Covid Archives - Dr Shawn

30/Jun/2022

What is Long Covid?

Long Covid is defined as symptoms that present 12 weeks after infection and that persist for at least 8 weeks. The most common symptoms being: Fatigue, Shortness of Breath and Cognitive Dysfunction. There will be an estimated 150 million cases of Long Covid cases worldwide as of 2022. Long Covid has the potential to significantly impact the lives of a large portion of the population making day to day activities difficult or near impossible. Although there are ways to reduce the risk factors in developing long covid, there aren’t many proven conventional medications to treat Long Covid once symptoms set in.

We now know that viral fragments, lingering spike protein and persistent inflammation are all likely features of Long Covid. This chronic state of immune activation leads to heart and blood vessel abnormalities, lung impairment, neurological injury and autoimmunity. Luckily, functional medicine practitioners have been at the forefront in developing protocols that work to resolve the aftermath of COVID-19 infection.

Mitochondrial Dysfunction

There is evidence of mitochondrial dysfunction in Long Covid cases as seen through disruption in fatty acid oxidation and altered lactate production. This would also partially explain the chronic fatigue of Long Covid. Functional medicine has a long history of developing protocols to address mitochondrial dysfunction. Many of the compounds used have been showing promise in treating Long Covid. For example, there is evidence of reduced levels of Coenzyme Q10 in COVID-19 infection. CoQ10 is an important compound in mitochondrial function and energy production. Supplementing with this compound along with other mitochondrial supportive nutrients (Niacin, N-Acetyl Cysteine, Alpha Lipoic Acid) have been helpful in treating Long COVID associated fatigue.

Chronic Inflammation

We also know that there is a wealth of data to suggest high levels of inflammatory markers in Long Covid sufferers. Conventionally, steroids such as prednisone have been used to effectively treat Long Covid symptoms. However, steroids can not be used indefinitely as there are significant side effects associated with long term usage. In Naturopathic and Functional Medicine we have evidence of a number of naturally derived compounds that work to treat Long Covid associated inflammation including: Curcumin, Resveratrol, Cannabinoids, Luteolin, Omega 3, and Black Cumin.

Immune System Abnormalities

We also know that there is immune system dysfunction in Long Covid as evidenced in abnormal T-cell behaviour. One of the most important compounds regulating immune function is vitamin D. There is strong evidence that having adequate vitamin D status prior to Covid infection is protective toward Long Covid and giving large doses of vitamin D to both active Covid-19 cases and Long Covid sufferers can be therapeutic.

Gastrointestinal Symptoms

Long Covid cases also seem to have a higher incidence of prolonged gastrointestinal symptoms and intestinal dysbiosis with organisms that increase inflammation. One of the best ways to treat intestinal inflammation is by promoting the growth of intestinal organisms that produce the short chain fatty acid Butyrate. Food that is high in fibre typically help to promote beneficial species of intestinal organisms. Oats, Apples, Onions, Asparagus, Broccoli, Whole grains, underripe bananas, Legumes, and Berries are some excellent foods shown to promote butyrate production.

Cannabinoids

Cannabinoids, and more specifically cannabidiol (CBD) has been shown to have some interesting mechanisms in the treatment of Long Covid. Strains of cannabis containing high levels of CBD have been shown to block spike protein from entering the cell (via ACE-2 receptors), modulate ACE-2 receptor density on cell surfaces (less doors of COVID to enter) and reduce inflammation. Therefore cannabinoids are very exciting compounds currently being investigated for use in Long Covid therapy.

Conclusions

Long Covid is a multifaceted chronic disease with effects on various physiological systems. Drugs with a narrow therapeutic scope are not going to be as effective as complex compounds that effect multiple physiological processes at the same time. This type of therapeutic synergy is a hallmark of naturally derived medicines and therefore functional medicine is going to play a pivotal role in dealing with this prevalent and highly complex disease state. In my Toronto practice I have had several cases of long covid that only began to resolve once a functional medicine protocol was put into place. So if you know someone who is suffering from Long Covid I recommend connecting them with a local Naturopathic Doctor or Functional Medicine Practitioner.

drshawn

01/Feb/2022

Intro

Our world is facing an epidemic of Long COVID over the next decade. Assuming at least 10% of COVID-19 survivors develop long COVID, which is likely underestimated, it is estimated that 5 million people are facing long COVID globally. Long COVID affects multiple systems in the body and therefore requires a multidisciplinary approach. It is a shared opinion amongst several specialists that a functional medicine approach will be needed to rehab these patients back to health. While we are still in the beginning stages of understanding this chronic disease, there are some emerging ideas on how to treat Long COVID as well as some nutritional supplements that may offer a complete or partial solution.

