Many people who get sick with COVID-19 (SARS-CoV-2, which I’ll call Covid for the duration of this post), even those with minor illness, do not experience a smooth recovery. Certain people who recover from the acute Coronavirus SARS-CoV-2 illness are left with longterm symptoms, known as long haul syndrome or long covid syndrome, that last for weeks or months and may fluctuate from day to day.
Long Covid syndrome is a persistent inflammatory condition marked by profound fatigue, shortness of breath, and neurological symptoms. There have been at least 200 symptoms associated with long covid (!!), (source) but the most common are fatigue, brain fog, headache, pain, breathing difficulties, mood swings, and circulatory problems. Loss of taste and smell may also persist.
Roughly 30% of people who’ve had Covid develop long Covid syndrome. People with a history of hospitalization, diabetes, and higher body mass index are most likely to develop long Covid based on the data we currently have. But the incidence and risk factors of long Covid still remain unclear. (source) Presently, there are no standard therapies or medications to treat long Covid symptoms in the conventional medical world.
We’ve made great strides in understanding what causes long Covid, and that’s helped us develop protocols to address the dysfunction it causes. Recovery from long Covid seems to vary: Some people have a long, slow recovery while others fluctuate between good and bad days (or weeks), but we’re discovering how to best address long Covid syndrome by addressing the underlying causes and the right nutrients to help you heal mitochondrial and organ damage.
What is Long Covid Syndrome?
A person is determined to have long Covid syndrome if he/she reported persistent symptoms 2-3 months after infection or hospitalization. Some research suggests that the virus may set off an autoimmune reaction that causes lingering symptoms. Researchers suspect long Covid acts like an autoimmune disease: Some people who get COVID-19 develop “auto-antibodies” that attack their own proteins — a hallmark of many autoimmune diseases. That process leads to inflammation that could trigger long COVID. (source)
Here’s what happens with long Covid:
The SARS CoV-2 is a respiratory virus with a spike protein that has an affinity for the cells that line your blood vessels, your endothelial cells. The virus invades your cells by locking into the ACE2 receptors that line your cells (this will come up later), which causes inflammation and vascular endothelium damage that produces blood clots and interferes with the delivery of oxygen to tissues. All your vital organs depend on good circulation for oxygen delivery. Long Covid causes circulatory challenges and massive damage to blood vessels and endothelium. This also causes systemic inflammation.
In fact, one recent study found persistent elevated inflammatory markers such as D-dimer and CRP In patients who’d had Covid and recovered from the acute illness. Study also found high ferritin levels among COVID-19 survivors 2 months after the onset of COVID-19. (source) Systolic blood pressure was significantly elevated in COVID-19 survivors.
Your brain has the greatest need for oxygen and is especially susceptible to Covid damage. MRIs in people who’d had Covid showed changes in the gray matter of the brain consistent with impaired circulation. We know neuro inflammation and destruction of brain tissue and neurons are present with long Covid.
Long Covid also causes mitochondrial damage. Your mitochondria are the energy producing powerhouses of your cell. Mitochondrial damage causes the profound fatigue that long haulers experience. Read more about your mitochondria and their role in energy production here. Reduced oxygen causes mitochondrial damage. Mitochondrial repair is a key element in healing long Covid.
We’re also seeing changes and damage to your gut microbiome with long Covid because the virus can remain in the GI tract after infection clears, causing (you guessed it) inflammation. Ongoing diarrhea or gut pain that doesn’t clear is an indication that the virus is affecting your gut. The bacillus probiotic listed below in the supplement section can help.
Basically what happens is in the acute phase of Covid, you experience damage to your blood vessel lining and inflammation that creates a lot of oxidative damage. This is a huge stress on your system, and circulation suffers, your mitochondria die, and you have fatigue and trouble breathing. The inflammation and poor circulation cause neurological symptoms like brain fog and depression, and inflammation destroys your mitochondria, causing fatigue. You may have changes to your gut health and microbiome.
In a “normal” Covid response, your cells react to the virus; there’s oxidative stress and changes and damage to your cells; there’s cell death. But then there’s a repair cycle in which destroyed mitochondria are rebuilt, and you recover normally. If the process doesn’t go like that, you get stuck in this hypo-metabolic state (which basically means oxygen starved brain and mitochondrial dysfunction and down-regulation).
