Periodic Fasting, Autophagy and Long COVID with Thomas Bunker, PhD - #123

Periodic Fasting, Autophagy and Long COVID with Thomas Bunker, PhD

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Hey everybody, welcome back to the Energy MD podcast, where we help you resolve your chronic fatigue, chronic fatigue syndrome or MECFS and long COVID by working on the real root causes, which are what I call the toxic five, a combination of heavy metals, chemicals, molds, infections, and nervous system dysfunction or trauma so that you can live your best life. So I'm really excited today because we're gonna be talking about the role of

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fasting and diet in Long COVID with my new friend, Dr. Thomas Bunker. So let's learn a little bit about him. So Dr. Thomas Bunker is a PhD immunologist from UC Davis and has been a long, a COVID-19 long hauler since 2020. Drawing on his expertise, Dr. Bunker founded the Facebook group Long COVID,

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where he shares insights on managing long COVID symptoms through intermittent fasting. He is currently running a clinical trial titled diet and fasting for long COVID, which explores dietary interventions and fasting as potential treatments for the condition. His innovative work seeks to unravel the benefits of autophagy and metabolic health in mitigating long COVID symptoms. Thomas, thanks so much for joining me today. It's a pleasure to be here.

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So in your bio, we mentioned a lot of words, and some of them people may not be familiar with. So I think maybe we can start with, maybe we start with autophagy. Can you tell us what autophagy is? Yes, autophagy is basically, it's fundamentally a response to a whole wide variety of cell stresses. So it's an ancient conserved process, and basically,

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It is a deep, like an internal deep house cleaning or a reset and repair. I mean, a simple analogy would be like your laptop has a major problem and you can't fix it and you restart. That's kind of like what autophagy is in the cell. Basically there's a wide variety of things that can get damaged in the cell, including our sensitive mitochondria.

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And autophagy has these really cool complicated mechanisms to like take rusty, damaged, leaky mitochondria and degrade them and recycle the basic components and then they're used to build new ones, shiny new ones. Excellent. So what are some of the mechanisms that we have to improve our autophagy or increase it? Well, I mean,

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The basic research around autophagy is amazing. I think there's like over 80,000 basic research papers on autophagy, but most of that is in cell culture or animal models or yeast or even fruit flies. And you know, we're actually the big stumbling block into applying this in human

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trying to measure topology real time at the cellular level in living, breathing people. It's a huge technical hurdle. And that's the only reason it hasn't been applied to dementia and aging and lots of other things. And so, and is that why you kind of, did you, well, I guess tell us the process that you kind of went through. So you...

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You obviously figured out that autophagy could be helpful and that fasting can increase autophagy. Is that part of what your process was? Yeah, I mean, I didn't set out to, I mean, I kind of stumbled on a lot of things by accident, but I had a prepared mind to understand what was going on. And so when I, when I first developed long COVID in 2020, I mean, I didn't even know about long COVID at the time. It was so early.

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And I was trying to improve my health, uh, desperately. And I, uh, one of the things I went through a phase where I rapidly gained 10 or 15 pounds and so I was like, Oh, I hate diets, but I want to lose some weight. And so that's when I started experimenting with like a no added sugar diet. And then eventually that led to doing some, uh, some water fasts and

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I saw dramatic improvements in my symptoms in my first long haul in 2020. And actually I was fortunate to fully recover. And by the early fall of 2020, I was elk hunting in the mountains with my bow and like going around rugged wild territory for five days. So yeah, I mean, and then I got COVID again, turned out my brother who was on the hunt with me had a...

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a new case of COVID and I got reinfected and three weeks later I had my second round of much more severe, much more typical long COVID. And so that's given me a lot of time to self experiment and start the Facebook group and share experiences and ideas with other people. And so what kind of fasting did you do to help you resolve that?

