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Long Covid: What we know now with Gary Kaplan, DO

Picture of podcast cover art with Christa Biegler and Gary Kaplan: Episode Long Covid: What we know now with Gary Kaplan, DO

This week on The Less Stressed Life Podcast, I'm excited to have Dr. Gary Kaplan back. Dr. Kaplan is a doctor of osteopathic medicine (DO). In this episode, Dr. Kaplan talks about what the treatment pie is for recovering from Long COVID, why you may be experiencing long term symptoms, how you can be evaluated for treatment, request treatment or get more information.

Dr. Kaplan's other episode on the LSL: 323: Chronic pain, depression, and sleep issues with Dr. Gary Kaplan

KEY TAKEAWAYS:

  • What are the symptoms of long COVID?
  • COVID can affect every system in the body
  • Why are we seeing an increase in cancer?
  • What helps with the loss of taste and smell?
  • Why do you lose taste and smell when you have COVID?
  • What is the treatment for a high fever?
  • Why do people struggle with detoxing and alcohol tolerance after having COVID?
  • What can you do to support the kidneys post COVID?
  • Solutions for Long COVID
  • How does metformin help Long COVID?
  • How do you diagnose Long COVID?
  • Benefits of methylene blue
  • What are cytokines?

 


ABOUT GUEST:
Gary Kaplan, DO a clinical associate professor at Georgetown University School of Medicine, founder and medical director of the Kaplan Center for Integrative Medicine and author of Why You Are Still Sick: How Infections Can Break Your Immune System and How You Can Recover. A pioneer and leader in the field of integrative medicine, Dr. Kaplan is one of only 19 physicians in the country to be board-certified in both Family Medicine and Pain Medicine. In November, Dr. Kaplan will co-chair an international conference on New Developments in Understanding Chronic Illness: The Role of the Immune Dysfunction and Infections.

Find Dr. Kaplan's conference information here: https://foundationfortotalrecovery.org/

WHERE TO FIND:
Website: 
https://kaplanclinic.com/
Instagram: 
https://www.instagram.com/kaplan_clinic/
Facebook: https://www.facebook.com/KaplanCenterforIntegrativeMedicine
YouTube: https://www.youtube.com/channel/UCjBaguhq1VYTBHMYlvKCMIw

WHERE TO FIND CHRISTA:
Website: 
https://www.christabiegler.com/
Instagram: @anti.inflammatory.nutritionist
Podcast Instagram: @lessstressedlife
YouTube: https://www.youtube.com/@lessstressedlife
Leave a review, submit a questions for the podcast or take one of my quizzes here: https://www.christabiegler.com/links

ANNOUNCEMENTS:
WORK WITH CHRISTA IN 2024https://www.christabiegler.com/fss

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Transcript:

[00:00:00] Dr. Gary Kaplan: The number one thing that shows up with post COVID interestingly shows up in almost all these other conditions. It's fatigue, brain fog, difficulty focusing, concentration, your brain's inflamed, you can't focus, you can't concentrate. 

[00:00:14] Christa Biegler: Stress is the inflammation that robs us of life, energy, and happiness. Our typical solutions for gut health and hormone balance have let a lot of us down. We're over medicated and underserved. At The Less Stressed Life, we're a community of health savvy women exploring solutions outside of our traditional Western medicine toolbox and training to raise the bar and change our stories.

[00:00:41] Christa Biegler: Each week, our hope is that you leave our sessions inspired to learn, grow, and share these stories to raise the bar in your life and home.

[00:00:58] Christa Biegler: today on The Last Dressed Life, I have back Dr. Gary Kaplan, who is a clinical associate professor at Georgetown University School of Medicine, founder and medical director of the Kaplan Center for Integrative Medicine and author of Why You Are Still Sick, How Infections Can Break Your Immune System, and How You Can Recover.

[00:01:13] Christa Biegler: He's a pioneer and leader in the field of integrative medicine, and he's one of only 19 physicians in the country to be board certified in both family Pain medicine. And last time he was here, we talked about neuroinflammation. We talked about depression, fibromyalgia. We talked about sleep stuff. So if that.

[00:01:29] Christa Biegler: Interests you, which I found it was really useful because every time people have full body pain, there's neuro brain inflammation. So we talked about some resources for that. And today we're going to move on to more related to the immune system and long COVID.

[00:01:43] Christa Biegler: Welcome back, Dr. Kaplan. 

[00:01:45] Dr. Gary Kaplan: So thank you for having me back on the show. I'm delighted to be here. 

[00:01:47] Christa Biegler: Yeah. I was actually in your neck of the woods last month and I referred someone to you who was asking me all about her inflammatory symptoms. And I said, you should see a guy who's from this area on this very topic.

[00:01:59] Christa Biegler: So I just recalled that.

 

[00:02:00] Christa Biegler: yEah, you have a thing coming up, you have a conference coming up that you've been working super hard on and it's all about the immune system. And I know this is going to publish a little bit after that, but is that just actually, if you don't mind, because last time we talked about your story.

[00:02:11] Christa Biegler: So why don't you tell me just a little bit about the conference? Because I'm sure it eats up your entire day talking about it or like planning and thinking about it probably right now. So tell us a little bit about it. Now when this comes out, it'll be post, but maybe it's even something people can access later.

[00:02:24] Dr. Gary Kaplan: So going to the website foundation for total recovery dot org or chronic illness dot org. So this is a conference on chronic illness. And what we've found is that if you look at chronic fatigue syndrome and you look at fibromyalgia and you look at post treatment Lyme syndrome and you look at pans, pandas, pediatric acute onset, neuropsychiatric disorder.

[00:02:45] Dr. Gary Kaplan: And you look at a whole bunch of neuropsychiatric illnesses, which are depression, anxiety disorders, OCD and you look at post COVID, that in fact, there's a whole bunch more in common with these things than there is not in common. And at the basis of what's in common, all these things is the immune system going a bit wacky doodles.

[00:03:08] Dr. Gary Kaplan: So we have experts. At the conference, we'll be talking about psychiatric aspects of these diseases. We have people at the conference who will be talking about the neurologic aspects of this disease. So Dr. Nath, who's head of the Division of Outpatient Neurology at NIH. We have some of the top people from around the world.

[00:03:28] Dr. Gary Kaplan: Dr. Goibles, from Liverpool, will be talking about autoimmune fibromyalgia. People from Stanford, Dr. Frankovich talking about PANS Pandas. So we've got an all star top line academic cast to talk about this, and this is open to the public because we want to educate the public as much as we're educating the profession about this stuff.

[00:03:50] Dr. Gary Kaplan: So all of these diseases have a great deal in common, and unfortunately when COVID came along, It brought all this into the forefront. As you and I were talking briefly before the show, the people who get hospitalized and the people who die because of COVID don't die because of an overwhelming infection, right?

