Month: June 2022

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

Loneliness is complicated. You can feel lonely when you lack friends and miss companionship, or when you’re surrounded by people — even friends and family.

Either way, loneliness can have devastating health effects. It boosts risk for coronary artery disease, stroke, depression, high blood pressure, declining thinking skills, inability to perform daily living tasks, and even an early death. The remedy? Below we offer three ways to ease loneliness and add happiness by helping you expand your social network.

Taking the first steps

Not all loneliness can be solved by seeking out people. Loneliness that occurs despite relationships may require talk therapy and a journey that looks inward.

Reducing loneliness caused by a lack of relationships is more of an outward journey to make new friends. “That’s a challenge as we get older, because people are often established in their social groups and aren’t as available as they might have been in a different phase of life. So you have to be more entrepreneurial and work harder to make friends than you once did,” says Dr. Jacqueline Olds, a psychiatrist at Harvard-affiliated McLean Hospital and the coauthor of two books on loneliness.

Trying these strategies can help.

1. Seek like-minded souls

Being around people who share your interests gives you a head start on making friends: you already have something in common.

Start by considering your interests. Are you a voracious reader, a history lover, a movie aficionado, a gardener, a foodie, a puppy parent, or an athlete? Are you passionate about a cause, your community, or your heritage? Do you collect things? Do you love classic cars? Do you enjoy sprucing up old furniture? Maybe you want to learn something new, like how to cook Chinese food or speak another language. Search for online groups, in-person clubs, volunteer opportunities, or classes that match any of your interests or things you’d like to try.

Once you join a group, you’ll need to take part in it regularly to build bonds. If you can gather in person, it’s even better. “The part of our brain involved in social connection is stimulated by all five senses. When you’re with someone in the same room, you get a much stronger set of stimuli than you do by watching them on an electronic screen,” Dr. Olds says.

2. Create opportunities

If joining someone else’s group is unappealing, start your own. Host gatherings at your place or elsewhere. “All it takes is three people. You can say, ‘Let’s read books or talk about a TV show or have a dinner group on a regular basis,'” Dr. Olds says.

Other ideas for gatherings — either weekly or monthly — include:

• game nights
• trivia nights
• hikes in interesting parks
• beach walks
• bird-watching expeditions
• running or cycling
• meditation
• museum visits
• cooking
• knitting, sewing, or crafting
• shopping
• day trips to nearby towns
• jewelry making
• collector show-and-tell (comic books, antique dolls, baseball cards).

The people you invite don’t have to be dear friends; they can just be people you’d like to get to know better — perhaps neighbors or work acquaintances.

If they’re interested in a regular gathering, pin down dates and times. Otherwise, the idea might stay stuck in the talking stages. “Don’t be timid. Say, ‘Let’s get our calendars out and get this scheduled,'” Dr. Olds says.

3. Brush up your social skills

Sometimes we’re rusty in surface social graces that help build deeper connections. “It makes a huge difference when you can be enthusiastic rather than just sitting there and hoping someone will realize how interesting you are,” Dr. Olds says.

Tips to practice:

• Smile more. Smiling is welcoming, inviting, and hospitable to others.
• Be engaging. Prepare a few topics to talk about or questions to ask — perhaps about the news or the reason you’ve gathered (if it’s a seminar, for example, ask how long someone has been interested in the subject). Or look for a conversation starter. “Maybe the person is wearing a pretty brooch. Ask if there’s a story behind it,” Dr. Olds suggests.
• Be a good listener. “Listen in a way that someone realizes you’re paying attention. Hold their gaze, nod your head or say ‘Mm hmm’ as they’re talking so you give feedback. Assume everyone in the world is just yearning for your feedback,” Dr. Olds says.
• Ask follow-up questions. Don’t ignore signals that someone has interesting stories to tell. “If they allude to something, your job is to look fascinated and ask if they can tell you more. They’re dropping crumbs on a path to a deeper exchange,” Dr. Olds notes.

Even chats that don’t lead to friendships can be enriching. A 2022 study found that people who had the most diverse portfolios of social interactions — exchanges with strangers, acquaintances, friends, or family members — were much happier than those with the least diverse social portfolios.

