It’s tempting to consider laying out the protocol that’s been useful and effective for me, but I believe that it would be a disservice. Successfully addressing Long COVID will require understanding and addressing the causes. Treating symptoms appears unlikely to cure Long COVID. My hope is that individuals and professionals can use this information and perspective to tailor treatments that address the causes. Policy makers need to pay attention. Decisions made by various institutions can either support resolution or extend personal and societal suffering that have been brought on by Long COVID.
I’m honored that to date, readers include a wide range of individuals. Thank you for understanding that some of what you read here might include lessons from a biology class that you took years ago and have long since forgotten. If you’re an expert and some of what you read here lacks the nuances that are common in journal type publications, thanks to you too for understanding the need for simplicity. Please use the comments section if you want more information or want to share your insights. Also, please feel free to challenge my assumptions.
The Long COVID diagram above shows five interacting elements. All of them are important. All were involved in my illness, and all have been involved in my recovery. An example is diet. I’ve had to pay attention to diet after discovering that I’d developed new food sensitivities during my early encounter with COVID-19. Certain nourishing foods that I’d once enjoyed had become highly inflammatory to my system. This early insight gave me hope and opened the small window that I mention in the introductory post. (https://longcovidjourney2wellness.substack.com/)
I will get back to each of these five elements individually as well as to discuss the evidence of how they appear to be interacting in Long COVID. But in this post, mitochondria are going to get center stage.
Mitochondria are tiny organelles that are found inside cells. Millions of these vital mitochondria play important roles in our bodies. They are best known for production of energy to fuel all body functions. That means that mitochondria provide necessary energy for our nervous system including the brain, other organs such as heart, lungs, digestive tract, our muscles and much more. Less often discussed are the roles of mitochondria in immune responses. As part of the innate immune system, mitochondria recognize the presence of invading viruses and help to clear the body of viral infections.
Evidence suggests that Long COVID is, in part, the result of COVID-induced mitochondrial dysfunction (1-3) made chronic (ongoing) by one or more sources of inflammation, dietary issues and stress. Mitochondria are a source of inflammation and, at the same time, vulnerable to damage from stress and inflammation. Here, stress means both environmental and cellular stresses that are part of normal biological and disease processes.
Fortunately, these tiny warrior-energy producing factories have the capacity to self-repair. That process is called biogenesis. In this process mitochondria can discard damaged sections (fission) and merge (fusion) with other mitochondria. Increased numbers of mitochondria can also be produced by this process. In this way, mitochondria can meet the changing needs of the body.
When the Sars-CoV-2 virus (the virus that causes COVID) enters a cell, it locates itself on the membrane walls of mitochondria and other internal cell parts. Scientists have shown that the virus disrupts normal processes and uses the cell’s energy to support viral replication. This deprives the human host of normal energy supply. Fatigue, brain fog and muscle weakness are easily understood in the context of a body competing with the virus for necessary energy.
Cell processes and the battles with the virus result in inflammation. In short, the millions of warrior-energy factories are damaged. This results in mitochondria that cannot work normally, what is called mitochondrial dysfunction. The good news is that mitochondrial dysfunction is not new. Physicians and scientist have devised solutions for treating it. One comprehensive example comes from a group that proposed care for post-ICU patients who were experiencing mitochondrial dysfunction (4). In their model and elsewhere, treatment involves readily available nutritional support (food and over the counter supplements). This was, for me, the place to start to recover. Later, when my energy level began to normalize, I added other strategies that favored restoring mitochondria to the pre-infection levels of vitality.
Resolution of Long COVID for me also involved reducing sources of inflammation throughout my body. Antihistamines and anti-inflammatories were not effective in addressing the inflammation. In my case it was apparently associated with gastrointestinal (GI Tract) inflammation. For me, it unequivocally required a change in my diet.
Fortunately, my sense of humor and my training in mucosal immunology and endocrinology were still in tack. More on diet in my next post.
A note on these references. They represent just a few of many high-quality peer reviewed journal articles addressing viral-mitochondrial interactions. Links to other peer reviewed quality articles are welcome in the comments section.
(1) KK Singh, et al., Decoding SARS-CoV-2 hijacking of host mitochondria in COVID-19 pathogenesis, 20 JUL 2020 https://doi.org/10.1152/ajpcell.00224.2020
(2) S Ajaz, et al., Virus-Host Cell Interactions and the Viral Life Cycle: Basic Science to Therapeutics: Mitochondrial metabolic manipulation by SARS-CoV-2 in peripheral blood mononuclear cells of patients with COVID-19- American Journal of Physiology-Cell Physiology, 2021
(3) Costa TJ, et al., Mitochondrial DNA and TLR9 activation contribute to SARS-CoV-2-induced endothelial cell damage. Vascul Pharmacol. 2022 Feb;142:106946. doi: 10.1016/j.vph.2021.106946. Epub 2021 Nov 25.
(4) Wesselink, E, et al.,Feeding mitochondria: Potential role of nutritional components to improve critical illness convalescence. Clinical Nutrition, 2018, https://doi.org/10.1016/j.clnu.2018.08.0320261-5614/© 2018 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Hello Catherine,
Thanks so much for these questions. Yes, the list of supplements AND the process of selecting foods that supported my recovery are published. I will add the links at the end of this response. In brief, as a scientist trained in immunology and having run clinical trials, it is my view and experience that Long COVID is primary caused by mitochondrial dysfunction, caused originally by the virus damaging mitochondria and then kept chronic by various sources of inflammation that continue to damage mitochondria. The length of time to recovery likely depends on the self-discipline and knowledge in those with LC, to minimize sources of inflammation and to optimize the vitality of mitochondria through nutrients and life style choices. Likely, a person's age and health history play a role, depending on the state of the mitochondria prior to the COVID infection and an individual's willingness to make changes that may not be easy.
In terms of my own recovery, it took time, so far about 9 months of recovery time after only getting sicker during the previous 2 years. In part, I was learning along the way. I have detailed this journey in my posts and would be happy to respond to questions. I consider myself about 90% recovered. My brain fog is rare now, so I am able to do research and to write. Fatigue is largely gone. It can re-emerge in response to significant stress including too much physical exercise, but a good night's sleep usually solves the fatigue.
My digestion is, and all gastrointestinal symptoms have, returned to a normal healthy state but I am aware that I did develop new food sensitivities during COVID. How long or if these will remain, I don't know. I am careful about my diet, still avoiding foods high in lectins, most nightshade vegetables and milk products contain A1 caseins. Goat's milk products are safe for me.
Here are the links to relevant posts, but I strongly recommend that you begin reading the posts from the beginning to get a full understanding. Especially do read about mitochondria. In my view and that of other scientists, they play a central role in LC.
https://longcovidjourney2wellness.substack.com/p/long-covid-choosing-foods-and-nutrients
https://longcovidjourney2wellness.substack.com/p/diet-and-its-role-in-long-covid
What supplements did you find helpful for mitochondrial dysfunction?