Defining Long Covid

The now accepted technical name for Long Covid is Post Acute Sequelae of CO-V-2 (PASC). While a widely accepted definition is lacking, there seems to be some consensus on the approximate timing of symptoms and the type of symptoms common to a diagnosis of PASC. Onset is typically anywhere from 2-8 weeks after a confirmed or suspected COVID-19 infection and may persist up to 6-months or more. Common symptoms include: fatigue, dyspnoea (shortness of breath), cognitive dysfunction, headache, myalgia, chest pain, joint pain, smell and taste dysfunction, cough, hair loss, insomnia, wheezing, rhinorrhea, autonomic dysfunction (POTS), cardiac and gastrointestinal issues.

Risk Factors

Some of the clearly defined risk factors for developing long COVID include: More than 5 initial symptoms, initial disease severity, female sex, pre-existing comorbidity, prior psychiatric disorder, and old age. There are also certain biomarkers in blood samples that appear to have a correlation with Long COVID including: Increased levels of D-dimer, CRP, IL6, procalcitonin, troponin-1, BUN, neutrophils and decreased levels of lymphocytes.

Pathophysiology

Although the exact mechanisms behind what causes PASC in not completely understood recent research has pointed towards a few mechanisms. For some Long Covid sufferers there seems to be evidence of long term tissue damage in the cardiovascular, pulmonary and neurological systems. There is also prevalence of unresolved inflammation, viral persistence, gut dysbiosis and autoimmunity.

Treatments

The obvious question that everyone would like know is if there are treatment interventions to both prevent and alleviate the symptoms of PASC. The most conventionally accepted treatments thus far are: Personalized rehabilitation programs (light aerobic and breathing exercises), analgesics, antidepressants, ivabradine (for POTS like symptoms) and antihistamines. It is also accepted that treatment to regulate immune and mitochondrial function would be useful. This is perhaps where naturopathic and functional medicine can make an enormous impact.

There is emerging research looking into nutraceutical compounds to help prevent and treat PASC, here is an overview:

Mitochondrial Support: The mitochondria is an energy producing organelle within every cell of our body. In high school science we are taught that the mitochondria is the “power plant of the cell”. Disruptions in mitochondrial function can lead to fatigue, muscle pain, headache and immune dysfunction. COVID-19 infections seems to disrupt mitochondrial function through mechanisms still being investigated but include oxidative stress and alterations in genetic mutation.

Co-factor nutrients that help support mitochondrial function are being investigated for use in treating COVID-19 infection and PASC. These nutrients include: L-Carnitine, Alpha lipoic acid and Coenzyme Q10. A CoQ10 deficiency has been reported in COVID-19 patients and therefore supplementation with this particular compound is of great interest amongst researchers.

Inflammation: Inflammation seems to be driving a lot of the symptomatology in PASC. Inflammatory compounds have been identified in multiple organ systems including the brain, lungs, pancreas and heart. As such one natural anti-inflammatory compound has been identified as being a possible adjuvant therapy in both COVID-19 infection and PASC.

Curcumin is a compound derived from Turmeric and has anti-inflammatory, anti-viral, anticoagulant, anti-platelet and cytoprotective properties. There has been some evidence to suggest that 1000mg of a turmeric supplement restored smell and taste in individuals who lost these senses following COVID-19 infection. Furthermore in vitro studies have demonstrated that curcumin can inhibit coronavirus from entering the cell, and can disrupt some of the signing processes of the virus.

Immune System: Many of the complications of COVID-19 can be attributed to a dysfunctional response of the immune system, either over-reactive or under-reactive. Many compounds that have a direct and indirect role in proper immune system activity are showing promise in treating COVID-19 infection and PASC.

Vitamin D acts as an immune activity regulator, helping to both increase and decrease immune activity as is appropriate to the situation. Some studies have demonstrated that vitamin D supplementation after COVID-19 infection is associated with less ICU admissions and decrease mortality. Another study demonstrated that a combination of vitamin D, selenium and zinc was able to mitigate the course of respiratory complications with COVID-19 infection. It is likely that co-factors and nutrients which help support normal immune activity can shorten the duration of PASC and alleviate symptoms.

Gastrointestinal: Symptoms affecting the gastrointestinal tract are both common in COVID-19 infection and PASC. There is evidence that COVID-19 and its associated spike protein can persist in the gastrointestinal tract for months after confirmed infection.

Autoimmune type syndromes are commonly seen with PASC. One hypothesis for this outcome is a type of molecular mimicry between spike protein and healthy tissue. Spike protein can enter through a compromised digestive tract into the blood stream. Once in the blood stream the immune system can create auto-antibodies in response.

Maintaining a healthy gut/body barrier is emerging as a possible area of treatment in COVID-19 infection and PASC. A healthy environment of commensal bacteria strengthens the gut/body barrier as well as driving the production of healing compounds such as butyrate.

