Treatment for Long Haulers Syndrome 2022

Up to 80% of patients experience prolonged illness after COVID-19. COVID long-haulers or LHCS (Long Haul COVID Syndrome) is not only seen after the COVID infection but it is being observed in some people that have received vaccines. 

According to a study of Mayo Clinic patients who had COVID-19, about 75% of the people suffering long COVID symptoms — defined as persistent symptoms even six months after recovery — are women.

LHCS may persist for months after the acute infection and almost half of patients report reduced quality of life. Patients may suffer prolonged neuropsychological symptoms, including multiple domains of cognition. (Ref, Ref)

Researchers are learning new details about the long-term effects of COVID-19. A study shows COVID-19 "long haulers" have a significantly higher chance of dying months after their infection.

According to the paper in Nature, COVID survivors have a 59 percent higher risk of death within six months of contracting the virus. 

Symptoms of Long Haulers Syndrome

Clinical signs and symptoms can be grouped in the following clusters. The reason for this grouping is to allow organ specific targeted therapy/individualized therapy. 

1. Respiratory: shortness of breath, congestion, persistent cough, etc. 

2. Neurological/psychiatric: brain fog, malaise, tiredness, headaches, migraines, depression, inability to focus/concentrate, altered cognition, insomnia, vertigo, panic attacks, tinnitus, anosmia, phantom smells, etc. 

3. Musculoskeletal: myalgias, fatigue, weakness, joint pains, inability to exercise, post-exertional malaise, inability to perform normal activities of daily life (ADL’s).

4. Cardiovascular: Palpitations, arrhythmias, Raynaud like syndrome, hypotension, and tachycardia on exertion. 

5. Autonomic: Postural tachycardia syndrome (POTs), abnormal sweating. 

6. GIT disturbance: Anorexia, diarrhea, bloating, vomiting, nausea, etc. 

7. Dermatologic: Itching, rashes, dermatographia 

8. Mucus membranes: Running nose, sneezing, Burning and itchy eyes. 

FLCCC I-Recover Protocol

Given the lack of clinical trials of long-haul COVID-19 syndrome, these recommendations are based on the abnormal changes within the body associated with the COVID-19 disease and post viral illnesses along with the collective experience of FLCCC members.

First-line treatment based on the FLCCC I-Recover Protocol.

• Ivermectin has been reported to have a role in the treatment of post-COVID-19 syndrome. A dose of 0.2-0.4 mg/kg day for 3-5 days, followed by once or twice weekly dosing for ongoing symptoms for up to 4 weeks. Discontinue after 2 - 4 weeks if all symptoms have resolved. A repeat course is recommended in those who respond poorly or relapse once the treatment is stopped. The anti-inflammatory properties of ivermectin may mediate this benefit.
• If inadequate response to ivermectin: Prednisone 0.5mg/kg daily for 5 days, 0.25mg/kg for 5 days followed by 0.12 mg/kg for 5 days. Patients with persistent organizing pneumonia may require higher doses for a more prolonged period of time. 
• If presenting with neurological symptoms i.e. poor concentration, mood disturbance. Fluvoxamine 50 -100 mg day for 15 days. Monitor response closely as some patients will respond poorly to this medication. Teens and young adults who are prescribed fluvoxamine can experience acute anxiety which needs to be monitored for and treated by the prescribing clinician to prevent rare escalation to suicidal or violent behavior. 

Supplements recommended to support the therapy

• Omega-3 fatty acids: Vascepa, Lovaza or DHA/EPA 4 g day. Omega-3 fatty acids play an important role in the resolution of inflammation by inducing resolvin production. [Ref, Ref] 

• Melatonin 2- 5 mg at night (slow release/extended release) with attention to sleep hygiene. 

• Vitamin D3 1000-3000 u/day 

• Vitamin C 500 mg BID (vitamin C inhibits histamine).[Ref] 

Second-line approach (after poor response to first-line protocol) and treatment of suspected mast cell activation

Choose a type 1 (loratadine or cetrizine) and type II antihistamine (famotidine) along with a mast cell stabiliser (rupadatadine, quercetin or luteoline).

Second line:

• montelukast 10 mg/day (for mast cell activation syndrome). Caution as may cause depression in some patients. 
• SSRIs (selective serotonin reuptake inhibitors) e.g. fluvoxamine, fluoxetine (prozac).

