Episode 80: Decoding Long-COVID How to Heal Using Root Cause Medicine with Dr Anna Sattah, MD

Show Summary:

Today we're excited to bring you a conversation about treating long-COVID using functional medicine with Dr. Anna Sattah.

Dr. Sattah is a critical care physician and recently joined our team as a functional medicine practitioner at Capital Integrative Health. After spending nearly 10 years practicing in critical care, in particular through the COVID-19 pandemic, Dr. Sattah turned to functional medicine to learn how to improve patient’s resilience in advance of a COVID infection as well as for addressing Long COVID.

As the world is still coping with the COVID-19 pandemic, many individuals are experiencing long-lasting symptoms, often for months after their initial infection. This can be tough to deal with and can leave people struggling to get back to their normal lives.

If this resonates with you, this is an episode you don’t want to miss. Please enjoy.

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Full Transcript:

Dr. Anna Sattah:

I think a lot of people who have been to many, many providers, they've had a lot of conventional testing already. And they probably tried a lot of things themselves, and they're not getting anywhere. And so if if I see those patients and I'm like, well just go home and eat a healthy diet, I think that's not going to be enough to pull them out of this system. Because when we talked about all the different ways that COVID could affect you, if it's affected your ability to absorb amino acids and proteins, you don't have the building blocks. If it's affected your mitochondria and you don't have the cellular energy to start in the repair process, then, then we need to do something about that because you trying to exercise is actually going to be depleting energy that you just don't have.

Dr. Andrew Wong: 

Welcome back to the Capitol Integrative Health podcast. I'm your host, Dr. Andrew Wong, and today we're excited to bring you a conversation about treating long COVID Using functional medicine with Dr. Anna Sattah. Dr. Sattah is a critical care physician by training and recently joined our team at Capital integrative Health as a functional medicine practitioner. After spending nearly 10 years practicing in critical care, in particular to the COVID-19 pandemic, Dr. Sattah turned to functional medicine to learn how to improve patient's resilience, as well as to address long COVID. As the road is still coping with COVID-19 pandemic, many individuals are experiencing long lasting symptoms, often for months after their initial infection. This can be tough to deal with and can lead people struggling to get back to their normal lives. If these experiences of long COVID or chronic fatigue, it resonate with you or your loved ones, this is an episode you don't want to miss.

Welcome Anna to the podcast. So glad you're here. Good to be here. Thanks. And we're of course, so glad you've joined Capital Integrative Health as a functional medicine doctor. Now before joining CIH, you are a critical care doctor. And let's let's kind of talk first about what drew you to become a functional medicine practitioner. After years of working as a doctor in critical care.

Dr. Anna Sattah: 

I guess it started some with the COVID pandemic, because I was seeing all the patients who were coming in with COVID. And we really didn't have a lot of treatment options for them. Like we could put them on the ventilator. But we didn't have a lot of things that were changing the disease course. And I kind of looked at all the research I could find from anywhere. And when they didn't find a lot of support in conventional medicine, I felt like you had to start looking at how do you support the patient's own immune system, so that your body that and I think your body's smarter than the rest of us can try to figure out how to fight the virus itself. And that goes back into your own native immune system and resilience. And that's not something that we look at as much in conventional medicine, but it's a lot of alternative medicine. And I was also trying to figure out how to make sure that if my husband and I got COVID, that we didn't end up like the patients I was seeing in the ICU that I couldn't help. And that led me down a lot of different routes and ultimately to functional medicine.

Dr. Andrew Wong: 

I think as healthcare professionals really called to, you know, be of service to the highest good and you're trying to help people etc. And I think this COVID pandemic, especially in the beginning, when the mortality rate was so high, really led to a lot of you know, physician and provider and health care, professional burnout, and really trying to find the like you said the why of why the immune system not not reacting, you know, appropriately to this to this virus to this disease.

Dr. Anna Sattah: 

I think there was a lot of, you know, I would get phone calls all night from the nurses about blood gases and labs and things that just they were not survivable lab house values, and you knew that in trying to figure out what can you do that is still helpful to people when you can't save them? Yeah. And so I looked in a lot of different, a lot of different avenues there.

Dr. Andrew Wong :

So speaking of kind of the root causes of, of COVID, we know that a lot of things that kind of occur to increase the risk of you know, someone dying from COVID, or having an adverse outcome from COVID, including long COVID, which we're gonna talk about today, are some of these kind of root cause physiologic factors that cause imbalances in the system, you know, the biological system, but today, we want to talk about long COVID. I know you've kind of gotten interested in that and been doing a lot of research on that. So I'd love to kind of take a deep dive into that into the rabbit hole like to say, as well.

