Approximately 10% of people who’ve had COVID-19 experience prolonged symptoms
— that is, longer than the typical two weeks. In some cases, weeks and months
longer. There are people who experience relapses after they’ve appeared to
make a full recovery.
Long Haulers Symptoms
Their typical symptoms can include:
COVID-19 long haulers report that these symptoms flare up unpredictably. They
are often in different combinations and can be debilitating for days and weeks
at a time.
- Cognitive issues
- Erratic heartbeat
- Fatigue
- Gastrointestinal issues
- Intolerance to physical or mental activity
- Low-grade fever
- Muscle and joint pain
- Shortness of breath
In one Italian study, COVID-19 long-haulers experienced fatigue, shortness of
breath, joint pain, and chest pain, in that order. None of the patients in
that study had a fever after their acute illness had passed. However nearly
half of them reported their quality of life had suffered.
Although numerous reports describe the epidemiology and clinical features of
post-COVID syndrome, studies evaluating treatment options are glaringly
sparse. Indeed, the NICE guideline for managing the long-term effects of COVID-19 provide no specific
treatment recommendations. In general, while the treatment of ‘Long COVID”
should be individualized, the following supplements may have a role in the
treatment of this disorder.
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| Nutraceutical Therapy by Mode of Action |
Natural Treatments for Long Haulers
1. N-Acetyl-L-Cysteine (NAC)
NAC is an amino acid that the body uses to create glutathione, the body’s master detoxifier. Glutathione is your master detoxifier and the most powerful free radical scavenger produced by your body.Eating plenty of cruciferous vegetables (such as kale, broccoli, and cabbage), as well as avocado, okra, spinach, and alliums, can help bolster levels of glutathione, as can supplementing with NAC.
Aaron Hartman, MD, founder of the Richmond Integrative and Functional Medicine clinic in Richmond, Va., describes one patient, a 26-year-old woman, whose symptoms — persistent low oxygen and shortness of breath — following a bout of COVID resolved after treatment that included NAC as well as omega-3 fish oil.
“NAC is one of the more important nutrients for people who get shortness of breath with COVID, because of its ability to break down those really, really small blood clots called micro-emboli,” explains Hartman.
2. Vitamin D
Vitamin D3 is essential for supporting healthy immune system function. It works hand in hand with your body to modulate both innate and adaptive immune responses which regulate everything from reactivity to antigens and pathogens.
Much has been written about the emerging link between COVID severity and
vitamin-D deficiency. A pilot study in Spain found that adding oral D3
supplementation significantly reduced the need for ICU treatment among people
hospitalized after infection. Leo Galland, MD, a functional-medicine internist
in New York City notes that D is an important promoter of ACE-2
activity.
He recommends that people with long COVID supplement with
up to 5,000 IU of D3 daily. Hartman advises aiming for a vitamin-D blood level
in the range of 60 to 80 ng/mL.
3. Resveratrol
Resveratrol is a polyphenol with antioxidant and anti-inflammatory effects
that’s found in red grapes, red wine, peanuts, and some berries. It’s also
available as a supplement.
Leo Galland, MD, a functional-medicine
internist in New York City, has found it to be particularly helpful in
restoring his COVID patients to health. “Resveratrol has a number of
beneficial effects on coronavirus infection,” he notes. “It supports ACE-2
function, it inhibits the growth of the deadly MERS coronavirus through
multiple mechanisms, and it diminishes the kind of inflammation associated
with coronavirus infection.”
Galland treated a physician in her 60s who’d been sick with COVID for six
weeks, continuing to run daily fevers with brain fog and fatigue. He
prescribed a combination of herbs and supplements, including resveratrol, and
her symptoms resolved within a couple of weeks.
He recommends long-COVID patients supplement with 200 mg of resveratrol twice a day.
Eating fermented foods, such as sauerkraut, yogurt, kefir, and kimchi, can help fortify and support the gut’s microbiome. And in the event of ongoing gut disturbances, working with a functional-medicine provider to design a well-rounded prebiotic and probiotic protocol can help bring the microbiome back into balance.
Supplementing with 1 - 2 mg of melatonin at bedtime might benefit those whose sleep–wake cycles have become dysregulated with long COVID.
Quercetin is a flavonoid found in dill, broccoli, onions, capers, apples,
and berries. Quercetin is a mast-cell stabilizer and has been used with
people who have allergies, asthma, and mast-cell issues.
Quercetin appears to bind to the spike protein of the coronavirus, inhibit inflammatory pathways, and block replication of infected cells. It is also antiviral and completely safe. In addition to getting sources of quercetin from diet, long-COVID patients can supplement with 250 - 500 mg twice a day.
He recommends long-COVID patients supplement with 200 mg of resveratrol twice a day.
4. Probiotics
COVID can wreak havoc on the gut microbiome, but research on specific probiotic strains that can best restore balance following the syndrome’s particular damage is in its infancy. Galland is looking into soil-derived bacteria of the genus Bacillus because it may have natural antibiotic properties, though there’s not yet enough data to make specific recommendations.Eating fermented foods, such as sauerkraut, yogurt, kefir, and kimchi, can help fortify and support the gut’s microbiome. And in the event of ongoing gut disturbances, working with a functional-medicine provider to design a well-rounded prebiotic and probiotic protocol can help bring the microbiome back into balance.
