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Long-Haul COVID Syndrome

Following the initial surge of COVID-19 infections, there has been a shift in focus on a new group of illness survivors, those with “post-acute COVID.”  This group is also known as the “COVID long-haulers” or colloquially as “long COVID.” 

I am seeing this syndrome arise in about 20-25% of those who had mild to severe COVID-19, up to 50% of those who were hospitalized and 10-15% of those who were vaccinated.  This seems to correlate with the recently published data that others in the medical community are seeing (1, 2, 3).

Long-Haul COVID-19 Symptoms

The most common symptoms that have been seen in this long-haul COVID group are general body pain, breathing difficulty, loss of taste or smell, brain fog, elevated cholesterol profiles, malaise, fatigue and hypertension (elevated blood pressure). However, some of the more severe cases have low blood pressure and orthostatic hypotension (low blood pressure drops on change of position).

Not only am I seeing this in post-COVID infection, but I am also seeing these symptoms occur in patients post COVID-19 vaccination with all the vaccine types.  The vaccine was designed to stimulate the same immune response that COVID-19 caused.  They seem to experience the same symptoms above with additional bruising, elevated D-dimer (protein fragments from breakdown of a blood clot), and changes in patients clotting factors.

These symptoms and presentations are going unrecognized and/or ignored by a large number of physicians.  This under recognition is suggested by the fact that large patient support groups are forming at locations like wearebodypolitic.com and longcovidsos.org with trending hashtags of #longcovid on Twitter.

Autonomic Nervous System & COVID-19

Many of these symptoms seem to correlate with autonomic nervous system (ANS) dysfunction after infection or vaccination.  These symptoms (fatigue, shortness of breath, loss of taste or smell, light headedness, increased bruising) are commonly persisting for longer than four weeks.

Many of my patients experiencing post-COVID symptoms have been found to have ANS dysfunction with orthostatic intolerance syndromes (light-headedness with change of position).  This occurs in men and women, but the literature seems to demonstrate a higher prevalence among females in the 26-50 year old range (2). Post-COVID syndromes, however, seem to be more prevalent in men as noted in the FAIR Health study (1).

Figure 1 – Post-COVID medical conditions more common in males than females: Mar 2020 -Feb 2021

Orthostatic intolerance syndromes are controlled by the ANS and include orthostatic hypotension (low blood pressure on standing), vasovagal syncope (stress induced passing-out), and postural orthostatic tachycardia syndrome (POTS) causing pulse rates greater than 110 with standing or simple walking.  All of these symptoms point to an autonomic nervous system disruption.

When a healthy person stands, blood pools in the pelvis and legs, reducing venous return to the heart. This is detected by baroreceptors in the heart and aorta, which respond by increasing sympathetic neural and adrenergic tone (mediated by norepinephrine and epinephrine respectively). This results in tachycardia (thus compensating for reduced stroke volume). This is then followed by vasoconstriction in the splanchnic vascular bed, which increases venous return to the heart.

In orthostatic intolerance, the release of the adrenal hormones epinephrine and norepinephrine causes pronounced tachycardia (rapid heart rate), which is experienced as palpitations, breathlessness and chest pain (common symptoms of ‘long COVID’). Very high catecholamine levels can lead to paradoxical vasodilatation, sympathetic activity withdrawal and activation of the vagus nerve resulting in hypotension, dizziness and ultimately syncope (4-7).  If a person is ill, or already dehydrated, these symptoms can be prolonged or exacerbated.

In my office, we regularly assess the autonomic nervous system as part of the yearly wellness exam. This is a 15-20 minute test looking closely at heart rate variability, blood pressure and sweat response to some simple vagal maneuvers.

COVID-19 & Autoimmunity

There is hypothesis that COVID-19 infections and the immune response to vaccination affects the autonomic nervous system.  The relationship between the two is very complex leading to the well documented “cytokine response syndrome” and “cytokine storm” from sympathetic activation inducing a pro-inflammatory cytokine release throughout the body.   Vagal stimulation results in an anti-inflammatory response, and suggests that the autonomic nervous system is a possible therapeutic target of treatment.

Because autonomic disorders have been associated with autoantibodies (8), there is speculation that there may be an underlying autoimmune component to the post-COVID syndromes we are seeing (11,12).  

Post-COVID Syndrome is Complex

Significant impairment along any of the extended autonomic nervous system (EAS) pathways when affected by COVID-19 infection has the potential to lead to death.  This is a very complex system with multiple variables.  We’ve seen this over the last year in various presentations of COVID-19. 

