The Dr. Hyman Show - Exclusive Dr. Hyman+ Functional Medicine Deep Dive: Long-Covid & The Immune System

Episode Date: April 27, 2021

My team and I are excited to introduce our revolutionary new platform, Dr. Hyman+, which offers premium content, perks, and information available exclusively for Dr. Hyman+ members.  In this teaser episode, you’ll hear a preview of our third Dr. Hyman+ Functional Medicine Deep Dive on Long-Covid and the immune system with Dr. Elizabeth Boham. To gain access to the full episode, head over to https://drhyman.com/plus/. With your yearly membership to Dr. Hyman+, you’ll gain access to: Ad-Free Doctor’s Farmacy Podcast episodes Access to all my docu-series, including Broken Brain 1, Broken Brain 2, Longevity Roadmap + bonus material Exclusive monthly Functional Medicine Deep Dives Monthly Ask Mark Anything by you and only for you

Hey everyone, it's Dr. Mark Hyman here. Now my team and I have been working hard on something that I'm so excited to share a little bit about today. It's a revolutionary new platform called Dr. Hyman Plus, which is a premium membership exclusive for my community. With Dr. Hyman Plus, you get a ton of private content and special access that no one else gets. This yearly membership gives you exclusive access to ad-free Doctors Pharmacy podcast episodes, access to all of my docuseries, including the Longevity Roadmap and Broken Brain 1 and 2, plus all the bonus content. You get monthly functional medicine deep dives where one of our doctors goes deep into a health topic to tell you everything you need to know to heal.

You'll also get access to a monthly Ask Mark Anything Q&A where I answer the Dr. Hyman Plus community's biggest health and wellness questions. This Q&A is only accessible with a membership. Now, because I'm so excited to share this premium membership content with you, I'm releasing a teaser of the brand new Functional Medicine Deep Dive episode diving into one of the most important topics in health. I hope you enjoy it and head over to drhyman.com forward slash plush. That's drhyman.com slash PLUS for more information. Okay, here we go. Hi everyone and welcome to another episode of Dr. Hyman Plus. Today, we're going to be talking about long COVID and the immune system. So welcome. My name is Elizabeth Boham. I'm a physician

and the medical director at the Ultra Wellness Center in Lenox, Massachusetts. And for the next hour, we're going to be really diving in deep. So we're going to take a functional medicine deep dive into a topic. And today the topic is the immune system and long COVID, which I know everybody's really interested in hearing more about. So we're going to really just talk a little bit about the functional medicine approach to what we can all do to support our immune system. And if we are struggling with some of the sequela of COVID-19, you know, what can we think about? How can we help support our body through that process?

And so that's what we're going to really be doing a deep dive into over the next few minutes or hour. So long COVID, the official name is now post-acute sequela of SARS-CoV-2 infection, or PASC, right? Post-acute sequela of SARS-CoV-2 infection, which is COVID-19 infection. So when somebody has the sequela of having had that infection for a long period of time, more than two months, we're calling it long COVID. But I want to just start with the immune system. We really want to start with the immune system. So, you know, we've all learned a lot more about the immune system over the last year with dealing with COVID-19, just everything

that's, you know, in the press and what you're learning about. But I want to just describe it a little bit more, help you understand some of the terms if you don't, and then we're going to be circling back and talking about COVID-19 specifically. So our immune system, we've got this amazing immune system. It is a collection of cells, tissues, molecules, and its function is to defend us against infectious microbes. So bacteria, viruses, tick-borne infections, parasites, foreign matter, and abnormal cells. So the immune system's job is just spending time looking around and saying, should this not be here? I want to get rid of it if it shouldn't be there and keep my body safe. And so the system is phenomenal and it's working all the time in our body, really in surveillance, making sure that something is not present that shouldn't be present.

