradually improve with time. But even when people recover enough to work, they can struggle with minds that are less nimble than before.

“I’ve had surgeons who can’t go back to surgery, because they need their executive function,” Monica Verduzco-Gutierrez, a rehabilitation specialist at UT Health San Antonio.

That specific constellation of problems also befalls many people living with HIV, epileptics after seizures, cancer patients experiencing so-called chemo brain, and people with several complex chronic illnesses such as fibromyalgia.

It’s part of the diagnostic criteria for myalgic encephalomyelitis, also known as chronic fatigue syndrome, or ME/CFS

People with brain fog also excel at hiding it: to protect their jobs when still able to work, or to protect their reputation, or out of embarrassment.

“I know my value in many people’s eyes will be diminished by knowing that I have these cognitive challenges.”

Individuals with previously above average cognitive ability often test “normal” but suffer significant loss compared to their prior ability.

A team of British researchers analyzed data from the UK Biobank study. The findings revealed structural changes in the brain with loss of tissue on MRI scans that correlates with symptoms.

They found that even mild infections can slightly shrink the brain and reduce the thickness of its neuron-rich gray matter. At their worst, these changes were comparable to a decade of aging.

They were especially pronounced in areas such as the parahippocampal gyrus, which is important for encoding and retrieving memories, and the orbitofrontal cortex, which is important for executive function.

In most cases the virus probably harms the brain without directly infecting it.

Inflammatory chemicals can travel from the lungs to the brain, where they disrupt cells called microglia (immune cells in the brain).

In their presence, the hippocampusa region crucial for memoryproduces fewer fresh neurons, while many existing neurons lose their insulating coats (demyelination), so electric signals now course along these cells more slowly.

These are the same changes seen in cancer patients with “chemo fog”.

Neuro-inflammation is “probably the most common way” that COVID results in brain fog, but that there are likely many such routes, such as reactivation of dormant viruses such as Epstein-Barr virus, which has been linked to conditions including ME/CFS and multiple sclerosis.

By damaging blood vessels and filling them with small clots, COVID also throttles the brain’s blood supply, depriving this most energetically demanding of organs of oxygen and fuel.

These problems can be exacerbated or mitigated by factors such as sleep and rest, which explains why many people with brain fog have good days and bad days.

Although other respiratory viruses can wreak inflammatory havoc on the brain, SARS-CoV-2 does so more potently than influenza.

For adults following SARS CoV-2 infection:

risks of cognitive deficit (known as brain fog), dementia, psychotic disorders, and epilepsy or seizures were still increased at the end of the 2-year follow-up period.

For children following SARS CoV-2 infection:

in the 6 months after SARS-CoV-2 infection, children were not at an increased risk of mood (HR 1·02 [95% CI 0·94–1·10) or anxiety (1·00 [0·94–1·06]) disorders, but did have an increased risk of cognitive deficit, insomnia, intracranial haemorrhage, ischaemic stroke, nerve, nerve root, and plexus disorders, psychotic disorders, and epilepsy or seizures (HRs ranging from 1·20 [1·09–1·33] to 2·16 [1·46–3·19])….  Unlike adults, cognitive deficit in children had a finite risk horizon (75 days) and a finite time to equal incidence (491 days).

The fact that neurological and psychiatric outcomes were similar during the delta and omicron waves indicates that the burden on the health-care system might continue even with variants that are less severe in other respects.

There are no proven drug treatments for long-haulers.

But there is hope.

Cancer researchers have developed drugs that can calm inflamed microglia in mice and restore their cognitive abilities;

“Metformin can promote the regeneration of neural precursor cell populations and improve cognitive function in a preclinical model of cranial radiation and a pilot clinical study of children after cranial radiation and chemotherapy.”

Treating cancer therapy–related cognitive impairment | Nature Medicine

With regard to long-haulers, better sleep, healthy eating, and other generic lifestyle changes can make the condition more tolerable. Breathing and relaxation techniques can help people through bad flare-ups; speech therapy can help those with problems finding words.

“Some people spontaneously recover back to baseline,”

The largest group of long-haulers—those whose brain fog has improved but not vanished, can “maintain a relatively normal life, but only after making serious accommodations,”

Patients struggle to make peace with how much they’ve changed and the stigma associated with it, regardless of where they end up.

Post-exertional malaise—severe crashes in which all symptoms worsen after even minor physical or mental exertion is commonly reported.

Many long-haulers try to push themselves back to work and instead “push themselves into a crash,”

Post-exertional malaise is so common among long-haulers that “exercise as a treatment is inappropriate for people with long COVID,”

Even brain-training games—which have questionable value but are often mentioned as potential treatments for brain fog—must be very carefully rationed because mental exertion is physical exertion.

People with ME/CFS learned this lesson the hard way, and fought hard to get exercise therapy, once commonly prescribed for the condition, to be removed from official guidance in the U.S. and U.K.

