Folic Acid for long COVID
FOLIC ACID (VITAMIN B9)
What is folic acid?
Folic acid is a water-soluble B vitamin. It is also known as vitamin B9 [[1]].
What does folic acid do in the body?
Folic acid belongs to the B vitamin family. All B vitamins help the body break down and derive energy from macromolecules such as carbohydrates, proteins, and fats. B vitamins also play a role in nervous system function [[2]].
Folic acid has many functions in human biochemistry. It is essential for proper balance in our cells [[3]].
Folic acid helps the body grow new cells and prevent changes in DNA that may cause cancer. Deficiency in folic acid is associated with a variety of health conditions, including cancer [[1]].
Folic acid works with vitamins B6 and B12 to regulate the levels of homocysteine in the blood [[4]]. Homocysteine is an amino acid linked to arteriosclerosis, cancer, aortic aneurysm, hypothyroidism, and end-renal stage disease, among other conditions [[5]].
How can folic acid help alleviate certain Long COVID symptoms and pathophysiology?
Folic acid can help curb inflammatory processes in Long COVID by regulating homocysteine levels.
Low levels of folic acid can also predispose to Long COVID [[6]]. Folic acid may also help reduce respiratory involvement in the acute phase of COVID-19, especially in the early phase [[1]]. Folic acid blocks the function of a protein called furin, which is involved in the viral replication of SARS-CoV-2, the virus that causes COVID-19 [[1]]. Decreased folic acid levels are expected in hospitalized COVID-19 patients, and scientists believe that lower folic acid levels are seen in more severe patients [[7], [8]]. Since more severe COVID-19 patients are more likely to develop Long COVID, folic acid levels should be measured in the acute phase of COVID-19 [[9]].
Probiotics for long COVID
PROBIOTICS
What are probiotics?
Probiotics are helpful microorganisms that can benefit the body when eaten or applied. They include bacteria, such as those from the group Lactobacillus, or other microorganisms, such as yeasts, including Saccharomyces boulardii [[1]].
What do probiotics do in the body?
Probiotics are a range of different microorganisms, so each probiotic may work differently. They can affect the immune system, help one’s body have a normal level of gut microorganisms, or even produce compounds beneficial for the body [[1]]. Probiotics can have immunomodulatory, antioxidant, and antiviral effects. They can improve cognitive function, reduce physical and mental fatigue, regulate brain health, improve sleep quality, and boost mood [[2]].
How can probiotics help alleviate certain Long COVID symptoms and pathophysiology?
The acute COVID-19 phase is associated with gastrointestinal systems such as diarrhea, nausea, vomiting, and loss of appetite. Furthermore, SARS-CoV-2 RNA can be found in stool samples even after the virus clears the respiratory tract [[3]]. Changes in gut microorganisms are linked to COVID-19 severity, possibly resulting from a post-COVID-19 “leaky gut” [[3]].
The gastrointestinal system is implicated in acute COVID-19 infection and Long COVID [[4]]. The severity of gut and lung microbiomes in COVID-19 and the effect of probiotics on these microbiomes remain under investigation by researchers. A systematic review showed that COVID-19 altered the microbiome, making opportunistic pathogens more prevalent. Furthermore, stress, hospitalization, and the actions of the SARS-CoV-2 virus directly on receptors in the gastrointestinal system are linked to gut microbiome imbalance. The altered microbiome may also change the lungs’ response to respiratory infections by modulating immune responses, and these changes may persist way after acute COVID-19 infection. Therefore, improving or supplementing the gut-lung microbiome axis is of interest in Long COVID. Probiotics such as Bifidobacteria and Lactobacilli may modulate immune function in the gut-lung axis [[5]].
Glutamine for long COVID
GLUTAMINE AND BRANCHED CHAIN AMINO ACIDS (BCAAs)
What are amino acids, including glutamine and branched-chain amino acids?
Amino acids are the building blocks of proteins and play essential roles in biological processes, including inflammation, glucose balance, and more, that may be involved in Long COVID. Amino acids contribute to intermediate molecules involved in energy-producing pathways. Glutamine, in particular, is used by the cell metabolism pathways and the immune system [[1]]. Glutamine is the most abundant amino acid in the body, and it is naturally produced in the body [[2]]. Other amino acids, such as branched-chain, are not made in the body and must be obtained from dietary sources.
