Episode 40: COVID Long-Haulers, Solutions For Those Suffering With Dr. Annette Fornos
Since the pandemic started, most of the world has had experience with COVID. While the rest recovered and went on with their lives, some people still feel lingering effects from it. We call them COVID long-haulers, COVID survivors with persistent symptoms. Dr. Annette Fornos of the Institute for Neuro-Immune Medicine joins Haylie Pomroy to unravel this syndrome. She outlines the similarities between long-haulers and patients suffering from chronic fatigue and offers solutions for those suffering, especially when it comes to their mental health and food choices. Diving deeper, Dr. Fornos also brings us some research on COVID and autoimmune disorders. Join this conversation and learn more about these very pressing health concerns brought on by this pandemic.
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COVID Long-Haulers, Solutions For Those Suffering With Dr. Annette Fornos
I have the most incredible guest. I'm always telling you that I travel all over the world, collecting these brilliant minds that have ideas, practical research, and clinical experience of changing people's lives, who advocates nutrition and putting power on your plate, and want you to have the answers and the success that you deserve. We have a superstar in integrative and functional medicine. I am pleased to tell you that we are going to be talking with Dr. Annette Fornos. She is part of the very powerful team at the Institute for Neuro-Immune Medicine. We're here at Nova NSU in Davie, Florida. We're going to talk to Dr. Fornos about the COVID long-hauler.
Dr. Fornos attended the University of Miami Miller School of Medicine. She went to complete her residency at Jackson Memorial Hospital. Before joining our group, she was an Assistant Professor at the University of Miami Miller School of Medicine. We are fortunate to have this incredibly intelligent, well-rounded physician that is here for all of us to help us get through this crazy thing we call COVID long-haulers.
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We're going to start this amazing interview with a dear colleague and physician whom I admire so much. She is with the Institute for Neuro-Immune Medicine. I talk about that place a lot. Annette Fornos, thank you so much for being here for our community and all of the people globally that are dealing with this important issue. Thank you so much for being here.
I’m excited to be here and spread the word about the syndrome that we have been dealing with for quite a time right now. As part of the Institute for Neuro-Immune Medicine, we do see quite a bit of patients suffering from chronic fatigue syndrome and now, with the pandemic, suffering from the post-COVID syndrome, which is similar. I'm honored and pleased to be here. Thank you so much for having me.
You said something that right away got my curiosity going. At the Institute for Neuro-Immune Medicine, we had this longevity, history, and legacy of being at the forefront of neuroinflammatory disorders. Can you tell me a little bit about some things that we see that are unique at the Institute for Neuro-Immune Medicine?
We see a wide variety of complicated patients. 99.9% of our patients are complicated. They have been suffering for many years, have been to many specialties, and have complex conditions that fall under the umbrella of chronic fatigue syndrome or myalgic encephalomyelitis. Among all the symptoms of myalgic encephalomyelitis, a classic symptom is exacerbating, severe fatigue for a long time that has an acute origin, usually following an infection. Patients are often able to pinpoint when they start feeling sick. It's a drastic change from the way they used to lead their lives prior to feeling ill. What's interesting about this type of fatigue is that it's non-restorative. It doesn't get better proportionally to the amount of rest that the patients may have.
I'm going to take it back a second. The Institute for Neuro-Immune Medicine is at Nova NSU in Davie, Florida. We are an Institute that has complex patients, especially with chronic fatigue syndrome and Gulf War syndrome. Our clinic is at full capacity. It's not like we are going to have everybody call the phones and make an appointment right now, which is why important for us to have this precious time with you. You said something powerful for our community. That is that with chronic fatigue and now we're seeing with COVID long-haulers, there is a fatigue that happens. It's systemic and not restorative.
We get a lot of comments in our community that they are frustrated. They go in and see their doctor and their doctor says, “Why don't you take a week off work? Why don't you take a vacation? Why don't you get a little sleep?” What I'm hearing you say is that's not the remedy for success, curative, or treatment for this particular disease, both chronic fatigue and now COVID long-haulers.
Rest is a crucial part of the treatment and the healing process for any illness in general, especially for chronic fatigue syndrome or long COVID syndrome. Rest is an important part, but here at our institute, we also look at the patient and underlying causes, things that may have led to the development of this condition, and treatment. It's not sufficient to rest our patients. It involves resting as much as needed, for patients to learn to recognize their bodies, and how they feel and be able to preemptively, pace or rest. Planning their activities can conserve energy. That in and of itself is not enough.
You said a lot there, and my brain's going back to something that you said before. I want to get this right out of the way. For all of you that are struggling that have either struggle with something like CSF Chronic Fatigue Syndrome or COVID long-haulers, we want you to know that I've got one of the most powerful physicians here with me that you believe them, I believe you. We've almost stepped past that because a lot of people are not either self-identifying or when they do, they're getting turned away by their physician.
One of the world's leading institutes in neuroinflammatory disorders, and one of the top physicians there, Dr. Fornos, can you talk to the community on the mental and emotional side? If a person's feeling this way, give me a little bit of a vision of what this syndrome looks like and that, as a leader in this industry, you believe their symptoms. We want you to know that we believe you because you guys went through this for years in any CSF or Chronic Fatigue Syndrome. Now we're seeing the same thing happen to patients with COVID long-haulers. Can you speak to the community and all those people out there that are struggling right now?
Here at the Institute, we spend a great amount of time with our patients. Our first-time visit may take up to 2 to 4 hours. I've spent some time up to four hours with specific patients, and that gives us time to listen to their stories. There's a lot of information in their story that, in the constraints of traditional medicine, which I have practiced for many years, there is not enough time to understand the whole picture from the patient's perspective or from the patient's side.
There's a lot that we don't know, and there's a lot that we learn every day from listening to our patients. In terms of the mental health of suffering that's involved not only in suffering from these chronic conditions but in the frustration of not being heard, understood, or seeing the lives that they're used to, it's scary. That would add up to the whole syndrome.
Even though depression and anxiety are not the cause of chronic fatigue syndrome or post-COVID syndrome, for some patients, they become part of their suffering and need to be acknowledged. That's one of the points that I wanted to talk about. It's what we can do as a community, patients, physicians, and healthcare providers to help our patients with this real and debilitating suffering that has come on in their lives as a result of being ill and did not proceed to the origin of their illness.
I want you to feel super confident walking into your physician's office saying, “This is a science-based syndrome.” This is a neuroinflammatory disorder. It's a complex disease. I always tell you guys, “Fill out your request for care, or we call it a Dear Dr. Sanders letter.” In our community, we have this letter that we have people do a self-assessment, health wishlist, and then fill out a letter to the physician before, because most people get 10 to 15 minutes maybe with their doctor. We call it INIM, the Institute for Neuro-Immune Medicine. You guys are practicing functional medicine, integrated medicine, immunology, and neurology. Everything is there for these complex neuroinflammatory disorders, but most people don't have that capacity.
We're going to do a couple of things for you. We're going to pull together some white papers, research papers, and some amazing research that's being done on COVID long-hauler supported with some science-based data so that you're going to also say that your new community advocate, Dr. Annette Fornos believes in you. You have all kinds of support. You've got me, Dr. Fornos, and this community at Institute for Neuro-Immune Medicine that wants to, and is pushing hard to find treatment, cure, and success to get you out of the suffering that you're in.
You had talked about the virus. The blessing of COVID is that we all learned a little bit about viruses, but with ME/CFS, and we're now seeing the COVID long-hauler, we're seeing some reactivation of historical viruses like EBV or Epstein-Barr Virus. What are you seeing in COIVID long-hauler patients? Are you seeing a reactivation of historical viruses? Is it this virus that's causing it? What's going on?
It's a difficult question to answer. When a patient comes to us for the post-COVID syndrome, symptoms post-COVID infection that has lingered or gone several weeks after the infection, there's a whole classification, depending on the duration or the initiation of those symptoms. They come to us because they don't feel good. They can say, “I had COVID whether I was vaccinated or not, whether my illness was mild or severe. After COVID, I kept on feeling, or began feeling fatigued. My brain is not working the same way. I'm unable to work. I'm unable to function. I'm unable to be the person that I used to be,” and many other symptoms that can occur.
Can we list those? I wrote down fatigue and brain fog. I sometimes know the taste and smell, but that could be someone that had a very mild case. What are some other symptoms?
It's true. It could be somebody that had a mild case of COVID and then suddenly, they’re post the isolation phrase and they feel a lot better. They try to go out and about and follow their lives the way they have led them before, just to be stuck a few weeks later with the onset of these symptoms, such as fatigue. Fatigue could be debilitating. Everybody's different, but it's significant enough for that particular person because we need to compare that person to that person before having COVID. It's on a personal and individualized basis. That's important.
