Long-Covid, taking a step back to find the route etiology

 

"Taking a step back to look at the big picture."
Created by D. Troy Roach on Midjourney (26-02-2023)

Long-Covid, taking a step back to find the route etiology

The TLDR: Long-Covid is essentially a minor Traumatic Brain Injury (mTBI). Technically it would be Acquired Brain Injury (ABI)... but I do not see it as fitting either term. I think there should be a new category of brain injury such as Post-Trauma Brain Injury (PTBI?). Post-Trauma is better than post-viral because it can encompass any physical damage to the brain which may be from bacteria or mold or even some kinds of chronic stress. But I will leave that debate for another post and I use mTBI or TBI below. 

In fact, I believe that the root cause of many diseases = mTBI. From Depression to MECFS, to MS, to Alzheimer's...to Parkinson's disease. Long Covid is just one "flavour". The exact disease is a factor of age, genetics, environment, region of the brain that is affected, cause(s), etc. Just read the books by Dr Amen on his correlations between brain scans and illness if you have any doubts.

Disclaimer #1: The injury is in the brain, but this physical damage in no way is "in your head, psychological, etc."

Disclaimer #2: I am not a doctor, just a patient with four-plus years of LC suffering, research, and n=1 trials run by a person with brain fog. Don't believe everything I say ;-)

Disclaimer #3: The brainstem is considered part of the brain...despite being left out of many scans because it moves too much while you breathe.

Long Covid = mTBI

Long Covid is a mTBI. Look at the list of symptoms for mTBI, ME, and LC... they all overlap a great deal!

The only problem is that the damage is not visible or clinically insignificant on most CAT or MRI scans. But it is there! Just ask about "micro-flares" and see the various changes in blood flow on various scans.

This group in Denver seems to have come to the same conclusion:

DU study finds long COVID patients could benefit from concussion treatment

"What they're saying: Because both conditions inflame the brain, research suggests physicians can begin to use the "same tools" to assess a concussion to also evaluate the severity of the lingering virus, Brad Davidson, the study's head researcher, tells Axios Denver."

 Post-Concussion Assessment as a diagnostic and mechanistic framework for treating patients with Long COVID

An important note. When a person is diagnosed with mTBI there is little or no treatment other than rest, neuroplasticity exercises, diet to improve healing and... time, time, time...

The difference between mTBI and PTBI (LongCovid) is that the damage is often more peripheral in TBI but rooted in the brainstem and limbic "central" areas of the brain.

My "theory" came about while researching neuroplasticity. The evidence of the benefits of neuroplasticity "Brain Training" comes from mTBI rehab research. In the world of TBI, there are no universal biomarkers and no clear recovery timeline, but it is well-recognized by clinicians and society. Moreover, in TBI the idea of "Brain Training" does not come with any negative psychologizing connotations.

Other researchers found a similar connection a year later: BBC article

Which cites:

Iaonis Mavroudis: Functional Overlay Model of Persistent Post-Concussion Syndrome
https://www.mdpi.com/2076-3425/13/7/1028

Emergency Department Risk Factors for Post-Concussion Syndrome After Mild Traumatic Brain Injury: A Systematic Review

This then seemed to overlap with mental and physical trauma such as PTSD and the resulting brain damage that is the same as mTBI in brain scans. Treatments, causes, and cures seem to meld together for all these "minor brain damage" events.

I spent more than a year reading and researching these overlapping topics. Most research came from books written by neurologists and psychiatrists that try to marry the two fields by focusing on the gap between the two silos that is often called the "brain-body connection"... but I don't feel that this term is the best one for this overlap.

The problem comes from the "silo" mentality of research and treatment. It should be called something like "Body Systems DISconnection". Everything is connected! Dividing the body into systems is about as useful as colonial powers dividing colonies with straight lines on a map. 

While taking notes from each book, research paper, and expert interview I worked to connect everything while getting it all straight in my brain-foggy head. Luckily, brain fog has gone down significantly over the past year. Treatment with the nicotine patch has made brain fog a rare occurrence now.