And one big major part of the immune system is the innate immune system. So the innate immune system is the immune system that's active all the time. It doesn't need to be primed or to learn what it needs to do. It's a part of the immune system that's ready to fight at any moment. Okay. It's immediately called into action. Part of the innate immune system, there's lots of cells in the innate immune system, right? They talk, we talk about here, the neutrophils and macrophages

part of that, the immune system. But in addition, there's also this first thing here, the epithelial barriers of our skin, our GI tract and our respiratory tract. So, so barrier function is really important in that innate immune system, right? We have the nasal passageways, our skin, the inside of our GI system, all of those barriers are critical, are critical for preventing things from getting into the body that shouldn't be getting into the body. Okay. So that's an important part of the innate immune system. And we're going to talk a little more about that in a few minutes. So I want to just really highlight that, that these epithelial barriers, these mucosal barriers are critical. And, you know, many times people are,

you know, they will use saline nasal spray, right. Just to, to help flush out any viruses or particles, antigens, things that the body might be allergic to from the nasal passageway so they don't get in and cause an infection. And that's something we can do just to stay healthy, right? So that barrier and keeping that barrier working well is critical for the innate immune system. We talked about those white blood cells that are part of the innate immune system. We also have these natural killer cells. These natural killer cells are part of the immune system that go around and gobble up things that shouldn't be there. We speak about that all the time with cancer prevention. It's also really important when we're dealing with, you know, prevention of getting sick,

right? We don't want good natural killer cell activity. People always talk about how those Asian mushrooms really help support our natural killer cell activity. So let's use an analogy. We're going to use a bank robbery, right? So when somebody comes in to rob a bank, the security guard that's standing outside the bank that's always there, you know, you've got a bank, there's a security guard outside, the security guard that's always there. Think of that as your innate immune system. He's ready to prevent the bank robber from coming into the bank as much as he can, right? That's his job, his or her job, right? That innate immune system. Now, there's another part of the immune system that learns how to handle infection. And that's called the adaptive immune system. So if we use the analogy of the bank robber, the the police officers that are specially trained at getting or handling a bank heist are the part of the, they learn how to handle that

situation. So a bank robber comes in, there's a security guard out front, but the bank robber gets past that security guard. And what happens? You end up calling the special police officers in who deal specifically with bank heists. So they don't stay at the bank all the time, but if there is a bank heist, they come in and they handle that situation. Okay. So what that would be, would be your adaptive immune system. Those specifically trained police officers come in in specific situations. And that's what happens in our immune system as well. So the adaptive immune system is normally silent, but if it sees an infection that shouldn't be there, or it sees an infection that it's known, it's seen before, it comes under, it gets revved up. It starts doing

its job and getting rid of those things that should not be there. So that would include part of your immune system, like the B cells and T cells. These are part of the immune system that learn over time. And this is how immunization works. It primes our adaptive immune system so that if we get exposure to that infection again in the future, that it has the, you know, it's ready to go. It's ready to attack those things that shouldn't be there. The first time that you get exposure to an infection though, what happens is this is the first, you know, the first infection. What happens here is the innate immune system responds really quickly. It's not very specific, but it responds very quickly. Okay. And the adaptive immune system is slower to respond.

And then over time, it can respond more quickly the second time or the third time. Or if you have had exposure to that infection, you know, your body's ready to go and will respond more quickly the second time. Or if you've had a vaccination, then the body knows, okay, I've got to respond to this more quickly. That's the adaptive immune system. So I just wanted to go over those a little bit. So now let's circle back to COVID-19. So SARS-CoV-2. So SARS just means the severe acute respiratory syndrome. So COVID-19 is one SARS infection. And we think it was first identified in Wuhan, China in December of 2019, if you don't remember.

In general, the average time from exposure to the infection to when you develop symptoms is about five days. Because of that, because there's this long time between exposure and symptoms, there is a high rate of asymptomatic transmission, as we've all heard about. It is transmitted through respiratory droplets. So close face-to-face contact, singing, talking, coughing, you're going to spread the infection that way, typically. And typical symptoms, you all know this by now, cough, shortness of breath, fatigue, headache, loss of taste and smell in some people, and for some people also gastrointestinal symptoms.

And as we've all been learning, severe illness is more common with people who are older and people who have some comorbidities. So other things going on. So people have underlying cardiovascular disease, people with metabolic syndrome or diabetes, people with high blood pressure, lung issues, cancer, kidney issues, and definitely obesity. There is a strong correlation with that whole metabolic syndrome and severe illness with COVID-19 and smoking. And this is important to pay attention to because we know that when we get a severe illness, we're more likely to have sequelae from the COVID-19 infection. So typically a mild infection, people are typically sick for, you know, within two weeks. And the severe disease, you know, they are dealing with the symptoms for sometimes up to two to three months. There is a wide range of variability in that. And what increases the risk of somebody having a more severe disease or more long-term sequela from the disease is, of course, the severity of the illness, how sick they get.

