Long COVID: How to Get Your Life Back

One of the newest studies on the long-term risks of COVID-19, published in Nature Communications in October 2022, says it all: Of the tens of thousands of people studied, 40 percent of those who were sick with COVID had not fully recovered from their infection many months later. And 5 percent never recovered at all. In other words, 45 percent of those with the novel coronavirus ended up with long COVID.

The researchers identified more than 20 symptoms linked to long COVID, like breathlessness, heart palpitations, and confusion or difficulty concentrating. They also found a high incidence of disturbances in smell, taste, sight, and hearing; muscle aches; and other symptoms related to mental health, the heart, and the respiratory system.

This isn’t the first or only study to find a high incidence of long COVID. In a study by researchers in England, 75 percent of patients who received care for the coronavirus were still suffering ongoing symptoms three months later. In another study in Ireland, more than half of 128 people reported persistent fatigue 10 weeks after their initial COVID symptoms.

The cause of long COVID

As a lifelong expert in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) who has treated thousands of patients with the problem, I believe that long COVID is a form of postviral ME/CFS. (Many viruses cause this condition, including Epstein-Barr and human herpesvirus 6.)  The common symptoms of post-viral ME/CFS include persistent, disabling fatigue, chills and sweats, body aches, brain fog and concentration issues, digestive issues, trouble sleeping, dizziness, and shortness of breath.

Why such a broad range of symptoms? Basically, post-viral ME/CFS affects the hypothalamus, a part of the brain that controls the dispersion of hormones throughout your body. ME/CFS also interferes with sleep and cripples the function of mitochondria, tiny structures within the cells that generate cellular energy. Those fundamental disruptions are why ME/CFS (and long COVID) affect multiple systems in the body—the brain, the heart, the lungs, the musculoskeletal system, the gastrointestinal system, the senses, and more.

About 10 percent of people will continue to have long COVID ME/CFS about a year after their infection. Fortunately, this is treatable with a patient-tested, science-backed protocol that has helped many people improve dramatically and even recover full health.

Step #1: Shut down excessive inflammation

Chronic inflammation—caused by an overactive immune system that’s still reacting to the virus—is a key feature of long COVID. A scientific summary published by the National Institutes of Health says that chronic inflammation is the likely “mechanism for the symptoms of long COVID.” In a study published in Current Medical Research and Opinion, people with “post-COVID syndrome” (another name for long COVID) had high levels of four biomarkers of chronic inflammation.

Several key supplements taken daily for six to 12 weeks can rebalance the immune system and help tame chronic inflammation.

• Take curcumin and glutathione daily. Curcumin, the active ingredient in the spice turmeric, is a potent anti-­inflammatory agent. Glutathione is a powerful antioxidant that neuters the free radical molecules that cause inflammation. I recommend 750 milligram (mg) daily of a form of curcumin with a high rate of absorption. For glutathione, I recommend 300 mg twice daily.

This combination is particularly effective for lung healing. However, it’s important to note that lung damage from COVID tends to improve and often resolves after two years. I recommend monitoring your oxygen levels with a pulse oximeter so you can see improvement over time and feel reassured. These two supplements help speed the process.

• If you’re in pain, add Boswellia. If you have significant pain, I recommend combining curcumin and the herb Boswellia. The curcumin balances the cyclooxygenase inflammation system, which affects the musculoskeletal system. The Boswellia balances the lipoxygenase pathway of inflammation, which plays an important role in the lungs and the gut. Take 750 mg of boswellia two to three times daily in addition to the curcumin recommendation above.
• Take omega-3 (fish oil). The omega-3 fatty acids found in fatty, cold-water fish like salmon, sardines, tuna and mackerel help balance the immune system. I recommend approximately 600 mg daily of a product that combines the essential fatty acids DHA and EPA.

Step #2: Boost energy

I recently conducted a study on the herb red ginseng, a plant renowned for its ability to protect and restore physical and mental stamina. In the study, 188 people with ME/CFS or post-viral fatigue took a special form of red ginseng grown hydroponically with a style of cultivation to help the plant generate a maximum level of ginsenosides, the compound that gives red ginseng its restorative powers. The product used in the study was Red Ginseng HRG80, which comes in the form of chewable tablets. Three out of every five people who took the herb had improved symptoms, including significant increases in energy, mental clarity, and quality of sleep, and decreases in pain. Take one chew, in the morning, with a second dose at lunch. 

Step #3: Consider the SHINE protocol

This protocol involves sleep restoration, hormonal support, infection treatment, nutritional supplementation, and exercise (as able). In a study published in the Journal of Chronic Fatigue, the SHINE protocol improved fatigue, sleep, mental clarity, pain, and well-being in 90 percent of people with post-viral ME/CFS. Key elements of the protocol include:

• Sleep restoration. Getting seven to eight hours of sleep is important for healing. But 40 percent of people with long COVID have sleep disturbances, according to researchers at the Cleveland Clinic, who reported their findings at the 2022 annual meeting of the Associated Professional Sleep Societies. I have found the best sleep medications for people with post-viral ME/CFS include zolpidem (Ambien), trazodone (Desyrel), and gabapentin (Neurontin). Talk to your doctor about the medication and dosage that is right for you.
• Hormonal support. In a study published in the Endocrine Journal, people with long COVID had imbalances in thyroid and adrenal hormones. These changes seem to be involved in the persistent symptoms of long COVID, the researchers said. Based on a mix of symptoms and blood tests, but even with normal testing, I treat patients with post-viral ME/CFS with bioidentical hormone therapy for thyroid, adrenal, ovarian, and/or testicular hormones. (Bioidentical hormones are chemical twins for the hormones generated by the human body.) Talk to your doctor about whether hormonal treatment is right for you.
• Infection treatment. Most people with post-viral ME/CFS have weakened immune systems, resulting in multiple chronic infections. The most common infection is with the fungus Candida albicans. I have found that many ME/CFS patients benefit from six weeks of treatment with the antifungal fluconazole (Diflucan). Talk to your doctor about testing and treating for candida infection. Epstein-Barr (mono) viral reactivation is also common.
• Nutritional supplementation. To optimize nutrition, my post-viral ME/CFS patients take a daily multivitamin mineral supplement. Look for a powdered supplement (for easy absorption) that delivers 500 to 1,000 mg of vitamin C, about 50 mg of most B vitamins, 200 mg of magnesium, and 55 micrograms (mcg) of selenium.
• Exercise. For many people with post-viral ME/CFS, exercise beyond a certain point makes the patient feel more fatigued. In a study published in the Journal of Translational Medicine, the problem of “post-exertional malaise” in long COVID and CFS/ME were exactly the same. But exercise is also important for healing. To exercise with long COVID, begin with light exercise, such as walking (or if regular walking is too difficult, water walking in a heated pool). Walk only as much as you comfortably can (or start with five minutes). Then increase the time you walk by one minute every one to two days, as is comfortable. When you get to the point that exercise leaves you feeling worse, cut back to a comfortable level and continue that amount of walking each day.

You can find out more about the SHINE Protocol in my book From Fatigued to Fantastic. Or you or your doctor can email me at fatiguedoc@gmail.com and ask for free treatment tools, which include the SHINE Protocol overview, intake and treatment protocol checklists, quick screens, and more.