[00:04:07] Dr. Gary Kaplan: So a meningitis where you get an overwhelming infection and the bug just destroys you. That's not what happens. What happens with COVID is you get an overwhelming response of the immune system to COVID. And that's what does the damage and that's what keeps you sick post COVID. So it's not the living bug itself, but rather it's what the bug does to your immune system and screws up your immune system that creates so much havoc.

[00:04:32] Dr. Gary Kaplan: And we've just, a paper came out just the other day talking about the damage that COVID does in the intestine. Into what's called the chromatin cells. You're serotonin. People know about serotonin and neurotransmitters. The way neurotransmitters work is that nerves get really close to one another, but they don't touch.

[00:04:50] Dr. Gary Kaplan: They send out little packets of chemicals and those chemicals are called serotonin and dopamine and norepinephrine. And so that then moves over to the next nerve. And sets up a reaction to propagate the signal and keep things going. So in the case of serotonin, 70 percent of the serotonin is actually produced in the gut.

[00:05:11] Dr. Gary Kaplan: It's not the brain and the chromatin cells in the gut are where they're produced. And now this paper is indicated that there's damage to the chromatin cells in the gut as a result of COVID. And that also then depletes serotonin from the system, and that's why we're finding in some people with post COVID syndrome that giving them a serotonin medication such as Zoloft, such as Paxil can in fact Bye.

[00:05:38] Dr. Gary Kaplan: Dramatically improve their condition. So it's our understanding of the way that COVID is damaging the immune system. That's helping us understand how to get people to recover from post COVID and also how to protect them from getting post COVID to begin with. So 

[00:05:55] Christa Biegler: let's bring up lots of questions. Yeah, no, I was going to say, maybe we should set the stage with some of the symptoms that you see that are most common long COVID symptoms?

[00:06:05] Christa Biegler: There's lots of questions that just came from what you just said, but maybe we should set the stage of long COVID first and then we can jump to the rest. 

[00:06:11] Dr. Gary Kaplan: The number one thing that shows up with post COVID, interestingly, shows up in almost all these other conditions. It's fatigue, brain fog, difficulty, focus, and concentration.

[00:06:23] Dr. Gary Kaplan: Your brain's inflamed. You can't focus, can't concentrate. Now, the other thing that COVID has in common with a lot of these other conditions is it hits everything. It hits the heart. It hits the intestinal tract. You end up with problems with slow digestion or too fast digestion, bloating, gas constipation stasis.

[00:06:42] Dr. Gary Kaplan: So you end up with problems with heart. And we certainly have heard. Lots associated with cardiomyopathies. This is and generalized inflammation of the heart associated with the virus. We have seen problems with the kidneys. I've unfortunately had a couple of patients who've gone into stage three or four kidney failure because of COVID.

[00:07:01] Dr. Gary Kaplan: So COVID can hit pretty much every single organ in the body. And damage every somewhere in the body and the blood vessels. We see we get these micro clots that occur. That is probably a result of over activation of platelets and inflammation of the blood vessels themselves. So it can affect pretty much every system in the body.

[00:07:21] Dr. Gary Kaplan: And people complain of shortness of breath. This difficulty and it's really interesting because I had covered early on and I got through my week and a half, two weeks of COVID and it was cleared. And I went to walk to a Vietnamese restaurant. That's about a mile from the house. And we're walking to the Vietnamese restaurant about a half mile until the walk.

[00:07:43] Dr. Gary Kaplan: I can't breathe. I'm short of breath. I'm feeling like I'm sitting there going, am I having a heart attack? What's going on? I'm not wheezing, but I can't breathe. I had this horrible sense of shortness of breath and I needed to sit down and it slowly passed. And I was able to get to the restaurant.

[00:08:01] Dr. Gary Kaplan: But this is what people experience. It's terrifying. And if you don't know what's going on you're in an emergency room trying to figure it out. And worse is you get to the emergency room and they examine you and everything looks fine. 

[00:08:13] Christa Biegler: Yeah. 

[00:08:14] Dr. Gary Kaplan: Because the problem is the sensors in the lung and the sensors in your brain are the reason you're short of breath.

[00:08:21] Dr. Gary Kaplan: Not that you're not moving air, but it can feel oppressive and it can feel very frightening. 

[00:08:26] Christa Biegler: All right. Let's just start with that one. What is someone supposed to do in that case? yOu've experienced it, you've gone through it. Is there really any solution? 

[00:08:35] Dr. Gary Kaplan: So the good news is I'm a doc, so I I get hysterical and and then my wife calms me down.

[00:08:41] Dr. Gary Kaplan: Because I'm running through my differential of, Oh my God, what is this? I think the reality of the matter is if you're having the experience, certainly the first time you have the experience, you need to be seen by somebody because It can be heart attack. It can be a severe asthmatic attack. And so we want to make sure that you're all right.

[00:08:59] Dr. Gary Kaplan: One thing you can do very quickly is throw a pulse ox on you. That little device that clips on your fingertips that all of us were told to get when COVID was first raging through tells you how much oxygen in your blood. So being able to look at that and see that your oxygen level is in fact 94 plus percent is very reassuring.

[00:09:18] Dr. Gary Kaplan: If you're looking at that and you're looking at it and it's under 90. Get yourself in the emergency room ASAP. So find out what your heart rate is. Is your heart pounding? Is your heart going over a hundred? That's a problem. Is your heart regular or irregular? If it's irregular, that's a problem. You need to get to the emergency room.

[00:09:39] Dr. Gary Kaplan: So you can check that by feeling your pulse at your wrist is probably the easiest way you can also feel it up in your neck. So ways of just grounding yourself and going, okay. Am I safe or aren't I safe? And frankly, if you think you're not safe, you belong in the emergency room. So we can take a look at you, make sure we haven't missed anything.

[00:09:57] Christa Biegler: Okay. So we're talking about how it affects every single thing. Here's a couple of things that I'm seeing it presented, and then we can talk about all those other systems as well. I am hearing about cancer rates, majorly increasing, which makes sense if it affects the immune system. What do you want to say about that, if anything?

[00:10:14] Dr. Gary Kaplan: So again, so this is, it's an inflammatory response on the part of the immune system, right? Cancer is in fact a failure of the immune system to keep things in check. We develop cancer cells all the time. And what the immune system's supposed to do is run around and go, Oh, that doesn't belong there, let's make that go away.

[00:10:31] Dr. Gary Kaplan: So when the immune system's operating ideally, it makes that stuff go away. If the immune system is not operating ideally, it's overreactive, it's not reacting properly to the things that are coming in, then what's going to happen is your cancer, if you've got a cancer, it's going to flare. And in fact, when we see most of our kids who are struggling with PANS, PANDAS and other neuroinflammatory diseases, they get much sicker when they get COVID.