BCAAs include leucine, isoleucine, and valine, which are involved in protein synthesis and glucose balance in the body. BCAAs may also directly and indirectly affect immune function [[1]]. Both glutamine and BCAAs aid muscle recovery, especially after exercise in healthy individuals [[3]].
What do glutamine and the branched-chain amino acids do in the body?
Glutamine is a source of TCA cycle intermediates that play a role in energy metabolism and may serve immune functions [[1]]. Glutamine replenishes the intermediates used up in biological processes in immune cells such as T cells and macrophages. BCAAs can be used by immune cells and are needed for lymphocytes to create proteins and nucleotides in response to stimulation. BCAAs also serve as a source of molecules that enter the TCA cycle to support mitochondrial health [[1]].
How can glutamine, branched-chain amino acids, and other amino acids help alleviate certain Long COVID symptoms and pathophysiology?
Amino acids, including glutamine and BCAAs, are essential for the immune response and mechanisms involved in acute and chronic COVID-19. Especially in older adults, the changes associated with aging, such as inflammation and anabolic resistance, as well as the risk of immune dysfunction and sarcopenia, make adequate amino acid supplementation necessary. Given these considerations, researchers recommend focusing on amino acid intake in COVID-19 survivors, especially in older patients with Long COVID who might be at greater risk of malnutrition [[1]].
Quercetin for long COVID
QUERCETIN
What is quercetin?
Quercetin is a flavonoid, a group of plant pigments that give fruits, vegetables, and flowers their colors. As a flavonoid, quercetin is a potent antioxidant. Along with the other members of the flavonoid family, quercetin reduces the risk of heart and metabolic disorders and certain cancers. Flavonoids work to combat oxidative stress in the body [[1]].
What does quercetin do in the body?
Quercetin lowers coagulation and reduces hyperglycemia, inflammation, and hypertension. Quercetin supplementation is used to prevent and treat chronic diseases including, but not limited to, cardiovascular issues [[2]].
How can quercetin help alleviate certain Long COVID symptoms and pathophysiology?
As antioxidants, quercetin and other flavonoids prevent oxidative stress and buffer against the effects of aging [[2]]. Quercetin is the most promising flavonoid to help deal with Long COVID because it has shown the ability to inhibit tumor necrosis factor alpha [[3]]. Tumor necrosis factor alpha is one of the most important cytokines involved in the intense and severe chronic inflammation in Long COVID [[4]].
While much remains to be known about Long COVID, an increasingly clear picture is emerging about its underlying mechanisms, and tumor necrosis factor alpha plays a role. Individuals with Long COVID have higher levels of tumor necrosis factor alpha and other types of immunoreactive cells than people who recovered fully from acute COVID infection [[4]].
What else should I know about quercetin?
Quercetin supplementation via over-the-counter supplements is common, but significant drug interactions exist [[5]]. According to WebMD, several drugs interact with quercetin, such as antibiotics, cyclosporin, warfarin, or drugs changed by the liver [6]].
Ginkgo Biloba for long COVID
GINKGO BILOBA
What is ginkgo biloba?
Ginkgo biloba is one of the oldest trees. Its leaves are used for supplements [[1]].
What does ginkgo biloba do in the body?
Ginkgo biloba, a vast source of antioxidants, is well-known for its health-promoting effects on the brain and vasculature, significantly increasing blood flow throughout the body [[2]]. It has been used to treat memory impairment, cognitive function, edema, inflammation, oxidative stress following traumatic brain injury, neurodegeneration, stroke, and vasooclusive disorders. It has also been used as an anti-aging supplement. Based on these uses, scientists propose that ginkgo biloba may work through antioxidant, neurotransmitter modulatory, and anticoagulant properties [[3]].
How can ginkgo biloba help alleviate certain Long COVID symptoms and pathophysiology?
Researchers believe gingko biloba’s effects as an antioxidant and anti-inflammatory and its role in preventing cell death make it helpful in treating Long COVID. Oxidative stress and inflammation drive cell death in Long COVID, resulting in a cycle of cell and tissue damage [[4]].
Ginkgo biloba’s actions in the nervous system to reduce oxidative stress may make it worthwhile to reduce cognitive and neurological symptoms ranging from mild to severe [[4]].
