Treating Long COVID

It may be 2025 and a few years past the initial outbreak of COVID-19, but I am still seeing symptoms and conditions that have been exacerbated by this virus. Symptoms that may seem completely separate from this infection, but after poring through years of a client’s medical history, we see a timeline emerge and the early beginnings of their symptoms lining up with a COVID infection. In this blog we will discuss the factors that can contribute to developing Long COVID and the severity of the infection.

‍

What is Long COVID

Long COVID is still rejected in many parts of the medical industry, due to the term itself initially being created by patients and spread across social media. People reported experiencing symptoms weeks to months post-infection, despite testing negative.

‍

It is important to note that research is still on-going for COVID and Long COVID, and we will continue to get updated information as the years go by and technology develops. However, there is no mistaking the hit our immune system takes with this infection. How your body responds and recovers depends on your initial health prior to COVID, and if any underlying inflammation or immune dysregulation was present. This is why consolidating your entire medical history is important within an initial consultation, to determine how your body has responded to illness and stress in the past.

‍

The World Health Organisation states that Long COVID symptoms start three months after the initial infection can last months or years. The majority of these symptoms overlap with chronic fatigue syndrome or encephalitis.

‍

Long COVID Symptoms

• Fatigue 
• Post exercise malaise 
• Memory and concentration issues
• Brain fog 
• Shortness of breath
• Disrupted sleep 
• Mylagia (muscle pain)

‍

Factors contributing to Long COVID and Severity of Infection

There are several issues that arise with a COVID infection that can contribute to delayed recovery and progression into Long COVID. 

‍

Increased blood coagulability & hyperactivity of platelets 

Blood coagulability is the body's ability to clot blood to prevent excessive bleeding when our blood vessels are damaged. Multiple studies have found that individuals infected with COVID-19 have elevated levels of D-dimer (1,2), a protein fragment that is released into the bloodstream when a blood clot has broken down. Elevated levels indicate the presence of a clot, or multiple. Further studies show elevated thrombin levels and thrombosis, indicating abnormalities in the body's ability to form and break down clots (3).

Furthermore, individuals severely infected also show excessive platelet and neutrophil activation within multiple organs, increasing the risk of thrombosis, inflammation, atherosclerosis, stroke, and fatigue from poor circulation (3).

‍

Neurological Dysfunction

Common neurological symptoms reported in Long COVID include 

• Headaches
• Dizziness
• Myalgia
• Fatigue
• Visual impairments
• Anxiety
• Brain fog
• Loss of sense of smell (hyposmia) and taste (hypogeusia)
• Changes to fine motor skills and balance (5, 6, 7). 

‍

The high level of inflammation generated by the infection can inflame endothelial cells that compose the blood brain barrier, allowing immune cells and proinflammatory chemicals to cross into the brain, damaging neurons and contributing to symptoms (8). The severity of headaches experienced by patients, can be due to the infection travelling up the nasal cavity trigeminal nerve endings (8). 

Neurological symptoms associated with Long COVID have also been linked to low levels of serotonin (11), which affects the sleep-wake cycle, appetite, mood, concentration, blood clotting, and digestion (13). 

Decreased levels of Serotonnin is due to decreased absorption of tryptophan (a precursor of serotonin) within the intestine, increased enzymatic breakdown and clearance of serotonin within the brain (via increased activity of the Monoamine oxidase enzyme), and hyperactivation of platelets impacting storage and transport of serotonin around the body (11).

Creatine kinase, an enzyme found in muscle and cardiac tissue, has also been reported to be elevated during infection and can contribute to muscle pain [myalgia] (9). Myalgia can also be due to high levels of inflammation and subsequent release of proinflammatory cytokines (10).

‍

Gut Health

The gut microbiome plays a significant role in the immune response as bacteria influences the development and functioning of immune cells like T and B cells, and macrophages (18). 