So whether they were hospitalized or not, their age, if they had any medical complications with the illness, like they had another pneumonia on top of the viral issue, and of course, your underlying health. And I think that's really important to recognize. We really have, you know, this pandemic has really shed light on the fact that we need to be paying attention to self-care and we need to be doing those things that keep our body healthy. We need to be maintaining a healthy weight and maintaining, preventing metabolic syndrome and insulin resistance, which we talk so much about. It makes a huge difference in terms of how people do. We do know that. You know, when you're looking at percentages, of course, there are some people who don't do as well, which you think they should, and that happens.

But in general, this is what you see. So again, risk of hospitalization and a poor outcome from when you get COVID-19, your underlying risk factors. If you have a lot of history of chronic diseases, your weight, type 2 diabetes, we also see it with people who are underweight. Anything that's increasing inflammation in the body increases our risk of having a lot of inflammation when we get COVID-19. So that's important just to pay attention to and something we work on all the time. What can we do to lower the person's inflammation in their body?

If somebody comes in to see me, I'm saying, okay, is there underlying inflammation? And what can we do to lower that inflammation? That's true all the time, no matter what somebody's coming to see me with, because we know inflammation is associated with disease. And so when somebody comes in and they wanna prevent COVID-19

or they're dealing with some of the sequela, we're paying attention to underlying inflammation in their body. Here, this study is showing that people with a BMI greater than 45, which is severe obesity, 33% increased risk of hospitalizations and unfortunately 61% increased risk of death. But poor nutrition and under is also increases risk as well. Okay. So let's get back to the PASC or post-acute sequela of COVID too. And so this study here looked at, you know, how common is this PASC or long COVID syndrome? How common is it?

Well, for people who are hospitalized, and there's multiple different studies out there. This is just one I picked, but they're similar in terms of percentages. One of the things I think is important to recognize is we think about 1% to 5% of people who get COVID-19 require hospitalization. So, you know, it's interesting, you know, some people think it should be higher than that or lower than that, but it's about one to 5% for what we know now. Okay. And what they, what they noted is that people who required hospitalization, 52 to 87% of those had symptoms for at least two months. So this study was looking at 1,600 patients. It was done in the U.S.

And they noted that 60 days after discharge, about a third still had symptoms. Okay, so these are the sicker patients, people who needed to get admitted into the hospital, but a third still had symptoms two months after discharge. And there are some other studies showing higher percentages and different percentages, but it is a significant situation. Most common symptoms are shortness of breath, especially when people are trying to climb stairs, cough, all over body pain, and that loss of taste and smell, which can linger for some people. So let's say, what about long COVID or PASC in people who are outpatients? So they never needed to go into the hospital. This study looked at 177 patients, and of those patients who were symptomatic with their COVID-19, 19% had one to two persistent

symptoms at six months, and 14% had greater than three symptoms. And a good percentage were really reporting a decreased quality of life, 29%. Most common symptoms here were fatigue, loss of sense of taste and smell, and shortness of breath. That's what dysp and smell, and shortness of breath. That's what dyspnea is, if you're not sure. So even in outpatients, we are seeing this PASC or the post-acute squalor of COVID-2. So, you know, really, we are seeing it. And it does make us take a step back and say, what's going on in that person's body?

What can we do to help improve how the body is functioning? Well, I hope you enjoyed that teaser of exclusive content that you get every single month with Dr. Hyman Plus. If you want to listen to the full episode and get access to ad-free podcast episodes, plus all the content from my docuseries and, of course, any future ones we're going to release, plus monthly Ask Mark Anything episodes, plus monthly functional medicine deep dive episodes. I guess, right, that's why we call it Dr. Hyman Plus. Head over to drhyman.com forward slash plus, that's drhyman.com forward slash plus that's drhyman.com slash PLUS to learn more. I'll see you there.

Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.