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first episode of COVID? I actually was fortunate that all I did was time restricted eating. Mostly I did time restricted eating for that first recovery. The no sugar diet and eating in a eight hour window every day seemed to like, I mean, after three weeks of that, I had a flare up of my head pressure. It was

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I don't like to call it a headache because it doesn't really feel like a migraine headache, but it was miserable. And I had about eight hours of this flare up, a head pressure, and then it was totally gone and it didn't come back. So I was like, wow, I don't know what happened, but that was a good thing. And basically that kind of led to my hypothesis that these, you know, once I learned about viral persistence, my hypothesis that

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we can do things like short fast and taking some supplements that cause cell stress and potentially induce atop a G to more strongly trigger the antiviral immune responses and That's potentially a beneficial thing So to clarify you talked about doing eating within eight hour period so

07:14

Essentially, so were you skipping breakfast and then you would eat between 12 and eight? I a lot of people skip breakfast when they go to like the 16 eight eating Pattern and I strongly recommend against that. There's you know, these circadian rhythms everything in the body and the hormones and cells operate on this dnit rhythms and I think we want to encourage those healthy rhythms and so I think eating breakfast

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you know, by nine or 10 o'clock in the morning is important. And so to choose a, I now suggest a nine to 10 hour window because percentage of long haulers, especially women, seeing the eight hours, I think is too restrictive where they get a flare up with their symptoms almost every evening or every day. So I, I'm for more general people, you know, I don't think we want to flare up every day.

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And so if eight hours is too restrictive, you know, try nine or 10 hours. So then they're eating breakfast at nine. Well, you know, I mean, it could be seven or eight or nine, something like that. Yeah. So generally means having an earlier dinner. And most importantly, I think this not having snacks in the evening. And what this does is that autophagy is like

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There's different levels of topology. There's something called basal topology, which is like this low level, you know, quick pick up the house type cleanup. And that happens, you know, every day, probably every evening and into the night. We're not really messing with that. I think that the short water fast and some of these other supplements like resveratrol appear to trigger

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heard my hypothesis, induce this atopology strongly, mainly in the evening and sometimes going into the night, depending on how strong.

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you know, how strong it's induced. So it seems like it's mainly, it's kind of eating a normal three meals, but yet your third meal is you're done by at an earlier time. So five or six, you know, depending on when you have your breakfast. Yes, exactly. I think that's, you know, I mean, so basically try to eat only in the daylight hours. Don't eat if it's dark. Interesting. And try to get a little bit of sunlight every day.

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Even some long haulers are mostly housebound.

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just to help your circadian rhythms. I think it's helpful to get some exposure to sunlight sometime in the morning. And so it sounds like you were saying by doing this you avert the flare because it sounded like there was more of a flare when they had a tighter window. Is that true? Yeah, I mean a lot of people can do an eight hour, can tolerate an eight hour window, but

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flare up every evening or it would just be in a constant flare up with an eight hour window and they get there going like is this the keto flow what's going on and I think it's just that they're uh kind of triggering potentially triggering stronger autophagy and uh you know inducing a stronger antiviral immune response you know pretty much every day which is no fun and it doesn't allow for any time for cellular rest and rebuilding.

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Yeah. And I've wondered too, you know, fasting is stressful on the body, right? And that's part of why it happens in this context. But if it is compromising the adrenals and the adrenals are producing cortisol, which is our body's main anti-inflammatory, then all of a sudden your circadian rhythm is off and then you get more inflammation. So yeah, you have to... Oftentimes, I talk about like a Goldilocks dose of so many things, whether it's supplements or whether it's...

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food or fasting. And so for some people, they could potentially do an eight-hour fast, but if they're noticing that it's too stressful, then maybe moving more towards a 10-hour. Yeah. And not an eight-hour fast, the eating. Oh, sorry, eight-hour window. Yeah. So I like the phrase, the terminology I prefer is like nine to 10-hour time-restricted eating. And then you are fasting for the rest of the evening and night, but it doesn't really feel like...

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fast. Yeah, interesting. Thank you for that. And so what prompted you then to start the Facebook group? Okay, well, so I guess I'll go back to my first long haul. I had recovered to the point where I was doing half-day hikes in the Colorado mountains. And the next day I would have

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take like an hour nap, I would just be wiped out. And I had no idea at the time, but that's kind of classic post-exertional malaise or PEM. And a lot of long haulers are familiar with that symptom. Some get this abnormal profound fatigue, even from something simple like sweeping the floor or doing some chore around the house. For me, I was able to...

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do a half day hike, and I felt fine. But then the next day, wow, I was wiped out. And so that's when I did my first fast. And I actually did a four night, three day fast. And the first evening that I didn't eat anything, so I started basically after supper.

