Long Haulers – Have you still got post-viral symptoms after coronavirus?

As we are starting to see a second wave of Coronavirus, it is important to remember that there are many people who haven’t recovered properly from the first wave yet.  It seems that we have all been given lots of important advice on how to avoid the virus in the first place and what to do when we get it, but very little on what to do when it turns into a long-term chronic health challenge.

A study published by Trinity College, Dublin found that more than half of Covid-19 patients suffer continued and persistent fatigue, regardless of the seriousness of their infection. With the numbers of Coronavirus “long-haulers” on the rise, here are some tips to help get your energy and vitality back on track.

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The problems that can persist after contracting coronavirus are now formally called “Post-acute Covid-19” and this is an umbrella term for a multisystem disease with long-term symptoms which can include cough, low grade fever and fatigue. Other symptoms include shortness of breath, chest pain, headaches, brain fog, muscle pains and weakness, gastrointestinal upset, skin rashes, chilblain like lesions (“covid-toe”), loss of smell and taste, metabolic disturbance such as poor control of diabetes, blood clots and strokes as well as depression and other mental health conditions. These symptoms can be continuous, or wax and wane and come back in waves.

The NHS have put together a useful guide focusing on a range of areas, including on testing to ensure there are no serious complications bubbling away in the background. They also suggest breathing techniques as well as graduated exercise. The NHS also nods to a general improvement in diet and lifestyle to include stepping up exercise, cutting back on alcohol, tobacco and caffeine.

We have seen plenty of post-viral Covid-19 clients in our NatureDoc virtual clinics over the summer. Many have had a tough time since they got the virus and they are not able to get back to work or struggle to look after their children. It seems that just as the virus severity affects people very differently at the time, the recovery and recuperation seem to differ wildly too. It is surprising to many fit and healthy people that they are taking much longer than they thought they would to recover and to get their mojo back.

This is a time when good old-fashioned post-viral recovery and recuperation time could not be more important. If you are suffering from symptoms, be gentle on yourself and build things up slowly – think of it as a marathon, not a sprint. If there is any benefit from less socialising right now, it’s that you have the chance to reset and renew whilst normal life is partly on hold.

Why might you recover more slowly than others?

There are many factors that can dictate how badly you experience Covid-19 at the time and we are all now very aware that age and pre-existing health conditions such as diabetes, heart disease and chronic lung issues can make things much more serious. What is less well known is why some people recover from the virus more quickly than others.

The NatureDoc clinical team has always specialised in post-infection inflammatory conditions which can manifest in long-term fatigue, brain fog, aches and pains, gastric issues as well as neuropsychiatric conditions. We find that there are usually many pieces in the puzzle that can contribute to why someone is wiped out or not themselves after experiencing a viral infection.

We run thorough laboratory tests to work out why the virus has affected that person so badly and why the post-viral symptoms are persisting.  This includes in-depth blood chemistry tests, gut microbiome tests, cortisol and adrenal function, and urinary organic acid, amino acid as well as oxidative stress analysis. Often these are markers that your GP will not check, and they are tests in addition to your GP bloodwork.

From these results we often unravel a host of underlying health issues that may have been ticking along in the background for a long time and exacerbated by the coronavirus experience such as an underactive or autoimmune thyroid, disrupted iron metabolism low B vitamin levels, low vitamin D, a lack of omega 3 essential acids or a depleted gut microbiome.

Poor stress management leading to an imbalance of cortisol during the day and night is a very common finding and we often also find challenges to the mitochondria (the batteries inside our cells that create our energy source).

Sometimes the symptoms are purely due to oxidative stress triggered by the cytokine storm from the body’s response to the virus that needs some extra focus to help to get that person’s mojo back. The oxidative stress is the primary area that we focus in on and diet and supplements are key restoring cell health and reducing the residual inflammation.

It’s as if the virus is the straw that breaks the camel’s back, rather than the only cause of the onset of this exhaustion and associated low oxygen symptoms. Once you have the information about what is going on inside, then a much more targeted and individualised health plan can be drawn together with the aim to restore equilibrium and strengthen.

What can you do at home to help with post-viral fatigue?

As an extension to the NHS guidelines, here is a little bit more detail on how you can self-manage your symptoms at home.

1) Prioritise Your Sleep

Try to aim for a good 8-10 hours of quality sleep every night until you are feeling fully re-charged. Post-viral fatigue can upset the circadian rhythm quite starkly, and this is super important to work on and get right.

The key sleep disruptors include caffeine, alcohol as well as screen time before bed. Whilst you are feeling drained and need the extra sleep switch your evening glass of wine to a herbal tea or alcohol-free spirit instead; aim to turn your phone or tablet off at least an hour before bed and ideally keep it out of the bedroom.

If you still don’t sleep well, consider herbal adaptogens like Ashwagandha, Theanine or Magnesium before bed. An Epsom salt bath before bed can induce sleepiness and is lovely and relaxing.

2) Breathing Exercises

It is the lung function that seems to take the longest to recover from the inflammation and the compromised lung function can lead to signs of poor oxygenation to include fatigue, weakness and headaches.

It’s important to learn breathing techniques and our in-house coach and yoga teacher Amber Macintosh offers breathing courses online to help to optimise oxygenation and lung health. Regular yoga helps to incorporate breathe work into your daily life, as does a walk or exercise in the fresh air.

3) Movement

Graduated exercise is key to post-viral recovery and is still one of the only treatments offered by the NHS for chronic fatigue. Aim to build up your daily walk from 5 minutes to one hour depending on your strength. Once you have achieved a full hour of walking consider starting to incorporate short sharp bursts of running to this walk.