In summary:

  1. Brain fog can occur even after mild or asymptomatic Covid-19.
  2. Although many patients improve over time, many are left with disability that can range from mild to incapacitating.
  3. Although these symptoms can occur following any viral infection, SARS CoV-2 seems to produce this with greater frequency compared to other viruses.
  4. Chronic brain inflammation is the likely cause in many individuals.
  5. Reactivation of Epstein Barr and/or other dormant viruses is suggested by various immune markers.
  6. The immune signature also suggests an immune response that mimics persistent infection in the absence of live SARS CoV-2 virus.
  7. Post exertional malaise following physical or mental exercise is a common and debilitating symptom without proven treatments. However there are guidelines that may help mitigate this devastating condition.
  8. Brain fog and post-exertional malaise are hallmarks of chronic fatigue syndrome/Myalgic encephalomyelitis which can occur following viral infections and major stress events such as physical and psychological trauma.
  9. Although not discussed in this post, chronically suppressed cortisol levels have been identified in this population. This in combination with physical changes noted on brain MRI demonstrate that there are physical correlates of brain fog.

In the meantime, preventive measures represent the low hanging fruit for health in general and with respect to the pandemic.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins.
  12. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors means clear benefit from a booster.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

AHS 2022 Lecture, Acute and Long Covid, Nutritional and Lifestyle Immunology

I recently gave a talk at the AHS 2022 meeting held at UCLA. You can view the video here:

This first slide gives a good overview.

The presentation covers a quick review of my presentations given last year at the PAH 2021 annual meeting (virtual) with additional information on long Covid.

Multiple nutrients acting synergistically support a balanced response to viral infections, including SARS CoV-2. Here is a picture.

The take home message is that no single nutritional intervention is likely to have significant impact with an acute infection unless all but one nutritional component is optimal. Nevertheless, there is compelling evidence that Vitamin D deficiency is rampant in the developed world and if one nutritional intervention is likely to be of benefit, Vitamin D supplementation, particularly in high risk populations, presents the most likely candidate. As usual, preventive supplementation would be preferable to rescue high dose intervention.

In a study of frail elderly hospitalized patients, regular vitamin D supplementation was associated with decreased mortality as demonstrated here. Compared to no supplementation, regular supplementation was associated with a 93% reduction in risk of death.

A study from Spain with very high dose Vitamin D in the form of Calcifediol showed significant benefit in hospitalized patients, suggesting that Vitamin D deficiency was prevalent in that population and that such a treatment intervention should be widely considered.

Calcifediol Treatment and COVID-19-Related Outcomes

The following graphic from another nutrition review article, with red additions added by myself, demonstrates the complex interaction between nutrition and the two main components of our immune system, innate immunity (immediate response) and adaptive immunity (based on immune memory). Again red highlights added by yours truely.

And here is a slide from my lecture with quotes from that article.

Yet most Americans are deficient in many of these essential nutrients as depicted here. The percentages represent the % of Americans that fall below the estimated amount required to prevent deficiency in HALF of adults (a very low standard).

The EAR is a very low bar to meet, yet many Americans fall below even that low standard.

The SARS CoV2 virus interferes with a crucial component of the the initial (innate) immune response, the production of interferon 1 and the signaling of interferon one to immune cell mediators as depicted in this graphic.

SARS CoV2 on the left is compared to Virus X on the right. On the left interferon 1 (IFN) production and signaling is blocked by the virus, interfering with an effective and controlled immune response, on the right IFN is not blocked. A cascade of events results in TOO LITTLE, TOO LATE, AND THEN TOO MUCH of an immune response, producing a cytokine storm.

Obesity, insulin and leptin resistance, also interfere with the production and signaling of interferon. The result is that people with insulin and leptin resistance (pre-diabetes, Type 2 Diabetes as well as sarcopenia) experience a double hit. First the virus itself disrupts the immune response and superimposed upon the viral effect is the effect of insulin and leptin resistance on the immune response.

SOCS: suppressor of cytokine signaling. Several recent viral studies have shown that viral genes can hijack SOCS1 to inhibit host antiviral pathways, as a strategy to evade host immunity
On the left Interferon production and signaling are normal and a successful immune response is mounted. On the right the presence of insulin and leptin resistance, associated with obesity results in an initial inadequate response and a late excessive response. TOO LITTLE, TOO LATE, THEN TOO MUCH.

Factors that can quickly impact insulin and leptin resistance include all the components of an ancestral lifestyle depicted in my website graphic. A paleolithic or ancestral diet that eliminates sugar added foods and beverages, replacing those empty calories with nutrient dense foods, exercise, adequate restorative sleep, stress reduction, avoidance of environmental toxins, social connection. All of these affect health in general, mitigate insulin and leptin resistance, and support a balanced immune response to viral infection. The circle of health depicted below is surrounded by the many deleterious aspects of modern living. Thus, a mismatch between our evolutionary biology and present day life.

Here is a slide from my lecture that lists many lifestyle factors that can impact infection with any virus, including SARS CoV-2

My lecture also included discussion of Long COVID, theories of etiology and pathophysiology which will be discussed in my next post.

For the full lecture which is about 34 minutes long, please follow the link above.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

AHS 2022 at UCLA, I am presenting a talk on COVID-19

I will be presenting at the next Ancestral Health Symposium, at UCLA, on August 18. The title of my talk will be:

Nutritional and Lifestyle Immunology related to Acute and Long Covid.

AHS includes talks, posters, movement sessions, workshops, and a welcome dinner.

It is a scientific conference but is generally lay-accessible.

AHS covers a wide range of topics, from diet to sleep, breathing, movement, and more — all examined through the lens of evolutionary mismatch

AHS examines various ways modern human life has diverged from how we evolved successfully for millennia and how those differences are affecting us, making us sick and unhappy.

