By Dr. Shawna Darou, ND
I have lately received several referrals of patients who are experiencing long-COVID symptoms, and wanted to share with you my perspective, areas to investigate and a possible approach. There is not much known about why some people are affected long-term from this infection and others only experience mild cold symptoms. It also seems to be more common for women to experience these long-term symptoms. The most common lingering symptoms are extreme fatigue and brain fog, and may also include vertigo, hives, elevated heart-rate, memory and concentration issues, muscle pain, headaches, and shortness of breath.
I take a functional medicine approach with all patients with long-COVID and assess each system to find out where the body is affected. What’s important to note is that each case is individual – there is not a single approach that his helping everyone. I’m going to start with a short description of the areas that I’m reviewing in patients with long-COVID symptoms. Again, the aim is to find all of the imbalances are that were affected by the virus. Usually there are several areas to support, not just one. This list is by no means comprehensive, and I am not claiming to ‘cure’ long-COVID. I do however want to share some of the areas to investigate based on clinical observation and improvement of symptoms over time, in hope of helping more people who are looking for answers.
Long-COVID – areas to investigate:
(1) Inflammation – Many people have ongoing inflammation symptoms post-COVID, which may be an autoimmune flare-up, or autoimmune prodrome. In some cases inflammatory markers in the blood are mildly elevated (CRP, ESR, ferritin, homocysteine) as indicators, or there may be preexisting insulin resistance creating an inflammatory state. An anti-inflammatory nutrition plan, supporting the gut and using supplements to reduce inflammation can be helpful. (https://www.nature.com/articles/s41590-021-01104-y)
(2) Histamine response – I’ve written several times about the increase in histamine response I have seen over the past year (flushing, hives, headaches, dizziness, nausea), and interestingly treatment with an over-the-counter antihistamine plus a low histamine diet in some cases will relieve or reduce brain fog from long-COVID. It doesn’t work in every case, but is worth a try. (https://jim.bmj.com/content/70/1/61)
(3) Nervous system dysregulation – Insomnia, anxiety, caffeine sensitivity and elevated heart-rate can be symptoms of a nervous system response to the virus or inflammation. These usually pass gradually over time, especially if stress can be reduced, there is time for rest, and we look at other tools for nervous system regulation too. Monitoring heart rate and heart rate variability are helpful in this case.
(4) Mitochondria dysfunction – Symptoms of mitochondria stress are classically fatigue, brain fog and muscle pain. This symptomatically fits very often with long-COVID patients. We can support mitochondria function with nutrients like CoQ10, Resveratrol, L-Carnitine, and N-Acetyl Cysteine, and also improve mitochondrial function with a very gradual return to exercise. (http://njhealth.multimedia-newsroom.com/index.php/2022/01/18/study-reveals-root-cause-of-long-term-covid-symptoms/)
(5) Previous chronic / hidden infections – From the beginning, reactivated Epstein Bar virus has been associated with long-COVID, and likely other latent infections such as herpes virus, cytomegalovirus virus and others may be involved. In these cases, we would see ongoing viral symptoms (swollen lymph nodes, possibly sore throat along with profound fatigue). Immune support, and anti-viral supplements can be helpful to manage other viral flare-ups that may have been triggered by the COVID-19 infection. (https://www.cell.com/cell/fulltext/S0092-8674(22)00072-1)
(6) Nutrient deficiencies – Several nutrient deficiencies can impact how well the body recovers from COVID-19: vitamin D (immune response in general, zinc (loss of taste and smell), and vitamin B12 (neurological symptoms, poor concentration, fatigue), and iron (ongoing fatigue) are key. The good news is that these are very simple to test and treat.
(7) Symptoms that look like brain injury – Many patients post-COVID present similarly to people who have experienced a concussion: sensitivity to screens, light, sound, movement; headaches; fatigue; exercise intolerance. In these cases, there is likely some form of brain injury from an inflammatory response, or reduced oxygen during illness. Here we use all that we know about concussion recovery to support brain recovery and repair – nutrition plan to reverse insulin resistance, omega-3 supplementation, very gradual return to exercise and more. (https://www.medicalnewstoday.com/articles/long-covid-primate-study-reveals-forms-of-brain-injury)
(8) Interfering factors – In some of my patients, there are interfering factors that are preventing the body from healing fully. This could be environmental mold exposure, ongoing high stress levels, concurrent hormone transition (ex. menopause or postpartum), and sometimes medications that are taken for other conditions. This is another reason why it is important to take a very thorough intake to see what else may be affecting recovery.
(9) History of trauma – Studies have found that childhood trauma increases the risk of long-COVID because ongoing nervous system imbalance impacts how the immune system responds to infection, and also increases inflammation, making it harder to recover from infection, and more likely to get stuck in an inflammatory response. In these cases, a focus on nervous system regulation, along with referral for mental health therapy are essential for full recovery. (https://www.medrxiv.org/content/10.1101/2022.02.18.22271191v1)
This list is by no means comprehensive, but there are areas that I address, and am seeing significant improvements in my patients, especially ones whose long-COVID symptoms began after Omicron strains. Progress is still slow however, especially if they have been unwell for several months. I continue to watch the research and what others are learning too.
Lab testing and assessment:
Here is a starting point of lab testing and assessment that might be considered. Again, this is not a fully comprehensive list but is a good starting point:
- Full bloodwork – CBC, liver and kidney function tests, full thyroid panel, fasting insulin and glucose, morning cortisol vitamin B12, vitamin D, ferritin and zinc levels, inflammatory markers (CRP, ESR, homocystein) and a lipid panel would be where I would start.
- Additional testing that may be recommended – EBV panel (Epstein Bar virus), Organic Acid Test (one way to check mitochondria issues), Comprehensive Digestive Stool Analysis, Mycotoxin test.
- Respiratory assessment with a respirologist if there is lingering shortness of breath and coughing (asthma is common post-COVID).
- Using wearable technology to monitor heart rate and heart rate variability (HRV), to assess nervous system response, and carefully monitor return to activity or exercise.
I hope that this short article has given you some insight, and some hope if you or someone you know is struggling with lingering symptoms after having COVID-19. Please share this article to anyone who might need it.
Again, I am not claiming to be able to treat every case of long-COVID, but hear that there are not yet many resources available. I wanted to share some ideas to build on, some assessment that can be done, and a functional medicine approach to assist in a full recovery.
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