Long Covid summary by Leo Galland, MD; is it similar to Encephalitis lethargica?
A happy gut is a healthy body and brain....foods to help support our Bifidobacterium species.
Main issues seen in “Long Covid” - (1) ACE2 receptor loss/dysfunction affecting circulatory function which causes symptoms that are “Covid19”-like. (2) ongoing hyperinflammation, T-cell changes and auto-antibody formation is common. (3) mitochondrial distress. (4) … “which should be first” - oral and gut microbiome dysbiosis. … “But the changes involve a loss of diversity and anti-inflammatory organisms and an increase in the levels of inflammation-inducing microbes. A recent study showed that probiotics actually can decrease the likelihood of the development of long COVID.” - Leo Galland, MD.
»»»»»»»> Pomegranate peel could help improve all four areas of dysfunction.
A question to consider - how much overlap is there between these symptoms and EL, “sleepy encephalitis”? I don’t have an answer in this post, but there are food ideas for helping the helpful gut species.
Addition - ACE2 receptor role in neurological conditions - related to CoV era bringing focus on the ACE2 receptor. Fulltext;
Li J, Kong X, Liu T, Xian M, Wei J. The Role of ACE2 in Neurological Disorders: From Underlying Mechanisms to the Neurological Impact of COVID-19. International Journal of Molecular Sciences. 2024; 25(18):9960. https://doi.org/10.3390/ijms25189960, https://www.mdpi.com/2957596
See this post - EL symptoms include extreme sleepiness while still being kind of aware of what’s going on was a symptom:
Copyright by author - Leo Galland, MD: Treating PASC (Post-Acute Sequelae of COVID): How to Address Long-Hauler’s Syndrome Effectively, an interview by Dick Benson, Integr Med (Encinitas) . 2021 Dec;20(6):36–37.(https://pmc.ncbi.nlm.nih.gov/articles/PMC8887227/)
“Leo Galland, MD, a board-certified internist, Dr. Galland was educated at Harvard University and the New York University School of Medicine and trained in internal medicine at the New York University-Bellevue Medical Center. He has received international recognition for developing innovative nutritional therapies to treat autoimmune, inflammatory, allergic, infectious and gastrointestinal disorders and has described his work in numerous scientific articles and textbook chapters.
Today we want to talk today about the presentation you are going to give at the Environmental Healthcare Symposium (EHS).
Dr Galland: Yes, my presentation will focus on COVID, from the perspective of not only treatment, but prevention because my view is that the prevention of long COVID in people who are exposed to the virus should be a major public health priority.
Integrative Medicine: A Clinician’s Journal (IMCJ): Is that because of the issues that people have before they are exposed to COVID or is it because of what COVID does?
Dr Galland: The reason I think it should be a priority is that there are reports that people who are hospitalized with COVID, 50% to 70% of them, take months to recover. And those people who are not hospitalized, in about 30% of them it takes months to get better. There are some patients who are pretty sick and disabled a year, a year and a half later. This is a huge number of people on whom the late effects of COVID had an impact, and there’s been really very little research on not only the treatment and reversal of COVID, but prevention at the time of acute infection.
My own experience with the protocol I had worked out for treating COVID is that fewer than 2% of the patients that I see have gone on to have what we’ll call long COVID. I think we know enough about the biology or the physiology of long COVID that it’s possible to have rational treatments, preventive measures as well as treatments, for the disease once it occurs.
IMCJ: Is the impact of long COVID consistent across patient types?
Dr Galland: There’s a great deal of variability and different organ systems are involved; there are different combinations. There’s not a clear relationship between how sick a person is and the likelihood of long COVID. So that’s one of the things that I’ll be addressing in the presentation; it’ll probably be the focus of my presentation.
Here’s what’s known about biological changes in the bodies of people who get COVID-19 when they’re recovering. These changes can be identified even in people who are not very sick. They fall into a few categories.
Number one are disturbances in circulatory function, which can be understood based upon the destruction of the enzyme that is the cellular receptor for the virus. The virus enters cells by attaching to an enzyme, ACE2, on the outside of the cell membrane. In the course of viral attachment and viral cell entry, ACE2 is destroyed, and ACE2 plays a vitally important role in circulatory function. It also has antiinflammatory effects, antithrombotic effects. Almost all the acute complications of COVID-19 can be traced to an ACE2 deficiency that results from the viral infection. Now, there’s evidence that this kind of deficiency persists into the recovery stage—and I’ll review some of the studies, which found that even healthy young people who are recovering from COVID-19 have disturbances in circulatory function—which are totally consistent with the effects of ACE2 deficiency.
