In this video, I review an excellent observational study of people with radiologically isolated syndrome (people who have multiple sclerosis lesions on MRI but no symptoms who are at risk of developing clinical multiple sclerosis). Do people with RIS who received covid-19 vaccines have an increased risk of MS?
Nuria Pastor-Soler, MD, PhD, is the principal investigator of the long COVID clinical trial and an associate professor of medicine at the Keck School of Medicine of USC. CREDIT Ricardo Carrasco III
Approximately 7% of Americans have had long COVID, a range of ongoing health problems experienced after infection and recovery from COVID-19. Symptoms can include fatigue, brain fog, headaches, chest pain, heart palpitations and more.
To date, there is no proven treatment for the syndrome, and the mechanisms that cause it are not fully understood.
Now, a new clinical trial from Keck Medicine of USC is investigating if a diet designed to lower inflammation may play a role in easing this often debilitating condition.
The premise of the trial revolves around recent research indicating that long COVID may be caused by a hyper inflammatory response that becomes activated during COVID-19 as the body fights off the virus but, in some people, does not recede even after the infection has passed. High inflammation levels in the body can lead to organ damage and other health problems.
“We are examining if food choice can quiet the body’s inflammatory response and in doing so, effectively minimize or curtail long COVID symptoms,” said Adupa Rao, MD, an investigator of the clinical trial and medical director of the Keck Medicine Covid Recovery Clinic.
The study will examine the anti-inflammatory effect of a low-carbohydrate diet to lower blood glucose (sugar) levels in combination with a medical food that raises blood ketone levels. Ketones, including beta-hydroxybutyrate, the active ketone in this food, are chemicals the body produces to provide energy when the body is low on carbohydrates and sugars. A low-carb diet and ketones have both been associated with reduced inflammation in the body.
Researchers plan to enroll 50 long COVID patients being treated by Keck Medicine’s Covid Recovery Clinic. Half the individuals will receive a 30-day dietary intervention and half will not. At the end of the month, researchers will determine how patients tolerated the regimen as well as compare inflammatory markers and long COVID symptoms between the two groups of patients.
If the nutritional intervention is tolerated well by patients and improves their health issues, researchers plan to expand the clinical trial to a larger population.
“Research like ours is vital to expand our understanding of long COVID and ultimately help identify effective treatments to improve patients’ quality of life,” said principal investigator of the clinical trial, Nuria Pastor-Soler, MD, PhD, who is also an associate professor of medicine at the Keck School of Medicine of USC. “The results of this trial will hopefully move us closer to potential solutions.”
Patient standing at 0 minutes CREDIT University of Leeds
An unusual case of a Long Covid patient’s legs turning blue after 10 minutes of standing highlights the need for greater awareness of this symptom among people with the condition, according to new research published in the Lancet.
The paper, authored by Dr Manoj Sivan at the University of Leeds, focuses on the case of one 33-year man who developed with acrocyanosis – venous pooling of blood in the legs.
A minute after standing, the patient’s legs began to redden and became increasingly blue over time, with veins becoming more prominent. After 10 minutes the colour was much more pronounced, with the patient describing a heavy, itchy sensation in his legs. His original colour returned two minutes after he returned to a non-standing position.
The patient said he had started to experience the discolouration since his COVID-19 infection. He was diagnosed with postural orthostatic tachycardia syndrome (POTS), a condition that causes an abnormal increase in heart rate on standing.
Dr Sivan, Associate Clinical Professor and Honorary Consultant in Rehabilitation Medicine in the University of Leeds’ School of Medicine, said: “This was a striking case of acrocyanosis in a patient who had not experienced it before his COVID-19 infection.
Patient standing at 2 minutes
“Patients experiencing this may not be aware that it can be a symptom of Long Covid and dysautonomia and may feel concerned about what they are seeing. Similarly, clinicians may not be aware of the link between acrocyanosis and Long Covid.
“We need to ensure that there is more awareness of dysautonomia in Long Covid so that clinicians have the tools they need to manage patients appropriately.”
Long Covid affects multiple systems in the body and has an array of symptoms, affecting patients’ ability to perform daily activities. The condition also affects the autonomic nervous system, which is responsible for regulating blood pressure and heart rate.
Patient standing at 10 minutes
Acrocyanosis has previously been observed in children with dysfunction of the autonomic nervous system (dysautonomia), a common symptom of post-viral syndromes.
Previous research by Dr Sivan’s team has shown that both dysautonomia and POTS frequently develop in people with Long Covid.
Dysautonomia is also seen in a number of other long-term conditions such as Fibromyalgia and Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome or ME.
Dr Sivan said: “We need more awareness about dysautonomia in long term conditions; more effective assessment and management approaches, and further research into the syndrome. This will enable both patients and clinicians to better manage these conditions.”
Long COVID risk has been found to increase with low levels of vitamin D, according to research presented at the 25th European Congress of Endocrinology in Istanbul. The findings suggest that individuals should have their vitamin D levels checked after COVID-19.
Also known as post COVID-19 syndrome, long COVID is a new condition in which the effects of COVID-19 last for more than 12 weeks after contracting the initial infection. Studies have shown that it affects 50-70% of patients previously hospitalised for COVID-19, yet very little is known about the condition. One risk factor for worse outcomes for hospitalised COVID-19 patients, such as intubation and mechanical ventilation or death, is low vitamin D levels, but its role in long COVID has not been adequately investigated.
For this study, supported by Abiogen Pharma SpA, researchers from the Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital in Milan examined 100 patients aged 51-70 years, with and without long COVID. They measured their vitamin D levels when first admitted to hospital for COVID-19 and six months after being discharged, and found lower vitamin D levels in patients with long COVID compared to those without. This result was more evident in patients who experienced ‘brain fog’ symptoms, such as confusion, forgetfulness and poor concentration, at the six-month follow-up.
The researchers included patients without any bone conditions and only those who went to hospital for COVID-19, without ending up in the intensive care units (ICUs). They matched the two groups, with and without long COVID, in terms of age, sex, pre-existing chronic diseases and COVID-19 severity. “Previous studies on the role of vitamin D in long COVID were not conclusive mainly due to many confounding factors,” said lead investigator Professor Andrea Giustina. “The highly-controlled nature of our study helps us better understand the role of vitamin D deficiency in long COVID, and establish that there is likely a link between vitamin D deficiency and long COVID.”
While Professor Giustina acknowledges that larger studies are needed to confirm this link, he and his team are now focussed on finding out whether vitamin D supplements can reduce the risk of long COVID. “Our study shows that COVID-19 patients with low vitamin D levels are more likely to develop long COVID but it is not yet known whether vitamin D supplements could improve the symptoms or reduce this risk altogether.”