Although there’s a lack of consensus on what to call it—long Covid, chronic Covid syndrome, post-Covid-19 syndrome or long-hauler Covid-19—it’s now widely accepted that some people are experiencing lingering post-viral symptoms after being infected with SARS-CoV-2, the virus that causes Covid-19. These symptoms include debilitating fatigue, breathing difficulties, brain fog, aches and pains and many more.
In a recent review of nearly 48,000 patients between 17 and 87 years old, 80 percent of those who had Covid developed one or more symptoms lasting beyond three weeks, the most common ones being fatigue, headache, attention problems, hair loss and shortness
Another study reported symptoms that persisted for at least three months in patients with both mild and severe Covid-19.2
Comparisons are being drawn to chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME). In a letter published in the British Medical Journal, Dr Charles Shepherd, trustee and medical adviser to the ME Association, points out the “important clinical and pathological overlaps between long Covid and ME/CFS” and that “a wide range of viral infections, including coronavirus infections, are capable of triggering a post viral fatigue syndrome and subsequent ME/CFS.”3
Indeed, evidence from the SARS (severe acute respiratory syndrome) epidemic shows that these effects can last for years.4
So what can you do if you’re suffering from long Covid? According to Dr Jeffrey Bland, the solution doesn’t lie in conventional medicine, which typically focuses on managing symptoms and treating specific organs, but in a functional medicine approach, which looks at what’s causing the symptoms in the first place and views the body as a whole.
Based on his three decades of research and experience working with patients with CFS and post-viral syndromes, Bland, known worldwide as a founder of the functional medicine movement, has identified four strategies he says are key to long Covid recovery, which he outlines in a recent video. 5 These strategies are meant to be carried out under the guidance of an experienced functional medicine practitioner, who can individualize the treatment plan to your needs. But here are the general guidelines.
“The gut immune system is tightly tied to symptoms of energy deficit, immune dysfunction and chronic inflammatory states—the characteristics that define some of the symptomatology found in long-hauler post-Covid-19,” says Bland. So addressing the gut should be an essential step in any treatment plan.
Functional medicine practitioners like Bland use the 4R program to restore gut health, which stands for remove, replace, reinoculate and repair:
• The ‘remove’ phase involves cutting inflammatory and common allergy-producing foods from the diet, such as dairy products and gluten-containing grains.
• The ‘replace’ phase involves eating healthy, ‘clean’ foods and supplementing, if needed, with digestive aids such as digestive enzymes.
• The ‘reinoculate’ phase focuses on restoring a healthy microbiome with probiotics (gut-friendly bacteria) and prebiotics (types of fiber that help the good bacteria grow).
• The ‘repair’ phase involves taking additional nutritional supplements to promote repair of the intestinal lining.
These supplements include:
L-glutamine: 6–10 g/day
Glycine: 6–10 g/day
Pantothenic acid: 500–1,000 mg/day
Zinc citrate: 10 mg/day
Omega 3 EPA/fish oil: 1–3 g/day
Vitamin E (mixed tocopherols): 400 mg/day
This program is meant to be followed for three months, with weekly check-ins with your practitioner, who can tweak it as needed.
The second crucial strategy is supporting the liver and other organs involved in detoxification—the process of converting toxic substances so that they can be safely and successfully eliminated from the body.
A number of factors, such as genes, nutrition and lifestyle, can affect a person’s capacity to detox, so employing methods such as reducing your exposure to potentially toxic chemicals in the home, eating a nutrient-rich diet and taking specific supplements can play an important role in getting your health back on track.
Click here for functional medicine doctor Jenny Goodman’s guide to detox.
According to Bland and other functional medicine practitioners, long Covid, like CFS/ME, is a mitochondropathy—an illness caused by the malfunctioning of the body’s energy-producing organelles, the mitochondria. And this is why fatigue is a
The good news is that there are specific ways of approaching nutritional and lifestyle support to improve biological energy production and combat fatigue, says Bland.
