Long COVID/Post-COVID-19 Illness

Long COVID, also known as post-COVID illness or post-acute sequelae of COVID (PASC) is a complex and poorly understood illness that affects between 10-30% of non-hospitalized cases of acute COVID infection, 50-70% of hospitalized cases and roughly 10-12% of vaccinated cases. It often affects multiple organ systems including the immune and respiratory systems, brain and central nervous system, cardiovascular, endocrine, renal and gastrointestinal systems. It often involves neuroinflammation and leads to cognitive impairment (difficulty with focus and concentration, unclear thoughts described as ‘brain fog’) and fatigue. It can be quite debilitating in some people. It can lead to microclotting and increase risk of thrombotic cardiovascular and cerebrovascular disease, chronic fatigue syndrome and dysautonomia (dysfunction of the autonomic nervous system) especially postural orthostatic tachycardia syndrome (POTS). Symptoms can persist for years and have dramatic impacts of quality of life.

Theories of Pathogenesis

There are several theories on how COVID can lead to so much dysregulation and dysfunction in the body, including persistent reservoirs of SARS-COV2 viral infection or ‘remnants’ of viral products, reactivation of other chronic viral infection such as Epstein-Barr virus (EBV) and human herpesvirus 6 (HHV-6), immune dysregulation and polarizations, and the induction of autoimmunity.  There is also evidence of negative impacts of SARS-CoV-2 on the gut microbiome with some studies showing the composition of the gut microbiome may reflect disease severity and dysfunctional immune responses in COVID-19 patients.  Other studies show vagal nerve and brainstem dysfunction leading to autonomic nervous dysfunction (dysautonomia).  There are also many studies showing that the direct damage to tissue from the inflammation and oxidative stress caused by the viral infection leads to permanent scarring and tissue damage.

Functional medicine management of Long COVID

Functional Medicine looks first and foremost at the patient’s current immune health status including the status of the innate immune system, signs of immune dysregulation and polarizations, imbalances in the gut microbiome, including bacterial and fungal overgrowths, excess oxidative stress and inflammation, mitochondrial function and environmental toxins (including mycotoxins) that may be impacting immune health.

In Functional Medicine, we tailor our approach to the needs of each individual. Emphasis on each of these areas depends on the current health status of the individual and any concurrent health issues. 

Therapeutic strategies may include:

  1. Targeting viruses directly (ie: licorice, astragulus, elderberry, andrographis, artemisinin, olive leaf, garlic, thuja occidentalis, Japanese honesuckle, Chinese skullcap, St. John’s wort, zinc, silver hydrosol)
  2. Blocking viral replication (ie: licorice, elderberry, berberine, zinc, selenium, NAC, silver hydrosol)
  3. Supporting innate immune function/NK activity, Th1 responses (ie: vitamin A, vitamin C, vitamin D, echinacea, astragulus, cordyceps, rhodiola, eleuthero, licorice, aloe vera, elderberry, NAC, glutathione, glutamine, zinc) and modulating Th2/Th17 responses (astragalus, NAC, quercetin, perilla, resveratrol, curcumin)
  4. Decreasing oxidative stress, inflammation and inflammatory by-products of viruses, such as histamine (vitamin C, vitamin E, selenium, NAC, glutathione, zinc, turmeric, resveratrol, grape seed extract, green tea, olive leaf, milk thistle, elderberry and berberine)
  5. Supporting cellular and mitochondrial function (ie: B vitamins, vitamin D, magnesium, NAC, glutathione, CoQ10, berberine, essential fatty acids and phospholipids)
  6. Addressing hypercoagulation and microclotting (nattokinase, lumbrokinase, serratiopeptidase, bromelain, dang gui, salvia miltiorrhiza, ginseng, ginger, turmeric, ginkgo, garlic, green tea)
  7. Supporting the gut microbiome and gut immune health (prebiotics, probiotics or antimicrobial herbs)

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