Natural Medicine and Alternative Therapies for Long COVID – What’s Realistic?

Nutritional Supplements

Nutraceuticals, supplements, and herbal extracts can modulate SARS-CoV-2 viral activity, dampen inflammation, reduce pain, and improve energy. But are they therapeutically active enough to effectively treat Long COVID? 

In this section, we’ll look at nutrients that support immune function and dampen SARS-Cov-2 activity to promote recovery from Long COVID. 

Probiotics and Prebiotics

Gut microbiome dynamics play a central role in health and disease. SARS-CoV-2 infection is no exception, nor is Long COVID. A 2022 paper looked at lasting symptoms, including fatigue and dementia, that persist after infection. It maintained that probiotic supplements support the body’s ability to fight viral infections and manage post-infection conditions, including preventing long-term COVID complications. 

The main contribution of this article is insights into the multi-organ dysfunctions of Long COVID. These include the gut-liver axis where leaky gut, common in Long COVID, and liver inflammation occur together. Probiotics and prebiotics support a healthy gut microbiome and help restore the relationship between the organ system and gut microbiome. 

But which probiotics are best for Long COVID, and how long do they take to work?

The American Society for Microbiology (ASM) maintains that probiotics produce compounds called bacteriocins that block the activity of the SARS-CoV-2 virus. Although the exact mechanisms are unknown, probiotics help reduce the severity of Long COVID symptoms. However, there’s no consensus about which probiotics are best for Long COVID. 

Here are the ones I recommend: Probiotic 50B CFU from Pure Encapsulations or ProBioMed 250B CFU by Designs for Health. These are high-dose probiotics, so you only need to take one capsule once or twice daily with food. They are available on Fullscript, my online supplement pharmacy. 

Intravenous (IV) Vitamin C Infusions

To get higher, therapeutic doses of vitamin C without experiencing gas, bloating, or diarrhea, you need an intravenous (IV) infusion. I advise starting with a weekly IV boost of 25 g (25,000 mg) for several weeks. If you’re sensitive to vitamin C, start with 10 g. If you do not react, increase to 25 g. A session takes about one hour. Gradually increase the dose by 5 or 10 g each session until you achieve a therapeutic response. Some need 50 or 75 g to notice improvement. The maximum dose is 100 g per IV, though some tolerate 150 g. 

However, before you start higher doses, you’ll need a blood test for Glucose-6-phosphate dehydrogenase (G6PD). Glucose-6-phosphate dehydrogenase deficiency is a common inherited enzyme deficiency, affecting an estimated 400 million people worldwide. It is more common in people of African, Mediterranean, and Asian descent. G6PD deficiency is an X-linked genetic disorder and, in general, affects males more than females. 

Symptoms of G6PD deficiency exacerbation include fatigue, weakness, dizziness, shortness of breath, rapid heart rate, dark urine, and a pale complexion. Your gums and tongue may become pale. You may also develop symptoms of jaundice including yellowing of your skin, eyes, and inside your mouth. When severe, G6PD deficiency can cause hemolytic anemia.

Herbal Medicine 

Herbal medicine plays a role in helping the body’s systems return to normal as a pathway toward healing from viral infections. For example, curcumin and licorice root extract are helpful for managing chronic low-grade inflammation. The most effective for COVID is Lithospermum erythrorhizon, called Gromwell root extract. A proprietary form, Tollovid, was developed in Israel as a 3CL protease inhibitor dietary supplement. 
To augment its effects, I recommend combining Tollovid/Tollo19 with ImmunoKinoko, an active hexose correlated compound (AHCC) medicinal mushroom extract. AHCC® is a standardized extract of cultured shiitake or Lentinula edodes mycelia with immune system modulating effects.

This combination is my recommended starting point for those recovering from acute COVID and those with Long COVID. Take one each twice daily for one month. You can find these on my online dispensary in Fullscript. 

The Role and Management of Adrenal Insufficiency 

Naturopathic doctors (NDs) recognize adrenal deficiency is associated with poor infection recovery. In the case of Long COVID, the theory suggests that the chronic fatigue of post-viral infection is related to the adrenal gland’s inability to keep up with physiological stress. 