Indeed, Dr Sarah Myhill, a functional medicine doctor and author of Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis, who has successfully treated more than 5,000 patients with chronic fatigue, has developed a treatment package for failing mitochondria as part of her protocol for CFS/ME. This involves:
• Supplementing with D-ribose, magnesium, acetyl-L- carnitine, coenzyme Q10 and nicotinamide adenine dinucleotide (NADH), to feed the mitochondria
• Getting enough sleep, to repair the mitochondria (aim for nine hours between 9:30 p.m. and 6:30 a.m.)
• Pacing, which is finding the right balance between rest and activity, to avoid undue stress to the mitochondria
• Detoxifying, as everyday pollutants like heavy metals, pesticides, drugs, alcohol and tobacco can poison mitochondria.
You can find out more about Dr Myhill’s comprehensive program in her book and via her website, www.drmyhill.co.uk.
The last strategy that Bland says is vital for Covid long-haulers is ‘immuno-rejuvenation.’ This is not just immune support, says Bland.
“What we find in Covid-19 long haul patients is that their immune systems are damaged. Damaged means it’s picked up injuries from the insult of the viral infection. And those immune systems remember that injury. Even after they’ve gotten over the immediate chronic infection.”
This injury translates to inflammation, says Bland, which perpetuates the symptoms like fatigue, muscle aches and pains, depression and digestive problems that are experienced by long Covid sufferers.
The solution is to not simply support the damaged cells, but to actually replace them using a process called autophagy, says Bland.
Autophagy is a natural process whereby the body’s cells clean out any unnecessary or damaged components. And there are a number of ways to stimulate and support this.
One is to provide the body with the nutrients needed for cellular renewal. These include vitamins C and D, zinc, and a family of plant compounds called flavonoids, which include quercetin, rutin and hesperidin.
These flavonoids are “specifically shown to have influence on autophagenic processes of the immune system—to cleanse, regenerate, rejuvenate the immune system,” says Bland.
Flavonoids can be found in brightly colored fruit and vegetables, but a particularly rich source is Himalayan Tartary buckwheat, which Bland has harnessed with his company Big Bold Health to create a range of supplements to help rejuvenate the immune system (see www.bigboldhealth.com).
According to Dr Rob Verkerk, scientist and director of the Alliance for Natural Health, another important tool for autophagy is intermittent fasting, when you alternate between periods of fasting and eating, such as with the 16/8 method, which involves fasting for 16 hours and eating within an eight-hour window.
“Our natural evolutionary autophagy mechanism is fasting,” says Verkerk, “which is why intermittent fasting provides such an array of health benefits.”
In fact, scientific studies have shown that fasting activates autophagy, which in turn promotes immunity. And some researchers have even suggested intermittent fasting as a potential strategy to fight Covid-19.6
These four strategies, which work on the ‘upstream’ causes involved in long Covid, have enabled many patients with CFS and similar syndromes to completely recover, says Bland. “I think this can reduce an extraordinary unnecessary burden of dysfunction and disease,” he says.
To find a functional medicine practitioner, visit the website of the Institute for Functional Medicine (www.ifm.org) or Natural Health Worldwide (www.naturalhealthworldwide.com). And the Functional Medicine Coaching Academy (www.functionalmedicinecoaching.org) can connect you with a health coach to help you implement your health program.
Dr Jeffrey Bland: www.jeffreybland.com
Get Well’s Healthy Gut Intensive recordings, where Bland discusses the 4Rs: www.getwell.solutions
WDDTY’s How to Combat Chronic Fatigue report: www.wddty.com/products
Res Sq. Preprint. 2021 Mar 1. doi: 10.21203/rs.3.rs-266574/v1
ERJ Open Res, 2020; 6: 00542–2020
BMJ, 2020; 371: m4938
BMC Neurol, 2011; 11: 37; Arch Intern Med, 2009; 169: 2142–7
Covid-19: The Functional Medicine Solution for Long-Haulers, available via Vimeo
Immunol Lett, 2020; 226: 38–45