Some people that used to be active runners are unable to jog or go for walks. Some people that lead a sedentary lifestyle may not be able to cook for their families. You don't think it’s relative to before and after. That is important because that fatigue doesn't get better with the same amount of rest that a normal person or a person who is healthy would put in.
We can have busy days and be tired, go to sleep, and wake up the next day, feeling refreshed and recovered. This doesn't happen to people suffering from chronic fatigue syndrome or post-COVID syndrome. It takes a large amount of rest and sometimes that's not even enough because we can have something that's called, “Tired but wired.” It's the sympathetic nervous system being overly activated. No matter how much you try to rest, it's never refreshing.
“Tired and wired.” We talk about that a lot in our community. You said it's the nervous system not being able to reregulate itself. It's not sleeping deeply or waking appropriately. When we talk about that neuroinflammatory, it's almost like a miscommunication or a cross-firing that's happening. You are a warrior in the clinic for your patients. What inspired you to do this? Can you share with our community a little bit about you? You're brilliant and fierce, but it's more than medicine. You lead with your heart, and if you can share where that came from.
It's more than medicine. I'm an internist. I'm a board-certified internal medicine physician. I was trained in a traditional way. We all go to medical school, graduate, and go through residency. We take many board exams and become more certified in our specialty. After many years of working as a primary care physician, there is always some meant to be or your personal legend, dream, or whatever it is that you're here to do and fulfill in this lifetime.
It just so happened that I learned from my patient what she had done when she was sick. She mentioned A4M or American Academy of Anti-Aging Medicine everything that she learned as a patient. That was about 2015. I became curious. I started going to their conferences and taking their courses, and it opened a whole new world. The first thing that I noticed was how little we knew as a medical community, how much more potential there is to learn, and how we will never fulfill that learning for learning and helping. That's what led me to study and become certified by The Institute for Functional Medicine, the American Academy of Anti-Aging Medicine.
I had the opportunity of meeting this amazing team at Neuro-Immune Institute. It blew me away and I had the opportunity of joining this team during the pandemic, which was a special time. I'm honored to be there. I learn every day from my colleagues. There’s a wide array of individuals from multiple backgrounds. It's amazing how much learning we do from each other, how much collaboration, and how much we learn from our patients. That's important to point out that our patients are educators for us every single day.
Free radicals are highly inflammatory.
We had our clinical meeting. Everybody is integrating all different aspects of medicine. I want to get to some things that you're seeing that work with the patient. I have an autoimmune disorder. This is my drive or what's caused me to find answers for people. I have ITP, so my platelets were trashed. When my platelets would come up a little bit, they would say, “You're not scaring us anymore. You're okay. Go live your life.” I'm like, “You don't understand. I'm bruising when I ride my horses. I'm bleeding when I brush my teeth. I'm fatigued. I have muscle weakness.”
It was hard to get somebody to put together a program and a plan for me to be outrageously healthy. I always tell my community, “I'm not looking just to have good labs. I want to be outrageously healthy. I want to swing from the chandeliers and have this big, amazing life.” I know that you advocate that for your patients, too. Even as a doctor, have you ever had a struggle getting appropriate care?
As a doctor, I'm open to modalities and alternatives that are part of integrative medicine that unfortunately, as a patient, sometimes I did not receive when in need. I don't want to place any blame because remember, we do the best we can. When I was a primary care doctor before all this beautiful training, I had no idea of all these modalities and interventions that can be done. We have all suffered from that. That's important because it humbles us and allows us to put ourselves in our patient’s shoes and how it feels like from the other side.
If I may share a little bit more about my personal history, since you share yours, I found out that I have Epstein-Barr Virus reactivation. I had no idea when I contracted Epstein-Barr Virus. This is another important point. You can live your entire life feeling healthy, having some viral infections, your immune system is capable of keeping it in their check, and then something else happens along the way. We call it a total toxic burden. The body is suddenly unable to deal with all the burden, the inflammation, or whatever it's dealing with. Now you have many possible syndromes, including environmental reactivation. That's one of what we're seeing every single day.
Also, I happen to have been diagnosed with Sjögren’s syndrome, which is an autoimmune disorder. I never ever thought that I could have an autoimmune disorder and I probably had it many years ago when this happened, but I could not believe, face, or acknowledge it until it's right there in your face. That's important. For our patients to know that they could have had mild COVID, but before they had that COVID infection, they probably could have had other dormant viruses, a lot of stress in their lives, or autoimmune conditions that have not manifested themselves yet.
Now they get a new insult. Their immune systems are unable to keep all this inflammation under check because there should be a balance between inflammation when appropriate, but also shutting it down when it's no longer needed. When that mechanism fails, we are dealt with chronic inflammation, which is the basis for chronic conditions such as post-COVID syndrome, chronic fatigue syndrome, and viral reactivations, among many others.
I appreciate you sharing that. Sometimes we have to remember that our doctors are human because sometimes, we expect you to be superhuman, swoop in, and have all the answers. Vulnerability and authenticity are what I've seen across the board at the Institute for Neuro-Immune Medicine, where everybody is there to help, like, “Let's figure these complex cases out.” I want to share because our community is all over the world at this point. Let's distill it down to three things that someone that's dealing with COVID long-hauler can focus on, that it can help to reinfuse their body, a body that has reached what we like to call a lot total toxic burden.
When a person's body is either in an autoimmune state or chronic fatigue state, and now in the COVID long-hauler state, we want to take the house, the body, and build it up as best as possible. It's debatable, but we don't have yet the greatest antivirals that don't cause a lot of problems like with the reactivation of EBV and things like that. We want to try to look at these bodies holistically. You and I talked about some of these top things. I'm all about putting power on your plate. Let's talk about food and supplementation first, and then go to some lifestyle modification a little bit next.
In the food world, we want to talk about some anti-inflammatory foods. I have an anti-viral soup recipe. We called it the COVID soup. I got that name because I had major brain fog with COVID. I was in a state of panic because being dyslexic, my memory is my crutch. I can't read. Everybody in my community knows I'm 3rd-grade 2nd month when I set for my graduate level test. They retested it.
It's not getting any better anytime soon, but I can't afford any regression there. I had a major COVID brain. I researched a lot of foods and things like that. I made this soup and I ate that for seven days, tons of it. I'll post that for you. Let's talk about some foods that would be good to nourish and nurture the body and maybe some unique foods that could do that. What do your patients get fed with?
We focus on nutrition. It’s an important fuel for the body, fuel to produce energy, but also these nutrients are also helping as anti-antioxidants to get rid of all that oxidative stress. I always tell my patients to think of colors. You don't know all the vegetables. Imagine a rainbow. Make your plate as organic and colorful as possible. Make it a nice rainbow. The brighter the colors, the more intensity, and the higher the intensity of the nutrients. The different colors have different nutrients like the purples, the berries with the antioxidants, but green leafy vegetables. That's something that I try to stress out. I also like to stress out fiber. It's great for elimination. It is anti-inflammatory and has healthy fats, and omegas. Hydration is a huge factor. Sometimes when we talk about nutrition, we forget enough hydration.
What you said was super powerful. We talk about a rainbow on your plate and colors. If you are feeling fatigued and you are brain fog, even if you send someone else to the grocery store, beg a neighbor, or you are in a position where your neighbor is struggling with this, your sister or brother, think about going and looking for colorful carrots, sweet potatoes, and green leafy vegetables.
That's why we did a soup. It’s funny because I've made the soup one million times, and I give it to everybody that I hear is sick. You said some gems. Guys, I want you to read colors. I am a big root vegetable person too, when my body's struggling. Things like radishes, sweet potatoes, carrots, and beets are anti-inflammatory.
The third thing I'm going to jump in is hydration. We always tell our community, “Half your body weight in ounces of water every day.” You are going to make sure you're using a clean water source, but we're writing your food prescription right here for you. If you're struggling with fatigue or brain fog, we want you to do colorful foods and antioxidant foods, and you use the word free radicals. I always say, “Please, in pencils and crayons,” explain to our community, when you say the word free radicals. I'm stopping you because it was profound. When you talk about this whole thing of inflammation, what are free radicals do in the nervous system that makes us feel awful?
Free radicals are pro and highly inflammatory. There are usually intermediate steps. The body goes and attacks viruses' damaged cells, by the produce of metabolism. To metabolize or eliminate occasionally will create intermediate steps called free radicals. That's a perfectly normal part of the metabolic detoxification process. The body has intelligently created a part that comes, neutralizes, and eliminates those free radicals.
When the burden exceeds our capacity to clear those out, that is when we get into trouble. We can have either excess inflammation from too much viral load or too much stress on nutrition, but we could also have a default system that's enabled to handle it because it lacks the right fuels to do its job. That's when we have free radical damage. Free radicals can damage DNA, activate the wrong genes, or damage cells directly. It is a risk factor for the development of other inflammatory conditions such as cancer. They're harmful and they tend to stick around when our immune system is not able to keep them in check.