Figure 2 below demonstrates the potential for various intervening variables to adversely affect the EAS system and lead to death (8). Five systems are interactive at the same time: Sympathetic Adrenergic System (SAS), Sympathetic Noradrenergic System (SNS), Arginine Vasopressin/Anti-Diuretic Hormone (AVP/ADH), Hypothalamic-Pituitary-Adrenocortical (HPA) Axis, and the Parasympathetic Nervous System (PNS).

Figure 2 -From EAS system activation to dyshomeostasis to death. Five effector components of the EAS are on the left. Intervening variables are in the center. Factors contributing the critical illness or death are on the right. The red bar under PNS indicates PNS inhibition. AI angiotensin I, ACE angiotensin-converting enzyme, AII angiotensin II, Aldo aldosterone, ATN acute tubular necrosis, IL-6 interleukein 6, Myo. myocardial, Cor. coronary, TNFa tumor necrosis factor alpha

Intravascular Clotting Problems

In the COVID-19 pandemic there has been an unexpectedly high frequency of intravascular clotting, manifested by deep vein thrombophlebitis, pulmonary embolism, myocardial infarction, or stroke. It has been proposed that an imbalance between coagulation and inflammation results in this hypercoagulable state. Thrombosis (clotting) initiated by the innate immune system may limit SARS-CoV-2 dissemination, but aberrant activation of this system could cause endothelial (lining of the blood vessel) injury, with dysregulation of fibrinolysis and formation of blood clots (9). The complex roles of neutrophilia, neutrophil extracellular traps, platelet activation, and proinflammatory cytokines are a subject matter of active investigation and ongoing clinical trials.

Adrenaline is also a potent hemostatic agent because of both vasoconstriction that it causes and promotion of platelet aggregation in part through its antagonizing effect at the alpha-2 adrenoceptors.  It’s contribution in clotting in COVID-19 patients is still unknown.

In December 2021, Yi Zheng and colleagues discover that the “SARS-CoV-2 spike protein can compete with anticoagulation factors. . . leading to exacerbated coagulation and other adverse consequences, especially in critically ill patients. This rapid coagulation response may be an additional independent factor for the inflammatory storm of severe COVID-19 patients.” (21)

In my office, this increased coagulation response can be identified by checking a D-Dimer level in the blood. I have found that the D-Dimer can be elevated for over 12 months in those with Long-Haul COVID symptoms after infection, and more commonly after vaccination.

Anxiety & Post-COVID Syndrome

It is theorized that feedback looping of the autonomic nervous system may be prevented with the use of benzodiazepines like alprazolam, or even L-DOPA to increase dopamine release. This has been seen clinically in those with anxiety as a part of their post-COVID syndrome.  These approaches are undergoing clinical trial currently.

Ketogenic Diets and Exogenous Ketones

Inhibition of the NLRP3 inflammasome has been shown to modulate the cytokine storm.  This can be done with ketogenic diets or the use of exogenous ketones.  The ketogenic state has been demonstrated to suppress the cytokine cascade in COVID-19 syndromes (10).

I have had great clinical success in my medial office through the use of ketogenic states (use of ketogenic diet and/or exogenous ketone salt use) to treat and prevent the post-COVID symptoms and syndromes when they present.

Mitochondrial Dysfunction

I have found in my clinical experience that the autonomic dysfunction correlates with mitochondrial dysfunction. Loss of function in mitochondria, the key organelle responsible for cellular energy production, can result in the excess fatigue and other symptoms that are common complaints in almost every chronic disease. At the molecular level, a reduction in mitochondrial function occurs as a result of the following changes: (1) a loss of maintenance of the electrical and chemical transmembrane potential of the inner mitochondrial membrane, (2) alterations in the function of the electron transport chain, or (3) a reduction in the transport of critical metabolites into mitochondria. In turn, these changes result in a reduced efficiency of oxidative phosphorylation and a reduction in production of adenosine-5′-triphosphate (ATP). Several components of this system require routine replacement, and this need can be facilitated with natural supplements (12).

Management of Post-COVID Syndrome

Education

Education, explanation and reassurance provide a cornerstone in understanding the post-COVID syndromes and orthostatic intolerances that can arise.