Ultimately, a wide variety of interactions contributes to well-being, whether you’re talking to the cashier at the supermarket, a neighbor, an old friend, or a new one. And all of these connections combined may go a long way toward helping you feel less lonely.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Making friends and finding social opportunities can sometimes be difficult, particularly for children with neurodevelopmental disabilities, such as autism spectrum disorder, attention deficit hyperactivity disorder, or an intellectual disability. Here’s what parents can do to help.

Building inclusive communities

Friendships and social connections are an important aspect of our lives. They provide a sense of belonging and allow people to be included in their communities.

People with neurodevelopmental disabilities may communicate, learn, and behave differently. Sometimes these differences make it harder than usual to develop friendships and participate in social activities.

But parents and others can help create more inclusive communities and opportunities to build social relationships, especially for people with neurodiverse abilities.

Below are some tips and strategies to help children learn and develop the social and emotional skills they need to make friends.

Practice at home: Tips for common social situations

Navigating social settings and making friends involve many skills you can practice with children at home.

• Greetings and questions. Make a habit of practicing greetings throughout the day. Model good listening for your child, and take turns asking and answering conversation starters like, “How are you?”
• Calm body movements. Sometimes it can be hard for children with neurodevelopmental disabilities to keep a calm body. Have your child practice giving their body enough room and keeping personal space between themselves and others by using an arm’s-length distance.
• Appropriate level of voice. Encourage your child to listen and match the level of your voice. Imagine your voice has a volume dial and practice turning the volume up and down.
• Eye contact. Looking directly into someone’s eyes can be difficult, so help your child instead look at different parts of your face or practice looking at their own eyes in the mirror.
• Reading and responding to social signals. People regularly communicate using more than just words. Social signals are the variety of ways in which we communicate through body language and facial expressions. Often this can be tricky to detect for children who are neurodiverse. Help your child recognize common social signals by asking what someone’s body or face might be saying.

Rerouting challenging behaviors to help children build friendships

Challenging behaviors may get in the way of making and keeping friends. It is important to address challenging behaviors like impulsivity and aggression through therapies and programming. Additionally, practicing the following fundamental skills can help reduce challenging behaviors.

• Patience. Learning how to wait for a turn to play or a time to speak in a conversation is an important social skill. Practice waiting with a timer, gradually building up from 10 seconds, to one minute, to five minutes.
• Flexibility. Help your child make compromises using first/then statements, such as, “First we play your way, then my way.” Model flexible play and redirect with new toys to show how play can evolve.
• Communicating strong emotions.Handling strong feelings can be difficult sometimes. Practice communicating these feelings effectively either by asking for help, using an emotions board, or taking a break.

How to throw a wide net socially

Encouraging social opportunities is an important part of supporting friendships and social relationships for children with neurodevelopmental disabilities. Social spaces offer chances for children who are neurodiverse to find activities they enjoy. They are able to practice the social and emotional skills they are learning and even meet other children practicing these same skills.

• Structure and organize play dates. Set up the environment before a play date by making a list of activities to do with a friend, then picking out of a hat which activities to do and in what order.
• Make a list of things that are fun to do and invite others to join. Look for free or low-cost programs or events out in the community.
• Connect with other parents of children with disabilities. Set up an activity for your children like an ice cream date, going on a walk, or a game night with adults and kids together. These encounters can give rise to repeat, planned social interactions.
• Check out organizations in the community for children with disabilities, like Special Olympics, or recreational programs that foster inclusive environments through Unified Sports.
• Look into facilitated recreational activities like a Lego club or pizza parties with teachers. Plan to bring a support person if needed.

Your child’s doctor or teacher may be able to suggest additional community or web-based resources designed to help families support friendships for children with neurodiverse abilities.

About the Authors

Sydney Reynders, ScB, Contributor

Sydney Reynders, ScB, is a clinical research coordinator in the Boston Children’s Hospital Down Syndrome Program. She assists in research investigating educational, behavioral, and medical interventions in Down syndrome and other neurodevelopmental disorders. She received her … See Full Bio View all posts by Sydney Reynders, ScB

Nicole Baumer, MD, MEd, Contributor

Nicole Baumer, MD, MEd is a child neurologist/neurodevelopmental disabilities specialist at Boston Children's Hospital, and an instructor in neurology at Harvard Medical School. Dr. Baumer is director of the Boston Children's Hospital Down Syndrome Program. She … See Full Bio View all posts by Nicole Baumer, MD, MEd