Dr. Anna Sattah:

I guess this started because even before long COVID was recognized. I had some of my colleagues from the hospital who developed COVID Early on in the pandemic and this was well before the vaccines and they weren't recovering. Some of the I mean, some of them clearly did and they were back towork in a week or two, but some people were out for months and months, and some people never came back. And because they were physicians, and they could imagine every different pathology that this might be, they would get all kinds of extensive workups and CT scans and MRIs and they would see every specialist that they knew. And no one was really finding solutions for their symptoms. And a lot of it was really severe fatigue that wouldn't resolve and dyspnea that wasn't going away. And so the more I was researching into how do you support your own body's defense systems from the standpoint of acute COVID patients, I was also looking for how do you treat all these patients with long COVID? And as that became a more recognized syndrome? And you could predict how many people got COVID? And how many people? Is this long COVID syndrome going to affect them? What are you going to do about it? It just, yeah, I spent a long time looking into that.

Dr. Andrew Wong :

Potentially millions of people, right, because, you know, the Marathi population probably has had at least one exposure to COVID. At this point around the world, I would say, certainly in the US, let's kind of go back formally in terms of is there a formal definition or heads or consensus statement on what is long COVID.

Dr. Anna Sattah:

There's a lot of different people who define it, then there's some definitions that say any of your symptoms that lasts longer than then four weeks, a lot more people are saying the symptoms that lasts longer than 12 weeks. And, and there's a broad range of symptoms that people are looking at the most common would be like fatigue, and post exertional fatigue. So you go out and you're trying to exercise and you actually feel worse. Persistent, dyspnea, or shortness of breath is a big problem. Brain fog and just not being able to think straight and cognitive difficulties is an issue difficulty sleeping, people are having changed changes in their taste and smell that aren't resolving in a lot of patients that does resolve but in some patients, it becomes chronic. And then you can get kind of aches and pains or headaches, different GI symptoms and rashes and mood disorders, anxiety and depression are very common. And there's something called Potts, which is an autonomic autonomic dysfunction, where essentially the nervous system telling your organs, what they're supposed to do is not working right. So the central nervous system control of your heart rate, for example, isn't working well, or the control to tell your blood vessels to constrict so that when you stand up, you don't get lightheaded. That's not working well.

And we're seeing that, and it seems very similar to something called chronic fatigue and myalgic encephalitis, which has been recognized several decades ago, and may be associated with EBV virus, or Epstein Barr Virus. But it seems like you're getting kind of the same constellation of symptoms for a lot of patients post COVID. And then you try and go through and say, Okay, well, what can account for all these different presentations? Yeah, so it sounds like there's a label of long COVID of chronic fatigue.

Dr. Andrew Wong :

What are some of the postulated, I think, you know, scientists still trying to figure this out. But what are some of the postulated mechanisms by which long COVID or chronic fatigue happens?

Dr. Anna Sattah:

So there, there are a lot of mechanisms, I think one of one of the most common ones that people talk about is mitochondrial dysfunction. And in conventional medicine, we talk about mitochondrial defects in pediatrics, like children who cannot create the cellular energy and they and it's obvious from birth or from very, very early in life, and there's these genetic deficits, but you can get mitochondrial defects that have arisen throughout your life where things used to work fine. And now they're not because certain enzymes aren't working well, or because there's been too much oxidative damage. And it seems like COVID has caused a lot of damage to the mitochondria. And the mitochondria are in every cell in your body. So they're in all the neurons there. And all your cardiac cells are in all your muscles and everything. And if you look at those organs, that use the most energy, your brain and your muscles would be some of those, those organs and they need a ton of mitochondrial energy or ATP. So if that systems offline, then it's going to be hard to repair anything. Well, so see, so COVID entered cells through the h2 receptor. And originally, we talked about h2 receptors as being in lungs, but it's actually their h2 receptors all throughout the body and all sorts of tissues, and particularly in the endothelial cells or the lining of the capillaries. But if you think of the capillaries that the capillaries in every organ, that's where you deliver oxygen to the tissue of every single organ, and if COVID is disrupting that endothelial lining, and so you're not good. Then grade oxygen connection, then you're getting damage to those tissues because you don't have oxygen. Plus, you can develop micro clots in those vessels. And it looks like there are some patients who have an increased propensity to create micro clots. These are potentially be the same patients that have increased clotting, that would have been really helpful in a trauma. And everything comes in, in a spectrum. And so some people clot more, more easily or less easily. And it seems like those patients who may have an easier time clotting also have an easier time making these micro clots, which just makes it that much more difficult for you to exchange oxygen to the tissues, we know that those h2 receptors are on so many different organs that yes, you're going to get effects to the brain, you're going to get effects to the gut, to the kidneys, to the pancreas to everything.

