Long COVID-19: Causes and Treatment using Functional Medicine

Are you not feeling yourself since having COVID? Are you tired, achey, suffering from frequent headaches, or your gut is often upset?

Long-COVID, is a varying set of symptoms, ranging from mild to debilitating, that persist weeks to months after initial infection with COVID-19.

These long term COVID symptoms are also knows as PASC, or Post-Acute Sequelae of SARS-CoV and colloquial terms include post-COVID syndrome, long COVID, long-term COVID or simply as “long-haulers”.

In this article, I’ll go in to some depth to explain the underlying imbalances that can drive Long-COVID and why Functional Medicine is a valuable tool in recovery.

If you are feeling unwell but are overwhelmed by the information presented here, that’s OK..

I suggest working with a professional such as myself to get the support that you need. The first step in this case, would be to arrange a free call with myself.

Symptoms of Long-COVID

Surveys from the UK Covid Symptom study app, found a wide range of recurring symptoms are experienced by patients, regardless of whether they were hospitalised, affecting the respiratory system, the brain, cardiovascular system and heart, the kidneys, the gut, the liver, and the skin. The report said these symptoms range in intensity and duration, and do not necessarily present in a linear or sequential manner.

A study from the University of Washington from February 2022 found that 32.7% of COVID-19 outpatients developed long-haul symptoms and 31.3% of hospitalized patients became long haulers. In people with autoimmune disease, that number may be as high as 50%.

Long-COVID seems to be common and the symptoms varied. These symptoms can include any number of the following:

General symptoms

• Fatigue (extreme tiredness)
• Symptoms that get worse after physical or mental effort (“post-exertional malaise”)
• Fever
• Pain
• GI Distress (Abdominal pain, Nausea, Diarrhoea, Weight Loss, Loss of appetite)

• Difficulty breathing or shortness of breath
• Persistent Cough
• Chest pain/ tightness
• Heart palpitations

• Cognitive Impairment (Brain fog, loss of Concentration & Memory)
• Headache
• Sleep problems
• Dizziness when you stand up
• Pins-and-needles feelings
• Mobility Impairment
• Visual Disturbance
• Change in smell or taste
• Depression or anxiety

• Joint, muscle pain and aches
• Rash and/or histamine issues
• Changes in menstrual cycles
• Tinnitus
• Earache
• Sore throat
• Nasal Congestion

Functional Medicine Support

Long-COVID lacks a clear definition, is experienced differently from person to person, and doesn’t have a single or biomarker to identify it. This can make its treatment difficult for conventionally trained doctors.

However, Functional Medicine provides an effective way of working with chronic health conditions such as this. Long COVID may respond well to the tools and treatments used to work with chronic fatigue syndrome, Fibromyalgia and Lyme disease and other multi-system chronic diseases.

Functional Medicine practitioners look at the different systems and organs in the body and their function. When they see someone in a post-infectious state with persistent symptoms, they ask ‘What are the Functional imbalances contributing to this?’.

The root imbalances for someone with Long-COVID may include the gut, their immune system including mast cell activation, or mitochondrial function (it’s likely several of these systems are out of balance). The Functional Medicine practitioner will then target the imbalances of that individual – there is no one size fits all solution for everyone (unfortunately!).

Gut Health

70% of the immune system lives in the gut, protecting our bodies from everything that passes through the gut. Because of this, the gut and the immune system are inextricably linked – an imbalance in one affects the other. The bacteria in the gut therefore helps to regulate our immune system.

New research demonstrates this as it has found a strong link between imbalanced gut bacteria and persistent symptoms in long-haulers up to 6 months after clearing the virus.

Long-COVID is often associated with persistent low grade inflammation in the body for an extended period after clearing the virus. T-Regulatory (T-Reg) cells can influence the immune system and switch-off this inflammation – this is where they get their name of T-Regulatory cells from. The gut plays an important role in the development of these T-Reg cells and so it’s proposed that improving gut health is an important treatment that switches off or dampens this persistent inflammation. See here for an in depth article on healing the gut.

Mitochondrial Restoration for Fatigue

Probably, the most commonly reported symptom post COVID is persistent fatigue, often worsening after physical or mental exertion. In this regard, it can be thought of as similar to post viral chronic fatigue syndrome – a condition which Functional Medicine can be effective in treating.