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And the first evening of my fast, I had a flare up of my symptoms. Um, and I had a new symptom I'd never had before, which felt like, uh, you know, pressure on my heart, I mean, potentially myocarditis or some sort of inflammation in the heart. And it was bad enough that I was like, wow, I think I should go to the ER and get this checked out. And I chose not to.

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And, you know, after a couple hours, it subsided. The next evening on my fast, exact same thing happened, except for the heart pressure was only lasted about 30 minutes. It was a little bit milder. The third evening. It, it was, you know, uh, only lasted five or 10 minutes and was much milder. And so then I, then the next day I resumed eating and.

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Uh, rested a couple of days and then I went up in the mountains and tried to hike. And to my amazement, I was able to do like a full day hike without suffering post-exertional malaise. And actually I did two eight hour hikes, two days in a row. And I had no post-exertional malaise. And I'm like, wow, not sure what happened, but that was probably a good thing.

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So then what are you currently?

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I don't want to say recommending. I mean, obviously you had this experience. Well, I mean, I do go as far. I mean, ever since I started the Facebook group, which I started because I started talking about, you know, my fasting experience on some of the other long COVID Facebook groups. And a lot of people were really interested that it made some people really mad. How dare you suggest that these sick people, you know,

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consider a fast and some people were really mad. And basically I got tarred and feathered and run out, got run out of town on one of the largest Facebook groups. Even though I was trying to stick only to telling my story in the first person. And so I was like, hey, well, you know, a friend suggested, well, why don't you start your own Facebook group? So that's what I did. And that turned out to be a good thing. And, you know, I started that Facebook group. I...

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suggested an autophagy protocol, even though really none of this is proven. I'm connecting a lot of dots. And I collected some preliminary data, and it was very positive. People are variable in how they respond. Not everyone sees decreases in symptoms. But in my preliminary data that I collected, I, you know,

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70% of the people saw improvements in their symptoms. And the best responders saw a dramatic decrease in their symptoms, but there was a wide range how people responded. And so then I got fortunate enough to connect with Dr. Jeffrey Novak at Pacific Northwestern University Health Sciences. And I'm like, hey, do you, you know, I really wanna make, turn this into a,

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legit, real clinical trial. I think this is really important. And I said, do you happen to know, have any connections with an IRB? And he said, well, I happened to be the chairman of our local IRB. And that was a good connection. Excellent, definitely. Yeah, I'm so pleased that you're doing that work. And I know we can't talk about it. So.

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I'll just go back to that. We can't talk about the results, right? But we can talk about the... We can talk about the methods? Sure. Okay, great. Well, let's go first to what you did initially where you saw that 70% improvement. So what... Okay. So what I... My preliminary data was different than what we did in the actual diet and fasting study.

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In my preliminary data, I was tracking the number of symptoms. And I was doing surveys in the community to identify and characterize patient-reported symptoms. So basically, it was pretty simple to do. The CDC has a list of 18 or 20 symptoms, but it's not a very good list. And it was very easy to come up with a much better list of patient-reported symptoms.

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And I used that as the basis for the clinical trial, the diet and fasting study, where basically, we, I mean, everything is from a patient perspective, since I am a long hauler. And I knew that long haulers were really aware of their symptoms and, you know, tracking them and, and, and that there's a lot of these flare ups. And so I kind of designed it with all that in mind. And basically, we captured

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patient reported symptoms, 28 of the most common plus another 30 less common ones that I just call checkbox symptoms because we made everything simple and easy for someone with brain fog to get through. So people were able to do this weekly symptom survey in less than 10 minutes. Nice. So we were collecting the number of symptoms and the severity. And so basically the-

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procedure is to calculate this overall long COVID symptom severity score based on the number and severity of symptoms. And they just get one point for the additional checkbox symptoms. But I think it's a very simple and powerful way to measure someone's overall burden long.

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I agree. And what were they asked to do as part of that? As part of the trial? So what we did is we did have them do. So the idea behind the diet, the no sugar diet was to kind of help stabilize them, patients and, you know, and also to get them in a healthy eating window. So we had them eat in a nine to 10 hour window.

