You can’t control the virus, but you can control the host when treating long haul COVID symptoms
The CENTERS FOR DISEASE CONTROL (CDC) defines long haul COVID symptoms, also known as PASC (post-acute sequelae of SARS-CoV-2), as new, returning or ongoing health problems appearing four or more weeks after being infected with the virus that causes COVID-19. Long-hauler syndrome encompasses a wide range of symptoms — a range that continues to expand as the pool of COVID-19 survivors grows.
The most common symptoms include fatigue, cognitive dysfunction, neurological issues, endothelial dysfunction, headache, loss of taste and smell, GI issues and muscle pain.
Long haul COVID symptoms: the scope of the problem
From the start of the pandemic in late 2019 through November 2021, more than 46 million Americans have contracted COVID-19.
A significant percentage of patients with mild, moderate, and even asymptomatic cases that didn’t require hospitalization have long haul COVID symptoms. A major international study of nearly 4,000 people showed:
- The prevalence of 203 symptoms in 10 organ systems (an average of 14.5 symptoms in 9.1 organ systems);
- 80% of patients reported persistent fatigue;
- 73% reported tiredness after exertion;
- 58% reported cognitive dysfunction;
- 56% reported sensorimotor symptoms such as loss of sense of taste;
- 54% reported headache; and
- 51% reported memory issues.
Among COVID-19 survivors who weren’t hospitalized, serious health risks linger for at least a year. In one follow-up study of nearly 152,000 patients treated in the VA health system, a year after diagnosis, the risk of developing heart failure was 39% greater; the risk of developing a fatal blood clot was 119% higher, and the risk of having a stroke was 29% higher.
Underlying causes of long-haulers syndrome
Why is long-haulers syndrome so common and long-lasting, even among people who experienced only mild illness? Underlying inflammation, particularly inflammation related to being overweight or obese, may be the upstream cause.
The majority of Americans entered the pandemic already in a state of chronic, low-level inflammation from excess visceral fat. Approximately 42% of Americans are overweight; 75% are overweight or obese. More than 100 million Americans, or nearly half of all adults, have prediabetes (metabolic syndrome) or Type 2 diabetes. That means 1 in 3 adults has prediabetes; 1 in 10 adults has diabetes. Only 12% of the adult population can be considered metabolically healthy.
Excess weight, particularly from excess visceral fat, markedly increases the severity of COVID-19. Visceral fat, found in the abdominal region, infiltrates the organs in the abdomen, including the liver and pancreas. It adds to the body’s overall weight but isn’t as visible as subcutaneous fat.
Compared to patients with a healthy body weight, the risk of hospital admission for people with moderate obesity is 28% higher; it’s 30% higher for patients with severe obesity. A meta-analysis in 2020 found that people with obesity who contracted COVID-19 were 113% more likely than people of healthy weight to need hospitalization. They were 74% more likely to be admitted to an ICU in the hospital and were 48% more likely to die. Another study showed that metabolic syndrome strongly increased the odds of death among hospitalized patients more than any one comorbidity (obesity, hypertension or diabetes) individually.
The COVID-19 virus itself doesn’t kill people. The body’s immune response — or inadequate response — does. Among overweight and obese people, chronic inflammation and insulin resistance interferes with the body’s ability to produce antibodies and mount an effective immune defense. One aspect of the complex immune response is dysfunction in insulin signaling. Because insulin plays an essential role in the inflammatory cascade that ultimately triggers the immune response of T cells, when signaling is impaired by excess body fat, the adaptive immune response is slower to develop. This slows the production of antibodies, the stealthy sentinels of immune protection. The delayed immune response means the virus has more time to make patients sicker or overwhelm their defenses. It also means these patients shed the virus for longer.
Long haul COVID symptoms and issues
The debilitating fatigue reported by many long-hauler patients may be related to virus-triggered damage to the mitochondria. The infection makes the mitochondria go into the danger cell response, where their activity switches from energy production for activity to energy production to support the immune system. The switch in cellular energy production favoring immune defense leaves little energy for other functions and leads to persistent fatigue.