Butyrate is a short chain fatty acid that is produced by beneficial bacteria in our gastrointestinal tract. Butyrate can cross the blood brain barrier and influence regeneration of damaged nerve cells. Probiotic strains belonging to the Lactobacillus and Bifidobactrium categories are

essential for Butyrate production. While probiotic supplementation can assist in developing a healthy gut environment most of the benefit comes from eating foods which help these probiotics thrive. A diet rich in fibre and polyphenols is therefore essential in influencing the growth of beneficial butyrate producing probiotics. Fruit, veggies, and polyphenols like curcumin, luteolin and resveratrol are likely an important part of what will be a holistic approach to treating PASC.

Conclusions: The COVID-19 virus has turned out to be a multifaceted disrupter of homeostasis in a large percentage of those who have been infected. A functional medicine approach to treatment is likely going to have the most profound impact in addressing PASC. We are already starting to see some natural compounds (L-Carnitine, Alpha Lipoic Acid, Coenzyme Q10, Curcumin, Vitamin D, Selenium Zinc and probiotics) having an impact of this ill defined syndrome. More properly funded research in the area of nutraceuticals and functional medicine for treatment of PASC is much needed. In the meantime Naturopathic Doctors and Functional Medicine Physicians have many tools to start treating PASC with safe and effective protocols.

References

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Zahedipour F, Hosseini SA, Sathyapalan T, Majeed M, Jamialahmadi T, Al-Rasadi K, Banach M, Sahebkar A. Potential effects of curcumin in the treatment of COVID-19 infection. Phytother Res. 2020 Nov;34(11):2911-2920. doi: 10.1002/ptr.6738. Epub 2020 Jun 23. PMID: 32430996; PMCID: PMC7276879.

Chabot AB, Huntwork MP. Turmeric as a Possible Treatment for COVID-19-Induced Anosmia and Ageusia. Cureus. 2021 Sep 8;13(9):e17829. doi: 10.7759/cureus.17829. PMID: 34660038; PMCID: PMC8502749.

Alexander J, Tinkov A, Strand TA, Alehagen U, Skalny A, Aaseth J. Early Nutritional Interventions with Zinc, Selenium and Vitamin D for Raising Anti-Viral Resistance Against Progressive COVID-19. Nutrients. 2020 Aug 7;12(8):2358. doi: 10.3390/nu12082358. PMID: 32784601; PMCID: PMC7468884.

Pal R, Banerjee M, Bhadada SK, Shetty AJ, Singh B, Vyas A. Vitamin D supplementation and clinical outcomes in COVID-19: a systematic review and meta-analysis. J Endocrinol Invest. 2022 Jan;45(1):53-68. doi: 10.1007/s40618-021-01614-4. Epub 2021 Jun 24. PMID: 34165766; PMCID: PMC8223190.

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Theoharides TC, Cholevas C, Polyzoidis K, Politis A. Long-COVID syndrome-associated brain fog and chemofog: Luteolin to the rescue. Biofactors. 2021 Mar;47(2):232-241. doi: 10.1002/biof.1726. Epub 2021 Apr 12. PMID: 33847020; PMCID: PMC8250989.

Crook H, Raza S, Nowell J, Young M, Edison P. Long covid-mechanisms, risk factors, and management. BMJ. 2021 Jul 26;374:n1648. doi: 10.1136/bmj.n1648. Erratum in: BMJ. 2021 Aug 3;374:n1944. PMID: 34312178.

Mercola J, Grant WB, Wagner CL. Evidence Regarding Vitamin D and Risk of COVID-19 and Its Severity. Nutrients. 2020 Oct 31;12(11):3361. doi: 10.3390/nu12113361. PMID: 33142828; PMCID: PMC7692080.

Yong SJ. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (Lond). 2021 Oct;53(10):737-754. doi: 10.1080/23744235.2021.1924397. Epub 2021 May 22. PMID: 34024217; PMCID: PMC8146298.

drshawn

18/Jan/2022

I didn’t quite get the Christmas present I hoped for this year. On the night of December 19th 2021 my wife started to exhibit the symptoms of a flu; fever, body ache, sore throat and congestion. The next morning, with a reserved anxiety behind a lackadaisical demeanour, I administered a COVID-19 rapid antigen test like I had done for her a dozen times before. However, this time was a bit different. Instead of the red dye settling on the negative C line, two lines appeared…positive! Uh oh, is what I anxiously muttered from the other room. Thats when the gears of my brain went into overdrive, trying to figure out the intricacies of the Ontario isolation policy back in December 2021. After confirming her status with a PCR test, my wife was to be quarantined to our bedroom and I would be taking care of her and the kids in isolation from the rest of the world for 10 days.