There also seems to be quite a bit of metabolic damage with long Covid. Diabetes rates skyrocketed in people who’d had Covid. Even mild Covid infections can amplify a person’s chance of developing type 2 diabetes, especially for those already susceptible to the disease. (source)
So: long Covid affects your brain, metabolism, circulation, mitochondria, gut biome, and blood vessels. You have chronic inflammation and oxidative stress from the Covid cytokine storm. You’re low in antioxidants and B vitamins which your body has burned through quickly in response to the oxidation and inflammation. Maybe you still can’t taste or smell. Your symptoms persist and may fluctuate, meaning you get better and worse. Many people compare long Covid to chronic fatigue syndrome and fibromyalgia.
Who Gets Long Covid Syndrome?
According to current research, the most common risk factors are
- Insulin resistance
- Gut microbiome imbalance
- Metabolic syndrome: High blood pressure, high blood sugar, obesity
- Weakened immune system
- Cardiovascular disease
- COPD or lung issues
- Other existing and underlying infections
- Chronic health issues
- Smoking and alcohol addiction
- ACE2 receptor deficiency problem
Long haul people have a deficiency in ACE2 receptors which is contributing to oxidative stress. When not enough ACE2 is present, the immune system can produce too much inflammation. Excessive inflammation could also boost production of autoantibodies that had previously only existed in the body at very low levels. (source)
Some degree of ACE2 deficiency has been associated with a variety of conditions including older age, hypertension, diabetes and cardiovascular disease, which also characterize people more likely to be infected and to present more severe complications. Clinical reports of patients infected with SARS-CoV-2 show that several features associated with infection and severity of the disease (i.e., older age, hypertension, diabetes, cardiovascular disease) share a variable degree of ACE2 deficiency. (source) So, correcting ACE2 deficiency is another key element in long Covid recovery.
Researchers have identified four factors that correlate with long Covid: (source)
- the level of coronavirus RNA in the blood early in the infection, an indicator of viral load.
- the presence of certain autoantibodies — antibodies that mistakenly attack tissues in the body as they do in conditions like lupus and rheumatoid arthritis.
- reactivation of Epstein-Barr virus, a virus that infects most people, often when they are young, and then usually becomes dormant.
- having Type 2 diabetes
Additionally, there’s some level of viral antigen that’s lingering in the body. There could be reactivation of pathogens or viruses like Epstein-Barr. Long haulers often have gut dysbiosis, inflammation, higher risk of blood clots, and higher risk of developing diabetes and autoimmune disease. (source)
How to Beat Long Covid Syndrome
The main goal in overcoming and healing long Covid is to restore mitochondrial function, address ACE2 receptor deficiency, repair organ damage, combat inflammation, and address gut damage. You’ll also need to pay mind to sleep, stress, and your diet. It’s time to baby yourself and put your health first.
The first factor to focus on for overall wellness is your diet. Eat plenty of brightly colored fruits & veggies because you need tons of antioxidants. In fact, people who have a largely plant-based diet seem to fare MUCH better with Covid infection because they have higher antioxidant levels. You can read the study here. Covid quickly depletes your antioxidants levels due to the oxidative stress the illness causes.
Focus on an anti-inflammatory diet (read how to do that here). You need plenty of omega 3 fats, zinc (which is depleted in illness and is crucial for your sense of taste), and B vitamins. You get these nutrients from fatty fish, nuts, leafy greens, and red meat, especially liver. Don’t want to eat liver? Take these capsules instead. Liver is truly a healing food for fatigue and depleted systems.
For organ repair, you’ll want to focus on brain and lung health. The impaired circulation and systemic inflammation long Covid causes affects brain health. You can restore brain cells and connections between cells (synapses) with diet, fish oil, curcumin, B vitamins, alpha lipoic acid (see supplement section below). Long Covid syndrome also causes lung scarring (fibrosis). N-acetyl cysteine helps lung health.
The supplements listed below, especially CoQ10, PQQ, B vitamins, and the supplement with l-carnitine help mitochondrial and heart muscle repair.
You also need plenty of fiber to nourish your gut bugs. Your gut bacteria turn fiber into fatty acids that nourish your colon cells and your brain. Chick peas and avocados in particular are great. Covid may also increase fungal/candida overgrowth. Check out my main post on candida here, as you may need a protocol to address candida, but fixing mitochondria and inflammation are priorities.
Sleep is vitally important for recovery. Read my sleep hygiene tips here. Try melatonin to help; it’s actually quite anti-inflammatory and may help fight both Covid and long Covid. Get early sun exposure to help regulate circadian rhythm. And sun exposure is good for mood and vitamin D levels. We spend way too much time indoors!
