Support For Long COVID & Chronic Fatigue
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Long COVID and Chronic Fatigue
Getting COVID-19 can be very physically draining, so it’s no surprise that getting Long COVID can (and usually does) result in chronic fatigue.
But, what does this mean and what can we do about it?
What makes Long COVID “long”
Long COVID is generally defined as COVID-19 whose symptoms last longer than 28 days, but in reality the symptoms not only tend to last for much longer than that, but also, they can be quite distinct.
Here’s a large (3,762 participants) study of Long COVID, which looked at 203 symptoms:
Characterizing long COVID in an international cohort: 7 months of symptoms and their impact
Three symptoms stood at out as most prevalent:
- Chronic fatigue (CFS)
- Cognitive dysfunction
- Post-exertional malaise (PEM)
The latter means “the symptoms get worse following physical or mental exertion”.
CFS, Chronic Fatigue Syndrome, is also called Myalgic Encephalomyelitis (ME).
What can be done about it?
The main “thing that people do about it” is to reduce their workload to what they can do, but this is not viable for everyone. Note that work doesn’t just mean “one’s profession”, but anything that requires physical or mental energy, including:
- Childcare
- Housework
- Errand-running
- Personal hygiene/maintenance
For many, this means having to get someone else to do the things—either with support of family and friends, or by hiring help. For many who don’t have those safety nets available, this means things simply not getting done.
That seems bleak; isn’t there anything more we can do?
Doctors’ recommendations are chiefly “wait it out and hope for the best”, which is not encouraging. Some people do recover from Long COVID; for others, it so far appears it might be lifelong. We just don’t know yet.
Doctors also recommend to journal, not for the usual mental health benefits, but because that is data collection. Patients who journal about their symptoms and then discuss those symptoms with their doctors, are contributing to the “big picture” of what Long COVID and its associated ME/CFS look like.
You may notice that that’s not so much saying what doctors can do for you, so much as what you can do for doctors (and in the big picture, eventually help them help people, which might include you).
So, is there any support for individuals with Long COVID ME/CFS?
Medically, no. Not that we could find.
However! Socially, there are grassroots support networks, that may be able to offer direct assistance, or at least point individuals to useful local resources.
Grassroots initiatives include Long COVID SOS and the Patient-Led Research Collaborative.
The patient-led organization Body Politic also used to have such a group, until it shut down due to lack of funding, but they do still have a good resource list:
Click here to check out the Body Politic resource list (it has eight more specific resources)
Stay strong!
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What Most People Don’t Know About HIV
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What To Know About HIV This World AIDS Day
Yesterday, we asked 10almonds readers to engage in a hypothetical thought experiment with us, and putting aside for a moment any reason you might feel the scenario wouldn’t apply for you, asked:
❝You have unprotected sex with someone who, afterwards, conversationally mentions their HIV+ status. Do you…❞
…and got the above-depicted, below-described, set of responses. Of those who responded…
- Just over 60% said “rush to hospital; maybe a treatment is available”
- Just under 20% said “ask them what meds they’re taking (and perhaps whether they’d like a snack)”
- Just over 10% said “despair; life is over”
- Two people said “do the most rigorous washing down there you’ve ever done in your life”
So, what does science say about it?
First, a quick note on terms
- HIV is the Human Immunodeficiency Virus. It does what it says on the tin; it gives humans immunodeficiency. Like many viruses that have become epidemic in humans, it started off in animals (called SIV, because there was no “H” involved yet), which were then eaten by humans, passing the virus to us when it one day mutated to allow that.
- It’s technically two viruses, but that’s beyond the scope of today’s article; for our purposes they are the same. HIV-1 is more virulent and infectious than HIV-2, and is the kind more commonly found in most of the world.
- AIDS is Acquired Immunodeficiency Syndrome, and again, is what it sounds like. When a person is infected with HIV, then without treatment, they will often develop AIDS.
- Technically AIDS itself doesn’t kill people; it just renders people near-defenseless to opportunistic infections (and immune-related diseases such as cancer), since one no longer has a properly working immune system. Common causes of death in AIDS patients include cancer, influenza, pneumonia, and tuberculosis.
People who contract HIV will usually develop AIDS if untreated. Untreated life expectancy is about 11 years.
HIV/AIDS are only a problem for gay people: True or False?