Diet and Nutrition

“Diet can be a source of inflammation, and whatever we can do to lower [inflammation] will allow the immune system to work better,” says Elizabeth Boham, MD, MS, RD, a functional-medicine physician and medical director at the UltraWellness Center in Lenox, Mass.

She recommends her patients limit their intake of refined carbohydrates and focus on whole foods rich in protein, fiber, healthy fats, and the micronutrients the immune system needs to thrive.

Supporting a good nutrient baseline is also key. “We see a significant amount of nutrient deficiencies and insufficiencies in the United States,” Boham says. Notably, insufficient levels of zinc and selenium are associated with worse outcomes from viral infections. Good sources of zinc include oysters, hemp seeds and pumpkinseeds, beans, nuts, and animal protein; sources of selenium include mushrooms, Brazil nuts, and seafood.

“Make sure you’re getting eight to 12 servings of phytonutrients a day from vegetables, fruits, spices, herbs, and tea,” she advises. Phytonutrients such as EGCG (epigallocatechin gallate, a polyphenol found in green tea) and curcumin (found in turmeric) can decrease inflammation and rebalance the immune system. 

N-Acetyl-L-Cysteine (NAC)

NAC is an amino acid that the body uses to create glutathione, the body’s master detoxifier. “Glutathione has a big impact on balancing the immune system,” explains Boham. “If we’re deficient in it, we’re more likely to get sick, and also to have a continued immune response.”

Eating plenty of cruciferous vegetables (such as kale, broccoli, and cabbage), as well as avocado, okra, spinach, and alliums, can help bolster levels of gluta­thione, as can supplementing with NAC. 

Aaron Hartman, MD, founder of the Richmond Integrative and Functional Medicine clinic in Richmond, Va., describes one patient, a 26-year-old woman, whose symptoms — persistent low oxygen and shortness of breath — following a bout of COVID resolved after treatment that included NAC as well as omega-3 fish oil.

“NAC is one of the more important nutrients for people who get shortness of breath with COVID, because of its ability to break down those really, really small blood clots called micro-emboli,” explains Hartman.

Vitamin D

Much has been written about the emerg­ing link between COVID severity and vitamin-D deficiency. A pilot study in Spain found that adding oral D3 supplementation significantly reduced the need for ICU treatment among people hospitalized after infection. 

Leo Galland, MD, a functional-medicine internist in New York City, recommends that people with long COVID supplement with up to 5,000 IU of D3 daily. Hartman advises aiming for a vitamin-D blood level in the range of 60 to 80 ng/mL.

Resveratrol

Resveratrol is a polyphenol with anti­oxidant and anti-inflammatory effects that’s found in red grapes, red wine, ­peanuts, and some berries. It’s also available as a supplement.

Galland has found it to be particularly helpful in restoring his COVID patients to health. “Resveratrol has a number of beneficial effects on coronavirus infection,” he notes. “It supports ACE-2 function, it inhibits the growth of the deadly MERS coronavirus through multiple mechanisms, and it diminishes the kind of inflammation associated with coronavirus infection.”

Galland treated a physician in her 60s who’d been sick with COVID for six weeks, continuing to run daily fevers with brain fog and fatigue. He prescribed a combination of herbs and supplements, including resveratrol, and her symptoms resolved within a couple of weeks.

He recommends long-COVID patients supplement with 200 mg of resveratrol twice a day.

Intermittent Fasting

Some functional providers believe intermittent fasting or time-restricted eating can help rejuvenate the immune system. Restricting feeding to shortened windows helps stimulate mitophagy (the removal of damaged mitochondria), Patrick Hanaway, MD, senior advisor to the CEO of the Institute for Functional Medicine, explains.

Fasting also supports the turnover of damaged cells throughout the body, making room for new, healthy mitochondria and cells to take their place.

Time-restricted eating can take a variety of forms. One of the most popular is simply eating all your day’s meals within an eight-hour window, then going 16 hours without food or calories. 

Probiotics

COVID can wreak havoc on the gut microbiome, but research on specific probiotic strains that can best restore balance following the syndrome’s particular damage is in its infancy. Galland is looking into soil-derived bacteria of the genus Bacillus because it may have natural antibiotic properties, though there’s not yet enough data to make specific recommendations.

