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Long COVID Explained
Many of the people who get acute COVID-19 won’t become severely ill and their symptoms resolve within the first 4 weeks. However, there is a chronic post infectious inflammatory, multi-organ, multi-system disorder that may follow acute COVID-19, that has an unpredictable relapsing-remitting response that occurs for weeks to months later. There is a lot of confusion as to what it is, who gets it and why and how to treat it. This article is going to look at the big picture of this post infectious syndrome to give you an overall understanding of the illness.
Much of what you read about long COVID in this article as well as future articles will be from the latest scientific research, and clinical results which are appearing rapidly. Many bits of the puzzle are starting to congeal. There are some remarkably interesting bits of information in here, although you do need to be seriously interested to wade through it all, as I do include scientific data where necessary.
The Basic Terminology and When Long COVID Begins
Although the point this post infectious syndrome begins has not been completely agreed on, it seems many clinicians and health organizations now agree it as somewhere between 4-12 weeks after diagnosis with acute COVID-19.It is defined by the USA Centers for Disease Control (CDC) in 2021 as "a range of new, returning, or ongoing health problems people can experience four or more weeks following the initial SARS-CoV-2 infection". The British National Institute for Health and Care Excellence defines it as “signs and symptoms that develop during or after an infection consistent with Covid-19, continue for more than 12 weeks and are not explained by an alternative diagnosis”.
COVID-19 infection appears to progress from an acute infection lasting approximately up to 2 weeks. However, acute symptoms have been claimed to last as long as a month. If symptoms remain, renew or start (after having no acute phase) after 4 weeks (earlier on, and in some areas of the world this is listed as 8 or even 12 weeks) this is the late stage of post infectious symptoms commonly called long COVID. Other names you will see used for long COVID are post-acute sequelae of COVID-19 (PASC), long-haul COVID, post-acute COVID-19, long-term effects of COVID, post COVID syndrome (PCS) or chronic COVID. Long COVID is used by most of society while researchers often use the term postacute sequelae of COVID-19 (PASC).
Experts around the world are working to learn more about short and long-term health effects associated with COVID-19. Everyone wants to know who gets the chronic syndrome, and why. More research is now available on long COVID, and we will be exploring all aspects of what is being learned in this and following articles. There is so much known at this point, that we can only graze over the data in this first article, which begins by examining what this post infectious syndrome is and the overall picture. While this article lays the ground-work for understanding long COVID, future articles will explore these subjects in greater detail.
Recognizing The Symptoms
It has been noted that SARS-CoV-1 of 2003 and MERS of 2012 have similar long-term complications as seen in COVID-19. The post- acute SARS-CoV-1, MERS and COVID-19 all show symptoms seen in other illnesses such as Chronic Fatigue Syndrome/myalgic encephalomyelitis, and long COVID shares similarities with biotoxin diseases such as CIRS-due to water-damaged buildings (often a cause of many of the issues seen in Chronic Fatigue Syndrome I would add). It has also been noted to share symptoms with sepsis and dysautonomia.
For those of you who have been identified as having chronic inflammatory syndrome (CIRS) due to water-damaged buildings, myalgic encephalitis, chronic fatigue syndrome, or chronic Lyme, you will recognize many of the signs and symptoms of those with long COVID, as they are similar to your own, although there are some slight differences relating mostly to respiratory symptoms. In fact, for those experiencing long COVID who also have CIRS due to water-damaged buildings, they may think they are reacting to a moldy building when they get long COVID, as the symptoms of this and other biotoxin disease are so similar. The signs, and symptoms seen with long COVID are indeed very similar to the same signs and symptoms seen from a variety of biotoxin generated illness. This includes those from other viruses, bacteria, fungi, parasites, as well as biotoxins from plants, animals, reptiles, insects and fish/seafood poisoning. This is why someone who is reacting from exposure to blue-green algae, or a moldy house, or Lyme Borreliosis all have similar signs and symptoms to long COVID with slight shades of differentiation. These symptoms that have the medical community baffled are not so unusual for a practitioner who treats individuals with these various environmental induced illnesses. I would suggest for those of you with long COVID who are having trouble getting treatment, contact a qualified practitioner who either practices environmental medicine, is a naturopath, or a practitioner of functional medicine. Ask them if they have had any experience treating biotoxin related diseases. If so, they may be able to recognize your symptoms as being similar to what they usually treat and will have some ideas on how to assist you.
Commonly Seen Symptoms
The signs and symptoms seen in long COVID can present as different types, and combinations of health problems for different lengths of time.