False, unequivocally. Anyone can get HIV and develop AIDS.
The reason it’s more associated with gay men, aside from homophobia, is that since penetrative sex is more likely to pass it on, then if we go with the statistically most likely arrangements here:
- If a man penetrates a woman and passes on HIV, that woman will probably not go on to penetrate someone else
- If a man penetrates a man and passes on HIV, that man could go on to penetrate someone else—and so on
- This means that without any difference in safety practices or promiscuity, it’s going to spread more between men on average, by simple mathematics.
- This is why “men who have sex with men” is the generally-designated higher-risk category.
There is medication to cure HIV/AIDS: True or False?
False so far (though there have been individual case studies of gene treatments that may have cured people—time will tell).
But! There are medications that can prevent HIV from being a life-threatening problem:
- PrEP (Pre-Exposure Prophylaxis) is a medication that one can take in advance of potential exposure to HIV, to guard against it.
- This is a common choice for people aren’t sure about their partners’ statuses, or people working in risky environments.
- PEP (Post-Exposure Prophylaxis) is a medication that one can take after potential exposure to HIV, to “nip it in the bud”.
- Those of you who were rushing to hospital in our poll, this is what you’re rushing there for.
- ARVs (Anti-RetroVirals) are a class of medications (there are different options; we don’t have room to distinguish them) that reduce an HIV+ person’s viral load to undetectable levels.
- Those of you who were asking what meds your partner was taking, these will be those meds. Also, most of them are to be taken in the morning with food, so that’s what the snack was for.
If someone is HIV+, the risk of transmission in unprotected sex is high: True or False?
True or False, with false being the far more likely. It depends on their medications, and this is why you were asking. If someone is on ARVs and their viral load is undetectable (as is usual once someone has been on ARVs for 6 months), they cannot transmit HIV to you.
U=U is not a fancy new emoticon, it means “undetectable = untransmittable”, which is a mathematically true statement in the case of HIV viral loads.
See: NIH | HIV Undetectable=Untransmittable (U=U)
If you’re thinking “still sounds risky to me”, then consider this:
You are safer having unprotected sex with someone who is HIV+ and on ARVs with an undetectable viral load, than you are with someone you are merely assuming is HIV- (perhaps you assume it because “surely this polite blushing young virgin of a straight man won’t give me cooties” etc)
Note that even your monogamous partner of many decades could accidentally contract HIV due to blood contamination in a hospital or an accident at work etc, so it’s good practice to also get tested after things that involve getting stabbed with needles, cut in a risky environment, etc.
If you’re concerned about potential stigma associated with HIV testing, you can get kits online:
CDC | How do I find an HIV self-test?
(these are usually fingerprick blood tests, and you can either see the results yourself at home immediately, or send it in for analysis, depending on the kit)
If I get HIV, I will get AIDS and die: True or False?
False, assuming you get treatment promptly and keep taking it. So those of you who were at “despair; life is over” can breathe a sigh of relief now.
However, if you get HIV, it does currently mean you will have to take those meds every day for the rest of your (no reason it shouldn’t be long and happy) life.
So, HIV is definitely still something to avoid, because it’s not great to have to take a life-saving medication every day. For a little insight as to what that might be like:
HIV.gov | Taking HIV Medication Every Day: Tips & Challenges
(as you’ll see there, there are also longer-lasting injections available instead of daily pulls, but those are much less widely available)
Summary
Some quick take-away notes-in-a-nutshell:
- Getting HIV may have been a death sentence in the 1980s, but nowadays it’s been relegated to the level of “serious inconvenience”.
- Happily, it is very preventable, with PrEP, PEP, and viral loads so low that they can’t transmit HIV, thanks to ARVs.
- Washing will not help, by the way. Safe sex will, though!
- As will celibacy and/or sexual exclusivity in seroconcordant relationships, e.g. you have the same (known! That means actually tested recently! Not just assumed!) HIV status as each other.
- If you do get it, it is very manageable with ARVs, but prevention is better than treatment
- There is no certain cure—yet. Some people (small number of case studies) may have been cured already with gene therapy, but we can’t know for sure yet.
Want to know more? Check out:
Take care!
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Imposter Syndrome (and why almost everyone has it)
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Imposter Syndrome (and why almost everyone has it)
Imposter syndrome is the pervasive idea that we’re not actually good enough, people think we are better than we are, and at any moment we’re going to get found out and disappoint everyone.