So that explains a lot. And then it affects your ability to absorb proteins. And some of that may be the interaction with the gut lining. But if you can't absorb amino acids, which are the building blocks of proteins, then you can't get your body to kick it over into more of a healing response. Because you don't have the building blocks that you need. And you need energy to repair stuff. So you need your mitochondria to be working, you need to be absorbing your nutrients, which people aren't doing well. You need blood to be flowing where it's supposed to be flowing. And that's not working well. So there are a lot of different things that I think are contributing, we know that there was a lot of oxidative damage. And I think of oxidation as like if you cut an apple and sit it down on the counter, it turns brown, that's oxidation. And we have a certain amount of antioxidant capacity in our body. And frequently we think of that as your glutathione stores. But there are a lot of antioxidants. And that system seemed to be completely overwhelmed and COVID. And people's glutathione levels were crashing and and then if you don't have the reserves to rebuild it, then you can't dig yourself back out of that hole. Yeah, so I think I think there's a lot of things that go into that.

Dr. Andrew Wong :

So in a way COVID It sounds like it's been crashing the entire kind of biological matrix that we we looked at in functional medicine.

Dr. Anna Sattah:

Yeah. Because I think if it was just one thing, then it would be much easier for people to identify what that thing is. And then you treat that thing and people get better. But this concept where people get really diffuse symptoms that are very nonspecific, is a lot harder to treat. And it makes sense that the vascular system or the capillaries carrying that oxygen to all the organs, all the tissues, so it's affecting basically every every cell in the body. Yeah

Dr. Andrew Wong :

What about the idea of reactivation of viruses or IPs or reactivation Lyme and stuff like that.

Dr. Anna Sattah:

So I think when I think a lot of people have viruses in their system that aren't causing problems, so if you know anybody, or if you have issues with cold sores, and it seems like they always flare every time you're under a lot of stress, or you haven't slept well or something, that virus is in your system all the time, and most of the time, your body has the ability to keep it under control. But if you're under really severe stress, then that virus can flare. And certainly COVID Was that stress for a lot of patients. So they're seeing reactivation of Epstein Barr Virus and some of the other herpes viruses, for patients who have chronic Lyme disease and other infections that seems to worsen those symptoms as well. And then once those symptoms get worse, they're that much bigger a draw or a drain on your body. And it makes it that much harder to recover from them.

If it impairs your ability to sleep. So for example, if you're not absorbing amino acids appropriately, and you can't produce melatonin, and you can't sleep, well, then you miss all the benefits and the restorative capacity of sleep, which makes it that much harder to sleep. And so you just get into this kind of downward spiral. And I think unless you can really identify some of the triggers, it's hard to come out of that.

They've done some studies on the gut microbiome or basically the population of bacteria that's in your colon. And patients who have long COVID seem to have a different population of bacteria in their body or in their colon and they lose a lot of the beneficial bacteria and you need those bacteria to help your immune system. kind of know what to be trigger happy about and what to lead be on how reactive to be. And so that gut dysbiosis can cause problems and it can cause mood and psychiatric problems then it just energy and autoimmune issues and GI symptoms. So you need to worry about the gut microbiome and try to correct that. And in the same way that people can have reactivated viruses, you can have reactivated gut pathogens that had been well controlled and not really been causing any symptoms, but we're sort of sitting in a dormant state in your colon. And now, the body's defenses have dropped. And so, the Giardia that you had 20 years ago that hasn't hasn't caused you a problem in you know, in decades. Now flares again, like you weren't in the woods, so nobody's testing for giardia, like that would seem ridiculous. So I think unless you do specialized stool testing and save, what is your gut microbiome? And do you have pathogens and what are they? And do you have leaky gut, you're not going to identify those things?

Dr. Andrew Wong :

Yeah, and I think we've talked about this a lot on this podcast, but we know that the majority, at least 70% of the immune cells are in the gut, right? So and of course, the immune cells are talking to the gut microbiome crosstalking, bi directionally. I think we also know that kind of COVID is almost like an an airport, customer or a person that goes to the airport, I should say, not a person, but let's say a virus that kind of once passed, once it passed security, they kind of you know, go into various terminals in a way and then it's sort of like it's very hard to find. So is there any role for persistent viruses special instance, we know that the gut and brain are some of the reservoirs for for COVID for like persistent COVID? Is there any sort of mechanistic way that that could be causing?

Dr. Anna Sattah:

Well, COVID. So I think there can be those same patients that have an increased propensity to form micro clots, they form more fibrin in their system, and their body doesn't break down the fibrin as efficiently. And fibrin is one of the components that builds clots. That's, that's why it's impacts your ability to make clots. But it's also something that bacteria and different pathogens and things can use to make biofilms on. So basically, these extracellular matrices that surround different pathogens, and make it much more difficult for your body to identify them, it makes it more difficult for antibiotics to hit them or antiviral agents and for your immune system to identify them. And so there's a thought that patients who have chronic infections have an increased propensity to form these biofilms. And you'll see that for example, when people have Lyme disease and the Lyme spire kids can be in the biofilms or people have chronic urinary tract infections that keep coming back over and over and over again, some of that bacteria can be sitting in biofilms in the bladder, and so you give antibiotics and it doesn't clear. And we know that same, those same biofilms can also trap viruses. And so this is speculating a little bit more because I don't know that they detected specifically back SARS cov. Two virus in these biofilms but they've detected a lot of other viruses. And we know that there's persistent virus in the body. If you do like stool samples and look at the the T regulatory cells in the body, which is part of your immune system, you can see evidence that there is still persistent virus or at least viral fragments in the body months and months and months after infection. So something is still there. And is that viral particles is that dormant virus or you know, hiding virus in the gut lining? We're not totally sure. But it's not gone. And some patients see, you know, one of the ways we we understand that that's an issue is that for some patients, they get a vaccine after they've had long COVID in the vaccine seems to then clear up their symptoms, perhaps because it reactivates their immune system, and they wipe out whatever residual viruses are there. Okay. That wouldn't work if, or I wouldn't expect that to have any effect if there wasn't a virus sitting there. Yeah. But yeah, so there's something hiding in the biofilms viruses, viral particles, maybe some other bacteria. Yeah, the different things like that. And I don't think I think there's so many places that COVID could hide that. I don't fully understand that saying it's definitely in a in a biofilm, or it's definitely in the gut. We just know that. It's not as simple as three weeks later, it's completely eradicated from your system.

Dr. Andrew Wong :

It's a house with a lot of hiding places. Yes, it is. Well, I think that let's get into treatment because I know that the listeners may either themselves or know people, their loved ones and friends that that may or may have you no no, someone I think most people know someone that has had either some sort of persistent or long COVID What are some of the the big treatment modalities we kind of think about systematically in a functional way in terms of hey, how do we how do we kind of start addressing this?

Dr. Anna Sattah:

I think some of it needs to start with lifestyle, because if you're going to try to optimize your body's own native ability to fight off an infection, you're going to need to be getting good nutrition and lots of healthy plants and proteins and a fiber in your system, you're going to need to be trying to get as much sleep as you can and decreasing your stress.

And for a lot of patients who have ongoing chronic inflammation from various food triggers, like whether that's gluten or dairy or eggs, which are very common in patients, I think, identifying those, and then like optimizing those, as much as possible, is really a necessary foundation to get any kind of healing happening. But then once you start working on that, for example, I think a lot of the patients who have chronic fatigue, that one of the biggest issues is mitochondrial function. And there's some specialized testing that looks at urinary metabolites of some of the biochemical steps to make ATP, on ATP is that energy production in all of your cells, is kind of like the gasoline for all the cells. And you need to have adequate supplies. And if there's one step in that pathway, that's not working, and we needed to support that step, then I would want to identify that and and do that.

There's some specific testing that we can do of the urine that identify some of those individual steps. We also know in general, things like CO Q, 10, and B vitamins and D ribose. And a number of other supplements can help support the mitochondria in general. Magnesium is very important as a cofactor for a lot of the enzymatic reactions that need to be working in all your cells. So trying to support the mitochondria, I think is helpful and doing that with a kind of a lab guided approach. So you know exactly what it is you're treating, instead of just taking handfuls of supplements is helpful. I think doing specific stool testing to see what is the status of any potential pathogens and whether or not you're absorbing your food appropriately. And looking at if you have leaky gut, or if you're reacting to gluten, trying to support those, support those systems, so that your body can rebalance itself and kind of re titrate the immune system. So it's not quite so trigger happy. There's something called the cell danger response, which is kind of your body's on the cells way of saying, hey, there's a problem, there's a problem. And it sends off alarms and creates all these cytokines. And we heard about cytokine storm with COVID. And there's some people where it seems like that alarm just never got turned off. And so their body stays in this chronic state of inflammation. And until you can turn off that inflammation, you're not going to heal. So trying to turn that down, certain fish oils can be helpful, there's something called as PMS or specialized pro resolving mediators, which are involved in the body's way of realizing it needs to turn off the alarms. So if if you've lost that sensitivity, trying to restore that can be really helpful as an addition to fish oils. Yeah, it's it's basically a step further down in the biochemistry of fish oils. So if you think that for whatever reason, you can't process fish oils to get to SPM, you could just take SPM. But I would want to have a little more, a little more data on that.

Dr. Andrew Wong 

So I have some broad questions in the specific questions about treatment. So the broad question is, let's say I know someone that has lung COVID. And they kind of are interested in some of the functional testing, but maybe they've kind of already been up the wazoo with being to doctors, being to practitioners being frustrated, wanting to get some sort of process going right now, where are you in terms of recommending to that patient? Hey, maybe starting on the lifestyle factors first noticing of exercise can help and nutrition can help and anti-inflammatory kind of lifestyle can help. Before getting into the specific things like organic acid testing and gut microbiome testing.