Exercise

Regular structured exercise that incorporates both aerobic and resistance elements help to re-balance the autonomic nervous system.  For those with severe orthostatic symptoms in upright positions, the use of recumbent exercise bikes or swimming may be used.

Fluids and Salt

Fluids cannot be emphasized enough.  Ensuring fluid repletion (2–3 liters or 64-100 oz of water per day and avoiding caffeine and alcohol) should be encouraged.  Additionally, one to two teaspoons of pink salt supplementation per day helps maintain plasma volume and avoid hypovolaemia (low intervascular volume).  I recommend the pink salts because of the additional magnesium, zinc and manganese these provide in fluid replete states.

Pharmacological Treatment

Discontinue any NRI’s like duloxeting, nortryptiline and tapentadol.  These just make the potential for cytokine release worse. Fludrocortisone can be used to expand fluid if hypovolemia persistently is present. However, fluid retention and hypokalemia can be a problem.

Midodrine is a sympathomimetic alpha-1 agonist and can increase vasoconstriction and venous return to the heart.  This may be helpful to treat the lower blood pressure and tachycardia that can arise.

Beta blockers may make the tachycardia and palpitations worse and should be avoided.  In severe cases L-methyldopa could be considered to help alleviate the hyper adrenergic symptoms with change of position.

For those with prolonged elevation in D-dimer levels, the use of colchicine 0.6mg daily has been found to effectively reduce the inflammatory and hyper-coagulability response to the virus and the vaccine. The GRECCO-19 randomized open-label trial in 105 hospitalized patients demonstrated colchicine to be effective in reducing the D-dimer levels and improving clinical outcomes (22). This approach to lowering the coagulation response was also demonstrated to be effective in the WHO R&D Blueprint (23). Ivermectin and hydroxychloroquine also have a significant effect on lowering the d-dimer levels.

Treating the Autonomic Dysfunction

Many pharmaceutical medications can have suppressive effects on the autonomic nervous system. These include medications that affect the heart, blood pressure and hormones of the brain.  The list of medications is vast and more than I can address here in this post. 

Thyroid dysfunction can also adversely affect the ANS and it is essential that the thyroid function is assess and balanced. Hashimoto’s and autoimmune thyroiditis must be treated as this will play a major roll in autonomic dysfunction.

Clinical trials have shown the notable improvement with using oral replacement supplements, such as l-carnitine, alpha-lipoic acid (α-lipoic acid [1,2-dithiolane-3-pentanoic acid]), coenzyme Q10 (CoQ10 [ubiquinone]), reduced nicotinamide adenine dinucleotide (NADH), membrane phospholipids, and other supplements. Combinations of these supplements have been effective in reducing the fatigue and other symptoms associated with COVID-19 and other chronic disease.  Supplementation has been shown to naturally restore mitochondrial function, even in long-term patients with intractable fatigue (13,14).

Clinically, I’ve found that effective refueling of the dysfunctional mitochondria and priming the autonomic nervous system can be done through the use of the following supplements (13-20).

  • Pregnenolone: 30 mg nightly
  • CoQ-10: 300-400 mg daily
  • D-Ribose: 15-30 grams daily
  • Magnesium glycinate: 400-600 mg daily
  • NADH: 10 mg twice daily
  • L-carnitine: 1000-2000 mg daily (Vegetarians and Vegans may need more as this is only found in red meat and avocados.)
  • Alpha lipoid Acid: 300 mg daily
  • Liposomal Glutathione 500 mg twice daily
  • Rosmarinic Acid 300 mg twice daily

Finding all these supplements can be a challenge. I designed my multivitamin with mitochondrial dysfunction in mind it contains the CoQ-10, L-Carnitine, alpha lipoic acid you need. It also contains N-acytylcystine (NAC) the cofactor for glutathione and NADH production in your body.

If you are using my vitamin supplement, I’ve provided links below to make it easier if you are looking for the other components on the list above.

For those with long-haul COVID syndrome, the treatment protocol above combined with a ketogenic diet, and exogenous ketones where needed, has been a game changer.  Hopefully, this will help you as well.

If you need my one-on-one help, sign up for one of my membership programs and I’d love to help you return to better health.