The second thing that we know about the pathophysiology of recovery from COVID is that there is an ongoing state of inflammation in the body. The immune system is not returned to its pre-COVID state, and the inflammation is actually fairly complex. It involves abnormalities in T cell function. There is also a high rate of autoantibody formation. That’s related to B cells, and the auto antibodies that develop are usually functional. That is, they have physiologic effects that are measurable. They’re not just there as a lab finding. Included in those autoantibodies are autoantibodies directed against ACE2, which were recently demonstrated by a group of researchers at the University of Arkansas. Those autoantibodies are also functional and were shown to have an impact on ACE2 function.
There are 2 mechanisms by which ACE2 is impaired. One is a direct attack on ACE2 by the virus and the other is the formation of anti-ACE2 autoantibodies. That’s a delayed effect, and it correlates with the development of antibodies against the spike protein.
The third thing that we know is that there’s mitochondrial distress that’s probably dysfunction, but definitely distress, that can be measured in people who are recovering from COVID.
The fourth, or maybe the first actually, is that there are disturbances in the oral and gut microbiomes, and these changes have mostly been measured in people who have been hospitalized, so we can’t be certain that they’re not in part a result of hospitalization. But the changes involve a loss of diversity and anti-inflammatory organisms and an increase in the levels of inflammation-inducing microbes. A recent study showed that probiotics actually can decrease the likelihood of the development of long COVID.
We’ve got those 4 components, and I think those 4 components are probably to some extent universal. That is part of what happens after COVID-19, and it may be severe enough to contribute to the long COVID syndrome.
In addition to that, damage to organs occurs, the brain and the lungs being the most important of these. Damage in the brain actually involves the loss of gray matter, which is quite common and is associated with impairment in higher cognitive functions even in people who haven’t been very sick. The other thing that may occur is damage to the autonomic nervous system. That’s another neurologic complication producing a syndrome called POTS—postural orthostatic tachycardia syndrome—which is now pretty well known because of COVID-19.
The damage to the lungs most of the time is not that obvious. If people get pneumonia, there’ll be evidence of COVID pneumonia. It’ll usually resolve. The long-term changes in the lungs involve 2 things. One is the thickening of the lining of the alveoli, of the air sacs, which interferes or slows down oxygen transport. This is called interstitial lung disease. This will produce shortness of breath and usually a drop in oxygen saturation with activity.
The other is the loss of blood vessels. So again, we’re back to the importance of the circulation. There is a loss of blood vessels in the lungs. There is a group in Boston that’s developed a computer program for analyzing CT scans to demonstrate this. Just looking at a CT scan, it may be read as normal, but using their computer algorithm, if the scan used thin enough sections, you’ll be able to determine that there’s just a loss of pulmonary circulation. Sometimes there are other things. There’s metabolic damage that can occur. Diabetes and high blood pressure occur as a complication of the post-COVID syndrome at a rate that … In other words, people who have had COVID are 2 to 3 times as likely to develop diabetes or high blood pressure over the subsequent 6 months as people who didn’t have COVID. Kidney damage may occur. These are not the most common complications, but they’re just examples of the tremendous variety of types of damage and dysfunction that this virus can leave in a person’s body.
IMCJ: How do you treat the condition?
Dr Galland: My approach to the treatment of acute COVID and the prevention of the complications of acute COVID dovetails really very tightly with the prevention and even the treatment of long COVID. Although, depending on the type of damage somebody has, you may need to perform other measures to treat long COVID. But it’s an increasingly systematic approach that I take, which starts with recognizing the 4 things that I said are together kind of universal: the oral and gut dysbiosis, preventing, reversing and treating that with some antimicrobial natural products, some probiotics and prebiotics; restoring ACE2 activity, primarily through diet, a high polyphenol diet, which also shapes the gut microbiome and specific supplements, of which the major ones are vitamin D, Resveratrol and curcumin. Those have been part of my treatment for acute COVID since February 2020. I strongly suspect that that has something to do with the very low incidence of long COVID in the patients who I’ve treated.
