Selenium for long COVID
SELENIUM
What is selenium?
Selenium is an essential trace element, meaning our bodies only need a small amount [[1]]. We can get selenium from the foods we eat or from supplements [[2]].
Selenium intake is essential to ensure the proper function of selenoproteins, which get their name, in part, from selenium [[3]]. Selenium is a crucial aspect of selenoproteins, which help make DNA and are involved in the antiviral response. More generally, selenoproteins protect against cell damage [1]]. Selenium supplements support the innate immune system and help regulate the secretion of pro-inflammatory molecules [[2]].
What does selenium do in the body?
Selenium is involved in the brain, hormones, heart, blood vessels, and immune functions. Our bodies also need selenium for antioxidant processes. Selenium deficiency increases susceptibility to COVID-19. Dietary selenium is necessary for proper immune function and may protect against certain diseases, such as cancers, asthma, and heart disease [[4]]. Selenium is thought to prevent cancer cells from growing and spreading due to its ability to shut down the cancer cell cycle, promote cell death of tumor cells, and initiate DNA repair [[5]].
How can selenium help alleviate certain Long COVID symptoms and pathophysiology?
Low selenium levels in COVID-19 are linked to increased tissue damage and Long COVID symptoms [[2]]. Low selenium levels may increase susceptibility to COVID-19, influence disease severity, and contribute to post-acute COVID symptoms, such as Long COVID. Many studies show that selenium concentration in COVID-19 patients is lower than in people who do not have COVID-19. Selenium concentration in COVID-19 is also linked to the severity and mortality of the disease [[2]].
[3] https://journals.lww.com/co-lipidology/abstract/2008/02000/selenium_intake_and_cardiovascular_risk__what_is.9.aspx
Vitamin B1 for long COVID
THIAMINE (VITAMIN B1)
What is thiamine?
Thiamine, also called vitamin B1, belongs to the group of vitamins known as the B vitamins. Like the other B vitamins, thiamine converts food into fuel for our cells. More specifically, thiamine helps break down carbohydrates we eat into energy [[1]].
What does thiamine do in the body?
Thiamine is essential for nervous system function because it helps brain cells communicate better, both in terms of the insulation needed for brain cells to communicate and the propagation of neural signals itself. Thiamine deficiency can lead to neurological issues such as memory problems, seizures, delirium, and more. Thiamine also has antioxidant properties; the body needs more during a viral illness. Continual dietary supplementation is vital because the body can only store a limited amount of thiamine and has a relatively short half-life [[2]].
How can thiamine help alleviate certain Long COVID symptoms and/or pathophysiology?
Research shows that thiamine depletion occurs in critical illness, including acute COVID-19 [[2]], and that this depletion is associated with an almost 50% increase in mortality [[1]]. One study found that the lower a patient’s vitamin B1 is, the larger the systemic inflammatory response, which is linked to adverse clinical outcomes in COVID-19 and is a risk factor for developing Long COVID [[3]].
Beyond thiamine’s role in dampening inflammation in acute illness, Long COVID symptoms resemble those of beriberi, or thiamine deficiency [[4]]. Many of the symptoms of beriberi involve the nervous system, which can be affected by long COVID. Therefore, sufficient thiamine intake may be essential to treat Long COVID symptoms, and potentially, especially those Long COVID symptoms that affect the nervous system.
Systemic Proteolytic Enzymes for long COVID
SYSTEMIC PROTEOLYTIC ENZYMES
What are systemic proteolytic enzymes?
We previously discussed bromelain’s utility in reducing inflammation. Bromelain, discussed in this guide, belongs to a larger class of systemic proteolytic enzymes, or SPEs. SPEs break down proteins to help facilitate normal body processes such as digestion or pain relief. They can also be used to reduce swelling and help with wound healing cleanup [[1]].
Other SPEs include lysozyme, catalase, and papain. SPEs break down proteins into smaller fragments and, ultimately, into amino acids, which are the building blocks of proteins and other vital molecules the body uses for various purposes [[2]].
What do systemic proteolytic enzymes do in the body?
SPEs can be taken as oral supplements or applied to the skin. Applied to the skin, they can aid in cleaning up tissue from wounds to support healthy wound healing [[1]].
As a supplement, SPEs can work in the body to perform a variety of processes related to immune health, digestion, and more. Regarding COVID-19 and its impact on the immune system in Long COVID, SPEs are known immune system modulators. SPEs work to combat oxidative stress and prevent cell and tissue damage [[2]].
How can systemic proteolytic enzymes help alleviate certain Long COVID symptoms and pathophysiology?
SPEs may be able to break down the spike proteins in SARS-CoV-2, the virus that causes COVID-19 [[2]]. They may also be able to unfold coronavirus proteins. SPE’s antiviral properties can be helpful because the virus can persist in Long COVID patients after the acute phase.