Dr. Anna Sattah:

I think a lot of people who have been to many, many providers, they've had a lot of conventional testing already, and they've probably tried a lot of things themselves, and they're not getting anywhere. And so if if I see those patients and I'm like, well just go home and eat a healthy diet, I think that's not going to be enough to pull them out of this system. Because when we talked about all the different ways that COVID could affect you, if it's affected your ability to absorb amino acids and proteins. You don't have the building blocks if it's affected your mitochondria and you don't have the cellular energy to start in the repair process, then, then we need to do something about that because you trying to exercise is actually going to be depleting energy that you just don't have, by the time they've seen you. They've probably been, it's pretty complicated. Yeah, yes. So I think, at least starting with some of the organic acids testing or even if it's just empiric treatment for the mitochondria with, you know, there's probably five or six different supplements that can be supportive of the mitochondria and trying them for at least a month or two to see if that helps. I think it'd be helpful particularly for patients who are just exhausted and they're sick of seeing doctor after doctor after doctor that runs a test and then doesn't have a way to intervene.

We know there's some effect of autoimmunity that seems to be kicked off. And so low dose naltrexone, which is a way of

modulating the white blood cells responses and the immune system responses, that seems to be helpful for some patients. And it's a compound in prescription. Yeah, so this is the same medication that is actually used for reversal of narcotic overdoses. But when you're reversing narcotics, you're using doses of like 50, or 100. And we're using low dose naltrexone, to try to modulate the immune system you're using like one and a half milligrams, or three milligrams, or four and a half milligrams. So it's it's much, much much lower doses. But at those doses, it seems to affect the reactivity of the white cells, so that you can kind of decrease that inflammatory and autoimmune response. We've also seen that LDN I mean, be helpful in some patients with with pots to purchase more Orthostatic Tachycardia Syndrome.

Dr. Andrew Wong :

What about the role of biofilm we touched on that earlier and how sometimes that biofilm can produce this covering that is kind of cloaking the bugs, whether it's viruses or other things from the immune system, what are your kind of go to treatments for looking at kind of biofilm reduction there?

Dr. Anna Sattah:

So I think you can, you can take it from two different perspectives. There is some specific testing that you can do for hypercoagulable look workup to see if you have some of the known propensities to create more clots. And that gives you a much more sure footing that yes, this is an issue for you, and you're on this supplement to treat this issue. And it may be a longer term issue. But we know medic, our supplements, like Lambro kinase are can help your body break down fibrin. And fibrin. It's not that you want to completely break down all the fibrin in your body. But your body's always producing some fibrin and then breaking it down and you want that system to be imbalanced. And if your body's breaking it down very slowly. And so little bitty micro clots that are sitting in the capillaries are staying there and they're not getting cleared out by the right systems, then taking some lumbar kinase to try to help support that is helpful. And there are a number of different fibrinolytic type agents that can be helpful.

And they work differently than like blood thinners or anticoagulant or antiplatelet agents. They're not nearly as strong as those agents. And when you think about somebody who's on like blood thinners for atrial fibrillation, that's a much stronger way to thin your blood and decrease your ability to clot.

This is more trying to adjust how long fibrin hangs out in your system. Yeah, because if it hangs out too long, it might turn into a biofilm. Yeah, essentially, yeah.

Dr. Andrew Wong :

Oh, how about IV nutrition. I know that you know, we we do some IVs here, of course, but I know this is something that maybe people would be interested in.

Dr. Anna Sattah:

So I think when you talk about all of the deficiencies that can develop like all the different B vitamins and magnesium and different things, once you are as deficient as some patients can be, then it can be difficult to absorb things. So even if I gave you like 20 bottles of supplements and not that I would do that. But say say you had a ton of supplements and you were taking a handful of pills every time you had a meal. You might not be absorbing those that well. And so in some patients I think going to IV nutrient support can be helpful when their own innate ability to to absorb has been compromised. And it's not that I think you'll need that forever. But I think that can be certainly a bridge to get enough healing going that then you can go back to more oral forms. There's also called something called phosphatidylcholine which is one of the chemicals that is used to make up cell membranes and the membranes and all your all the cells and the organelles in your body.

And that's particularly important for the membranes in the mitochondria because the mitochondria don't function well unless the membranes are nice and fluid and, you know, not oxidized. And so if there's been a lot of damage to the mitochondrial membranes phosphatidylcholine can be helpful. And you can do that as IV and you can do that as oral. So, I think I think there are a lot of people that could benefit from phosphated Okay, that makes that makes a lot of sense.

Dr. Andrew Wong :

Um, just to add that, you know, on the lifestyle and also on the bodywork, integrative wellness, I think having some, some body work can be really helpful in activating mitochondria. It's PT, or massage, or acupuncture. Some sort of exercise. I know, we talked about exercise at first, but I think like you said, you have to be kind of conservative with that in terms of not not over exercising, because that would be to mitochondrial uncoupling, and basically a decrease in ATP.

What about your thoughts about nitric oxide we talked about earlier how capillaries can be inflamed, and you know, the vascular and the ileum can be kind of affected by COVID. So then we have a decrease in nitric oxide.

