Long Covid: A Functional Medicine Perspective and How To Tackle It
Introduction
Unless you have been inhabiting another planet in the last year or so, chances are the name covid-19 forms part of your lexicon.
If you have just come back from your space mission, don't worry, we will start from the beginning.
What Is Covid-19?
Covid-19 is a new strain of virus belonging to the larger family of Coronaviridae.
Viruses of the Coronaviridae family cause varying diseases in humans from the common cold to more severe diseases such as severe acute respiratory syndrome (SARS-Cov)
The story starts in December 2019 in China's Wuhan province where an increasing number of pneumonia cases of unknown cause were recognised.
The cause would later be found to be due to a novel virus called Covid-19, previously never seen in humans, and thought to have originated in one of Wuhan's wet markets.
What are the symptoms of Covid-19?
When most people think of the symptoms of Covid-19, they are alluding to the acute symptoms.
In other words, symptoms one immediately gets after infection, and which resolve after a relatively short period.
It is important to make this distinction, as symptoms that persist over longer periods would be accurately classed as chronic.
Using this classification, the main acute symptoms cited by the Government include a high temperature, a continuous cough, breathlessness, and loss in the sense of smell or taste.
It is however important to note that the symptoms of Covid-19 are a lot more varied than this, and include:
Sore throat, sinus pain, loss of appetite, aches and pains, rashes, and gut symptoms like diarrhoea and vomiting.
Talking of gut symptoms, some studies show that up to a third of Covid-19 patients have gut symptoms.
Infection with Covid-19 presents in varying ways, from mild flu-like symptoms to death, depending on age and individual risk factors.
While finally getting over days of a high temperature, breathlessness and coughing is the end for most, others however go on to have ongoing chronic symptoms.
The term long Covid has now been coined to describe this group of symptoms.
What is long Covid?
I overheard a colleague five months ago jokingly saying long covid might soon be the new chronic fatigue syndrome (CFS) or fibromyalgia, implying it was psychosomatic-In other words all in your head!
This couldn't be further from the truth on both counts.
I see flat out exhausted patients in both my NHS and private practice almost daily. Take it from me, it is real!
As previously mentioned, long Covid describes a cluster of ongoing symptoms that persist weeks or months after initial infection with the virus.
Patients will long Covid would typically have recovered from their acute symptoms and even tested negative for the virus.
A now used colloquial term used to describe patients with long Covid is long haulers.
It is worth pointing out at this point that chronic fatigue and related symptoms are not unique to covid-19 and have plagued millions of patients for years following infection with other viruses.
Unfortunately, conventional medicine has largely dismissed this cluster of symptoms, explaining them off as anxiety, depression, or as my colleague’s quote above, all in the head.
What are the symptoms of long Covid?
Typical symptoms of long Covid include:
Physical and mental exhaustion, typically affecting daily activities like walking, housework, gardening, and so on.
Breathlessness
Ongoing flu-like symptoms-"I've got this flu that never seems to go"
Brain fog-"I feel like my head is full of cotton wool"
Low mood, anxiety, and depression.
Insomnia
Constant headaches or migraines
Joint pain and muscle pain.
Heart problems like palpitations and low blood pressure
Gut symptoms ranging from bloating, diarrhoea, constipation, and indigestion.
I have even seen two cases of tinnitus (ringing in the ears) as well as a change in taste!
Why long Covid?
At this point you might be asking yourself many questions:
Why does one end up with long Covid or how does it happen?
How long does long Covid last if you were to have it?
Would your long Covid symptoms get worse?
Would they get better?
These are all important questions, and to answer some of them we need to briefly understand how covid-19 interacts with our bodies.
Please note this is a rapidly evolving area, as our knowledge about the virus increases daily.
In fact, a recent paper showed covid-19 might be present in the cells of some affected up to six months after the initial infection.
This is however not unique, a quality shared by some viruses or even bacteria like chickenpox, herpes, HIV, or hepatitis.
That said, we know that infection with Covid-19 causes an exaggerated immune response, leading to widespread or systemic inflammation.
This systemic inflammation can then potentially affect different body systems to various degrees, depending on the individual.
At the level of the immune system, the inflammation seems to be mainly mediated by a type of white blood cell called mast cells.
Some observational studies have pointed similarities to the clinical picture seen in the so-called mast cell activation syndrome. (MCAS)
In MCAS, your mast cells become dysfunctional and release histamine at the wrong times, causing varied symptoms.
The damage by Covid-19 doesn't stop at the immune system, however, and as the virus replicates, it leads to oxidative stress thus depleting the body's antioxidants like glutathione (GSH) and others, while also disrupting the body's detoxification pathways.
The resulting damage can potentially lead to mitochondrial damage (mitochondrial dysfunction) and also negatively impact the gut microbiome, potentially leading to leaky gut and leaky brain (brain inflammation)
Systemic inflammation could potentially trigger a wide variety of autoimmune disorders, potentially also explaining the varied symptoms seen.
How can I treat my long Covid?
It is frustrating for patients who want to know if their long Covid would get better, if it would get worse or if they might die from it.
Like many similar chronic diseases like chronic fatigue syndrome (CFS) and fibromyalgia, to name a few, long Covid does not fit into the diagnostic mold of conventional medicine.
Because symptoms span multiple body systems, patients end up seeing a string of consultants in different specialties, with blood tests usually showing "a bit of inflammation" if at all, some "organ damage" and nothing else.
Thankfully, some long Covid clinics have been set up in different parts of the country which might help the growing numbers of long haulers.
As we have already mentioned, Covid-19 affects everyone differently.
Successful treatment of long Covid, therefore, lies in appreciating the body as a whole, while adopting an individualised approach-In essence, personalised medicine.
Practically speaking, this means a thorough history, exploring not only symptoms of long Covid, but digging deep to explore your medical history starting from birth.
In some cases, functional tests might be required to help get a clearer picture.
Having said that, here are some general approaches and supplements for long Covid that are worth trying.
Diet-Low histamine
I believe the first step and most efficient approach to address long Covid or any chronic disease for that matter is diet.
Remember we mentioned in some patients long hauler symptoms were similar to the picture seen in mast cell activation syndrome. (MCAS)
In MCAS, your mast cells become dysfunctional and release histamine at the wrong times, causing varied symptoms.
This means you would want to go on a low-histamine diet as a trial.
This strategy helps a subset of long Covid sufferers.
Common foods to avoid include:
Processed foods especially cured meats, dairy, fermented foods like sauerkraut, kimchi and kefir, spinach, tomatoes, avocadoes, shellfish, canned foods, and much more.
Also avoid tea, coffee, and alcohol.
Anti-histamines
Following this, antihistamines are worth trying.
Common over the counter ones like chlorphenamine (Piriton) or Loratadine (Claritin) are some examples.
Anything stronger will need a GP prescription.
Vitamin C
Vitamin C is a potent antioxidant, anti-inflammatory, and immune booster that also processes anti-histamine properties.
I recommend a good quality vitamin C supplement preferably with added bioflavonoids at a dose of 2000-3000mg/day.
Vitamin D-1000IU
There is incontrovertible evidence on the benefit of vitamin D for immune function.
I recommend a maintenance dose of 1000-2000 IU of vitamin D a day.
However, if a test shows your levels are very low, you will need a loading dose of 20,000 IU twice a week for seven weeks before transitioning to a maintenance dose.
Zinc
Zinc is an essential trace mineral that helps with immune function, and also forms part of superoxide dismutase (SOD), an important antioxidant.
I recommend a dose of 15-30mg/day.
Selenium
Selenium is also an important immune booster and forms part of glutathione peroxidase, the body's master antioxidant.
I recommend a dose of 100-200mcg/day. (I prefer the selenomethionine form)
NAC stands for N-Acetyl Cysteine (NAC)
NAC is a drug used in the emergency department for patients with injured livers, but also available as a supplement.
NAC helps restore levels of the master antioxidant glutathione peroxidase mentioned above, and thus a great immune booster.
I recommend a dose of 500-1000mg/day.
Probiotics
As most of your body's immunity resides in the gut, it makes sense to supplement on a good quality probiotic.
However, for best results, a comprehensive stool test is recommended to get a clearer picture.
Coenzyme Q10 (Co-Q10)
Co-Q10 is a beneficial compound found in the mitochondria, the powerhouse of your cells.
It has been shown in studies to help restore the body's energy machinery and thus reduce fatigue.
I recommend a dose of 100mg/day.
Will my long Covid end?
Finally, remember it takes time and patience to fully recover from long Covid.
This is mainly because your immune system has been essentially damaged by the virus.
However, with diligent history taking, sensible testing, trial and error, and persistence, your body will heal.
Last but not least, please remember this is not medical advice, so consult with your own doctor before taking any of the above supplements.
Please share this article with anyone you know might benefit, and if you have any questions, please feel free to get in touch.
Thank you!
TAGGED: Long covid / long haulers / covid-19 infection / chronic infection / covid-19 / fatigue / insomnia / depression / flu-like symptoms / brain fog / anxiety / breathlessness / muscle pain / joint pain / tired all the time / diarrhoea / bloating / poor appetite / indigestion / pins and needles / long covid / supplements / vitamin c / vitamin d / selenium / zinc n-acetyl cysteine / NAC / probiotics / antihistamine / slow histamine diet / mast cell activation syndrome / MCAS / supplements for long covid
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