As the fast spreading Omicron variant swept through the house, hitting me second and my daughter third, 10 days quickly turned into a full 2-weeks of isolation. Having received a booster vaccine a week earlier, my symptoms were mild and I knew that my body was busy preparing antibodies that would help me fight off the virus rather quietly. It became my mission to do my best to help my wife (who had not yet received a booster) and daughter (3 years old and therefore not vaccinated) get through the infection swiftly, and to do my best to prevent my son (aged 7 with a single dose of vaccine) from contracting it.

Although a COVID-19 infection was something I hadn’t treated the before, the symptoms painted a picture of something I had treated hundreds of times. Fever, congestion, sore throat and body aches are all hallmarks of an activated immune system fighting off an infection, no matter what that infection may be. The most effective tool in destroying a viral infection is our immune system. It’s our job to support the immune system in its fight against the virus. Aside from getting good quality sleep and keeping hydrated, these are my recommended supplements to help support the immune response:

Probiotics – Studies have shown that probiotics affect immune cells throughout the body. When certain strains of probiotics are introduced into our intestine they help to repair intestinal cells and they boost production of antimicrobial substances. One of the most effective and well studied strain for immune support is Lactobacillus Rhamnosus GG.

Vitamin C – Vitamin C is very important for optimal immune system functioning. Vitamin C helps immune cells get to where they need to be, kill pathogens effectively, protect the body from damage and clean up after battling infections. Studies have shown that adequate vitamin C in the blood helps prevent infections, is necessary to fight infections and helps with recovery. The recommended daily intake of vitamin C is 100-200mg/day; however during active infection, the metabolic demand increases and therefore the requirement for vitamin C is likely to be higher. Even in this day and age, vitamin C is the fourth leading nutrient deficiency in North America. Poor diet and increases in free radical exposure due to an unhealthy lifestyle may be contributing factors. Excellent sources of vitamin C are Broccoli, Citrus Fruits and Berries.

Zinc – The importance of zinc for proper immune function has been well established. Zinc deficiency undoubtedly causes immune system malfunction. The cells of our body are in constant communication. During infection there is a need for effective communication between immune cells in order to get rid of the “bad guys”. Communication happens in the form of chemical messengers and enzymes. Zinc is an essential component of these chemicals and enzymes. As with vitamin C, during active infection our requirement for zinc is likely to increase. Studies have shown that Zinc supplementation during infection can shorten the duration of the illness. Excellent dietary sources of zinc include: Meat, Shellfish, Legumes, Nuts and Seeds. Supplementation may be important with a vegan or vegetarian diet.

Vitamin D –Vitamin D has many functions in the body, and receptors for vitamin D can be found on many different tissues. One important function for vitamin D is in the modulation of our immune system. Studies have suggested that vitamin D is able to both calm down and rev-up the immune system according to what our body needs it to do. This is why Vitamin D is thought to be as important in autoimmune disorders as it is in infections.

Vitamin D deficiency can cause the immune system to behave erratically. Unfortunately in Canada we have one of the highest incidences of vitamin D deficiency in the world. Our primary source of vitamin D is from sunlight and therefore supplementation becomes important especially during the winter months. Studies have shown that there is a higher incidence of upper respiratory tract infections in athletes who are deficient in the vitamin and who train in the wintertime. Supplementation had preventative and symptom reducing effects. Aside from sunlight, some dietary sources of vitamin D are: fortified foods, fatty fish, beef liver, egg yolks and cheese.

Elderberry – Not only does elderberry syrup taste great, studies have shown that it inhibits the bacteria and viruses associated with common colds and the flu. One study demonstrated that an elderberry liquid extract possesses antimicrobial activity against both streptococci bacteria and influenza viruses. Another study looked at 312 air travellers flying from Australia to an overseas destination. Those travellers who took an elderberry extract before, during and after travel had fewer colds, less sick days and less symptoms.

Although supplements can offer a much needed support, sleep, hydration and diet are fundamental for a healthy immune response. Using a humidifier at home will also help keep the respiratory membranes moist supporting mucus production (our natural defence mechanism). As for diet, when I’m sick I like to incorporate intermittent fasting into my “get well” regime. Intermittent fasting (IF) is the practice of splitting the day into an eating time (usually 8-10 hours) and a fasting period (14-16 hours). There are many health benefits associated with IF including regeneration of immune cells and modulation of the intestinal microbial environment. If intermittent fasting is not your thing, stick to a healthy balanced diet, like a mediterranean style diet.

I am happy to say that my daughter, my wife and I have fully recovered. My son never contracted the infection, despite being in isolation with three active cases for 2-weeks! Everyone responds to COVID-19 infection differently and so I hope that these tools may help guide some of you through your recovery too.

Naturopathic Medicine for Long Covid Part 2