[00:10:55] Dr. Gary Kaplan: Much sicker. And and indeed we've seen people, basically the risk factors for long COVID and the risk factors for worsening COVID, hospitalization or obesity, hypertension, kidney disease. All right. So diabetes. So these are factors which we've demonstrated clearly already have a taxed immune system and COVID makes things much, much worse.

[00:11:20] Dr. Gary Kaplan: So cancer is flaring. Not surprising. We've seen glaucoma. We've seen people develop eye problems secondary to the COVID senses in terms of taste and smell. Early on Delta variety of COVID was a big deal with that. We've not seen it so much with Omicron and the latest versions of COVID.

[00:11:38] Dr. Gary Kaplan: So these seem to be a little bit milder in some case, and we're hopeful we'll see a little bit less long COVID from these. 

[00:11:45] Christa Biegler: Yeah, I was actually going to be a question back to the people who were really affected by smell and taste issues. If that has not resolved. What's in the toolbox for that these days?

[00:11:58] Dr. Gary Kaplan: IN one sense, we treat it as a neuropathy, that's damage to the nerves. And so using an anti seizure medication, such as Neurontin, has been helpful for some people. Using a low dose naltrexone, which helps in terms of inflammation of the central nervous system, has also been helpful for some people.

[00:12:14] Dr. Gary Kaplan: Acupuncture has been helpful for some people. And we'll definitely have that in our toolbox in terms of what we're doing. And unfortunately... That's pretty much it, the taste and smell stuff is one of the toughest symptoms from long COVID that we've seen trying to manage it. 

[00:12:31] Christa Biegler: And what was happening?

[00:12:33] Christa Biegler: Do we know what happened that caused that? 

[00:12:37] Dr. Gary Kaplan: Damage to the cerviform plate, there's a whole bunch of, the cerviform plate is up behind your nose, behind your eyes, and there's a whole bunch of little nerves that come down there that carry, they're stimulated chemically so that's your sense of smell and taste.

[00:12:52] Dr. Gary Kaplan: And that those nerves were damaged as a result of COVID and that damage is your senses. So it's really a neurologic problem that created the issue. 

[00:13:01] Christa Biegler: Okay. That made me think about some banter. I saw that. I didn't fully pay attention to about high fevers causing. Essentially damage to things having very high fevers for a while.

[00:13:14] Christa Biegler: Is that something like, can you speak to that at all?

[00:13:17] Dr. Gary Kaplan: Think about febrile seizures. In kids under two years of age, all right, what's going on, what's going on is the brain is immature. The blood brain barrier is immature, and you start having high fevers, 102, 103, 104, in some cases, and then you have seizures, because the brain doesn't do well, basically high fevers.

[00:13:38] Dr. Gary Kaplan: Break down your enzyme systems and all kinds of cellular processes stop working. So there's an ideal temperature with the body works. And that's where the enzyme systems converted. One thing to another is supposed to work. When you get at high temperatures, all of that starts breaking down. And the next thing, You've got all kinds of problems and in the central nervous system, especially in little kids, you'll see febrile seizures in adults and very adults don't tolerate high fevers at all.

[00:14:04] Dr. Gary Kaplan: So when you see adults at 104 fever, which is pretty much the upper end of it, you start getting to 106 and you are deathly ill and need to be in the hospital. And so you're, and this is the body's response to try and fight off or kill the bugs. So in one sense, the fever is supposed to be helping us.

[00:14:20] Dr. Gary Kaplan: But in another sense, the high fevers start breaking down our cellular processes, our cellular functioning. And it can do a lot of damage to pretty much every part of the 

[00:14:28] Dr. Gary Kaplan: body. 

[00:14:30] Christa Biegler: When you go into the hospital for a really high fever, what's the 

[00:14:32] Christa Biegler: treatment? 

[00:14:34] Dr. Gary Kaplan: First thing, the same thing that we would do outpatient, right?

[00:14:36] Dr. Gary Kaplan: So if we can get you with aspirin or Tylenol then, or Motrin, one of the nonsteroidals will control the fever with that. Otherwise we will pack people on ice. We, there are medications you can give that are vasodilators in order to be able to help kick off some of the heat from the body. And there are things that we will do in terms of trying to protect the brain and the nervous system.

[00:14:59] Dr. Gary Kaplan: But those are extreme measures. Basically you want to control that fever as best you can. 

[00:15:04] Christa Biegler: Here's another one that I feel like comes up a lot post COVID, which is people struggle with alcohol or detoxification, like they suddenly can no longer tolerate alcohol. 

[00:15:15] Dr. Gary Kaplan: Yeah. So your liver enzymes are not able to process the alcohol the way they used to and your detox pathways aren't working.

[00:15:23] Dr. Gary Kaplan: All the detox pathways go through the liver. So simple take home message. Don't do it. Why increase the burden on your liver? But yes, I hear that a lot, that people are not able to tolerate alcohol the way they could they find that they get drunk after half a drink and they used to be able to have a couple of beers without any problem and we simply say, back off because your enzyme systems have broken down on the liver.

[00:15:47] Dr. Gary Kaplan: It's not detoxifying it. The alcohol is building up in your system much faster, and so it's really important that you stop taxing it like that, and you may need to pay attention to that with medications because it may change your ability to process most medications when you take them are what's called pro medications, meaning that you take them pro drugs, you take them, and then they go to the liver and the liver breaks them down, and they break them down into a metabolic byproduct and the active drug.

[00:16:14] Dr. Gary Kaplan: Yeah. And so you need certain enzymes in order to be able to do that. The P450 is the best understood of those processes, but you need certain enzymes enabled to be able to break down those drugs. If the liver is impaired, it's going to have trouble processing the drugs, and it may allow for an accumulation of some of the metabolites.

[00:16:33] Dr. Gary Kaplan: That'll make you sicker. It may be able. It may make it so that it can't effectively convert it into the active form of the drug. So you may need if you're really sick, we may need to adjust the dosages of the medications that you're taking. The other thing we have to pay attention to is Yeah. Remember, I mentioned that I've seen people go into early kidney damage as a result of COVID.

[00:16:54] Dr. Gary Kaplan: Then drugs also have to be cleared by the kidney. And so are the kidneys able to do the job they need to do in order to be able to clear toxins from our body, the drugs from our body? Are they able to regulate the main thing that kidneys are doing are regulating our electrolyte balance. So can they keep the amount of proper amount of sodium, the proper amount of potassium, in particular, and calcium in our system, or are we losing them?

[00:17:16] Dr. Gary Kaplan: And now we're getting hypokalemic, too little potassium or too high potassium, which can get you in a lot of trouble in a short time period. There's a lot of damage that COVID can do to the entire body. By disrupting different enzyme systems and doing direct cellular death.

[00:17:33] Christa Biegler: I'd like to think that we can be supportive to systems and help some of them improve.