So, I decided to create a series of posts, one for each book or topic, with my TLDR notes for:

TBD sometime in the future: 

1. How these injuries are linked...

2. What Long Covid and MECFS can learn from the TBI/ABI/PTSD/Trauma treatment protocols...

3. What I have included into my Seflcare routines...

4. The HSP (Highly Sensitive People) post explains why some people are more likely to suffer a TBI after an acute infection.

It might take me a while to get through all the notes. I will start with a list of books and a playlist of videos from YouTube. Then I will slowly add separate posts for each element and link to them here when I have each post completed.

I will start my list with the aim of showing how Long-Covid (LC) and ME/CFS (ME) are both brain damage caused by injury to the brain, specifically the ANS. Therefore, LC and ME should both have a type of Post-acute Viral minor Traumatic Brain Injury (PAV-mTBI) -- Or PTBI for a broader definition. And, as an extension, I postulate that the vagus nerve, and its connection to the digestive tract, should be considered as part of the brain (CNS), not just an extension (PNS). The antiquated model of dividing anatomy by systems should be re-thunked ;-). 

 

Neurology/Neuroplasticity Books: TBD sometime in the future: 

Books related to Trauma: TBD sometime in the future: 

A YouTube playlist: with a mix of videos that helped me understand these topics, the science behind my theories, and how some topics overlap.

My mental journey, how I took a step back and arrived at this conclusion:

1. Very quickly, doctors were more lost than patients. Patients were looking for answers.

2. The MECFS community (also lost and abandoned for many years) taught people with LC (pwLC) how to pace, adapt, experiment, deal with gaslighting, etc...

3. (This Note will make sense later: The "mTBI community" did not reach out to #LongCovid since they had a diagnosis, and "legitimacy" that the MECFS community lacked.)

4. Doctors misdiagnosed LC as a "psychological" disease of people who were "deconditioned".

5, Doctors prescribed SSRIs (anti-depression meds) and exercise (GET).

6. Many people rejected the "in-your-head" diagnosis.

7. Those prescribed GET often got worse, not better.

8. However, a few people who did take SSRIs had benefits with hypersensitivity issues. And some people with PASC or LC who were not too bad off and who did not have PEM benefited from GET.

9. With no accepted biomarkers, 60% of doctors continue to think it is a "mental problem" and point to the various cases of people who did benefit from SSRIs and GET. Meanwhile, they ignore the heterogeneous nature of LC, they confuse short-term PASC with LC, and they don't take into account the benefits of SSRIs that don't have anything to do with depression. (Note: After decades, experts still do not know exactly why SSRIs work!)

10. I slowly improved my first year to about 90%, but I crashed and dropped back down to 30% when I tried to "push" and incorporate run-walk (aerobic exercise) into my training. I did not know about PEM and avoided SSRIs since I was not depressed. I was frustrated but highly motivated!

11. For My second infection I continued to push through and work until I ended up in the hospital from the post-viral cytokine storm in my neck and head -- which was probably partially caused by the GI issues which led to my Diverticulitis (ascending) a year later.

12. Despite the second infection, I continued to be optimistic. I was partially correct since the second infection seemed to "cure" my heart and lung issues. However, It left me with new Neurological, Digestive, and various other issues such as being unable to speak while finishing the semester with my Nursing and PT students. How could some organs be "healed" by the infection and for other problems to pop up in their place? There had to be a neurological component.

13. While searching for cures I came across random success stories involving one medication, supplementation or other "miracle cure", but there were no clear trends until I started seeing repeated remissions from people who had done fasting, a personalized diet that limited various individualized problems and many people being "cured" through brain training.
14. It quickly became clear that there were many elements to healing (diet, mental health, pacing, vagal tone, movement, etc) but each person seems to credit the last big adjustment with their cure... and discount the 100s of other interventions.
15. The various key components of healing seemed to overlap, but brain training seemed to be the missing piece for many people. Brain training also seemed to be held back by a mixture of:

A. misunderstandings around the solid science behind it, 

B. confusion about the powerful "Body Systems" connection,

C. a lack of understanding about trauma, chronic trauma, and micro-trauma,

D. misunderstanding of how much energy is lost through "unproductive thoughts, reactions and emotions" that can easily be reduced... thus helping us pace!!!