The third component would be restoring mitochondrial function. For that, I look for evidence of mitochondrial dysfunction, and there are several things that can be helpful for that. Dietary supplements, which include Coenzyme Q10, the most studied supplement for mitochondrial restoration, and sometimes niacin and NAC to support mitochondrial complex 1 specifically. Then, as far as rebalancing inflammation, I may add some specific nutrients or herbs to help up with that. Omega-3s, I think are very important, possibly combined with alphalipoic acid for their anti-inflammatory and neuroprotective effects. And Andrographis, which is a traditional Chinese medicine herb, for its immune modulating effects.
The bottom line is that it is possible to have a comprehensive, systematic approach to treating and reversing long COVID. To me, it makes the most sense to start by preventing it with measures that conserve or restore ACE2 function, balance the inflammatory response at the beginning when someone is actually sick with COVID, and definitely preventing or reversing the oral and gut dysbiosis, which seems to be very common with this disease.
We also know that vaccination may have no impact on the risk of long COVID. Or if it does, there may be a 50% reduction in its effects. Well, going from 30% to 15%, we’ll leave millions and millions of people with long COVID. I have also seen a study indicating a 50% reduction and another study indicating no reduction, no impact with the vaccines.
The best case scenario with the Omicron strain would be that it’s highly infectious but has very low virulence. That would be like a natural vaccine. If there’s very low virulence, but high infectivity, maybe this will spread throughout the world and induce immunity at a very low cost. That, of course, is a dream. That’s the dream solution that this virus somehow evolves into essentially its own vaccine. But there’s no way of knowing whether that’s really happening at this time.
IMCJ: Thank you very much for your time. I am sure you will have many updates between now and your presentation at EHS.
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Copyright by author - Leo Galland, MD: Treating PASC (Post-Acute Sequelae of COVID): How to Address Long-Hauler’s Syndrome Effectively, an interview by Dick Benson, Integr Med (Encinitas) . 2021 Dec;20(6):36–37.(https://pmc.ncbi.nlm.nih.gov/articles/PMC8887227/)
What do our beneficial Bifidobacterium species like to eat? Quite a lot of zinc, and resistant starches or certain types of fiber. This section was included in a different long post but I added to it in an X post.
Dandelion greens, onions, leeks, flax seed, other foods.
Bifidobacterium like inulin (ITF) rich leeks and arabinoxylan (AXOS) rich psyllium or flax seed.
Aerobic Bifidobacterium - benefits:
“Several functions have been attributed to bifidobacteria, encompassing degradation of non-digestible carbohydrates, protection against pathogens, production of vitamin B, antioxidants, and conjugated linoleic acids, and stimulation of the immune system. During life, the numbers of bifidobacteria decrease from up to 90% of the total colon microbiota in vaginally delivered breast-fed infants to <5% in the colon of adults and they decrease even more in that of elderly as well as in patients with certain disorders such as antibiotic-associated diarrhea, inflammatory bowel disease, irritable bowel syndrome, obesity, allergies, and regressive autism.” (Rivière, et al., 2016)
Anaerobic Butyrate-producing species - benefits of butyrate for the colon:
“Butyrate is an essential metabolite in the human colon, as it is the preferred energy source for the colon epithelial cells, contributes to the maintenance of the gut barrier functions, and has immunomodulatory and anti-inflammatory properties.” (Rivière, et al., 2016)
Inulin and arabinoxylan fiber help promote both bifidobacterium in the small intestine and butyrate producing species in the colon.
Two types of starch promote both butyrate species and bifidobacterium, seemingly in an interactive supportive way referred to as “cross-feeding”. The starches are inulin-type fructans (ITF) and arabinoxylan-oligosaccharides (AXOS). (Rivière, et al., 2016) Bifidobacterium species also seem to work together to digest the AXOS fiber.
“It has been shown that the butyrogenic effects of ITF and AXOS are the result of cross-feeding interactions between bifidobacteria and butyrate-producing colon bacteria, such as Faecalibacterium prausnitzii (clostridial cluster IV) and Anaerostipes, Eubacterium, and Roseburia species (clostridial cluster XIVa). These kinds of interactions possibly favor the co-existence of bifidobacterial strains with other bifidobacteria and with butyrate-producing colon bacteria in the human colon.” (Rivière, et al., 2016)
Food sources of inulin include:
chicory root, 41.6 gr.,
Jerusalem artichokes (aka sunchokes), 18 gr.,
dandelion greens, 13.5 gr.,
garlic, 12.5 gr.,
leeks, 6.5 gr., *and onions, scallions, etc.
asparagus, 2.5 gr.,
wheat bran, 2.5 gr., *and rye and barley.
bananas, 0.5 gr.. (Livestrong.com)
*The grams of inulin fiber is per 100 grams of the food, about 3.5 oz.