Eating fermented foods, such as sauerkraut, yogurt, kefir, and kimchi, can help fortify and support the gut’s microbiome. And in the event of ongoing gut disturbances, working with a functional-medicine provider to design a well-rounded prebiotic and probiotic protocol can help bring the microbiome back into balance. 

Melatonin

You may have heard of melatonin as a sleep aid. Melatonin is produced by your brain to help facilitate falling asleep, but like niacin, melatonin is an antioxidant that helps prevent release of inflammatory cytokines. Like niacin, melatonin increases adiponectin levels. Melatonin helps keep the inner lining of your blood vessels healthy and prevents clots.

Supplementing with 1 mg of melatonin at bedtime might benefit those whose sleep–wake cycles have become dys­regulated with long COVID.

Melatonin is also neuroprotective. The brain consumes 20% of the body’s oxygen. All that oxygen passing through the brain makes a toxic byproduct called reactive oxygen species, which can damage nerves and blood vessels. Your brain uses many different antioxidants, including melatonin, to neutralize the reactive oxygen species before they can cause harm. Therefore, it is not surprising that studies show melatonin seems to provide some protective effect against diseases like Alzheimer’s.

COVID-19 infection and vaccination are major stressors on the entire body, particularly the brain. Stress increases blood flow and the supply of oxygen, which can increase formation of reactive oxygen species. That may be what’s behind reports of worsening cognitive defects post-COVID-19 vaccination. Therefore, in theory it would be a good idea to have plenty of melatonin on board in the face of either COVID-19 infection or after COVID-19 vaccination. Melatonin facilitates sleep, which is important for the cleanup of damaged proteins in the brain and general immune system recovery.

Also worth noting is that your brain synthesizes melatonin from serotonin. That is why many believe fluvoxamine, a selective serotonin reuptake inhibitor (SSRI), appears to be beneficial for COVID-19 infection. If you inhibit the reuptake (aka clearance) of serotonin, then there is more serotonin floating around in the brain that can be converted into beneficial melatonin.

Quercetin

Quercetin is a flavonoid found in dill, broccoli, onions, capers, apples, and berries. “Quercetin is a mast-cell stabilizer,” says Boham. “We use it with people who have allergies, asthma, and mast-cell issues.” (Mast cells, a type of white blood cell found in connective tissue throughout the body, produce allergy-related symptoms and can also be activated by SARS-CoV-2 infection.)

Quercetin appears to bind to the spike protein of the coronavirus, inhibit inflammatory pathways, and block replication of infected cells. It is also antiviral and completely safe, she adds.

In addition to emphasizing sources of quercetin in their diet, Boham says, long-COVID patients can supplement with 500 mg twice a day.

Other phytonutrients such as EGCG (epigallocatechin gallate, a polyphenol found in green tea) and curcumin (found in turmeric) can decrease inflammation and rebalance the immune system. 

Vitamin C

Vitamin C inhibits histamine. Healthcare professionals are administering vitamin C intravenously to deliver it directly into their patient’s bloodstream to be immediately available. Liposomal vitamin C is the next best option. It’s the most bioavailable form of vitamin C on the market today. The liposomal form can survive the digestive process to be up to 135% better than traditional oral vitamin C.

Long-COVID patients can supplement with vitamin C 500 mg twice a day. 

Vaccine Related Side Effects, Niacin and Niatonin Protocol

You got vaccinated and now you want that stuff out of your body? Sorry to break the news, but that isn’t possible. 

According to ParacelsusDoc on Substack:

What is possible is to optimize your health, and to leverage the results of independent science conducted in the remote corners of the internet that have not yet been censored. If you do an internet search for “COVID-19 vaccine detox”, you’ll likely see niacin and melatonin. There are theoretical and anecdotal data that these two naturally occurring substances can provide some protective effects against vaccine-related side effects.

Niacin is Vitamin B3, and like all B vitamins has general anti-inflammatory effects. What makes niacin special is that it is the precursor to nicotinamide adenine dinucleotide (NAD), which you may recall was in an IV drip that Joe Rogan received for his COVID-19 treatment. NAD helps catalyze more than 400 different chemical reactions in your body. NAD helps stabilize your genes (promoting normal genetic expression), and decreases the production of harmful inflammatory cytokines. Those actions are particularly important in the face of these genetic therapies being marketed as vaccines.