Heart issues are another persistent problem for many with long haul COVID symptoms. In one study based on data from wearable devices, 1 in 6 people experienced an increased heart rate and irregular heartbeat for more than four months after developing initial symptoms. On average, they took 24 days to return to their normal sleep pattern, 32 days to return to their pre-infection step count, and 79 days to return to their normal resting heart rate.
Cognitive impairment from COVID-19 is another commonly seen aspect of long-haulers syndrome. None of 740 patients in a study at a major New York City medical center had an earlier history of dementia. However, 7-8 months after contracting COVID-19, a significant number showed signs of cognitive impairment, particularly memory and slowed processing speed. Sixteen percent showed deficits in executive functioning, 24% showed deficits in memory encoding, and 23% showed deficits in memory recall.
Kidney issues are also an ongoing problem for many with long haul COVID symptoms. A study of nearly 90,000 patients treated in the VA health care system for COVID-19 showed that 1-6 months after being infected, they were 35% more likely to have kidney damage or substantial declines in kidney function.
The persistent fatigue reported by so many long-haulers may be attributed to a COVID-19 inflammation-induced reactivation of Epstein-Barr virus infection. COVID-19 seems to share a similar inflammatory immune response with autoimmune conditions, so it’s also possible that some patients with long-haulers syndrome now have an autoimmune disease triggered by the virus.
Recovery and post-COVID
Following recovery from COVID-19 infection, some patients may experience a rise in autoimmunity and increased inflammatory status, as indicated by an elevation in biomarkers directly correlated with autoimmunity. The development of autoantibodies that attack the patient’s own proteins leads to inflammation that could trigger long-haul COVID. Increases in cases of multisystem inflammation syndrome, macrophage activation syndrome, and myocarditis have been reported.
Another possibility is that patients with long-hauler syndrome have a persistent viral reservoir in their gut that releases the virus and virus particles into the circulation through increased intestinal permeability. Viral ghosts — persistent fragments of the virus (RNA proteins) that linger on after infection — may be stimulating the immune system even though the infection is over.
Post-COVID gastrointestinal disorders may surface months after a patient has recovered from the infection. One recent study showed that nearly 40% of 200 patients developed new GI disorders several months after they had recovered from COVID-19 infection. Of those, 58 reported functional dyspepsia, and two were diagnosed with irritable bowel syndrome.
Many patients with long haul COVID symptoms have higher measures of blood clotting factors. This may help explain persistent breathlessness, fatigue and decreased exercise tolerance.
Anyone who became ill with COVID-19, regardless of how severe the symptoms were, can develop long-haulers syndrome. However, a recent systematic review shows that individuals with more than five symptoms during the first week of infection are at a higher risk of developing long-haul COVID.
Treatment strategies and protocols
Among post-COVID-19 patients we are seeing a tremendous rise in new medical issues and conditions. Effective strategies and protocols for treating long-hauler patients are critical. My protocol focuses on calming systemic inflammation through a multi-pronged approach, including dietary modifications, nutritional support, resolving gut dysbiosis and intestinal permeability, and improved sleep. At the same time, underlying inflammation needs to be addressed.
My protocol for treating patients with long haul COVID symptoms focuses on four aspects:
- Mitochondrial support for reducing fatigue
- Immune activation
- Gut health
- Managing and modulating inflammation, particularly from blood sugar issues and obesity
Mitochondrial support includes a range of supplements that can help return the mitochondria to normal energy production, such as: B vitamins: 60 mg/day; CoQ10: 300 mg/day; acetyl-L-carnitine: 1,000 mg/day; NMN (nicotinamide mononucleotide), a precursor to NAD+: 200 mg/day; alpha-lipoic acid (ALA): 600 mg/day; NAC/liposomal glutathione: 500 mg/day; magnesium: 200 mg/day; zinc: 40 mg/day; selenium: 200 mcg/day; vitamin C: 2000 mg/day.