Beyond the workplace
Imposter syndrome is most associated with professionals. It can range from a medical professional who feels like they’ve been projecting an image of confidence too much, to a writer or musician who is sure that their next piece will never live up to the acclaim of previous pieces and everyone will suddenly realize they don’t know what they’re doing, to a middle-manager who feels like nobody above or below them realizes how little they know how to do.
But! Less talked-about (but no less prevalent) is imposter syndrome in other areas of life. New parents tend to feel this strongly, as can the “elders” of a family that everyone looks to for advice and strength and support. Perhaps worst is when the person most responsible for the finances of a household feels like everyone just trusts them to keep everything running smoothly, and maybe they shouldn’t because it could all come crashing down at any moment and everyone will see them for the hopeless shambles of a human being that they really are.
Feelings are not facts
And yet (while everyone makes mistakes sometimes) the reality is that we’re all doing our best. Given that imposter syndrome affects up to 82% of people, let’s remember to have some perspective. Everyone feels like they’re winging it sometimes. Everyone feels the pressure.
Well, perhaps not everyone. There’s that other 18%. Some people are sure they’re the best thing ever. Then again, there’s probably some in that 18% that actually feel worse than the 82%—they just couldn’t admit it, even in an anonymized study.
But one thing’s for sure: it’s very, very common. Especially in high-performing women, by the way, and people of color. In other words, people who typically “have to do twice as much to get recognized as half as good”.
That said, the flipside of this is that people who are not in any of those categories may feel “everything is in my favor, so I really have no excuse to not achieve the most”, and can sometimes take very extreme actions to try to avoid perceived failure, and it can be their family that pays the price.
Things to remember
If you find imposter syndrome nagging at you, remember these things:
- There are people far less competent than you, doing the same thing
- Nobody knows how to do everything themselves, especially at first
- If you don’t know how to do something, you can usually find out
- There is always someone to ask for help, or at least advice, or at least support
At the end of the day, we evolved to eat fruit and enjoy the sun. None of us are fully equipped for all the challenges of the modern world, but if we do our reasonable best, and look after each other (and that means that you too, dear reader, deserve looking after as well), we can all do ok.
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What You Should Have Been Told About The Menopause Beforehand
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What You Should Have Been Told About Menopause Beforehand
This is Dr. Jen Gunter. She’s a gynecologist, specializing in chronic pain and vulvovaginal disorders. She’s also a woman on a mission to demystify things that popular culture, especially in the US, would rather not talk about.
When was the last time you remember the menopause being referenced in a movie or TV show? If you can think of one at all, was it just played for laughs?
And of course, the human body can be funny, so that’s not necessarily the problem, but it sure would be nice if that weren’t all that there is!
So, what does Dr. Gunter want us to know?
It’s a time of changes, not an end
The name “menopause” is misleading. It’s not a “pause”, and those menses aren’t coming back.
And yet, to call it a “menostop” would be differently misleading, because there’s a lot more going on than a simple cessation of menstruation.
Estrogen levels will drop a lot, testosterone levels may rise slightly, mood and sleep and appetite and sex drive will probably be affected (progesterone can improve all these things!) and
not to mention butwe’re going to mention: vaginal atrophy, which is very normal and very treatable with a topical estrogen cream. Untreated menopause can also bring a whole lot of increased health risks (for example, heart disease, osteoporosis, and, counterintuitively given the lower estrogen levels, breast cancer).However, with a little awareness and appropriate management, all these things can usually be navigated with minimal adverse health outcomes.
Dr Gunter, for this reason, refers to it interchangeably as “the menopausal transition”. She describes it as being less like a cliff edge we fall off, and more like a bridge we cross.
Bridges can be dangerous to cross! But they can also get us safely where we’re going.
Ok, so how do we manage those things?
Dr. Gunter is a big fan of evidence-based medicine, so we’ll not be seeing any yonic crystals or jade eggs. Or “goop”.
See also: Meet Goop’s Number One Enemy
For most people, she recommends Menopausal Hormone Therapy (MHT), which falls under the more general category of Hormone Replacement Therapy (HRT).
This is the most well-evidenced, science-based way to avoid most of the risks associated with menopause.
