Treatment for long COVID: supplementation, oxygenation, and suggested treatment modalities

Treatment for long COVID includes methods to improve oxygenation and provide proper supplementation in addition to these modalities.

LONG-COVID PATIENTS, or post-acute COVID-19 cases, are defined as the presence of symptoms extending beyond three weeks from the initial onset of symptoms. Long-Haul Syndrome is reserved for chronic COVID-19 symptoms extending beyond 12 weeks. The most persistent symptoms I hear from patients seeking treatment for long COVID include (in no particular order) : “I’m just tired” to severe “fatigue” or “exertion tiredness”,  “My sense of smell has not returned yet” “Shortness of breath” to “I get winded easily” “I was told I have heart problems” , “Pins and needles sensations in the arms and legs” , “Tingling in my arms and legs” , “Headaches” (from mild to severe) , “Everything gets worse when I am fatigued” , “I had to stop participating in sports” (or other activities) , “Feeling faint” from low blood pressure , “Weakness all the time” , “Difficulty finding words” , “Body aches” (mild to moderate) “Joint pain” , “Vertigo” , “Tinnitus” , “Nausea” , “Anxious” and “I look pale.”

Other common symptoms are pain or tightness in the chest, chills or sweats, brain fog, palpitations, light-headedness, concentration challenges, and confusion and memory problems. I’m used to treating the “good day, bad-day feeling” patients, but long-haulers exhibit a new level of this.

CDC long-haul symptoms

The U.S. Centers for Disease Control (CDC) says people commonly report experiencing different combinations of the following symptoms: difficulty breathing or shortness of breath; tiredness or fatigue; symptoms that get worse after physical or mental activities (also known as post-exertional malaise); difficulty thinking or concentrating (sometimes referred to as “brain fog”); cough; chest or stomach pain; headache; fast-beating or pounding heart (also known as heart palpitations); joint or muscle pain; pins-and-needles feeling; diarrhea; sleep problems; fever; dizziness on standing (light-headedness); rash; mood changes; change in smell or taste; and changes in menstrual period cycles.

The chiropractor approach to long-hauler rehabilitation

Coronavirus can stymie any organ and tissue in the body, especially the lungs.

Chiropractic treatment for long COVID must support the heart and lungs, and restore healthy breathing. Spend time teaching patients powerful breathing methods; use your hands and modalities that improve circulation and movement of lymph in the body, and help clear toxins and carbon dioxide from the body. I look for procedures and methods to improve oxygenation to the cells. This may include:

Stress reduction: Prioritize rest and relaxation; avoid pushing yourself; balance activity and breaks; use meditation and breathing.

Sleep: I insist patients get more sleep and I will do everything I can to help these patients improve deep and REM sleep. Monitor this with various wearable devices.

Energy optimization: Blend together mitochondrial nutritional support (see below) and movement, and limit the hours of work per day.

Exercise: The best thing is to listen to your body. If you know that something’s pushed you over the edge in the past, then don’t repeat it. Do something active, but for less time or less strenuously. I start my patients with marching in place and moving the arms overhead. This allows patients to do this at home or outside but certainly stay close to home. I literally start with two-minute bouts. If that goes well, they increase the two-minute march in place to several times a day. I talk about “strategic pacing” and stacking exercise throughout the day rather than doing it all at once. This is a concept to help conserve energy. I monitor movement steps on smartphones.

Detoxification: Sweat, use saunas, light therapy, hot showers, etc. I encourage patients to try and mobilize the body enough to sweat and excrete toxins.

My long-haulers therapy approach has been going after key components of a post-viral syndrome. I look to include the following treatment for long COVID in my overall program:

1. Mitochondrial support with key micronutrients. Ensuring that the mitochondria are well-supported nutritionally will enable every other aspect of a healing program to work more effectively.
2. Microbiome support guided by comprehensive stool testing. COVID-19 viral particles are frequently found in fecal samples. Further, several gut commensal organisms with known immunomodulatory potential, including bifidobacteria, are underrepresented in COVID-19 patient samples. It is important to engage patients in making dietary changes and in the use of supplements aimed at improving microbiome health. Avoidance of unnecessary antibiotics is also key.
3. Adrenal support with micronutrients, botanicals such as ginseng and ashwagandha, and even hormone replacement. It’s important to check cortisol levels and achieve optimal physiological ranges.
4. Deep, restorative sleep is an absolute necessity.
5. Avoidance of excessive stress.
6. Environmental testing to rule out the possibility of mold exposure and chemical toxicity that can contribute to a patient’s lack of immune resilience.

