UPDATE 24 Aug 2022: A study showing similar results has made it to pre-print stage, and I discuss it in the post “Immune Profiles of People with Long Covid.” (link coming)
High cortisol is an issue in many diseases, it is one of the big ‘stress hormones’ and when it is too high for too long it causes problems. While there have been scattered reports of Long Covid patients with low cortisol, the prevailing thinking was that these were outliers, these were unusual cases. But some researchers are now making the dramatic claim that we have it all backwards - their research indicates that most long haulers have low cortisol levels, and that this is a big mechanism behind the malaise and suffering.
This new hypothesis on long covid was presented at the 2022 International Conference on myalgic encephalitis and chronic fatigue syndrome (ME/CFS). A good report of the presentations can be found here:
“The Hugely Predictive Factor for Long COVID…is also found in ME/CFS and Fibromyalgia: the IACFS/ME Conference II.” 3 Aug 2022, Health Rising website.
Some major points:
Cortisol is so consistently low in long haulers that it provides a good indicator or predictor of who has the condition.
The lower the cortisol levels, the worse the symptoms.
There are some similarities between Long Covid and two other conditions: fibromyalgia, and ME/CFS.
There is a persistent immune reaction to the SARS2 virus indicated by IgE antibodies, suggesting either a chronic, low-level infection, or a pattern where the immune system is ‘stuck’ in the on position to fight the virus.
Epstein-Barr virus (mononucleosis) and varicella zoster virus (chicken pox and shingles) seem to be reactivated in the body in many long covid patients.
Immune T cells are lower than normal, they are ‘depleted.’ At the same time, monocytes and B cells are increased.
As to why the cortisol levels are low, there are several possible explanations (but none is clearly proven yet). Disturbed immune hormones or antibodies might be interfering with the signals needed to operate the adrenal gland normally, or antibodies could be directly attacking and incapacitating the gland.
Is Taking Prednisone or Cortisone an Answer?
Probably not. Steroid replacement therapy is used on a short-term basis for acute inflammation, and is sometimes used over the long term in exceptional cases. But it has a lot of side effects and risks.
One of the problems of taking corticosteroids is that dependency sets in quickly. When there is a lot of cortisol or cortisol-like stuff in the body, the adrenal glands stop producing cortisol. If a person who is dependent on corticosteroids suddenly stops taking the medicine, they experience a dramatic drop in steroid levels — it can be deadly. It is common to see these medicines prescribed in “tapers” that boost the levels for a brief time, and then gradually reduce the dose to give the body time to turn internal production up again.
And high doses of steroids cause all sorts of problems, from thinning skin to high cholesterol to mood disturbances. In an ideal world, levels of cortisol are in the goldilocks zone … and pills once or twice a day lead to big ups and downs, and the side effects that come with that type of surge.
One of the ‘Holy Grails’ of pharmacology is the development of Dissociated Corticosteroids - molecules that carry the benefits of these steroids, but which lack most of the heavy side effects. I’ve written a bit about them here. While there are a few plants that seem to contain that type of compound, we are still in the early stages of dissociated corticosteroids.
The bottom line - this new direction in the research seems very promising. I will be keeping an eye on it, posting updates as they become available, and looking for ways that the mechanism(s) involved can be harnessed to speed recovery.
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