Long Haul COVID and The Brain Connection, Neuroplasticity Treatment
In a recent Ask Nurse Alice podcast, Nurse Alice interviewed Ashok Gupta, a neuroplasticity expert, and Director of the Gupta Program about how he treats patients with certain chronic conditions through retraining the brain and how new developments are emerging with long-haulers.
Listen to this episode on the Ask Nurse Alice podcast
From Patient to Clinician
Ashok Gupta shared with Nurse Alice that he got into his line of work because he himself once suffered from ME, a form of chronic fatigue. After healing successfully from his condition, he became interested in helping other people with chronic illnesses and turned to neuroplastic research and eventually, actually treating patients himself.
After spending the last 25 years treating conditions such as chronic fatigue syndrome (CFS) and fibromyalgia, Gupta noticed that many long-haul COVID patients started coming to the clinic with symptoms that were similar. Because the long-haul COVID patients shared many of the same symptoms as chronic fatigue patients, the team decided to treat them in the same way—and the results were positive. Spurred on by the success they saw in treating long-haulers, the team at Gupta also turned to do research into the condition.
Gupta presented an interesting theory, “Studies do seem to show that in the first few months of long COVID, the symptomatology is a little different to ME/CFS with more of a prevalence of immune symptoms,” Gupta explained. But then, as the months go on, the two start to become more similar. Thus, the theory is that infection with COVID-19 acts as a trigger for a chronic condition like ME or CFS, rather than a distinct condition. Gupta noted that so far, this is just a hypothesis and it’s too soon to say for sure.
What is Long-Haul COVID? There are Many Theories
With that theory in mind, Gupta further elaborated on what exactly long-haul COVID is. He explained that a “normal” COVID infection could have symptoms that last from 6-8 weeks. However, symptoms that linger beyond that initial 6-8 weeks, are more likely to be long-haul COVID.
“People are finding that between 10 to 20% of infections lead to long COVID symptoms, which is making a very serious condition,” Gupta said. He compared long-haul COVID to mono and the Epstein-Barr virus (EBV), which causes between 10 to 15% of patients to have lingering symptoms. Like EBV, long-haul COVID runs a full spectrum of symptoms in people, from those who may need full assistance to those whose symptoms are milder.
The Theory: Long-Haul COVID Lives in the Brain
Gupta also added that there are many different theories for what exactly is behind long-haul COVID, from inflammation to viral particles left in the body causing damage, but Gupta theorizes that the key to the condition actually lies in the brain.
“We believe parts of the brain—the amygdala and the insula, specifically—are reacting as if the COVID infection is still present, and then going on to cause the ongoing symptoms,” he noted.
He added that there is an overstimulation of the immune system and nervous system creating all these symptoms in the body (such as tight muscles, difficulty thinking, all of the immune symptoms and cognitive symptoms) and those symptoms in the body then loop back to a hypersensitive brain, creating this overreaction. “So it's like the brain and the body are playing a game of tennis, hitting a ball harder and harder against each other, reacting to each other creating these chronic symptoms. And this is obviously a hypothesis but it's also now being backed up by the latest neuroscience on what's going on [in] the brain and what we call conditioning effects in the brain.”
He also compared the condition to “a physiological PTSD response.”
“So just like someone who goes to a war zone, comes back from that war zone, and a balloon can pop and they suddenly get a rush of this nervous system reaction, in the same way, our nervous system and the immune system has become hypersensitive,” he explained. “So anything that reminds it of the original COVID-19 infection becomes a trigger to trigger immune responses and nervous system responses, creating the very symptoms in the body that the brain is sensitive to, creating a vicious cycle.”
While there is some evidence that Omicron may be prompting less severe infections and thus, hopefully, fewer long-haul COVID cases, Gupta cautioned that it’s still too early to know for sure and that we know that even mild infections can trigger long-haul cases. “With Omicron, we would hope that it doesn't cause as many long COVID cases because it overall is milder, but at the same time, we shouldn't become complacent.”