A Nature Reviews article has shown that low cortisol levels are common in Long COVID patients. Researchers found a greater than 50 percent lower morning cortisol level in a blood sample among Long COVID patients. Salivary cortisol testing is also used and more convenient because you can do it at home and get immediate results. 

Support your adrenal glands by taking a bovine adrenal cortex extract supplement. Bovine extracts are processed from cow adrenal glands, but pig and lamb adrenals are also used. Adrenal Rebuilder is a classic naturopathic doctor-prescribed product from pig adrenals. Glandokort A-17 Natural Adrenal Peptide Bioregulator capsules are also helpful. However, this medication comes from Europe and must be ordered online, whereas Adrenal Rebuilder is made in the U.S. from grass-fed, organically-raised livestock. 

Vegetarian Adrenal Support

For vegans and vegetarians, licorice root extract such as glycyrrhizin supports adrenal gland function. Glycyrrhizin is the major active constituent of licorice root and has been used in traditional medicine to alleviate bronchitis, gastritis, and jaundice. Its constituents include glycyrrhetinic acid (glycyrrhizin), flavonoids, hydroxyl coumarins, and b-sitosterol. 

Glycyrrhizin is a triterpenoid saponin, a plant steroid. It promotes liver health and is used to help reverse fatty liver disease. It has anticancer properties and is used to treat stomach and other cancers. As a mild steroid, it has anti-inflammatory properties and can lower IL-6 and TNF-alpha. It also supports adrenal function and helps fight fatigue. Choose a licorice root extract supplement with at least 12% standardized glycyrrhizin. 

Though glycyrrhizin is a cornerstone for treating CFS and Long COVID, too much glycyrrhizin has a downside. Over time, excess use interferes with the body’s utilization of cortisol and reduces aldosterone, another adrenal hormone, resulting in high blood pressure.

Low-Dose Hydrocortisone

Physicians practicing integrative medicine may prescribe low-dose synthetic hydrocortisone as an alternative to glycyrrhizin or adrenal organ extract. Low-dose hydrocortisone is a form of hormone replacement therapy; therefore, it can suppress the adrenal glands’ ability to make cortisol. The dosage is 5 or 10 mg daily in the morning. When you stop using it, your cortisol level may be lower than before treatment. Short-term symptom improvement is not a good tradeoff for long-term health. Focus on supporting and restoring adrenal gland function over time. 

Support Adrenal Health with Ginseng

Ancient doctors knew about the importance of the adrenal gland. Traditional Chinese medicine (TCM) recognized the symptoms of adrenal deficiency more than a thousand years before the West. They termed it kidney yang deficiency. The TCM treatment is taking adaptogenic herbs like ginseng. 

According to modern TCM, ginseng, ren shen (“man-root”), not only has an anti-fatigue effect, but it is also an antiviral, has immune remodeling capabilities, and supports normal endocrine function. Side effects are uncommon when taken in recommended dosages, but can include insomnia, restlessness, anxiety, and headaches. 

There are two major types of ginsengs: (1) Asian ginseng and (2) American ginseng. The Asian varieties include those from China and Korea. They are the most scientifically studied and are what you need for Long COVID. The American variety is more calming and used for stress management and insomnia. Asian ginseng is more stimulating and used for endurance. Both contain ginsenosides, the active chemical in ginseng root. I recommend 250 mg twice daily between meals of a standardized Asian ginseng extract containing 12% ginsenosides. 

Value of Vitamin C for Adrenal Health

Another way to support your adrenal health is to get enough vitamin C. The adrenal glands have the highest level of vitamin C of all organs in the body. You must take enough to restore vitamin C depletion. Take at least 3,000 – 6,000 mg daily. Remember, too much vitamin C causes diarrhea. Reduce the dose if you experience loose stools or get intravenous vitamin C infusions.

