Dr Jess says: Long COVID is the description for ongoing symptoms that continue for several weeks or months after coronavirus infection. This doesn’t always seem to be related to how bad your symptoms were, although I have definitely seen it more in people who had to go to hospital or had strong symptoms. Fatigue, headaches and feeling run down have been common complaints in many of my patients.
Approaching COVID-19 like recovery from any other serious illness, like flu or a chest infection, has meant that most of my patients have made a full recovery after we supported their health, nutrition and immune system and in many cases, we used adaptogen herbs.
Stress, anxiety, and social isolation have led to being out of our normal diet and exercise routines, lowering our health and increasing our susceptibility. We can learn a lot from the traditional Chinese philosophy of immune health. We should all make convalescence after an illness a part of modern life, wherever possible, to give your body the time and support it needs to heal
what is long COVID?
Obviously, we are all still collectively learning about coronavirus, COVID-19 and its causes, effects and treatments. We all know that some people develop symptoms that are much worse than they are in other people and for a small percentage of people who contract COVID-19, they go on to develop what is being referred to as ‘long COVID’.
10%1 of patients with COVID-19 report fatigue (tiredness), breathlessness, brain fog and in some cases pain for three weeks or longer after their initial infection. These symptoms have also occurred in some people who only had mild cases of COVID-19. There appears to be a proportion of people who are still experiencing ongoing symptoms for some time after their initial COVID-19 infection has resolved. In some people, these symptoms disappear spontaneously, but in about 1 in 201 people, they are still present up to six months later.
what are the symptoms of long COVID?
Ongoing for more than four weeks*:
- Breathlessness and cough
- Chest tightness, chest pain or palpitations
- Positional changes in heart rate or blood pressure (see POTs below)
- Brain fog
- Sleep disturbance
- Pins and needles
- Chronic pain
- Recurrent infections
- Low mood or anxiety
- Sore throat
- Loss of taste or smell
- Diarrhoea, nausea, reduced appetite
*If any of these symptoms have persisted for more than a few weeks, it’s important to see your doctor or healthcare professional to rule out any other possible causes.
why might some people develop long COVID?
There are several current theories as to why some people have gone on to develop long-term symptoms after COVID infections:
1. Stress and anxiety: We definitely aren’t saying that it’s all in your head, or made up! The last few years have been extremely stressful for almost all of us. Stress has a big impact on our immune health, making us more susceptible to all kinds of recurrent infections and also mean that we are less likely to heal well.
The fear and anxiety about a positive PCR test, particularly in vulnerable patients or those with underlying health conditions, can create a very real and strong stress reaction that comes about from worrying about ending up in hospital, or even dying, or passing COVID on to our loved ones. We can struggle to recover properly from all kinds of illness and infection when we are stressed.
People with pre-existing mental illness were 65% more likely to be diagnosed with long COVID in a recent Lancet study.2
2. Post-viral fatigue. This condition is poorly understood, but is a widespread diagnosis, linked to ME and chronic fatigue syndrome. Some viruses seem to be more likely to create ongoing fatigue after infection and can also leave your immune system more vulnerable to other infections. Glandular fever or mononucleosis are common examples that can leave people feeling fatigued for many months afterwards.
I see many patients in my clinic who have never been well since an illness and have been diagnosed with chronic fatigue syndrome, which can encompass severe fatigue, muscle and joint aches and pains, depression and sleep disturbance. It can be extremely debilitating.
While we don’t know why some people develop CFS, using a functional medicine approach we can look at nutrition, the body’s ability to heal, gut health and immune health, to form a diagnosis and to help to aid recovery.
Working through The Natural Doctors’ refresh programme could be very helpful. Dr Jess has observed COVID-19 causing fatigue for up to six weeks, during which time her patients appear to be at a higher risk of further infections.
