As Covid-19 becomes endemic, Long Covid may well become a major public health threat. A large study from the US Veterans Administration found that each time a person develops Covid-19, the risk of long-term complications increases, rather than decreases, regardless of vaccination status. Moreover, a large international study found that 90% of people with persisting symptoms after Covid-19 had a mild illness to begin with. Understanding the unique nature of Long Covid is essential for effective prevention and treatment. Despite what you may see on the news, we know a great deal about the causes of Long Covid and almost all can be reversed or treated.
Treatment of Long Covid and other late complications of Covid-19 cannot be done by formula; it must be individualized. The purpose of this blog is to give you information that will allow you to pursue multiple avenues that may be needed to find solutions.
There are many different types of long-term problems that follow acute Covid-19. Some people get sick and don’t fully recover. Others appear to get well and then experience a relapse of their symptoms. For some people, a new set of symptoms emerges, either soon after acute Covid or sometime later, after another acute illness, usually an apparent viral infection. For many others, the problem is the appearance of a new disease within 6 to 12 months of having acute Covid-19. Diabetes, high blood pressure, immune problems and neurological or psychiatric disorders are twice as likely to develop during the year after Covid-19 than would be expected. There are still others for whom Covid-19 leads to an aggravation of an underlying condition that was previously mild and is now much more severe. At Transformation Health our approach has been to help patients understand the physiological changes that occur in the body when someone has Covid-19 and recognize how these may be contributing to the problem each individual has, whatever the symptoms or manifestations.
SIX TIPS TO SUPPORT YOUR RECOVERY FROM LONG COVID
Conventional treatments offered to people with Long Covid are basically designed to reduce symptoms. Our goal is to address the causes of Long Covid through self-care. Fortunately, most of these measures will also alleviate symptoms.
1. Sleep and hydrate.
Sleep more than you think you need to, but do it on a regular schedule. If you are having difficulty sleeping, there are a number of natural sleep aids you can try, including melatonin, magnesium, theanine and herbs such as Passionflower, Ziziphus and Jamaican dogwood.
Make sure you stay well-hydrated. Drink enough water to alleviate thirst. Unless you have high blood pressure, do not be afraid to use salt. Hydration is especially important for people who get fatigued, dizzy, or weak when standing or walking and feel much more comfortable lying down. This condition is called orthostatic intolerance. In people with Long Covid, it is usually a sign of damage to the autonomic nervous system, which regulates heart rate and blood pressure.
2. Eat food that supports your recovery
Diet has a profound impact on the outcome of Covid-19. A large-scale study at John Hopkins found that a 40% increase in vegetable consumption produced a 70% decrease in the likelihood of severe or moderately severe illness in people with Covid-19. People eating more vegetables happened to be eating less sugar, but sugar is not what made the difference. A sub-group of people eating a low-carb, high-protein diet were almost 4 times likelier to get severely ill as people whose diet was mostly plant-based whole foods. The plant based diet was not a true vegetarian diet as it included fish, eggs, and dairy products, and even a little meat. Just a lot more vegetables!
3. Address and support the nervous system to reduce anxiety and depression
A crucial area of focus is supporting the nervous system to reduce anxiety and depression, which are common psychological challenges experienced by long COVID patients. The pandemic has taken a huge toll on our psyches and emotional trauma itself can hinder recovery.
COVID-19 can affect the autonomic and central nervous systems. It can affect organ systems directly through infection or indirectly via dysfunction in the nervous system. That means a host of crazy-sounding symptoms – such as blood pressure changes, memory and attention issues and gastrointestinal upset.
Some practices we encourage you try at home are;
Exercise regularly. If you are having trouble exercising, please seek the assistance of an exercise physiologist or physiotherapist.
Gargle and hum; Doing so activates the vagus nerve, which can help to calm your autonomic nervous system.
Eat smaller, more frequent meals. Doing so puts less strain on the nervous system since it does not have to orchestrate digestion for a large meal.
Follow a strict sleep schedule. Sleep quality is often lacking for COVID long-haulers. Following a strict schedule and practicing good sleep hygiene can help.
Take more breaks throughout the day. The human brain and body need to rest more often during COVID recovery. Consider yoga, mindfulness, calming music and other relaxing activities when you can.
Consider talking to your natural healthcare practitioner about suitable supplements to support your nervous system; some include herbs such as Zizyphus, Withania, Lemon Balm, Passionflower, Rhodiola and nutrients such as magnesium, tyrosine, GABA and B vitamins.
4. Repair and reduce oxidative stress and damage caused by the virus
For any virus to make you sick, that virus must attach to your cells, enter them, and cause damage within them. In the case of Covid-19, the gateway is ACE2, a vital enzyme that is essential for health and recovery from illness. When the Covid virus attaches to ACE2 in your cells, it damages ACE2. Virtually all complications of Covid-19 can be traced to an ACE2 defiency. Once the virus destroys ACE2, the resulting inflammation impacts the mitochondria, tiny powerhouses inside your cells that generate 90% of the energy you need to live. Even after mild Covid infection, mitochondrial distress can continue for months. The good news is that the reverse is also true; restoring ACE2 and rescuing mitochondrial function are the foundation for protecting yourself and healing from Long Covid. Supplements for ACE2 enhancement include;
- Vitamin D increases the levels of ACE2 in your cells.