The COVID strain initially gains entry into cells by binding to the Angiotensin-converting enzyme receptor that is expressed not only in the lungs, but also within cells of the gastrointestinal tract (20). This disrupts the gut lining leading to increased intestinal permeability or ‘leaky gut’, allowing food and endotoxins such as lipopolysaccharides to enter the bloodstream, worsening the inflammatory cascade and multiple organs (22). Leaky gut can contribute to symptoms such as bloating, alternating constipation, diarrhoea, new food sensitivities, poor resilience to other infections, and poor energy (20). 

Researchers have found that viral RNA from COVID can persist within the gut for up to 2 years post infection (17).

Researchers have also discussed the role of histamine and the widespread inflammatory cascade that occurs after immune activation. The activation of immune cells within the lungs leads to an increased release of mast cells that release histamine, cytokines, chemokines, proteases, and leukotrienes which further increases inflammation (23). When too much histamine is flooding the body and gut from the initial infection, these can create symptoms that mimic histamine intolerance, such as new food sensitivities, bloating, diarrhoea, abdominal pain, dizziness, vertigo, headaches, skin rashes, and fatigue (24). 

‍

“Reactivation” of dormant viruses 

Numerous studies have found that a COVID infection ‘reactivates’ latent viruses lying dormant within the body, contributing to the severity of and development of Long COVID (14). The most common reinfections are the Epstein Barr Virus (Glandular fever), Herpes simplex virus, Varicella Zoster virus (shingles), and Cytomegalovirus (15).

This can contribute to fatigue, nerve pain, swollen glands, reimmersion of cold sores, and other immune-related symptoms.

‍

Your Treatment 

Supporting your recovery from Long COVID is multi-faceted and requires an individualised approach. Your treatment will involve quality supplementation to target underlying inflammation and improve circulation, changes to your lifestyle, boosting the immune system, and identifying your body’s constitutional weakness - the areas that were vulnerable prior to your COVID infection. 

‍

Practitioner-grade supplementation 

Inflammation is like a fire. When there is an active ‘fire’ within the body, nutrients obtained from food or poor quality supplements are not delivered to cells to focus on growth or repair. They are instead diverted to the inflammation in order to ‘put out the fire’. This can create a deficit within the body, where your cells and mitochondria are undernourished, underfed, and general mineral stores are depleted.

‍

The benefit of seeing a qualified and registered Naturopath is gaining access to therapeutic grade supplementation that has been vigorously tested for purity and dosage. For some individuals with COVID or Long COVID, your body may need higher doses and specific forms of vitamins and minerals to support your current infection and dampen the inflammatory cascade.

‍

Lifestyle Changes

The focus here is on activities that can keep your lymphatic fluid mobile, keep the detoxification channels open with gentle sweating, and nourishing your nervous system.

‍

Regulate your circadian rhythm

On waking, expose your eyes to 5-10 minutes of morning sunlight. A massively underrated tip, but has the power to increase allopregnanolone conversion that increases GABA, an inhibitory neurotransmitter that reduces anxiety and a racing mind, regulates your circadian rhythm that can support your melatonin secretion that night and improve sleep, regulates your blood sugars, and wakes up genes within your organs (that are also wired to an internal circadian clock) to get to work for the day (19).

At nighttime, limit all screens 1-2 hours before bed to support your melatonin levels and nervous system. 

‍

Restorative Movement 

The key here is engaging in movement that restores you, not depletes  you. Your high intensity classes will still be there when you return. Remember the ‘fire of inflammation’? Your body is already hot, overworked, and depleted from trying to calm the inflammatory cascade. Movement that is incredibly taxing to your central nervous system or that provokes a lot of sweat production can inflame your immune system and increase your overall inflammation. Walking, yoga, strength training (around 70% of RPE with ample rest between sets), are great to keep active.

‍

It is helpful to keep a symptom diary to record how your body responds immediately after and up to 72 hours post exercise. If you experience your chest tightening, increased mucus production and wheezing, dizziness or vertigo, moderate-intense fatigue for 1-3 days, or glands swelling, then that session was too much for your body right now.

