Dealing With Long COVID

“Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible.”

—Francis of Assisi

In our first post about dealing with Long COVID, we gave a background about symptoms and the medical community response to the syndrome. In Part II of our three part series on Post COVID Inflammatory Syndrome, we addressed some risk factors for Long COVID. Now in part III, we’re going to briefly do a 10,000-foot overview of some of the treatment options for Long Haulers and those affected by Long COVID.

This article is not meant to be a complete or exhaustive listing of all the treatment options. Instead, it’s to start the conversation and create some talking points and questions for patients to take to their practitioners. This can also serve as an educational starting point for practitioners as they learn about post-COVID and Long Haulers. All of the suggestions outlined below should be done with your primary care provider and supervising physician.

Over-the-Counter Medications With a Big Impact on COVID

Let’s talk about mast cells. It appears that both acute COVID and post-COVID can most likely be categorized as a mass cell activation syndrome. While this sounds a little scary, what this actually means is simple H1 and H2 histamine blockers can be very helpful in easing symptoms. Your good ol’ Pepcid is a H2 blocker that is already being used for prevention and treatment of severe COVID in hospitals.

We’re now coming to realize that H2 blockers (like Pepcid) can also be used in combination with H1 blockers (like Zyrtec, Claritin and Allegra) as an outpatient solution for Long COVID.

Natural Alternatives for Stabilizing Mast Cells

When dealing with Long COVID, it’s also helpful to take a holistic, natural approach on the road to recovery. By taking inflammation, gut health and nutritional deficiencies into account, we can start to address some of the symptoms Long Haulers are dealing with.

Some vitamins and anti inflammatory supplements to take a look at are:

• Quercetin: Quercetin is an onion extract that can stabilize mast cells, helps with gut inflammation and boosts immune reactivity
• Vitamin D and Vitamin C: You’re probably already familiar with these two! They’re massively helpful in dealing with COVID symptoms
• Luteolin and OAA:  Luteolin is an anti-inflammatory molecule that a lot of people might be  familiar with and associate with eye Health, but it also helps stabilize mast cells. Enol-oxaloacetic acid, or OAA, is a metabolism precursor that can help patients with fatigue—andalso has been used by some researchers for mast cell activation syndrome

Nutrient Deficiencies and COVID

So obviously if supplements can help ease symptoms associated with mast cell activation syndrome, we need to think about nutrient deficiencies when it comes to COVID and Long COVID

Doing a nutritional evaluation can be very important, but it can also be costly. Without doing an evaluation we already know through statistics that there are some things that most Americans are deficient in—and some of these things are directly related to Long COVID or post-COVID.

Nutritional deficiencies common in the United States include:

• B Vitamins: The first of these deficiencies are your B Vitamins. These include thymine (B1), riboflavin (B2), B12, folic acid (B9), pyridoxine (B6). Interesting tidbit:  Thymine was one of the vitamins that was used at Eastern Virginia Medical School in the hospital with their COVID patients.
• Trace minerals: Trace metals are also important, and the most important of these is zinc—but selenium, manganese, copper, a whole host of other minerals are important. Many Americans are deficient in these.
• Ultra-trace minerals: And then there’s ultra-trace minerals. These are the things you get from bones, organ meat andseaweed. Most Americans are deficient in these, mainly because of the fact that we turn to processed foods instead of eating them in their natural whole food form. .
• Vitamins D and C: As we mentioned above, D and C can help deal with COVID—and most of the population are deficient.

By identifying and dealing with nutritional deficiencies, we can start to get to the root of Long COVID symptoms.

Long COVID Disease-Specific Conditions

When approaching post-COVID care, we also want to think about disease-specific symptoms and offer solutions for each of said symptoms.