If you feel you need to build strength then spend a few minutes every day doing some basic exercises like lunges, squats and press-ups to build up strength. Again, build this up super slowly and do not push yourself too much. Overexertion could potentially knock you back energy-wise.

4) Cold Showers

Brrrrrr. This is probably the last thing you fancy doing first thing in the morning; however, it could make quite a difference to how you feel. Follow your warm shower with a blast of cold to start off with and you will probably start to feel a bit more vibrant. As per the teachings of Wim Hof, this cold shower is ideally built up to 3 minutes, and this longer cold blast can make even more of a difference to energy and mental clarity.

5) Hydration

Something that is often forgotten is that a well hydrated body and mind helps to reduce residual inflammation. Start each day by drinking at least 500ml water and aim to drink 2 litres over the day. Top up with herbal teas and avoid too much caffeine or alcohol until you are strong again.

6) Diet

A healthy Mediterranean diet rich in vegetables, salads, fruits, pulses, nuts, seeds, oily fish, good quality protein, cocoa and olive oil is known to be anti-inflammatory, whereas a highly processed convenience-food diet can be very pro-inflammatory and can exacerbate the symptoms related the post-viral inflammation. Your recuperation time is a chance to reset daily eating habits and nourish yourself with yummy home cooked food.

Aim to eat lots of foods that help to ameliorate the oxidative stress – these are the ones that help us to internally make our master antioxidant glutathione that helps to modulate inflammation helps with cell repair.

These foods are the highly pigmented fruits and vegetables such as red, orange, yellow, green and purple foods – this is why “eating the rainbow” every day is so important. Alliums such as onions and leeks also help us to make glutathione, as do cruciferous vegetables including broccoli, Brussel sprouts, cabbage, cauliflower and rocket.

7) Foods & Supplements for Inflammation & Oxidative Stress

Sometimes a better diet and improved lifestyle is not quite enough to support someone in a chronic fatigue state and sometimes you need to consider some extra support to help get you bounce back faster and feel better sooner.

It is important to understand that we are all wired differently and the underlying causes of the ongoing fatigue and is complex and individual to everyone. This is why we encourage talking with a qualified nutritional therapist, naturopath or functional medicine practitioner and getting focused and individualised help when it comes to supplements.

However here are some of the basic nutrients where there is some sound scientific evidence to help with recuperation from the systemic inflammation a virus can leave behind. These focus particularly on the nutrients and botanicals that help to reduce inflammation from the cytokine storm, reduce oxidative stress to help renew the cells, and also help to regain better lung function:

Vitamin D
As well as being important for immunity to protect us from getting viruses badly, vitamin D is a natural anti-inflammatory. Hopefully you will have some stores from the amazing summer weather we have had, however some people carry genetic SNP’s called VDR (Vitamin D Receptor) which compromises vitamin D uptake despite sun exposure, a good diet and supplementation. Ideally levels should be checked via a blood test to keep levels optimised. It is thought that a blood level of 100-110 is ideal for reducing inflammation.

Vitamin C
Several controlled trials have found significant effects of vitamin C helping with recuperation from lung conditions such as pneumonia. Vitamin C has both antioxidant and anti-inflammatory properties and can be taken orally up to 2,000mg daily. Parsley, red peppers and potatoes contain a surprising amount of vitamin C, as well as citrus fruits and berries.

Zinc is being researched for supporting those with active viral load as it has both antioxidant and antiviral properties. Zinc may also be helpful in the post viral stage as is one of the building blocks for making our digestive juices. Those with a zinc deficiency often have a poor sense of taste and smell, zinc is also well documented at helping clear up diarrhoea. Oysters contain the most zinc, you can also get some in other shellfish and beef. Baked beans and pumpkin seeds also contain some zinc.

Omega 3
A key nutrient that drives down systemic inflammation. This essential fatty acid has been found to decrease overall lung tissue inflammation as well as reducing cell death in pneumonia. It also helps to nourish the gut microbiome and is well known to help with cognitive challenges. You can get lots of omega 3 in oily fish such as salmon, mackerel, sardines, anchovies as well as omega 3 rich eggs, organic whole milk. There is a little in walnuts, flax and chia seeds.

It is thought that gut permeability, also known as leaky gut, can contribute to the severity of coronavirus, especially amongst the frail. This often happens when the gut microbiome is out of sync and is challenged by an overgrowth of unwanted bacterial, viral and yeast infections and there is not enough beneficial bacteria to keep things in balance. Probiotic rich foods such as kefir, live yoghurt, sauerkraut, kimchi, miso and apple cider vinegar can all help to reset the balance. Some people also benefit from probiotic supplementation.

This bright yellow spice is a well-established systemic anti-inflammatory and it has been found to be particularly helpful at supporting those with acute lung injury from infection as it helps to repair lung injury and reduces the pesky inflammatory cytokines. It may also help to rebalance red blood cell markers and one of the hallmarks of coronavirus is high ferritin levels (iron stores) due to oxidative stress and inflammation.

N Acetyl Cysteine
NAC is the precursor to glutathione which the master antioxidant our metabolism generates when it is healthy. Glutathione helps regulate immunity, detoxification and inflammatory pathways. NAC is also a mucus thinner and may also help to counteract the effects of oxidative stress and inflammatory response in post-viral patients. It has also been found to be helpful for those with chronic lung disease.

I hope that these tips are helpful at helping you to restore your energy and vitality. If you are struggling then do book in with one of our NatureDoc clinical team who can dig a bit deeper and work out how to get you back on track.



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