Month: January 2023

Low energy, brain fog, and lung problems are a few of the lingering aftereffects reported by some people who have had COVID-19. Could gut troubles also fall among the constellation of chronic symptoms that people with long-haul COVID experience? And if so, what do experts suggest to help ease this?

What happens to the gut during a COVID infection?

As we head into the fourth year since COVID-19 became a global health emergency, hundreds of millions of people around the globe have been infected with the virus that causes it. Since 2020, we’ve known that the virus particles that cause lung illness also infect the gastrointestinal (GI) tract: the esophagus, stomach, small intestines, and colon. This can trigger abdominal pain and diarrhea, which often — but not always — clear up as people recover.

We know chronic gut problems such as irritable bowel syndrome (IBS) sometimes occur even after illness caused by microorganisms like Campylobacter and Salmonella are cured. Could this happen with COVID-19?

What is long COVID?

While most people who get COVID-19 will survive, medical science is becoming aware of a group of people suffering from lasting declines in health. Well-reported long COVID aftereffects include tiredness, breathing difficulty, heart rhythm changes, and muscle pain. But few people, even in the medical field, are aware that long COVID symptoms may include chronic diarrhea and abdominal pain.

Why might the gut be involved in long COVID?

It is not clear why chronic gut symptoms might occur after a COVID-19 infection. One possible insight is a well-known syndrome called post-infectious irritable bowel syndrome (IBS) that may occur after a stomach flu (gastroenteritis).

Long after the bug causing the illness is gone, a change in gut-brain signaling may occur. A complex network of nerves connects the gut and the brain, and controls communication between different parts of the gut. These nerves tell body organs to produce digestive juices, alert you to the need to go to the bathroom, or prevent you from having another serving of stuffing at the Thanksgiving table.

The nerve network of the gut is so complicated that it is sometimes called the second brain. When the nerves are working well, you won’t notice a thing: you eat without pain, you move your bowels with ease, you have no GI worries. But what if the nerves are not working well? Then, even if the process of digestion remains normal, you may frequently have symptoms like pain or a distressing change in your bowel movements, such as diarrhea or constipation.

Once known as functional GI disorders, these health problems are now called disordered gut-brain interactions (DGBIs). When viruses and bacteria infect the gut, experts believe they may prompt a change in gut-brain signaling that can cause a DGBI like IBS to develop.

What to do if you’re noticing long-lasting gut problems after COVID-19 infection

We still do not know conclusively if COVID-19 can cause a long-term change in gut-brain messaging that leads to IBS or other disordered gut-brain interactions. But increasing evidence suggests that GI distress lasting six months or longer might be a symptom of long COVID. While we wait for more evidence, some GI specialists, including myself, recommend trying approaches that help relieve irritable bowel syndrome and other DGBIs.

If you are suffering from chronic abdominal pain and a change in your bowel movements after having had COVID-19, talk to your primary care doctor. Many health conditions have similar symptoms, including viral or bacterial infections, inflammation, or even cancers. A thorough exam can help to rule out certain conditions.

If the problem persists, do not suffer alone or feel embarrassed to act! Seek help if severe pain or changes in bowel movements are harming your quality of life or affecting daily activities. Talk with your doctor about the possibility that your chronic gut symptoms might be a form of long COVID. Find out if they can recommend helpful treatments or suggest a referral to a GI specialist. As research continues, new information may be available.

About the Author

Christopher D. Vélez, MD, Contributor

Dr. Christopher Vélez is an attending gastroenterologist in the Center for Neurointestinal Health of Massachusetts General Hospital's division of gastroenterology and the MGH department of medicine. He focuses on neurogastroenterology and motility disorders of the esophagus, … See Full Bio View all posts by Christopher D. Vélez, MD

Ketamine is an unusual type of psychedelic drug — called a dissociative — that is undergoing a resurgence in popularity. Originally derived from PCP, or “angel dust,” ketamine has been used in hospitals and veterinary clinics as an anesthetic for decades, and has been cited as a drug of misuse under the moniker “special K.”

It is the effects that ketamine reliably produces that underlie both its medical and recreational uses: pain control, forgetfulness, intoxication, disassociation, and euphoria. Recently, it has been used more widely due to its approval for treatment-resistant depression (TRD) — that is, severe depression that has not improved via other therapies, including people who are experiencing suicidal thoughts.