References:

  1. A Detailed Study of Patients with Long-Haul COVID. FAIR Health White Paper, June 15, 2021. (https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/A%20Detailed%20Study%20of%20Patients%20with%20Long-Haul%20COVID–An%20Analysis%20of%20Private%20Healthcare%20Claims–A%20FAIR%20Health%20White%20Paper.pdf)
  2. Dani M, Dirksen A, Taraborrelli P, et al. Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies. Clin Med (Lond). 2021;21(1):e63-e67. doi:10.7861/clinmed.2020-0896.
  3. Logue JK, Franko NM, McCulloch DJ, et al. Sequelae in Adults at 6 Months After COVID-19 Infection. JAMA Netw Open. 2021;4(2):e210830. doi:10.1001/jamanetworkopen.2021.0830
  4. Freeman R, Abuzinadah AR, Gibbons C, et al. Orthostatic hypotension: JACC State-of-the-Art Review. J Am Coll Cardiol 2018; 72:1294–309. 
  5. Jardine DL, Wieling W, Brignole M, et al. The pathophysiology of the vasovagal response. Heart Rhythm 2018; 15:921–9.
  6. Fenton AM, Hammill SC, Rea RF, Low PA, Shen WK. Vasovagal syncope. Ann Intern Med 2000; 133:714–25.
  7.  Fedorowski A. Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management. J Intern Med 2019; 285:352–66. 
  8.  Goldstein DS. The extended autonomic system, dyshomeostasis, and COVID-19. Clin Auton Res 2020;30:299–315
  9. Colling ME, Kanthi Y. COVID-19-associated coagulopathy: an exploration of mechanisms. Vasc Med. 2020 doi: 10.1177/1358863X20932640. 
  10. Bradshaw PC, Seeds WA, Miller AC, Mahajan VR, Curtis WM. COVID-19: Proposing a Ketone-Based Metabolic Therapy as a Treatment to Blunt the Cytokine Storm. Oxidative Medicine and Cellular Longevity, Vol. 2020, Article ID 6401341, 34 pages, 2020. https://doi.org/10.1155/2020/6401341
  11. Guilmot A, Maldonado Slootjes S, Sellimi A, et al. Immune-mediated neurological syndromes in SARS-CoV-2-infected patients. J Neurol 2020, in press ( 10.1007/s00415-020-10108-x).
  12. Ruzieh M, Batizy L, Dasa O, et al. The role of autoantibodies in the syndromes of orthostatic intolerance: a systematic review. Scand Cardiovasc J 2017;51:243–7.
  13. Nicolson GL. Mitochondrial Dysfunction and Chronic Disease: Treatment With Natural Supplements. Integr Med (Encinitas). 2014;13(4):35-43.
  14. Kerr DS. Treatment of mitochondrial electron transport chain disorders: a review of clinical trials over the past decade. Mol Genet Metab. 2010;99(3):246–255.
  15. Murugan S, Jakka P, Namani S, Mujumdar V, Radhakrishnan G. The neurosteroid pregnenolone promotes degradation of key proteins in the innate immune signaling to suppress inflammation. J Biol Chem. 2019 Mar 22;294(12):4596-4607. doi: 10.1074/jbc.RA118.005543. Epub 2019 Jan 15. PMID: 30647133; PMCID: PMC6433066.
  16. Sinha R, Sinha I, Calcagnotto A, Trushin N, Haley JS, Schell TD, Richie JP Jr. Oral supplementation with liposomal glutathione elevates body stores of glutathione and markers of immune function. Eur J Clin Nutr. 2018 Jan;72(1):105-111. doi: 10.1038/ejcn.2017.132. Epub 2017 Aug 30. PMID: 28853742; PMCID: PMC6389332.
  17. Agadjanyan M, Vasilevko V, Ghochikyan A, et al. Nutritional supplement (NTFactor) restores mitochondrial function and reduces moderately severe fatigue in aged subjects. J Chronic Fatigue Syndr. 2003;11(3):23–26.
  18. Dimauro S, Rustin P. A critical approach to the therapy of mitochondrial respiratory chain and oxidative phosphorylation diseases. Biochim Biophys Acta. 2009;1792(12):1159–1167.
  19. Luan H, Kan Z, Xu Y, Lv C, Jiang W. Rosmarinic acid protects against experimental diabetes with cerebral ischemia: relation to inflammation response. . J Neuroinflammation.  2013;10:28. 
  20. Rocha J, Eduardo-Figueira M, Barateiro A, Fernandes A, Brites D, Bronze R, Duarte CM, Serra AT, Pinto R, Freitas M, Fernandes E, Silva-Lima B, Mota-Filipe H, Sepodes B.. Anti-inflammatory effect of rosmarinic acid and an extract of Rosmarinus officinalis in rat models of local and systemic inflammation. Basic Clin Pharmacol Toxicol. 2015;116(5):398–413
  21. Zheng Y, Zhao J, Li J, et al. SARS-CoV-2 spike protein causes blood coagulation and thrombosis by competitive binding to heparan sulfate. Int J Biol Macromol. 2021;193(Pt B):1124-1129. doi:10.1016/j.ijbiomac.2021.10.112
  22. Deftereos SG, Giannopoulos G, Vrachatis DA, et al. Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial. JAMA Netw Open. 2020;3(6):e2013136. doi:10.1001/jamanetworkopen.2020.13136
  23. World Health Organization. R&D blueprint and COVID-19. Available at: https://www.who.int/blueprint/priority-diseases/key-action/novelcoronavirus/en/. Accessed March 25, 2020.

