Do you have some of the following symptoms?
- extreme tiredness (fatigue)
- joint/ muscle pain
- shortness of breath
- memory and concentration impairment/ brain fog
- depression, anxiety
- digestion issues, stomach pains, nausea, diarrhoea
- heart palpitations
- difficulty sleeping, insomnia
- dizziness
- cough, headaches, sore throat, change to smell or taste
- skin rashes
- tinnitus, earaches
- impaired balance or gait
- pins and needles, tingling in extremities
Related conditions: Mast cell activation syndrome (MCAS) and postural orthostatic tachycardia syndrome (POTS) may also be related to/ caused by long covid
Long Covid, long haul covid or PASC (post-acute sequelae of covid) is defined as symptoms lasting beyond 12 weeks after covid infection that cannot be explained by any other diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body1.
Underlying cause – Immune dysfunction
It is thought that the virus can suppress normal immune responses, which is one of the reasons why it is so prevalent and harmful. This leads to an irregular immune response during the acute infection. In long covid two things might be happening2:
– Immune exhaustion: suppression of immune cells such as NK cells and T cells. This lead to ‘sickness behaviour’ which are messages from our brain to tell us that we are still ‘sick’ and that we should respond by taking it easy, staying in bed and giving symptoms of illness.
– Chronic inflammatory signals: the immune system is very complex and you can have both immune exhaustion on one hand and chronic activity at the same time. Ongoing inflammation may cause many symptoms and ongoing organ damage. Inflammatory signals in the brain can cause brain fog and ‘sickness behaviour’ also.
– Inflammation can also cause damage to mitochondria, the tiny factories in our cells that produce energy
What to do – a multi-systems approach
Many systems are typically involved with long covid – the average for any one patient is 9 different systems3.
Lungs Liver Heart Kidney Pancreas Gut
Thyroid Immune Energy production/ Metabolism Adrenal Hormonal
Neurological/ Brain Peripheral nervous system Neurotransmitters/ Mood
Depending on your presenting symptoms and history, we can target these systems to support function and reduce inflammation and damage. Restoring immune balance may be common to all. We will work alongside any medical support you are also receiving to support your recovery. Along with your symptoms, some of your standard GP tests might indicate which of these systems are involved for you.
Can Nutrition help?
Nutrition will play an important role in recovery as many foods we eat can actively reduce inflammation and support balance in the immune system.
Supplying our bodies with good amounts of essential nutrients can fuel energy production. There is often very high demands for nutrients during illness and ongoing inflammation, so you may need more than just an average healthy diet. We can advise you on supplements as they are needed.
80% of our immune system surrounds the gut and our microbiome plays a critical role in balancing the immune response. If there is any persistent virus, it is also thought that these viral reservoirs are most commonly found in the gut. Restoring healthy gut function and feeding the microbiome might be one of the most important steps to restoring health.
Immune imbalance
After initial infection, the immune system can be ‘exhausted’4. There may be a correlation with the severity of initial infection and inflammation and the resulting exhaustion that occurs. There are a number of factors though that also may play a role such as vaccination status, medicines like steroids administered during infection and the status of the microbiome – see Digestion below.
As in Chronic Fatigue Syndrome, it is thought that low NK cells, low white blood cells and changes in T cell populations are prevalent in long covid5. In addition, there are also increased pro-inflammatory cytokines and damaging reactive oxygen species (ROS) which can result in ongoing organ damage in many different systems. Supporting immune balance is a key step in recovery.
Long covid has also been associated with Mast Cell Activation Syndrome (MCAS)6. This leads to excess histamine release which can impact many other systems including energy production and the brain/ cognition. Dietary and supplement supports are very helpful alongside any medical intervention that may be prescribed.
Best Tests
Advanced Immune Profile or NK cell activity test: to assess the level of ongoing inflammation and the level of suppression or immune exhaustion. This is helpful to tailor any protocol as not everyone will need to support their NK cell function, but some patients will have quite significant immune exhaustion which may need to be prioritised.
Energy
Ongoing inflammation and reactive oxygen species (ROS) can damage the mitochondria, the energy producing factories of our cells. This results in chronic fatigue and reduced energy output. Reducing the source of damage is important and some supplements might be helpful to support mitochondrial function.