I'm putting you on the spot here. Please, can we do a show on that? I'm super candid. I've been in clinical practice for many years now. The way you described that was the biggest a-ha moment for me. We hear inflammation, free radicals, pro-aging, and damaging the cartilage and tissue. What you said is that free radicals are normal, and neutralizing them is crazy. I love what you said. I'm all about power on your plate. We are huge nutrition advocates at Nova in general, but Institute for Neuro-Immune Medicine. Let's talk about using strategic supplementation.
A lot of this is going to be right around that free radical and anti-inflammatory space because that's the part of the syndrome that we have to do a correction with neuro-inflammatory disorders. We have to evoke a correction in that because it's almost self-fulfilling or self-perpetuating. Inflammation begets inflammation.
At some point, we have to intervene and interject or super-infuse with the nutrients that can almost shift the pathway. I always say I love supplements for what they do for the body. I'm like, “I love you. You've helped me so much.” I'm emotional with my supplements because I always say they saved my life personally. What are the top ones when we're dealing with the inflammatory response and COVID long-hauler?
One important point is there are many as there are good nutrients out there in food. We do not need to use or consume them all at the same time. I'm going to throw in some examples, but don't think that because you don't take all of them, you're not doing it right. I'm going to try to stick to the simpler ones that you can do, like the antioxidant vitamins.
I love vitamin C. We all knew and loved vitamin C as little kids, even before knowing what it was good for. Vitamin C is a good antioxidant. When my whole family and I had COVID, we started getting sick one by one. I was the last person to get sick. I'm like, “This is horrible because I have missing work because I have to quarantine, but I don't know until when.” Finally, I did get it and it was mild, thankfully, but we loaded up with antioxidants. We took a lot of vitamin C.
Make sure that vitamin C is not corn-derived. About 90% of the vitamin C in the United States is corn-derived. We are big. Make sure it's beet or palm-derived. When we do IV vitamin Cs, we do not do corn-derived because it can be pro-inflammatory. You hope that there are enough milligrams of vitamin C to counterbalance it, but we don't want to put something in that defeats the whole purpose. I have here vitamin Cs like back from the days of scurvy. We had been so well researched. I appreciate you bringing that right to the forefront because it's pretty safe and benign. A lot of people are very familiar with it. Be diligent about your vitamin C. Thank you. That's wonderful. What would be the next one?
I love vitamin D. We all know the beneficial effects on bone health, but in addition to that, vitamin D has a crucial role as an immune modulator. It helps to modulate the immune system. What does that mean? It doesn't mean that it elevates things. It keeps it modulated. The body is smart. It can do what it needs to do. Vitamin D is one of those modulators that allow the immune system to work properly.
Vitamin D is also good for mental health, for mood. We mentioned that, and this is a huge aspect of post-COVID syndrome, the suffering. It's important. We like the vitamin D levels to be optimal, not just normal. You will get a test by the laboratory and the reference value will say, “You're normal.” We want it to be optimal, which is not just normal.
A good quality multivitamin goes a long way.
Do you know that number?
For vitamin D, a level of 60 to 90. Above 100 to 110, you can experience toxicity. It's not something that will happen in closer to 90. To be safe, I always recommend having your doctor or healthcare provider involved. Know what you're taking, measure, and follow up. Those two, vitamin C and vitamin D, absolutely. Because I was taking them before, that's probably the reason why it was hard for me to, eventually, contract the virus, even though my whole family and my kids have removed their masks because it's hard to give them masks and be isolated.
I'm a big advocate for D3 and K2. D3 puts less burden on our body to convert and use it for modulation than a K2. I'm always saying if you're going to put something in, the last thing that we want to do is have it be a stressful introduction. I had a couple of friends that in early COVID were hospitalized at UCLA with COVID. I have a lot of friends over there and I was so excited. I was texting my friend that works over at the Santa Monica Campus. I'm like, “I'm excited. You guys are giving D3 and K2. I wanted to cry because you guys are at the forefront of things.” It takes a while for people to catch up. It was very exciting. I'm going to let you give us a third.
I want you to make sure that Dr. Fornos told us all that we want to be working and communicating with our doctor. Remember, that's your body. Our wish for our health is to be at optimal levels of vitamin D. This does play into what you said that blew my mind about the antioxidants, which that immune modulation. The ability to clear the free radicals that are normally part of our immune system, and that step two, being able to clear it. Vitamin D is so important with prostaglandins.
That's why we see it with our sex hormone modulation, mineral corticoids, ability to modulate bone and bone density, blood pressure, and all those things. We find that those long-hauler COVID patients are consuming vitamin D like crazy. Sometimes to get their levels up to that between 60 and 90, we've got to spot-check them and make sure we're getting enough vitamin D3 and K2. This is good data. Number three and a half?
I'm just going to deviate from vitamins for a second, and want to mention a bioflavonoid called Quercetin. I love Quercetin. It is a bioflavonoid and it has excellent properties as an anti-inflammatory and antioxidant, but it also is a mast cell stabilizer. It has very good functions for the immune system. Remember oxygen radicals, free radical scavengers, anti-inflammatories, and muscle activation that can occur in both inflammations.
You brought in a new term and so we get to define it, mast cell activation. I do it with pencils and crayons. That's how my brain can get it in. I always say, “Mast cells make you lumpy and itchy.” They create an inflammatory response, but they can be vascular. In all these COVID, and it's not even secondary, we're now considering it a disease of the vascular system. We're seeing this inflammatory response in the vascular system. You introduced another part of the immune system called mast cell activation. Are they also what makes you itchy and sneeze if you have allergies?
They play a role in allergies. The array of symptoms that can be attributed, or at least inference by muscle activation is huge. The plastic ones are allergies, the patients who have suffered all their lives. It’s not that everybody who has allergies has muscle activation. It is important. The one that we classically remember is that of runny nose, wheezing, watery eyes, and rashes, but patients and one that is not often attributed to mass cells. It's mental fogginess and less concentration. We get that a lot from patients who suffer from chronic inflammation, chronic fatigue syndrome, and post-COVID syndrome. It is difficulty with concentration, memory, stress, and anxiety that plays an important and debilitating role in anxiety. Gastrointestinal symptoms as well.
We see the adult onset of food allergies all the time. Brain fog and mass cell activation with our people that are going through menopause, because remember, our hormone signaling has an inflammatory response. You brought up mass cells. I love it.
Imagine a patient comes in with anxiety post-COVID. It's normal to have some anxiety after an illness. We give them enough medications. Sometimes they need that. We give them an SSRI and they have muscle activation. They have inflammation, and we're not addressing that root cause. We're not targeting the issue. We're not helping enough by not looking at what else is going on in the body. That's what we try to do here at the institute.
I'm going to show you something. I brought this. This is a product that has Quercetin in it, and you see why it's orange. That's that bioflavonoid, the metabolism energy. A food way to get in is we always say, “Scrape the pip of your grapefruit.” We have an H-burn smoothie or a hormone smoothie that we have. We tell you, “Put grapefruit in your smoothie, but take a spoon and scrape out the pip, the white part of your smoothie.” It's got a little bit of a bitter, but it's got a lot of bioflavonoids, anti-inflammatory, and anti-mass cell stabilization.
Look into Quercetin. I've been using Quercetin for many years. I ride horses and have hay allergies. I have lots of dogs and animals. I have always used Quercetin a lot. I was excited when it came to the forefront of research with COVID and COVID long-haulers because it's a cool food-derived concentrated bioflavonoid nutrient. I'm grateful that you brought that up. What is your other favorite?
This is hard because I have many more. How about instead of expanding, I just give you an of couple names? Multivitamins. You can go wrong with a good source of multi because you'll get your Bs that are super important for mitochondrial function, energy production, and detoxification. You get more antioxidants there. You'll get lucky if you get a little bit of magnesium and zinc in it. A good quality multivitamin goes a long way and omegas. I like the omegas very much because our body produces something called post-resolving mediators that, after any infection or pro-inflammatory state that is necessary, come and clean up all the garbage and the residues.
Post-resolving mediators are derived from fatty acids. I understand that. In our community, we're big advocates for fatty acids. We talk a lot about the hormone components but post-resolving mediators. You say the word cleaning up the garbage and posts-resolving mediators. Our body's done all of this immune. I was reading this study. It was in one of our clinical reviews. Dr. Travis brought it up. They're finding residual COVID in the stool eight months later. Some people aren't clearing the virus. Other people are annihilating the virus, but there's a lot of garbage left that's creating this inflammatory syndrome. The omega-fatty acids can help clean up that garbage.