Obesity, Anxiety and The Divided Mind

In past posts, we’ve discussed how to effectively and efficiently lose weight and open the gates of the fat cells.  We’ve talked about the keys to the back doors of the fat cells that must be opened to create effective lipolysis (releasing of fat from the fat cells) and weight reduction.

I want to focus, today, on another key found in the brain.  The brain neuropeptides play a huge role in metabolic balance of the body and have direct relationships to anxiety, stress and post-traumatic stress disorder (PTSD).  In the last few years, research into the hormones of the brain (neuropeptides) and body demonstrates that the “autonomic nervous system” plays a very significant roll in losing weight.

The autonomic nervous system is the part of the nervous system responsible for “fight or flight responses.”  If a bear rises up in front of you while you are strolling in the woods, and begins to chase you, the autonomic nervous system kicks in to speed up the heart rate, shunt blood to the muscles and turn down the processing of food in the gut while you run from or fight the bear.  This autonomic nervous system is also the system that links emotions (like happiness, sadness, stress, anger, depression) between the conscious and subconscious mind and creates the attachments of these emotions to specific memories.

The Divided Mind and Disease

A disconnect or poor communication between our conscious mind and subconscious mind wreaks havoc in the balance between memory, emotion, cognitive function, endocrine glands and immune system.  One example of this is the onset of panic attacks for no reason.  Another example is chronic fatigue and many symptoms found in autoimmune diseases.  This same autonomic nervous system, when malfunctioning, plays a significant roll in our ability to lose weight.   The subconscious mind triggers the autonomic nervous system without the conscious mind’s involvement.

Thanks to the work of John E Sarno, MD, and Candace B. Pert, PhD, the link between our subconscious mind and the autonomic nervous system is much more clear.  This opens the door to our understanding how the subconscious mind can have a profound effect on obesity.

This field of research requires one to understand a concept about the psyche initially outlined by Dr. Sigmund Freud and his colleague Dr. Josef Breuer (the Father of Psychoanalysis) in the 1880’s.  Misconceptions regarding the basic drives of the human psyche aside, they identified through their clinical evaluations that the human psyche is made up of three parts, the subconscious (the id), conscious (the ego), and the super-conscious (the superego).  They identified an essential concept that the subconscious is a more primitive and childish component of the mind functioning much more instinctually,  and that the ego and super-ego house the intelligent, ethical, and moral consciousness.  They also identified that a split or division can arise between these two partitions causing physiological conflict to arise (i.e. – onset of a panic attack for no reason).

Autonomic Nervous System is made up of two parts: Sympathetic and Parasympathetic divisions. These divisions act like a gas pedal or brake for various organs and functions.

It is important to understand, as Freud pointed out, that you cannot divide the mind into neat compartments suggested by these three divisions.  The mind acts as a single unit.  However, understanding the “id” and it’s instinctual functions being tied to the autonomic nervous system is central to understanding how subconscious can derail weight loss.

Freud and Breuer identified in their Studies on Hysteria that a simple subconscious idea or instinct could be strong enough to exert powerful physical responses without  sufficient intensity to become conscious thought recognized by the individual. This means that a physiologic motor response in the body could be stimulated without being conscious of the reason for the stimulus.  They, along with Jean-Martin Caharcot, Alfred Alder, Franz Alexander and Allan Walters, witnessed this multiple times clinically.  They came to the conclusions that pain and other nervous functions could originate and could actually be created by the mind.