It is the mitochondria, or the powerhouses of our cells that our responsible for producing ATP, the energy currency that our bodies run on. Recently, several studies have found that patients with long COVID may have compromised mitochondrial function as a result of infection with the virus, and this is likely contributing to their reported fatigue through a reduction in ATP produced and something called oxidative stress. When stressed (not working optimally), mitochondria will switch roles from producing energy to signalling that there is a threat (the cell danger response), leading to further inflammation.

In addition, the findings of a recent study, found that people with long COVID were unable to produce normal amounts of energy from the breakdown of fatty acids. This is important as the body burns glucose and fatty acids to make ATP (energy), and burning glucose creates more of the oxidative stress that I mentioned earlier and so can be considered less ‘clean’ burning. A patient with Long Covid may need nutritional and supplemental support to help their mitochondria burn fatty acids. Once this is in place, having more good fats, and avoiding processed vegetable oils, in their diet will then be helpful.

It’s important to bring your mitochondria back up to full energy producing capacity to feel better. There are many supplements available to use to boost mitochondrial function (such D-Ribose, B Vitamins, CoEnzyme Q10, Vitamin C, Glutathione). However eating an anti-inflammatory diet, not eating to excess, and focussing on sleep and rest, should be the foundation of any program for improving mitochondrial health. There are many other tools in the Functional Medicine toolbox to support the mitochondria but it’s important to lay the foundations first..

Immune System Balance

The underlying mechanisms for long COVID are still not clearly defined in the scientific research, but a sustained inflammatory response caused by the persistence of the virus in tissue and organs, or autoimmune processes (where the body is essentially attacking itself) are two of the most considered hypotheses.

Following COVID infection, chronic inflammation and cellular damage in the body can remain. This explains the myriad of possible symptoms reported. This inflammation can be reduced at its source through a process known as autophagy. Autophagy is the process by which old ‘malfunctioning’ immune cells are cleared and replaced with new cells that function appropriately. Overtime, this leads to a reset of the immune system.

Resetting your immune system involves a comprehensive strategy that takes time to see the full benefit. Some ways to boost autophagy in particular include:

• Intermittent fasting or a fasting mimicking diet
• Good quantity and quality of sleep
• Specific immune-enhancing nutrients like Sulforaphane, Vitamin A and D, Zinc, Vitamin C, NAC
• Healthy diet and lifestyle as illustrated at the end of this article

COVID also appears to cause a re-activation of viruses, particularly the Epstein Barre Virus (EBV), in some individuals. In one study of 185 COVID patients in which 56 (30.3%) reported persisting long-COVID symptoms, 67.7% were positive for EBV reactivation compared to 10% of control subjects who did not have COVID. When this happens, you are now dealing with re-activated EBV and this may need to be treated. Further research is also finding that mast cell activation symptoms, which are histamine mediated, are also prevalent in long-COVID and may need addressing.

Auto-Immunity

A new study has suggested the body can produce higher than normal amounts of autoantibodies months after contracting even “mild severe” COVID infection. These autoantibodies indicate an auto-immune process where components of the immune system are directed against our own tissue; Commonly this is referred to as the immune system attacking our own tissue. Long COVID can have an unpredictable flare and remission pattern and cause similar symptoms to auto immune conditions such as rheumatoid arthritis and lupus .

If auto-immunity is found, then steps should be taken to reduce this auto-immune process by going through the Functional Medicine process of identifying and addressing any imbalance in the body or environmental trigger including poor diet and lifestyle habits.

Nutrition and Lifestyle

I can’t wrap up this article without stressing the importance of nutrition and lifestyle when healing from any chronic health condition. I’ve included just a brief general outline of some supportive recommendations here:

Diet, A diet low in refined starch and sugar, high in omega-3 fatty acids, and high in specific dietary polyphenols and flavonoids (i.e. brightly coloured fruit and veg)

Sleep, Getting enough sleep is vital to our health, to repair and restore.  Sleep also affects the gut microbiota.   Adults needs 7-9 hours sleep each night. There are many herbal options to assist with sleep issues.

Hydration, drinking adequate water is vital for proper hydration, flushing toxins in the body and contributing overall to immunity.  Herbal teas are also a great hydrating option.

Rest and recouperate, keep warm and get some sunlight exposure daily.

Need some professional help?

As I have discussed, Functional Medicine provides a very effective framework for working with chronic health issues such as Long COVID. It targets the underlying imbalances in the body of the individual to improve symptoms and also benefit overall health.

If you would like professional help with your recovery, we offer a personalised Functional Medicine Program that is ideal for this purpose. The first step to see if this is right for you is to arrange a time for a free introductory call.