They're excellent. They're precursors for a lot of other important mediators and substances in the body. Proper solving mediators are derived from omega acids and the body's ability to produce them in a healthy state, come and clear that the inflammation, the residue, or whatever needs to be taken away because it's just the byproduct. It stays in the system. It doesn't move on there. It's going to generate more inflammation unless it's cleared out.
Problem-solving mediators have the capacity of doing this when our immune system is not working properly or scavenger cells are not. It’s not that they're not doing their job. They're doing their job. They're doing the best they can. They just cannot cope. It's important to give them more than the fuel, the nutrients that the body needs to be able to do its job and produce pros which resolve mediators, clear out the post-inflammatory residues, activate that post-inflammatory response, and inactivate the pre or pro-inflammatory response.
I love for us as a community to understand the why. Through the lenses of your being in a neuroinflammatory complex clinic, it gives you such tremendous insight. We have the ability there to run all kinds of neuroinflammatory labs, flow cytometry, CD8, and CD4 of B-cell activation. Because we have a tremendous research center, we can run all of these things and see, not just in theory, that something's helping, but what manifests in the chemistry.
There's education and knowledge, but then there's also this unique experience that you bring to the table with these patients. We, as a community out here, appreciate this so much. I have made a list of what I promised everybody. I promised everybody that you would be back. We're going to give them a great, rainbow soup antiviral. We call it our COVID soup at our community recipe. We are going to give you a list that you can download of potential supplementation. We're going to talk about making sure that your D level's optimal.
I'm going to get this all organized for you, guys. I will also give you the Dear Dr. Sander letter, which is a way to take all of this incredible data that Dr. Fornos gave us and organize yourself, a self-assessment, questionnaire, and a letter to prep for your doctor so that they can walk in with this amazing self-reflection of what's going on in your body. There's power on your plate and food is going to feel less, and our supplementation's going to help get the neuroinflammatory system remodulated. What can you encourage this community that's suffering to do from lifestyle modification and also ways to maybe protect our mental health in this process?
It’s a huge part. If anything is the most important part, it is to talk to the person that's suffering. The person is first. The illness is second. If we wouldn't do that, we are not going to be able to reach that root cause and work together. Take care of yourself first of all. Understand that you’re suffering and it's perfectly okay. You just went through a virus, whether mild or more severe. This is happening to you. There's help. There are people that are willing to help and you're not alone.
There are three things. That brings me to, “It's okay to take care of myself. I don't have to go running. My isolation is over. My fever is gone. I'm puffing a little. I'll be okay. I'll go back to being the soccer mom or a doctor in the emergency room.” You are close to fulfilling but give yourself a break and try to do it at your own pace little by little.
Self-care is very important. Rest, the concept of pacing, knowing what your body needs and preventively planning for that to not overdo it, and sleep. There are other supplements that we can do for that, that we weren't able to get into, digestion, rest, and nutrition. Nutrition is very important. We talked about that. Anything that has to do with rest and digestion, we're talking parasympathetic. Anything that helps you relax is important.
We talk a lot about the nervous system and modulation. In our community, we talk about this. There's a reason why you lose most of your weight at night when you sleep. Rest and digest is part of the actual act of feeding yourself, as long as it's not something that's obesogenic or toxic. It's actual food, organic, and rainbow, even more important. That evokes modulation. Adequate digestion evokes deep sleep because of the peristalsis of the bowel. As the GI tract moves, stimulates those hormones in the brain that causes to have deep restorative sleep. Lymphatically during that sleep is the only time our brain can release some of those neurotoxins.
I'm a nutritionist, so I'm like, “Nutrition is everything.” It is everything. I don't know how else we create any other cell in our entire body, immune, hormone, or anything. It's all nutrient based. It's how we are made up, but I love that concept of rest and digestion. When you talk about pacing, sometimes we'll talk about scheduling, whether you use an electronic scheduler or I'm a paper calendar girl still.
Take care of yourself, first of all. Understand that you are suffering, and it's okay.
I learned this when I was going off of Prednisone. Off of 60 to 80 milligrams of Prednisone a day, I had to schedule time to rest. It's great if you can lay prone because that does help your autonomic nervous system, even if you just put your head down on a table, but I would set a timer. I have a powerhouse. I'm hyper as they come. I have microbursts of resting. I have to use the word microbursts of resting because it makes me feel emotionally okay if I rest.
If I have downtime, for some reason, in this weird-wired brain, I pass judgment on myself. I call it my resting microbursts. Whatever makes you feel like you are loving yourself and your self-care doesn't have to be somebody else's model of self-care. I had to change the nomenclature to get myself to be at peace with resting. Microburst sounds like I'm off there doing something. I lay flat because I've done that testing where you check your blood pressure up and down and how it affects your nervous system. I lay flat with no pillow. If I can, I elevate my feet and I microburst rest like the best of them. That's my version of pacing.
Especially in a society that praises the over-doers, the type As, and overachievers. When we feel the need to rest, we also feel guilty about what we are not doing or those who depend on us, what we're not doing for them. I try to remind my patients, “What you do in terms of self-care because you need it right now. It's going to, in the long run, make you more present, able, and capable to do what your goal and role in life are.” That guilt feeling that we all harbor because we're not used to taking self-care is a huge barrier to healing and to wellbeing. We need to stop. I know you're there but stay right there. Right now is the time for me to practice self-care and heal. That's important.
I'm going to put that on a script pad. That is a prescription for wellness like none other. Coming from you and giving that permission, and also some of the tools of how to implement it, is incredible. We have this large community out there that I know fell in love with you and wishes that they were your patient. The amazing takeaway here is that we're going to be doing a series of things that we can give you things that you can do at home, in your life, and for your lifestyle. These are the things that are going to be available to you in the community. Dr. Fornos, I cannot thank you enough.
The interesting thing and the unique environment that we find ourselves in at INIM is that there is a lot of parallel with what you and the institute have been researching for many years. We have been able to circumvent a lot of the pondering and go right into the action from an integrative, medical perspective from day one.
You guys did not stop. Even when everything was locked down, you guys were treating patients and doing telehealth, and t-shirts were made for the institute that says, “We didn't go home. We couldn't go home.” You had patients to treat. First, I thank you for that. On behalf of everybody that is reading, I'll give you an opportunity. Any part words for everybody out there?
The most important message is to seek help. Understand that you need help. It's okay. There's nothing to fear in terms of losing hope or feeling that you're alone and feeling hopeless. Look for that support and help. We are social individuals. We live in a community. We thrive in relationships. Look for a relationship with a healthcare provider. It's not one size fits all. It's not one pill that's going to cure you that's different from the traditional model of which I'm a part. It's a dual partnership, relationship, and healing. I read this somewhere. This is not my phrase, but I love how illness that if you add W, it becomes wellness.
That's what I want to stress out. Do the things you need to do. We've shared some information about things that you can do on your own and do them, the nutrition, the rest, and some of the supplements you can do on your own. Have faith and patience and seek help. For health issues, anxiety, depression, PTSD-type of symptoms, insomnia, and flashbacks, do not judge yourself. It's part of the process. It's happening to a lot of healthy individuals, young people, adolescents, and young girls. Seek help. You're not alone. You can heal. That's the most important message. We can heal.
I cannot thank you enough. I know you're booked to full capacity. This is a gift that you're giving right now. I appreciate your commitment to continuing to help me on this journey. Thank you. I will see you in the clinic.
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That was an incredible interview. I love Dr. Fornos. I feel privileged to get to work with her at the Institute for Neuro Medicine. We see the most complex cases, but it's that passion, knowledge, and heart, quite frankly, that seems to bring care to the next level. Every suggestion and recommendation has a lot behind it. Make sure that you take action.
I love what she said at the end that “we” is what takes illness to wellness. We want you to partner with your physician. We want you to bring your doctor, nurse practitioner, acupuncturist, yoga instructor, family, and friends into the conversation. Make sure you let us know what topics you want to read next. Know that I believe in you. We believe in you and that there is help and power that you can put on your plate. Make that soup.
It's an incredibly delicious, nurturing recipe. Infuse your body with quality supplements. Make sure that you're taking care of your time, yourself, and your self-care. Use whatever nomenclature fits you the best, uplifts you, and makes you feel like you are on your to-do list. Until next time, make sure that every time you rest and digest, you're putting power on your plate. Love to you all. Talk soon. Your nutritionist. Bye.