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pretty much throughout the entire 10 weeks of the study. But the first two weeks, it was just making dietary changes. And also in their enrollment session, I would review their supplements and medications. And I tried not to change any medications, but there were a few that they weren't allowed to take it if they were gonna participate in the trial, like LDN, which is a real common one for long haulers.

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And so basically, the first two weeks were to track their symptoms, to kind of get a baseline while they recently stopped a bunch of supplements. We had one participant that was taking 50 supplements all at the same time. Wow. And I'd say the average long hauler is taking five to 10 supplements. And so you know.

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We had their two week baseline, and then we had a crossover design. So they do four weeks of treatment A or four weeks of potential treatment B. And so half the people do A and B. The other half do B then A. So really, the power of the study is that people are their own controls, because the exact same person tries treatment A versus treatment B. And we can directly compare the two statistically and see which is more effective.

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So it's actually a pretty powerful design compared to the more typical, you know, random

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you know, just one treatment per arm design. And so basically they would just continue the no sugar diet and eating in a nine.

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actually it was a 10 to 12 hour window for four weeks. That was like treatment A and treatment B, we narrowed the time meeting window to eight hours a day.

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And that was not my choice. And I wanted to keep the time eating the same. But and then we kept the diet the same. And basically, we added in the once a week water fast. And participants were encouraged to attempt a water fast, where basically they can drink water, tea, and take a simple salt water solution for electrolytes.

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and magnesium glycinate, 400 milligrams per day on the fasting days. And so we've given them electrolytes to prevent the slim possibility, but possibility of something called re-feeding syndrome, which is life-threatening. It's usually much more of a risk for malnourished people that are undergoing the weeks long fast. But anyway, we're tracking adverse events, so we wanted to establish if this is safe or not.

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So anyway, the main difference, other than a slight difference in the eating window, this once a week water fast or not. And the average, and they could fast for one full day or two full days, the majority of people fast at night, day, night for about 38 hours.

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And so that was in the clinical trial or was that was in the... That was in the clinical trial. In the preliminary data, people could fast for one day or two days. Again, most of the people opted to fast for one day.

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And what did you find? You can tell us about the results of preliminary data, right? In the preliminary data, it appeared that the two-day fasting was a little bit better than the one full day. But the numbers were not, you know, I mean, we didn't have a huge end number. So I'm not, you know, I didn't attempt to calculate statistical significance. So the preliminary data suggested two-day fasts might be longer than one, better than one-day fasts. But.

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Let's just say I backed off that. All I'll say is nobody knows the optimum duration for a long hauler to fast. And it might be variable from person to person. What I have seen is some long haulers have really severe flare ups, apparently triggered by the water fasting, usually upon refeeding, sometimes during the fast.

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And I strongly, you know, if people try this themselves, I strongly recommend starting with just a supper to supper fast and seeing how things go. Like take baby steps. Don't jump into it with preconceived notions that, oh, a five-day fast is the way to go. And was this an assessment for a week, a couple of weeks? Were they doing several of these?

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So yeah, both of the treatment periods were for four weeks. So they did four weekly fasts for four weeks, and then another four weeks for comparison purposes. So it would be great to do a future trial where we fasted them four times, once a week for a month, let them rest for three or four weeks, and then repeat it.

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But we kind of chose that duration because to do this A versus B comparison, it's not valid if someone's cured, right? So this design applies to people with a chronic health condition. Now, if you cure them in treatment A or treatment B, all the statistics and comparison goes out the window. It's kind of like a sensitive scale, old fashioned balance scale. We're comparing A versus B, but if it goes like that, you don't...

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you lose the ability to compare the treatments. In the preliminary data, did you see anybody with complete resolution? Yes, incredibly. Not very many, but yeah, the small percentage of good responders are really, really good responders. Excellent. And I wonder if it persists improvement.

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Yeah, I don't have any data on that. Anecdotally from talking to a few people, I mean, this is not, I mean, I wanna say this is not a cure. This is a way to potentially reduce the burden of your long COVID. I know some people have largely maintained their improvements for a year.

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But I also know of a few people that have not been able to maintain their improvements. And it's all very complicated because given the current, you know, Kp.3 or Kp.2 COVID wave, you know, lots and lots of people are getting reinfected. And you know, that just everything's around the pandemic for long coat, long haulers. It's not over.