Evidence of the benefit of ketamine

A prescription version of ketamine called esketamine (Spravato), given through a nasal spray, was approved in 2019 by the FDA for TRD; however, according to the guidelines, it is only to be used “under the supervision of a health care provider in a certified doctor’s office or clinic.” That means medical professionals need to watch you use it, and then follow you after you’ve taken your dose, checking your vital signs and how you are doing clinically.

The effectiveness of ketamine for TRD was first demonstrated for short-term treatment in research that resulted in clinically and statistically significant decreases in depression scores for ketamine versus placebo (In both groups in this study, the patients continued with their regular antidepressants because of concern of not treating TRD in the placebo arm.) Nasal ketamine was shown to have longer-term efficacy, in a study where ketamine (plus the regular antidepressant) helped people stay in stable remission 16 weeks into treatment.

Relief from TRD with ketamine happens rapidly. Instead of waiting for an SSRI to hopefully provide some relief over the course of weeks, people who are suffering under the crushing weight of depression can start to feel the benefits of ketamine within about 40 minutes.

Is ketamine the right treatment for you?

This is a discussion that should include your primary care doctor, your mental health provider, and any other health care professionals who care for you. It’s important to remember that ketamine isn’t a first-option treatment for depression, and it is generally used only when other, more longstanding treatments haven’t been effective. It is not thought to be curative; rather, it improves symptoms for a certain amount of time. It is easier to say who isn’t appropriate for ketamine treatment, based on the side effects.

Should you go to a ketamine clinic for treatment?

Independent, outpatient ketamine clinics are popping up all over the place. It is estimated that there are currently hundreds to thousands of these clinics — almost all of which were established in 2019 when ketamine was approved for TRD. Typically, these clinics are for-profit enterprises that are staffed by some combination of either a psychiatrist or an anesthesiologist (who can administer the infusion), a nurse, a social worker, and (of course) the businesspeople who make it all work.

In writing this piece, I called several ketamine clinics, posing as a patient, to investigate what would be involved in receiving ketamine therapy. Most of them seemed as if they would provide ketamine for me without any major hurdles, after an introductory medical interview by a nurse or a social worker. A few clinics required communication or a diagnosis from my psychiatrist — and this seemed quite sensible.

The clinics operate on a fee-for-service arrangement, so you would pay out of pocket, as insurance rarely covers this treatment. In the Boston area where I live, the ketamine infusions cost about $600 each, and a course of six infusions and a clinical re-evaluation are typically recommended. (I should note that the ketamine clinics affiliated with medical academic institutions seem to have more safeguards in place, and they may also be enrolling people in clinical trials.)

Are ketamine clinics safe?

These ketamine clinics raise many questions — namely, what does one look for in a reputable and safe ketamine clinic? Currently, we don’t yet have definitive answers to that question. One wonders if a ketamine infusion, which can cause a profound dissociation from reality, would be better controlled in a hospital setting, where there are protocols for safety in case anything goes wrong. It was unclear (in part because I didn’t actually go through with the therapy) how much communication, if any, there would be between the ketamine clinic staff and your health care providers, and typically the treatments you receive would not be included in your primary electronic medical record.

What are the side effects?

Ketamine is generally considered safe, including for those who are experiencing suicidal ideation (thoughts or plans for suicide). The main side effects are dissociation, intoxication, sedation, high blood pressure, dizziness, headache, blurred vision, anxiety, nausea, and vomiting. Ketamine is avoided or used with extreme caution in the following groups:

• people with a history of psychosis or schizophrenia, as there is concern that the dissociation ketamine produces can make psychotic disorders worse
• people with a history of substance use disorder, because ketamine can cause euphoria (likely by triggering the opioid receptors) and some people can become addicted to it (which is called ketamine use disorder)
• teenagers, as there are some concerns about the long-term effects of ketamine on the still-developing adolescent brain
• people who are pregnant or breastfeeding
• older adults who have symptoms of dementia.

More detailed research needs to be done on the longer-term benefits and side effects of ketamine treatment, and on its safety and effectiveness for teens and older adults, as well as for the emerging indications of ketamine therapy for PTSD, OCD, alcohol use disorder, and other mental health conditions.

Finally, there is some concern that, with repeated dosing, ketamine can start to lose its effectiveness and require larger doses to produce the same effect, which is not sustainable.

Ketamine could provide hope for people with serious depression

Serious, treatment-resistant depression can rob people of hope for the future and hope that they will ever feel better. Ketamine can provide help and hope to patients who have not found relief with any other treatments. Given its efficacy in people considering suicide, it is plausible that ketamine may be lifesaving.

