Living A Full Life

Unlocking Long COVID

• Full Life Chiropractic • Season 3 • Episode 47

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The mystery of Long COVID continues to puzzle both patients and medical professionals. Why do some people recover completely from COVID-19 while others experience debilitating symptoms for months or even years? This deep dive into the biology of Long COVID reveals the hidden mechanisms driving persistent symptoms that affect millions worldwide.

At its core, Long COVID involves multiple overlapping biological disruptions. Fragments of the virus may remain in tissues long after the acute infection, continuing to trigger low-grade inflammation. The immune system becomes dysregulated, sometimes attacking the body's own tissues or reactivating dormant viruses. Tiny blood clots form in small vessels, starving tissues of oxygen and nutrients. The autonomic nervous system—which controls unconscious bodily functions—falls into disarray. Mitochondria, our cellular power plants, become damaged and inefficient. Even the gut microbiome shifts in ways that perpetuate inflammation throughout the body.

These biological mechanisms manifest as the constellation of symptoms that define Long COVID: crushing fatigue that worsens after even mild activity, cognitive "brain fog" that impairs thinking and memory, shortness of breath, heart palpitations, dizziness, joint pain, and mood disturbances. For those suffering, understanding these mechanisms offers validation and direction. This isn't psychosomatic—it's a complex physiological condition with measurable biological markers.

Recovery requires a multifaceted, individualized approach. Strategies that have shown promise include energy pacing to avoid symptom flares, prioritizing restorative sleep, adopting an anti-inflammatory diet rich in whole foods and omega-3s, stress management techniques, and targeted therapies like red light therapy and specific supplements based on individual needs. Though progress is typically slow, understanding the biology of Long COVID is the first step toward developing effective treatments and reclaiming health.

If you're struggling with Long COVID symptoms or know someone who is, reach out for support. Recovery is possible with the right approach and patience. Contact us to learn more about personalized strategies to address your specific symptoms and begin your healing journey.

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Speaker 1:

Dr Enrico Dolcecori, md, mph, md, phd, phd, phd, phd, phd, phd, phd, phd, phd, phd, phd, phd, phd, phd, phd, PhD, phd, phd, phd, PhD, phd, phd, phd, phd, PhD, phd, phd, phd, PhD, phd, phd, phd, phd, PhD, phd, phd, phd, phd, PhD, phd, phd, phd, phd, PhD, phd, phd, phd, phd, PhD, phd, phd, phd, phd, PhD, phd, phd. Not just the lingering cough or fatigue, but the hidden changes inside the body that make recovery complex. We'll walk through what's happening at the physiological level, why many people struggle with symptoms long after the acute infection and what steps you can take to help support healing. Whether you had COVID months ago or you care for someone that has, this episode will give you the understanding, hope and actionable insights. Let's get into it.

Speaker 1:

When most people think of COVID, they think of the initial infection, the fever, the cough, the respiratory distress and then recovery. But for a subset of people, symptoms persist for weeks to months. That's why we call it long COVID. It's also called post-acute sequelae of SARS-CoV-2 infection or PASC. Long COVID is often defined as symptoms lasting more than three months after infection that cannot be explained by another diagnosis. Symptoms are very broad. Symptoms are very broad Fatigue, brain fog, post-exertional malaise, shortness of breath, chest pain, autonomic dysfunction, joint pain, gastrointestinal issues, mood and sleep disorders and more. It's important to note that long COVID can occur, even in people who had mild acute infections. You don't have to be hospitalized to develop lingering issues and that's from nature. But why do some people recover fully while others carry symptoms for months or years? That's what we're going to explore in this episode together. What we need to understand is how long COVID works. We need to peek inside the biology.

Speaker 1:

Multiple overlapping mechanisms seem to drive the persistent symptoms. No single mechanism explains all cases, but the research points to a few reoccurring things and I'll break them down, at least the major ones. The first one is the viral persistence and residual viral components. In some people, fragments of the SARS-CoV-2 or even reservoirs of the virus may remain in tissues months after acute infection. These residual viral proteins, or RNAs, are called spike proteins that can continue to stimulate low-grade immune activity, and it's that low-grade immune activity that persists the symptoms of malaise, brain fog and a bunch of other things that can happen. Some studies have found that viral antigen, or RNA, in gut tissue, blood plasma, lymph nodes, even brain tissue and other organs long after the acute phase. So these fragments are lasting a long time. This leftover antigen exposure can trigger chronic inflammatory signaling in the body and we're all a little different on how we respond to that signaling.

Speaker 1:

The second thing is immune dysregulation and chronic inflammation in the body. After the acute infection the immune system doesn't always fully reset. Some cytokines and inflammatory markers remain elevated, for example, interleukin-6 or interleukin 1 beta, tnf and other chemokines can just stay elevated for long periods of time, causing immune system dysregulation and constant fighting. There's evidence of autoimmunity, that is, the immune system begins targeting host tissues or autoantibodies or dysregulated immune signals so they compete for binding sites and cause chaos in our immune system and our immune system starts fighting itself. Reactivation of latent viruses, so maybe a stacking effect of like old flu viruses, and then reactivation of other things like EBV or HHV-6 or Epstein-Barr or other things that can be lingering in there old chickenpox virus, herpes viruses, all these things that could be in our tissues already. And having this stacking effect Oof COVID's been a mess, hasn't it? It has been documented in long COVID patients possibly triggered by immune strain. The net result an immune system that is stuck on low level, alert, causing tissue stress, oxidative damage and metabolic disruption. So that's what's happening on a science-based level, behind the scenes, where I don't think I gave you any clarity on that. But the stacking effect and a dysregulated immune system can just linger these symptoms for a really long time. It's like a really bad flu, but even if you've been through those, we eventually get over them. It feels like some of these long COVID patients are. We're like a year down the road and they're still trying to get back to normal.