5. Melatonin
Melatonin is an anti-inflammatory and antioxidant chemical our bodies produce to help regulate the sleep–wake cycle. It also supports the gut lining, which promotes healthy immune function.Supplementing with 1 - 2 mg of melatonin at bedtime might benefit those whose sleep–wake cycles have become dysregulated with long COVID.
6. Vitamin C
Vitamin C inhibits histamine. Healthcare professionals are administering
vitamin C intravenously to deliver it directly into their patient’s
bloodstream to be immediately available. Liposomal vitamin C is the
next best option. It’s the most bioavailable form of vitamin C on the market
today. The liposomal form can survive the digestive process to be
up to 135% better than traditional oral vitamin C.
Long-COVID patients can supplement with vitamin C 500 mg twice a day.
7. Omega-3 fatty acids
Vascepa, Lovaza or DHA/EPA 4 g day. Omega-3 fatty acids play an important
role in the resolution of inflammation by inducing resolvin
production.
8. Quercetin, EGCG and Curcumin
Quercetin have broad spectrum anti-inflammatory properties. These
natural flavonoids inhibit mast cells and have been demonstrated to
reduce neuroinflammation.
Quercetin appears to bind to the spike protein of the coronavirus, inhibit inflammatory pathways, and block replication of infected cells. It is also antiviral and completely safe. In addition to getting sources of quercetin from diet, long-COVID patients can supplement with 250 - 500 mg twice a day.
Other phytonutrients such as EGCG (epigallocatechin gallate, a
polyphenol found in green tea) and curcumin (found in turmeric) can
decrease inflammation and rebalance the immune system.
FLCCC I-Recover Protocol
Given the lack of clinical trials of long-haul COVID-19 syndrome, these
recommendations are based on the abnormal changes within the body
associated with the COVID-19 disease and post viral illnesses along with
the collective experience of FLCCC members.
First-line treatment based on the FLCCC I-Recover Protocol.
- Ivermectin has been reported to have a role in the treatment of post-COVID-19 syndrome. A dose of 0.2-0.4 mg/kg day for 3-5 days, followed by once or twice weekly dosing for ongoing symptoms for up to 4 weeks. Discontinue after 2 - 4 weeks if all symptoms have resolved. A repeat course is recommended in those who respond poorly or relapse once the treatment is stopped. The anti-inflammatory properties of ivermectin may mediate this benefit.
- If inadequate response to ivermectin: Prednisone 0.5mg/kg daily for 5 days, 0.25mg/kg for 5 days followed by 0.12 mg/kg for 5 days. Patients with persistent organizing pneumonia may require higher doses for a more prolonged period of time.
- If presenting with neurological symptoms i.e. poor concentration, mood disturbance. Fluvoxamine 50 -100 mg day for 15 days. Monitor response closely as some patients will respond poorly to this medication. Teens and young adults who are prescribed fluvoxamine can experience acute anxiety which needs to be monitored for and treated by the prescribing clinician to prevent rare escalation to suicidal or violent behavior.
Supplements recommended to support the therapy
• Omega-3 fatty acids: Vascepa, Lovaza or DHA/EPA 4 g day. Omega-3 fatty
acids play an important role in the resolution of inflammation by
inducing resolvin production. [Ref, Ref]
• Melatonin 2- 5 mg at night (slow release/extended release) with
attention to sleep hygiene.
• Vitamin D3 1000-3000 u/day
• Vitamin C 500 mg BID (vitamin C inhibits histamine).[Ref]
Second-line approach (after poor response to first-line protocol) and
treatment of suspected mast cell activation
Choose a type 1 (loratadine or cetrizine) and type II antihistamine
(famotidine) along with a mast cell stabiliser (rupadatadine, quercetin
or luteoline).
Second line:
- montelukast 10 mg/day (for mast cell activation syndrome). Caution as may cause depression in some patients.
- SSRIs (selective serotonin reuptake inhibitors) e.g. fluvoxamine, fluoxetine (prozac).
Post-Vaccination Long Haulers?
Dr Bruce Patterson
reported he’s assessed from 100-200 people who came down with what looks
like long COVID in the months after being vaccinated. Machine learning
analyses indicated it was a quite heterogeneous group, but with one
exception (no elevations of VEGF), immunologically, they looked like
long haulers and the long-hauler treatment worked for them.
In order to reduce your post-vaccinated risk of heart complications, there
are a few basic strategies as advised by
Dr Mercola:
- Make certain you measure your blood vitamin D level and take enough vitamin D orally (typically about 8,000 units/day for most adults) to make sure your level is 60 to 80 ng/ml (100 to 150 nmol/l).
- Eliminate all vegetable (seed) oils in your diet, which involves eliminating nearly all processed foods and most meals in restaurants unless you convince the chef to only cook with butter. Avoid any sauces or salad dressings in restaurants as they are loaded with seed oils. Also avoid chicken and pork as they are very high in linoleic acid, the omega-6 fat that is far too high in nearly everyone and contributes to oxidative stress that causes heart disease.
- Consider taking around 500 mg/day of NAC, as it helps prevent blood clots and is a precursor for your body to produce the important antioxidant glutathione.
- Consider fibrinolytic enzymes that digest the fibrin that leads to blood clots, strokes and pulmonary embolisms. The dose is typically two, twice a day, but must be taken on an empty stomach, either an hour before or two hours after a meal. Otherwise, the enzymes will digest your food and not the fibrin in the blood clot.
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