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there's a lot of anxiety about getting reinfected. Yeah, and you talked about how you had recovery after your first COVID bout, and then you got reinfected and you haven't been able to recover from that. Is that something that you're also seeing in the group? I'd say as a general trend, yes, that it's harder to recover from your second bout of long COVID.

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are a small, I do these informal surveys and I think I had 8% that reported, of current long haulers, 8% reported that they recovered fully from long COVID the first time and 4% reported that they recovered fully from long COVID a second time. And I think that's, you know, that's the numbers aren't very big, but it's suggestive that with each.

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about a long COVID, it's harder and harder to, your chances of full recovery are diminished. That's what it certainly feels like to me because my second long haul, again, I was experimenting with a little bit with fasting, but a lot with different supplements, such as resveratrol and apalipoic acid, carnitine, and various things that are known in basic research to stress cells and eustetopoge. And almost every time,

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I mean, this has been my hobby for the last several years, looking at the basic research. Oh, that's what's shown in cell culture to induce autophagy. I think I'll try it. And almost always, those supplements, and usually at the standard doses on the supplement, sometimes less. I take it in the morning, and it flares up my symptoms in the evening, or sometimes not until

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like day two and day three. So there's some crazy things like fish oil, even eating like a normal generous portion of salmon for dinner. I will be in a flare up the second and third day from eating a generous portion of salmon. Interesting. And in the basic research, the omega-3 fatty acids, DHA and EPA are one of the things that have been shown to cause autophagy.

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There's different flavors of autophagy and those cause lipophagy where the lipid droplets within the cells get targeted to the lysosome for degradation. Yeah, that's interesting. With salmon, unfortunately, fish can be high in mercury and so maybe there's a mercury component. Yeah, although I can take it with cod liver oil, I can take it with algal, DHA and the same thing happens.

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Oh, okay, interesting. Yeah. Yeah, so that's my hobby is like trying things to see what flares up my symptoms or not. And it's amazing. So I actually have another paper that I'm writing and working on. It's kind of slow going. It's on the back burner at the moment. It's my first hypothesis. Basically, I think a lot of these long, long haul flare ups are triggered by

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at least the ones related to certain foods and diet and some medicines, by the way, as well, are things that stress cells enough to trigger strong autophagy. And I believe that the internal deep cleaning in the cells is degrading some of the viral proteins in the cells and tissues that

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tied into the regulation of innate immunity and angiopresentation. And I think it's like this virus is trying to hide. It's got a lot of tricks to hide from the immune system. And I think my theory is that inducing strong autophagy kind of breaks that, pulls off that Harry Potter cloak of invisibility. So all of a sudden,

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the cytotoxic T cells and the natural killer cells can also go, aha, there's that pesky virus and they go after it and you get a flare up of your symptoms. Yeah, and I think that's an important point where a lot of people don't realize that your symptoms oftentimes are an expression of your immune system. It's the indirect, it's the response of the immune system to the spike protein or to the infection. Yeah, yeah. And it's not just the spike protein. So...

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There's a lot of evidence for viral persistence now. And the spike protein is one of the most abundant proteins. It's probably the easiest one to detect. So that's what you see most commonly in the studies. But in the studies where they look for the viral RNA nucleic acids or other viral proteins, like the nucleocapsid, they find it. And so

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One of my favorite studies on viral persistence was, and it's kind of like a, just a case example for one specific symptom. It was the University of Maryland study where the YOW at all team, they took 16 people that had loss of taste or altered taste, one of the, which is common in acute COVID, but also some long haulers have it, like roughly 10% of.

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long haulers have altered or loss of taste, some for years. And they did biopsies of the tongue, multiple biopsies over a period of like six months. And out of 16 people with loss of taste, they found SARS-CoV-2 RNA, spike protein, and nucleocapsid protein.

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viral remnant. This is very likely persistent viral infection. They also found, you know, local inflammatory cytokines and elevated levels of, I think, T cells. So it looked like an act of ongoing viral infection and when, and they could look, you know, right next door or someone that recovered, they could look at their taste buds after they recovered. The virus is gone. The inflammation is gone.

