How I recovered from long COVID - Dr Tam Lewis

0:01Dr Sophie Shotter:Hi, I'm Sophie and this is Age Well with Dr Sophie Shotter, a space devoted to all things health, wellness and longevity. Because for me, ageing well is about looking and feeling like the best possible version of ourselves, inside as well as out. So together with my producer Fee, I'll be deep diving into the latest research, sifting fact from fiction. I'll also be talking to all kinds of trusted experts, tapping into their knowledge, along with bringing you conversations from a range of interesting women, and men finding out how they age well. So this is my show, welcome along and as always thank you so much for listening.

0:46Dr Sophie Shotter:Tam you're not only a physician who brings over two decades of clinical experience but you're also one of the UK's most respected and sought-after longevity specialists. You trained in both conventional and functional medicine and now you're the founder and medical director of Wellgevity which from what I can tell enables you to bring your medical lens to a more holistic approach. So I guess what we'd call integrative or functional medicine whether that's through hormone optimization or medical grade supplements. I do want to ask you about testing first of all because what we noticed looking at the Wellgevity website was that you hone in on personalized testing ahead of issuing any advice or any supplements.

1:28Dr Sophie Shotter:And this really chimes with my ethos because for a long time, I felt that just blindly taking a load of supplements is the wrong approach because we need to figure out what our body needs. And if we overdo it on certain vitamins and supplements, it can actually have a negative impact. For example, we know that with vitamin B6, high doses can cause peripheral neuropathy. Can you explain to listeners, firstly, the kinds of tests you offer, but also why personalised testing is such an imperative.

1:56Dr Tam Lewis:Thank you, Sophie, and thank you for welcoming me on your podcast. It's a real pleasure to be here. I've become passionate about personalised testing because some of them are standard tests that are offered through not just your NHS GP, if you're sick, for example, but also through the consumer tests available to us are really only our broad strokes when it comes to optimizing how we feel, function and our health trajectory, but also what supplements we actually need. I think there's become a lot of popularity now around taking various supplements, including anything from vitamin D to NAD precursors to glycine to creatine to omega-3s.

2:36Dr Tam Lewis:And a lot of people are getting different supplements in different doses from different brands, and they're sort of putting it into one mixing pot, which is their stomach, and hoping for the best. And actually, when you test people, you see very nuanced results on what people actually need. And when you can be more prescriptive about the supplements that you prescribe for someone, not just based on the test, but based on symptoms, you know, fatigue, insomnia, hair loss, etc. You can really change, you know, how people feel, function, and like I say, their experience of illness and disease. It's slightly more complicated, but it involves mineral testing, organic acids testing, sometimes stool testing, microbiome testing, etc.

3:18Dr Tam Lewis:But if you listen to the human in front of you, the patient, their client, and you put that in together with the test, then you can really create something that, as I said, makes people feel better.

3:30Dr Sophie Shotter:Fee and I both did a genetic test last year as part of our at-home health test episode and Fee learned that she has both a COMT gene mutation and an MTHFR gene mutation. My results showed I have an enhanced pain tolerance which I would say definitely resonates in terms of how hard I can push myself with training and if I am suffering an ache or pain it's so so gradual or so slight. I also do have an increased risk of bone density issues, which again doesn't surprise me based on family history. So I try to mitigate that with lifestyle. And amongst other things, my results showed I had a higher risk of gluten intolerance.

4:10Dr Sophie Shotter:What's interesting here is that I have no symptoms of this. But I've also heard that for many women, it's only when they start to get into the perimenopause years that gluten intolerance can start to show up. So maybe this is a good pivot into starting to talk about all things hormones, as I know this is a cornerstone of your work. I think that the perimenopause and menopause conversation has been pretty well socialised by now. But shall we talk through some of the lesser known hormonal changes that women go through? So thyroid issues and some of the under the radar symptoms that may come with this.

4:44Dr Tam Lewis:Absolutely. I think it's important to state that it got into my work on hormones through a psychiatry background. because I was amazed how much suffering was happening in times of hormonal change, in people's experience of depression, anxiety, mood swings, bipolar, and even psychosis and schizophrenia were soon to be related to changes in hormone states. So that's not just sex hormones. Thyroid is intricately related to weight, to metabolism, to constipation, to feeling the cold. and also as you've highlighted gluten intolerance which is basically related to your body how your body processes or reacts to gluten which in many individuals and increasingly now so because we have big gluten molecules and things which aren't well tolerated by the gut the immune system reacts to this gluten molecule and if the immune system's reacting that can cause a downstream effect including inflammation, which is, as you know, cytokines, histamine, inflammation in the body.