Important Links
About Annette Fornos, M.D., IFMCP, ABAARM
She is Born in Cuba
Undergraduate: University of Miami, Biology, Summa Cum Laude
Medical School: University of Miami School of Medicine
Internal Medicine: Jackson Memorial Hospital
Board Certified in Internal Medicine (ABIM)
Certified in Functional Medicine (IFM)
Board Certified in Anti-Aging and Integrative Medicine (A4M)
Fellowship in Anti-Aging and Integrative Medicine (A4M)
Married, three children
Since the pandemic started, most of the world has had experience with COVID. While the rest recovered and went on with their lives, some people still feel lingering effects from it. We call them COVID long-haulers, COVID survivors with persistent symptoms. Dr. Annette Fornos of the Institute for Neuro-Immune Medicine joins Haylie Pomroy to unravel this syndrome. She outlines the similarities between long-haulers and patients suffering from chronic fatigue and offers solutions for those suffering, especially when it comes to their mental health and food choices. Diving deeper, Dr. Fornos also brings us some research on COVID and autoimmune disorders. Join this conversation and learn more about these very pressing health concerns brought on by this pandemic.
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Watch the episode here
Listen to the podcast here
COVID Long-Haulers, Solutions For Those Suffering With Dr. Annette Fornos
I have the most incredible guest. I'm always telling you that I travel all over the world, collecting these brilliant minds that have ideas, practical research, and clinical experience of changing people's lives, who advocates nutrition and putting power on your plate, and want you to have the answers and the success that you deserve. We have a superstar in integrative and functional medicine. I am pleased to tell you that we are going to be talking with Dr. Annette Fornos. She is part of the very powerful team at the Institute for Neuro-Immune Medicine. We're here at Nova NSU in Davie, Florida. We're going to talk to Dr. Fornos about the COVID long-hauler.
Dr. Fornos attended the University of Miami Miller School of Medicine. She went to complete her residency at Jackson Memorial Hospital. Before joining our group, she was an Assistant Professor at the University of Miami Miller School of Medicine. We are fortunate to have this incredibly intelligent, well-rounded physician that is here for all of us to help us get through this crazy thing we call COVID long-haulers.
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We're going to start this amazing interview with a dear colleague and physician whom I admire so much. She is with the Institute for Neuro-Immune Medicine. I talk about that place a lot. Annette Fornos, thank you so much for being here for our community and all of the people globally that are dealing with this important issue. Thank you so much for being here.
I’m excited to be here and spread the word about the syndrome that we have been dealing with for quite a time right now. As part of the Institute for Neuro-Immune Medicine, we do see quite a bit of patients suffering from chronic fatigue syndrome and now, with the pandemic, suffering from the post-COVID syndrome, which is similar. I'm honored and pleased to be here. Thank you so much for having me.
You said something that right away got my curiosity going. At the Institute for Neuro-Immune Medicine, we had this longevity, history, and legacy of being at the forefront of neuroinflammatory disorders. Can you tell me a little bit about some things that we see that are unique at the Institute for Neuro-Immune Medicine?
We see a wide variety of complicated patients. 99.9% of our patients are complicated. They have been suffering for many years, have been to many specialties, and have complex conditions that fall under the umbrella of chronic fatigue syndrome or myalgic encephalomyelitis. Among all the symptoms of myalgic encephalomyelitis, a classic symptom is exacerbating, severe fatigue for a long time that has an acute origin, usually following an infection. Patients are often able to pinpoint when they start feeling sick. It's a drastic change from the way they used to lead their lives prior to feeling ill. What's interesting about this type of fatigue is that it's non-restorative. It doesn't get better proportionally to the amount of rest that the patients may have.
I'm going to take it back a second. The Institute for Neuro-Immune Medicine is at Nova NSU in Davie, Florida. We are an Institute that has complex patients, especially with chronic fatigue syndrome and Gulf War syndrome. Our clinic is at full capacity. It's not like we are going to have everybody call the phones and make an appointment right now, which is why important for us to have this precious time with you. You said something powerful for our community. That is that with chronic fatigue and now we're seeing with COVID long-haulers, there is a fatigue that happens. It's systemic and not restorative.
We get a lot of comments in our community that they are frustrated. They go in and see their doctor and their doctor says, “Why don't you take a week off work? Why don't you take a vacation? Why don't you get a little sleep?” What I'm hearing you say is that's not the remedy for success, curative, or treatment for this particular disease, both chronic fatigue and now COVID long-haulers.
Rest is a crucial part of the treatment and the healing process for any illness in general, especially for chronic fatigue syndrome or long COVID syndrome. Rest is an important part, but here at our institute, we also look at the patient and underlying causes, things that may have led to the development of this condition, and treatment. It's not sufficient to rest our patients. It involves resting as much as needed, for patients to learn to recognize their bodies, and how they feel and be able to preemptively, pace or rest. Planning their activities can conserve energy. That in and of itself is not enough.
You said a lot there, and my brain's going back to something that you said before. I want to get this right out of the way. For all of you that are struggling that have either struggle with something like CSF Chronic Fatigue Syndrome or COVID long-haulers, we want you to know that I've got one of the most powerful physicians here with me that you believe them, I believe you. We've almost stepped past that because a lot of people are not either self-identifying or when they do, they're getting turned away by their physician.
One of the world's leading institutes in neuroinflammatory disorders, and one of the top physicians there, Dr. Fornos, can you talk to the community on the mental and emotional side? If a person's feeling this way, give me a little bit of a vision of what this syndrome looks like and that, as a leader in this industry, you believe their symptoms. We want you to know that we believe you because you guys went through this for years in any CSF or Chronic Fatigue Syndrome. Now we're seeing the same thing happen to patients with COVID long-haulers. Can you speak to the community and all those people out there that are struggling right now?
Here at the Institute, we spend a great amount of time with our patients. Our first-time visit may take up to 2 to 4 hours. I've spent some time up to four hours with specific patients, and that gives us time to listen to their stories. There's a lot of information in their story that, in the constraints of traditional medicine, which I have practiced for many years, there is not enough time to understand the whole picture from the patient's perspective or from the patient's side.
There's a lot that we don't know, and there's a lot that we learn every day from listening to our patients. In terms of the mental health of suffering that's involved not only in suffering from these chronic conditions but in the frustration of not being heard, understood, or seeing the lives that they're used to, it's scary. That would add up to the whole syndrome.
Even though depression and anxiety are not the cause of chronic fatigue syndrome or post-COVID syndrome, for some patients, they become part of their suffering and need to be acknowledged. That's one of the points that I wanted to talk about. It's what we can do as a community, patients, physicians, and healthcare providers to help our patients with this real and debilitating suffering that has come on in their lives as a result of being ill and did not proceed to the origin of their illness.
I want you to feel super confident walking into your physician's office saying, “This is a science-based syndrome.” This is a neuroinflammatory disorder. It's a complex disease. I always tell you guys, “Fill out your request for care, or we call it a Dear Dr. Sanders letter.” In our community, we have this letter that we have people do a self-assessment, health wishlist, and then fill out a letter to the physician before, because most people get 10 to 15 minutes maybe with their doctor. We call it INIM, the Institute for Neuro-Immune Medicine. You guys are practicing functional medicine, integrated medicine, immunology, and neurology. Everything is there for these complex neuroinflammatory disorders, but most people don't have that capacity.
We're going to do a couple of things for you. We're going to pull together some white papers, research papers, and some amazing research that's being done on COVID long-hauler supported with some science-based data so that you're going to also say that your new community advocate, Dr. Annette Fornos believes in you. You have all kinds of support. You've got me, Dr. Fornos, and this community at Institute for Neuro-Immune Medicine that wants to, and is pushing hard to find treatment, cure, and success to get you out of the suffering that you're in.
You had talked about the virus. The blessing of COVID is that we all learned a little bit about viruses, but with ME/CFS, and we're now seeing the COVID long-hauler, we're seeing some reactivation of historical viruses like EBV or Epstein-Barr Virus. What are you seeing in COIVID long-hauler patients? Are you seeing a reactivation of historical viruses? Is it this virus that's causing it? What's going on?
It's a difficult question to answer. When a patient comes to us for the post-COVID syndrome, symptoms post-COVID infection that has lingered or gone several weeks after the infection, there's a whole classification, depending on the duration or the initiation of those symptoms. They come to us because they don't feel good. They can say, “I had COVID whether I was vaccinated or not, whether my illness was mild or severe. After COVID, I kept on feeling, or began feeling fatigued. My brain is not working the same way. I'm unable to work. I'm unable to function. I'm unable to be the person that I used to be,” and many other symptoms that can occur.
Can we list those? I wrote down fatigue and brain fog. I sometimes know the taste and smell, but that could be someone that had a very mild case. What are some other symptoms?
It's true. It could be somebody that had a mild case of COVID and then suddenly, they’re post the isolation phrase and they feel a lot better. They try to go out and about and follow their lives the way they have led them before, just to be stuck a few weeks later with the onset of these symptoms, such as fatigue. Fatigue could be debilitating. Everybody's different, but it's significant enough for that particular person because we need to compare that person to that person before having COVID. It's on a personal and individualized basis. That's important.