Use of DHEA

Supplementing with DHEA is integral to sustaining adequate adrenal hormone activity. I recommend starting with 10 mg and working up to 25 mg for women and 50 mg daily for men. Measure DHEA-Sulfate (DHEA-S) in a lab test to evaluate your DHEA status. The reference range is between 138-475 µg/dL. For my patients, I want to see at least 150 µg/dL. I consider optimal levels between 250-450 µg/dL. 

Acupuncture  

In anticipation of a chronic COVID crisis, I published a paper in 2022 on the role of acupuncture for Long COVID. The premise was that acupuncture favorably modifies the duration of illness and outcome of Long COVID. Patients feel better and recover in a shorter time. For those whose recovery has plateaued, acupuncture can stimulate critical physiological systems to reignite healing. 

Acupuncture modulates the autonomic nervous system. Therefore, it is useful for conditions and symptoms associated with all organs and physiologic systems, including Long COVID. (Feng 2023) However, though there are few research papers on the effects of acupuncture for Long COVID, the results in those papers are positive. My clinical experience using acupuncture for lingering post-infection cases and Long COVID patients confirms the usefulness of acupuncture as part of a treatment regimen. 

Mitochondrial Support

In a 2023 paper, researchers found that when the immune system senses tissue damage, like from SARS-CoV-2, certain molecules are released to trigger an immune response via pathogen-associated molecular patterns. A contradictory biological effect is that the same compounds that work with the immune system can induce mitochondrial damage. The profound exhaustion experienced by Long COVID patients is not normal tiredness. It’s worse without rest but doesn’t improve with rest or sleep. The researchers in this paper believe it’s due to mitochondrial damage-associated molecular patterns (DAMPs). These patterns are also found in myocardial infarction, cancer, autoimmune diseases, and atherosclerosis. 

Unlike other diseases, long COVID doesn’t have a single phenotype. Instead, the authors contend that Long COVID involves different sub-phenotypes, each with its own diagnosis and treatments. We haven’t yet unraveled all these processes. However, altered mitochondrial functions may be the underlying cause of Long-term COVID. The authors propose a treatment involving antiviral drugs and nutrients that support mitochondrial health. They admit that antiviral drugs have limited benefits. However, antioxidant nutrients like NAC, glutathione, and catalase reduce mitochondrial damage. 
A 2022 paper found Mito-MES (Mitoquinone/mitoquinol mesylate) has antiviral and anti-inflammatory activity in preclinical models of SARS-CoV-2 infection.

Are Cognitive Therapies Helpful?

The rarity of complete recovery in Long COVID patients who attend conventional treatment centers informs us that modern medicine doesn’t know what causes it or how to treat it effectively and safely. Brain retraining for cognitive dysfunction and wakefulness drugs for drowsiness and fatigue do not address the immunological and metabolic changes at the root of Long COVID. These are hopeful methods at best. Though some patients experience minor benefits, they are ineffective in providing lasting recovery. 

Cognitive behavioral therapy (CBT), a widely used “talk therapy,” may help some navigate the psychological journey of long COVID. Still, CBT does not resolve somatic factors like chronic pain associated with low-grade inflammation. It does nothing to rebalance hormones or address mitochondrial dysfunction. I’ve concluded that addressing biochemical and immunological imbalances comes first and provides the most benefits, followed by psychological counseling and cognitive therapies. 

Long COVID patients may have post-traumatic stress syndrome induced by the ordeal of being in a hospital ICU for a few weeks or longer. In these cases, CBT may have some benefits and can be used to parallel treatments that address biological causes. Though CBT may be useful in a comprehensive approach to managing Long COVID, deeper-acting biological therapies are primary approaches to resolving this condition.  

Long COVID is not a psychological condition. However, it has emotional and cognitive issues. Before starting any form of cognitive therapy or psychological counseling, I order cortisol and DHEA levels. If these adrenal hormones are too low or above the upper end of the reference range, talk therapy will have limited or no benefit. First, address adrenal hormone imbalances. Then start CBT or other psychological therapies. 

Physical Therapy and Body Movement 

Physical therapy, tai qi, and yoga can improve motor function, stabilize balance, lessen joint and muscle pain, and lift mood and energy. Although useful, these activities are not biological answers to the immunological needs of Long COVID patients.