Long Covid Treatment

Hi, thank you for coming back for the latest edition of Beyond Primary Care’s blog- Long Covid Treatment. In Beyond Primary Care blogs we highlight healthcare news, advice for medical conditions, and how membership for care works! Beyond Primary Care is an insurance free, membership based family medicine clinic. Beyond Primary Care is the highest rated Direct Primary Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne counties giving families and employers peace of mind about healthcare costs by providing affordable and accessible primary care services.

In this blog post, we want to educate our patients and any prospective patients about Long Covid Treatment.

What Is Long Covid

Most people who contracted the coronavirus (Covid-19) feel better within a few days or a few weeks of their initial symptoms. However, for some people, after being infected with Covid-19, they may experience long-term effects from their infection including a range of health problems that can last weeks to months, or longer. There are a lot of terms that we use for persistent Covid-19 symptoms:

• Long-Covid

• Post-acute sequelae of SARS-CoV-2 infection (PASC)

• Post-acute Covid-19

• Chronic Covid-19

• Post-Covid Syndrome

What’s been suggested for a definition of persistent Covid-19 symptoms is any symptoms that are 12 weeks or more after or during Covid-19 symptoms and can not be explained by another diagnosis (eg- a blood clot). People who experience long covid most commonly report of range of symptoms including:

• Pronounced tiredness or fatigue

• Brain fog

• Muscle aches

• Chronic cough

• Inability to take a full breath

• Rapid heart beating / palpitations

• Sleep problems

• Headache

• Dizziness

• Changes in smell or taste

• Depression or anxiety

• Stomach pain

It can be difficult for a doctor to recognize long covid as there is no test to collectively diagnose post covid conditions. The vast majority of people with long covid test negative for the coronavirus. Your doctor can consider your current health history along with your diagnosis of Covid-19.

Why Long Covid Happens

There are a number of possible mechanisms that supports the coronavirus hurting people by stubbornly persisting in the body- even after the acute infection passes. 

One theory is that the bodies immune system was destabilized by the coronavirus attack and is unable to reset itself. In a study in Nature, 31 long Covid patients, who all had fatigue and other characteristic symptoms at least 3 months after infection, had there blood collected to analyze immune markers. Long Covid patients had an immune system in constant ‘high alert,’ or an ongoing, sustained inflammatory response.

Another theory published in the journal Metabolites is mitochondrial dysfunction is a major contributor to long Covid. The enzymes involved in B-oxidation, which is the breakdown of fats to go into the citric acid cycle- for we can get energy from it- is not working and it is causing a backlog of fatty acids and Acyl carnitine molecules. Molecules we are seeing in the plasma of patients with long Covid. It is thought that because these molecules are not working, people have less energy and less ability to exert themselves.

Long Covid Treatment

L-Acetyl Carnitine: This is an amino acid. Carnitine serves an important role in burning of fat for energy and ferrying fatty acids across the walls of the mitochondria, where they undergo oxidation and are turned into energy. Most of us eat foods that have sufficient quantities of this, and all of us make it- so it is not evident that healthy individuals supplementing will have any worthwhile effects. Yet, it may be beneficial to improve cognitive functions as we age. It's used for Alzheimer's disease, improving memory, thinking skills, treating symptoms of depression, and reducing nerve pain in people with diabetes. One small scoop (powder form), or between 1.0-2.0 grams / day.

Alpha Lipoic Acid (ALA): This is a mitochondrial compound involved in energy metabolism. It is commonly taken with L-Carnitine supplements, as they are related in mechanisms. It supplement form, it has shown benefits for various forms of oxidation and inflammation. It is used for protecting people against heart disease, liver diseases, diabetes, and nerve pain. Standard doses are typically in the range of 300-600 mg. 

Low-dose Naltrexone (LDN): Naltrexone, is a generic drug typically used to treat alcohol and opioid addiction. As the name suggests, low-dose Naltrexone, or LDN, is about 2-5% the normal dose and has been used with success in similar complex syndromes marked by cognitive deficits and overwhelming fatigue called myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS). Naltrexone has anti-inflammatory properties and has been used at low doses for years for various chronic conditions such as fibromyalgia, Crohn’s disease, and multiple sclerosis. This medication is by prescription only. Standard chain pharmacies can not typically supply LDN as this is commonly found at compounding pharmacies.

Turmeric: Turmeric is the spice that gives curry its yellow color. Curcumin is the main active ingredient in turmeric. Turmeric is considered a safe, nontoxic, and effective alternative for many conventional drugs due to its distinguished therapeutic properties and multiple effects on various systems of the body. It exerts potent anti-inflammatory and anti-oxidant effects. Turmeric is also used as a remedy for various conditions including coughs, diabetes, dermatological conditions, respiratory problems, heart problems, arthritis, and IBS. Some curcumin preparations also contain piperine, which may increase the bioavailability of cur cumin by inhibiting its metabolism. To supplement curcumin with piperine, take1.5 grams of curcumin and 15-20 mg of piperine per day.

Magnesium: Magnesium is an essential mineral and has several functions. About half of the US adult population may have insufficient magnesium intake to support nutritional adequacy. Dietary sources rich in magnesium includes leafy green vegetables, unrefrined grains, legums, beans, and nuts. Combined intake of ALA and magnesium results in reinforcement of the protective effect, mainly increasing the antioxidant defense. Limiting to 200 mg per day is recommended to avoid intestinal discomfort. 

Vitamin D: Vitamin D regulates inflammatory and immune response. Observational studies have documented an association between vitamin D deficiency and increased incidence and severity of the coronavirus disease. For moderate supplementation, a 1,000-2,000 IU dose of Vitamin D3 is sufficient to meet the needs of most people.

Methyl B Complex: This is a combination of Riboflavin, B6, Folate, B12 and Betaine. This is a highly bioavailable form of the B vitamins used for neuroendocrine and cognitive health. Vitamin B plays a key role in proper immune function, energy metabolism, and cell function. 

What to do?

Beyond Primary Care is accepting new patients and can help guide you through ruling out other causes for your symptoms and even discuss treatment. Beyond Primary Care is a Direct Primary Care clinic located in Ann Arbor, Michigan and cares for patients all throughout Washtenaw County, Wayne County, and Livingston County.

Thank you for reading
To make an appointment with Dr. Jeff O’Boyle please see our scheduling link.