‍

Boosting your Immune System

Depending on your prior medical history, current lifestyle and eating habits, your treatment plan and prescription may include:

• Vitamins and minerals to support inflammation and improve communication between immune cells. Some examples include Vitamin C, D, Zinc, and CoQ10.
• Strain-specific probiotics to enhance the immune system, such as Lactobacillus rhamnosus or Lactobacillus plantarum.
• Nutrients to strengthen your gut lining, such as immunogobulins, amino acids, zinc, and vitamin A.
• Nutrients to improve your circulation and histamine metabolism. 
• Medicinal herbs and mushrooms to target the initial infection, enhance immune cell activity, reduce inflammation, improve lymphatic drainage, and support the nervous system.
• Strategies to support sleep hygiene, stress management, and tailoring your exercise to your body’s current capability. 

‍

Discovering your body's constitutional weakness

Every body responds differently to stress and infection. One person may get headaches or migraines when stressed, while another develops insomnia. One person may get sick and have the illness immediately settle into their chest, while for another it settles into their sinuses. The key to rebuilding a strong foundation after COVID, is discovering and treating your body's weakness first. Some areas to investigate within your past medical history are your histamine response and general immune resilience, and any nervous system, circulation, and gut health challenges. 

For example, individuals who have had a prior constitutional issue with histamine (such as heavy periods, skin rashes, rosacea, or significant hay fever) before contracting COVID may now exhibit signs of histamine intolerance due to the inflammatory cascade triggered by the infection.Individuals with an underlying digestive issue (SIBO, bloating, food sensitivities, constipation/diarrhoea), could now experience a flare or ‘reinfection’ of their gut condition due to COVID harming the gut lining and bacteria.

Individuals with an underlying issue with their circulation (chillblains, raynauds, swelling in lower legs, slow cognition, family history of clotting disorders, strokes etc), could now experience an exacerbation of this due to COVID affecting blood coagulability. 

‍

In your initial consultation, we will complete a thorough deep dive into your medical history to investigate how your constitution has responded to illness, stress, or sudden life changes in the past. Knowing how your body has responded under stress is essential to forming a prescription that is tailored to your unique biochemistry and experiences. 

