A recent study has estimated that nearly 1/20 people in the UK are suffering from prolonged symptoms after contracting Covid, known as Long Covid. With the repeated waves of Covid infections we are seeing, this figure is likely to increase further. The symptoms of Long Covid, fatigue, worsening after physical or mental activity, sleep disturbance, brain fog (problems with memory and concentration), dizziness, shortness of breath and joint and muscle aches and pains are shared with chronic fatigue syndrome / ME, leading many to conclude they are the same condition. The ME association has highlighted a health crisis with the estimated 250,000 sufferers of chronic fatigue syndrome in the UK. The additional impact of Long Covid is leading to profound consequences on individuals, carers, families, education, businesses and the wider economy. Here we explore some of the thinking around these topics and how Harpenden Medical can help people with these debilitating conditions.
One of the first things we have to acknowledge is that these conditions are real. ME was described as long ago as the 1930s, with the term epidemic neuromyasthenia being coined in the late fifties. It has taken the medical profession a long time to recognise chronic fatigue as a distinct entity. With no diagnostic tests for the conditions, it led many to seek a psychological explanation for symptoms, bolstered by some evidence showing a part response to antidepressant medication. The lack of positive support for fatigue as a condition from the medical profession has inevitably prejudiced wider perceptions and attitudes in society, deepening the difficulties faced by sufferers.
Even now there remains a lack of confidence in committing to a diagnosis of fatigue conditions such as Long Covid. The concern about missing another important condition as well as the perceived impact that accompanies a diagnosis contribute to this. However as people suffering from these conditions will know, recognition and an explanation for their symptoms is extremely important and of course there is no evidence that a firm diagnosis worsens symptoms or hampers recovery.
The fact that Long Covid and Chronic Fatigue Syndrome affect so many body systems at the same time, as well as those affected also experiencing variation in symptoms has hampered understanding to a profession that is geared to body systems. How can a single condition affect musculoskeletal system, the nervous system the respiratory system, the gastrointestinal system at the same time in different ways, when the established tests for these are normal? The answer lies in starting to see the functioning of the body in a different way, not at a system level, but a cellular one. There is growing research and evidence that malfunction in cells is a key factor in understanding fatigue.
Billions of years ago, probably by chance, a primitive cell, enveloped bacteria and incorporated it into its cellular structure. With many more years of evolution, these bacteria became the battery packs of our cells, that we call mitochondria. Mitochondria are essential components of our cells, supplying them with energy. How well our mitochondria function determines how much energy is available for our cells to operate. Cells like our muscles and brain, require a lot of energy to function. It is no surprise therefore, that viruses that invade our cells and use our cellular energy to replicate themselves, deplete the energy available for us, leaving us feeling tired and drowsy. With continued mitochondrial dysfunction as a possible explanation for chronic fatigue and Long Covid, it is easy to see why fatigue, poor concentration and worsening symptoms after exercise are typical symptoms, when it is our muscle and brain cells that require the most energy to function properly.
Despite the growing evidence base of mitochondrial and cellular dysfunction as an explanation for chronic fatigue and Long Covid, there is no consensus opinion that this is the case at the moment, partly because current research cannot be unified. However, there is evidence that treatments directed at improving mitochondrial function can positively impact symptoms of long Covid and chronic fatigue. A course of Intermittent Hypoxia / Hyperoxia Therapy, has been shown to improve symptoms of fatigue and brain fog and whole body cryotherapy has also shown significant benefit. Managing diet to maximise energy available to the cells is also an important aspect of care.
NICE revised their guidelines on chronic fatigue syndrome in 2021. Part of this review recognised that the traditional treatments of graduated exercise programmes and cognitive behavioural therapy lacked the evidence base to definitively recommend and, in the case of exercise could be harmful, if not done at a pace tolerated by a patient. There has been criticism of NICE downplaying the evidence base for these therapies and the concern that this will be detrimental to patients in the longer term. However, recognition that making a definitive diagnosis, providing support and patients being in charge of their own programme are important issues.
If you have, or know someone that is struggling with energy after a recent infection, has Long Covid or Chronic Fatigue Syndrome, why not make an appointment for assessment at Harpenden Medical and let us help to try to move things forward with our innovative health and wellness treatments, including Intermittent Hypoxia Hyperoxia Therapy or Whole Body Cryotherapy.