What else should I know about ginkgo biloba?
Scientists urge caution for patients taking coagulants who want to take ginkgo biloba. Therefore, you should check with your doctor before starting a ginkgo biloba regimen if you take coagulants [[3]].
CoQ10 for long COVID
CoQ10
What is CoQ10?
Coenzyme Q10, or CoQ10, is one of today’s most popular dietary supplements. It is not a vitamin because it is a substance made by the body; however, it is similar in structure to vitamins such as vitamin K [[1]].
CoQ10 is a substance produced naturally by the body that plays a role in cell growth and maintenance. It is fat-soluble, so its absorption is increased with a fatty meal [[2]].
CoQ10 is present in all body tissues. The highest concentrations are seen in tissues with high energy requirements: the heart, kidney, liver, and muscle [[1]]. In tissues with abundant CoQ10, the CoQ10 is focused in the mitochondria, the cell’s energy powerhouse.
What does CoQ10 do in the body?
CoQ10 helps convert food into energy and serves as an antioxidant. Its specific role involves turning energy from carbohydrates and fats into chemicals that can power cells’ machinery to ensure proper cellular function [[3]].
As a scavenger of free radicals, CoQ10 reduces inflammation. As a result, It has been recommended for a variety of inflammatory diseases. CoQ10 ensures the immune response has the proper energy supply and cell types [[2]].
Two common uses of CoQ10 in the clinic are congestive heart failure and statin-associated myopathy syndrome [[4]].
How can CoQ10 help alleviate certain Long COVID symptoms and pathophysiology?
In addition to generating chemical energy for cells, CoQ10 has antioxidant functions in the body. It can recycle other antioxidants to increase antioxidant bioavailability, which can be helpful for COVID long-haulers who may deal with inflammation [[4]].
Studies have found that CoQ10 improves performance, lessens fatigue in healthy individuals, and chronic fatigue syndrome and juvenile fibromyalgia [[2]].
Glutathione for long COVID
GLUTATHIONE
What is glutathione?
Glutathione is a tripeptide of glutamate, glycine, and cysteine [[1]]. It has been called a “mighty little molecule” because of its antioxidant, immune response, antiviral defense, and other functions [[1]].
What does glutathione do in the body?
Glutathione is an antioxidant made in our bodies and found in our cells. It is the most abundant of the endogenous antioxidants found in our cells. Its high concentration reflects its important functions in detoxifying the body’s tissues, folding proteins, defending the body against viruses, and regulating the immune response [[2]].
Glutathione can neutralize reactive oxygen species, molecules involved in chronic inflammatory disorders. Many enzymes, including regulators of blood vessel function, also use glutathione as a co-factor for chemical processes. Glutathione also helps generate nitric oxide, stimulate blood flow, and promote brain and vascular health [[3]].
How can glutathione help alleviate certain Long COVID symptoms and pathophysiology?
COVID-19 creates a severe inflammatory response that leads to the overactivity of immune cells called cytokines in the lungs. This so-called “cytokine storm” can be dangerous and, if not lethal, may linger after the acute infection phase [[3]]. Glutathione has a protective response against this inflammatory response.
Risk factors for severe COVID, such as advanced age, diabetes, and being immunocompromised, are linked to glutathione deficiency as well as increased oxidative stress [[2]].
A study found that hospitalized COVID-19 patients have a glutathione deficiency and increased oxidative stress. Oxidative damage was worse in older people but also present in younger adults, in whom it typically does not happen [[4]]. Given that Long COVID involves oxidative damage, glutathione’s antioxidant effects could potentially help reduce the serious manifestations of post-COVID syndrome.
Vitamin B3 for long COVID
NIACIN (VITAMIN B3)
What is Niacin?
Niacin, also called vitamin B3, belongs to the B vitamin family. Niacin helps convert the food we eat into energy to power our cells. We can get niacin from the food we eat or from supplements.
What does niacin do in the body?
In our bodies, vitamin B3 helps create nicotinamide adenine dinucleotide, or NAD+ for short, which is used in many metabolic reactions [[1]]. NAD+ affects cellular functions beyond energy metabolism, such as DNA repair, cellular aging, and immune system function [[2]]. NAD+ also reduces the inflammatory response, so by synthesizing NAD+, vitamin B3 helps temper inflammation.