As we learn more from research on ketamine and from people’s experiences in newer clinics, we will be better able to answer the questions of ketamine’s longer-term effectiveness and what safeguards are needed for treatment. We may also learn who is most likely to safely benefit from ketamine therapies, and the best method of administration: intravenous infusion, a nasal spray, or a pill.

About the Author

Peter Grinspoon, MD, Contributor

Dr. Peter Grinspoon is a primary care physician, educator, and cannabis specialist at Massachusetts General Hospital; an instructor at Harvard Medical School; and a certified health and wellness coach. He is the author of the forthcoming book Seeing … See Full Bio View all posts by Peter Grinspoon, MD

Are you having a little trouble hearing conversations? If so, you’re not alone. An estimated 23% of Americans ages 12 and older have hearing loss. Although most of those people have mild hearing loss, for people ages 80 years and older, it’s more common for hearing loss to be moderate to severe than mild.

But not only is moderate to severe hearing loss disruptive to one’s life, it also makes you more likely to develop dementia. A new study helps explain why — and what you can do about it.

What did the new study look at and find?

A study published in JAMA focused on a sample of adults in the United States from the National Health and Aging Trends Study, which follows Medicare beneficiaries. The participants sampled were 70 or older.

The researchers found that about 33% of participants had normal hearing, 37% had mild hearing loss, and 30% had moderate to severe hearing loss. Dementia occurred least often among those with normal hearing (6%), more often among those with mild hearing loss (9%), and most often among those with moderate to severe hearing loss (17%). That’s a large increase in risk, particularly for those whose hearing loss is moderate to severe.

What else to know about this study

The study sample was selected to make it possible to analyze subgroups by age and apply findings to a diverse population. The sample included additional participants ages 90 years and older, and additional participants who identified as Black. Of the 2,413 total participants, 53% were ages 80 years and older, 56% were female, 19% were non-Hispanic Black, 4.5% were Hispanic, and 74% were non-Hispanic white.

Also, unlike previous research, this study looked objectively at hearing loss and dementia. Prior research had shown that hearing loss is thought to account for about 8% of all dementia cases worldwide. Exactly why the connection exists is not known.

It’s important to note that most large studies that found this link were based on questionnaires that people fill out. In other words, no one actually measured the hearing of those participating in the study to make sure that they had hearing loss — or that their hearing was really normal.

In this new study, however, the investigative team used an electronic tablet-based audiometer to evaluate participants’ hearing for four pure tone frequencies that are most important for understanding speech. So, for the first time in a large study, there was objective measurement of hearing loss.

How do hearing aids reduce the risk of dementia?

If you have hearing loss, does that mean you’re doomed to develop dementia? Not at all. This study found that those with moderate to severe hearing loss could significantly reduce their risk of dementia simply by using hearing aids.

This research helps us understand why hearing loss causes dementia. Here’s the connection:

There is increasing evidence that the more the brain is stimulated, the less likely it is that dementia will develop. When there is hearing loss, auditory stimulation is reduced. This, by itself, likely increases dementia risk. But even more important is that when an individual suffers from moderate to severe hearing loss, they are less likely to participate in social activities. Perhaps they are embarrassed about their hearing loss. Or they may simply find it unrewarding to attend a social event when they cannot hear what is going on.

It turns out that social activities are one of the best ways to stimulate the brain, as there is evidence that our brains evolved to facilitate social behavior. Given all this information, you won’t be surprised to learn that reduced social activity has been linked to cognitive decline. Thus, this new study provides additional evidence that the reason hearing loss increases the risk of dementia is because hearing loss reduces brain stimulation — both directly and through reduced social interaction.

What to do if you have hearing loss

Don’t let hearing loss raise your risk of dementia.

• Keep your ears clean. (But remember, never put anything in your ears smaller than your elbow. Ask your doctor if you’re not sure how to clean your ears.)
• If you can’t hear and you don’t have hearing aids, get them. Hearing aids now available over the counter can help many people with mild to moderate hearing loss.
• If you have hearing aids, wear them.
• If your hearing aids aren’t working, get them fixed.
• Don’t be passive — ramp up your social life and other activities.

All these things will help to reduce your risk of dementia. And you might just find that, despite some hearing loss, you’re enjoying life more.

About the Author

Andrew E. Budson, MD,

Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Andrew E. Budson is chief of cognitive & behavioral neurology at the Veterans Affairs Boston Healthcare System, lecturer in neurology at Harvard Medical School, and chair of the Science of Learning Innovation Group at the … See Full Bio View all posts by Andrew E. Budson, MD