3. Underlying inflammation and blood sugar issues: Evidence has shown that COVID-19 can trigger an inflammatory reaction in the body called a ‘cytokine storm’. This is more likely in those with raised blood sugar3 (one in four of the UK adult population have signs of blood sugar problems). It is also more likely in those with pre-existing inflammation4 – many chronic diseases like autoimmune diseases, heart disease and even cancer and dementia can be linked to long-term, low-level inflammation. Unfortunately, we are in an epidemic of inflammation, and this is likely why those countries with a high proportion of overweight and obese individuals have a much higher rate of complication and death from COVID.
The good news is that you can change your health with lifestyle, food and nutrition. Our refresh programme and our immune and infection toolkit can help you improve inflammation and blood sugar control.
4. Autoimmune reaction: Other viruses that we know more about than COVID have been shown to trigger autoimmune diseases. An autoimmune disease occurs when the body becomes confused – which can be because of a viral infection. The body produces antibodies that damage its own tissues.
There is a theory that Long COVID occurs due to these autoimmune antibodies. Support for this theory comes from evidence that some long COVID patients experience conditions called POTS (Postural Orthostatic Tachycardia Syndrome) and orthostatic hypotension – the heartbeat and blood pressure are affected by standing up and changing position and can cause weakness, dizziness and fainting. POTS are shown to be related to the same antibodies that work against our own tissue.5
POTs would again make it important to work on underlying inflammation and look at the immune and infection toolkit as well as considering circulation supports like magnesium, coenzyme Q10 and possibly herbs like Crataegus spp. (hawthorn) and Leonorus cardiaca (motherwort).
5. A traditional Chinese medicine (TCM) explanation: The philosophy of TCM is thousands of years old, based on the observation of the human body long before we fully understood anatomy, physiology or viruses. Their explanation for post-viral symptoms is that we all have a defensive ‘coat’ that protects us from infectious illnesses (we would now call this the immune system) which they call the Wei Qi. This coat can be a fine mesh or it can be a suit of armour (it depends on our underlying health). When something attacks, it can either bounce off a suit of armour, barely causing any symptoms, or it can go straight through the thin mesh coat and invade deeply, causing strong symptoms and long-term damage to our deeper energy. By improving our ‘wei Qi’ we can all build our metaphorical suits of armour, so that infections don’t cause us as much damage.
how do you support long COVID?
With a whole-body approach that focuses on:
Good nutrition: A diet that is low in processed food, high in healthy omega 3 fats and grass-fed animal proteins (if possible), rich in plant foods and low in sugar is the best way to fortify your immune system and reduce inflammation. Try The Natural Doctors’ refresh programme for how to do this. Our recipe area is also full of healthy, nutritious recipes.
Restorative foods: Culturally, we have used soups and stews for thousands of years to help us recover from illness and it makes sense that when the body is weakened we should whole foods, vegetables and broths to help us restore depleted nutrients. Many cultures have a ‘chicken soup’ philosophy and a couple of small studies have shown that chicken soup and bone broth may help the immune system.
By optimising your nutrition and supporting your gut, and taking the time to heal, we are more likely to recover more rapidly from any illness. Convalescence is an old-fashioned word for resting and taking time out after illness and is something we should consider doing in modern life, wherever possible, before rushing back to our busy lives. Try our delicious Thai chicken noodle soup and sweet potato & miso soup, if you are in need of a nourishing (and tasty) immune boost.
Appropriate vitamin supplements. Consider having your vitamin D levels tested (many people in the UK have low levels of vitamin D, even in the summer. This can cause fatigue and low immunity. Also consider taking supplements for boosting magnesium, B vitamins, iron and zinc to recover and fortify your immunity.
Consider Coenzyme Q10 supplementation – There is evidence that COVID-19 may cause mitochondrial dysfunction (the mitochondria in our cells produce the energy for our body). Several research papers have hypothesised that supplementation with Coenzyme Q106,7,8 (which we recommend in the form ubiquinol), which has been shown to support the mitochondria and improve inflammation,9 may be helpful in recovering from COVID 19. Lamberts ubiquinol is a good brand, safe to take daily.
Consider N-Acetyl Cysteine supplementation – N-Acetyl cysteine has anti-viral activity and may directly inhibit COVID-19. It can also support the immune system and lung function and has shown promise in case studies during COVID-19 infection showing some positive results.10 N-Acetyl Cysteine is a widely available supplement which has been shown to be extremely safe and can be taken daily.
