Long Covid: What are the symptoms, causes and what you can do to lessen the impact 

It is sad to hear that Derek Draper died this week of multiple organ failure after a long battle with the complications of Covid following a severe infection in 2020, from which he never recovered. A lot of research has focused on long Covid and ways to lessen the impact. Derek had a severe form of long Covid, officially now known as post-acute sequelae of SARS-CoV-2 infection (PASC). The degree and type of symptoms vary from person to person depending on which organs are affected. The exact cause remains unresolved, and there are likely to be a number of contributory factors. These include a persistent grumbling virus which never adequately cleared after the acute infection and a chronic abnormal immune response which starts attacking the host's own body cells – a form of autoimmune disease. This can also happen after other viral infections, such as flu and shingles, in which case it is called Post Viral Fatigue Syndrome.

Common Symptoms of Long Covid

• Fatigue, weakness, and low energy levels, affecting work, exercise, and daily activities.
• Shortness of breath and a persistent cough.
• Poor concentration, memory, and reduced cognitive function (Brain Fog).
• Aches and pains in the joints and muscles, resembling fibromyalgia or arthritis.
• Chest pains relating to exertion or breathlessness.
• Heart palpitations or heart damage including heart failure.
• Raised blood pressure leading to medications.
• Abdominal pain, bloating, nausea, and persistent diarrhea or constipation.
• Insomnia and disrupted sleep patterns.
• Low mood, depression, and anxiety, aggravated by the toll of the prolonged illness.
• Skin rashes and an exacerbation of other conditions such as eczema or psoriasis.

Factors Increasing the Risk of Long Covid

First and foremost, it must be emphasized that the very last thing we should do is to blame people for the suffering that Covid-19 has caused to innocent people across the world. Many fit men and women have been struck down, for no fault of their own, but the reality is that people with medical or poor health conditions do have significantly increased odds of developing serious long-term consequences of this awful virus. The official published data from New York, at the height of the pandemic, for example, showed that of the many tragic deaths from Covid-19, less than 2% did not have either diabetes, heart disease, high blood pressure, obesity, or concurrent serious illnesses. Obviously, the older we get, the more chance we have of getting one or more of these conditions, but one interesting study from China showed that 80-year-olds who were slim, fit, physically active without any chronic disease did not have much more of a risk than 50-year-olds. In general, many of these chronic conditions are strongly influenced by overeating, unhealthy eating, being overweight, sedentary activity levels, and poor lifestyle choices accumulated over many years. The big question, however, is whether a change in nutrition and lifestyle will act quickly enough to prevent the development of long Covid after an acute infection or help people currently suffering from Long Covid.

Poor Gut Health

Around the world, scientists started finding that healthy strains of gut bacteria such as Lactobacillus were depleted in the majority of patients with Covid expressing gastrointestinal symptoms and especially those with persistent ongoing problems. Individuals with a history of symptoms suggested poor gut health, also did significantly worse. The authors of these studies postulated that an imbalance of gut bacteria (microfloral dysbiosis) contributed to worse Covid damage via increased gut inflammation, impaired gut wall integrity, which correspondingly leads to systemic inflammatory dysfunction and reduced immune surveillance. About this time, research generated from the UK Zoe app team also reported that people taking probiotics, which aimed to improve gut health, had fewer covid symptoms. This link between the severity of the disease and gut health did not just apply to gut symptoms but for general symptoms such as fatigue, brain fog, and joint pains. At first, doctors did not understand how gut health could affect the lungs, but in the same way, there is a gut-brain axis, there is a gut-lung axis. Overgrowth of “bad” gut bacteria has been found in the systemic circulation and within pulmonary aspirates leading to an increased and inappropriate inflammatory response to the virus. This excess inflammatory response further damages the lung and causes pulmonary exudates (sludge), both features of Acute Respiratory Distress Syndrome (ARDS), a term later coined the Inflammatory storm.

