Is chronic stress the invisible factor behind Long COVID?

When it comes to a COVID-19 prognosis, it has become abundantly clear that ‘underlying health conditions’ are the most important factors associated with our outcome. Pre-existing heart conditions, type 2 diabetes and obesity are just some of the factors which make us more likely to suffer complications. This makes sense - at a very basic level these conditions create long-standing inflammation in the body, leaving many unable to fight off the additional inflammation brought on by the virus, and therefore more vulnerable to severe disease (1). In other words, how well you weather the fight depends on the status of your battlefield.

So how do we explain those suffering with “long-COVID” who claim, not only to have no underlying conditions, but to be incredibly fit and healthy? Hospital doctors who frequented the gym 4 times a week, nutritionists who drank green juices every day or yoga teachers who practice mind-body connection? I believe that there is one massive elephant in the room that no-one seems to be talking about: chronic stress. I suspect it is the key factor which sits between an ‘otherwise healthy’ person and Long-COVID.

First, let’s start with what Long-COVID is...

Although it feels new, it is actually a form of ‘post-viral fatigue syndrome’ (PVFS) which we have seen before in those suffering with Epstein-Barr, Influenza, Glandular Fever and after other major pandemics including 1918 Spanish Influenza and 2003 SARs (2,3). According to the World Health Organisation, post viral fatigue syndrome is…

“…a complex medical condition, characterised by long-term fatigue and other symptoms. These symptoms are to such a degree that they limit a person’s ability to carry out ordinary daily activities”

There is a clear resemblance to Chronic Fatigue Syndrome (CFS)/Myalgic Encephalomyelitis (ME) in that, conventional blood lab results are normal, but symptoms are very real, very debilitating and wide-ranging. Severe fatigue and exhaustion is often coupled with muscle and joint pain, headaches, brain fog, gastrointestinal issues, sleep and mood disorders (3).

So, what’s actually going on in the body?

A major school of thought is that post viral syndrome is the result of an overactive immune system which fails to switch off once it’s fought off the infection, leading to an increase in chemicals called cytokines. These chemicals create inflammation and therefore produce symptoms of illness (5). Of particular note is the highly aggressive cytokines IL6 and 7 which can cross the blood brain barrier and lead to a build-up of inflammatory toxins in the brain. This is why so many people suffer with neurological symptoms such as fatigue, confusion and low mood.

What is the role of stress?

Experiencing a stressful situation leads to the brain activating stress hormones which communicate with the parts of the body that need to be ready for ‘fight or flight’. Blood gets pumped to the brain for alertness and to muscles for combat, pupils dilate for better vision and glucose pours into the bloodstream for energy. These hormones also send messages to switch off the bodily functions we don’t require, including immune function. Why would we need to tackle an infection while we are fighting for our lives?

When stress is prolonged or chronic, it can weaken our innate immunity, creating challenge for our body when it experiences an infection (4). It is the job of our innate immune system to act as first line of defence by recognising and immediately acting on an invading pathogen (6). Our adaptive immune system which has evolved as we have, takes several days to mount a defence and is highly aggressive (6). So when the innate immune system is suppressed and less able to fight the pathogen, not only is the infection able to do more damage, the adaptive immune system is left feeling as though it has to overreact with aggressive chemicals (such as IL6 and 7) which kill the virus, but leave significant inflammation in their path (5).

So, whilst a healthy person may experience the effects of their immune system working via unpleasant symptoms, they will be able to recover from those symptoms swiftly, because their innate immune system has acted effectively and their inflammation response is appropriate. When we are chronically stressed, we may have had to spend longer fighting the infection, meaning that more damage has been done, the effects from the adaptive immune system are more severe, and we are also depleted, leaving us much less able to recover from the the inflammation. It’s no wonder that we are left with debilitating, long lasting symptoms.

Where do we go from here?

I believe it’s critical that we understand just how insidious stress is. Low level stressors are everywhere, from the amount of information we consume day to day, to the continual comparisons we make on social media, to the expectation to be always-on at work. The effects of stress build in the body over time, usually without us knowing. Perhaps most worryingly, our culture glorifies stress. It’s seen as a mark of success to be busy, always on-the-go, with never enough time to sleep.