Best Tests
ATP/ Mitochondrial test: to assess energy production in cells. Some specialist supplements may be used if the level of ATP production (energy molecule) is very low.
Digestion/ Gut
The microbiome plays an essential role in immune balance. Beneficial bacteria may be depleted in chronic illness and restoring good gut function is a very important step. Studies have shown that a specific pattern in the microbiome is correlated with increased risk for long covid, including reduction of anti-inflammatory strains and protective bacteria. In addition, probiotic supplementation with or without additional polyphenols can improve fatigue and symptoms in long covid7.
The gut is also the most common viral reservoir, meaning that the virus can persist here in a latent forma after infection. Re-activation of this virus can happen which might be happening in people who think they have be re-infected but in fact they never fully cleared the virus.
It will be important to work with a Nutritional Therapist to slowly augment the diet to support gut health and reduce gut symptoms rather than exacerbate. Including a diet high in polyphenols, such as found in brightly coloured fruits, vegetables and herbs, can be very beneficial to immune balance. However, many of these polyphenols act via the beneficial bacteria in the gut so this may need improvement first. We will work with you to prioritise dietary interventions, it is not a once size fits all.
Best Tests
GI Ecologix stool test is one of our most commonly used to tests to asses the immune interface in the gut and allow us to support recovery of the microbiome. It also includes markers of pancreatic function.
Hormonal interactions
Cis-gender females may be 3-4 times more likely to have long COVID8. Females express immune receptors differently to males, having higher responses to viral infection, producing more antibodies and more severe reactions also to immunisation for example9. A higher immune response is associated with greater risk of developing long covid.
Some patients will also feel like their symptoms wax and wane through the menstrual cycle and hormonal imbalances could impact their wellbeing further. Low oestrogen in the perimenopause or menopause can also mimic a number of symptoms and be a significant confounding factor in recovery.
Other factors/ systems
Thyroid function should be carefully assessed in all long covid. It is critical to immune balance, energy production, hormone production and digestion amongst other systems. We offer more comprehensive testing if this is needed.
Nutrient deficiencies can be measured by blood tests with our clinic. This can show whether you are deficient in protective antioxidants, anti-inflammatory nutrients and fats and of course, the level of vitamin D is very important.
Adrenal function may be impacted by illness. Often lifestyle interventions are important including maintaining a good circadian rhythm and utilising gentle approaches that will not exacerbate fatigue.
Lung, liver, heart, kidney, pancreatic inflammation may be detected by your GP, if you have been for any scans or seen a specialist. Inflammatory markers can be monitored using blood tests with our clinic which may be useful for assessing progress. We can work alongside your medical doctor to support a reduction in inflammation.
Best Tests
DUTCH Adrenal profile
Thyroid testing – comprehensive panels via at-home pin prick test or phlebotomy via our clinic
Functional Nutritional Profile – blood test for nutrients
Blood tests for markers of inflammation, inflammatory cytokines to monitor progress
Where to start?
Because everyone experiences long covid differently, it is best to have an initial consultation with our team so that we can tailor your protocol specific to you.
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References
- NICE guidelines – Overview | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE
- Longitudinal immune dynamics of mild COVID-19 define signatures of recovery and persistence. BioRxiv 05.26.442666
- Davis et al (2021) Characterising long covid in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine 38:101019
- Varcetta at al (2021) Unique immunological profile in patients with COVID-19. Cellular & Molecular Immunology 18;604–612
- Van Eeden et al (2020) Natural Killer Cell Dysfunction and Its Role in COVID-19 Int J Mol Sci21(17): 6351
- Weinstock (2021) Mast cell activation symptoms are prevalent in Long-COVID. Int J Infect Dis 112:217-226
- Thomas et al (2022) A Randomised, Double-Blind, Placebo-Controlled Trial Evaluating Concentrated Phytochemical-Rich Nutritional Capsule in Addition to a Probiotic Capsule on Clinical Outcomes among Individuals with COVID-19—The UK Phyto-V Study COVID 2(4), 433-449
- Bai et al (2021) Female gender is associated with long COVID syndrome: a prospective cohort study. Clinical Microbiology and Infection; 11.00.
- Klein (2012) Sex influences immune responses to viruses, and efficacy of prophylaxis and therapeutic treatments for viral diseases. 34(12): 1050–1059.
