This year, I have seen a great deal of Long Covid in my practice. This is a collection of symptoms following covid infection that continues to linger for more than 28 days. In some cases, patients have been struggling for months to recover fully. Many viruses out there can cause post-viral issues if the immune system does not resolve the infection efficiently. However, Covid seems to be in a different league altogether in terms of long-haul symptoms.
A recent study in the USA looked at 3700 patients who had covid, 92% of which had only mild to moderate infection and were not admitted to hospital. More than 60% of the patients in the study continued to have some symptoms 6 months after the initial infection. Some of the most reported symptoms include fatigue, cognitive decline, loss of sense of smell and taste, headaches, sleep issues, muscle weakness and lung issues.
Closer to home, in a UK study, 70% of hospitalised patients did not feel fully recovered 6 months after the infection. Many will complain that they feel worse after episodes of exertion, stress, mental activity, or even mild exercise.
In a study that looked at 26 professional athletes who had tested positive for Covid, more than 15% had abnormal cardiac MRIs showing myocarditis and injury to the heart after infection. So, we know that there are lasting measurable effects for some individuals. This has certainly been my experience in my patients.
The research indicates that if you had more than 5 symptoms during the initial infection, you would be 4 times more likely to have symptoms after 28 days. Recovery in patients that experienced the following symptoms is often slower: Fatigue, shortness of breath, body pain, hoarse voice, and headache.
The UK study showed that individuals that had only mild symptoms, had a more robust immune response and were able to return to normal much quicker. It appears that they did not in the most part have ongoing issues. We now know that long covid develops when there is a weakened attempt by the immune system to deal with the infection, leading to widespread inflammation and abnormal inflammatory reactions.
How do we tackle Long Covid from a Functional Medicine Perspective?
Dealing with long covid requires an approach that reduces inflammation, reduces free radicals, and normalises immune signatures. Here are some of the key areas to focus on for recovery, but more importantly, prevention.
The first thing to determine is whether there is a persistent viral response where the body did not mount a sufficient immune response at the time of the infection to effectively overcome the infection. Or perhaps the virus has been cleared out, but the body has been left in a chronically stimulated inflammatory cycle.
The strategy will be slightly different depending on how the body has responded to the infection, but the underlying terrain that caused the immune system to not respond appropriately, should be investigated.
Here are things to consider when looking at the recovery from long-covid.
1. Elevated blood sugar
Diabetics have worse outcomes with covid infection. It appears that elevated blood sugar levels favours infection and promotes the replication of the virus. Many people are not even aware that they have blood sugar dysregulation as there is a whole spectrum from the extremes of diabetes and hypoglycaemia. We often see normal blood glucose levels, but abnormal insulin levels. It makes sense to have your insulin levels tested every year as it is a sensitive predictor of blood sugar dysfunction nearly a decade before diabetes is diagnosed.
There are many solutions to helping restore blood sugar regulation such as improved nutrition, exercise, and natural supplements such as berberine or Indole-3-carbinol (which is found in vegetables such as broccoli). If you are diabetic, it is important to work closely with a practitioner so that your treatment is adjusted as blood sugar regulation improves.
2. Gut Health
The gut microbiome plays a vital role in our immune system in so many diverse areas such as nutrient absorption, modulation of inflammation and immune responses. So, it is not a surprise that people who suffer from dysbiosis are more prone to severe infections and the lingering sequela.
If there’s one thing you can do that will have the biggest impact on health, that is to keep the terrain of the gut healthy. A healthy ecosystem within the gut will translate into health benefits for the entire system.
That means eliminating processed foods and eating clean, increasing phytonutrients in the diet, and dealing with any infections or inflammation. It can be helpful for most people (unless you have bacterial overgrowth) to increase live fermented foods such as sauerkraut, kimchi and kefir.
3. Oxidative Stress:
If the infection is not fully resolved, it can lead to mitochondrial stress and inflammation at cellular level. This contributes to fatigue and brain fog but also to many other health conditions over time. If fatigue and brain fog are the main symptoms that linger, investigating oxidative stress and mitochondrial function is warranted.
Thorough testing for Long Covid is important to understand what the underlying reasons are for not resolving the infection efficiently.
Here are some of the key things to investigate:
1. Gut microbiome function
2. Nutrient absorption and assimilation
3. Nutrient deficiencies
4. Inflammatory markers
5. Oxidative stress markers
6. Blood glucose and insulin levels
Having this information can help to put together a very personalised strategy for the individual that will help them not only in the immediate recovery of Long Covid, but also in terms of long-term health.
In my experience, once you address the underlying issues, health should bounce back within a very short period of time.