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I mean, the temporal and spatial correlation was basically perfect. So, and that's, I think that's, you know, exhibit A for how this persistent virus could be causing whole host of symptoms, but what the symptom is, varies depend upon the cell type and tissue that happens to be infected. Yeah, I couldn't agree more. Yeah, so essentially, you know, if you've got pain in your muscles,

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It's because the virus is in the muscles in that particular location. Yeah, the muscle pains, I'm not positive. There could be other things that cause that, but I think most of the symptoms, like in the gut, there's a lot of, and dysautonomia type symptoms. I think it gets in the vagal nerve. I'm really concerned from personal experience. I know this gets in the nerves.

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I went to, I had dental work done a week ago and I got two lidocaine shots in my right cheek. I had, I've been in misery the last week, at least in the evenings, because the lidocaine, uh, apparently my theory is that it stressed the, the, the cranial nerves, you know, near my jaw and my cheek and throat. Uh, because I had a

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For me, a severe flare up of my cranial nerves, like below the hinge of the jaw. In the evenings, it was like a migraine headache, but just focused on my temple, which I think is the trigeminal nerve. I had a little bit of eye socket pain or behind the eye socket pain. Occasionally I have pains elsewhere on the right side. All of this...

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cranial, what I think is cranial nerves flare up was on the right side of my head. I had nothing on the left side of my head. So I was really surprised by that, but I've had a lot of surprises in my long COVID journey. So my hypothesis is that lidocaine is yet another medication or, you know, there's lots of supplements as well that can flare up my symptoms. But this one was really fascinating because it was such a localized.

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which would kind of make sense with that's probably where the cells and tissues that got exposed to the lidocaine. Right. Yeah, where it's causing some sort of damage to the cells and that the virus really prefers areas that are weaker potentially. So I don't, I mean, I think it's like, there isn't much research on lidocaine and autophagy, but I think it, you know, a lot of these things can stress

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I think it caused really strong autophagy and I was getting these, you know, evening flare ups of my right side cranial nerves for a week.

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So to me, it's just another example of what I call a verx, but a very interesting one because it was so localized. So why do you think that we're seeing this viral persistence? Why do people get long COVID essentially? That's a million dollar question and I certainly don't have the answer, but I strongly suspect that, you know, there's certain genetic predispositions to having long COVID.

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I, for example, had, when I was a young man, I had mono, you know, Epstein-Barr virus infection, probably worse than average. And during times of stress in my adult life, I had it reoccur several times. So to me, that implies that my, some aspect of my antiviral immunity is not 100%. I mean, I didn't think it was bad, but it wasn't 100%. And so, you know, antiviral and innate.

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or natural immunity is really complicated. There's a whole bunch of pieces to it, but basically, there could be hundreds of genes and everything has to be working perfectly for it to be 100% effective. And I think SARS-CoV-2 is a virus that the stress testing are innate immunity and the people that don't face the test are more likely to get long-cold.

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So essentially you're saying that when functioning correctly, our immune system should be able to prevent the COVID virus from taking hold in the body. But for some reason, the immune system is not functioning correctly. It's distracted, whatever it is. And the virus comes in and takes up shop. Yeah. So if you have a version of RNAase L, a protein that's induced, I mean, basically, in an innate immunity,

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cells, and all cells have this, not just immune cells. All cells have innate immunity, and they have these pathogen receptors that identify like bacteria or viral fragments, and they sound kind of a viral on, and the way that it's a complex biochemical pathway, but basically it triggers type 1 interferons, and these type 1 interferons stimulate what are called

39:54

interfere on stimulated genes within the cell and also in immediate neighboring cells. And these interfere on stimulated genes, there's hundreds of them, produce kind of like a natural pharmacy of antiviral and antibacterial compounds. So RNA cells, one of the things that gets turned on and that degrades any viral RNA floating around in the cell, for example.

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But the SARS-CoV-2 virus, I mean, all viruses have tricks to be evade immunity. And otherwise they wouldn't be a successful virus. But SARS-CoV-2 bag of tricks, I think is especially sneaky and it, it actively suppresses autophagy. So during the, there's multiple steps to the top of G pathway and several of the viral proteins actively block key steps in the pathway, for example,

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There's these vesicles that are like engulfing contents of the cell or damaged proteins or damaged mitochondria. And then that has to, it's called autophagosome. That has to fuse with a lysosome. SARS-CoV-2 makes a virus that blocks the autophagosome fusion with a lysosome. And I think it's doing that because autophagy is so important in triggering innate immunity and alerting a cell that there's a...