Vaccine side effects are due in part to the spike protein. Many ill effects from the COVID-19 virus are also from the spike protein. Therefore, it follows that what helps with COVID-19 infection may also help after COVID-19 vaccination. Niacin has three additional actions which are worth mentioning on that front. First, niacin helps convert dietary cholesterol into steroid hormones, which are essential in the body’s response to any stress. Second, niacin increases the concentration of adiponectin, a molecule with anti-inflammatory and anti-cytokine actions. It’s important to keep cytokines in check as severe COVID-19 infection and some autoimmune reactions after vaccination are likely due to destructive cytokines causing tissue damage. Third, niacin deficiency leads to paranoid and suicidal behaviors, as well as auditory and visual hallucinations. There are disturbing reports of psychiatric breakdowns post-COVID-19 vaccination, therefore it’s prudent to make sure your body’s stores of niacin are topped off.

Although there are many variations of COVID-19 vaccine detox protocols, here are the common recommendations for flush niacin and melatonin (aka niatonin protocol).

Flush Niacin (nicotinic acid form)

• Take 2-3 times per day with melatonin
• Start with 500 mg dose, work up to 1,500 mg – 2,000 mg per dose as tolerated*
• Ex. 500 mg 3 times a day on Day 1, 1,000 mg 3 times a day on Day 2, etc.

*It’s called flush niacin for a reason. The flushing is a warm, prickly sensation in the face and upper body that starts 15-30 minutes after taking niacin and lasts 1-2 hours. The flush is not harmful but is an unusual sensation at first. Taking melatonin at the same time will help reduce flush symptoms.

Melatonin

• Take 2-3 times per day with flush niacin
• Start with 10 mg dose, work up to 20 mg per dose^
• Ex. 10 mg 3 times a day on Day 1, 15 mg 3 times a day on Day 2, etc.

^Some protocols go up to 40 mg per dose. Although there is no theoretical maximum melatonin dose, the higher the dose the more drowsy you will feel.

Also key:

• Do not drink alcohol during any of this (or ingest other intoxicating substances)
• Get plenty of sunlight for natural vitamin D, but feel free to add a vitamin D supplement, especially if you live in cold, dark climates
• Consider adding a vitamin C supplement, but no sooner than two weeks after your last vaccine dose. In the meantime, get vitamin C from natural food sources. The theoretical reason to wait two weeks to supplement vitamin C is to avoid your immune system going into overdrive and activating those destructive cytokines.

Issues & Precautions:

• There is great ambiguity on the timing of niacin and melatonin related to vaccination. Some discuss using this protocol before going for a vaccine, others immediately afterwards, and others only if side effects develop.
• There are not many FDA / academic peer reviewed studies related to this.
• Avoid taking melatonin with any SSRIs like fluvoxamine. If you are on a SSRI then take a lower dose of melatonin.
• Long-term use of high dose melatonin causes habituation, meaning your body builds up a tolerance to that dose, and may also decrease your body’s natural production of melatonin.

The Path Ahead

One of the pandemic’s few bright spots is the way it’s accelerated telehealth services. Patients now enjoy unprecedented access to a broad range of healthcare providers across the nation. 

Find healthcare providers or one who provides virtual consulting:

• www.ifm.org/find-a-practitioner (Functional Medicine)
• https://covidlonghaulers.com/.

Related:

• Long Haulers: World Council for Health Reveals Spike Protein Detox

• FLCCC I-MASK+ Prevention and Early Outpatient Protocol

• Bruce Patterson Long Hauler Protocol
  
  

Disclaimers: 

• This post is not medical advice. This post is for informational purposes only.
• Always see or talk to your doctor before taking these drugs, supplements and over the counter products. Be aware that most of the 'treatment' dosages are above the recommended dietary allowance (RDA) and therefore such dosages should not be maintained on a long term basis. 
• Our aim here isn't to replace your doctors' advice. It is intended as a sharing of knowledge and information. Do take note that supplements are not 100% protective or curative against COVID-19.
• You still need to follow the advice given by CDC, WHO and your local authority in terms of local guidelines such as mask wearing, social distancing, vaccination and avoiding crowds. It's better to combine multiple strategies in order to defend yourself against this virus.
• According to US NIH: "...Guidelines should not be considered mandates. The choice of what to do or not to do for an individual patient is ultimately decided by the patient and their provider."