Beetroot for long COVID
BEETROOT JUICE
What is beetroot juice?
Beetroot juice is, as its name implies, juice from the red beetroot (also called a beet), Beta vulgaris. It has garnered much attention due to its potential health effects on the cardiovascular and pulmonary systems, as well as metabolism and inflammation. These health effects stem from its status as the juice of a vegetable with a high nitrate content [[1]].
What does beetroot juice do in the body?
Beetroot juice, like other foods high in nitrates, such as leafy green vegetables, makes nitric oxide more available to the body’s cells. This, in turn, can boost physical performance and improve endothelial function, which is also reliant upon nitric oxide. Those at risk of dysfunction in the endothelial system, such as older adults, people with peripheral artery disease, pregnant women, and people with high cholesterol and high blood pressure, can benefit from beetroot juice [[1]]. Research from animal studies shows that the nitrate content of beetroot juice may also reduce the inflammatory response by acting directly on pro-inflammatory cells. It may also increase the availability of nitric oxide in the lungs, improving respiratory defenses and potentially protecting against respiratory infections [[1]].
In addition to its nitrate content, beetroot juice boasts other compounds with antioxidant and anti-inflammatory properties, such as polyphenols, carotenoids, and other inflammation-busting compounds. These compounds can scavenge free radicals in the body and regulate the immune response.
How can beetroot juice help alleviate certain Long COVID symptoms and pathophysiology?
Because a feature of Long COVID is endothelial dysfunction, and another is inflammation, consuming beetroot juice could potentially help improve endothelial function and reduce the body’s inflammatory response in Long COVID. According to the above research, the endothelial health benefits may be significant for people with high cholesterol and high blood pressure who are already at higher risk of endothelial dysfunction.
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]].
Composition CALCIUM CITRATE-250MG + L 5 METHYLFOLATE-1MG + METHYLCOBALAMIN-1500MCG + PYRIDOXAL 5 PHOSPHATE-5MG + VITAMIN D3-2000IU + VITAMIN K2 7-45MCG
Nasal Saline Irrigation for long COVID
NASAL SALINE IRRIGATION
What is nasal saline irrigation?
Nasal saline irrigation, often done with a neti pot, is a non-medicated alternative that can be used as an additional treatment to relieve nasal congestion from allergies or upper respiratory tract infections. To perform nasal saline irrigation, wash and completely dry the neti pot or a similar device before use. Prepare the saline rinse with preferably distilled or sterile water. Lean over a sink and tilt your head sideways and downward to keep the saline rinse from flowing into your mouth. Breathe through your mouth while inserting the neti pot into your upper nostril so the saline can drain from the other nostril. Then repeat on the other side.
How can nasal saline help alleviate certain long COVID symptoms?
The primary target of the SARS-CoV-2 virus starts initially in the nasal epithelium and spreads to the throat and airways. It is believed that nasal saline irrigation can help to remove and limit the viral load in the nasal passages and throat. When added to standard-of-care measures, nasal saline irrigation has been shown to clear viral loads faster in more severe or hospitalized COVID patients.1 In vitro, saline has also been reported to reduce viral replication by 50-98%.1 Also, earlier studies have shown that nasal saline may even help reduce household transmission of COVID.2 Given its ability to clear the nasal passages, nasal saline may help in the reduction of nasal symptoms post-COVID as well as smell or taste dysfunction.
What evidence supports the use of nasal saline for long COVID?
In a study of 140 patients with 68 participants who performed daily nasal saline irrigations for 12 days, there was an average reduction of 24.7% in nasal congestion, a runny nose, and sneezing.3 Smell or taste dysfunction may take 10-40 days to resolve with nasal saline irrigation, and the evidence is somewhat mixed in effectiveness.1 In the previously mentioned study, lack of smell and taste did not vary significantly between the treatment and control groups.3 However, other studies have found significant differences in loss of smell between patients who used nasal saline irrigation and gargling and those who did not.4 Another study found that using nasal saline irrigation in combination with triamcinolone acetonide nasal spray (a topical corticosteroid available over the counter) significantly improved the sense of smell compared to nasal saline irrigation alone.5
What should you be aware of when using nasal saline?
Nasal saline irrigation appears to be safe with no reported serious adverse events with proper administration. Remember to thoroughly wash your neti pot before and after each use. Some may experience nasal irritation and stinging. Reducing the amount of salt in the solution or adjusting the temperature of the water may help. It is important to use distilled or sterile water to prevent potential infection from tap water.
References:
L-Carnitine for long COVID
L-CARNITINE
What is Carnitine?
Carnitine is a generic term for several highly related compounds, such as L-carnitine, acetyl-L-carnitine, and propionyl-L-carnitine. As a nutrient, carnitine is comprised of two essential amino acids, lysine and methionine [[1]]. We get carnitine from foods, especially animal products, and we can also get it from supplements [[2]]. Carnitine deficiency creates fatigue, tiredness, and lethargy [[1]].
Within the cell, L-carnitine and acetyl-l-carnitine are virtually identical, as one can be converted to the other easily. Acetyl-carnitine has better gut absorption than carnitine and can cross the blood-brain barrier, which gives it some advantages from a drug delivery standpoint [[3]].
What does carnitine do in the body?
L-carnitine and a similar compound, acetyl-l-carnitine, both work to improve mitochondrial function [[4]]. Mitochondria are the cell’s powerhouse, generating chemical energy to fuel the cell’s processes. Mitochondrial damage is linked to early aging and neurodegeneration. Carnitine and acetyl-l-carnitine have an important mitochondrial function [[5]].
How can carnitine help alleviate certain Long COVID symptoms and pathophysiology?