5:48Dr Tam Lewis:How that relates to hormone changes and thyroid function is a little bit less well documented. But we do know that there is a far more increased risk of developing thyroid problems in your mid to late 30s as the shifts in hormone states tend to occur. And again, the body is a system, right, a system of glands and all hormones are on some level interrelated. I think it's important to note that most NHS GP practices will only test you for thyroid function if you have overt symptoms, like very pronounced symptoms of weight gain, fatigue, constipation, maybe you're losing your hair, then they will test you for thyroid.

6:32Dr Tam Lewis:But also people can become hyperthyroid, which is known as Graves' disease. But instead of just testing for one marker, which is TSH, some of the companies that you can buy consumer tests on very inexpensively now will test your full thyroid panel. So not just the brain control of the thyroid gland, but also the levels of the thyroid hormones in your blood. And there are ways to improve that that doesn't involve taking thyroid hormone replacement. The other common hormonal issue I would say that we see with an integrative physician's lens in midlife is this adrenal dysfunction, which you can read a lot about online, looking about cortisol fluctuations and cortisol and belly fat and insomnia.

7:20Dr Tam Lewis:And what we often see is that people are spiking their cortisol at the wrong time of day. So you wake up, you feel groggy, you've actually got low cortisol in the morning, it takes you four coffees to get yourself going. And then as we hit later in the day, we're more activated and we have cortisol high at night, which stops us sleeping. So I encourage people to do a lot of breath work, looking at adaptogens, looking at pantothenic acid, phosphatidylserine and other fatty acids, which can help calm the adrenals.

7:53Dr Sophie Shotter:Tam, just quickly, what do our adrenals actually do? Your adrenal hormones help you deal with the demands of stress in your day-to-day.

8:01Dr Tam Lewis:And what happens is that as we move into our midlife and our sex hormone levels are going up and down, our estrogen specifically is going up and down, and our adrenals are shooting off left, right and center to keep us going with cortisol. And we're secreting cortisol, the major stress hormone, often at the wrong times of the day. So we're tired in the morning and then we're wired at night. We can't sleep. If we can't sleep, we can't regenerate properly. So it's really worth doing a full panel just to see what's happening, if anything, with your adrenals, with your thyroid. And also, you know, noting how your specific pattern in the perimenopause plays out for you in terms of changes in the period, changes in your sleep, in your stress tolerance, etc.

8:43Dr Tam Lewis:And there's lots of ways to mitigate it. But working on your nervous system and your stress response through breath work, through yoga, through meditation, through strategic supplements that can calm the adrenal response really does help bring the system back into balance.

8:59Dr Sophie Shotter:Another thing that came up for me is that I have a genetic tendency towards higher cholesterol. And again, going back to some of our previous episodes, we had a fascinating chat with Professor Ben Bickman about, amongst other things, cholesterol. and as I said to him why are we so obsessed with testing cholesterol why not triglycerides which is another lipid that's far more predictive of heart attacks does this possibly all relate to what the pharmaceutical industry is able to produce and therefore sell I'd love to hear your thoughts on this because particularly for many women myself included they do have a genetic predisposition to high cholesterol and while of course we do need to keep an eye on these things there are many women who are totally asymptomatic of it.

9:43Dr Sophie Shotter:And my Swedish grandmother was one of them.

9:46Dr Tam Lewis:Yes, I think there's a lot of myths about cholesterol online. And, you know, there's also a lot of pseudoscience out there. I think cholesterol cannot be taken in and of itself as being predictive of anything. As you know, there are many different types of cholesterol. And actually, having a higher cholesterol level per se doesn't mean it's depositing necessarily in your arteries, which is the problem, which is where it builds up and cause cardiovascular disease. I myself as a former athlete, I do have a genetic predisposition to high cholesterol, but athletes and even people with anorexia have higher cholesterol levels because cholesterol has many other functions in the body other than being a substrate that gets deposited in the arterial walls to cause cardiovascular disease.

10:33Dr Tam Lewis:So I think we need to understand that there is a process and it's called atherosclerosis, right? And cholesterol is just one part of that puzzle. So if you look at a full lipid panel and you see your total cholesterol, which could be as high as seven, but you also have a decent level of HDL cholesterol, which is otherwise known as good, but it's more, it has a protective role in the body. It's high density lipoprotein cholesterol. But we need to look at the triglycerides, which you said, which are the circulating fats, which tend to go high in metabolic syndrome, which is where you have high cholesterol, and you have glucose dysregulation, which is, you know, surges in glucose levels, blood sugar levels, and you have inflammation.