Dr. Anna Sattah:

Yeah. So I think nitric oxide is what your body uses to dilate your blood vessels. It's, it's the way Viagra works. And you need to dilate blood vessels for Viagra function. Yeah. But you also need that in all your capillary beds. So when you get up and you know, if you're gonna go and do something that's a little more aerobic, and you need your blood vessels to dilate some so you get a little more blood flow. You do that via nitric oxide, and you can detect your body's ability to create nitric oxide, just put these saliva test strips, it's a little strip of plastic with a little piece of filter paper on the end, and you put some, you know, you stick it in your mouth for a few seconds. And basically, it turns a different shade of pink. And when it turns nice, bright pink, that means that you've good got good nitric oxide function. And when it doesn't change, you really don't have great function. And there are a number of supplements that you can take to support nitric oxide.

And in foods can help you be beetroot juice can help on a number of other things, but trying to support the nitric oxide, so the capillaries are doing as much as possible is helpful. We know there was a lot of endothelial damage, so the lining of the blood vessels in the lining of the capillary system. And there's, there's another supplement that tries to help support that lining. That's the the glycocalyx, which is kind of the inside lining of theblood vessels. It's, it's a little bit of a slippery, slimy layer on the inner side of the capillary network. And it protects the endothelial cells below it. So if you think of almost like a Teflon coating, protecting the endothelial cells, and that's one of the things that gets damaged in diabetics who develop micro vascular disease over time, because this protective coating on the inside of the vessels kind of shrinks away. And now the epithelial cells are exposed to all of the blood cells that are rushing by and all the plasma and everything and you just get more damage to those cells. So if you can do anything to support the glycocalyx, that can be helpful. I don't know that there are direct studies yet that look at that in relation to COVID. But in a lot of a lot of these because COVID is so new, it's hard to have studies yet because the if you want to find the patients and then do a study and then have follow up for six months or a year, those types of follow up studies just haven't really been completed yet. But that's something that makes sense from a pathophysiologic standpoint, to me, and goes along with capillary health.

Dr. Andrew Wong :

Yeah, I think the kind of the imbalance in capillary health and low glycocalyx status, low nitric oxide status they are measuring. They're starting to research that now and hypertension, which has a similar mechanism there of endothelial dysfunction. So it probably is going to be applicable to other things physiologically, like long COVID or COVID. In general. Let's go to the social media questions. So we actually asked this time, think, Jen, and the team basically has kind of collected some questions from social media. So thank you for all the questions that you are sending to us for this podcast episode here for Dr. Anna. So we do know that there's not really a magic bullet for long COVID that there's all these things that can kind of work in conjunction and build up the body, you know, and in a systematic connected way. In addition to that, we know that there's a need for you know, focusing on the fundamental lifestyle factors is going to build that terrain of immune health and total body health. But there are some things that kind of people are asking about here on social media, so let's go with a no

Just in question first about methylene blue, there's a question about does methylene blue, which is a substance that I think decreases inflammation, does that help with recovery? Maybe if you could get into like what that is, first, I hopefully it's not something that you use to repair cars or something.

Dr. Anna Sattah:

So it is a dye and like it was developed for the fabric dyeing industry, but it looks like it has a fairly strong antioxidant benefit. And in very low doses, it also appears to help with mitochondrial dysfunction. So there's some promise with that being able to help long COVID It's been used in the past for patients looking for neurologic protection and for cognitive improvement. And it seems to have some benefits. I think in the standard, like in standard medicine, sometimes it's used in in certain specific overdoses and other settings. And so this isn't that kind of indication. But I think if it has a potential to help with stimulating mitochondria, which have basically gone to sleep on you, through alternative ways to to activate the electron transport chain and the cytochrome. C system, then it has some potential. I haven't used it myself. But I think it's an interesting and interesting, I have used it for for cognitive decline. And it seems like it helps there.

Dr. Andrew Wong :

And like you mentioned, it is used, I think in the especially in the emergency room for potentially overdoses conventionally. It's just not used, you know, in this way for, you know, cognitive decline or long COVID Yet, you know, it's not FDA approved for that. But you know, I think that that would make sense to potentially try that. So, yeah, it seems like it's very safe to eat. Yeah, it's been around for a long time. It's been around for a while, conventional medicines use it for a while. And yeah, we're just trying to find, you know, what, what are the things that are going to move the needle for people that have had these, you know, chronic issues like long COVID? What about a question about smell and taste, so we know that that COVID can affect smell and taste, and a lot of people will get it for a week or two, and then comes back? The one person is asking about how do you get your Smell Taste back after two years, it's pretty long time.

Dr. Anna Sattah:

So there were a lot of theories early on with COVID, that the virus may actually be getting into the the olfactory nerves and traveling up to the brain. And the more recent research looks like it's affecting the system, Angular cells, which are kind of like supportive cells that are sitting in the olfactory network, and they are supporting and providing growth factors and nutrients to the nerves themselves, but they're not the actual nerves. And at least as far as what I've been able to identify so far, it looks like the sustained Angular cells have a lot of h2 receptors on them, whereas the neurons themselves don't. But if the sustained Angular cells have been damaged, and the neurons have not, they're still not getting the supportive nutrients that they need for the neurons to function well.