- Difficulty breathing or shortness of breath
- Tiredness or generalized fatigue
- Symptoms that get worse after physical exertion (also known as post-exertional malaise)
- Symptoms may also get worse after mental activities that overwhelm the person
- Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
- Cognitive dysfunction (Memory and thinking issues)
- Chest pain
- Stomach pain
- Fast-beating or pounding heart (also known as heart palpitations)
- Slow-beating heart
- Joint or muscle pain
- Muscle weakness
- Pins-and-needles feeling
- Lack of sensation in a body part
- Loss of appetite
- Sleep problems
- Dizziness on standing (lightheadedness)
- Skin rash
- Hair loss
- Mood changes such as anxiety, depression, PTSD
- Change in smell or taste
- Changes in menstrual period cycles
- Hearing and vision changes may be part of the symptoms
- Decreased quality of life
For more details on symptoms of long COVID see Short-term and Long-term Rates of Postacute Sequelae of SARS-Co--2 Infection
If you want to compare these symptoms with those seen in CIRS due to water-damaged buildings, check out the symptoms seen in this illness here.
Similar Signs And Symptoms In Long COVID To Chronic Inflammatory Response Syndrome Due To Water-Damaged Buildings
The researcher, Dr. Ritchie Shoemaker theorizes from the data collected from transcriptomic testing that long COVID occurs in individuals who have environmental exposures and increased transformational growth factor (TGF) signaling. He calls for more research and consideration of treatment similar to that given for people with reactions to water-damaged buildings.
Long COVID looks similar to biotoxin type illness in that their symptoms overlap as well as testing, which includes failed visual contrast sensitivity testing, and shared transcriptomic findings. Those with long COVID also have a high occurrence of reacting to water-damaged buildings.
The shared transcriptomic findings as seen in individuals with CIRS due to water-damaged buildings as well as long COVID are as follows:
- Molecular hypometabolism and proliferative physiology
- Elevated levels of ribosomal stress responses in conjunction with an increase in gene activation of transforming growth factor – beta receptor
- Common co-expression of CD14 and Toll Receptor 4, correlated to exposure of amplified microbial growth of Actinobacteria and endotoxin from water-damaged buildings
Signs And Symptoms During Long COVID Not Directly From COVID-19
For those individuals who are hospitalized, we need to account for repercussions from the procedures used at the hospital, including drugs the individual is given, mechanical ventilation, and other procedures. Just being in bed for so long can cause long term complications, signs and symptoms. Some people can also get a type of post traumatic syndrome disorder from being in the hospital ICU and treatments given. All of these consequences are associated with the care given at the hospital, and not directly a cause of the virus, so it is incorrect to call these long COVID signs and symptoms. However, at this point this fact is not being accounted for. Another issue we need to keep in mind that can look similar to a bad long COVID syndrome is the post-vaccination syndrome reported in various articles printed on https://pubmed.ncbi.nlm.nih.gov, but which has not really been researched at this point.
Who Gets Long COVID
Some researchers claim it is common for 75% of the individuals who have COVID-19 to have at least one symptom after acute recovery, that can last for 6 months or more. Some may have very mild symptoms while others have debilitating symptoms. The numbers of those who have debilitating symptoms that we consider long COVID-19 are debated between scientists and health organizations. I have seen various health organizations list 10% to as high as 80% as the amount of people who get long COVID who have had the acute disease (acute illness with or without symptoms). Obviously, we really don’t know yet how many people are getting this chronic illness. The World Health Organization estimates 10-20% of people worldwide are experiencing lingering symptoms 3 months after infection. A review of studies published on October 13, 2021, found the following from examining all the studies available:
- At one month the COVID-19 patients experiencing at least 1 symptom after acute COVID-19 was 45.0%-69.0% – using 13 studies as a reference.
- At 2 to 5 months the COVID-19 patients experiencing at least 1 symptom after acute COVID-19 was 34.8%-65.5% - using 38 studies as a reference.
- At 6 or more months the COVID-19 patients experiencing at least 1 symptom after acute COVID-19 was 31.0%-67.0%; using 9 studies.
In this review more than half of these individuals were experiencing symptoms 6 months after acute recovery. The most common issues from this review were lung abnormalities, mental health disorders, and functional mobility impairments.
Those Without Symptoms May Get Long COVID Too
It was noted that even people who did not have acute COVID-19 symptoms in the days, or weeks after they were infected can have post-COVID.