AHS is fun and inspiring, and you’ll leave having made new friends and with new ideas about how to optimize your health

If you decide to join us, please come say hello. Tickets are available through the AHS Website, at ancestralhealth.org — [“Ancestral Health Dot Org”] — where you can also see the three-day schedule for the event, from August 18 to 20.

You can get a 10% discount using the the Eventbrite promo code “PresenterFriend”.

COVID UPDATE FROM Institute of Functional Medicine

I just viewed an excellent video presentation from the Institute of Functional Medicine providing very useful data on COVID, particularly focusing on the Omicron variants. You can watch it here:

COVID-19 Functional Medicine Resources – The Institute for …

https://info.ifm.org/covid-19

I will summarize the information. But first a few disclaimers.

  1. I have not vetted all of these notes but none disagree with any reports or studies I have read
  2. I have read many but not all of the studies that support these statements
  3. I viewed the video with frequent pauses and replays to facilitate accurate note taking. If you view the video and find any errors please make a comment.
  4. I had a mild case of breakthrough COVID last week and seem to have some brain-fog, feeling like the morning after working most of the night on-call in the operating room.
  5. Many general observations on varied topics related to COVID-19

Omicron Timeline:

11/11/21 Omicron first appears,

1/15/22 Omicron is 99.5% of US cases

1/26/22 B.2 variant appears in US and Europe

2/5/22 B.2 variant 3.6% of US cases

Omicron presents with about 50 mutations, 15 on the RBD (receptor binding domain) with increased affinity for the ACE 2 receptor

Omicron has a cluster of mutations at the S1S2 Furin Cleavage Site. Furin is an enzyme that cleaves the virus to allow for entry into human cells, present in large amounts in the brain, lung and GI tract (thus omicron affecting these organs perhaps more and possibly increasing the risk in people with comorbidities “associated with Furin”.)

Some Omicron mutations are associated with a degree of immune escape, evading anti-bodies and T cells.

B2 may not be picked up by some tests (not discussed in detail)

Compared to B1, B2 is 2.5 times more transmissible in non-VAX folks.

But Vaccine effectiveness against B2 appears to be at least as good or possibly better than effectiveness against B1. (Strange but stated)

Omicron has on average a 3 day latency between infection and symptoms. It appears to replicate “70X more quickly” compared to delta with 3.5 times greater household transmission. Fortunately lung involvement is 10 times lower compared to the original “Wuhan virus”.

Prior infection with delta DOES NOT SEEM TO PROTECT AGAINST OMICRON.

Hospitalization rate with omicron 38/1000 infections vs 101/1000 infections with delta.

In hospital mortality 29% with delta vs 3% with Omicron BUT because of a dramatic increase in transmission with Omicron, daily death rate in US has been 2200 to 2900 per day during the surge, more than delta. (Greater number of infections outweighs the lower mortality rate)

 preprint study published last month looked at data from about 52,000 people infected with the omicron variant, and about 17,000 infected with delta, in southern California. Compared with patients who had the delta variant, omicron patients had a 53% reduced risk of hospitalization, a 74% reduced risk of ICU admission and a 91% reduced risk of death. The study has not yet been peer-reviewed.

Duration of infection averages 10 days. Estimates for being contagious after onset of symptoms:

5 days 1/3, 7 days 16%, 10 days 5%, therefor some practitioners are recommending isolation for 14 days after onset of symptoms.

PCR can remain positive for months after infection because of non-infectious remnants of viral RNA.

Negative antigen test after isolation is reassuring but does not guarantee patient is not contagious. The home antigen tests were not designed or studied for predicting degree of contagion, only for diagnosis.

LONG COVID can be as high as 30% of all cases, as high as 10% after mild cases.

Vaccination reduces risk of LONG COVID by about 50%.

A study published in GUT demonstrates altered GI microbiome 6 months after infection. The gut microbiome is extremely important for immune function.

One year following COVID infection (previous variants) there is a 60-70% increased risk of heart attack, stroke and congestive heart failure.

In the UK 25% of worker absenteeism is due to LONG COVID.

Infection rates: UNVAX 1000/100,000, VAX 600/100,000, VAX+BOOSTER 300/100,000

A Swiss study showed 98% reduction in death with VAX plus booster.

2/15/22 published study from IOWA showed that 90 minutes of exercise on the day of vaccination increased antibody levels measured 4 weeks after vaccination. Similar data are available for influenza vaccination. I reviewed data on various non COVID vaccine effectiveness relative to sleep and exercise in 2 talks given last year. This result is not surprising.

Individuals with infection from prior variants, but not vaccinated, show no effective neutralizing antibody activity against omicron. (Very worrisome, I will try to vet this one)

Omicron has 4.5 times higher re-infection rate compared to delta.

Omicron infection appears to decrease risk of infection with delta, but prior infection with delta (without vaccination) does not appear to protect against omicron.

Prior infection (before omicron) PLUS vaccination provides 76% protection against omicron infection which is about the same protection of VAX + booster, and this appears to include protection against B2 variant.

T cell immunity after infection (pre omicron) and after vaccination appears to persist and T cell activity increases with time after infection and after vaccination.

Novavax has applied for EUA with the FDA. This is a vaccine made with S-protein particles plus adjuvant (no mRNA).

