Post COVID19 Fatigue

Over the last few weeks, I have started receiving inquiries from people suffering from the debilitating effects of post COVID19 fatigue. We were hugely surprised at the number of people who seem to be suffering from this condition. From personal trainers to business owners and professors of medicine, lives have been put on hold due to the debilitating effects of this fatigue, making it difficult to carry out even simple tasks such as reading or making a phone call.

After a quick bit of research, it seems that there may be thousands of people who will continue to suffer the chronic fatigue-like after-effects of COVID19. So, whilst lockdown restrictions may be easing, we turn our minds to the possibility of a 'second wave', not of reinfection, but of significant numbers of people unable to even get out of their beds due to the ongoing effect of this post-viral fatigue. I believe this is the next part of the COVID story which we will need to address. I also firmly believe that it will need a systems medicine approach, rather than conventional medical thinking.

A systems medicine approach is one that attempts to understand how all the systems of the body communicate with each other, provide defense against, and are affected by the virus at any one time. It is also about understanding the key underlying mechanisms that may continue to drive this ongoing inability to recover? These underlying mechanisms are likely many and each person is going to have their own unique post-COVID19 fatigue journey. We are going to have to personalize their recovery based on their current ongoing symptoms and a deep dig into their health history. That said, I believe there are a few major well-known mechanisms that could and should be looked at.

1. An immune system that is worn down and unable to respond optimally.

Once your body has finished it's battle with the COVID19 virus, it may leave parts of your innate immunity compromised, in particular the gut wall, a major barrier that protects us against the outside world. Damage to the gut wall and a lack of protective immune proteins can result in an increased flux of troublemakers crossing this barrier. Once the gut wall has been compromised, the scientific evidence shows that the blood-brain barrier can also be compromised through similar mechanisms. This commonly results in symptoms such as brain fog, depression, anxiety, and as already mentioned, debilitating fatigue. It is interesting to hear that many patients have had, and continue to have digestive symptoms. Given that the digestive tract is the main immune battlefront against the outside world it would make sense in patients with ongoing digestive complaints to investigate barrier integrity, the balance of good to bad bacteria, and the numbers of protective barrier proteins such as Secretory IgA.

If we never help the barriers heal (fat-soluble vitamins and sunshine important here) we will always be more exposed to gastrointestinal trouble makers such as Lipopolysaccharide (LPS), an endotoxin that is implemented in many chronic diseases. With a weakened immune system (both innate and acquired) we may not be able to keep other viruses such as Epstein Barr or Cytomegalovirus at bay, viruses which would normally be kept under control by a healthy immune system. These particular viruses (which almost all of us have had) can be reactivated with lowered immunity, continuing to keep many post COVID19 patients in a chronically fatigued state. These viruses can easily be tested in order to determine whether reactivation has occurred. Permeability of both digestive and blood-brain barriers can also easily be carried out although these tests can be somewhat expensive.

2. Ongoing and unresolved inflammation.

You may have heard that once COVD19 has been contracted, the mechanism that ultimately leads to a patient becoming critically ill is that of the uncontrolled cytokine storm. It is possible, in my opinion, that many ongoing sufferers continue to experience the impact of elevated cytokines.

Cytokines are like the special forces of the immune system, creating a myriad of chronic fatigue like symptoms in the duty of defending you. The best way to understand how cytokines work and feel is when you have the flu. You just want to lie in your bed, not drink, eat or talk to anyone. You feel depressed, fatigued, your body aches all over and you have a temperature. That's the cytokine response, an evolutionary process of your body dealing with a threat. It disables you so that your body can get on top of the infection. Indeed both chronic fatigue and depression have been linked in the scientific literature with elevated cytokines and indeed I have seen this with patients. Clearly it is important to find the root cause of elevated cytokines. Find this and you have a pathway to reduce cytokine production and resolve some of the symptoms.

Interestingly we can start to identify those patients that may be more "at-risk" through the use of genomic testing that is integrated with standard testing approaches. Here is an example of one of our Type 2 diabetic patients and their genomic potential for increased inflammation.

Increased inflammation is a key mechanism that underpins most chronic diseases, especially obesity and type 2 diabetes, hence why having these increases your risk of COVID. The short of it is, the more fat you have (especially fat that surrounds your major organs, known as visceral adipose tissue) the bigger your risk. This is because this fat is 'angry fat' and it sends out inflammatory signals to the body increasing the levels of inflammation. In short, reducing your body fat, reduces your risk.

3. Damage to the power plants in our cells that create energy.

Whilst our immune system defends us from viral invaders, it is not without consequences. Your immune system largely defends by chemical warfare and one of the outcomes of this is peripheral damage to surrounding cells. As a consequence of immune activation, we see an increase in oxidative stress and inflammation. This can affect our ability to generate energy from the mitochondria (the power plants of our cells). How we ultimately make energy from our foods is via a complex cascade of energy cycles. This involves orchestrated step by step processes that require multiple inputs. Anything that damages this coordinated process, or provides inadequate vitamins, minerals, fats, and other cofactors leaves the mitochondria incapable of generating enough energy to give us the get-up and go for normal living. In other words, resulting in fatigue. For those with post-COVID fatigue, this may well be an area of investigation, a developing area where appropriate dietary and lifestyle advice and nutrient supplementation is well established in helping mitochondria recover.

A call to arms!

It is our belief that we will see and hear from more people with post-viral fatigue due to COVID-19 who are going to need help. At present they are simply told to go home and rest. For some, this works, but for others, it may be several months with still no improvement in symptoms. There is a need for an individualised approach using a systems biology framework that is best provided by functional medicine. We need to address the symptoms but importantly find the root causes and underlying mechanisms that continue to drive them.

My associates and I are keen to hear from you if your recovery from Covid-19 is still ongoing and you feel you need external help. We also recognize that organisations may well discover that some of their returning employees may be affected resulting in reduced productivity. Whilst we do not have all the answers (no one currently does) we can at least offer good scientific perspectives and practical help on your COVID recovery journey. We look forward to hearing from you. Feel free to contact us personally or begin your conversation here.