Some of these symptoms (and solutions) include:

• Shortness of breath: This common post-COVID symptom tends to be related to small arteries in the lungs not getting appropriate blood supply and having small micro clots. Things like inositol, cysteine or NAC supplements have been shown to break these down, as well as resveratrol (which is a NLRP3 stabilizer) and helps treat the inflammation here.
• Pain: With the pain that’s related with COVID, as well as some fatigue, low-dose naltrexone can have a lot of impact. Low-dose naltrexone is also currently getting ready to be studied as a stand alone medication for long COVID. It’s an immune modulator that helps balance your innate and your adaptive immune system, and has been used with chronic fatigue, fibro dysautonomia, Postural Orthostatic Tachycardia Syndrome (POTS), SIBO, IBS, and a whole host of other auto-inflammatory syndromes.
• POTS: If you have any POTS or dysautonomia symptoms, you need to treat that, specifically. Patients who have any form of dysautonomia or POTS,are not going to have enough blood flow to their organs, brain, or heart, etc. So just increasing blood flow to these organs will help you feel better. The Children’s Hospital of Philadelphia has a whole host of exercises that can be helpful to increase blood flow to your organs. Compression clothing and compression stockings can be helpful to increase blood flow to your core organs. Balancing minerals with sodium chloride and lots of hydration is super important. There are medications that can be used for this, but those need to be done by pot specialists, or dysautonomia specialists.
• Fatigue: Fatigue is a very common symptom for Long COVID. Melatonin is a really great anti-inflammatory, a brain anti-inflammatory, as well as a sleep supplement. It’s one of the preventatives and treatment supplements that were recommended in our COVID guide in April 2020, and is also used at Eastern Virginia Medical School.  Magnesium glycinate is another great solution to help you sleep soundly and battle fatigue. Magnesium is a great calming mineral. It also helps block the NMDA receptor, which is a brain inflammatory receptor. The glycinate (or glycine amino acid) in it, has a detoxifying factor and helps with the body’s production of glutathione.

Treating Underlying Functional Conditions

When dealing with Long COVID, it’s truly helpful to treat some underlying functional conditions.

This includes looking at the gut/brain immune access. Does the patient have gut symptoms? That’s a sign that immune symptoms need to be addressed. This is a big, deep dive in itself, and I’ll only mention it briefly here.

Let’s go further into a great way to address a host of underlying functional conditions: Detoxification. Detoxing is a huge part of dealing with the inflammation factor with Long Haulers. Here are some things you can look at in your own life:

• Air quality: How clean is your air? Check your house and your environment out, looking for the quality of your air. Why is this a big deal? We know micro particulates have a huge lung inflammatory aspect, and they also cause inflammation in the small arteries and endothelium. Something as simple as a HEPA filter can be a nice way to start  this.
• Water quality: We inhale clarets, chloroform, chloromethanes and a whole host of chemicals routinely when we take showers. If you want to learn about the water quality of your house, check out the environmental working group’s tap water database at ewg.org/tapwater. Check in your zip code there and you’ll have a whole host of information on how clean your water is.
• Diet: And finally, food. Food is just a really, really big deal when it comes to post-COVID care and treating inflammation in general. . If you’re inflamed and you don’t address the way you eat, it’s going to be hard to recover and this applies to long-COVID too.. Start with a clean anti-inflammatory diet. The Renew Food Plan from the Institute  for Functional Medicine is a great place to start.

Repurposing Medications for COVID

We’ve mentioned low-dose naltrexone multiple times as an immune modulator for COVID, but this really is a great repurposed drug.

Other repurposed drugs include ivermectin, which is still considered controversial, but has been used by the Eastern Virginia Medical School, FL CCC group, as well as practitioners in Central South America and Brazil. It’s a pretty safe medication that’s been used worldwide. Over 30 billion doses have been given throughout its history.

There are other undoubtedly additional repurposed drugs to come as we learn more.   As some are added to the list, some will come off. But the point is, we have other options and we’re learning on the fly. We are just at the beginning of this wave of this ‘Post-Pandemic Epidemic.’

Helping Long Haulers is a great opportunity for functional medicine practitioners to walk hand-in-hand with local primary care physicians, to give them the tools and the concepts they’ll need to take care of their patients. Just documenting symptoms won’t be enough. We’ll need to act in conjunction with our patients and this will need to start at the grassroots level. It can’t be a top down. It has to be a bottom up.

I hope this three-part series on long COVID was helpful. The purpose of this is just to educate people, to engage the practitioners, and get the word out there that there are things we can do for post-COVID and Long COVID patients, treating post-COVID syndrome and helping them recover to full health. We’re ready to act.