Stress and mental health support. We are big believers in ongoing mental health support for all. At The Natural Doctors, we have many ways of reducing stress, through our mindfulness area, yoga area and brain function and mental health zone. Making regular time for your brain to detox with practices like meditation and time in nature to regenerate and repair can have miraculous effects.
Consider acupuncture, herbs or seeing a functional medicine practitioner. There are many supports in integrative and functional medicine that can help boost your health. A functional medicine practitioner can take a full history to look for any root causes or triggers and help you deal with them.
There are many traditionally-used medicines like traditional Chinese medicine that have herbs that they have used for thousands of years to recover from illness. Astragalus is an excellent example of this and is historically used as a ‘wei Qi‘ herb, taken after infection for exhaustion, breathlessness, lung issue, aching and boosting immunity. It is also considered to be an adaptogen – a herb that helps the body deal with stress. It can be added to soups and stews, as well as taken as a supplement, like our Plant+.
- Whitaker M, Elliott J, Chadeau-Hyam M, Riley S, Darzi A, Cooke G, Ward H, Elliott P. Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people, REACT-2 long covid. Pre-print, Imperial College London. 2021
- Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021 Feb;8(2):130-140. doi: 10.1016/S2215-0366(20)30462-4. Epub 2020 Nov 9. Erratum in: Lancet Psychiatry. 2021 Jan;8(1):e1. PMID: 33181098; PMCID: PMC7820108.
- Erener S. Diabetes, infection risk and COVID-19. Mol Metab. 2020 Sep;39:101044. doi: 10.1016/j.molmet.2020.101044. Epub 2020 Jun 23. PMID: 32585364; PMCID: PMC7308743.
- Meftahi GH, Jangravi Z, Sahraei H, Bahari Z. The possible pathophysiology mechanism of cytokine storm in elderly adults with COVID-19 infection: the contribution of “inflame-aging”. Inflamm Res. 2020 Sep;69(9):825-839. doi: 10.1007/s00011-020-01372-8. Epub 2020 Jun 11. PMID: 32529477; PMCID: PMC7289226.
- Dani M, Dirksen A, Taraborrelli P, Torocastro M, Panagopoulos D, Sutton R, Lim PB. Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies. Clin Med (Lond). 2021 Jan;21(1):e63-e67. doi: 10.7861/clinmed.2020-0896. Epub 2020 Nov 26. PMID: 33243837; PMCID: PMC7850225.
- Gvozdjakova A, Klauco F, Kucharska J, Sumbalova Z. Is mitochondrial bioenergetics and coenzyme Q10 the target of a virus causing COVID-19? Bratisl Lek Listy. 2020;121(11):775-778. doi: 10.4149/BLL_2020_126. PMID: 33164536.
- Moreno Fernández-Ayala DJ, Navas P, López-Lluch G. Age-related mitochondrial dysfunction as a key factor in COVID-19 disease. Exp Gerontol. 2020 Dec;142:111147. doi: 10.1016/j.exger.2020.111147. Epub 2020 Nov 7. PMID: 33171276; PMCID: PMC7648491.
- Ouyang L, Gong J. Mitochondrial-targeted ubiquinone: A potential treatment for COVID-19. Med Hypotheses. 2020 Nov;144:110161. doi: 10.1016/j.mehy.2020.110161. Epub 2020 Aug 5. PMID: 32795832; PMCID: PMC7403158.
- Hargreaves I, Heaton RA, Mantle D. Disorders of Human Coenzyme Q10 Metabolism: An Overview. Int J Mol Sci. 2020 Sep 13;21(18):6695. doi: 10.3390/ijms21186695. PMID: 32933108; PMCID: PMC7555759.
- Shi Z, Puyo CA. N-Acetylcysteine to Combat COVID-19: An Evidence Review. Ther Clin Risk Manag. 2020 Nov 2;16:1047-1055. doi: 10.2147/TCRM.S273700. PMID: 33177829; PMCID: PMC7649937.