The Vaccinated Get It Too But There Is Some Protection
In a study of health care workers, 19% of the fully vaccinated workers who had COVID-19 had persistent symptoms more than 6 weeks after acute recovery. https://pubmed.ncbi.nlm.nih.gov/34320281/ However, it appears for those who get long COVID they may have at least half the number of symptoms. Israel studies have shown fully vaccinated people have a decreased chance of getting long COVID. They found there was 54% less headaches, 64% less fatigue and 68% less muscle pain than unvaccinated counterparts. A UK study also found vaccinated people had half as much long COVID as unvaccinated counterparts. THey pointed out that it is not known at this time if vaccination provides any protection from long COVID with Omicron.
Studies Looking At Age, Sex, Race
A Study This Winter Found These People More Likely To Get Long COVID were:
- Smokers - active smokers
- Older Age
- Female Gender
- This study showed severity of disease did not matter - contrary to another study mentioned elsewhere in this article
Additional Evidence Shows Long COVID and specific symptoms are seen more commonly in Some Groups As listed below
Large differences seen in this study on basis of age.
Older adults had the highest burden, however these symptoms below were more common in those under 60 years of age:
- Chest pain
- Sleep disorders
- Mood disorders
- Smell problems
Small differences in these symptoms seen in this study on basis of race.
Black people in comparison to white people had an increase of:
- Acute kidney injury
- Diabetes mellitus
- Chest pain
- Substance abuse
White people had an increase of
- Gastroesophageal Reflux Disorder (GERD)
- Smell dysfunction
Moderate differences in these symptoms seen in this study on basis of Sex.
More likely in females:
- Shortness of breath
- Chest pain
- Smell problems
- Hair loss
- Skin rash
More likely in males:
- Muscle weakness
- Acute coronary disease
- Joint pain
- Acute kidney injury
- Sleep disorders
- Memory Problems
- Chronic kidney disease
- Substance abuse
- Heart failure
There were large differences seen in this study on basis of prior comorbidities.
Almost all symptoms were more pronounced in those with prior comorbidities
Differences In Women And Men in other studies
- Women tend to get long COVID much more commonly than men, as much as 3 fold.
- According to this study women have a higher proportion of symptoms of most physical and all psychological symptoms than men overall. This differed from the study above.
- As mentioned in the autoantibody section above, One study found even without severe clinical disease, there can be a wide range of autoantibody response. This same study found there were sex-specific patterns noted with autoantibodies. Overall it was found that the autoantibody response was more prominent in women following asymptomatic infection. However, the breadth and extent of autoantibody reaction was greater in men following at least a mild symptomatic infection.
Long COVID And Children
The following data is from a review of studies.
A nationwide register in Norway was used to estimate the effect of long COVID on the 1.3 million children in their healthcare database. However, the researchers found it hard to compare those with, and without possible long COVID as more than half the children who never had acute COVID-19 experienced symptoms such as headaches, fatigue, sleep disturbance, and concentration difficulties during the pandemic.
In the UK a study found that almost all symptoms reported in children positive for SARS-CoV-2 were also found in those testing negative for the virus. There was no difference amongst the two groups as far as overall wellbeing, mental health or impairment of activities.
Other studies have reported similar findings.
Health Factors Identified In Those With Long COVID
We are beginning to get some ideas why some people get long COVID while others do not. A variety of health factors appear to be associated with long COVID and they are listed below. Additionally, there are post COVID-19 effects that can be caused by hospitalization and the treatment during hospitalization that may be thought to be long COVID, but are really iatrogenic (harmful complications or other ill effects caused by medical treatment). These people are sometime included in the group of long COVID individuals, but they should not be considered as such since SARS-CoV-2 did not cause their symptoms, it was the treatment in the hospital and the long period of time being bed bound that caused their remaining issues. Sometimes the person has both long COVID and complications from medical treatment.
Why We Want To Know The Health Factors Involved In Long COVID
Knowing the factors associated with the appearance of long COVID helps us to look for these factors before long COVID begins. There are both factors that exist prior to the disease as well as factors that show up during the acute phase of the disease that are helping to predict long COVID.
By knowing the causative factors, we may be able to address them early on and prevent, or decrease an individual’s chances of getting long COVID. When we know the physiology of what is taking place, we may be able to stop it from happening, or if we can't stop the process, we may be able to take steps to decrease it, or at least minimize cellular damage, organ damage, physiological dysfunction as well as symptoms experienced.
Following are short synopses of various theories that are backed by research indicating possible causative factors behind this post infectious syndrome.
This is a section that has a lot of scientific data. If it gets to be too much, just skip to the next section.