“The Novavax COVID-19 vaccine, codenamed NVX-CoV2373, is a subunit COVID-19 vaccine candidate developed by Novavax and the Coalition for Epidemic Preparedness Innovations (CEPI), brand name Covovax.”

“Results from a Phase 3 clinical trial enrolling 29,960 adult volunteers in the United States and Mexico show that the investigational vaccine known as NVX-CoV2373 demonstrated 90.4% efficacy in preventing symptomatic COVID-19 disease. The candidate showed 100% protection against moderate and severe disease. In people at high risk of developing complications from COVID-19 (people 65 years or older and people under age 65 with certain comorbidities or with likely regular exposure to COVID-19), the vaccine showed 91.0% efficacy in preventing symptomatic COVID-19 disease.”

Read more on en.wikipedia.org

The US Army is in phase I clinical trial with a multi-valent “ferritin nanoparticle multi-faced” vaccine. This “soccer ball shaped” vaccine has 24 “faces” with multiple variant antigens. Each “face” carries a different antigen.

US Army developing vaccine to fight ‘array’ of COVID variants

“The Spike Ferritin Nanoparticle platform is designed to protect against an array of SARS-CoV-2 variants and SARS-origin variants but was not tested on the Omicron variant,” Walter Reed officials said.

J&J vaccine issues:

The J&J vaccine is associated with a risk of thrombosis-thrombocytopenia (blood clots and decreased platelets). Risk: 1:100,000 doses in women age 30-50. CDC recommends against J&J vaccine unless there is a contra-indication to mRNA vaccine. 15% of these cases are fatal.

A full discussion of therapeutics (drugs) against COVID can be read at IFM.org/COVID

PAXLOVID is an oral combination of two anti-viral medications reserved for adults (age >= 18) with increased risk, given within day 3-5 of symptom onset. It decreases risk of hospitalization and death by about 70% in low-risk and 89% in high risk groups. There are many contra-indications to use including specific medications and supplements (such as Saint John’s Wort). Availability is a problem.

A recent study published in NEJM used IV Remdesivir (daily for 3 days) for early out- patient treatment in high risk patients, reduced risk of hospitalization/death by 87%. This would represent an off-label use of the drug based on a well controlled study.

Home antigen tests on average become positive 3 days after first positive PCR (nasal swab), 2 days after a positive saliva PCR.

The BiaxNOW home antigen test is 73% sensitive (27% false negative rate)

Pregnancy-COVID and vaccination:

A study of 40,000 pregnant women found no increase in pre-term birth, small for gestational age, or any other complication following vaccination during pregnancy.

But COVID infection in unvaccinated women during pregnancy is associated with increased risk for pre-term birth, still born, low birth weight, cesarean section, decreased fetal growth, maternal intubation and death.

Maternal Vaccination produces anti-Covid antibodies found in fetal cord blood at birth.

Intra-uterine demise with COVID is associated with massive placental insufficiency.

There is no data to support decreased female or male fertility following vaccination.

A study of menstrual regularity following vaccination showed < 1 day change in cycle length post vaccination, not clinically significant. Post vaccination regularity equivalent to expected variation in menstrual cycles.

Two months following COVID infection there is a decrease in male but not female fertility rate.

Multiple studies have demonstrated association between low Vitamin D status and risk for severe-critical disease and death. Association does not equal causation but there is biologic plausibility (Vitamin D is a major immune regulator) and consistently increased risk associated with low levels. A recent study demonstrated 14 times greater risk for severe-critical disease in hospitalized patients with levels <20 compared to patients with levels >40. I will update my previous discussion of Vitamin D and COVID in a future post. Spoiler alert: An intervention study with high dose Vitamin D done in Spain demonstrated improved clinical outcome.

Risk factors for poor outcome in descending order:

  1. Age > 65
  2. immuno-compromised state
  3. lung disease
  4. liver disease
  5. kidney disease
  6. neurologic disorders
  7. diabetes
  8. cardiac disease

Patients with severe disease had >= 1 risk factor

78% of patients who died had >= 4 risk factors.

“Nearly two years into the pandemic, unvaccinated Americans are still making up the majority of COVID deaths.”

“Data from the Centers for Disease Control and Prevention shows that during the first week of December — when the omicron variant began taking hold — unvaccinated people were dying at a rate of 9 per 100,000.”

“By comparison, fully vaccinated people were dying at a rate of 0.4 per 100,000, meaning unvaccinated people were 20 times more likely to die of the virus”

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. Drink water filtered through a high quality system that eliminates most environmental toxins.
  12. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors means clear benefit from a booster.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Long Covid: Vascular Inflammatory Response Mediated by non-classical monocytes.

Today I listened to Dr. Bruce Patterson discuss his research on Long-Covid.

Bruce Patterson was director of a virology lab at Stanford before establishing Incelldx, a biotech firm in the area of virus diagnostics. Bruce was interviewed today (second half of the program) on The People’s Pharmacy (NPR). The transcript and podcast will be available tomorrow at PeoplesPharmacy.com (show #1273)

Utilizing AI and data from over 10,000 patients, Incelldx has developed diagnostic tools to characterize the immune system dysregulation associated with long covid. According to Dr. Patterson’s research, Long-Covid involves “non-classical monocytes” that are reacting to remnant virus proteins (not RNA or DNA), producing a vascular inflammatory process. That was the missing link. Researchers were looking for RNA, but the problem appears to be in the monocyte reaction to remnant viral proteins that stimulate these specialized monocytes, producing a chronic vasculitis.