Medicinal mushrooms to improve immune activation: reishi, maitake, lion’s mane, chaga and shiitake.
Restoring gut health is central to treating long-haulers syndrome. Many COVID-19 patients experience gastrointestinal symptoms such as diarrhea, which is often overlooked due to the emphasis on respiratory symptoms. In addition, many patients, especially in the earlier stages of the pandemic, were treated with antibiotics. Although GI symptoms are thought to be relatively rare in long-hauler patients, at least compared to symptoms such as fatigue and shortness of breath, a significant minority report them. The GI symptoms of COVID-19 alone are enough to cause gut dysbiosis and increased permeability. Add in antibiotic treatment and the likelihood increases. The viral reservoir in the gut continues to escape through the loosened tight junctions, continues to circulate in the bloodstream, and adds to existing inflammatory cytokines and other chemicals to cause hyper-inflammation.
Resolving gut permeability can be very helpful for reducing inflammation and improving fatigue. I recommend following my Super 7(R) Action Plan:
- Reset diet/lifestyle/mindset
- Remove triggers such as food sensitivities and pathogens
- Replace digestive enzymes and stomach acid
- Regenerate damaged intestinal mucosa
- Re-inoculate with quality pre- and probiotics
- Reintroduce certain foods removed in step 2
- Retain your health and GI integrity
The recently-introduced supplement BPC-157 can be beneficial for treating leaky gut syndrome. This peptide, found naturally in gastric secretions, helps regenerate cells in the intestinal walls and helps seal up damaged areas. It also helps stabilize the microbiome and helps treat dysbiosis.
To modulate inflammation, weight loss is crucial for all patients with excess visceral fat, even those not overweight based on BMI or waist circumference. The apparent risks of severe COVID-19 infection for those with excess body fat are an excellent teachable moment for motivating patients.
Weight loss is a slow process, but inflammation can be quickly modulated through diet by having patients follow a 16:8 intermittent (fasting) eating schedule. This schedule allows autophagy, where the body breaks down and removes damaged cells, and mitophagy, where damaged mitochondria are removed. Autophagy and mitophagy remove dysfunctional cells and mitochondria and recycle their components, empowering the body to renew itself.
Diet plays a crucial role in modulating inflammation. Avoid processed foods and low-quality, high-glycemic-index carbohydrates, better known as junk food. Just 300 calories of low-quality carbohydrates can reduce immunity by 50% for two hours. Other foods to avoid include foods with gluten and foods with added sugar. Foods to add to the diet include high-quality fats and high-quality proteins.
Moderate exercise (at least 30 minutes a day) and improved sleep also have rapid effects on inflammation.
Low-level laser therapy can help improve mitochondrial function, encouraging them to switch to energy production for regular activity instead of immune support. The increased ATP production from laser stimulation leads to improvements in persistent fatigue.
Roughly 1 in 3 patients become long-haulers
Some 37% of COVID-19 patients are likely to develop long haul COVID symptoms. In my experience to date, I believe that number is already higher — and will go higher still.
We’re seeing a precipitous rise in new medical conditions among COVID-19 survivors. Long-haulers syndrome may portend a secondary epidemic following on the heels of the current pandemic. Practitioners need to understand the multifaceted causes of long-haulers syndrome and be equipped to support their patients with a multi-pronged approach.
ROBERT G. SILVERMAN, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR, is a chiropractic doctor, clinical nutritionist, national/international speaker, author of Amazon’s #1 bestseller “Inside-Out Health,” and founder and CEO of Westchester Integrative Health Center. He graduated magna cum laude from the University of Bridgeport College of Chiropractic and has a Master of Science degree in human nutrition. The ACA Sports Council named him “Sports Chiropractor of the Year” in 2015. He is on the advisory board for Functional Medicine University and is a seasoned health and wellness expert on the speaking circuits and in the media. A frequently published author in peer-reviewed journals and other mainstream publications, he is a thought leader in his field and practice. His new book, “Superhighway to Health,” was published in June 2021. He can be reached at drrobertsilverman.com.