Oxidative Stress and Endothelial Inflammation Is a Large Factor in Acute and Long COVID
The researchers Libbey and Luscher think COVID-19 is primarily a disease of the endothelium, especially when it comes to long COVID. They believe the endothelial inflammation, damage, and dysfunction is one of the main factors causing the symptoms of long COVID, and that redox dysregulation caused by the virus initially in the acute stage instigates the inflammation, damage and dysfunction in the endothelium. (endothelium is found lining the inside surface of the blood vessels, the inside surface of the lymphatic vessels, and the endothelium in these hi-ways of the body form a barrier between the blood/lymph circulation in these two types of vessels and the tissues of the body, thereby controlling the flow of substances into and out of the body tissues) Damage to the endothelium can disrupt, not just the blood and lymph vessels, but can have complications in the entire body due to lack of blood and lymph flow to tissues and organs through-out the body. The reactive oxygen species in an acute infection is a necessary part of the infectious process and even part of the healing and strenghtening of the body, but when it carries on chronically it becomes an issue. Excessive damage from oxidative stress can also cause damage that is hard to repair.
Some Specifics On This
Multiple examples of redox dysregulation have been reported in acute COVID-19, as is typical of many viral infections. In the acute stage, SARS-CoV-2 virus binds to the ACE-2 protein on endothelial cells lining blood vessels and enters these cells in order to replicate. Viral replication causes oxidative stress due to elevated levels of reactive oxygen species. There is associated endothelial inflammation. Although, many of the infected people appear to have eliminated the virus from their body after 28 days and resume normal activity, some have persistent, low level inflammation and report a variety of symptoms (see the symptom list above) that may be due to the results of oxidative stress and endothelial inflammation/dysfunction. These symptoms are similar to other conditions associated with oxidative stress such as CFS/ME/CIRS due to water-damaged buildings/Chronic Lyme.
The study by Libbey and Luscher point out that COVID-19 is an endothelial disease and all organs are perfused by the vascular microcirculation with capillaries composed of endothelium and pericytes. Proinflammatory cytokines elicit changes in endothelial cell homeostatic functions from protective homeostasis to those that can contribute to thrombosis (formation of a blood clot in one or more deep veins - often legs) and local tissue injury. Alterations in endothelial thrombotic/fibrinolytic balance can predispose to thrombosis in pulmonary circulation as well as peripheral veins and arteries of the cerebral circulation, causing strokes in healthy young people and contributing to the local poor blood flow in ‘COVID toes and fingers’ that probably represent microvascular dysfunction with tissue ischemia. Endothelial dysfunction and thrombosis can also occur in microvasculature including the circulation to the heart and kidneys.
Predicting Long COVID Based on Data in The Acute Stage With 75% Accuracy
Researchers in this study found a way to predict which acutely ill patients will get long COVID. They can predict with about 75% accuracy that those who have lower levels of IgM and IgG3 combined with older age, asthma history and 5 or more acute COVID-19 symptoms are likely to get long COVID.
They found 94% of those with a history of bronchial asthma developed long COVID compared to 59% of those without bronchial asthma.
Four Main Factors Identified Using Multiomics
One Extensive Study Using Multiomics Has Identified 4 Factors Linked to Long COVID
These researchers used a mix of various types of genetic testing (called multiomics when this is undertaken) to come up with four factors that are associated with getting long COVID.
- The patient has Type 2 diabetes at the time of diagnosis of COVID-19
- A high load of viral load of SARS-CoV-2 RNA in the blood
- The reactivation of the Epstein-Barr virus (EBV) was noted. They detected EBV viremia at clinical diagnosis in 14% of tested patients, and positive SARS-CoV-2 RNAemia in 25% of patients. Few of the individuals tested positive for both. Both of the viral assays, and signals dropped 2-3 fold between the time of diagnosis and during the acute phase period. They were barely detected during the 2-3 month period after the acute stage. Epstein-Barr virus is known to infect people at a young age and they may or may not know they had it. It is thought to exist in as high as 90-98 % of the world’s population (depending on which research article you read), was seen.
- The presence of specific autoantibodies (antibodies that turn against the individuals own body). In the study they found that patients with autoantibodies during the post infectious period (44% had them) had already exhibited mature (class-switched) autoantibodies as early as at diagnosis (56% had them at diagnosis), indicating to the researchers that the individuals had the autoantibodies prior to the infection with COVID-19, but only 6% of them had diagnosed autoimmune conditions before having COVID-19, so most of the autoantibodies noted at diagnosis of COVID-19 were subclinical (not noted by prior medical exams, testing).
Some Additional Thoughts on Autoantibodies
- Autoantibodies have been shown to survive up to at least 6 months after the infection.
- One study found even without severe clinical disease, there can be a wide range of autoantibody response. This same study found there were sex-specific patterns noted with autoantibodies. Overall it was found that the autoantibody response was more prominent in women following asymptomatic infection. However, the breadth and extent of autoantibody reaction was greater in men following at least a mild symptomatic infection.