The Mind has the Power to Create Disease

Dr. Pert’s research over the last 40 years has been able to clearly identify a communication system between the brain, the endocrine system and the immune system.  Dr. Pert’s research identified that memory and/or subconscious idea is directly tied to emotion through the brain hormones called neuropeptides that, when triggered, reproduce stored memory, emotion physical autonomic responses (like changes in heart rate, dry mouth, dilation or constriction of the pupils, sweating of the palms or trunk, chest pressure, etc) and even auto-immunity.

Memory, Emotion & Storage Controlled by Neuropeptides

Neuropeptides also participate in memory sorting, storage and recall .   In his recent book, Beyond Order, the clinical psychologist and professor Dr. Jordon Peterson explains that the miracle of memory is not that we remember, the miracle of memory is that we forget and that we only remember what is necessary.  The miracle of memory is that we only remember those things that are important and teach us meaning.  Because we can forget, we don’t drag the horrible details of the past along with us.  Our memories allow us to get free of the past.  All you need is three sleepless nights in which you cannot dispense with the past and you would understand that life would be a literal hell if we cannot dispense with the day, the memory and the emotions of each day. We must renew ourselves in this cyclical unconsciousness we call sleep and resetting of the memory.   It is during this time that memory, emotion and neurohormones are tied together.

Our memories are tied to emotions through neurochemical synapses created in the brain by the neuropeptides.  Forgetting and remembering are very complex and sophisticated cognitive processes.  Our subconscious reduces the memory, emotion and experience to it’s significance.  The significance is then recorded as memory with it’s associated emotion, then our brain lets go of the details.
If you think about it, we boil our lives down to the “jest” of the story and then we remember only the significance of that story with attached emotion.  This process saves us from being crushed by days, years and decades of the gory details of day to day experience.

Anxiety Provoking Memories are Experiences that Still Need Unpacking

If memories from 18 months or older are still bothering you, if they produce negative emotions, that is a sign that that memory has not been correctly or completely unpacked by the complex processes of the brain. It is essential that the brain unpack wisdom from the past that learning can occur and it can be applied to the future.  This process occurs so that you don’t do the same stupid thing over and over again.  Or, it is there so that you can repeat things that worked well.  That is the purpose of memory.  Not recollection, our memory is the extraction of wisdom for the lesson of life from vast experience.
If you have a memory that is still hurting you, making you anxious, causing, fear, guilt or shame, you have not undertaken the complex process of analyzing that memory, pulling out from it the moral, and dispensing with the details.   This is why writing down these specific memories is so very important.
You must write the bad memory out.  You must write out all of the details you remember and the emotions of that experience.  It allows the mind to do the complex processing of identifying wisdom and social moral barriers of uncertainty, anxiety, threat, fear and panic that are bothering you.  This is what therapy does when talking about and discussing the past.
If journaling and writing out the memory is not effective in resolving the anxiety or if you are unable to identify the memory causing the anxiety, you may want to consider hypnotherapy and directed meditation.  This has been very effective with many of my patients having anxiety relating to childhood experiences improperly tied to strong emotions.
W. Dennis Parker does a wonderful job in his book, Spiritual Mind Management, elucidating how our subconscious mind inappropriately ties emotion to simple experiences and memory, and how these can cause anxiety. For those with resistant anxiety to journaling and therapy, hypnotherapy has been very effective.

