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How to Treat Long-Haul COVID



Nicole Press started feeling unwell in March 2020. At first, the stage manager, who splits her time between New York City and Pennsylvania, thought it might be allergies. But about a week in, she crashed hard.

“It felt like the worst flu I’ve ever had,” recalls Press, 37. She got tested for the coronavirus — SARS-CoV-2 — and her results came back positive. “At the time, I thought I was lucky,” she says. “I thought I’d be through with it and then be able to donate antibodies to others.”

But her COVID-19 symptoms dragged on and on and became debilitating: rashes, muscle aches, dizzy spells, fatigue, cough, shortness of breath, absence of taste and smell, vomiting, brain fog, body tingles, acid reflux, broken blood vessels, and hair loss.

“It hit two weeks, then three weeks, then a month,” says Press. “In hindsight, I would have done things differently [and gone to the doctor], but at the time, there were trucks full of bodies, healthcare workers were overwhelmed, and the message was ‘Stay home, don’t ask for help.’ So I just took vitamins and hoped for the best.”

Two months on, Press finally telephoned her doctor, who called her in for bloodwork. She tested positive for coronavirus antibodies, showed high levels of a generic inflamma­tion ­marker, and was deficient in vitamin D. She also tested positive for mononucleosis (an illness caused by the Epstein-Barr virus), which she had previously contracted in high school. The rest of her labs looked normal.

She now understands that her condition is shared by many who have been infected with the novel coronavirus. It’s become known as COVID long-haulers phenomenon — as well as long COVID, post-acute COVID, or post-COVID syndrome — and it is receiving more attention as the number of sufferers with lingering symptoms rises worldwide.

A survey of Americans with mild COVID cases found that 35 percent hadn’t fully recovered two to three weeks after diagnosis. And English researchers estimated in the British Medical Journal that around 10 percent of people will experience symptoms lasting more than three weeks, while a smaller proportion will continue to feel unwell for months.

With more than 105 million confirmed COVID cases worldwide at press time, millions of people are or will be in the same boat — struggling to make sense of ongoing symptoms that their healthcare providers are often unable to help them address.

The absence of a clear biomarker makes chronic conditions like these challenging for many conventionally trained doctors, explains Elizabeth Boham, MD, MS, RD, a functional-medicine physician and medical director at the UltraWellness Center in Lenox, Mass.

“That’s what’s hard with all the postinfection inflammatory syndromes — long COVID, as well as chronic fatigue syndrome and chronic Lyme. There’s not one biomarker that says, ‘Oh, this is what it is.’ So physicians may discount it and say, ‘You’re recovered. You should be feeling better.’”

Yet increasing numbers of patients with chronic conditions, including growing numbers of COVID long-haulers, are looking for functional and integrative solutions, says Leo Galland, MD, a functional-medicine internist in New York City.

Postviral Fatigue

Long COVID shares several key characteristics with chronic fatigue syndrome (CFS) and chronic Lyme disease. These include problems with mitochondrial function (mitochondria are the energy-producing powerhouses inside our cells), fatigue, brain fog, and muscle pain.

The condition also has unique features, notes Galland. “In long COVID we see more organ systems involved. Chest pain, cough, and shortness of breath are common, as well as GI symptoms and abdominal pain. It’s also notable the degree to which they fluctuate. People can feel good one week and lousy the next, or even day to day.”

This certainly describes Press, who says her symptoms came in random waves. “Some days I pick up a glass of water and it feels like a glass. Other days it feels like a sandbag. I wake up in the morning and I don’t know how it’s going to be.”

While long COVID can present a larger and more varied constellation of symptoms than CFS or chronic Lyme, it seems to respond well to the same tools functional-medicine providers use to address those conditions.

“In the functional-medicine world, we look at the different functions that go on in the body,” explains Patrick Hanaway, MD, chief medical education officer at the Institute for Functional Medicine. “When we look at a post-infectious state where someone is having persistent symptoms across multiple organs, we ask, ‘What’s the functional imbalance that’s going on here?’”

Seeking the Root Causes of Symptoms

About three weeks into her ­COVID infection, Press started to lose feeling in her lips and struggled to breathe as a tingling numbness spread across her face. Her husband, Max, took her to the ER, where doctors dismissed her symptoms as a panic attack and sent her home.

In online support groups, many people describe similar experiences: lingering COVID symptoms are dismissed as a product of emotional or psychological distress.

“It’s real, but the doctors often say they don’t know what to do anymore,” says Press.