How can niacin help alleviate certain Long COVID symptoms and/or pathophysiology?
The immune response to COVID-19 and the inflammation that may follow and persist in Long COVID, threatens NAD+ metabolism. COVID-19 severity and persistence of symptoms after acute infection rely upon the robustness of the patient’s NAD+ salvage pathway [[2]]. Long COVID, in many ways, resembles pellagra, or vitamin B3 deficiency, similarly characterized by increased inflammation. Therefore, vitamin B3 supplementation may help restore the NAD+ balance in Long COVID [[2]].
What else should I know about niacin?
Niacin supplements are known for an acute flush reaction, which can worsen when taken with other vitamins, such as zinc. Also, niacin can increase the risk of bleeding events when combined with selective serotonin reuptake inhibitors or non-steroidal anti-inflammatory drugs and increase the risk of rhabdomyolysis when taken together with statins [[3]].
Iron for long COVID
IRON
What is iron?
All living organisms need iron. Iron is a mineral required for growth and development by our bodies [[1]]. Iron is used to shuttle oxygen from the lungs all over the body, including to muscles and our brains. Beyond its involvement in oxygen transport, iron also plays a role in the immune response. We also use iron to make hormones [[1]].
What does iron do in the body?
Iron is essential in biological processes such as oxygen transport, energy production, and the synthesis of nucleic acids like DNA. Iron is also involved in the body’s antiviral response; in a viral infection, the quickly-replicating viruses compete for iron with the person’s cells. Iron balance also influences the immune response. Low iron levels are associated with altered growth of immune cells, higher levels of pro-inflammatory molecules, and increased oxidative stress. In COVID-19, markers of low iron status can be both risk factors and prognostic indicators. These iron measures include ferritin, a protein used to store iron that stimulates pro-inflammatory compounds; high ferritin levels are linked to COVID-19 severity and mortality [[2]].
How can iron help alleviate certain Long COVID symptoms and pathophysiology?
Iron deficiency can be expected after COVID-19 and can contribute to long-term outcomes in terms of symptoms [[3]]. Changes in iron balance can linger for at least two months after acute COVID-19 infection. Therefore, monitoring iron levels in patients with Long COVID is essential. Fatigue and difficulty breathing (dyspnea) are symptoms of iron deficiency, so supplementation with iron may help improve these symptoms in Long COVID patients with deficient iron. Iron deficiency is linked to impaired performance as well as non-resolving lung disorders in people who are post-COVID-19. Iron supplementation may also reduce inflammation and improve immune response to COVID-19 vaccination [[2]]. In one study of Long COVID, iron deficiency was not associated with structural lung impairment but was linked to impaired stress resilience [[3]].
Lumbrokinase for long COVID
LUMBROKINASE
What is lumbrokinase?
Lumbrokinase is a substance that is naturally found in earthworms. Lumbrokinase comes from the scientific name for earthworms, which is Lumbricus. Lumbrokinase has been used as a traditional medicine in China, Japan, and other Asian countries for centuries to support the body’s healthy circulation. To harvest lumbrokinase and other healthy compounds present in earthworms, the earthworms can be dried and powdered, then taken as an oral supplement to support healthy circulation [[1]].
What does lumbrokinase do in the body?
Lumbrokinase refers to a collection of enzymes isolated from the earthworm. There are two ways lumbrokinase supports healthy blood circulation. It can break down a protein called fibrin, which is an insoluble protein that forms during blood clotting. It can also create plasmin, a substance that breaks down blood clots. As a result, lumbrokinase shows promise in reducing the aggregation of blood clots, dissolving the blood clots, and making blood less viscous and more able to flow. Lumbrokinase does not adversely affect organ systems or body tissues [[1]].
How can lumbrokinase help alleviate certain Long COVID symptoms and/or pathophysiology?
Lumbrokinase is already being used to treat stroke, heart disease, deep vein thrombosis, and diabetes. It is also used to help the cardiovascular system stay healthy. Given the heightened risk for blood clotting disorders in Long COVID, lumbrokinase can be used to maintain healthy cardiovascular function [[1]]. Most of interest to Long COVID, lumbrokinase’s anticoagulant and fibrin degrading properties make it an ideal choice to help patients with improved circulation [[2]].
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