If you’re struggling with anosmia or hyposmia, click here for my article on it. Zinc, lion’s mane, and alpha lipoic acid may help. Interestingly, researchers have found that drinking 2 strong cups of coffee per day may help you recover your sense of taste. There isn’t a lot of research on this, but the study is in this video around 19.30.
Finally, around 10% of people who have long Covid get remarkably better after being vaccinated, likely because the immune boosting effects of the vaccine help clear infection.
Testing & Supplements for Long Covid Syndrome
In addition to focusing on diet and healthy lifestyle habits, you’ll need supplements to address inflammation and mitochondrial and organ repair. I recommend testing so you can tailor your protocol to your specific needs. Get blood work, a CBC (complete blood count) with inflammation markers like hsCRP, homocysteine, fibrinogen, ferritin. Check fasting glucose and HbA1c also. You can order your own labs here (10 Most important tests at the top of the menu).
An organic acids test (OATs) is also a good idea because it lets you know detail about mitochondrial health, brain health, and overall nutrient and antioxidant status, as well information on carb and fat metabolism (eg how well your body is using food for fuel). You can order it here (the bottom of this menu). You’ll need a professional to help you interpret the results and customize your healing program.
Typically you’ll need the following supplements to overcome long Covid (listed in order of importance):
Your supplement protocol should depend on your unique symptoms.
- Nitric oxide which increases circulation and helps heal endothelium and blood vessels. Necessary for shortness of breath and to repair circulation. Also lowers blood pressure.
- For energy: A formula to repair mitochondrial damage. I recommend this one. It contains l-carnitine which is necessary for mitochondrial repair.
- CoQ10 and PQQ also heal mitochondria, Prioritize CoQ10. It’s expensive, but this is the best one I’ve found.
- N-acetyl cysteine for lung & immune health, boosts glutathione (your master antioxidant which becomes depleted after Covid), repairs lung damage.
- Antioxidants for oxidative stress
- B vitamin complex for just about everything + mitochondrial repair
- Alpha lipoic acid for anosmia, hyposmia, brain health, overall health. Can’t go wrong with this one.
- Curcumin for inflammation. The most potent anti-inflammatory.
- Amino acids (best assessed via organic acids test to see particular deficiencies)
- Fish oil for gut health, inflammation
- Bacillus probiotic for gut health and especially with persistent diarrhea
- Vitamin D
- You may also benefit from certain anti-virals for Epstein-Barr or to help your body clear the virus. Monolaurin is my go-to rec.
We’re still learning a lot about long Covid, but we do know it’s marked by chronic inflammation (and neuro inflammation), oxidative stress, mitochondrial and metabolic damage, fatigue, circulatory issues, gut damage, brain fog, and mood issues. By systematically healing the underlying organ dysfunction, you may be able to fully recover from long Covid.
Your main goal is reducing inflammation and healing mitochondrial, organ, and gut damage using a combination of diet, supplements, healthy sleep, and daily movement.
For more information on Covid and long Covid, click here and watch the webinar also.
Have you experienced long Covid? What has helped you? Please comment below.
Mary Vance is a Certified Nutrition Consultant and author specializing in digestive health. She combines a science-based approach with natural therapies to rebalance the body. In addition to her 1:1 coaching, she offers courses to help you heal your gut and improve your health. Mary lives in San Francisco and Lake Tahoe in Northern California. Read more about her coaching practice here and her background here.
I live in Humboldt County and have had Long Covid for four months. I tested positive January 23 with an initial ‘flu like’ infection. I probably caught the Omicron variant. I am 2x vaxed and once boosted all prior to my infection. Initial blood work, and other tests all came back negative for poor health. Before Covid I was a healthy, retired, but active 66y/o female, but my life has pretty much come to a standstill. I have lost some weight, but it’s healthy. I’m 5’1” and weigh 110. My ongoing symptoms are mostly ‘fatigue’, afternoon headaches, poor circulation and I still have some numbness in my fingertips. Even taking a shower can wear me out. I eat, drink and sleep healthy. No breathing or heart issues. I’m wary of supplements because I find I don’t digest them well and I’ve always had a sensitive digestive system. While I have tried acupuncture, and cranial sacral work, what seems to help my recovery most is basic rest, clean diet, lots of water and pacing. I have improved slowly over time from where I’ve started but I feel like I’ve plateaued. Do you think your coaching would be a good fit?
Thank you. Oh, I was referred by Tina George.
Hi Rhonda, thanks for your comment, I will send you an email.
I just tested positive yesterday. I’ve had what seems like a head cold. At what point do you start your long Covid protocol? Is it something you should wait on, or should it be started immediately?