None of us are immune, including the doctors who think of themselves as fit. Being ‘exercise fit’ does not necessarily mean you are healthy. In fact, if you are carrying out a stressful job, perhaps alongside poor sleep and then go out to do high intensity exercise, you could just be adding to the high level of stress hormones already circulating around your body (7).

Another source of stress we talk little about is trauma. Situational traumas such as childhood abuse or collective traumas such as systemic racism and the isolation many have felt during this pandemic, all create physiological stress and a weakening of the immune system. With trauma being so widespread, and so few knowing how to properly heal it, it would not surprise me at all if trauma is a root cause of Long COVID for many.

I was someone who for many years held down a high pressured job, busy social life and frequent exercise. On the surface I looked well. But I was also sleeping very few hours at night, eating on-the-go most days, worrying about trying to be everything to everyone and grappling with my own past traumas. Consequently, I was in a perpetual state of fight or flight. Eventually my body gave me its bill in the form of Post Viral Fatigue Syndrome. In my case, it was triggered by a nasty bout of food poisoning, but the symptoms and the effect on my life was just as severe as many of those with Long COVID are reporting.

So far, the media has spent a lot of time telling us to be frightened of this virus, but very little time educating us about how we weather the storm better next time. Each and every one of us has the power to build better health, which in turn will give us better resilience to infections. It’s empowering to know that we don’t need to wait for the government to take action on this, it’s within our control. Reducing chronic stress in all its forms - psychological, physical, social - is in my opinion, a very good place to start.

How to build your resilience to stress:

1. Prioritise Sleep

When we don’t sleep well, our body is flooded with stress hormones because it thinks we are not sleeping in order to prepare for fight or flight. Sleep is also critical for the body’s repair mechanisms to function properly. Prioritise it by getting to bed earlier, creating a wind down routine and switching off devices that keep you alert at night. If you’d like to understand more about the importance of sleep, read my blog here.

2. Activate your rest and digest mode every day

Breathing exercises, meditation, yoga and walking in nature are all scientifically proven methods for shifting your body out of fight or flight and into rest and digest. Find what works for you and be religious about it.

3. Create joy in your life

How many of us forget about or de-prioritise this? When we experience a moment we consider to be joyful, our brain responds by releasing dopamine and serotonin, which make us feel happy (8). When we are happy, it’s much harder to become stressed. Whether it’s playing with the kids, painting or getting outdoors, try to make time for it, because it has a real physiological effect on your wellbeing.

4. Eat anti-inflammatory foods

When we eat inflammatory foods such as those laden with sugar or chemicals, over time our bodies read this as a threat and produce stress hormones. Stress from a physical source such as this has the same downstream effects on the body as stress from a psychological source. The more you replace processed, deep fried and high sugar foods with whole, plant based, phytonutrient-rich foods, the more your body will respond by calming down its stress response. For delicious anti-inflammatory recipes go here.

5. Reduce your exposure to toxins

Just like inflammatory foods, toxins are a physical source of stress to the body and in the 21st Century, they are ubiquitous. You can reduce your exposure by opting for organic food where you can, 'cleaner' toiletries and furniture made from natural materials. You can find more strategies for avoiding toxins here.

6. Heal trauma

As Lissa Rankin, expert on the physiological effect of trauma says "it is my hope, as an advocate of healing during a great public crisis, that the medical system not make the mistake it usually does- neglecting and ignoring the impact of trauma on the origin and treatment of physical disease". I couldn't agree more, and I would implore you to seek expert advice if you think that trauma could be affecting you. Methods for treating complex traumas include Internal Family Systems and Advanced Integrative Therapy.

7. Embrace short term stress

Short term stress is associated with improved immune function and overall health. Saunas, open water swimming, strength based exercises and sex are all examples of short term stress which ‘shock’ the body to enhance the immune system (9). The trick is to ensure any stress is short term and that you able to resume your rest and digest mode following the activity.

8. Heal downstream effects of chronic stress

Many of us are struggling with downstream effects of stress such as high blood sugar, under active thyroid, poor digestion and malabsorption. Left unattended, these mechanisms can create disease, but it is possible to reverse them with shifts to diet and lifestyle. Please get in touch if you would like support with this.