On today’s episode of The Modern Vital Podcast, we’re going to talk about four subtypes of Long Covid and how to work with them from an integrative medicine perspective.
Our Modern Vital Fact of the Day is that the ACE2 receptor may be the key to understanding Long Covid, as it is present in epithelial tissues, which create a protective barrier in organs such as the lungs, heart, blood vessels, kidneys, liver, gut, and much more, including the nose and mouth. Of course, the mouth is just part of the gut. It’s the end of the tube.
The ACE2 receptor acts as a braking system to inflammation in those areas, so when the Covid virus binds to the receptors and shuts them down, inflammation and subsequent damage in those areas can ensue and potentially cause the symptoms of Long Covid, depending on each individual.
Long COVID is a complex chronic illness that is now only just beginning to be understood and properly defined.
10 million Americans are estimated to have three or more symptoms of long covid. An article in Global Advances in Health and Medicine that came out in November of 2021 suggested that Long Covid patients require an integrative health approach, one that combines traditional medical management, non-pharmacological approaches and behavior and lifestyle changes, aka naturopathic medicine.
I agree and I believe that an integrative health practitioner, such as a naturopathic doctor, is an essential member of your Long Covid healthcare team.
Where holistic medicine shines the most is particularly with regard to complex chronic illness illnesses, such as fibromyalgia or Lyme disease or maybe Long Covid.
We will discuss four different subtypes or subphenotypes of Long Covid and some naturopathic and functional medicine strategies to approach Long Covid.
Of course, this is not health advice. Please consult your healthcare provider or an integrative healthcare physician for further workup and diagnosis and treatment.
Long Covid is known by many names. Depending on the source that you consult, you may come across names such as Post-Acute Covid 19, Chronic Covid 19, Chronic Covid, Post Covid Syndrome, Long Haulers, Long Haulers Syndrome, Long Haul Covid, et cetera.
The first thing that we need to do is define what we mean when we say Long Covid or any of these other equivalents.
Long Covid is a diagnosis of exclusion. Basically, Long Covid refers to patients with symptoms that develop during or after SARS-CoV-2 infection and continue for more than four weeks post-infection. There also has to be a lack of another underlying cause to make it a diagnosis of exclusion. For example, if a patient presents with symptoms of Long Covid but also has an active Epstein Bar infection, then Long Covid cannot be diagnosed. Chronic Covid 19 refers to Long Covid symptoms for three months or more. This is the way that we refer to Chronic Covid 19.
However, when we refer to chronic disease in general, we usually mean that a condition has persisted for more than one year.
While there is no lab that will diagnose Long Covid, some of the top symptoms include fatigue, shortness of breath, cough, palpitations, brain fog, headache, loss of smell, pins and needles feelings. These are referred to medically as paraesthesia, depression, diarrhea, joint or muscle pain, referred to medically as arthralgias or myalgias.
The CDC estimates that Long Covid affects anywhere from 7.7 million to 23 million individuals in the US. We could extrapolate these numbers to about a quarter billion globally.
Recently, a Harvard economist estimated that Long Covid could cost the US economy 3.7 trillion in 2023 alone.
Chris Anderson wrote a business book in 2008, about 15 years ago, called The Long Tail, and in it he discussed how new niche markets are emerging every day, and it was particularly with regard to books and Amazon and to music and Apple.
Clinically, and as evidenced by a recent Nature study, which came out a few months ago, four subphenotypes of Covid, Long Covid, that is, were defined.
And Long Covid appears to have its own tail, its own long tail, meaning that there are small subgroups of Long Covid that are being missed and going under the radar.
Long Covid represents an important largely undiagnosed and untreated population, many of whom are suffering from vague or non-specific symptoms such as those mentioned above.
As a naturopathic doctor, the way that I’ve been treating long covid varies from person to person.
A recent study demonstrated that long covid appears to have a neuro-immune and neuro-oxidative origin.
Regardless, we have to support the body’s healing mechanisms. We have to provide antioxidant support. We have to help reduce nutrient deficiencies, lower inflammation, lower toxicity. I’ve been using a variety of treatments, many of them from traditional naturopathic medicine such as castor oil packs, constitutional hydrotherapy, herbal medicine, liposomal glutathione, micro liposomal, vitamin C, bioavailable trace minerals.
I’ve referred my patients to Chinese medicine. I’ve seen ozone therapy work well for Long Covid. I regularly do food intolerance evaluations. Bodywork also seems to help a lot in Long Covid.
