Long COVID is a persistent threat, and it’s something affecting many people long after the popular media has stopped talking about it so much.

See for example: Long COVID Persistence and Surveillance Gaps Across 58 US Hospitals and, for that matter: Why Women Are 3x More Likely To Get Severe Long COVID.

On which note, regular 10almonds readers may remember this interesting guest article: Can you die from long COVID? The answer is not so simple

Actually, the answer is quite simple:

• In practical terms, it’s “yes”.
• In pedantic terms, it’s much like how technically nobody dies of AIDS (one gets AIDS, one’s immune system flatlines, and then one dies of pneumonia, or flu, or a cold, or something like that).
  • So, on the books, people aren’t directly dying of long COVID, they’re dying of other things because they have long COVID which has compromised their ability to deal with the other things.
  • In that paper we linked up top, for example, among the 74,560 identified long COVID cases, 66,587 people (89.31%) developed at least one chronic condition requiring ongoing management.

See also: falling doesn’t kill anyone!

What kills people is other events that transpire after falling (i.e., starting from when you stop falling).

So, what’s this about reducing its effects?

So long, COVID

Researchers (Dr. Daniela Carla Medeiros Silva et al.) found that fluvoxamine, a commonly prescribed antidepressant, significantly reduced fatigue and improved quality of life in people with long COVID, making it one of the first medications to show meaningful benefits for this condition.

Not the only medication! We wrote previously about: How Metformin Reduces Long COVID Risk By 63%

And even supplements can help: NAD⁺ vs Long COVID! ← there are caveats with this one though, as NAD⁺ is difficult to effectively supplement, and can often be more efficiently boosted indirectly.

Back to the recent study, it was a randomized placebo-controlled clinical trial (RCT) involving 399 adults who experienced persistent fatigue after confirmed COVID infection.

Participants were randomly assigned to receive fluvoxamine, or metformin, or a placebo.

The results, in numbers:

❝Fluvoxamine showed a significant reduction in fatigue compared with placebo at day 60 (mean difference, −0.43 [95% credible interval {CrI}, −0.80 to −0.07]), with a sustained effect at day 90 (mean difference, −0.58 [CrI, −0.98 to −0.16]). Fluvoxamine also improved quality-of-life scores with high posterior probability. Metformin showed no significant benefit. Adverse events were less frequent with fluvoxamine (20.0%) than with metformin (28.8%) or placebo (29.7%).❞

In other words, people taking fluvoxamine experienced 50–60% greater reductions in fatigue than those taking a placebo.

With regard to “Metformin showed no significant benefit”, you may be thinking “what? I thought you said earlier…” and the key difference is that in what we wrote about before, the study was looking at how metformin reduces the risk of developing long COVID—not whether it helps if taken when one already has long COVID.

You can read the paper in full, here: The Effect of Fluvoxamine and Metformin for Fatigue in Patients With Long COVID: An Adaptive Randomized Trial

Want to do more?

Check out:

What Can Be Done About Long COVID? ← scientists have found a possible cure, a procedure known as epipharyngeal abrasive therapy, which as enjoyable as it sounds, and is not yet proven to cure it completely (although to give it its due, the science so far really is promising)

Take care!

❝There’s been a controversy over hormone therapy use. There was a study back in 2002 called the Women’s Health Initiative, and its results scared everybody out of using estrogen therapy. For a long time, people stopped prescribing and using those therapies, thinking that it was going to lead to negative outcomes. Since then, there’s been a lot of revisiting of those findings and discovering that there were some problems with them❞

~ Dr. Amber Watts

We at 10almonds previously covered the (deeply flawed) WHI study, discussing its (many) faults, here: Cancer & HRT: What’s Safe?

And followed it up with such news as: New Evidence: HRT Doesn’t Increase Cancer Risk Even If You Have The Genes For It

But that’s all about cancer. What about the brain?

Sooner or later…

Should we put off menopausal HRT for as long as possible?

Or should we hurry to get it as soon as it becomes clinically relevant?

The first thing to understand when it comes to HRT and brain health, is the critical role that sex hormones play in Alzheimer’s pathogenesis and progression.

We wrote about that, here: Alzheimer’s Sex Differences May Not Be What They Appear

But HRT’s effects on the brain are more far-reaching than just that, as explained in our article: Your Brain On (And Off) Estrogen

To answer the “sooner or later” question, researchers (Dr. Robyn Honea et al., wherein the “et al.” includes as second-listed author the Dr. Amber Watts we quoted up top), analyzed 459 women aged 65–80 and found that greater lifetime exposure to female hormones, particularly estrogen, was associated with brain structures generally linked to healthier brain aging.

This was true even from quite small doses: women who had used hormonal birth control had larger gray matter volumes in parts of the temporal, occipital, and frontal lobes compared with those who had never used it.

In particular, women who used both hormonal birth control earlier in life and menopausal hormone therapy later in life showed greater brain volume in parietal and temporal regions, along with thicker cortex in areas including the posterior cingulate, a region often affected early in Alzheimer’s disease.

Not only was it found that women who experienced menopause at a later age, resulting in longer exposure to female hormones, had greater cortical thickness in several brain regions vulnerable to Alzheimer’s disease, but also, people who underwent early surgical removal of the ovaries (thus creating a surgically-induced early menopause) definitely benefited from early exposure to hormone therapy, too.

As for why this happens?

❝Estrogen is neuroprotective. It’s beneficial for white matter integrity. It helps protect neurons and strengthens neural connections.

It is also important for vascular function. One of the things we get wrong about estrogen is people think of estrogen as this thing that has to do with reproduction. But really, estrogen is very important for a lot of different body systems. It’s important for the brain, it’s important for the heart, it’s important for bone density, and it’s important for the immune system.❞

~ Dr. Amber Watts again

A refreshing read, in times when even the use of hormonal birth control, let alone menopausal HRT (which involves much higher doses than those needed for contraceptive purposes), is often demonized, including (invariably unsourced) claims of being harmful to the brain.

You can read the paper in full, here: Lifespan exposure to hormone therapies and structural brain morphometry in older women

Want to learn more?

You might like this book we reviewed:

The Menopause Brain – by Dr. Lisa Mosconi

Take care!