And so there are some people who've looked at like olfactory training, which is basically when you have a lot of like sniffing cards and things to try to recalibrate your system. There's different people looking at steroid rinses, or Gabapentin and ours, there's something there. They're stellate blocks, which I think in some academic centers, they're doing in ENT departments that may be helpful. And then I found some studies out of Stanford where they were using basically concentrated plasma, so platelet rich plasma, which has a lot of your, you basically take a blood draw from yourself, and then spin off the plasma, which is the liquid portion of the blood and concentrated, and there's a ton of growth factors in there and other supportive nutrients in that and they've gone and injected that into the cribriform membrane where the olfactory system is, and you'll do multiple injections. And that appears to us to supply enough nutrient burden, or enough nutrients support that people recover some of their sense of smell and taste.

And to me that, you know, that's a not an easy technique to apply to a lot of patients. But it does show that your body still has the ability to heal. It's not like these nerves are just dead and they're never coming back. We just need to figure out how to provide this support that they need. And if part of this is that the sustained ocular cells have been hanging out in this chronically inflamed state, and that's why they haven't kind of gone back to their normal function, then I wonder if there's something we can do to reduce that overall body burden of him formation. So for example, the SPM that we had talked about, this is me speculating at this point. But other things that you can do to decrease inflammation to bring those sustained Angular cells back online to support the neurons, because clearly the neurons don't appear to be dead. They just, it's like they're dormant because they don't have the support that they need.

Dr. Andrew Wong :

So this is not a spelling bee, I won't ask you to spell sis an ocular. I just was wondering, are those cells in the brain or the olfactory and the nail in the air?

Dr. Anna Sattah:

They're in the olfactory system. So they're basically like, if you imagine a packaging system for oranges, where you're packing them all tightly together, and these would be like, packaged right around the oranges if the oranges were the, the olfactory nerves, everything around them? Are these supporting cells come out like glial cells for the neurons? Yeah, very much like that.

Dr. Andrew Wong :

Got it. Okay, that's, that's great. Well, learn something new every day. Not I remember learning about that anatomy class. But that's a great system is that there's all these always supportive cells. And often it's those cells are the ones that are often called symptoms, if they're if they're disrupted, it sounds like.

Dr. Anna Sattah:

Yeah

Dr. Andrew Wong :

And then another thing is that people are suffering from cognition and, and balance. And that sounds like both neurologic kind of things. And he treatments for those those issues.

Dr. Anna Sattah:

I think cognition is going to be a multi factorial problem. Certainly, you're going to need the mitochondria to be up and running optimally for your neurons to be firing the way you would want to. There's also a thought that when people develop leaky gut, that you can get leaky brain. And I know, you guys have talked about leaky gut in earlier podcasts. But basically, that's when the lining of the gut membrane isn't doing its barrier function very well, where there's enough inflammation that things are getting across the barrier of the gut that weren't ever supposed to be absorbed. So gluten is getting across or different pathogens, or different partially digested foods or things are coming into your system and being absorbed systemically. That shouldn't be. And those same chemicals appear to be able to get into the gut or into the brain. And I'm not totally certain about whether the process of leaky gut like what makes the leaky gut is that the same thing that makes the brain the blood brain barrier leaky? Or is it just that the chemicals that are getting absorbed through the leaky gut are then breaking down the blood brain barrier, but either way, it seems like if you can do as much as you can to try to support leaky gut and to heal that you can also support leaky brain. So a lot of the gut restorative techniques are helpful. And there's also something called Lion's Mane, which is helpful. And there's been good evidence of Lion's Mane, not just in like, long COVID. But it's it's been looked at in cognitive decline and in Alzheimer's and in patients who have chemo brain on, like, cognitive issues associated with chemotherapy. So I think that's, that's potentially helpful. There are a number of other supplements that can support brain derived neurotrophic factor, which is kind of this is an oversimplification, but it's kind of like a fertilizer for the brain or for the neurons itself. And organic fertilizer. Yes, exactly. No glyphosate here. Yeah. And the same way for like nerve growth factor was, which is NGF. There's some supportive supplements for that.

In general, we think of exercise as being super supportive for the brain derived neurotrophic factor. But you have to make sure that if you're doing exercise that you actually have the ATP stores to do it. So I think getting some movement so that you're not just sitting there. Static is important. But if you're getting, if you go and do some sort of exercise, and you feel worse afterwards, that now was too much. So even if it's just getting up every hour and standing up, like walk around your house, or go to the bathroom or something so that you are up and moving all the time, but you're not necessarily going for a hike may be helpful as well.

Dr. Andrew Wong :

So no, don't watch Netflix. 24/7 But don't run a marathon. Yes. Okay, exactly. Okay, sounds good. That's that sounds very reasonable here. What is the number one thing that you feel? I mean, this is a kind of a loaded question here. But what is the number one thing or the most helpful things that you found that can help someone struggling with long COVID?