[00:17:41] Christa Biegler: Maybe liver detoxification. I think those are possibilities. I think I worked in kidney care for a very long time. I think that can be a little bit tricky. Do you have any opinions or do you see things improve over time at any point? I think for a long time, we've always thought, Hey, once you've got this damage, it's done.

[00:17:57] Christa Biegler: But sometimes I think we're surprised also that the GFR can jump around a lot, a little bit too. 

[00:18:03] Dr. Gary Kaplan: So first off, there's a number of people that we've seen over the course of a year where they fully recover. So absolutely, positively, we see people fully recover. Using glutathione and NAC has been extremely effective in helping people recover.

[00:18:17] Dr. Gary Kaplan: NAC is N acetylcysteine. Glutathione is the most abundant antioxidant in the central nervous system. things aren't working well, you're producing lots of reactive oxygen species, reactive nitrogen species. So you're chewing up your glutathione. And so NAC helps build up the stores of glutathione in the body.

[00:18:35] Dr. Gary Kaplan: And there are some case reports of using glutathione in hospitalized patients. with COVID with dramatic recovery. So increasing glutathione stores in the body with NAC and also giving glutathione can be extremely helpful in terms of doing that. In terms of the heart, D ribose can be a very effective vitamin in terms of helping With the heart muscle recovery, D ribose has been shown to take people from a so we have stages of heart failure, and it's actually been shown to dramatically improve heart failure in the New York classification by just giving D ribose.

[00:19:09] Dr. Gary Kaplan: So D ribose is something I would add to anybody who's having heart problems Certainly if I have people with just heart failure, but if I have a myopathy secondary to post COVID, the ribose is one of the things that we want to use. So lots of things we can do in order to help support the system.

[00:19:24] Dr. Gary Kaplan: High dose vitamin C can also be effective. Typically high dose vitamin C, we're going to be giving IV though, because we need to give upwards of about 20 grams at a time to do that. We want to make sure that nutritionally you're well supported. You have absolutely. Adequate magnesium in your system. wE want to make sure your vitamin D levels, low vitamin D levels is a risk for getting post COVID and a risk for having more serious COVID.

[00:19:46] Dr. Gary Kaplan: Vitamin D is absolutely essential for the normal function of the immune system. And and a normal vitamin D level, vitamin D should be a part of your normal physical exam to find out what your levels are, a normal vitamin D level is set at 30 nanograms per deciliter. I disagree. I think that's too low.

[00:20:03] Dr. Gary Kaplan: I think optimal is 50 to 80. And so vitamin D3. So making sure that your vitamin D3 levels are adequate. The other thing that we've found has been helpful is omega 3 fish oils. And so I'll frequently put people on a gram and a half of mixed omega 3s a day. THere's lots we can do and lots we can do to help support you to keep you healthy, cozy.

[00:20:25] Dr. Gary Kaplan: Q 10, another one. So if you're under 40 coq 10, 300 milligrams a day can help in terms of your immune system and help recovery. If you're over 40, you don't tend to convert coq 10 into ubiquinol, which is ultimately what you're trying to get. So we recommend that you take ubiquinol, again as a supplement, 300 milligrams a day.

[00:20:50] Christa Biegler: So I want to talk about some of these things. It would make sense that vitamin D is low in people with low long COVID because they already have an inflammatory response and vitamin D is a sign of longer term inflammation. One of the reasons he is low as with omega threes, right? So inflammation uses up phospholipids, omega threes, et cetera.

[00:21:09] Christa Biegler: It's so that's why I think cycling omega threes into your life is really important. People could take it all the time. That's fine too. It's not a harmful thing. I just to, it can be expensive. I think it's good to. Don't cycle on and off things and not just be stuck on them. I want to talk about why glutathione works.

[00:21:24] Christa Biegler: I want to just walk through that physiologically because I think it's interesting. So we have long coat, we have COVID it creates. Damage to the kidneys to the liver and it damages the enzymes. Maybe the enzymes are partially damaged because of the fever stuff. Maybe the immune stuff. So we know glutathione is this master antioxidant, but you mentioned something.

[00:21:46] Christa Biegler: Yes, that sometimes when people. Got high doses of glutathione when they were hospitalized with COVID, they would improve. Why do you think that was? Because that felt like a step before, right? Does that make sense? What I'm trying to say? It almost felt like a step before the liver damage. So it's like, why was the glutathione helpful in what was happening with what was happening with the virus in the body?

[00:22:10] Christa Biegler: Do you think? 

[00:22:11] Dr. Gary Kaplan: So I believe what was going on is that you have very high cell turnover, and when cells are dying, they're kicking out things, reactive nitrogen species reaction. So cells die. What happens is things inside the cell, leave the cell. Then what happens is the immune system comes back in. Okay.

[00:22:31] Dr. Gary Kaplan: The immune system, if you look at microglia in the central nervous system, macrophages and peripheral, basically what they do, their first job is to go in and Clean up the damage. They will if it's if the problem is a result of a bug, they literally release factors to blow up that bug. So reaction auctions and reactive nitrogen species to make the bug die.

[00:22:53] Dr. Gary Kaplan: They will also release a whole bunch of other factors that were looking factors is inflammatory factors, including 6 and 10. So there's a whole bunch of chemicals that gets released from these immune cells, and their job is to get rid of all the cellular debris, clean everything up, but then they're supposed to stop?

[00:23:15] Dr. Gary Kaplan: And send out another set of signals that bring in the general contractors who come back in to clean everything up. If they keep in their hyper reactive phase where they're constantly kicking out destructive factors, okay. Cell death. Now what's happening is glutathione, which is part of that cleanup process is depleted severely.

[00:23:37] Dr. Gary Kaplan: So now what happens is you haven't got anything to help clean you up and. The you continue to blow things up and damage things. So what's happening is the garbage is accumulating. Nobody's removing it. 

[00:23:48] Christa Biegler: Yeah. 

[00:23:48] Christa Biegler: Or it could have even been accumulating before probably right? Maybe you come in with backed up trash.

[00:23:54] Christa Biegler: That would make sense. That's pretty normal for humans. I feel like too. 

[00:23:58] Dr. Gary Kaplan: I think you're absolutely correct. And yeah, so you've got all this stuff, which is accumulated. And now you're running out of the garbage trucks you need in order to remove everything. That's where we need to put more glutathione in the system.

[00:24:10] Dr. Gary Kaplan: You put more glutathione in the system. It's helping remove all of that trash. Okay. And that's allow the cells a chance to regenerate and rebuild the trash builds up. Nothing moves. So everything gets clogged up. So glutathione is helping in terms of that detoxification process throughout the body and in the central nervous system in particular.

[00:24:31] Dr. Gary Kaplan: And NAC is important because NAC, the rate limiting steps, the thing that stops you from making lots of glutathione is lacking a thing called cysteine. Okay. NAC is N acetylcysteine. It has two cysteine groups that will actually cross the blood brain barrier, thus allowing you to make more glutathione. So NAC is the precursor to make glutathione.