- We will examine the autoantibody data in more detail soon in an in-depth article on the subject. Autoantibodies are seen in association with other viruses. In fact, it is seen with EBV which has been associated with a number of autoimmune diseases. As noted above, EBV viremia was found in 14% of the long COVID patients during the acute COVID-19 diagnosis time period.
A personal Comment
Many practitioners are now finding Long-Covid patients have dormant infections that were stirred up when the individual got COVID-19, and now the person is dealing with one, or more dormant infections such as EBV, CMV, various tick born infections, mycoplasma etc. and now their immune system is dealing with these infections. There is a flare of various inflammatory cytokines from one or more dormant infections causing the symptoms that is thought to be COVID-19 based, but that was simply a stimulus for releasing one or more dormant infections that the patient is now dealing with.
- Various studies are finding involvement of the gut flora and are identifying changes in gut flora in both the acute state of COVID-19 as well as long COVID. There appears to be an association between the changes in gut microbiome and the different types of symptoms seen in long COVID. I am quite interested in seeing where this goes. They are identifying specific gut flora in relationship to specific symptoms.
- Disease severity during the acute phase was associated with persistent fatigue and weakly associated with the total number of symptoms at 6 months. However, I would mention people can have no or low level acute COVID-19 symptoms and end up with long COVID.
- Increased convalescent levels of antibody titers which appear 1-2 months after initial infection, which can act as a marker for the intensity of the immune response, were shown to be higher in hospitalized patients than home-isolated patients. Higher titers at 2 months were associated with severity of initial illness, older age and higher BMI. Higher antibody titers were associated with persistent fatigue and total number of symptoms at 6 months.
- Pre-existing chronic lung disease was associated with persistent fatigue and total number of symptoms at 6 months, and suspected to be related to autoantibodies and unresolved viral fragments, although experimental validation on large patient cohorts are still pending.
Transcriptomic Data And Other Testing Link Long COVID To Biotoxin Disease
- Acute COVID-19 initiates a secondary innate immune and/or metabolic response, which may progressively disable long COVID patients.
- Long COVID looks similar to biotoxin type illness, in that their symptoms overlap, and there are some shared testing results which includes failed VCS testing, and similar transcriptomic findings.
- Those with long COVID also have a high occurrence of reacting to water-damaged buildings.
Direct Cell Damage As Cause Of Long COVID
- We know the SARS-CoV-2 virus itself can cause direct cell damage and this can cause ongoing symptoms from organ damage.
- Studies suggests that COVID-19 may use the mitochondria of immune cells and replicate within their structures, which damages the mitochondrial leading to cell death. Mitochondria are the powerhouses of our cells. Our body depends on them. Increasing evidence also suggests that mitochondria from COVID-19 infected cells are highly vulnerable, and vulnerability increases with age.
Something You Might Think Is long COVID, But Is Not, And Needs Immediate Attention
Multisystem Inflammatory Syndrome – Also Chronic After COVID-19
I am mentioning this here as it is a syndrome that can be associated with COVID-19 and can be both acute or chronic. Children can get this syndrome chronically and it should be distinguished from long COVID. It is rare, but if suspected, the child needs immediate emergency care.
Acute Multisystem Inflammatory Syndrome (MIS-A):
The case definition includes people who are 21 years and older.
Chronic Multisystem Inflammatory Syndrome (MIS-C):
The case definition includes people who are younger than 21 years old.
Chronic multisystem inflammatory syndrome is a rare but serious condition that presents about 4 weeks after acute COVID-19 and I don’t want you to confuse it with long COVID. Those who have this inflammatory syndrome will have various body parts become inflamed including the heart lungs kidneys, brain, skin, eyes or gastrointestinal organs. There is an acute phase (MIS-A) and a chronic phase (MIS-C) that can exist. The acute and chronic phase may include the following symptoms:
- Ongoing fever plus more than one of the following:
- Stomach pain
- Bloodshot eyes
- Dizziness or lightheadedness
- Skin rash
MIS-C is more common than MIS-A.
More information is available at this CDC website. https://www.cdc.gov/mis/index.html
This is a complicated area. As has already been mentioned previously, patients present with different types of pictures in long COVID. This is true in all health conditions, but in this illness and disease presentations of similar illness such as CIRS due to water-damaged buildings, chronic fatigue syndrome, chronic lyme and other biotoxin illness, it is even more true. There are some underlying main ideas to take into account and I can share the big picture of what to think about with some links that give some additional specific ideas on treatment protocols. Remember however, that each individual will have different signs and symptoms and different factors that got them to where they are. This all has to be accounted for in coming up with a treatment plan for that patient.