Fatigue is a feature of Long COVID, and previous studies of carnitine have shown that it can reduce fatigue in people with chronic diseases such as cancer and multiple sclerosis [[1]]. This leads researchers to believe carnitine can also help relieve fatigue in Long COVID [[6]].
Carnitine’s antioxidant properties are also relevant to Long COVID. Supplementing carnitine, CoQ10, and lipoic acid can lower inflammatory markers, which can be elevated in Long COVID. Lastly, carnitine can boost anti-inflammatory and antioxidant mechanisms along with its anti-fatigue characteristics. Potentially, carnitine can also regulate the formation of acetylcholine, a substance in the brain that is involved in memory [[1]].
Rhexical Plus Tablet
- Rhexical Plus Tablet replenishes nutritional deficiency.
- Elemental Calcium is used to prevent or cure low blood calcium levels in patients who do not ingest enough calcium.
- Vitamin D3 (Cholecalciferol) regulates calcium and phosphate levels in the body.
- L-5-Methyltetrahydrofolate aids in the treatment or prevention of low folate levels.
- Methylcobalamin helps to enhance the nervous system and is essential for DNA synthesis and maturation.
- Pyridoxine-5-Phosphate is responsible for various functions such as energy production and amino acid metabolism.
- Vitamin K2-7 is essential for calcium metabolism (the main mineral found in the bones and teeth).
Neurofeedback for long COVID
NEUROFEEDBACK
What is neurofeedback?
Neurofeedback is a brain training process that allows people to self-control their brain functions by measuring their brain waves and then providing a feedback signal to encourage or discourage a certain brain activity.1 This is done by placing electrodes on a particular part of the patient’s head to obtain their electroencephalographic (EEG) or brain wave activity. When the detected EEG activity is in an optimal range, the patient receives a visual or auditory cue that is perceived as “good” and is considered a reward. When the EEG activity is abnormal, the patient receives feedback that it is “bad” to encourage the patient to change their brain activity.
Consistent sessions are needed to reinforce positive changes in brain function. Typically, patients will notice a difference of about ten sessions; however, 20 sessions are generally required to retrain the brain.
How can neurofeedback help alleviate certain long COVID symptoms?
Neurological symptoms of long COVID can include headache, insomnia, anxiety, depression, dizziness, seizures, and fatigue.2 There are several proposed mechanisms for why COVID can cause these symptoms. Damage to neural tissue can be caused by direct and indirect interaction of the SARS-CoV-2 virus with the brain. The SARS-CoV-2 virus is believed to reach the brain through the blood and infect neurons and astrocytes, which make up a large portion of the central nervous system. COVID can also indirectly impact the brain with respiratory symptoms that prevent sufficient oxygen from reaching the brain and a heightened pro-inflammatory response that can damage neural tissue.2
Various studies have also noted EEG abnormalities in COVID patients.3 Retraining the brain to allow a patient to correct these EEG abnormalities is believed to be able to make micro-structural changes of white and gray matter in the brain and improve plasticity with improvement in the trained brain areas.2 Neurofeedback has been studied for headaches, insomnia, depression, and fatigue and has been used in multiple sclerosis patients who can experience symptoms similar to those of neurological long COVID symptoms.
What evidence supports the use of neurofeedback for long COVID?
A pilot study looking at the use of neurofeedback therapy on post-COVID fatigue, anxiety, and depression included 10 participants experiencing these symptoms for at least three months. Electrodes were placed on the right and temporal lobes, and the participants underwent five sessions, each 25-45 minutes, completed within two weeks. The study found a significant reduction in anxiety and depression persisting for at least one month but an insignificant effect on fatigue.4
A review of 12 studies assessing the effect of EEG-based neurofeedback on depression found significant cognitive, clinical, and neural improvements in patients’ depressive symptoms.5 Thus, it appears that neurofeedback therapy can be an effective non-pharmacologic treatment method for new-onset anxiety and depression in post-COVID individuals; however, more studies are needed to assess its efficacy in long COVID.
What should you be aware of with neurofeedback?
Neurofeedback therapy has a relatively low risk of side effects, but side effects can include anxiety, agitation, emotional lability, headaches, and fatigue.6 These side effects are often transient. Severe side effects are rare but include seizures, depression, manic attacks, and memory problems.
References:
Vitamin E for long COVID
VITAMIN E
What is vitamin E?
Vitamin E is an antioxidant known for its free radical scavenging properties [[1]]. It is a fat-soluble vitamin [[2]]. We get vitamin E entirely from dietary sources [[3]].
What does vitamin E do in the body?
Vitamin E is potent against cancer, aging, arthritis, and cataracts. It is also vital for the health of our visual and reproductive systems. It also prevents platelet aggregation and can combat atherosclerosis [[3]].
Vitamin E is an antioxidant, which means that it protects the body’s cells from free radicals. Free radicals are a form of oxidative stress that causes cell and tissue damage. Vitamin E also supports immune health, enabling the body to fight off viruses. Its functions include widening blood vessels, preventing blood clots, and improving communication between cells [[2]].
How can vitamin E help alleviate certain Long COVID symptoms and pathophysiology?
Because of its role as a scavenger of harmful free radicals, vitamin E can protect against oxidative damage caused by COVID-19, both in the acute and post-acute phases. Research suggests that vitamin E may have anticlotting effects, which can be useful for acute COVID-19, given that blood thickening is a common symptom associated with severe COVID-19 and is also a feature of Long COVID [[4]].
Vitamin E may also have anti-platelet and anti-clotting effects, which can promote vasculature health. Given that clotting abnormalities can be a feature in severe COVID-19 and Long COVID, vitamin E can potentially reduce blood clot risks for both patient populations [[4]].
Vitamin E may lower levels of an inflammatory substance known as C-reactive protein or CRP [[5]], which can be elevated in patients with Long COVID [[6]].
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