[00:24:55] Dr. Gary Kaplan: And so giving glutathione directly is good, but glutathione has a short half life in the system, meaning it doesn't last very long. Whereas NAC allows you to actually build it up from the get go. So doing both at the same time, especially in an emergent situation, such as sitting in an ICU, is the best way to go about doing this.

[00:25:16] Christa Biegler: You brought up vitamin D. When I think about vitamin D, I also think about vitamin A supporting the immune system. Do you check vitamin A stores or do you check, not vitamin, do you 

[00:25:23] Dr. Gary Kaplan: Yeah, vitamin A also needs to be paid attention to. Zinc copper need to be a paid attention to and make sure that there are adequate amount of all of that's necessary for a normal functioning immune system.

[00:25:34] Dr. Gary Kaplan: And yes, we make sure that zinc and copper levels are adequate. Make sure the vitamin A levels are adequate along with vitamin C is tricky to measure because it's it flows in and out of the system so fast. But vitamin C is a superb antioxidant. And when somebody is really sick, high dose vitamin C can help get them help them recover that much faster.

[00:25:54] Christa Biegler: I think we've done a good job talking about solutions before we even go into the background of the immune system. So we'll go to the immune system and talk about that a little bit nerd out about that next. But before we do, let's go back to that number one, most common symptom of fatigue. I feel like everything you mentioned could really help with fatigue, especially the CoQ10 conversation.

[00:26:12] Christa Biegler: What else? Last time we talked about Low dose naltrexone. We talked about CBD because we talked about brain inflammation. You're a brain inflammation or inflammation guy. And I would almost wonder as we're talking about this, if we're having brain inflammation, if people are having a lot of pain all over their body, suddenly post COVID too.

[00:26:29] Christa Biegler: So anyway, let's talk about the fatigue, and the brain inflammation a little bit. 

[00:26:33] Dr. Gary Kaplan: So the fatigue is the thing that's been most intriguing and for which NIH has now devoted about a billion dollars in research funds to go understand that better. And there's a big study that's just getting underway at NIH looking at.

[00:26:46] Dr. Gary Kaplan: Now we've begun to understand. So Very interesting thing. I was at Health and Human Services on the advisory committee for chronic fatigue syndrome for four years until 19 2018. The biggest issue at the time was nobody believed it existed. 

[00:27:01] Christa Biegler: So really hard to get anything done if everyone can't be on the same damn page.

[00:27:05] Christa Biegler: Oh, I thought we could move past this point if we devoted dollars to this. 

[00:27:10] Dr. Gary Kaplan: We got to give dollars to it. So we do the research, but you got to believe it exists before you give dollars to it. 

[00:27:14] Christa Biegler: Yeah.

[00:27:16] Dr. Gary Kaplan: The poor patients were being told that they were making it up, that they were malingering, that they were just being horribly abused, and it was in 2018 when finally NIH had what's called a PPP conference and said, you know what?

[00:27:29] Dr. Gary Kaplan: Chronic Fatigue Syndrome is real, and we need to study it. And we managed to get a couple of centers established around the country to begin to fund that. We went from about $5 million in funding for the condition, which was a joke. In research terms, that's not much money at all to about 25 to $50 million in funding.

[00:27:49] Dr. Gary Kaplan: But now what's happened is fatigue being such a big symptom associated with post COVID syndrome. The NIH said wait a minute. We need to understand this better. And huge amount of money is now poured into this. And we now say, yeah, post viral fatigue, post infectious fatigue is a real thing.

[00:28:09] Dr. Gary Kaplan: We have a lot to go in terms of understanding it. In terms of reducing inflammation, centrally, we want to make sure that we're doing things, the stuff we've already talked about, but yeah, One of the things we were also coming to understand is with post COVID syndrome, we were also interested in preventing this, right?

[00:28:27] Dr. Gary Kaplan: So it turns out that the vaccinations maybe lower the risk of getting post COVID by about 10 to 15%. The Paxlovid, which is used for treatment of post COVID, looks like it lowers the risk of getting post COVID maybe another 15%. All right, but metformin. Metformin is a medication designed for diabetes.

[00:28:51] Dr. Gary Kaplan: We found that during the height of the COVID disaster, what was happening is diabetics who were on metformin had less risk of being hospitalized and less risk of dying if they were hospitalized. And we've now done a big study looking at metformin and it turns out that metformin is a good way to modulate the functioning of the immune system.

[00:29:12] Dr. Gary Kaplan: And give us a chance to not develop post COVID. How big a chance it looks like somewhere between 40 and 60 percent decreased risk. So that if you get COVID one of the prescriptions now, my opinion, based on the research that I've been reading, 500 milligrams of metformin day one. Thousand milligrams of Metformin Day two, 1500 milligrams of metformin from day three until day 10.

[00:29:36] Dr. Gary Kaplan: Alright, I got question and that looks like it's protective. Yes 

[00:29:40] Dr. Gary Kaplan: ma'am. 

[00:29:40] Christa Biegler: Alright. Okay. I wanna talk about the mechanism of action around metformin, and then I wanna talk about nature's metformin, which is berberine or in acetol. I guess you could argue maybe both, but absolutely.

[00:29:50] Christa Biegler: You

[00:29:51] Dr. Gary Kaplan: absolutely could. 

[00:29:51] Christa Biegler: So metformin is typically the drug given orally to people who don't have crazy blood sugar issue. Correct me if I'm wrong. That's how I perceive it. It's like first line therapy. Yep. First line therapy. Try this first before we put you on insulin, essentially. So I thought we were going toward, Hey, metformin really reduces the risk of post COVID by pretty much half because if you have good blood sugar, your life is good.

[00:30:16] Christa Biegler: But you're saying it's making a different, is it the blood sugar that's informing the immune system here, or is there a different role of the drug that's also in formulating or informing or modulating the function of the immune system? Is my question. 

[00:30:29] Dr. Gary Kaplan: Different role. 

[00:30:30] Dr. Gary Kaplan: So the mechanism of action we're looking at specifically for this is an mTOR.

[00:30:37] Dr. Gary Kaplan: So what this does is it modulates the acquired immune system. All right. The immune system that makes antibodies and so it modulates it so it doesn't become overreactive. And again, what kills you in COVID or makes you very sick in COVID is the overreactivity of the immune system and in particular the acquired immune system.

[00:30:56] Dr. Gary Kaplan: The Mari and target of rapamycin is what that stands for. Rapamycin literally made from dirt. It's a fungus that was found on Easter Island. And it does a beautiful job of modulating we use it as a chemotherapy agent, but we use it to reduce the production of overproduction of beta cells.

[00:31:13] Dr. Gary Kaplan: B not beta, but B cells in the immune system, which B cells are the antibodies that get produced. And so what metformin does is it slows the production of those, it doesn't allow them to overreact, and that clearly has some impact in terms of the creation of long COVID, and thus it also has impact in terms of focus and concentration, because it reduces inflammation in the brain.