Some people that used to be active runners are unable to jog or go for walks. Some people that lead a sedentary lifestyle may not be able to cook for their families. You don't think it’s relative to before and after. That is important because that fatigue doesn't get better with the same amount of rest that a normal person or a person who is healthy would put in.
We can have busy days and be tired, go to sleep, and wake up the next day, feeling refreshed and recovered. This doesn't happen to people suffering from chronic fatigue syndrome or post-COVID syndrome. It takes a large amount of rest and sometimes that's not even enough because we can have something that's called, “Tired but wired.” It's the sympathetic nervous system being overly activated. No matter how much you try to rest, it's never refreshing.
“Tired and wired.” We talk about that a lot in our community. You said it's the nervous system not being able to reregulate itself. It's not sleeping deeply or waking appropriately. When we talk about that neuroinflammatory, it's almost like a miscommunication or a cross-firing that's happening. You are a warrior in the clinic for your patients. What inspired you to do this? Can you share with our community a little bit about you? You're brilliant and fierce, but it's more than medicine. You lead with your heart, and if you can share where that came from.
It's more than medicine. I'm an internist. I'm a board-certified internal medicine physician. I was trained in a traditional way. We all go to medical school, graduate, and go through residency. We take many board exams and become more certified in our specialty. After many years of working as a primary care physician, there is always some meant to be or your personal legend, dream, or whatever it is that you're here to do and fulfill in this lifetime.
It just so happened that I learned from my patient what she had done when she was sick. She mentioned A4M or American Academy of Anti-Aging Medicine everything that she learned as a patient. That was about 2015. I became curious. I started going to their conferences and taking their courses, and it opened a whole new world. The first thing that I noticed was how little we knew as a medical community, how much more potential there is to learn, and how we will never fulfill that learning for learning and helping. That's what led me to study and become certified by The Institute for Functional Medicine, the American Academy of Anti-Aging Medicine.
I had the opportunity of meeting this amazing team at Neuro-Immune Institute. It blew me away and I had the opportunity of joining this team during the pandemic, which was a special time. I'm honored to be there. I learn every day from my colleagues. There’s a wide array of individuals from multiple backgrounds. It's amazing how much learning we do from each other, how much collaboration, and how much we learn from our patients. That's important to point out that our patients are educators for us every single day.
Free radicals are highly inflammatory.
We had our clinical meeting. Everybody is integrating all different aspects of medicine. I want to get to some things that you're seeing that work with the patient. I have an autoimmune disorder. This is my drive or what's caused me to find answers for people. I have ITP, so my platelets were trashed. When my platelets would come up a little bit, they would say, “You're not scaring us anymore. You're okay. Go live your life.” I'm like, “You don't understand. I'm bruising when I ride my horses. I'm bleeding when I brush my teeth. I'm fatigued. I have muscle weakness.”
It was hard to get somebody to put together a program and a plan for me to be outrageously healthy. I always tell my community, “I'm not looking just to have good labs. I want to be outrageously healthy. I want to swing from the chandeliers and have this big, amazing life.” I know that you advocate that for your patients, too. Even as a doctor, have you ever had a struggle getting appropriate care?
As a doctor, I'm open to modalities and alternatives that are part of integrative medicine that unfortunately, as a patient, sometimes I did not receive when in need. I don't want to place any blame because remember, we do the best we can. When I was a primary care doctor before all this beautiful training, I had no idea of all these modalities and interventions that can be done. We have all suffered from that. That's important because it humbles us and allows us to put ourselves in our patient’s shoes and how it feels like from the other side.
If I may share a little bit more about my personal history, since you share yours, I found out that I have Epstein-Barr Virus reactivation. I had no idea when I contracted Epstein-Barr Virus. This is another important point. You can live your entire life feeling healthy, having some viral infections, your immune system is capable of keeping it in their check, and then something else happens along the way. We call it a total toxic burden. The body is suddenly unable to deal with all the burden, the inflammation, or whatever it's dealing with. Now you have many possible syndromes, including environmental reactivation. That's one of what we're seeing every single day.
Also, I happen to have been diagnosed with Sjögren’s syndrome, which is an autoimmune disorder. I never ever thought that I could have an autoimmune disorder and I probably had it many years ago when this happened, but I could not believe, face, or acknowledge it until it's right there in your face. That's important. For our patients to know that they could have had mild COVID, but before they had that COVID infection, they probably could have had other dormant viruses, a lot of stress in their lives, or autoimmune conditions that have not manifested themselves yet.
Now they get a new insult. Their immune systems are unable to keep all this inflammation under check because there should be a balance between inflammation when appropriate, but also shutting it down when it's no longer needed. When that mechanism fails, we are dealt with chronic inflammation, which is the basis for chronic conditions such as post-COVID syndrome, chronic fatigue syndrome, and viral reactivations, among many others.
I appreciate you sharing that. Sometimes we have to remember that our doctors are human because sometimes, we expect you to be superhuman, swoop in, and have all the answers. Vulnerability and authenticity are what I've seen across the board at the Institute for Neuro-Immune Medicine, where everybody is there to help, like, “Let's figure these complex cases out.” I want to share because our community is all over the world at this point. Let's distill it down to three things that someone that's dealing with COVID long-hauler can focus on, that it can help to reinfuse their body, a body that has reached what we like to call a lot total toxic burden.
When a person's body is either in an autoimmune state or chronic fatigue state, and now in the COVID long-hauler state, we want to take the house, the body, and build it up as best as possible. It's debatable, but we don't have yet the greatest antivirals that don't cause a lot of problems like with the reactivation of EBV and things like that. We want to try to look at these bodies holistically. You and I talked about some of these top things. I'm all about putting power on your plate. Let's talk about food and supplementation first, and then go to some lifestyle modification a little bit next.
In the food world, we want to talk about some anti-inflammatory foods. I have an anti-viral soup recipe. We called it the COVID soup. I got that name because I had major brain fog with COVID. I was in a state of panic because being dyslexic, my memory is my crutch. I can't read. Everybody in my community knows I'm 3rd-grade 2nd month when I set for my graduate level test. They retested it.
It's not getting any better anytime soon, but I can't afford any regression there. I had a major COVID brain. I researched a lot of foods and things like that. I made this soup and I ate that for seven days, tons of it. I'll post that for you. Let's talk about some foods that would be good to nourish and nurture the body and maybe some unique foods that could do that. What do your patients get fed with?
We focus on nutrition. It’s an important fuel for the body, fuel to produce energy, but also these nutrients are also helping as anti-antioxidants to get rid of all that oxidative stress. I always tell my patients to think of colors. You don't know all the vegetables. Imagine a rainbow. Make your plate as organic and colorful as possible. Make it a nice rainbow. The brighter the colors, the more intensity, and the higher the intensity of the nutrients. The different colors have different nutrients like the purples, the berries with the antioxidants, but green leafy vegetables. That's something that I try to stress out. I also like to stress out fiber. It's great for elimination. It is anti-inflammatory and has healthy fats, and omegas. Hydration is a huge factor. Sometimes when we talk about nutrition, we forget enough hydration.
What you said was super powerful. We talk about a rainbow on your plate and colors. If you are feeling fatigued and you are brain fog, even if you send someone else to the grocery store, beg a neighbor, or you are in a position where your neighbor is struggling with this, your sister or brother, think about going and looking for colorful carrots, sweet potatoes, and green leafy vegetables.
That's why we did a soup. It’s funny because I've made the soup one million times, and I give it to everybody that I hear is sick. You said some gems. Guys, I want you to read colors. I am a big root vegetable person too, when my body's struggling. Things like radishes, sweet potatoes, carrots, and beets are anti-inflammatory.
The third thing I'm going to jump in is hydration. We always tell our community, “Half your body weight in ounces of water every day.” You are going to make sure you're using a clean water source, but we're writing your food prescription right here for you. If you're struggling with fatigue or brain fog, we want you to do colorful foods and antioxidant foods, and you use the word free radicals. I always say, “Please, in pencils and crayons,” explain to our community, when you say the word free radicals. I'm stopping you because it was profound. When you talk about this whole thing of inflammation, what are free radicals do in the nervous system that makes us feel awful?
Free radicals are pro and highly inflammatory. There are usually intermediate steps. The body goes and attacks viruses' damaged cells, by the produce of metabolism. To metabolize or eliminate occasionally will create intermediate steps called free radicals. That's a perfectly normal part of the metabolic detoxification process. The body has intelligently created a part that comes, neutralizes, and eliminates those free radicals.
When the burden exceeds our capacity to clear those out, that is when we get into trouble. We can have either excess inflammation from too much viral load or too much stress on nutrition, but we could also have a default system that's enabled to handle it because it lacks the right fuels to do its job. That's when we have free radical damage. Free radicals can damage DNA, activate the wrong genes, or damage cells directly. It is a risk factor for the development of other inflammatory conditions such as cancer. They're harmful and they tend to stick around when our immune system is not able to keep them in check.