Ibuprofen for long COVID
IBUPROFEN
What is ibuprofen?
Ibuprofen is a nonsteroidal anti-inflammatory (NSAID) medication commonly used to relieve pain and reduce fevers. Unlike acetaminophen, it also has some anti-inflammatory properties and can be used for inflammatory diseases such as osteoarthritis and rheumatoid disorders.
How can ibuprofen help alleviate certain long COVID symptoms?
Ibuprofen works by reversibly inhibiting enzymes in our body called COX-1 and COX-2 that help reduce fever, pain, and inflammation. It is also believed to reduce pro-inflammatory substances called cytokines and inhibit the activation of other immune cells that can cause inflammation.
The prevalence of post-COVID pain is estimated to be up to 63.3%, and patients with chronic pain can have exacerbated symptoms after COVID.1 There are multiple possible mechanisms behind post-COVID pain. Post-COVID pain may be caused by the virus entering and attacking musculoskeletal and nervous systems, including the brain. Persistent inflammation from overactivated inflammatory pathways and excessive activation of blood clotting can also contribute to pain. Various types of pain can also be caused by COVID, such as headaches, neuropathic pain, musculoskeletal pain, chest pain, arthralgia, and fibromyalgia.
While other prescription medications are typically used to treat headaches, neuropathic pain, chest pain, and fibromyalgia, ibuprofen can be used to relieve short-term headaches, musculoskeletal pain, arthralgia, and myalgias that persist or worsen after COVID; however, it should not be used to treat COVID or to reduce the duration of COVID symptoms. Post-COVID headache can also be treated first-line with acetaminophen or NSAIDs like ibuprofen.2
What evidence supports ibuprofen’s use for long COVID?
Early on in the pandemic, anecdotal reports suggested that NSAIDs could potentially increase susceptibility to COVID due to their ability to increase expression of ACE2 receptors that are targeted by the SARS-CoV-2 virus.3 However, several studies have since debunked this theory and have shown that the use of NSAIDs is not associated with increased COVID severity or risk of all-cause mortality.4
A survey of 696 COVID patients in Italy reported that the use of standard analgesics such as ibuprofen in the post-acute phase of COVID had a temporary reduction in pain severity.5 NSAIDs can also be effective in managing migraines and are commonly used for headaches as well.6 While there are few studies investigating the use of ibuprofen for long COVID pain, the use of NSAIDs for pain is well-established and can be used safely in many patients post-COVID. Chronic use of NSAIDs, however, should be discussed with a healthcare provider.
What are some things to be aware of when taking ibuprofen?
Ibuprofen is not recommended in people at risk for or with existing cardiovascular disease, GI disease, kidney impairment, chronic liver disease, or people at higher risk of bleeding. Use of NSAIDs is associated with an increased risk of serious cardiovascular events such as heart attacks and strokes. New-onset hypertension can also occur with NSAIDs and can exacerbate heart failure. There is also a higher risk of gastrointestinal adverse events such as gastrointestinal bleeding or ulcers. Do not take ibuprofen for more than 10-15 days per month for headaches. Ibuprofen should be taken with food, and you should let your doctor know if you are taking ibuprofen regularly for long COVID symptoms.
References:
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]].
Rhexical Plus Tablet Benefits – Vitamins, Minerals & Health Support
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Rhexical Plus Tablet is a supplement that treats nutritional deficiencies while promoting overall health. It is a blend of essential vitamins and minerals that include Elemental Calcium, Vitamin D3, L-5-Methyltetrahydrofolate, Methylcobalamin, Pyridoxine-5-Phosphate, and Vitamin K2-7.
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Naproxen for long COVID
NAPROXEN
What is naproxen?
Naproxen is a non-steroidal anti-inflammatory (NSAID) medication commonly used to relieve pain and reduce fevers. Unlike acetaminophen, naproxen has anti-inflammatory properties and can be used for inflammatory diseases such as osteoarthritis and rheumatoid disorders. It is typically taken as 500 mg followed by 250-500 mg every 12 hours as needed for the immediate-release formulation or 1 g once daily for the extended-release formulation.
How can naproxen help alleviate certain long COVID symptoms?
Naproxen works by reversibly inhibiting enzymes in our body called COX-1 and COX-2 that help reduce fever, pain, and inflammation. It is also believed to reduce pro-inflammatory substances called cytokines and inhibit the activation of other immune cells that can cause inflammation.