[00:31:39] Dr. Gary Kaplan: Think of focus and concentration and fatigue as issues as a result of fatigue. of inflammation of the brain, so everything we do that reduces inflammation of the brain can help with that. So metformin works via that reduction of inflammation, so it stops the over inflammation of the brain that occurs during the acute infection.

[00:31:59] Dr. Gary Kaplan: Doesn't look like it'll prevent the occurrence of COVID, but it sure looks like it can be very useful in preventing the occurrence of long COVID and should be used. And by the way, metformin is being investigated as an anti aging drug because aging is an inflammatory process. And so using things that modulate the inflammatory process, like metformin, can be useful in terms of slowing the aging process, or at least so we think.

[00:32:24] Christa Biegler: I always feel like that's an oxymoron personally anti aging drug. I always think of drugs being actually more aging or more mitochondrial depleting. Are there other anti aging drugs? 

[00:32:37] Dr. Gary Kaplan: Oh, good lord. There's a whole bunch of them on the horizon. 

[00:32:39] Christa Biegler: No, 

[00:32:39] Christa Biegler: Not my stuff. Tell me, I'm curious.

[00:32:43] Dr. Gary Kaplan: So there's a lot of things that we're looking at in terms of anti aging. So that form is certainly one of the big ones out the gate and it's currently under study MSM is being investigated. So MSM is available now, but as actually for mitochondrial support, and there's studies going on at Harvard where they're actually trying to turn that into a specific pharmaceutical agent, high enough quality research.

[00:33:05] Dr. Gary Kaplan: There are some really interesting studies I've seen preliminary data that I've seen where the military is using MSM in terms of and you can buy this. Without going waiting for the study. Now, single is one of the better brands. I have no commercial interest. But that actually looks like it's really good in terms of mitochondrial repair.

[00:33:26] Christa Biegler: So the military's using MSM for mitochondrial repair and I don't think of that as a drug. 

[00:33:30] Dr. Gary Kaplan: They're experimenting with it, 

[00:33:32] Christa Biegler: but okay. 

[00:33:32] Dr. Gary Kaplan: It is a supplement, but they're going to be turning it into a drug. 

[00:33:35] Christa Biegler: there's a little bit of a, and to go back to 1 step. Whatever I go back.

[00:33:39] Christa Biegler: It's. The lesser of problems, maybe I would rather us be using certain things over others, but how does that foreman just curious? Where does Mark Foreman come from? I don't know. I 

[00:33:51] Dr. Gary Kaplan: don't know either. As a matter of fact, an excellent question, but I don't know the answer to that. 

[00:33:55] Christa Biegler: As we jump into anti aging drugs and we're talking about MSM, I'm like that's not a drug.

[00:33:59] Christa Biegler: That's a supplement, which is cool. No problem. And it's fun. It's always fun to hear what the military is like investing research dollars in. It's Oh, why are you guys, tell us more about how the military got interested in mitochondria. Thank God. Like, why isn't everybody interested in mitochondria?

[00:34:12] Dr. Gary Kaplan: They need their soldiers to recover quickly. They need their soldiers to be stronger. And guess what? Better mitochondria, stronger soldiers, 

[00:34:23] Dr. Gary Kaplan: faster recovery. 

[00:34:24] Christa Biegler: And they've got really high stress, which degrades the anyway, keep going. Very good. Very good. 

[00:34:29] Dr. Gary Kaplan: So the low dose naltrexone, which we've talked about, it also looks like again, reducing inflammation.

[00:34:35] Dr. Gary Kaplan: And reducing aging a supplement would be in the category of hello, NAD. NAD looks like it also helps with mitochondrial repair. And another thing that I would consider using. So in terms of the big ones that are sitting there at the moment, those are the ones that are currently under study and have advanced far enough along the way that we can say, yeah, this makes sense There's a lot more research going on, a lot more supplements.

[00:35:01] Dr. Gary Kaplan: There are a couple of things just very preliminary with the with medications. But the fact of the matter is, and the thing to keep in mind is, what the real message is it's possible to modify aging. It's possible. We now acknowledge that it is possible to modify something we didn't think we could do.

[00:35:19] Dr. Gary Kaplan: We can absolutely modify it, and it's completely reasonable to think in terms of being able to have lifespans potentially of 120, 140, and 160 years. 

[00:35:31] Christa Biegler: Oh that's new. Interesting information. 

[00:35:34] Dr. Gary Kaplan: The other drug is rapamune. 

[00:35:37] Christa Biegler: What's that? 

[00:35:37] Dr. Gary Kaplan: They use in the app. So rapamune is a medication originally developed for treatment of certain types of leukemia.

[00:35:45] Dr. Gary Kaplan: It's a chemotherapy drug. So you want to be very careful about using this, but for the anti aging community and in some of the patients who are chronic fatigue syndrome, because it modulates again, it's an mTOR. So it mod rapamycin, rapamune. It modulates the the functioning of the immune system much more powerfully than metformin does.

[00:36:07] Dr. Gary Kaplan: And so using somewhere between, one to six milligrams a week looks like it may be helpful. This piece is very experimental. And I'm not recommending everybody run out and try this by any means, but we have used it with some of our patients for me CSF chronic fatigue syndrome with good success.

[00:36:30] Dr. Gary Kaplan: Will it be useful for other patients?

[00:36:33] Dr. Gary Kaplan: Will it be useful for what we're seeing also in post COVID syndrome? Don't know yet. But again, other, the big anti inflammatory factors you need to keep in mind are exercise, meditation. Okay, sleep. So these are things that we want to pay attention to. We want to protect our sleep.

[00:36:54] Dr. Gary Kaplan: We want to be getting at least seven, eight hours of sleep at least, but seven, eight hours of sleep is the appropriate amount, unless you're a teenager, then nine to 10. So these things. are all things that protect and improve the functioning of our immune systems. So we want to be paying attention to that.

[00:37:09] Dr. Gary Kaplan: But if you've got chronic fatigue, you also want to be careful about pacing, not pushing. And we find the same thing going on with post COVID syndrome. We want to make sure that these individuals don't exhaust themselves because what will happen is they exercise too much and too much.

[00:37:25] Dr. Gary Kaplan: Maybe walking around the block and they crash. We don't want crashes or inflammatory. So we want to make sure that's not happening. 

[00:37:32] Christa Biegler: And that's a very common human situation. Someone starts to feel better and so they want to do more things and then they feel like crap the next day.

[00:37:38] Christa Biegler: And we learn the most through experience. So sometimes it just has to happen. 

[00:37:42] Dr. Gary Kaplan: Some curves are sure are shallower than others. So sometimes you have to stand really far back to see that I have a curve and learning. 

[00:37:52] Dr. Gary Kaplan: I want to talk about one other thing that we haven't covered in terms of diagnosing long COVID.