In June 2020, Press enrolled in a post-COVID patient-study group at New York City’s Mount Sinai Hospital. She was referred to an array of specialists, including a neurologist, rheumatologist, cardiologist, pulmonologist, rehab physician, dermatologist, and gastroenterologist.

While she was happy to be taken seriously, she didn’t sense they were connecting the dots among her wide-ranging symptoms. One doctor put her on an anti-inflammatory diet, but when she started having digestive issues, another instructed her to end it.

“I’m grateful for all of them, but I wish the doctors communicated with each other,” she says.

Complex conditions like this often challenge physicians who specialize in particular areas, but the root-cause approach of functional medicine can be especially well-suited to the task.

“Long COVID is a complex, multifactorial condition,” notes Hanaway. “We need to look at it not on an organ-system basis, but from a functional basis, to say, ‘What’s underneath here? What are the functions that interrelate those systems and how do we address that?’” (For more on what differentiates functional medicine, see “Functional Medicine: A Science Whose Time Has Come“; for functional-medicine recommendations for boosting immunity, see “5 Ways to Boost Your Immunity“.)

Going Upstream

Some people are infected by the corona­virus and never get sick; others suffer damage to their immune system and ongoing inflammation. These effects can produce a broad range of symptoms, including cardiac inflammation and tachycardia (a heart rate of more than 100 beats per minute), fatigue, pain, brain fog, and breathing difficulties.

Two primary mechanisms may account for long-haul symptoms, says Galland: persistent immune imbalance and a disturbed gut microbiome.

“One thing that’s been documented in people who haven’t recovered from an acute infection is a consistent upregulation of white blood cells called monocytes and macrophages,” he says. “A lot of the symptoms have to do with that persistent immune imbalance and increased inflammation. It’s like a switch gets turned on that doesn’t get turned off.”

Galland traces this to the way COVID inactivates the ACE-2 enzyme. ACE-2 is the doorway the virus uses to enter our cells and is one of the body’s best tools for establishing balance and controlling inflammation.

“All the severe long-COVID symptoms can be traced back to the loss of ACE-2 activity, even in those who didn’t get really sick,” he explains. “Loss of ACE-2 can cause problems with energy metabolism and mitochondria, and result in cardiac problems, pneumonia, blood clots, kidney failure, strokes, seizures, brain fog, purple toes, excessive inflammation, and autoimmune disease.”

There is an abundance of ACE-2 receptors in the GI tract as well, and COVID commonly produces gut dysbiosis. This allows pro-inflammatory bacteria to thrive in the gut microbiome and contributes to other inflammatory symptoms, he says.

Dietary changes can be the first step to easing inflammation and oxidative stress, supporting ACE-2 activity, and improving mitochondrial function. “The treatment that I’m favoring involves supplements and a diet that is anti-inflammatory and flavonoid-rich, and helps to create a healthier gut microbiome,” he says. This functional-medicine approach allows him to address the range of symptoms at their root.

“We have experi­ence using these tools with people with tick-borne and viral infections in the past and seeing improve­ments,” notes Hanaway. “Functional practitioners are using those same systems-biology tools to help return [long-haulers] to normal function.”

Mo Perry
is an Experience Life contributing editor.

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One Step At a Time: Blake Mycoskie



Some of Blake Mycoskie’s best ideas arrive while he’s on vacation.

The native of Arlington, Texas, was in Argentina in 2006, taking a month off from a tiring work schedule, when he came up with the concept for TOMS Shoes. He’d traveled to the far Southern Hemisphere to study polo and relax, but he ended up starting the world’s first One-for-One business after meeting two aid volunteers in a café.

They were providing shoes to children who needed them to ­attend school, and their work inspired ­Mycoskie to create TOMS, which would donate a pair of new shoes to someone in need for every pair sold. ­During its One-for-One phase, TOMS donated more than 95 million pairs of shoes in more than 80 countries; it now dedicates a third of its earnings to a “giving fund” that supports charitable nonprofits.

More recently, Mycoskie was moved to create his next venture while floating on a surfboard. Alongside him was former Navy SEAL Pat Dossett, and they were wondering how they could make the world a better place as they contemplated the waves.

Recognizing that positive col­lective change starts with healthy, self-realized individuals, they agreed to commit the coming year to gathering a team to study human behavior. The team would include neuroscientists, life coaches, physical therapists, and mental-health ­experts. Mycoskie and Dossett wanted a program that would help one person at a time reach their highest potential for happiness, creativity, and health — and maintain it.

That led to the design of a 10-month behavior-change program called Madefor. Each month focuses on a single habit, such as hydration, sleep, or gratitude, and offers a kit with tools to help develop it. Notably, none of the tools is digital — analog is central to the mission of physical behavior change.