The prevalence of post-COVID pain is estimated to be up to 63.3%, and patients with chronic pain can have exacerbated symptoms after COVID.1 There are multiple possible mechanisms behind post-COVID pain. Post-COVID pain may be caused by the virus entering and attacking musculoskeletal and nervous systems, including the brain. Persistent inflammation from overactivated inflammatory pathways and excessive activation of blood clotting can also contribute to pain. Various types of pain can also be caused by COVID, such as headaches, neuropathic pain, musculoskeletal pain, chest pain, arthralgia, and fibromyalgia.
While other prescription medications are typically used to treat headaches, neuropathic pain, chest pain, and fibromyalgia, naproxen can be used to relieve short-term headaches, musculoskeletal pain, arthralgia, and myalgias that persist or worsen after COVID; however, it should not be used to treat COVID or to reduce the duration of COVID symptoms. Post-COVID headache can also be treated with acetaminophen or NSAIDs like naproxen.2 Compared to ibuprofen, naproxen acts longer and can be taken every 8-12 hours, while ibuprofen acts faster and can be taken every four to six hours.
What evidence supports naproxen’s use for long COVID?
Early on in the pandemic, anecdotal reports suggested that NSAIDs could increase susceptibility to COVID due to their ability to increase expression of ACE2 receptors that are targeted by the SARS-CoV-2 virus.3 However, several studies have since debunked this theory and have shown that the use of NSAIDs is not associated with increased COVID severity or risk of all-cause mortality.4 A study in which hospitalized COVID patients were randomized to either naproxen 500 mg twice a day or placebo for five days along with standard treatment demonstrated improvement in cough and shortness of breath.5 This result requires additional studies to confirm these findings, but naproxen has also been found to improve headache, malaise, myalgia, and cough in a study of patients with rhinovirus.6
A survey of 696 COVID patients in Italy reported that the use of standard analgesics such as naproxen in the post-acute phase of COVID had a temporary reduction in pain severity.5 NSAIDs can be effective in managing migraines and are commonly used for headaches as well.2
What are some things to watch out for with naproxen?
Naproxen is not recommended in people at risk for or with existing cardiovascular disease, GI disease, kidney impairment, chronic liver disease, or people at higher risk of bleeding. Use of NSAIDs is associated with an increased risk of serious cardiovascular events such as heart attacks and strokes. New-onset hypertension can also occur with NSAIDs and can exacerbate heart failure. There is also a higher risk of gastrointestinal adverse events such as GI bleeding or ulcers. Do not take naproxen for more than 10-15 days per month for headaches. Naproxen should be taken with food, and you should let your doctor know if you are taking it regularly for long COVID symptoms.
References:
3) Kushner, P., McCarberg, B.H., Grange, L. et al. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in COVID-19. npj Prim. Care Respir. Med. 32, 35 (2022). doi: 10.1038/s41533-022-00300-z
Bromelain for long COVID
BROMELAIN
What is bromelain?
Bromelain is a combination of different enzymes naturally found in pineapple, both in the fruit and in the stem. Its job is to break down proteins [[1]].
What does bromelain do in the body?
Bromelain has many useful clinical properties. It is anti-edema, anti-cancer, anti-inflammatory, and anti-thrombotic. It is also pro-fibrinolytic, which can dissolve blood clots [[1]]. As an anti-inflammatory agent, bromelain exerts activity widely throughout the body in the respiratory, digestive, immune, and circulatory systems [[2]]. Bromelain controls inflammation through its effects on biological pathways that regulate the synthesis of the immune system’s inflammatory molecules, cytokines.
Clinical applications of bromelain include treating cardiovascular disorders, bronchitis, sinusitis, surgical trauma, thrombophlebitis, wound healing, osteoarthritis, and diarrhea [[1]]. Researchers hypothesize that bromelain may also help with chronic fatigue, joint pain, and myalgia [[2]]. Bromelain shortened symptom duration in one study of children with sinusitis [[3]].
How can bromelain help alleviate certain Long COVID symptoms and pathophysiology?
Because bromelain can help treat several disorders, it could be promising for Long COVID patients, who often face multi-organ system challenges. Bromelain’s effects are documented on the cardiovascular, circulatory, musculoskeletal, immune, vascular, and digestive systems. It also has the capacity to impact cancer cells directly and change molecular pathways of cancer malignancy. While it has several benefits, the exact mechanisms by which these benefits are conferred remain unclear. However, its multifaceted effects could benefit Long COVID patients [[1]].
Inflammation is a problem for Long COVID patients, and bromelain directly modulates inflammatory cytokine pathways. Another issue faced by Long COVID patients is difficulties with clotting and circulation, and bromelain’s effects in preventing thrombosis and breaking down clots can be helpful. Bromelain also may have analgesic effects by regulating the synthesis of pain mediators such as bradykinin. Lastly, bromelain may have inhibitory effects on SARS-CoV-2, which causes COVID-19, by its enzymatic activity breaking down its various proteins and receptors [[2]].
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