Agave lobes (7-10%of fresh biomass), Salsify roots (15-20% of fresh biomass) and other edible roots tend to be the most concentrated sources of inulin: (Table,
https://www.researchgate.net/figure/nulin-content-of-some-plants_tbl1_257939767).
We are more likely to eat 3.5 ounces of Jerusalem artichoke tubers or dandelion greens than of wheat bran or chicory root. Asparagus doesn’t have as much as leeks but more people eat asparagus than leeks, and would eat a half cup compared of asparagus but only a spoonful of wheat bran sprinkled on something else. Onions in general are also a source of inulin, and rye and barley are mentioned in another source.
Forage for Burdock root, or buy a dried herbal powdered Burdock
Foragers can go look for burdock and dig up the roots which are starchy and a good source of inulin. The Japanese cultivate burdock root as a favored food called Gobo. Burdock grows in ditches, gets enormous leaves and then grows taller stems with burrs that get caught on clothes or fur. (healthline.com) Foraging identification guide: (ediblewildfood.com) More about the medicinal benefits: Burdock – A Common Weed with Powerful Plant Medicine - The Back Yard Herbalist (thebackyardherbalistschool.com)
Food sources of arabinoxylans include:
psyllium,
flax seed,
bamboo shoots,
and all cereal grains including rice (bran more than a refined grain).
Rye grass, and pangola grass (?).
“Arabinoxylans have been found in all major cereal grains, including rye, wheat, barley, oats, rice, sorghum, maize, millet (Izydorczyk and Biliaderis, 1995), as well as in other plants, such as psyllium (Fischer et al., 2004), flax seed, pangola grass, bamboo shoots, and rye grass.”
Arabinoxylans, M.S. Izydorczyk, in Handbook of Hydrocolloids (Second Edition), 2009.
Pangola grass is used for cattle or other grazing animals in tropical and sub-tropical regions. It is preferred by the animals when the grass is young and tender. (https://keys.lucidcentral.org/keys/v3/pastures/Html/Pangola_grass.htm)
Dandelion greens are also best in the spring or when new growth. Plantain leaves, Ground Ivy, and garlic mustard are other spring greens for foraging in non-pesticide treated areas (and not trespassing). Kudzo greens or flowers are edible and growing throughout southern areas of the US.
Disclaimer: This information is being shared for educational purposes within the guidelines of Fair Use and is not intended to provide individual health guidance.
Some References & more info are in this post:
'Bifidobacterium, CoV, Sabine Hazan, and butyrate producing colon species.' "Feed them well and you are feeding yourself well too! Vitamin C, D, zinc, inulin, arabinoxylan, and pomegranate peel help support bifidobacterium and butyrate producing species of the microbiome."
Banner image of Dandelions is Grok AI generated. Image below is my photo. The US is not going to run out of dandelions. Or kudzu.
A mountain of dandelions?
Kudzu root is a source of starches called acid-soluble polysaccharides, which change as it ages into more fiber called acid-insoluble polysaccharides. Kudzu has medicinal benefits from phytonutrients and in not rich in inulin (those are more woody like roots). It has more caloric valued from the starches and can be used as a potato-like cooked tuber. Kudzu starch/fiber may also be useful for making paper and has even been spun into yarn!
"Acid-soluble polysaccharides and acid-insoluble polysaccharides are mostly starch and fiber, respectively. Starch, fiber, and puerarin are the most important compositions of kudzu root." (Zhao, et al., 2014) -- Analysis of Puerarin and Chemical Compositions Changes in Kudzu Root during Growth Period,
X article about Kudzu medicinal benefits: Zombie drug crisis & Why aren't we eating Kudzu?
Disclaimer: This information is being provided for educational purposes within the guidelines of Fair Use and is not intended to provide individual health care guidance.
I would add a 5th item to this list of common problems- dysautonomia.