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viral pathogen present. And it's got a number of other tricks, but it definitely blocks and alters the autophagy pathway as one of its tricks. So basically I think it's unusually good at hiding from females immune systems. Yeah, one of the things that I've noticed is that when we remove...

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some other immune system distractors like heavy metals, chemicals, molds, and other infections like Epstein-Barr or mono like you talked about, that oftentimes that can help to resolve the COVID symptoms. And I don't know exactly why that is, but it seems like those things are potentially distracting the immune system. Does that make sense? I mean, yes. I mean, certainly there's a possibility that other latent viruses get reactivated like mono or other herpes viruses.

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Uh, but I think, I mean, I think 95% of what's going on is directly due to the SARS-CoV-2 virus persisting in the gut and unfortunately in the nerve, sometimes the peripheral nerves, the vagus nerve and probably parts of the brain.

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Do antivirals, you think those are going to be viable treatments? Yes, I think this is my prediction, is that this is going to go the path of HIV treatments, where it took roughly a decade for them to finally figure out, develop, and figure out that they needed combinations of highly effective antivirals to pin the virus in a corner so it couldn't rapidly replicate and mutate around a single drug.

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So I think it's a big challenge for the, uh, you know, for big pharma. And, uh, in the meantime, you know, we've got to figure out how to keep ourselves afloat and minimize, you know, the symptom burden as much as possible. And another paradigm is hepatitis C, you know, so, which is chronic infection of the liver that is. That is, can be usually completely cured by 180 days of antivirals.

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Interesting. For example, the first Paxilvid trial out of Stanford was a bust. I think there may have been some temporary benefit from the 15 days of Paxilvid, but they were asking symptoms only once every five weeks. So by the time they gave 15 days of Paxilvid, and then several weeks later, they checked patient symptoms, there was no statistical benefit. I think that probably there was a transient dip in symptoms.

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Because the person that ran it at Stanford said, patients tell us they feel better. Patients tell us they're getting better. And then when they measured several weeks later, no benefit. Interesting. So it appears to me, since I specialize in chronic fatigue syndrome, myalgic encephalitis, also known as ME-CFS, that this looks very much like that, where

44:34

It's just a different infection and there are several infections, a lot of infections that we look at that cause similar symptoms. What do you think? Do you think it's similar or dissimilar? Yes. I think it's extremely similar to ME-CFS and I'm a proponent that viral infections are the main trigger or cause of ME-CFS.

45:04

I think modern medicine, even though we have all this technology, it's like we're back in the middle ages and nobody knows anything about bacteria or that bacteria cause disease. The technology just isn't there to accurately assess persistent low-level viruses in the human body. The UCSF researchers are...

45:33

kind of leading the charge on this front. And they have some high tech assays where they can like look and see where activated T cells are. And they light up all around the spine and several other sites in the body of long haulers. So, you know, there's a number of studies suggesting there's an ongoing antiviral immune response in long haulers.

45:59

Well, Thomas, this has been very educational. I appreciate you taking the time to share this with us. If people want to learn more about this work that you're doing, is the best place to go the Facebook group? Yes, that's the best place to go. And if you do opt to check it out, you know, go into the featured post section. So like there's a top of G banner. And then right below that are the featured posts. And I've got, you know,

46:29

you can get a good overview of autophagy and what the group is all about by looking at the featured posts. Well, I just so appreciate the work that you're doing. You're definitely a pioneer in the space. Well, I will say it's nearly impossible to get a human trial of fasting approved by an IRV. I was fortunate to.

46:57

Dr. Novak and I were fortunate to clear that hurdle, but it was truly a minor miracle. Well, thank goodness. And when can we anticipate to see the results? Well, we're doing the analysis and write-up. I'm crossing my fingers that, you know, I mean, that there's actually a lot of steps to, you know, the peer review process and submission, and we don't know if it's gonna get accepted by the first journal or rejected or...

47:26

how hard the reviewers are going to be for us. If all goes well, we might have a paper out there by the end of the year. So fingers crossed. Fingers crossed. Thanks so much for joining me today.