Other Hormones associated with Anxiety and Obesity

Over the last two decades, I’ve found that two other hormones play a huge role in handling stress, anxiety, brain repair and play a very large role in sleep.  Both of these hormones are derived directly from cholesterol.  Low fat, vegan and vegetarian diets lead to low cholesterol availability and I commonly see low levels of the following hormones in both men and women.
The first of these is Pregnenolone.  Pregnenolone is the precursor sex hormone derived from cholesterol in the blood stream.  When serum pregnenolone level is lower than 50 mg/dL anxiety, insomnia, hair loss, poor recovery from exercise and difficulty with concentration become chronic.  The cognitive cloudiness that occurs with low pregnenolone levels make the unpacking of traumatic experiences and the sorting of wisdom from day to day experience difficult due to poor sleep.  I have been amazed that just the simple supplementation of pregnenolone nightly reverses anxiety, improves sleep, stops chronic migraine headaches, increases cognition and frequently allows people to “feel normal again.”
The second hormone is Progesterone.  Interestingly progesterone is derived directly from pregnenolone.  If large amounts of mental or physical stress are occurring, pregnenolone is used to make DHEA, Cortisol and Cortisone.  Little is left to make progesterone which is necessary for further hair growth, sleep, focus, memory, the healing effects from stress and trauma in the brain.  Progesterone often acts like a “brain steroid” healing both brain and spinal cord from stress and trauma.
Any evaluation for anxiety, insomnia, PTSD or stress must include screening both of these hormones, because without them, I’ve seen patients suffer for years with failure of the standard approaches.
One other molecule that has hormonal activities in the arena of anxiety and weight loss is that of methylated folic acid.  Folic acid is converted into L-Methyl Folate within every cell of the body.  This is accomplished by and enzyme called methytetrahydrofolate reductase (MTHFR).  About 60-65% of the patients I see in my office with insulin resistance, impaired fasting glucose or diabetes have a deficiency in one or both of the MTHFR genes leading to poor conversion of folic acid to the methylated form.   This is detrimental as methylated folic acid is essential in using Vitamin B12 within every cell of the body.
Lack of effective MTHFR enzymes leads to neuropathy, anxiety, depression, obesity and in severe cases elevated homocysteine levels and schizophrenias.  You can learn more about that by reading my blog article on Folic Acid here and a youtube video on it here.

The Search for Individual Meaning is The Deepest of Human Instincts

The human psyche is stabilized by the search for and the experience of individual meaning within life. The subconscious instinct for understanding our individual meaning is the deepest thing about us as humans.  It is innate and is part of our survival instinct.  What if the instinct understanding or experiencing meaning meaning goes wrong?  Pathologizing or lying about that individual meaning causes one to become “lost.”  Understanding that the instinct for meaning can be distorted or lied about is the most frightening thing upon this planet.  If you pathologize that individual meaning with deceit, you will be in the hands of things you do not want to contemplate.  If you have no theory of good and evil, if you’ve never been exposed to malevolence and someone malevolent touches you, you’re done for.
Being true to one’s self or truthful with your understanding of individual meaning helps to properly orient a person in the world, and find middle ground between complete chaos on one side of life and rigid totalitarianism on the other.   Finding and living in that middle ground requires one to rely upon individual instincts founded in truth.   If you want to live in harmony with yourself and your instincts, and live in a middle ground between a life of chaos and one of totalitarianism, don’t feed yourself or surround yourself with indigestible lies, half-truths and deceit.  You certainly shouldn’t try to warp the world around you by intentionally sharing deceitful meaning.

Anxiety Arises from Naivete

The sheltered soul or naive person is raised with the mindset that “all people are innately good.”  The thought or concept that people are “fundamentally good” is a complete misconception.  Being “good” is very difficult.  It is by no means the default position of the natural man and the subconscious mind. Entropy, catastrophe, tragedy, malevolence and death is the default position of human nature and the subconscious mind.  Good struggles up against this continually.
The people who are most prone to post-traumatic stress disorder (PTSD) are usually naïve people who have been sheltered from malevolence – sheltered from those who are truly spiteful, hostile, vicious, malicious, malignant, vindictive, pernicious, vengeful, hateful, rancorous, and evil-minded.  This is a well known clinical fact and can be found throughout the psychology literature.  There is nothing about this fact that is questionable.  The naïve world view is that you believe the world is fundamentally good – you believe that good behavior is rewarded with good in return – and you don’t really believe that there is any such thing as evil, and you encounter someone who is malevolent (and often you encounter this in yourself).  That sheltering is general throughout our society.  Death no longer occurs at home, it usually occurs in a hospital.  People live in cities and are rarely exposed to the death of animals and the cycle of life seen 100 years ago in farm and ranch life.
Often in those with PTSD, people who have been sheltered from these things, do something, or are required to do something, so morally reprehensible that it damages them psycho-physiologically. Until their psychological framework of good and evil changes, it is very difficult to recover.   These people have no framework in which to conceptualize violent death, evil or the reprehensible act.  They are unable to balance the conscious and subconscious memories and emotions attached to reprehensible emotional guilt, and it destroys them.  This is very common among soldiers.  It’s not always what they saw, it’s what they did or what they were a part of.
Telling and teaching people that humans are innately good (which has been part of our school system teaching for decades) and that evil doesn’t really exist makes them ripe picking for the malevolent and there is nothing about that which is positive.  It leaves tremendous anxiety and psycho-physiological scars in the wake.  This sheltered outlook is cowardice masquerading as virtue.  We see it more and more in our society.
This is why a teenage boy or girl in a traditional Christian or Jewish school is wiser and happier than the 50 year old professor of philosophy in a secular college.  The person who innately understand that good and evil exist within the world have a much easier time coping with and handling stress and trauma that will cross all of our paths.

