Had Covid-19 and not felt right ever since? It could be a post-viral syndrome or what some call ‘long Covid’. Functional nutritionist Pauline Cox chats to Top Santé editor Katy Sunnassee about what long Covid is, which key symptoms you should look out for, plus how you can naturally support your immune system to recover after an infection…
What is long Covid?
‘It’s basically a post-viral syndrome, much like what you’d get after another viral infection. But although long Covid has some similarities to other post-viral syndromes, and with things like chronic fatigue syndrome, there are also very distinctive symptoms. Thankfully, there are things you can do to recover from long Covid.
Common symptoms of long Covid include:
- fatigue – not just feeling a bit tired but debilitating tiredness even when waking up in the morning
- brain fog and lack of ability to concentrate
- memory loss
- fatigue after short bursts of exercise
‘Others are experiencing different long Covid symptoms, such as headaches, low mood, digestive issues, shortness of breath, migraines; things you might not even link to a Covid infection months earlier. It’s really challenging to define long Covid as people get a broad spectrum of symptoms. As it’s a systemic inflammatory condition, it means inflammation can set in, in several areas, which is why you can get things like gut issues. This inflammatory state within the neurological system can lead to muscle aches and pains, tiredness and heavy limbs.
‘Covid has been called “the great revealer” because it tends to target a part of the body where you might have an underlying weakness. So, for someone who has lupus, for example, you might get a flare up of that condition. Alternatively, for someone who has a compromised respiratory system already, it could flare up their asthma. Or, if someone is prone to chest infections, they might get more severe respiratory issues than someone else who catches the virus.’
What causes long Covid?
‘There are a number of factors that have been correlated with severity of Covid symptoms, including high BMI, visceral fat and metabolic health. If somebody already has poor metabolic health and a lot of inflammation, and they have a large number of fat cells, particularly visceral fat, which is in itself inflammatory, then it’s perpetuating what’s called a cytokine storm.
‘Cytokines are inflammatory markers that literally wreak havoc on the body. When you get inflammation in the brain, it can really affect recovery of brain cells. There are proteins within the brain, one of which is brain derived neurotrophic factor (BDNF). This is very important for maintenance and repair of brain cells. With Covid, BDNF can decrease, while other inflammatory cytokines go up. This can cause mood alterations, such as depression and anxiety. It can also cause a lack of ability to focus.’
Does long Covid affect men and women and children in the same way?
‘It’s still early days with the research but it seems to be women at the moment who are suffering from long Covid more than men. Children don’t seem to be as vulnerable, but then they’re not necessarily as vulnerable to Covid in general. And there does seem to be a correlation with long Covid and severity of the Covid infection. So, we seem to find that if you can reduce the severity of Covid, you are much less likely to suffer from post-viral syndrome or long Covid.’
With Sars-Cov-2 being a respiratory virus, why does Covid affect several body systems rather than being confined to the lungs?
‘The virus is airborne, so it enters your body via your respiratory system. However, the way it actually infects you is through the spike protein attaching to a receptor called ACE2. This receptor is everywhere in your body. It’s in your lungs, cardiovascular system and gut for a start. Because this ACE2 receptor is so prevalent, it’s where the virus attaches and accesses your body. It then replicates, and whether it does this quickly or slowly depends on your immune function.
‘When the spike protein from Sars-Cov-2 attaches to your ACE2 receptors, your body produces fewer of them. ACE2 is a very important protein for maintenance and function of your whole system. In the lungs, it’s very important for maintenance, repair and proper functioning. When these ACE2 levels go down, you can start to get long-term effects within the gut that can really affect amino acid transportation, particularly an amino acid called tryptophan. The levels of certain friendly gut bacteria can also decrease. This includes one called butyrate, which is a really important short chain fatty acid.
‘So, basically these friendly gut bacteria produce something that goes into your bloodstream, and into your brain to make you feel a certain way. When the gut microbes change, that changes how your brain is able to focus and function, and also how you feel. There are all these different things going on, not just those particular systems that are affected by inflammation as an isolated system.
Are the ACE2 receptors part of your immune system?