11:16Dr Tam Lewis:That is the high risk state, not having a high cholesterol per se. And so I think there needs to be a little bit more of an understanding about the whole picture. There are drugs available just to treat triglyceridemia, so the high triglycerides. So I'm not sure it's a pharma-driven thing per se, but we always like to be reductionist in our approach to understanding human physiology. And unfortunately, we are complex. So, you know, what high cholesterol in you isn't the same as perhaps the builder down the street that smokes and also has blood sugar problems.

11:52Dr Sophie Shotter:Hi, Tam. I'm loving, first of all, hearing both of you talk about all of these things. I'm going to be jotting loads of things down here. But I also really enjoyed reading on the Wellgevity website that your approach is trauma-informed and I think a lot of Safies listeners are quite well versed on the link between trauma and health and this idea of the body keeps the score which of course is the work of Bessel van der Kalk. What supplements have you found most impactful in terms of calming the nervous system?

12:19Dr Tam Lewis:I guess I can't talk about trauma and the nervous system and trauma-informed approach and somatic therapy and I really encourage you to read Elie Joly's work. You should link to that because she's phenomenal. I've learned a lot from her, who she herself turned with Gabo Marte. Psychedelics, you know, the very emerging industry where this idea that we can take substances to shake up our brain patterns more strongly than years and years of therapy. And obviously, there's a lot of clinical trials. It's not legal to do any psychedelics in the UK other than ketamine-assisted psychotherapy, but ketamine is not strictly a psychedelic.

12:54Dr Tam Lewis:So what they do is change pathways in the brain and help reset deep held narratives about ourselves and can really improve the outcome of therapy. But as I said, in the UK, clinical trials are the only way you can access psychedelics like psilocybin at the moment. So if we want to think about legal supplements in the UK that can help regulate the nervous system and put yourself into a repair state, some of the lesser known ones are glycine, You might have touched on glycine, but you need anything from one to three grams of glycine in the evening could have a very calming effect on the nervous system.

13:30Dr Tam Lewis:And then rhodiola has been shown to improve pain perception, pain tolerance and endurance. And I don't really want to talk to ashwagandha that much because I'm not particularly fond of it. We've got lion's mane, which can improve the brain. There's an anti-inflammatory, so it can have positive effects on brain health. and your brain health is related to how you feel and function on a day-to-day basis. I think we talk about brain health enough as it relates to our emotional state.

13:58Dr Sophie Shotter:So yeah I'm curious about what you said just now about ashwagandha. It's had a bit of controversy due to its potential adverse effects on thyroid function and fertility amongst other things and I know that Denmark has now actually banned it. Yeah some people still swear by it for stress and anxiety so I'd love to hear your thoughts.

14:18Dr Tam Lewis:Yeah, it's a tricky one, ashwagandha. As you say, it's an individual response, but anything that can change how you feel significantly can be prone to abuse. So we have seen people on massive doses of ashwagandha, which is kind of numbing the system. But you can get an adverse response. So your body, because it can lower the amount of cortisol that interacts at the cellular level, you can get a paradoxical response, which means that your body can increase the amount of cortisol it's producing to sort of overcome the effect of the supplement. So that's one thing I see. Two, if people go cold turkey on it after they've been on it for a while, that can also have an impact.

15:00Dr Tam Lewis:So you can get a rebound worsening of anxiety and insomnia and whatever you were using it to treat in the first place. So it's a tricky one. And my view is that if you find it beneficial and you're not overusing it then it's probably not a bad thing although with some obvious caveats that check that you it's not affecting your health in any other way including the things that you mentioned but yeah that's basically my opinion on it I don't use it personally it's unpredictable its effect in many of my clients also I don't like it in me I feel

15:36Dr Sophie Shotter:completely zonked on it I feel absolutely knocked out on ashwagandha and if I take it at night even in the morning I feel groggy just doesn't suit me at all.

15:47Dr Tam Lewis:It's so interesting because you know maybe you're a higher cortisol type and your body is wired to run on more cortisol because it really does stop cortisol's action on the cell in some people.

15:58Dr Sophie Shotter:Yeah I tried it this is going back a few years when my stress levels were definitely less controlled than they are now. I haven't tried it again recently but yeah it was at a point in my life where I was definitely running on cortisol in a way I probably don't anymore.

16:15Dr Tam Lewis:Well it's probably that then it's probably like here you go if we take away cortisol you're going to stay in bed and fall asleep which is what you probably needed to be doing but couldn't. Exactly.

16:26Dr Sophie Shotter:Actually Tam we'd love to know what's your current day and night routine in terms of again the supplements you take and the health care practices that are non-negotiables for you and do drop in any brand recommendations because Sophie's audience loves to hear a recommendation but what is your routine?