Nevertheless, there are scare-stories out there, ranging from painful recommencement of bleeding, to (once again) increased risk of breast cancer. However, most of these are either misunderstandings, or unrelated to menopause and MHT, and are rather signs of other problems that should not be ignored.
To get a good grounding in this, you might want to read her Hormone Therapy Guide, freely available as a standalone section on her website. This series of posts is dedicated to hormone therapy. It starts with some basics and builds on that knowledge with each post:
Dr. Gunter’s Guide To The Hormone Menoverse
What about natural therapies?
There are some non-hormonal things that work, but these are mostly things that:
- give a statistically significant reduction in symptoms
- give the same statistically significant reduction in symptoms as placebo
As Dr. Gunter puts it:
❝While most of the studies of prescription medications for hot flashes have an appropriate placebo arm, this is rarely the case with so-called alternative therapies.
In fact, the studies here are almost always low quality, so it’s often not possible to conclude much.
Many reviews that look at these studies often end with a line that goes something like, “Randomized trials with a placebo arm, a low risk of bias, and adequate sample sizes are urgently needed.”
You should interpret this kind of conclusion as the polite way of saying, “We need studies that aren’t BS to say something constructive.”❞
However, if it works, it works, whatever its mechanism. It’s just good, when making medical decisions, to do so with the full facts!
For that matter, even Dr. Gunter acknowledges that while MHT can be lifechanging (in a positive way) for many, it’s not for everyone:
Informed Decisions: When Menopause Hormone Therapy Isn’t Recommended
Want to know more?
Dr. Gunter also has an assortment of books available, including The Menopause Manifesto (which we’ve reviewed previously), and some others that we haven’t, such as “Blood” and “The Vagina Bible”.
Enjoy!
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Dates vs Figs – Which is Healthier?
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Our Verdict
When comparing dates to figs, we picked the dates.
Why?
Dates are higher in sugar, but also have a lower glycemic index than figs, which makes the sugar content much healthier. On the flipside, figs do have around 3x more fiber.
So far, so balanced.
When it comes to micronutrients though, dates take the prize much more clearly.
Dates have slightly more of most vitamins, and a lot more of most minerals.
In particular, dates are several times higher in copper, iron, magnesium, manganese, phosphorus, selenium, and zinc.
As for other phytochemical benefits going on:
- both are good against diabetes for reasons beyond the macros
- both have anti-inflammatory properties
- dates have anticancer properties
- dates have kidney-protecting properties
So in this last case, another win for dates.
Both are still great though, so do enjoy both!
Want to learn more?
You might like to read:
Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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The “Five Tibetan Rites” & Why To Do Them!
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Spinning Around
In Tuesday’s newsletter, we asked you for your opinion of the “Five Tibetan Rites”, and got the above-depicted, below-described, set of responses:
- About 41% said “I have never heard of these before”
- About 27% said “they restore youth by adjusting internal vortexes”
- About 22% said “they are basically yoga, by a different name”
- About 11% said “they are a pseudoscience popular in the US”
So what does the science say?
The Five Tibetan Rites are five Tibetan rites: True or False?
False, though this is more question of social science than of health science, so we’ll not count it against them for having a misleading name.
The first known mentioning of the “Five Tibetan Rites” is by an American named Peter Kelder, who in 1939 published, through a small LA occult-specialized publishing house, a booklet called “The Eye of Revelation”. This work was then varyingly republished, repackaged, and occasionally expanded upon by Kelder or other American authors, including Chris Kilham’s popular 1994 book “The Five Tibetans”.
The “Five Tibetan Rites” are unknown as such in Tibet, except for what awareness of them has been raised by people asking about them in the context of the American phenomenon.
Here’s a good history book, for those interested:
The author didn’t originally set out to “debunk” anything, and is himself a keen spiritualist (and practitioner of the five rites), but he was curious about the origins of the rites, and ultimately found them—as a collection of five rites, and the other assorted advices given by Kelder—to be an American synthesis in the whole, each part inspired by various different physical practices (some of them hatha yoga, some from the then-popular German gymnastics movement, some purely American spiritualism, all available in books that were popular in California in the early 1900s).