[00:37:57] Christa Biegler: Perfect. 

[00:37:57] Dr. Gary Kaplan: So one of the things that we've been doing a lot of research with is cytokines. Okay. Remember cytokines are some of those chemical messengers we talked about that come out of the cell. Bruce Patterson and I've been doing some research with him and his team looking at cytokine patterns to help us understand what's gone on with long COVID.

[00:38:18] Dr. Gary Kaplan: And in this particular case, where Bruce believes most of the problem is a particular type of white cell called a non classical white cell, monocyte, non classical monocyte. And what happens to this thing is several things. One is COVID gets in there. And here's the other take home piece of message here, okay?

[00:38:37] Dr. Gary Kaplan: It gets complicated, because we're not sure whether or not you're looking at an active bug that's still creating the problem, meaning I could culture this virus out of you and find that it's still growing, or what we're really looking at is a piece of the bug that continues to annoy the immune system and keep it firing.

[00:38:55] Dr. Gary Kaplan: In the case of COVID, we're fairly certain the majority of the problem is a piece of the bug, probably that S protein. So you can't grow bugs. It's not like COVID is still growing inside you like Lyme disease and continuing to do damage because ongoing growth, but rather now it's all about the immune system.

[00:39:14] Dr. Gary Kaplan: And so in this particular case, Bruce's hypothesis is that the spike has damaged the nonclassical monocyte. Two things have happened. One is monocytes, all cells have a normal cycle where they die. They're supposed to live for so long and then die. Monocytes, five days should be out of the system.

[00:39:32] Dr. Gary Kaplan: That screws up the mechanism of that, and you end up with a zombie cell. So this cell continues to live, kinda. It's not doing much except eating up a lot of energy, and it's a senescent cell in a sense. But it's also kicking out lots of inflammatory factors. Specifically, we're measuring cytokines.

[00:39:53] Dr. Gary Kaplan: And Patterson has developed a process for measuring the cytokine levels and has calculated through deep machine learning what the patterns are that are most consistent for long COVID. So it's a way of diagnosing whether or not you have long COVID. And then we have medications such as Maraviroc, which was originally developed for treatment of HIV.

[00:40:15] Dr. Gary Kaplan: We use Low dose naltrexone in some of these people. We use statins. It can be anti inflammatory. Okay, we may need there's a specific cytokine called the SCD 40 L. That is a cytokine inflammatory factor produced by platelets. And so hyperactivity of the platelets. And so that may be contributing to the micro clots that we're seeing.

[00:40:39] Dr. Gary Kaplan: Using low dose aspirin can be effective for that. Using nano kinase can be effective for that. That would be a supplement. And so in lumbar kinase is another form. So we're using the cytokine diagnosis in order to help us get another picture in terms of how the immune system has been damaged and then things we can do in order to treat it.

[00:40:58] Dr. Gary Kaplan: Now, we also have used the cytokine diagnosis to look to differentiate the pattern with chronic fatigue syndrome and differentiate the pattern from chronic Lyme. Post treatment Lyme syndrome. So we're getting to a point with these cytokine diagnoses of being able to classify diseases according to specific inflammatory patterns that we're looking at for them.

[00:41:22] Dr. Gary Kaplan: And this is work ongoing. We're some of it's been published, not all of it. Yes. But Bruce Patterson's work through in cell diagnostics has been pioneering this work, and we've been privileged to be able to do some studies with him looking at this. So I think that's an important diagnostic tool. 

[00:41:39] Christa Biegler: Yeah, 

[00:41:39] Christa Biegler: I was gonna say it doesn't sound like it's a tool that's available broadly yet.

[00:41:44] Christa Biegler: Quite yet. 

[00:41:45] Dr. Gary Kaplan: It's available broadly. You can get that test done throughout the country. Yeah. Physicians could order it, but you can also if you call up in cell, they actually have a physician outline. They can put you in touch with people and they can now wrote many times. They can order the test in your state, so you cytokine study done or I N C E L in cell.

[00:42:05] Christa Biegler: Always think about being like a pile of inflammatory mediators. And so it sounds like you're getting specific looking at which ones are really you. Most prevalent, maybe is that 

[00:42:17] Dr. Gary Kaplan: so it's the balance of cytokines. Okay. And cytokines are both inflammatory. So interleukin 6 is pretty much always inflammatory, but interleukin 10 is the balance of that and is typically anti inflammatory.

[00:42:32] Dr. Gary Kaplan: Interleukin 4 swings both ways, depending on the environment that it's in. So different cytokines are always inflammatory, other inflammatory, other cytokines are anti inflammatory, they bring the inflammation down, and yet other change according to the environment that they're in to being inflammatory or anti inflammatory.

[00:42:52] Dr. Gary Kaplan: So as we understand this, and recently there was a paper that came out, New England Journal looking at cytokine differentiation for autoimmune diseases and being able to say, you know what, in this particular type of rheumatoid arthritis, these are the cytokines that are active, and as such, this medication would be a better choice than even though this person also has rheumatoid arthritis, this set of cytokines is active, and these medications would be a better choice.

[00:43:19] Dr. Gary Kaplan: The cytokine diagnosis is going to open up a whole new area of being more specific in our diagnosis and being more specific in terms of directing our therapies. 

[00:43:28] Christa Biegler: Yeah, that'll be interesting. I wonder how far that could really stand. I feel like it could stand farther than the drugs. I don't know. I'm just rolling it around in my head.

[00:43:36] Christa Biegler: I'm just rolling it around in my head. It's interesting because my original education around the immune system had to do with a lot of like food reactions. I've grown from that dramatically, but there's when the immune system is feeling haywire for X, Y, Z reason, it throws a lot of it.

[00:43:53] Christa Biegler: Inflammatory mediators that foods sometimes like different cytokine or different types of mediators. So anyway, I'm just thinking about that a little bit. 

[00:44:01] Dr. Gary Kaplan: It's an important thing to think about because remember what I said is that COVID can absolutely impair the motility of the intestinal track, which is going to completely screw up your gut microbiome, which will create a leaky gut.

[00:44:14] Christa Biegler: Yeah. So now actions.

[00:44:15] Dr. Gary Kaplan: It's exactly correct. And so we have to be very thoughtful in terms of we'll take people off as we're rehabbing them. We talk about a hypoallergenic diet, rice, fish, chicken, fresh fruits and vegetables. I've taken them off as such gluten. I've taken them off milk and milk products.

[00:44:31] Dr. Gary Kaplan: I've taken them off soy, take them off corn. Okay. Because those are the most common, not all of them, but they are the most common allergenic agents in terms of our food, though, unfortunately, in my case, so is eggplant. 

[00:44:44] Christa Biegler: Yeah. And sometimes, and I respect all of those positions and I've done a lot of those.