16:44Dr Tam Lewis:Well there's a few things that I really swear by and stick with and travel with and the first is something called Electrolyte Synergy and it's by a company called Designs for Health which is a medical grade company based in the US and they have amazing products and I've used electrolyte synergy for donkey's years and the reason it's different from most electrolytes is because it contains more potassium than sodium but not only that it contains a gram of vitamin c but also d-ribose when not many people know about d-ribose but d-ribose is a mitochondrial support agent it's it's a type of sugar that's not metabolized like glucose but it can support how your body generates energy so I love electrolyte synergy I then always have something called 7-keto DHEA which being an adrenal junkie as well I have been used to living on high cortisol my adrenals are a little bit tired so I take a form of DHEA which is a precursor to many different stress hormones released by the adrenal gland and 7-keto DHEA also supports thyroid function so I take just a small dose of that just 25 milligrams every morning it's a prescribed product in the UK although some people can buy it online there's various websites that sell it and then I have a ketone coffee so I use a product called ketone q-i-t-o-n-e which is a ketone ester so it's providing beta hydroxybutyrate directly into my body which makes my brain go zing and gives ketones into my blood I love that product I always add collagen peptides to my coffee.

18:19Dr Tam Lewis:So I have this sort of ketone collagen peptide coffee with my electrolytes. And then I take a product called NAD Regen. So NAD Regen is a synergistic blend of by Biostack Labs. Again, no affiliation. I don't actually have any affiliation with any supplement companies at the moment. I just like lots of them and I try everything. So NAD Regen And it's NAD precursors that support how your body produces NAD naturally, which is nicotinamide riboside. And it contains some other cofactors that support how that is produced, how that is funneled down to the NAD pathway, which is the energy molecule of the cell.

19:02Dr Tam Lewis:So I take a couple of those. I've started using medicinal mushrooms to support my immune system because I charge around all over the place in multiple countries all over the time. So my body's also always exposed to different viruses. And I have had long COVID as we'll get to. And I use a company called Heifas Deterra, H-I-S-A-S. I use their Mycovia product, which is a blend of medicinal mushrooms. I take an omega-3, usually when I have my first, when I first eat. So whatever I'll have, I'll take the first supplements. I use riboflavin. Again, my supplement list is generated by my own testing.

19:39So I did a test called Genova Nutrival, which is quite an expensive test, but it's worth doing it once a year.

19:46Dr Tam Lewis:It's probably about 700, 800 quid. And it's a urine and a blood test, and it measures metabolites not only in the blood, but also in the urine. And it compares the two, so how your body is actually turning over and utilizing different vitamins and minerals. So I take riboflavin, which is B2, which my body seems to need quite a lot of, which is related to your comp, to your MTH of R genes and the way your body processes B vitamins generally. There's one test that I do once a year called the Genova Diagnostics NutriVal test, which is a blood and urine test. It's a slightly complicated, relatively expensive test, but I think it's worth doing because what I've seen in people time and time again is that the same patterns represent themselves year in, year out.

20:28Dr Tam Lewis:So once you get a prescription for what you need, it tends to be that your body is always needing extra of those things. And for me, that's riboflavin, vitamin B2. So I take way above the recommended daily allowance. I take 100 milligrams of B2 and I really notice the effect on my energy. I take, when I remember, alpha-lipaic acid, L-I-P-O-I-C, which is a precursor to glutathione. Again, this whole precursor thing is, you know, your body likes to be given things to make its own substrate. If we just give it the substrate, N-A-D, glutathione, it gets a bit lazy at making them. So alpha-lipaic acid, I sometimes take iron before my main meal, bisglycinate, which is an absorbable non-upset tummy form because I run relatively low on ferritin, which is your iron storage protein.

21:19Dr Tam Lewis:Before I go to bed, I take magnesium glycinate and a supplement called Diome, D-I-O-M-E, which is brilliant for restorative sleep. It contains glycine, California poppy, magnesium and a couple of absorbable B vitamins that are non-stimulating. I also take magnesium threonate, which improves my REM sleep. Sometimes some other things.

21:44Dr Sophie Shotter:Love this list. Thank you. And can you tell us a little more about your work with Long Covid, including your own story? So can we talk about causes? Is this all to do with some of the viruses having a very long tail, so to speak? and I'm also intrigued to hear you talk about the autonomic nervous system and histamine and mast cell issues as they relate to long COVID and of course how did you get into recovery I hear that oxygen and light therapy were part of your protocol alongside of course good nutrition