Chiropractic modalities and treatment for long COVID

What can the chiropractor do in these cases? Targeted chiropractic treatment, including:

Anything chiropractic: For me this includes hands-on therapy (mobilization, manipulation and modalities), photobiomodulation laser light treatments, PEMF, frequency therapy, vibration/percussion, lymphatic drainage therapy, TECAR therapy and SCENAR therapy.

Diet: High-fat whole foods and a plant-rich diet (ketogenic, intermittent fasting).

Nutrient optimization: In addition to the supplements below, eating lots of green leafy vegetables throughout the day; include arugula, lettuce, beets, celery, broccoli and turmeric, etc., at every meal. These are rich sources of nitrates and will help create less arterial stiffness.

Topical cream: Every patient gets CBD with a menthol base. This can help aches and pains and work on a microvascular level.

Cognitive optimization: Get the brain active.

Hormonal optimization: Check the thyroid, adrenal and sex hormones.

Gut optimization: Heal leaky gut, include probiotics and eat more diverse (fermented) foods.

Immune/inflammation optimization: Check off everything above and use specific herbs/nutrients the patient might need.

I follow and recommend the Front Line Critical Covid-19 Care Alliance recommendations. For specific supplementation these are:

• Vitamin C, 500-1,000 mg twice a day
• Zinc, 100 mg/day
• Quercetin, 250 mg twice a day
• Vitamin D, 4,000-5,000 IU per day
• Melatonin, 10 mg before bed
• Omega-3 fatty acids, 4 grams/day

In addition to the above my clinical and research experience has identified several key mitochondrial nutrients that, when combined, yield synergistic and clinically significant benefits. These include:

• Acetyl-L-carnitine (500-1,000 mg/day)
• N-acetyl-cysteine (600-1,200 mg/day)
• Alpha lipoic acid (200-400 mg/day)
• Coenzyme Q-10 (100-200 mg/day)

These nutrients are even more effective when administered with therapeutic dosages of key cofactors including B-vitamins (30-60 mg/day), vitamin C (1,000-2,000 mg/day), magnesium (100-200 mg/day), zinc (15-30 mg/day) and selenium (100-200 mcg/day).

Look into the Mast Cell Diet for patients who seem continuously inflamed, especially with lung and heart problems. Fasting may not be for everyone, but try a 1- to 3-day fasting protocol to help with monocytes on the list.

Long-Haul Syndrome and testing

Some Long-Haul Syndrome patients are able to monitor measures of blood. Testing can help explain persistent symptoms, such as reduced physical fitness and fatigue.

Clotting markers have been significantly elevated with long-haulers compared with healthy controls. All comorbidities associated with virus are nitric oxide (NO) deficient states. I can easily test NO levels in the office with a simple saliva test strip. Nitric oxide governs circulation and micro-circulation, modifies platelet activation/aggregation aka clotting, and is also anti-thrombotic, inhibits fibrin deposition, is anti-atherogenic, inhibits platelet adhesion molecules, inhibits leukocyte adherence and migration, and inhibits microvascular inflammation.

By age 40, endothelial NO (eNOS) functions around 50%; by the time we are 60, only around 15%. When eNOS is dysfunctional or uncoupled it becomes a superoxide, generating enzyme instead of NO generating enzyme, and increasing oxidative stress. Many factors increase eNOS uncoupling including age, SAD (Standard American Diet), lack of exercise, meds such as antibiotics, antidepressants, birth control pills, NSAIDs, PPIs, fluoride in toothpaste, mouthwash, EMF, pollution, glyphosate, genetic SNPs and stress. A key therapy for me is to optimize NO for prevention, recovery from virus, as well as vax shots and boosters.

Supporting the nitrate/nitrite/NO pathway not only increases NO directly, it helps recouple NOS, increasing NO through that pathway, and decreasing superoxide production and oxidative stress. I show my patients a list of vegetables that increase nitrate and/or offer them a clinically proven nitrate supplement.

Supporting long-hauler patients

If the heart and lungs are not able to adequately respond to physical stress of exercise, support the heart and lungs. Try to restore patients with less efficiency at exercising.

Those with brain fog or cognitive issues will also have lower measures of oxygenation (even at rest) and will be especially poor at exercise efficiency. Look to recommending hyberbaric oxygen therapy (HBOT) for patients with reduced oxygen uptake, reduced cardiac performance, and inefficient pulmonary ventilation. Again, do everything you can to increase oxygenation to the cells.

Some long-haulers do have organ damage and/or muscle conditions. Chiropractic manual therapy and a multi-modal treatment approach is helping my patients improve the mitochondria dysfunction. Medical doctors have rest and medications to offer. We can provide manipulation, sound nutritional advice, fascial therapy, and modalities that are improving the lives of these patients.

Evaggelos Tsonos, Chiropractor MSc.