How Neuroplasticity Treatments Might Help
If you are suffering from chronic pain, it's important to first seek help through your primary care provider.
The Journal of Medicine released a pilot study on the Mindfulness-Based Program of Neuroplasticity. And, though, it may not be a common term Gupta explained that neuroplasticity brain retraining techniques are used to train how the brain responds to real or perceived threats. “These aren't psychological techniques,” he explained. “These are what we call neuroplasticity techniques.”
He added that while you may not be able to control the immune system, what can be controlled—or at least impacted—is how the brain recognizes those danger signals. The goal, he noted, is to train the brain to realize it is no longer in that infected state and is instead in a “safe space,” so it can switch off and reset the immune system.
Gupta said that his clinic has spent the last 20 years refining and testing the neuroplastic techniques and that recent research has shown that in animal studies, the immune conditioning or immune learning effects occur in the amygdala and the insula parts of the brain, which are exactly the parts of the brain that his team been targeting for years. “So modern neuroscience is beginning to back up a lot of the things that we are saying in this regard,” he added. “And we've now done a recent randomized control trial showing that and we're looking to do more randomized control trials to show that this is an effective treatment.” (Here’s a pilot study on the program that appeared in the Journal of Clinical Medicine.)
The really exciting part is that the neuroplastic technique can be taught even virtually, through video training, which the clinic offers through their website. He compared some of his brain training techniques to how physical changes happen in our body just through visualization—we may start to get hungry when we think of our favorite food, or feel fear when we think of an upcoming presentation, for instance. In the same way, he believes you can train the brain to believe it’s no longer in an infection state to allow for a reduction in symptoms.
Creating Hope and Limiting Stress
Gupta advises that if you feel that you are suffering from long haulers you should first get thoroughly checked out by your doctor, and once all options have been exhausted maybe try neuroplasticity.
While long-haul COVID and the other chronic conditions that Gupta sees can sound scary, he reassured listeners that many people do get better from various different treatments and in some cases, resolves on their own, so it’s important to “remain positive.”
He added that with the clinic treatments using neuroplasticity techniques, shifts and changes can occur as quickly as within weeks, with 80 to 90% recovery within three to four months and 90-95% recovery within six months. However, he cautioned that the most important thing is for people to not become complacent because throwing yourself back into old, stressful habits could cause a relapse. He warned that nurses especially are at risk (along with teachers), because both professions are very self-sacrificing, feel a strong sense of duty, and of course, work very stressful jobs.
“But if you do have long COVID or you've actually got the COVID infection, we strongly advise that you really rest and really take the time out to heal fully and properly before you go back to work,” he said. “Because the worst outcomes are when we're treating patients, they get to 70 - 80% and think, ‘I just need to get back to work,’ then throw themselves into a busy lifestyle and of course, the body sees that as a threat because it sees that as an inability to overcome the virus from the stress and therefore retriggers immune responses and then somebody has a dip or a relapse afterward.”
“So both during COVID 19 infection and long COVID, taking adequate rest to fully heal is incredibly important,” he concluded. And resting means resting in all ways, he added. “Make sure that you fully rest and that doesn't mean just physical rest but emotionally and mentally rest—because people can be sitting in their bed but typing away on their laptops, and that's not really resting,” he pointed out.
And while the scientific community may not fully be there just yet, Gupta believes that his program represents a “new branch of medicine.” He noted that while medicine has gotten very good at treating the “hardware” problems of the body, it’s the software problems—aka the brain–that need to be addressed more fully.
“The software problems are the kinds of illnesses that keep people coming regularly into a clinician's office. Things like pain disorders, where there's not really a lot that can be done, depression or anxiety, allergic response or food sensitivities, mold sensitivities, chronic fatigue, long COVID, are very difficult to treat because we believe they're in the brain in the unconscious brain,” he said. “ So if we recognize that these are brain conditions and software problems, and we can start retraining them and reprogramming the brain, we can bring the body back to balance and heal so many conditions for so many people.”