Here is a link to the Long Covid clinical program based upon this research.

https://covidlonghaulers.com/

The program involves immune testing by Incelldx and based on the results, treatment recommendations are made.

So far 2 drugs repurposed for long-Covid appear effective when used in combination.

A CCR5 antagonist (maraviroc) which has been used to treat HIV and a Statin medication which blocks binding of the monocytes to artery walls.

According to Dr. Patterson, Long Covid in many patients is a vascular inflammatory process, mediated by non-classical monocytes which are activated by viral remnant proteins.

Dr. Patterson has seen many patients respond to this drug combination. He uses an old, early statin drug (pravastatin) which has a low side effect profile compared to the more commonly used atorvastatin (which gave me severe myopathy, notorious for that problem but understated by drug company reports).

This is cutting edge, most physicians, even in university settings, are not aware of this diagnostic/therapeutic approach.

This is still considered experimental but appears to be very promising.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml. (read this Open Letter)
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. If you are over age 12 and eligible for vaccination, consider protecting yourself and your neighbor with vaccination.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Vaccination risks vs. infection risks, COVID 19

A recently published study from Israel compared vaccinated vs unvaccinated people who developed COVID 19. The study was huge. It evaluated the absolute risk of various events following vaccination vs no vaccination with COVID-19 infection. The absolute risk numbers are presented as # of events per 100,000 people. The data clearly shows safety of the vaccine and a large difference between vaccination vs no vaccination/infection. The study matched vaccinated individuals with unvaccinated individuals (before the vaccine was available) for various risk factors and followed the two groups for 42 days. Events were recorded during the 42-day study period.

Here is a summary of the findings. The vaccine was the mRNA vaccine (Pfizer).

“We used a data set involving more than 2.4 million vaccinated persons from an integrated health care organization to evaluate the safety profile of the BNT162b2 mRNA Covid-19 vaccine. The main potential adverse events identified included an excess risk of lymphadenopathy (78.4 events per 100,000 persons), herpes zoster infection (15.8 events), appendicitis (5.0 events), and myocarditis (2.7 events).

To place these risks in context, we also examined data on more than 240,000 infected persons to estimate the effects of a documented SARS-CoV-2 infection on the incidence of the same adverse events. SARS-CoV-2 infection was not estimated to have a meaningful effect on the incidence of lymphadenopathy, herpes zoster infection, or appendicitis, but it was estimated to result in a substantial excess risk of myocarditis (11.0 events per 100,000 persons). SARS-CoV-2 infection was also estimated to substantially increase the risk of several adverse events for which vaccination was not found to increase the risk, including an estimated excess risk of arrhythmia (166.1 events per 100,000 persons), acute kidney injury (125.4 events), pulmonary embolism (61.7 events), deep-vein thrombosis (43.0 events), myocardial infarction (25.1 events), pericarditis (10.9 events), and intracranial hemorrhage (7.6 events).

Another particularly notable class of adverse events that has been reported in the context of Covid-19 vaccines is thromboembolic events. These adverse events, which primarily affect young women, have been linked with the ChAdOx1 nCoV-1932 and Ad26.COV2.S (Johnson & Johnson–Janssen) Covid-19 vaccines,33 both of which are adenoviral vector vaccines. However, we did not find an association between the BNT162b2 (mRNA) vaccine and various thromboembolic events in this study.”

We already know that vaccination substantially decreases the risk of severe illness, hospitalization and death. The media has reported on potential, rare complications of the vaccine.  Those reports have frightened some people primarily because when the media report them in a sensational way, they do not compare the risk of the same events with infection. This study demonstrates that the rare complications of vaccination pale in comparison to the risk of the same complications with infection. This study also identifies several serious complications of infection that do not occur as a result of vaccination.

Read the article.

And here is a graphic display of the results:

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml. (read this Open Letter)
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. If you are over age 12 and eligible for vaccination, consider protecting yourself and your neighbor with vaccination.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Nutrition and Lifestyle vs Pandemic

Earlier this year I gave 2 presentations on this topic at the (virtual) annual meeting of Physicians and Ancestral Health, a physician organization dedicated to incorporating evolutionary biology and lifestyle recommendations into the practice of medicine. Here is the first slide:

And here are some very important references:

Please note that this lecture was given before the delta variant arrived so the data applies to the pre-delta period.

MI= Myocardial Infarction (heart attack with loss of muscle), PE=Pulmonary Embolus, DVT= Blood Clots in legs, SIRS= Systemic Inflammatory Response Syndrome

I will skip several of the slides and get to the nutritional immunology and other lifestyle factors.

This slide shows many lifestyle factors that interact with the immune system. The “12% metabolic health” refers to a study demonstrating that only 12% of American adults are metabolically healthy, which will be explained later. Dysbiosis refers to an imbalance in gut bacteria favoring inflammation and immune compromise. The rest should be self explanatory but discussed in detail later in this series.

Here is the very busy slide that summarizes nutritional immunology:

w3/w6 refers to the omega 3 to omega 6 ratio in the diet, ROS= Reactive oxygen species (oxidative stress), CH: carbohydrates; GALT: gut-associated lymphoid
tissue; GPRs: G-protein-coupled receptors; FA: fatty acids; GI/GL: glycemic index/load; RAR/RXR:
retinoic acid receptor/retinoid X receptor; SCFA: short-chain fatty acids; TF: transcription factors; VDR:
vitamin D receptor.