I'm putting you on the spot here. Please, can we do a show on that? I'm super candid. I've been in clinical practice for many years now. The way you described that was the biggest a-ha moment for me. We hear inflammation, free radicals, pro-aging, and damaging the cartilage and tissue. What you said is that free radicals are normal, and neutralizing them is crazy. I love what you said. I'm all about power on your plate. We are huge nutrition advocates at Nova in general, but Institute for Neuro-Immune Medicine. Let's talk about using strategic supplementation.
A lot of this is going to be right around that free radical and anti-inflammatory space because that's the part of the syndrome that we have to do a correction with neuro-inflammatory disorders. We have to evoke a correction in that because it's almost self-fulfilling or self-perpetuating. Inflammation begets inflammation.
At some point, we have to intervene and interject or super-infuse with the nutrients that can almost shift the pathway. I always say I love supplements for what they do for the body. I'm like, “I love you. You've helped me so much.” I'm emotional with my supplements because I always say they saved my life personally. What are the top ones when we're dealing with the inflammatory response and COVID long-hauler?
One important point is there are many as there are good nutrients out there in food. We do not need to use or consume them all at the same time. I'm going to throw in some examples, but don't think that because you don't take all of them, you're not doing it right. I'm going to try to stick to the simpler ones that you can do, like the antioxidant vitamins.
I love vitamin C. We all knew and loved vitamin C as little kids, even before knowing what it was good for. Vitamin C is a good antioxidant. When my whole family and I had COVID, we started getting sick one by one. I was the last person to get sick. I'm like, “This is horrible because I have missing work because I have to quarantine, but I don't know until when.” Finally, I did get it and it was mild, thankfully, but we loaded up with antioxidants. We took a lot of vitamin C.
Make sure that vitamin C is not corn-derived. About 90% of the vitamin C in the United States is corn-derived. We are big. Make sure it's beet or palm-derived. When we do IV vitamin Cs, we do not do corn-derived because it can be pro-inflammatory. You hope that there are enough milligrams of vitamin C to counterbalance it, but we don't want to put something in that defeats the whole purpose. I have here vitamin Cs like back from the days of scurvy. We had been so well researched. I appreciate you bringing that right to the forefront because it's pretty safe and benign. A lot of people are very familiar with it. Be diligent about your vitamin C. Thank you. That's wonderful. What would be the next one?
I love vitamin D. We all know the beneficial effects on bone health, but in addition to that, vitamin D has a crucial role as an immune modulator. It helps to modulate the immune system. What does that mean? It doesn't mean that it elevates things. It keeps it modulated. The body is smart. It can do what it needs to do. Vitamin D is one of those modulators that allow the immune system to work properly.
Vitamin D is also good for mental health, for mood. We mentioned that, and this is a huge aspect of post-COVID syndrome, the suffering. It's important. We like the vitamin D levels to be optimal, not just normal. You will get a test by the laboratory and the reference value will say, “You're normal.” We want it to be optimal, which is not just normal.
A good quality multivitamin goes a long way.
Do you know that number?
For vitamin D, a level of 60 to 90. Above 100 to 110, you can experience toxicity. It's not something that will happen in closer to 90. To be safe, I always recommend having your doctor or healthcare provider involved. Know what you're taking, measure, and follow up. Those two, vitamin C and vitamin D, absolutely. Because I was taking them before, that's probably the reason why it was hard for me to, eventually, contract the virus, even though my whole family and my kids have removed their masks because it's hard to give them masks and be isolated.
I'm a big advocate for D3 and K2. D3 puts less burden on our body to convert and use it for modulation than a K2. I'm always saying if you're going to put something in, the last thing that we want to do is have it be a stressful introduction. I had a couple of friends that in early COVID were hospitalized at UCLA with COVID. I have a lot of friends over there and I was so excited. I was texting my friend that works over at the Santa Monica Campus. I'm like, “I'm excited. You guys are giving D3 and K2. I wanted to cry because you guys are at the forefront of things.” It takes a while for people to catch up. It was very exciting. I'm going to let you give us a third.
I want you to make sure that Dr. Fornos told us all that we want to be working and communicating with our doctor. Remember, that's your body. Our wish for our health is to be at optimal levels of vitamin D. This does play into what you said that blew my mind about the antioxidants, which that immune modulation. The ability to clear the free radicals that are normally part of our immune system, and that step two, being able to clear it. Vitamin D is so important with prostaglandins.
That's why we see it with our sex hormone modulation, mineral corticoids, ability to modulate bone and bone density, blood pressure, and all those things. We find that those long-hauler COVID patients are consuming vitamin D like crazy. Sometimes to get their levels up to that between 60 and 90, we've got to spot-check them and make sure we're getting enough vitamin D3 and K2. This is good data. Number three and a half?
I'm just going to deviate from vitamins for a second, and want to mention a bioflavonoid called Quercetin. I love Quercetin. It is a bioflavonoid and it has excellent properties as an anti-inflammatory and antioxidant, but it also is a mast cell stabilizer. It has very good functions for the immune system. Remember oxygen radicals, free radical scavengers, anti-inflammatories, and muscle activation that can occur in both inflammations.
You brought in a new term and so we get to define it, mast cell activation. I do it with pencils and crayons. That's how my brain can get it in. I always say, “Mast cells make you lumpy and itchy.” They create an inflammatory response, but they can be vascular. In all these COVID, and it's not even secondary, we're now considering it a disease of the vascular system. We're seeing this inflammatory response in the vascular system. You introduced another part of the immune system called mast cell activation. Are they also what makes you itchy and sneeze if you have allergies?
They play a role in allergies. The array of symptoms that can be attributed, or at least inference by muscle activation is huge. The plastic ones are allergies, the patients who have suffered all their lives. It’s not that everybody who has allergies has muscle activation. It is important. The one that we classically remember is that of runny nose, wheezing, watery eyes, and rashes, but patients and one that is not often attributed to mass cells. It's mental fogginess and less concentration. We get that a lot from patients who suffer from chronic inflammation, chronic fatigue syndrome, and post-COVID syndrome. It is difficulty with concentration, memory, stress, and anxiety that plays an important and debilitating role in anxiety. Gastrointestinal symptoms as well.
We see the adult onset of food allergies all the time. Brain fog and mass cell activation with our people that are going through menopause, because remember, our hormone signaling has an inflammatory response. You brought up mass cells. I love it.
Imagine a patient comes in with anxiety post-COVID. It's normal to have some anxiety after an illness. We give them enough medications. Sometimes they need that. We give them an SSRI and they have muscle activation. They have inflammation, and we're not addressing that root cause. We're not targeting the issue. We're not helping enough by not looking at what else is going on in the body. That's what we try to do here at the institute.
I'm going to show you something. I brought this. This is a product that has Quercetin in it, and you see why it's orange. That's that bioflavonoid, the metabolism energy. A food way to get in is we always say, “Scrape the pip of your grapefruit.” We have an H-burn smoothie or a hormone smoothie that we have. We tell you, “Put grapefruit in your smoothie, but take a spoon and scrape out the pip, the white part of your smoothie.” It's got a little bit of a bitter, but it's got a lot of bioflavonoids, anti-inflammatory, and anti-mass cell stabilization.
Look into Quercetin. I've been using Quercetin for many years. I ride horses and have hay allergies. I have lots of dogs and animals. I have always used Quercetin a lot. I was excited when it came to the forefront of research with COVID and COVID long-haulers because it's a cool food-derived concentrated bioflavonoid nutrient. I'm grateful that you brought that up. What is your other favorite?
This is hard because I have many more. How about instead of expanding, I just give you an of couple names? Multivitamins. You can go wrong with a good source of multi because you'll get your Bs that are super important for mitochondrial function, energy production, and detoxification. You get more antioxidants there. You'll get lucky if you get a little bit of magnesium and zinc in it. A good quality multivitamin goes a long way and omegas. I like the omegas very much because our body produces something called post-resolving mediators that, after any infection or pro-inflammatory state that is necessary, come and clean up all the garbage and the residues.
Post-resolving mediators are derived from fatty acids. I understand that. In our community, we're big advocates for fatty acids. We talk a lot about the hormone components but post-resolving mediators. You say the word cleaning up the garbage and posts-resolving mediators. Our body's done all of this immune. I was reading this study. It was in one of our clinical reviews. Dr. Travis brought it up. They're finding residual COVID in the stool eight months later. Some people aren't clearing the virus. Other people are annihilating the virus, but there's a lot of garbage left that's creating this inflammatory syndrome. The omega-fatty acids can help clean up that garbage.