- Curcumin is a bioflavonoid found in the Indian spice turmeric. Curcumin increases ACE2 activity. It also enhances brain recovery after injury and may have direct anti-viral activity.
- Omega 3 Fatty Acids (EPA and DHA) are anti-inflammatory and neuroprotective. They stimulate ACE2 indirectly, by increasing activity of a group of hormones called apelins, which are potent promoters of ACE2.
- Resveratrol is best known for its presence in red wine. It is the agent of the so-called French paradox (despite eating a lot of animal fat, French people have a relatively low rate of heart attacks). Resveratrol has been shown to aid brain recovery after injury and to enhance immunity. It may also have direct anti-viral and anti-bacterial effects.
- Alpha Lipoic Acid is an anti-oxidant that complements omega-3 fats and has a special relationship with ACE2. It has been shown to preserve ACE2 activity in the brain. It also helps to repair damaged nerve tissue.
- NAC (N-acetylcysteine) is another antioxidant that protects ACE2 from the destructive effects of inflammation. NAC has many beneficial actions; it helps lung function and is useful for treating asthma and bronchitis. It strengthens immune function and can ameliorate symptoms of influenza.
5. Support mitochondrial function
There are no drugs that enhance mitochondrial function, but there are supplements that have been shown to do so. The following information explains how and why each supplement works;
- Coenzyme Q10 (CoQ10) tops the list because it’s been studied the most. Unlike a vitamin or mineral, CoQ10 is a molecule your body can make, but may not make enough. A number of drugs interfere with its synthesis. Coenzyme Q10 is the single supplement I have found to be most beneficial for reversing Covid-related fatigue.
- B-Vitamins are commonly used for mitochondrial rescue, especially vitamin B1 (thiamine), vitamin B2 (riboflavin), and vitamin B3 (niacin), which is probably the most important. Both NAC and resveratrol support the ability of coenzymeQ10 and niacin to enhance mitochondrial function.
- L-Carnitine, like CoQ10,is normally synthesized in your body, but may be depleted in states of fatigue. L-carnitine and its derivatives, like acetyl-L-carnitine, are often used for mitochondrial support and incorporated into various “mitochondrial cocktails” and formulas. I’ve seen mixed results with these, and I recommend that in the setting of LongCovid carnitine use be supervised by a health professional.
- D-Ribose is involved with ATP production, is known to reduce fatigue in both CFS and fibromyalgia patients.
6. Re-establish a healthy gut microbiome
Consistent abnormalities of the gut microbiome have been described in people with Covid-19 and identified as predictors of development of Long Covid: specifically the loss of a diverse population of beneficial bacteria and an increase in undesirable, toxic or inflammatory bacteria. Fungal and yeast overgrowth may also occur.
This type of imbalance is referred to as dysbiosis, and correcting it is essential for recovery. The first step in its correction is restoration of ACE2, because ACE2 performs special functions in the gut that protect against dysbiosis. The next step is eradicating remnants of SARS-CoV-2 from the gut, because whether they are infectious or not, these viral remnants cause inflammation. Studies have shown that the virus may persist in the GI tract for months after acute Covid and that its proteins may be found in the cells lining the intestinal tract for a year or more. We have employed the following strategy to address gut microbial dysbiosis, viral persistence, and T-cell impairment as a triad in Long Covid. It works both for reversing Long Covid and for preventing it when a person is sick with acute Covid.
The goal is to build a robust gut microbiome that will help the brain to repair itself. Here are some tips to building a strong micobiome;
1. A high fiber, plant-based diet, described above for restoring ACE2 activity, emphasizing fermented foods and berries, because of their specific benefits.
2. Vitamin D and Resveratrol. Resveratrol and vitamin D may improve the intestinal microbial barrier by inhibiting the growth of pathogens and modulating the composition of intestinal dominant flora.
3. A probiotic, Lactobacillus plantarum, which is also found in fermented plant-based food like sauerkraut.
4. To ensure adequate levels of butyrate, a prebiotic powder like arabinogalactans or galactooligosaccharides, or supplementation with butyrate itself. Butyrate can also be generated by eating foods such as rolled oats, legumes and cooked potato and rice.
5. Medicinal mushrooms such as Shiitake and Reishi, available as capsules or in food.
6. Zinc, which is important for T-cell function. Zinc accumulates within effector T-cells and is released when needed for its antiviral effects.
In Conclusion.
This is not a hopeless, mysterious disease that we are only barely beginning to understand. There has been a lot of science and a lot of research already applied to Long Covid, and it will continue.
As research continues to unfold, natural medicine holds the potential to play a significant role in supporting individuals with long COVID on their journey toward healing and improved quality of life. By embracing an integrative approach that combines the best of both conventional and natural therapies, we can empower ourselves and our communities to navigate the challenges of long COVID with resilience and hope.
References;
1. Ziyad Al-Aly, Benjamin Bowe, Yan Xie et al. Outcomes of SARS-CoV-2 Reinfection, 17 June 2022, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-1749502/v1]
3. LONG COVID; PREVENTION AND TREATMENT. Leo Galland, M.D. January 15, 2023. http://drgalland.com/wp-content/uploads/2023/01/LONG-COVID-PREVENTION-AND-TREATMENT-FINAL1.PDF