Key points in this slide:

  1. Omega 3 fats from fatty fish fight inflammation, excess omega 6 fats from refined “vegetable oils” (corn, soy, cotton seed, sunflower seed, safflower, etc.) contribute to inflammation and blood clots, contributing to cytokine storm and bradykinin storm.
  2. Vitamin D interferes with the virus at multiple points.
  3. Adequate iron (Fe) from meat and seafood is essential for immune function (Iron from plant sources is much less bioavailable compared to meat and seafood.)
  4. Adequate complete protein (not available from vegan diets) is essential for immune function.
  5. Zinc and selenium (both found in seafood and meat) are essential for multiple protective pathways in the immune system (enhancing response to infection and mitigating excessive inflammatory response as cofactors for antioxidant enzymes)
  6. Sugar and high glycemic foods cause inflammation, high blood sugars suppress the immune system
  7. Dietary fiber supports a healthy gut microbiome which in turn suppresses inflammation and provides the gut lining with SFAs (gut epithelium requires SFAs for energy and function, gut barrier function needs SFAs)
  8. Phenolic compounds in colorful vegetables and berries modulate multiple essential immune pathways that can inhibit viral replication.
  9. Carotenoids, phenolics support several vital immune pathways.
  10. Omega 3 fats are the building blocks of chemicals that help resolve inflammation and mitigate against cytokine storm and bradykinin storm.
  11. Multiple vitamins and phenolics support our internal anti-oxidant system.
  12. To get a balanced protein intake we should eat “nose to tail”. Include connective tissue (home made bone broth is a great source) and organ meats (from grass fed/finished ruminants) in addition to muscle meat.

Here is another busy slide that presents more detail, note the reference at the bottom of the slide to read more.

Sorry for the small print but you can see the blow up on line by going here.

http://A Review of Micronutrients and the Immune System-Working …

So does the “Standard American Diet” meet these nutritional needs to support a healthy immune system?

The % above represent the % of American adults with intakes BELOW the EAR (Estimated Average Requirement) for various vitamins and minerals. But note the definition of EAR:

“nutrient intake value that is estimated to meet the requirement of half the healthy individuals to avoid symptoms of a clinical or subclinical deficiency” (NOT OPTIMAL LEVELS for immune function)


Note also that this study did not consider omega-3s, phytonutrients, flavonoids, polyphenols, fiber, etc., all of which are essential to a robust immune response to any virus including SARS CoV-2.

With regards to omega 3 vs omega 6 fats:

Omega 3 fats (EPA and DHA) found in seafood fights inflammation, blood clots. DHA and EPA are the building blocks of SPMs which help RESOLVE INFLAMMATION (MITIGATE CYTOKINE STORM)

We will return to this topic in my next post. We are just scratching the surface of a complex system.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml. (read this Open Letter)
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. If you are over age 12 and eligible for vaccination, consider protecting yourself and your neighbor with vaccination.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

An important reason to get vaccinated, respect for the safety of others.

I just read an article by an immunocompromised physician published in JAMA (Journal of the American Medical Association). In this article, Dr. Lindsay Ryan, an ER physician who takes immunosuppressive medication to treat her auto-immune disease, describes her thoughts on folks who refuse to be vaccinated against COVID-19. She acknowledges the many possible reasons one might choose to avoid vaccination, many related to lack of scientific information and confusion by false information so widely spread on the internet. At the heart of her discussion lays a fundamental conflict, individual freedom vs responsibility to protect our neighbor. Dr. Ryan has been vaccinated but her immunosuppressant medication has significantly blunted her response to vaccination, leaving her unprotected by the vaccine. Therefore in her job as an ER physician she is constantly at risk for infection from an asymptomatic or symptomatic patient with any infectious disease including COVID-19. Beyond that, living a “normal life” will remain elusive for her as so many individuals continue to refuse vaccination based on a “freedom of choice” decision which places their own freedom over the interests of one’s neighbor. Many Americans are immuno-compromised. There are many medications that render the immune system less effective to various degrees. There are many conditions that compromise immune systems and render vaccination less effective. By definition, all patients who have received an organ transplant are immunocompromised. All such individuals are at increased risk of death or disability from COVID-19 exposure. The single most effective way to help protect these individuals is for everyone eligible to become vaccinated.

You can learn more about organ transplants by perusing organ transplant data for the USA. Your neighbor, the person you pass in the aisle of the grocery store, the person who is sitting in the restaurant at a table next to you, could be a transplant recipient or on an immunosuppressive drug for auto-immune disease.

According to the National Institutes of Health, up to 23.5 million Americans (more than seven percent of the population) suffer from an autoimmune disease—and the prevalence is rising.

Alternatively, they may be immunosuppressed because of chemotherapy for cancer.

How many people in the United States have cancer? More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone.

If you choose to avoid vaccination as a form of personal freedom expression, is that choice a charitable or responsible choice? Does it balance personal freedom against responsibility for the health and safety of our neighbor? Are not immuno-compromised individuals entitled to “life, liberty and pursuit of happiness” and freedom from unnecessary risk exposure because of their neighbor’s personal choices?

