Re-activation of latent HHVs (EBR, CMV, etc) following SARS-CoV-2 infection
Mounting body of research indicating Covid infection reactivates latent HHVs, particularly HHVs1-5 (with which 95% of the world population is infected with at least one). “Long Covid” symptoms often track closely to HHV-4 (EBV) and/or HHV-5 (HCMV). HHVs 2-5 outbreaks are increasingly documented following Covid infection in young healthy adults. Is it time to reconsider drawing antibody titres for and treating symptomatic HHV reinfections following Covid infection? Pre-pandemic the answer was ‘No’ bc HHVs are extremely widespread, can’t be eradicated with available treatments, and adult recurrence of HHVs 3-5 is (was) rare unless immunocomp. But how dangerous are these HHV reinfections long term and how worried shd we be? Many of these HHVs elevate cancer, CV, and neurodegenerative risks for example. So is it time to reconsider treatment protocols wrt otherwise young “healthy” patients presenting with multiple HHV outbreaks following mild/asymptomatic Covid infection, incl shingles, genital herpes, mononucleosis (etc)? What are the pros and cons of making various antivirals more widely available to these patients in the post-Covid world? And is there any evidence that doing so improves long term outcomes, considering that not one of the 10 (ish?) HHVs known to infect humans can be successfully ”cured”? Bring on the herpes experts let’s get into it!
Further Bone Health Items
Thank you for another excellent AMA. As a family physician of over 20 years I realize I have some insight, some bias, and always something to learn. There were a few items that I wish you and your team had time to explore and maybe could come up in a future episode. These are items that are relevant on a daily basis in my family medicine clinic. The first, although I think there is general agreement that low levels of vitamin D set us up for numerous problems, I find that the data that vitamin D supplementation as the cure is quite lacking. I'm no researcher by training but in what I've been able to see, strong data for the usefulness of vitamin D supplements really seems to be weak at best. Similarly for calcium supplements, those also seem to be lacking in robust data for bone health and most other health related items. The second relates to healthy bones in children. As historically we naturally make much of our vitamin D through sun exposure, I'm worried about the current generation of children either spend significant time indoors or whose parents feel they are watching out for their future skin health by covering them from head to toe and leaving them looking like ghosts. Sadly, you are almost shamed as a parent currently if your child has a tan. This worries me that these children may not be getting the deposition they need and whether a vitamin D supplement would even close the gap. I guess cod liver oil worked during the Industrial Revolution with children in factories but I don't see vitamin D supplementation being routinely prescribed today. I do agree with you, I wish to be doing densities much earlier age, I think it would be useful consider doing them at the age of 20 to make sure that we are hitting our peak at a time we can still make a little bit of a difference. Since the real price of bone density doesn't really hit until 65 or above the private insurers can easily pass this on to Medicare anyway rather than incur the cost As you you seem to be able to swim further for sure than I can, I would love to know think of the available data
Pull in Charles Brenner on NAD
I know your skepticism about NAD and various precursors (NR, NMN, etc.), as discussed in the most recent Drive with Josh Rabinowitz. (Appreciated your correction on intravenous NAD, btw.) I wonder if you've ever considered having Charles Brenner as a guest on the Drive? He has made a name for himself being very skeptical of longevity claims on Twitter, which I'm sure rubs some people the wrong way but is largely refreshing in a world of hyperbolic claims. Yet he's obviously a pretty big believer that NR is beneficial (though would perhaps stop short of saying for longevity) and I suspect given his skepticism has pretty strong evidence to back it up. I'd be interested to hear a back and forth between the two of you on NAD.