They're excellent. They're precursors for a lot of other important mediators and substances in the body. Proper solving mediators are derived from omega acids and the body's ability to produce them in a healthy state, come and clear that the inflammation, the residue, or whatever needs to be taken away because it's just the byproduct. It stays in the system. It doesn't move on there. It's going to generate more inflammation unless it's cleared out.
Problem-solving mediators have the capacity of doing this when our immune system is not working properly or scavenger cells are not. It’s not that they're not doing their job. They're doing their job. They're doing the best they can. They just cannot cope. It's important to give them more than the fuel, the nutrients that the body needs to be able to do its job and produce pros which resolve mediators, clear out the post-inflammatory residues, activate that post-inflammatory response, and inactivate the pre or pro-inflammatory response.
I love for us as a community to understand the why. Through the lenses of your being in a neuroinflammatory complex clinic, it gives you such tremendous insight. We have the ability there to run all kinds of neuroinflammatory labs, flow cytometry, CD8, and CD4 of B-cell activation. Because we have a tremendous research center, we can run all of these things and see, not just in theory, that something's helping, but what manifests in the chemistry.
There's education and knowledge, but then there's also this unique experience that you bring to the table with these patients. We, as a community out here, appreciate this so much. I have made a list of what I promised everybody. I promised everybody that you would be back. We're going to give them a great, rainbow soup antiviral. We call it our COVID soup at our community recipe. We are going to give you a list that you can download of potential supplementation. We're going to talk about making sure that your D level's optimal.
I'm going to get this all organized for you, guys. I will also give you the Dear Dr. Sander letter, which is a way to take all of this incredible data that Dr. Fornos gave us and organize yourself, a self-assessment, questionnaire, and a letter to prep for your doctor so that they can walk in with this amazing self-reflection of what's going on in your body. There's power on your plate and food is going to feel less, and our supplementation's going to help get the neuroinflammatory system remodulated. What can you encourage this community that's suffering to do from lifestyle modification and also ways to maybe protect our mental health in this process?
It’s a huge part. If anything is the most important part, it is to talk to the person that's suffering. The person is first. The illness is second. If we wouldn't do that, we are not going to be able to reach that root cause and work together. Take care of yourself first of all. Understand that you’re suffering and it's perfectly okay. You just went through a virus, whether mild or more severe. This is happening to you. There's help. There are people that are willing to help and you're not alone.
There are three things. That brings me to, “It's okay to take care of myself. I don't have to go running. My isolation is over. My fever is gone. I'm puffing a little. I'll be okay. I'll go back to being the soccer mom or a doctor in the emergency room.” You are close to fulfilling but give yourself a break and try to do it at your own pace little by little.
Self-care is very important. Rest, the concept of pacing, knowing what your body needs and preventively planning for that to not overdo it, and sleep. There are other supplements that we can do for that, that we weren't able to get into, digestion, rest, and nutrition. Nutrition is very important. We talked about that. Anything that has to do with rest and digestion, we're talking parasympathetic. Anything that helps you relax is important.
We talk a lot about the nervous system and modulation. In our community, we talk about this. There's a reason why you lose most of your weight at night when you sleep. Rest and digest is part of the actual act of feeding yourself, as long as it's not something that's obesogenic or toxic. It's actual food, organic, and rainbow, even more important. That evokes modulation. Adequate digestion evokes deep sleep because of the peristalsis of the bowel. As the GI tract moves, stimulates those hormones in the brain that causes to have deep restorative sleep. Lymphatically during that sleep is the only time our brain can release some of those neurotoxins.
I'm a nutritionist, so I'm like, “Nutrition is everything.” It is everything. I don't know how else we create any other cell in our entire body, immune, hormone, or anything. It's all nutrient based. It's how we are made up, but I love that concept of rest and digestion. When you talk about pacing, sometimes we'll talk about scheduling, whether you use an electronic scheduler or I'm a paper calendar girl still.
Take care of yourself, first of all. Understand that you are suffering, and it's okay.
I learned this when I was going off of Prednisone. Off of 60 to 80 milligrams of Prednisone a day, I had to schedule time to rest. It's great if you can lay prone because that does help your autonomic nervous system, even if you just put your head down on a table, but I would set a timer. I have a powerhouse. I'm hyper as they come. I have microbursts of resting. I have to use the word microbursts of resting because it makes me feel emotionally okay if I rest.
If I have downtime, for some reason, in this weird-wired brain, I pass judgment on myself. I call it my resting microbursts. Whatever makes you feel like you are loving yourself and your self-care doesn't have to be somebody else's model of self-care. I had to change the nomenclature to get myself to be at peace with resting. Microburst sounds like I'm off there doing something. I lay flat because I've done that testing where you check your blood pressure up and down and how it affects your nervous system. I lay flat with no pillow. If I can, I elevate my feet and I microburst rest like the best of them. That's my version of pacing.
Especially in a society that praises the over-doers, the type As, and overachievers. When we feel the need to rest, we also feel guilty about what we are not doing or those who depend on us, what we're not doing for them. I try to remind my patients, “What you do in terms of self-care because you need it right now. It's going to, in the long run, make you more present, able, and capable to do what your goal and role in life are.” That guilt feeling that we all harbor because we're not used to taking self-care is a huge barrier to healing and to wellbeing. We need to stop. I know you're there but stay right there. Right now is the time for me to practice self-care and heal. That's important.
I'm going to put that on a script pad. That is a prescription for wellness like none other. Coming from you and giving that permission, and also some of the tools of how to implement it, is incredible. We have this large community out there that I know fell in love with you and wishes that they were your patient. The amazing takeaway here is that we're going to be doing a series of things that we can give you things that you can do at home, in your life, and for your lifestyle. These are the things that are going to be available to you in the community. Dr. Fornos, I cannot thank you enough.
The interesting thing and the unique environment that we find ourselves in at INIM is that there is a lot of parallel with what you and the institute have been researching for many years. We have been able to circumvent a lot of the pondering and go right into the action from an integrative, medical perspective from day one.
You guys did not stop. Even when everything was locked down, you guys were treating patients and doing telehealth, and t-shirts were made for the institute that says, “We didn't go home. We couldn't go home.” You had patients to treat. First, I thank you for that. On behalf of everybody that is reading, I'll give you an opportunity. Any part words for everybody out there?
The most important message is to seek help. Understand that you need help. It's okay. There's nothing to fear in terms of losing hope or feeling that you're alone and feeling hopeless. Look for that support and help. We are social individuals. We live in a community. We thrive in relationships. Look for a relationship with a healthcare provider. It's not one size fits all. It's not one pill that's going to cure you that's different from the traditional model of which I'm a part. It's a dual partnership, relationship, and healing. I read this somewhere. This is not my phrase, but I love how illness that if you add W, it becomes wellness.
That's what I want to stress out. Do the things you need to do. We've shared some information about things that you can do on your own and do them, the nutrition, the rest, and some of the supplements you can do on your own. Have faith and patience and seek help. For health issues, anxiety, depression, PTSD-type of symptoms, insomnia, and flashbacks, do not judge yourself. It's part of the process. It's happening to a lot of healthy individuals, young people, adolescents, and young girls. Seek help. You're not alone. You can heal. That's the most important message. We can heal.
I cannot thank you enough. I know you're booked to full capacity. This is a gift that you're giving right now. I appreciate your commitment to continuing to help me on this journey. Thank you. I will see you in the clinic.
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That was an incredible interview. I love Dr. Fornos. I feel privileged to get to work with her at the Institute for Neuro Medicine. We see the most complex cases, but it's that passion, knowledge, and heart, quite frankly, that seems to bring care to the next level. Every suggestion and recommendation has a lot behind it. Make sure that you take action.
I love what she said at the end that “we” is what takes illness to wellness. We want you to partner with your physician. We want you to bring your doctor, nurse practitioner, acupuncturist, yoga instructor, family, and friends into the conversation. Make sure you let us know what topics you want to read next. Know that I believe in you. We believe in you and that there is help and power that you can put on your plate. Make that soup.
It's an incredibly delicious, nurturing recipe. Infuse your body with quality supplements. Make sure that you're taking care of your time, yourself, and your self-care. Use whatever nomenclature fits you the best, uplifts you, and makes you feel like you are on your to-do list. Until next time, make sure that every time you rest and digest, you're putting power on your plate. Love to you all. Talk soon. Your nutritionist. Bye.
Important Links
About Annette Fornos, M.D., IFMCP, ABAARM
She is Born in Cuba
Undergraduate: University of Miami, Biology, Summa Cum Laude
Medical School: University of Miami School of Medicine
Internal Medicine: Jackson Memorial Hospital
Board Certified in Internal Medicine (ABIM)
Certified in Functional Medicine (IFM)
Board Certified in Anti-Aging and Integrative Medicine (A4M)
Fellowship in Anti-Aging and Integrative Medicine (A4M)
Married, three children