Dr. Anna Sattah:

I think first of all, is to have some faith that your body still has the ability to heal. Yeah. And I think when people have been struggling with this for months and months or potentially years by now and they're not getting better, it can be difficult to have that faith. But I very much believe that, that your body has that ability to heal, we just have to figure out what is standing in the way. And I think getting some testing, particularly to try to support the mitochondria. So you know what you're treating is helpful, both because I think it can be, you know, you might feel a little better. But it's also helpful to see a report on paper that says these symptoms are not just in your head look like, here are the all these markers that are telling you that you don't have ATP. So we're going to do something to try to improve those. But you're not just making up the symptoms or are crazy. Yeah, exactly. And for patients who are having mood, mood issues and depression or anxiety, that some of that same testing includes testing of the neurotransmitters and clearly, if you don't have the right neurotransmitters, then yes, it's gonna affect the way your brain is thinking. And it's not something that you're going to be able to kind of work your way out of, on your own through sort of brute force, you're going to need some sort of physiologic support to get the neurotransmitters functioning well. And so I think just seeing that, on paper, with this thought of this is not all in your head, can be really helpful for patients.

Dr. Andrew Wong :

Seeing is believing. Exactly. And yeah, I think it is a struggle for a lot of people where they've been suffering for two months, four months, six months, over a year. But I think like you said, keeping the faith keeping the hope and someone's in their own ability to, to heal that innate capacity and kind of partnering with, with clinicians and practitioners that are really dedicated to figuring out the root cause, like yourself.

Dr. Anna Sattah:

I mean, one of the things that drew me into functional medicine, is there really is a very different approach to healing. Because in regular medical training, you know, I went to medical school, and I'm a standard physician. But we learn a lot about pathology. And we learn a lot about all the things that go wrong, and how do I classify this disease? And you know, what's the drug that you prescribed for this disease? And how do I classify the next one, but the process of pathology and how things go wrong is very different than the process of how your body heals. And there's a, there's a theory about Saudi Genesis, which is basically healing. And it's different than just reversing the pathology. So I tried to describe this, like, if you had a building, like I could destroy my house in a number of ways, because the the roof could collapse, or it could flood or, you know, it could be burned to the ground, or like, all these different things could destroy the house. And me figuring out exactly how the roof collapsed, or exactly why or which beam failed first, like, that might be helpful to try to prevent the next house from breaking down. But it's not going to fix my house, what I need is to figure out how do you rebuild the house? How do you clear out all the stuff that's broken? And how do you set a good foundation and rebuild it, and that is Sega Genesis, and that's a totally different kind of medicine, than what we typically learn in standard medical treatments. And I think functional medicine really does an excellent job of focusing on Sega Genesis and healing, once you've gotten over something, and the way your body heals, whether it's from COVID, or it's from any number of other things is going to be similar.

Dr. Andrew Wong :

It's a transformational model. And I would say also, Anna, that I think it's really potentially transformation for someone's consciousness and sort of mindset around kind of even the, the kind of the problem or the goal at hand, right? If our if our kind of focus is always on pathogenesis, and there's always a need for that at some point with acute care and different things very, you know, serious things that need to be, you know, handled by conventional medicine, but then there's also a need for Saudi Genesis and rebuilding that house. So I think that combination, but certainly, a lot of people are not really used to that that second side that talked about. Yep. So thank you so much for coming on today and talking about lung COVID. This has been a really broad conversation. hope that's been helpful for all of you listening out there. Thank you for all the questions from social media and Anna, we do have a fun closing question for you. Part of our mission at Capital integrative health, as you know, is making integrative health care more accessible and focusing on the small steps we can take to improve our health. So we'd love to hear from you what is one thing under $20 that you feel has transformed your own health personally.

Dr. Anna Sattah:

So I've been a member of audible for, I don't know, a long, long time, awesome, which is all audiobooks. And I guess it's not going to be under $20 for the length of time I've been doing it but it's certainly less than $20 a month. And having access to all of the different books and things that people have written gives you so much broader perspective on, on things that you just wouldn't have encountered.

I wondered like, and I think a lot of times information can be silowed, where everybody in your field knows all this stuff. And it's all kind of over here, but nobody really knows what's in the other fields. And I think being able to read is very helpful for getting different perspectives. And that's certainly how I found functional medicine.

I think Dale Bredesen wrote a book about the end of Alzheimer's that I listened to on Audible. And they talked about different strategies to reverse cognitive decline, which is supposed to be impossible, like everything I was ever taught says, that does not happen, right? And I listened to this book, and it's like, well, maybe it does. And so I think, being exposed to ideas that you wouldn't have otherwise come across.

Dr. Andrew Wong:

It's literally my mind blowing and powering. Yeah, transformative. That's awesome. Yeah. Thank you so much for sharing that, Hannah. And thank you so much for coming on today. We really appreciate it. Yeah. Thanks.

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