What does anxiety, chronic stress and PTSD have to do with obesity and weight gain?

Signals in our environment from very stressful life experiences on a daily basis, chronic underlying stress, chronic anxiety, radiation exposure, infectious organisms (such as bacteria and viruses), xenobiotic chemicals, allergens, intestinal bacterial metabolites and food-derived bioactive substances (including phytochemicals), all have influence on messages received by our genes that then influences their expression. Gene expression can turn on and off neuropeptides.  This can effect the autonomic nervous system turning the metabolism up or down.  The expression of our genes in turn controls our health and disease outcomes.  This is one of the reasons COVID-19 seems to effect some people more dramatically than others.

The hormonal counterbalance of blood sugar is regulated, in part, by the autonomic nervous system.  Changes to this system increase or decrease cortisol & glucose production, thereby affecting production of insulin and other weight mediating hormones.  Changes in neuropeptides from stress or anxiety can act just like eating a meal.

As blood sugar falls, the autonomic nervous system responds to balance the blood sugar.  If this system is dysfunctional or under chronic stress, cortisol and adrenalin will cause higher blood sugars due to the stress response and can trigger increased hunger inappropriately.

This is why chronic stress, poor sleep, or even getting cut off while driving in traffic is the equivalent of eating a donut to your hormone responses.  If you’re not exercising, theses hormones will cause weight gain without any change in your diet, and even with caloric restriction.

How Do You Combat Chronic Stress or Anxiety?

  1. Exercise – Because these hormones are released subconsciously, the only way to help control them is regular and consistent physical activity or exercise.  Exercise, 20-40 minutes 3-6 days per week, is often the only way my patients have been able to combat the weight gain from chronic stress, anxiety and PTSD.
  2. Adequate Protein – Recent studies have demonstrated that hitting protein thresholds in men ( > 150 grams per day) and women ( > 90 grams per day) increased growth hormone and decrease insulin, helping to offset the negative effect of stress and anxiety.  This is a key component of a ketogenic or carnivorous lifestyle.
  3. Sleep -Lack of sleep has been implicated in difficulty with weight loss and weight gain.  Lack of sleep places the body into a state of chronic stress. This elevates cortisol, lowers testosterone, increases insulin (there’s that insulin problem, again) and increases the other inflammatory hormones. This perfect storm of stress, driven by lack of restful sleep, plays a big role in fat loss. My average patient needs at a minimum of 6-7 hours of restful sleep to maintain and lose weight. This is where untreated sleep disorders like sleep apnea play a big role. If you have sleep apnea, get it treated. What else can you do to help improve sleep?
    • Remove the computer, iPad and cell phones from the room.
    • Lower the room temperature. Men sleep better around 68-70 degrees F and women sleep better when the temperature is <70 degrees F.
    • Close the blinds or shades to add or darken the room.
    • Don’t study or watch TV in the same room you sleep in. Your body gets used to doing certain activities in certain rooms of the house. The bedroom should be reserved for sleep.
    • Go to bed at the same time
    • Get up at the same time. 
  4. Journaling – Daily journaling of experiences is one of the most powerful keys to helping the brain sort powerful emotions related to anxiety and memory.
  5. Meditation – I’ve created a 23 minute relaxation/meditation audio file that you can listen to for 30 days to help change your subconscious script on weight loss.  You can find it here.
  6. Some people need additional help through hypnosis.  Talk to your doctor about a certified hypnotherapist near you.  If you are a patient of Dr. Nally’s, he offers these services. Set an appointment today.
  7. Additional Resources – If this information is helpful, you may find additional interest in the following books:
  • “Loving What Is ” by Byron Katie
  • “Overcoming Worry and Fear” by Paul A Hauck
  • “The Joys of Living” by Orison Swett Marden

What to Expect

It may take your body and body’s biorhythm 3-4 weeks to adjust to changes you make around exercise, journaling, protein & sleep habits. Be patient with yourself.

Knowing that these challenges plague people on and off throughout the year, and, seeing people get hung up on these issues, I’ve created the Ketogenic Lifestyle 101 Course.  This program gets you jump-started into ketosis and gives you the tools to overcome the individual hurtles you will experience on your health journey.