Each Long Haul Covid health plan is tailored to the individual. So a recent cohort study relying on machine learning that came out in Nature a few months ago, defined four subphenotypes of Long Covid, which broadly matched the four types that I see in clinical practice and I treat a lot of Long Covid these days.
Long Covid Type #1 affects the cardiovascular system and the kidneys making up approximately a third of the over 34,000 patients that were surveyed in this cohort study.
Circulation appears to be significantly impacted frequently in these types of individuals leading to symptoms and associated conditions such as anemia, electrolyte imbalance, and even endocrine disorders. This type of patient is predominantly a little bit older, averaging 65 years of age, and about 48 point a 5% are male.
These types of individuals were hospitalized the most and are most likely to end up on a mechanical ventilator, and of course they also have the most preexisting conditions.
These types of patients are most likely to need natural therapies like electrolytes and trace minerals and nephroprotective herbs, such as milk thistle, circulation support, herbs like Hawthorne, adrenal support, antioxidants such as liposomal glutathione.
Of course, this is not medical advice. Please consult your naturopathic or functional medicine doctor in order to receive diagnosis and treatment.
Long Haul Covid Type #2 affects the respiratory system and also can really impair sleep and affect mental health causing conditions such as anxiety. This type made up less than a third of all patients in the cohort study. Headaches are more frequently seen in these individuals. The average age is 51 years old and about two thirds are female, actually 62.8%, a higher incidence of comorbidity for respiratory conditions predominates.
In this population, we see conditions such as sleep apnea and COPD.
More commonly, these types of individuals are most likely to benefit from therapies such as adaptogenic herbs, GABA inducing nutrients like L-theanine, respiratory herbs such as mullein, anxiolytic herbs like Melissa and lavender.
Again, this is not healthcare advice. Please consult your healthcare physician. Seek out an integrative medicine provider for diagnosis and treatment.
Long Covid Type #3 affects the musculoskeletal system in the nervous system, approximately a quarter of the cohort. 23.37% made up this population. The average age is 57 years old and about 60% are female, and we see autoimmune diseases such as rheumatoid arthritis being more common in this population. These patients are also more likely to be on pain medications such as ibuprofen. Anti-inflammatory support using herbs such as turmeric may benefit these individuals. Liver support herbs like dandelion pain, modulating herbs like passiflora. Physical medicine therapies like craniosacral, acupuncture for chronic pain.
Again, this is not healthcare advice. Please seek out an integrative medicine provider for diagnosis and treatment.
Long Haul Covid Type #4 affects the digestive system and only about 10% of the overall population in the cohort study made up these types of patients. They are more likely to have GERD or heartburn as well as inflammatory issues like gastritis.
The average age is 54 years old and these types of patients are probably most likely to benefit from the removal of food intolerances or food sensitivities and from digestive support herbs.
Again, this is not healthcare advice, so please seek out a naturopathic doctor like myself for workup. There is no Long Covid protocol that works for everyone. No one size fits all. Each Long Covid patient is affected predominantly in different organ systems.
Each individual is unique, good holistic medicine employees, therapeutic techniques such as good case taking and effective listening in order to begin to put together an individualized health protocol that will help that specific individual resolve their chronic issues of Long Haul Covid.
Naturopathic doctors are the most educated and sought out integrative medicine practitioners throughout the world, and they’re particularly specialized in the diagnosis and treatment of chronic illness that is complex, and I posit that Long Haul Covid falls into this category.
I recommend that you strongly consider adding an integrative medicine practitioner to your Long Covid healthcare team, or at the very least, seek an integrative medicine practitioner out for a consult if you suspect that you might be struggling with the symptoms of Long Covid.
That concludes episode #4 of The Modern Vital Podcast. We would love to hear from you. We value your feedback. If you have any questions or suggestions, please reach out to me at firstname.lastname@example.org. I read all of the comments and I read all of the emails. Also, please leave us a review if you enjoyed this episode. We look forward to having you join us next week for another exciting episode of The Modern Vital Podcast.
If you’re looking to dive deeper into understanding the intricacies of chronic disease and its impact on your overall well-being, consider checking out Dr. Reebs’ book, “The Serpent & The Butterfly: The Seven Laws of Healing.” In this book, he discusses the laws of healing essential to resolving chronic disease and much more to help you on your journey to optimal wellness. Click here to purchase your copy: https://www.drreebs.com/serpent-butterfly-book/
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