I will also include some additional articles that relate to prevention and treatment in COVID-19/Long COVID at the very end of this article.
In the big picture, there is the need to protect the individual from excessive oxidative stress with the use of antioxidants. As noted above oxidative stress can cause symptoms of both acute and chronic COVID-19. In acute infections our body makes ROS to get rid of pathogens. The mitochondria make them intracellularly to fight off the pathogen in the cell. So, we don't necessarily want to stop all reactive oxygen species. In an acute infection we may want to help our immune system and take a small amount of antioxidants in that process, but we don't want to over do it. There are so many foods, herbs and nutrients that act as antioxidants, that the choices are endless and those that best fit each person should be identified. For ideas on antioxidants one can begin by looking at the herbs that are used as spices. Spices are generally strong antioxidants. Each herb is a little different than the others and you want to pick one that fits each specific person. Look at the herbs actions, properties and contraindications. For instance Cinnamon is a good antioxidant and it is also helpful with diabetes (one of the factors that may lead to long COVID), inflamed and irritated digestive tracts (another possible factor), for yeast (may have overgrowth of gut yeast due to antibiotics some of these folks are given), high triglycerides, and other issues. It is also drying, warming and stimulating. It has some contraindications too. Enough contraindications and some serious contraindications, that I would suggest anyone thinking about using it as a medicine should read more about the contraindications here.
One very common nutritional antioxidant is vitamin C. If a person is having trouble getting adequate vitamin C from the diet taking a supplement can be helpful. If they have trouble with absorption, using liposomal vitamin C or intravenous vitamin C can be of use.
You can assume most brightly colorful vegetables and fruits have some degree of antioxidant activity.
I am not going to give you a list of antioxidants here, I am just giving you an idea of how common antioxidants are. They are easy to include in a healthy diet by eating a variety of fresh fruits and vegetables. To decrease oxidative stress in a chronic illness such as this, you want a lot of antioxidants but largely from your food which is a safe way to get them. So, eat a lot of vegetables, fruits and make it varied.
You will notice that many of the alternative treatments for COVID-19 are high in antioxidant activity.
Support The Digestive Tract
Keeping your digestive tract in good condition and feeding your gut bacteria is another factor that will help protect individuals. In some cases flora replacement may be needed. If a person is unable to maintain good gut health they should contact a local naturopathic physician or functional medicine practitioner for assistance. Your gut health is imporant. As noted above specific changes in gut flora are being connected with particular long COVID symptoms. This article written for inividuals with CIRS due to water-damaged buildings has information on digestive tract health that can be useful to this situation.
Support Normal Immune Function
Keeping the immune system in tip-top shape is helpful and an article on the immune system and COVID can be found here. There are issues if someone is immunocompromised and is underacting in which case it can't defend our body as noromal from the SARS-CoV-2 virus, but there is also an issue if the immune system over reacts and creates inflammatory cytokines. Excess histamine has been noted in long COVID-19 and methods to stabilized mast cells and lower histamine have been used successfully for some people. Looking to normalize the immune system is important. How that is done depends on each individuals situation.
Work on Comorbidities
If someone has any of the known COVID-19 comorbidities, they should work on reducing them. The article linked here will identify what these comorbidities are and what to do.
Mitochondrial dysfunction takes place in folks with long COVID and it also takes place in people with CIRS from water-damaged buildings. In my experience with the folks reacting to moldy buildings I have found some mitochondrial dysfunction treatments that help them. Many of these remedies have research showing they benefit the mitochondria. These same remedies can also assist those with long COVID. I have meant to create an article on mitochondrial support, but have never done it. So, I will include additional data here and hope to make a more inclusive article soon. At that time I will create a link to it here. Sign up for my newsletter on the home page and you will know when it is available. If you are not a practitioner and reading this article to look for ideas personally, please do not simply take all these things, as they are not meant for everyone and no one needs all of them. A local qualified practitioner such as a naturopathic physician, or functional medicine practititioner can guide you through picking out the specific treatment you need.
I should start by saying that a body that is under stress from a long term infection, chronic toxins, other stresses, ends up having dysfuncitonal mitochondria from these stresses. The mitochondria sees these stresses as something to fight against and will tend to decrease energy output of the cell while increase reacctive oxygen species to fight and to use as cell signaling to let the body know it is under attack. This means that folks with long-Covid-19 have dysfunctional mitochondria and the other thing they have is a deficient immune system which is not getting rid of cells with dysfunctional mitochondria. Methods such as ozone, IVIG, immune modulating herbs, vitamin D, thymic peptides and pineal peptides, cold plunges, heat therapy, exercise, breath holding exercises, intermittent fasting are all used to support autophagy and remove cells that need to be removed from the body. These methods also make the mitochondria that are still functional enough to remain stronger than before. Only then, can other methods be used in a more supportive manner to feed the mitochondria. Using peptides is usually the easiest method for someone to use at this beginning point as other choices can be more expensive, or things like heat, cold or exercise is hard for the indivdiual at first. They have to go low and slow with all these things and it takes time to build up to a point that gives them results. If they don't go slow they will get a set back usually. I will give you an example of exercise.
Exercise - be careful
Exercise routines can be set up specifically to remove dysfunctional mitochondria and grow new ones. Support and replication can be enhanced through intensive exercise and strength training, this is too much for long COVID sufferers usually. Exercise has to be slow for short periods of time. If the person finds they are set back the next day from exercise, it was too much. The individual should start with much less than they think they can do and build up. This is why I suggest peptides as a first step for many people in their recovery.
Breath Holding Exercises
This is something that someone with a chronic illness may be able to do. This is a type of hormetic exercise that does not take great effort and can be stopped immediately when it feels like too much.
How To Feed and Support Your Mitochondria
- When mitochondria are fueled by ketones instead of glucose, their ability to produce ATP is enhanced and free-radical byproducts are reduced. This is why some people find diets that are lower in carbohydrates, and especially diets removing simple carbohydrates are helpful. Diets emphasizing protein, vegetables, healthy oils and small amounts of fruit can help many people. However, I find for some people they need more carbohydrates than other people, so the diet has to be adjusted to each individual.
- Avoid or eliminate ingredients that are toxic to your mitochondria, including processed flours, all sugars and refined sweeteners, trans fats, processed foods, food chemicals, gluten, and dairy products.
- Water soluble fiber-rich foods are useful to help detox the poisons that can build up when mitochondria slow down and water soluble fibers also feed your gut flora. (examples include okra, marshmallow root, slippery elm root, apples, pears)
- Essential Fatty Acids – Eat omega 3 fatty acids - this includes salmon and other cold water fish, fish oil, also taking flax, but I would caution you to not take as much flax as fish oil as it also contains omega 6 which most people have too much of.
- Eat 6-9 cups of fresh vegetables and fruit each day – eat the rainbow (varied colorful beg and fruit) – lots of dark green vegetables are necessary. Focus on the vegetables with a smaller amount of fruit. Variety is important also.
Supplements That Support The Mitochondria
Acetyl l carnitine – transports fatty acids into the mitochondria
Alpha Lipoic acid – a mitochondrial coenzyme and reduced in the mitochondria to a potent antioxidant. It is an inducer of around 200 phase 2 antiocxidant and thiol-protective enzymes including those necessary for glutathione synthesis. As with all sulfur containing supplements they can upset the digestion if they feed specific sulfur using bacteria that may or may not be in the gut, or if they are pulling certain toxins out of the tissues, they can make a person feel bad while that is happening. Some people also lack enough molybdenum to produce sulfite oxidase. Practitioners need to be aware that someone may react to lipoic acid, glutathione, N-acetylcysteine or other sulfur containing supplements for a variety of reasons and not tell the person to simply get through it.
A monosaccharide used in energy production. It has been shown to improve cellular processes when there is mitochondrial dysfunction. It can bypass part of the pentose pathway to produce D-ribose-5-phosphate for energy production.
Acetyl L-Carnitine and Lipoic Acid in old rats can restore much of the lost mitochondrial function. – improves cognition and other functions. These are both synthesized in the body but are decreased in the elderly and in people with toxin issues.
Bio B 100 by Biotics Research (B6 has exacerbated some people’s neuropathy even in low doses and this company makes a low dose B vitamin.) – try magnesium with it. Often people who have trouble with B6 don’t have enough magnesium. Many Bs are high in dark green veg. B12 is best to take as a sublingual.
High in dark green veg, meat and nuts. Often needs to be supplemented. I find low magnesium is the main cause of muscle spasms that can show up as charlie horses in the lower legs, ticks in the eye lids or other muscle pain. If supplementation is used, it needs to be used multiple times per day and many find liquid ionic forms bring better results, perhaps through better absorption.
Vitamin C, vitamin E, iron and selenium are also required nutrients for mitochondria to function. These can all be found in vegetables, nuts, seeds, beans/lentils, dairy products, fish and meat. Selenium is usually deficient in this area of Oregon where I live, but some areas have a lot of it, so a person could theoretically get too much selenium from supplementation. Check with your practitioner before taking minerals, especially iron and selenium. Most people do not need iron and it is not a good idea to supplement it if not needed.