We have laws against driving under the influence. Such laws seek a balance between personal freedom and responsibility towards one’s neighbor. As a society we have accepted restrictions on personal behavior that places others at risk and we have instituted laws to enforce such restrictions.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml. (read this Open Letter)
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)
  11. If you are over age 12 and eligible for vaccination, consider protecting yourself and your neighbor with vaccination.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

COVID-19 UPDATE: Masks, social distancing much more important than cleaning surfaces.

Today’s update from the Johns Hopkins Center for Health Security:

An editorial published in Nature discusses the need to shift focus away from surface decontamination as a mechanism to reduce SARS-CoV-2 transmission risk. Multiple studies have found that transmission of SARS-CoV-2 via contaminated surfaces, or fomites, is relatively rare compared to respiratory transmission via droplets or aerosols. Despite the evidence supporting respiratory exposure as the overwhelming driver of community transmission, numerous public health entities, including the WHO and US CDC, continue to emphasize the importance of surface decontamination, which can cause confusion among the public regarding transmission risk and appropriate protective measures. Notably, surface decontamination efforts, while highly visible and easy to recognize, are costly and likely not effective means of reducing transmission risk. The editorial calls for increased focus on improving ventilation and air filtration capacity to reduce respiratory exposure. Additionally, proper physical distancing and face mask use remain key tools in mitigating exposure and transmission risk for individuals.

The key to reducing the risk of symptomatic infection, especially moderate to severe illness and death appears to be vaccination.

While vaccination clearly reduces the risk of severe illness and death, we do not yet know whether or how much vaccination reduces the risk of carrying and transmitting the virus. So even after vaccination, an asymptomatic or minimally symptomatic person can still transmit the disease to others.

50-60% of viral transmission appears to be from asymptomatic individuals. So wearing a mask, social distancing, and avoiding unventilated crowded indoor spaces remains extremely important.

DOUBLE MASKING IS MORE EFFECTIVE THAN SINGLE MASKS.

A TRIPLE LAYER MASK OF TIGHTLY WOVEN FABRIC IS MORE EFFECTIVE THAN a SINGLE OR DOUBLE LAYER MASK.

N95 MASKS ARE MOST EFFECTIVE BUT THEY MUST FIT THE FACE WITH A TIGHT, SNUG FIT. 

TO IMRPOVE THE BARRIER FUNCTION OF MASKS WEAR A SNUG FABRIC MASK OVER A SURGICAL MASK OR OVER AN N-95. THIS WILL PROTECT BOTH THE WEARER AND THOSE AROUND THE WEARER. The fabric mask over a surgical or N-95 mask provides two mechanisms of protection. It adds an extra layer and it provides for a tighter fit of the underlying mask.

Doctors and nurses in hospitals and clinics often wear a surgical mask over an N-95. 

Face shields do not protect you or those around you from infection. Face shields and goggles (more so) likely decrease the risk of infection transmitted from aerosols that hit your eyes but do nothing for the most important mechanism of spread, breathing aerosols or droplets into your nose. Aerosols spread around a face shield into your nose. 

Think about smelling the pleasant odors of food cooking in a kitchen. Face shields will not block those aerosolized food vapors from entering your nose, but tightly fitting masks will do it to some degree.

SARS-CoV-2 virus is at least 10 times more lethal than an “average” case of influenza. Newer circulating variants have mutations that have probably increased the mortality rate.

SARS-CoV-2 is at least 10 times more easily transmitted compared to most respiratory viruses. Newer circulating variants have definitely increased ease of transmission by at least 30%. As a result, herd immunity will likely require 85-90% vaccination of a given population.

10 times 10 equals 100 TIMES MORE SERIOUS.

In addition, compared to other respiratory viruses, this virus will more frequently cause long lasting or even permanent damage and disability involving one or more organs (heart, lung, kidney, brain). Long-COVID can occur following minimally symptomatic illness and even after asymptomatic illness.

This virus is unique in that TRANSMISSION OCCURS MOST FREQUENTLY FROM ASSYMPTOMATIC INDIVIDUALS.

This occurs for two reasons.

1. Unlike most other respiratory viruses, there is a long time from the onset of when a person becomes infectious to when they become symptomatic. (an average of 5 days)

2. Some individuals never develop symptoms but are still highly infectious for up to 2 weeks.

Restaurants, bars, churches, meeting rooms, cafeterias, parties in closed spaces are situations for SUPERSPREADER EVENTS. An this includes SUPER BOWL PARTIES.

Studies in hospitals show that transmission to health care workers occurs most frequently in the cafeteria and in meeting rooms, not at the bedside where providers are wearing PPE.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml. (read this Open Letter)
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Autoimmunity: Another reason why VACCINE is safer than INFECTION.

There is growing evidence that self-attacking ‘autoantibodies’ could be the key to understanding some of the worst cases of COVID-19.

This might explain why lung damage and other organ damage sometimes continues to worsen AFTER the body seems to have cleared the SARS-CoV-2 virus. And it could explain why some individuals fail to mount an adequate immune response early in the disease.

With respect to the later, in September 2020 researchers at the Rockefeller University reported that > 10% of 987 patients with severe COVID-19 infection had antibodies that blocked type 1 interferon molecules, an essential part of the innate immune system.

Other researchers have screened patients with varying severity of COVID-19 and found higher prevalence of autoantibodies against the immune system in infected individuals compared to uninfected controls.