‍

References

1. COVID-19-associated coagulopathy: An exploration of mechanisms. Meaghan E Colling, Yogendra Kanthi (2020). doi: 10.1177/1358863X20932640.
2. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Iba et al. (2020). doi: 10.1007/s00011-020-01401-6.
3. Immunothrombotic Dysregulation in COVID-19 Pneumonia Is Associated With Respiratory Failure and Coagulopathy. Nicolai et al. (2020). doi: 10.1161/CIRCULATIONAHA.120.048488.
4. Mao L., Jin H., Wang M., Hu Y., Chen S., He Q., Chang J., Hong C., Zhou Y., Wang D., et al. Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77:683–690. doi: 10.1001/jamaneurol.2020.1127.
5. Campiglio L., Priori A. Neurological symptoms in acute COVID-19 infected patients: A survey among Italian physicians. PLoS ONE. 2020;15:e0238159.
6. Karadas O., Ozturk B., Sonkaya A.R. A prospective clinical study of detailed neurological manifestations in patients with COVID-19. Neurol. Sci. 2020;41:1991–1995. doi: 10.1007/s10072-020-04547-7.
7. Bolay H., Gul A., Baykan B. COVID-19 is a Real Headache! Headache. 2020;60:1415–1421. doi: 10.1111/head.13856.
8. Pitscheider L., Karolyi M., Burkert F.R., Helbok R., Wanschitz J.V., Horlings C., Pawelka E., Omid S., Traugott M., Seitz T., et al. Muscle involvement in SARS-CoV-2 infection. Eur. J. Neurol. 2020. doi: 10.1111/ene.14564.
9. Harapan B.N., Yoo H.J. Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19). J. Neurol. 2021. doi: 10.1007/s00415-021-10406-y.
10. Wong et al. Serotonin reduction in post-acute sequelae of viral infection. (2023); 186:4851–4867. doi: https://doi.org/10.1016/j.cell.2023.09.013.
11. Wong AC, Devason AS, Umana IC, Cox TO, Dohnalová L, Litichevskiy L, et al. Serotonin reduction in post-acute sequelae of viral infection. Cell. 2023;186(22):4851–67.e20. Epub 20231016. https://doi.org/10.1016/j.cell.2023.09.013.
12. Wang B, Zhang L, Wang Y, Dai T, Qin Z, Zhou F, et al. Alterations in microbiota of patients with COVID-19: Potential mechanisms and therapeutic interventions. Signal Transduct Target Ther. 2022. Apr;7(1):143. doi: 10.1038/s41392-022-00986-0.
13. Chronic viral coinfections differentially affect the likelihood of developing long COVID. J Med Virol. 2023 Apr;95(4):e28745. doi: 10.1002/jmv.28745.
14. Chen YC, Ho CH, Liu TH, Wu JY, Huang PY, Tsai YW, Lai CC. Long-term risk of herpes zoster following COVID-19: A retrospective cohort study of 2 442 686 patients. J Med Virol. 2023 Apr;95(4):e28745. doi: 10.1002/jmv.28745. Erratum in: J Med Virol. 2023 Jul;95(7):e28944. doi: 10.1002/jmv.28944. PMID: 37185849.
15. Jing Y, Luo L, Chen Y, et al. SARS-CoV-2 infection causes immunodeficiency in recovered patients by downregulating CD19 expression in B cells via enhancing B-cell metabolism. Sig Transduct Target Ther. 2021;6:345. https://doi.org/10.1038/s41392-021-00749-3.
16. Peluso MJ, Ryder D, Flavell RR, et al. Tissue-based T cell activation and viral RNA persist for up to 2 years after SARS-CoV-2 infection. Sci Transl Med. 2024 Jul 3;16(754). doi: 10.1126/scitranslmed.adk3295.
17. Wu HJ, Wu E. The role of gut microbiota in immune homeostasis and autoimmunity. Gut Microbes. 2012;3(1):4–14. Epub 20120101. https://doi.org/10.4161/gmic.19320.
18. Tähkämö L, Partonen T, Pesonen AK. Systematic review of light exposure impact on human circadian rhythm. Chronobiol Int. 2019 Feb;36(2):151–170. doi: 10.1080/07420528.2018.1527773. Epub 2018 Oct 12. PMID: 30311830.
19. Lamers MM, Beumer J, van der Vaart J, Knoops K, Puschhof J, Breugem TI, et al. SARS-CoV-2 productively infects human gut enterocytes. Science. 2020 Jul;369(6499):50–4. doi: 10.1126/science.abc1669.
20. Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020 May;115(5):766–73. doi: 10.14309/ajg.0000000000000620.
21. Lamers MM, Haagmans BL. SARS-CoV-2 pathogenesis. Nat Rev Microbiol. 2022 May;20(5):270–84. doi: 10.1038/s41579-022-00713-0.
22. Conti P, Caraffa A, Tetè G, Gallenga CE, Ross R, Kritas SK, Frydas I, Younes A, Di Emidio P, Ronconi G. Mast cells activated by SARS-CoV-2 release histamine which increases IL-1 levels causing cytokine storm and inflammatory reaction in COVID-19. J Biol Regul Homeost Agents. 2020 Sep–Oct;34(5):1629–1632. doi: 10.23812/20-2EDIT.
23. Mashauri HL. COVID-19 Histamine Theory: Why Anti-Histamines Should Be Incorporated as the Basic Component in COVID-19 Management? J Infect Dis Epidemiol. 2022;8:287.
24. Chen YC, Ho CH, Liu TH, Wu JY, Huang PY, Tsai YW, Lai CC. Long-term risk of herpes zoster following COVID-19: A retrospective cohort study of 2 442 686 patients. J Med Virol. 2023 Apr;95(4):e28745. doi: 10.1002/jmv.28745.