You may be wondering: why didn’t Kelder just say that, then, instead of telling stories of an ancient Tibetan tradition that empirically does not exist? The answer to this lies again in social science not health science, but it’s been argued that it’s common for Westerners to “pick ‘n’ mix” ideas from the East, champion them as inscrutably mystical, and (since they are inscrutable) then simply decide how to interpret and represent them. Here’s an excellent book on this, if you’re interested:
(in Kelder’s case, this meant that “there’s a Tibetan tradition, trust me” was thus more marketable in the West than “I read these books in LA”)
They are at least five rites: True or False?
True! If we use the broad definition of “rite” as “something done repeatedly in a solemn fashion”. And there are indeed five of them:
- Spinning around (good for balance)
- Leg raises (this one’s from German gymnastics)
- Kneeling back bend (various possible sources)
- Tabletop (hatha yoga, amongst others)
- Pendulum (hatha yoga, amongst others) ← you may recognize this one from the Sun Salutation
You can see them demonstrated here:
Click Here If The Embedded Video Doesn’t Load Automatically
Kelder also advocated for what was basically the Hay Diet (named not for the substance but for William Hay; it involved separating foods into acid and alkali, not necessarily according to the actual pH of the foods, and combining only “acid” foods or only “alkali” foods at a time), which was popular at the time, but has since been rejected as without scientific merit. Kelder referred to this as “the sixth rite”.
The Five Rites restore youth by adjusting internal vortexes: True or False?
False, in any scientific sense of that statement. Scientifically speaking, the body does not have vortexes to adjust, therefore that is not the mechanism of action.
Spiritually speaking, who knows? Not us, a humble health science publication.
The Five Rites are a pseudoscience popular in the US: True or False?
True, if 27% of those who responded of our mostly North American readership can be considered as representative of what is popular.
However…
“Pseudoscience” gets thrown around a lot as a bad word; it’s often used as a criticism, but it doesn’t have to be. Consider:
A small child who hears about “eating the rainbow” and mistakenly understands that we are all fuelled by internal rainbows that need powering-up by eating fruits and vegetables of different colors, and then does so…
…does not hold a remotely scientific view of how things are happening, but is nevertheless doing the correct thing as recommended by our best current science.
It’s thus a little similar with the five rites. Because…
The Five Rites are at least good for our health: True or False?
True! They are great for the health.
The first one (spinning around) is good for balance. Science would recommend doing it both ways rather than just one way, but one is not bad. It trains balance, trains our stabilizing muscles, and confuses our heart a bit (in a good way).
See also: Fall Special (How To Not Fall, And Not Get Injured If You Do)
The second one (leg raises) is excellent for core strength, which in turn helps keep our organs where they are supposed to be (this is a bigger health issue than most people realise, because “out of sight, out of mind”), which is beneficial for many aspects of our health!
See also: Visceral Belly Fat & How To Lose It ← visceral fat is the fat that surrounds your internal organs; too much there becomes a problem!
The third, fourth, and fifth ones stretch our spine (healthily), strengthen our back, and in the cases of the fourth and fifth ones, are good full-body exercises for building strength, and maintaining muscle mass and mobility.
See also: Building & Maintaining Mobility
So in short…
If you’ve been enjoying the Five Rites, by all means keep on doing them; they might not be Tibetan (or an ancient practice, as presented), and any mystical aspect is beyond the scope of our health science publication, but they are great for the health in science-based ways!
Take care!
Don’t Forget…
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Broccoli vs Cauliflower – Which is Healthier?
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Our Verdict
When comparing broccoli to cauliflower, we picked the broccoli.
Why?
This one is quite straightforward. Superficially, they’re very similar:
Both are great cruciferous vegetables with many health benefits to offer. Even for those keen to avoid oxalates, which cruciferous vegetables in general can be high in, these ones are quite low.
However, if you have IBS, you might want to avoid both, for their raffinose content that may cause problems for you.
For pretty much everyone else, unless you have a special reason why it’s not the case for you, both are a good source of abundant vitamins and minerals, and yet…
Anything cauliflower can do, broccoli can do better!
Broccoli contains more of the vitamins they both contain, and more of the minerals they both contain.
Broccoli also beats cauliflower on amino acids (except lysine), and contains a lot more lutein and zeaxanthin, carotenoids important for healthy eyes and brain.
So by all means enjoy both, but if you’re going to pick one, pick broccoli!
Want to know more?
Check out: Brain Food? The Eyes Have It!
Enjoy!
Don’t Forget…
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