Yet another study found that some infected individuals had autoantibodies against proteins in their blood vessels, heart and brain.

Many patients with severe COVID suffer from life threatening blood clots. Phospholipids play a major role in controlling blood clotting. 52% of 172 people hospitalzied with COVID 19 were found to have anti-phospholipid antibodies.

Annexin A2 is a human protein that protects the integrity of small blood vessels in the lung. Researchers have found a significantly higher average level of anti-annexin A2 antibodies in people who died of COVID-19 compared to patients with less severe illness.

So far it is unclear whether the virus caused these antibodies or whether these unlucky individuals had higher than normal amounts of auto-antibodies prior to infection.

A paper published in the immunology literature just yesterday might shed some light on this issue as well as on the topic of LONG COVID.

We sought to determine whether immune reactivity occurs between anti-SARS-CoV-2 protein antibodies and human tissue antigens, and whether molecular mimicry between COVID-19 viral proteins and human tissues could be the cause.

In other words, they tested antibodies against the SARS-CoV-2 virus to see whether they reacted against various kinds of human tissue. Here is what they found.

We found that SARS-CoV-2 antibodies had reactions with 28 out of 55 tissue antigens, representing a diversity of tissue groups that included barrier proteins, gastrointestinal, thyroid and neural tissues, and more.

This extensive immune cross-reactivity between SARS-CoV-2 antibodies and different antigen groups may play a role in the multi-system disease process of COVID-19, influence the severity of the disease, precipitate the onset of autoimmunity in susceptible subgroups, and potentially exacerbate autoimmunity in subjects that have pre-existing autoimmune diseases.

You can read the full study here: https://www.frontiersin.org/articles/10.3389/fimmu.2020.617089/full

Cross reactivity between antibodies against COVID-19 virus and human tissue was found for every major organ system in the human body.

The concept of “molecular mimicry” has been well described in auto-immunity for many years. This occurs when a portion of a foreign protein (on for example a virus or bacterium) is identical to a portion of a protein found in human tissue. When the immune system responds to invasion by a virus or bacteria it creates antibodies to various proteins on the invader. But in so doing the anti-bodies can react against human tissue that shares a small common string of amino acids (referred to as an epitope).

A famous example of molecular mimicry occurs with Rheumatic Heart Disease in which antibodies against the bacteria responsible for Strep Throat cross react with heart tissue causing destruction of heart valve tissue and a resultant leaky heart valve. In this situation cross reaction can also occur with tissue in joints resulting in arthritis, another hallmark of rheumatic fever. These were serious complications of Strep Throat before Penicillin became widely available.

So far we know that sicker COVID-19 patients demonstrate antibodies against multiple types of human tissue.

We also know that antibodies that react against various portions of the virus can also react against human tissue.

Finally we know that multi-organ failure is an inflammatory response wherein the immune system, rather than the virus, causes organ failure.

It would be a reasonable conclusion that auto-immunity can acutely contribute to cytokine and bradykinin storm.

It would also be a reasonable conclusion that auto-immunity contributes to LONG COVID.

So why would that make an mRNA vaccine safer?

The mRNA vaccine results in antibodies against one part of the virus (one epitope, the spike protein).

But infection results in antibodies against MULTIPLE PARTS OF THE VIRUS (multiple epitopes). Because multiple antigens or epitopes are involved in the immune response to infection, it increases the probability that cross reaction with multiple human tissues can result.

From an autoimmune perspective, the mRNA vaccine is much safer.

Obviously, given the fact that over 400,000 deaths have resulted in the US from this infection and no deaths have been attributed to the vaccine, the vaccine appears to be much safer than infection. Both the Pfizer and Moderna vaccine have decreased the risk of symptomatic infection by 95%. Severe symptomatic infection can lead to death. Even asymptomatic infection can cause LONG COVID. The risk-benefit analysis overwhelmingly favors the vaccine.

For a deeper dive into auto-immunity and COVID-19 here are a few more references:

High frequency of cerebrospinal fluid autoantibodies in COVID-19 patients with neurological symptoms

Autoantibodies against type I IFNs in patients with life-threatening COVID-

Diverse functional autoantibodies in patients with COVID-19

Prothrombotic autoantibodies in serum from patients hospitalized with COVID-19

 Association between anti-interferon-alpha autoantibodies and COVID-19 in systemic lupus erythematosus

Autoantibodies related to systemic autoimmune rheumatic diseases in severely ill patients with COVID-19

 IgM autoantibodies recognizing ACE2 are associated with severe COVID-19

Is the association between IgG anti‐cardiolipin autoantibodies and COVID‐19 severity related to the lung injury or to the SARS‐CoV‐2 infection?

Do cross-reactive antibodies cause neuropathology in COVID-19?

Immunoserologic detection and diagnostic relevance of cross-reactive autoantibodies in coronavirus disease 2019 patients

Anticardiolipin IgG Autoantibody Level Is an Independent Risk Factor for COVID‐19 Severity

Rheumatic manifestations of COVID-19: a systematic review and meta-analysis

The immunology of multisystem inflammatory syndrome in children with COVID-19

Clinical, Serological, and Histopathological Similarities Between Severe COVID-19 and Acute Exacerbation of Connective Tissue Disease-Associated 

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml. (read this Open Letter)
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob