Covid-19 has now become endemic, and Long Covid is quickly being recognized as 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. According to current estimates from recent controlled studies, the risk of developing symptoms consistent with post-COVID syndrome is approximately 30% for those who have been infected. Our understanding of this phenomenon is an evolving science and medical professionals across multiple disciplines or working to understand the complex sequela that millions of people are experiencing. Within the integrative/functional medicine communities, there are multiple efforts underway to understand and treat this condition with nutritional therapeutic modalities. Based on a review of the current literature, I would like to present my interpretation of what post-COVID syndrome is and discuss relevant nutritional therapies that are being used and/or studied by some physicians in the field of nutritional medicine.
Post-COVID Syndrome-What is it and how does it happen?
Covid enters your body as a respiratory infection, but it is essentially a circulatory disease because the virus has a high affinity for the cells that line your blood vessels. Once the virus attaches to the tissue that lines capillaries, veins, and arteries, it causes inflammation and also causes microscopic blood clots that interfere with circulation, and therefore with the delivery of oxygen to your tissues. Every part of your body requires oxygen. This is why, even if Covid presented as an upper respiratory infection, similar to a cold, Long Covid can damage every part of your body. Symptoms of post-COVID syndrome can vary depending upon the type of COVID variant acquired, vaccination status, age, gender, co-morbidities, and length of infection. The majority of patients will experience one or more of the following common symptoms with varying severity: chronic fatigue, loss of cognitive acuity (brain fog), muscle pain and fatigue, loss of taste and smell, hair loss, cardiovascular abnormalities, metabolic disorders, gastrointestinal issues, and a complex of respiratory conditions including chronic cough. The appearance of new symptoms and persistence of existing symptoms during the post-infection phase may result from the body’s inability to clear the spike protein from affected tissues. Researchers have found that, apart from a few cases, our bodies successfully clear the viral RNA, but the spike protein may persist in 73% of patients. One theory is that long COVID is associated with difficulty clearing the remnants of the virus from tissues, which may explain why patients are experiencing increased inflammatory conditions post-infection.
Doctors are increasingly concerned about the cardiovascular, metabolic, immune, and cognitive effects of a COV-2 infection. Brain imaging (MRI) from patients with Post COVID Syndrome shows actual loss of brain cells in regions associated with higher cognitive functions, and as a result, many people are experiencing “brain fog” and short-term memory loss. We know the virus can cause damage to the vascular endothelium compromising the heart and circulatory system, and directly affecting pancreatic tissues. For a subset of people, three months after infection, a diagnosis of high blood pressure or diabetes (type I) has been reported. Immune system abnormalities have been identified in lymphocytes, monocytes, and cytokines, particularly alpha-interferon, which is the body’s main antiviral defense system.
The mechanism of action for this pathophysiology involves the destruction of the ACE2 (angiotensin-converting enzyme-2) receptor by the virus. This vital epithelial cell protein is present in many cell types and tissues throughout your body. It protects your blood vessels, heart, brain, lungs, kidneys, and bone marrow from many types of damage, inhibits inflammation, prevents abnormal blood clotting, and enables healing without scarring. A group of researchers from the University of Arkansas has identified autoantibodies to ACE2 in 80% of patients with an active COV-2 infection, and those with Post COVID Syndrome. While the ACE2 receptor is the primary site for coV-2’s entry into the cell, it is not the villain that early news reports have claimed. Scientists have now determined that the presence and activity of ACE2 do not cause a coV-2 infection, but rather its destruction by the virus has severe consequences for human health. The loss of ACE2 underlies all the terrible complications of COVID-19, including pneumonia, heart failure, blood clots, kidney failure, strokes, seizures, brain fog, purple toes, loss of lymphocytes, excessive inflammation, and autoimmune disease. ACE2 deficiency and mitochondrial stress are the initial sources of nearly all the manifestations of Long Covid. The good news, however, is that by restoring the ACE2 receptor and rescuing mitochondrial function, you are building a foundation for protecting yourself and healing from Long Covid.
Nutritional Therapies for Post-COVID Syndrome
Within the integrative and functional medical communities’ clinicians are using dietary and lifestyle modification with targeted nutritional protocols to treat the sequela of a coV-2 infection. It should be noted that treatment protocols work best the earlier they are implemented, but clinicians have seen significant benefits even for people who have been suffering from Long Covid for two years. There is a consensus developing among physicians that any effort to assist patients in addressing symptoms and recovering a normal state of health will involve an in-depth focus on decreasing inflammation, rebuilding a properly functioning immune system, and supporting cellular energy production systems.
- Nutrition
A large-scale study at Johns Hopkins https://nutrition.bmj.com/content/4/1/257 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. The importance of a healthy diet cannot be discounted. Eighty-five percent of the human immune system is gut-mediated, so a whole foods diet rich in probiotic bacteria (fermented foods), plant polyphenols (colored fruits/vegetables), and fiber can decrease inflammatory markers and support a healthy immune system. Avoid sugar in all its forms and restrict refined, grain-based carbohydrates. Both are pro-inflammatory and negatively affect the immune system. Research has shown that Intermittent fasting can help the immune system regenerate by increasing the rate of autophagy, which is an essential cellular recycling process. Time-restricted eating has also been shown to help balance the hormonal system in which ACE2 is such a critical component.
Some patients with Post Covid Syndrome experience high levels of mast cell activation which can create higher levels of inflammation and suppress the immune system at the same time. Adopting a low histamine diet would be recommended. Contact me if you need more information on low-histamine foods.
Certain herbs and spices have been shown to enhance ACE2 activity like rosemary, basil, sage, thyme, oregano, spearmint, and curcumin from turmeric. Including these in your daily diet may be helpful.
- Lifestyle
Sleep is an incredibly important component of any successful recovery from a Covid-19 infection. Sleep more than you think is necessary and do it often. If you’re having sleeping problems, there are numerous natural sleep aids available that are effective. Contact me if you’re having a difficult time choosing one for yourself.
Make sure you stay well-hydrated. Unless you have high blood pressure, do not be afraid to use salt. Adding an electrolyte mix to your water 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.
- Supplementation
As mentioned above, one hallmark of a coV-2 infection is the destruction of cellular ACE2, and over 90% of post-COVID syndrome symptoms are related to ACE2 deficiency. This vital enzyme is critically important for managing inflammation and maintaining a normal immune response. Doctors are recommending several nutritional supplements that may either support or rebuild ACE2 in post-COVID syndrome: vitamin D, curcumin extract, resveratrol, and alpha-lipoic acid. The anti-inflammatory activity of omega-3 fatty acids from fish cannot be overstated and may be especially therapeutic in post-COVID inflammatory conditions. Omega-3 oil includes the fractions EPA and DHA, which play a critical role in nerve cell regeneration. Other nutritional strategies that may help rebuild innate and adaptive immune responses are medicinal mushrooms (mycology), vitamin C, and Andrographis.
Cellular mitochondria generate 87% of the ATP our bodies need for energy, and a coV-2 infection does specific damage to the mitochondria in the lining tissues of our blood vessels. This can increase the risk of blood clots, circulatory disturbances, and neurological dysfunction. Many patients complain of debilitating fatigue and muscle weakness, as well as cognitive decline. The destruction of ACE2 by the coV-2 virus directly affects the structure and function of cellular mitochondria, which produce the chemical energy (ATP) of life. One of the most evidence-based nutritional supplements for supporting mitochondrial energy production is coenzyme Q10. Other nutraceuticals that protect and support mitochondrial function include niacin (B3), acetyl-L-carnitine, NAC (N-acetyl cysteine), and glutathione. It should be noted that NAC increases the production of BDNF (brain-derived neurotropic factor) which may people patients recover from COVID-related cognitive issues.
Microscopic blood clots (microthromboses) are very common with acute COVID-19 and often persist for weeks or months after recovery. Quercetin, a bioflavonoid found in foods like apples and onions, has a specific effect on blood clotting. Quercetin prevents white blood cells called neutrophils from initiating the clotting process and also can be very helpful in treating mast cell activation. Quercetin has been shown to reduce the severity of acute Covid-19. The enzyme nattokinase, derived from fermented soybeans (natto) has anti-thrombotic activity and can also heal the lining of blood vessels. One intriguing effect of nattokinase: it destroys the SARS-CoV-2 spike protein and may help restore the lining of blood vessels by removing remnants of the spike protein attached to cells.