 

16. The Mindfulness/Brain training techniques in and of themselves will not cure anyone, but they are valuable tools that can greatly conserve energy and these tools will be useful for the rest of your life.

17. Each person will need to add in an individual treatment plan and outcomes will vary. Even "recovery" is not a universal endpoint.

Take care of yourself, and if you can, someone else too! --Stephen Dubner

PS:
Perplexity.ai search for nicotine and TBI:

Recent research has explored the potential benefits of nicotine for Traumatic Brain Injury (TBI), revealing some promising findings. While smoking tobacco is generally harmful, isolated nicotine may offer neuroprotective effects in TBI cases.

## Potential Benefits of Nicotine in TBI

**Cognitive Function Improvement**

Studies suggest that nicotine could potentially treat cognitive deficits following TBI by reversing impaired signaling pathways in the brain, including those involving nAChRs, TH, and dopamine[1]. Chronic intermittent nicotine administration has been shown to attenuate TBI-induced cognitive dysfunction in animal studies[6].

**Neuroprotection**

Nicotine has demonstrated neuroprotective properties in several ways:

1. Preventing stress-induced damage in the hippocampus[5]

2. Enhancing cognitive performance and resistance to brain injury[2]

3. Upregulating neuroprotective signaling pathways

**Sensorimotor Function Recovery**

A recent study found that post-injury chronic nicotine exposure via e-cigarette significantly improved nesting performance in mice with controlled cortical impact (CCI). The research revealed that nicotine exposure:

- Increased survival of cortical neurons in the perilesion cortex

- Upregulated mBDNF expression, P-Erk, and p-Akt in perilesion cortical tissue

- Attenuated microglia-mediated chronic neuroinflammation[3]

## Mechanisms of Action

Nicotine's potential benefits in TBI appear to be mediated through several mechanisms:

1. Binding to nicotinic receptors, creating an electric current in neurons

2. Changing the electrochemical status of neurons, making them more excited and resilient

3. Triggering the release of chemicals that alter the brain's chemical environment[2]

4. Upregulating BDNF-TrkB signaling, which is associated with neuroprotection and neuroplasticity[3]

## Considerations and Limitations

While these findings are promising, it's crucial to note several important considerations:

1. Most studies showing benefits have been conducted on animals, and more human clinical trials are needed[1].

2. The addictive nature of nicotine presents a significant challenge to its therapeutic use[7].

3. Smoking tobacco, as opposed to isolated nicotine administration, is associated with potential harms in TBI patients[1].

In conclusion, while research suggests potential benefits of nicotine in TBI treatment, particularly for cognitive and sensorimotor recovery, more studies are needed to fully understand its effects and develop safe, non-addictive therapeutic applications.

Citations:

[1] https://pubmed.ncbi.nlm.nih.gov/35138210/

[2] https://www.unthsc.edu/newsroom/story/can-nicotine-actually-heal-the-brain/

[3] https://www.authorea.com/users/676880/articles/674222-nicotine-inhalant-via-e-cigarette-facilitates-sensorimotor-function-recovery-by-upregulating-neuronal-bdnf-trkb-signaling-in-traumatic-brain-injury

[4] https://journals.lww.com/ccmjournal/citation/2024/01001/1559__association_of_smoking_and_hospital.1502.aspx

[5]https://www.researchgate.net/publication/358493617_The_impact_of_cigarette_smoking_and_nicotine_on_traumatic_brain_injury_a_review

[6] https://pubmed.ncbi.nlm.nih.gov/12831873/

[7] https://www.sciencedirect.com/science/article/abs/pii/B9780128130353000095

[8] https://www.tandfonline.com/doi/pdf/10.1080/02699052.2022.2034186