[00:44:49] Christa Biegler: And then I will also just like devil's advocate say that when they're really depleted in nutrients and there's a lot of immune system chaos and this is just, I'm just opening this for both options, right? That sometimes that creates more chaos or people have more reactions because there's other things like the immune system needs to calm down.

[00:45:09] Christa Biegler: The system needs to calm down so it can tolerate the foods and sometimes removing the foods will work. And I've had the experience several times where sometimes it doesn't. So I'm just leaving that open. So people know that both situations can happen and there's, guess what? There's options.

[00:45:23] Christa Biegler: Like you don't have to be reactive to foods, I guess would be the main point there. 

[00:45:28] Dr. Gary Kaplan: And I think, Krista, to your point, it's extremely important that we individualize what we're doing with people. For sure. It's not one size fits all. Totally. And you're absolutely correct. You need somebody who will think outside the box, who will think in terms of herbal approaches, who will think in terms of, you're right, it may not be the foods.

[00:45:45] Dr. Gary Kaplan: There may be significant bacterial overgrowth in the gut that needs to be addressed. There may be motility problems in the gut that need to be addressed. So it's complicated and you need somebody to work, partner with you and work this through more individualized, not one size fits all the other medication.

[00:46:02] Dr. Gary Kaplan: I want to talk about briefly is methylene blue. 

[00:46:05] Christa Biegler: All right. 

[00:46:06] Dr. Gary Kaplan: Methylene blue can also help repair mitochondrial functioning. Methylene blue as such can help repair your energy. Okay. And help address the fatigue. Now it may be, if you're so depleted, we have to start at a very low dose of methylene blue, five milligrams a day.

[00:46:24] Dr. Gary Kaplan: Okay, and then gradually build that up. Methylene blue has to be compounded. It's not something available over the counter. And you have to be attentive to it because it can also interact with serotonin medications and cause an overdose of serotonin in your system. So if you're taking a selective serotonin reuptake, and they were some of the antidepressants, you have to be very careful with that, because it acts as what's called an MAOI.

[00:46:47] Dr. Gary Kaplan: So you need to, it's an extremely valuable drug in terms of helping repair mitochondrial function. It's an extremely valuable drug in terms of being able to help you recover, not just your energy, but also can help in terms of balancing your psychiatric stuff, balancing the nervous system and inflammation in the brain.

[00:47:10] Dr. Gary Kaplan: At high doses, it's actually been used for treatment of bipolar depression. 

[00:47:13] Christa Biegler: How long have you been using though? 

[00:47:15] Dr. Gary Kaplan: Methylene blue, oh, probably about three, four years. 

[00:47:19] Christa Biegler: Oh, cool. To recap that, start small, could interrupt your sleep maybe as the negative. 

[00:47:27] Dr. Gary Kaplan: But interrupt your sleep unlikely unless you're overdosing on serotonin.

[00:47:31] Dr. Gary Kaplan: But more commonly, what it's going to do is it's going to start rebuilding you. So it's going to start helping you, your mitochondrial functioning again because that's the basis of your powerhouse of the cell, right? So everything you can do to help repair mitochondria is going to ultimately benefit your energy.

[00:47:49] Dr. Gary Kaplan: So you're right. We've talked about fatigue from the standpoint of inflamed brain, but the other piece of fatigue is mitochondrial dysfunction. And so being able to do things to help repair the mitochondria is extremely important. 

[00:48:00] Christa Biegler: Yeah, cool. I love that. I think we did a great job serving the listener today.

[00:48:05] Christa Biegler: Bottom line, what you just said, fatigue and both the inflamed brain and Need for rebuilding nutrient stores, mitochondria, et cetera. Couldn't agree more. I think that's awesome. Love it. We talked about all these different organ systems and how they're influenced. You got into some nerdy stuff there. You talked about things that help each system.

[00:48:24] Christa Biegler: Love it. You brought up the whole cytokine. I'm going to call it diagnostics. And so that's almost another conversation for another day. Anything else you feel like you really want to make sure we include? I know that it was a loaded question, but 

[00:48:38] Dr. Gary Kaplan: we've covered a lot of territory. But I also want to emphasize the importance of individualization.

[00:48:46] Dr. Gary Kaplan: It's not one size fits all. There's a lot of evolving information very quickly. I think people should maintain hope. Thank you. Because we keep coming up with better answers all the time. This conference that next week is about bringing together some of the top specialists in the world to talk about this stuff and get better answers and get us cooperating with each other, breaking out of our silos and having conversations across specialties, across research fields, so that we come up with much better answers.

[00:49:14] Dr. Gary Kaplan: I'm excited about what's coming down the pike. I'm excited about it. AI in terms of being able to factor in genetics and epigenetics and proteomics for better diagnostics. We've been using AI already deep machine learning for the cytokines. I think the future is bright. I think that there's reason for hope for a whole array of things, not just post COVID, but for all these other conditions we've been talking about chronic fatigue syndrome, chronic pain syndromes.

[00:49:39] Dr. Gary Kaplan: But I also see it. In terms of multiple sclerosis, I see it in a myotrophic lateral sclerosis, and perhaps another time we'll have a long conversation about stem cells. 

[00:49:50] Christa Biegler: Hey, I'm here for it. I'd love it. Okay, cool. I hope to catch some of the conference online. I hope that people are listening to this and it's past that time, which it will be that they can access some of that stuff if they're interested.

[00:50:02] Dr. Gary Kaplan: It will still be online. 

[00:50:04] Christa Biegler: And where do you want people to find you online, Dr. Kaplan? 

[00:50:07] Dr. Gary Kaplan: Finding me online is Kaplan clinic dot com finding the foundation online is foundation for total recovery. org. And that'll also get you that access to the the recordings from the from the conference. It'll also let you sign up for the conference.

[00:50:24] Christa Biegler: Thank you so much, Dr. Kaplan. I feel like you're living in your zone of genius and synthesizing all of your life experiences into something that is hoping to, I think for sure, impacting the world. So thank you for your work. I know putting on an event like that is not an easy, it's not an easy thing. So I hope it goes.

[00:50:45] Christa Biegler: Yeah. I hope you have fun. I hope you have fun when it arrives and it's not stressful for you. And someday we'll talk about stem cells. 

[00:50:52] Dr. Gary Kaplan: Kristen, thank you very much for having me on the show. Thank you for all the work you're doing and informing your audience, educating people letting them know there's a path to getting better.

[00:51:00] Christa Biegler: Yeah. 

[00:51:01] Christa Biegler: Thank you.

[00:51:02] Christa Biegler: Sharing and reviewing this podcast is the best way to help us succeed with our mission to help integrate the best of East and West and empower you to raise the bar on your health story. Just go to review this podcast. com forward slash less stressed life. That's review this podcast. com forward slash less stressed life.

[00:51:23] Christa Biegler: And you'll be taken directly to a page where you can insert your review and hit post.

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