Vitamin D Deficiency

The Zoe app team also reported that people taking regular vitamin D had less severe Covid. Other studies from China and the USA found that people with below normal levels of vitamin D3 had higher risks. This relationship was confirmed by the massive prospective UK Biobank study, which found a strong association between low serum vitamin D with Covid-19 severity, even considering and adjusting for obesity and ethnicity. This information led to official management guidelines, eventually changing to include the correction of vitamin D deficiency.

Phytochemical-Rich Foods

Phytochemicals provide the color, aroma, and taste of plants but also have enormous health benefits. The biggest group called polyphenols, are abundant in vegetables, salads, herbs, spices, teas, nuts, fruits, mushrooms, seeds, and legumes. The typical western diet, is often deficient in polyphenols, meaning we need to think about eating a lot more of them. Ideally, we should aim to have two or more vegetable, fruit or other phytochemical rich food with every meal of the day. Previous and ongoing studies are investigating whether supplementing these foods in nutritional capsules could enhance exercise performance, help fatigue, improve mood, mental agility and a reduce risk of cancer and other chronic diseases. Laboratory research shows they have direct antiviral properties by slowing replication and blocking the spreading of the virus, especially curminoids (in turmeric); resveratrol and citrus flavonoids (grapes, polygonum cuspidatum root); ellagic acid and quercetin (pomegranate) and apigenin (chamomile, parsley, and celery). Resveratrol has also been shown to help reduce virus-induced exudate production and lung injury in laboratory studies. All these phytochemicals have the ability to dampen excess inflammation, which explains why they help reduce inflammation-associated joint pains, a symptom common among people with long Covid. But, unlike aspirin and ibuprofen, actually protect gastric mucosa, kidneys, and the heart. Furthermore, unlike steroids and other immune suppressants, the ability of phytochemicals to suppress inflammation does not lead to a reduced viral immune response.

The Phyto-V Study

As the head of a nutritional research unit, I was in a position to be able to work with colleagues from other Cambridge University-linked hospitals to design and conduct a scientific study to answer this question. Together we designed a double-blind randomized trial which turned out to the first and largest nutritional intervention for people suffering from COVID in the World, called the phyto-v study. Male and female were all given a specifically made capsule containing five blends of Lactobacillus probiotics together with a prebiotic called inulin and vitamin D, which after the trial became known as Yourgutplus. Half were randomized to additionally take either a placebo or a bespoke broad-spectrum phytochemical-rich supplement containing concentrated pomegranate, chamomile, citrus bioflavonoids from oranges, purified turmeric and resveratrol from polygonum cuspidatum root, which after the trial became known as Phyto-V. An analysis of the final results, by Bedford University, showed a 2-fold improvement in fatigue, cough, breathlessness, and overall quality of life after taking the Yourgutplus capsule. This was certainly welcomed, especially among those who had suffered for over 100 days and especially those with gut problems in whom the overall effect was greater. For those randomized to the additional Phyto-V capsules, the benefit was even greater, with a further three-fold improvement in symptoms compared to the placebo group. There was particularly good improvement in insomnia. Although the ingredients were non-sedating, this benefit was brought about by the improvement in mood, gut health, melatonin production, and circadian rhythm, which combined to improve natural sleep patterns. From this data, the manufacturers have gone on to produce a sleeping aid, another advantage of this research. The final research papers were published in the international journal COVID and received widespread media attention, and the supplement is now used in many long covid clinics across the world.

Conclusion

In summary, long Covid is a real and troublesome complication contributing to a major burden of illness for a great deal of people in the UK and internationally. It can affect anyone, even those previously fit and healthy but is more likely to affect people with pre-existing conditions, poor gut health, low vitamin D levels, and low intake of phytochemical-rich fruit, herbs, and vegetables. The best tactic is to avoid getting complications from Covid and other future viruses in the first place through staying as fit as possible by stopping smoking, exercising 3 hours a week, maintaining a normal weight, eating lots of fruit, vegetables, and healthy fats. If you suffer from long Covid, these measures still apply, but the research data which has emerged from the pandemic is strongly suggesting an emphasis on improving gut health, vitamin D levels, and phytochemical-rich food intake.