‘No. The ACE2 aren’t so much a part of the immune system. However, they produce a protein that’s important for the maintenance of different systems. For example, you have ACE2 in the cardiovascular system; when the spike protein attaches to those, it diminishes the receptors. So, then the body’s ability to produce that protein diminishes too. You can start to get this scuffing of the inside of the cardiovascular system; the endothelial lining can become inflamed and it’s then very prone to other issues.
‘Essentially, the virus needs an entry into your body so it can exert its effects and start to replicate. Viruses don’t have their own DNA, so they need a host to replicate. They do this with the spike protein, which attaches onto the receptor, in this case ACE2, where it enters and starts to replicate. Because the ACE2 receptors are now being used for another purpose, they stop doing what they’re meant to be doing. To restore normal function, you need to increase your ACE2 levels.’
How to support your immune system and recover from long Covid
Pauline Cox reveals the three crucial nutrients she tells most of her clients to take when they are looking to overcome debilitating symptoms and finally recover from long Covid or any post-viral issues…
Covid and long covid are systemic inflammatory conditions, wreaking havoc on the body. So the first thing you should aim to do when trying to recover from long Covid is reduce inflammation with your diet. There is an inflammatory state within the neurological system and this is what causes a great deal of memory issues and mood issues too. We need to allow the brain to recover by restoring normal inflammatory levels.
An anti-inflammatory diet and anti-inflammatory supplements can help lower levels of inflammation. How can you do this? With omega-3 fatty acids. You’ll have heard of these, as well as omega-6 fatty acids. The body also needs the latter, but they are pro-inflammatory if not in balance with aomega-3. The ratio should be one to one, but if you have too much omega-6 in your diet, this is very pro-inflammatory. And with the western diet high in grains and sugar and seed oils, this tends to increase your omega-6 levels, whereas omega-3 are already fairly low.
How to increase your omega-3 levels:
You can increase omega-3 levels by having fatty fish, such as wild Alaskan salmon, tinned sardines, and smoked salmon, 3-4 times a week, as well as pasture-raised organic eggs. Also consider a high-quality and high-potency fish oil supplement. Look for one with around 1,000mg fish oil. You really should start to feel the benefits within hours of taking them, unlike with some supplements, which take weeks or months to build up and have an effect.
If you don’t like fish or are vegan or vegetarian, supplement with high-quality algae oil, which is rich in omega-3 DHA and EPA. You can also get omega-3 from things like hemp and chia, but the body needs to convert these into EPA and DHA before it can use them. In an ideal world, particularly when you’re recovering from illness, you want to give the body what it needs without it having to convert the raw materials into something useful. So, fish oil or algae oil is going to help reduce systemic inflammation more easily.
Another supplement that’s good for helping to reduce inflammation is turmeric. The spice has been used therapeutically for thousands of years. We’re now starting to get more research to justify its use in modern medicine, and how it can have a potent anti-inflammatory impact and help with things like joint pain and general aches and pains that come from systemic inflammation.
The bioactive compound within turmeric that we are interested in is curcumin. But you must have it with fat because that’s what makes the curcumin bioavailable so you can absorb it. Black pepper also increases also bioavailability. If you’re looking to recover from long Covid, drinking turmeric in tea will have some beneficial properties, but the curcumin levels will be low. Although you could add some butter, olive oil, MCT (medium chain triglyceride) oil, coconut oil, or make a sort of creamy hot chocolate with cacao butter plus the black pepper to increase the absorption. You can also get it as a supplement, which will likely give you a higher potency than using it in cooking. I personally like the fermented turmeric capsules from Terranova.
Another thing that’s anti-inflammatory and has many benefits on the body, including restoring ACE2 levels, is resveratrol. There have been around 150 studies on resveratrol and how it helps people to recover from long Covid and its main symptoms. It’s the dark pigment in grapes and you find it in red wine – not that I’m suggesting red wine as part of your recovery! Although if you are going to have a drink, have red wine over a spirit as at least you’re getting some resveratrol. However, always have it with a meal, as food lessens the impact of the ethanol on your liver.
Resveratrol is also easier to source these days, as more companies are producing it. And even if you’re not using it for post-viral long Covid recovery, it’s a great supplement to take for anti-ageing and protecting your DNA. There’s a lot of research showing how it helps protect DNA and prevent cellular ageing, too.