N- acetyl cysteine
Great antioxidant and supportive of mitochondria, but as with all sulfur containing supplements they can upset the digestion if they feed specific sulfur using bacteria that may or may not be in the gut, or if they are pulling certain toxins out of the tissues, they can make a person feel bad while that is happening. Some people also lack enough molybdenum to produce sulfite oxidase. Practitioners need to be aware that someone may react to lipoic acid, glutathione, N-acetylcysteine or other sulfur containing supplements for a variety of reasons and not tell the person to simply get through it.
Nicotinamide riboside – Increases NAD+ which helps repair and protect mitochondria.
A product called MitoQ is a mitochondria-targeted CoQ10 antioxidant. Helpful in protecting them. It has been researched to get inside the mitochondrial membrane. ( found in Beans, potatoes, parsley, celery, carrots, cabbage, banana, kiwi)
Really high in fermented bean products. Not as noticeable to me as far as helping patients when taking it as a supplement and it is expensive. Some do report benefits though.
Phosphotidyl choline is abundant in cellular membranes and mitochondrial membranes.
There are a lot of things that support the mitochondria. Many of the things mentioned as antioxidants for example are helpful. This is because the mitochondria need antioxidants to protect them. They make a lot of reactive oxygen species. This is why antioxidants help them.
Absolutely necessary for some mitochrondrial functions. As with all sulfur containing supplements they can upset the digestion if they feed specific sulfur using bacteria that may or may not be in the gut, or if they are pulling certain toxins out of the tissues, they can make a person feel bad while that is happening. Some people also lack enough molybdenum to produce sulfite oxidase. Practitioners need to be aware that someone may react to lipoic acid, glutathione, N-acetylcysteine or other sulfur containing supplements for a variety of reasons and not tell the person to simply get through it.
There are many other things that also help to support and protect mitochondria such as resveratrol, Astragalus, Schidandra, phosphatidyl serine, vitamin D, use of full body near infrared saunas, adaptogen herbs can be largely considered as mitochondrial supportive herbs. I will share additional lifestyle factors, herbs, nutrients and how they benefit the mitochondria in a future article.
Decrease Excess Inflammation Seen In Long COVID
Inflammation is a biological response of the immune system and a necessary part of healing. However, excess inflammation is problematic. If a person is inflamed, finding the source of inflammation and attending to it is the first thing to do. The next thing is to find ways to decrease the inflammation while working on the causative factors. The way to lower inflammation depends on the person again, but for some general ideas (the big picture) on inflammation and lowering it check out this article. Oxidative stress, and cytokines are associated with the inflammation of COVID-19 and you can read more about these features and inflammation here.
Although the SARS-CoV-2 virus itself can cause inflammation acutely and that continues to linger due to a variety of reasons, many of us have other factors in our lives where inflammation is being created and we can attend to this issues. Here are a few factors that might add to excess inflammation in our bodies:
- Gut dysbiosis (imbalance of digestive flora)
- Lack of a healthy diet without the basic nutrients necessary to keep inflammation under control.
- Food allergies or sensitivities
- Eating food that induces histamine or has histamine in it
- Stress - physical, emotional, mental
- Environmental toxicity
- Chronic infections
- Drugs - both prescribed and non-prescribed (make sure your patients are only on the drugs they absolutely have to be on - same goes for supplements)
- Lack of exercise
- Autoimmune reactions from lack of immune tolerance - for an eye opening treatment for this, see parasite article
- Poor sleep
- Excess weight - obesity
- Histamine reactions from mast cell activated by the virus or other reasons
- Oxidative stress as discussed above, also this link gives some antioxidant ideas
- Mitochonrial Stress
There are still many questions and we are at the very beginning of understanding what is taking place in long COVID. Most of this information is new and is filled with unanswered questions. As time passes we will have more accurate data. For now, we are collecting information to accumulate as much understanding as possible. You might have also noted a couple studies contradicting each other a bit. This is normal in research unfortunately and for varied reasons. I have learned to take all research with a grain of salt, but I read vast quantities of the data and find it helps me to understand complicated health conditions when no other answers are available. Sometimes one research article turns that light bulb on and gives us the answer we need. Hopefully, this article turned on a few light bulbs in you my dear readers.
In future articles, we will explore more thoroughly some of the subjects above. If you have interest in something in particular regarding long COVID, let me know and I will push the items with the most requests to the front of the article line-up. I am already working on a couple of the subjects above.
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