The choice to focus on a single behavior each month is also deliberate, based on the idea that the human brain is best suited to learning only one practice at a time. Likewise, routine repetition is helpful to making any healthy behavior into a habit.

The inquiry behind Madefor was at least partly personal for Mycoskie, 44, who notes that he has completed the program twice.

Though always animated by a mission to improve the world, he’s faced some personal challenges. When he stepped down from his role of CEO at TOMS and sold half the company in 2014, he found himself depressed for the first time.

He explains how Madefor helped change his mindset and behavior so he could begin to truly appreciate the life, and the family, he’s worked so hard to build.

Experience Life | How did you go from selling shoes to creating a program based in the science of behavior change?

Blake Mycoskie | I’ve always been curious about how to get the most out of life, but it wasn’t until I experienced depression that I discovered a passion to help others live better, too.

My depression really was the product of false expectations. Everything and everybody in my life told me that I would be “happy” when I built a great company that helped people, got married, had kids, had financial freedom, got accolades and awards. . . . But everything that would supposedly make me happy and give my life meaning was externally focused.

Once I did and had all these things and still did not feel a deep lasting peace and joy, I did not know where to turn. I didn’t know if I would ever truly be “happy.” The fear that happiness was unattainable led to the depression.

There are a lot of other factors that contributed as well, but I can now say that many of the Madefor practices and habits helped counter some of the negative influences and habits I had adopted while building a company and family in this modern society.

EL | How would you describe Madefor? 

BM | Madefor is a 10-month program that applies the principles of modern neuroscience, psychology, and physiology to make your brain and body better.

EL | What would you say to someone who believes that human behavior is too complex to be reduced to scientific formulas?  

BM | I would agree! But science does have some really powerful principles that we can draw on to help inform how best to navigate our unique lives and the environments we find ourselves in.

EL | Why is the Madefor program almost entirely analog? 

BM | Our lead advisor, Andrew Huberman, PhD, is a neuroscientist at Stanford who specializes in an area of research called neuroplasticity, which studies our brains’ ability to change and grow. Huberman notes that an important part of neuroplasticity is managing your focus and attention, which is hard to do if you’re head down in a device, app, or screen that’s constantly pinging with alerts and notifications.

And my cofounder, Pat Dossett, likes to say that if you have to look outside yourself to understand how you are feeling or performing — which is what we do when we look at screens — then you’ve missed a critical step: understanding from the inside out how your actions are affecting you.

EL | Has Madefor helped you change your own behavior or thinking?   

BM | I like to be on the move. I’m always seeking the next adventure or creating a perfect moment to share with the people in my life. In the past my focus was always on the results of my effort, about finding the peak. Since Madefor, I’ve learned to enjoy the journey more.

It has also helped me forge a more resilient mind. I see short-term setbacks in a more positive light now, recognizing that this is part of the journey and not a sign that I’m incapable of getting where I want to go.

For example, getting my kids dressed and out onto the slopes for ski school is a massive ordeal. It sounds like a small thing, but now, the struggle doesn’t really bother me. In fact, some days we never make it to the slopes, and I’m OK with that, too.

To me, this shows how Madefor has helped me be more compassionate. Often we think of compassion as something you have for others — but I now see that it’s also about the grace we extend to ourselves. We may begin each day with the best of intentions, but sometimes things don’t go as planned. We fall short or fall off entirely, and that’s OK. We’re human.

I’ve found that extending myself the same compassion I give to others allows me to be more resilient and helps keep me on my path.

EL | What healthy habits do you come by naturally?   

BM | Doing something physical every day helps me stay sane. It could be a great workout, surfing, rock climbing. Being active is my normal state of being.

EL | The words “The more you give, the more you live” are featured prominently on your website. Is this a motto you live by?  

BM | Yes, this is definitely something I live by. You can’t take material possessions with you. So, whether it’s giving to a local nonprofit, investing in a new startup I believe in, or fulfilling a bucket-list item for someone close to me, it all brings me an immense amount of joy.

In my daily life, it really starts with my kids and my partner. I find that if I wake up thinking how I can serve them, help them, give to them in a way that meets their needs, then my needs almost always get taken care of naturally.

Outside of my family, I always try to have a few key nonprofits I am supporting, so I stay connected to how much need there is in the world and the amazing people on the front lines addressing it.

EL | The past year was difficult, and we’ll be recovering from 2020 for some time. Are you as hopeful about our collective future as you are for individuals seeking change?   

BM | Yes, I am hopeful. I believe one day we will look back on the challenges we are currently navigating as the very things that made us — maybe even forced us to — be better.

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