Speaker 1:

There's endothelial dysfunction, microclots and coagulation. In some studies that show that SARS-CoV-2 infects or injures the vascular endothelium, which is the lining of blood vessels, that can lead to dysfunction, leakage, microvascular injury and small microclots. Microclots or microthrombi reduce capillary blood flow. This impairs tissue perfusion which can starve tissue, including the brain tissue and muscle tissues, of nutrients or oxygen. Hence the fatigue. Endothelial injury triggers further inflammation and oxidative stresses. In some patients coagulation markers remain abnormal for prolonged periods of time.

Speaker 1:

There's also autonomic dysregulation and dysautonomia. Many long COVID patients show signs of autonomic nervous system imbalance, like heart rate variability changes, orthostatic intolerance, pots symptoms, which is postural orthostatic tachycardia syndrome, blood pressure dysregulation, because autonomic function is intimately connected with the vascular tone, heart and respiratory control. Dysfunction here produces many of the hallmark symptoms lightheadedness, palpitations, fatigue, brain fog helped many POTS symptoms patients over the years Post COVID. It's been kind of weird because we're seeing a lot of the POTS type symptoms but they're not qualifying with POTS because it's actually long COVID, so they're not getting the same testing positives that POTS patients were, where if you put them on an inversion table immediately, their blood pressure decreases, they feel faint and all this. You put somebody with long COVID, they flip them over, they're not feeling faint and long, so there's little things that are happening there. Where it's not quite POTS, it could be long COVID.

Speaker 1:

Then we get mitochondrial dysfunction and energy impairment. This is where the fatigue and malaise comes from. With the mitochondrial impairment that happens from inflammation. So inflammatory and viral stress can damage mitochondria. The mitochondria are the cell's power plant inside of each and every cell. This leads to less efficient energy production, atp and reactive oxygen species. For metabolic fatigue.

Speaker 1:

Some studies draw parallels between long COVID and myalgic encephalitis or encephalomyelitis chronic fatigue syndrome wherein a hallmark is impaired cellular energy metabolism. So it's masking a lot of these previous diagnoses that we've done and causing a lot of turmoil and chaos in the medical industry because we just don't know what to do for patients. We can't really treat them for the disease because they don't have POTS or encephalomyelitis or chronic fatigue syndrome. They're having long COVID. So how do we help these people?

Speaker 1:

It also affects the neurological and central nervous systems. The spike protein or viral fragments may cross the blood-brain barrier or damage barrier itself, allowing inflammatory molecules into the brain. Microglial activation the brain's immune cells, micro-glial activation, the brain's immune cells and neural inflammation have been impacted in cognitive symptoms, memory issues and brain fog. Some studies suggest a leaky blood-brain barrier might underline brain fog, allowing proteins like S100B to leak into the blood. Disrupted neural networks coherence, for example via infected glial astrocyte cells, might impair communication between brain regions. Some experimental modeling suggests this. This is from axial studies.

Speaker 1:

And then gut microbiome and dysbiosis. So the SARS-2 infection can shift the gut microbiome, leading to dysbiosis, imbalance of bacterial populations, gut barrier dysfunction leaky gut can allow microbial products and endotoxins into circulation, triggering systemic inflammation. Because the gut is deeply connected to the immune regulation, the gut immune axis, this pathway may perpetuate inflammatory circuits in long COVID. And finally, interconnected feedback loops and allostatic load. Many of these mechanisms feed into one another. For example, inflammation causes mitochondrial damage, which causes more oxidative stress, which further activates immune signaling. It's almost like this negative feedback loop or this negative tornado that's happening, causing all these other effects.

Speaker 1:

The body's allostatic load, the cumulative stress burden, is often high in long COVID patients, meaning the physiologic system are under strain and less able to recover. There may be an individual susceptibility factor like genetics, prior health, age, sex, metabolic status and nutritional reserves that can also play into this role. So we got to map all these types of symptoms into the mechanisms to truly understand what is happening with this long COVID. So we got to connect the biological changes to what people feel so that we can understand and help target recovery. Here are some common symptoms that we're seeing in my practice just from people with long COVID.

Speaker 1:

The fatigue and post-exertional malaise are number one. People are like I just don't have the energy, can't do my workouts. We have mitochondrial dysfunction and immune over activation and autonomic dysregulation. People often feel a crash after modest exertion. For these people what we've done is we've put them through regimens of red light therapy to help photomodulation increase mitochondrial repair in the inflammatory body. So we have like a tanning bed in our office. They lie there for 12 minutes at the right frequencies and we've been seeing like people's brain fog clears up right away. The malaise is happening through some targeted supplements that each patient needs review on through blood work or testing, or even gut testing to see what they need. But glutathione, either intravenously through IV or liposomal underneath the tongue, along with red light and chiropractic adjustments to regulate the autonomic nervous system, that has been really good since 2020, when this all started. That has been our recipe for the people that come in saying they just don't have the energy. Others come in with other issues like the brain fog, memory issues and cognitive slowness. The red light does work there because of the neuroinflammation, but blood-brain barrier disruptions and glial activation can also cause a bunch of other stuff. We need some brain supplements for those types of patients. Shortness of breath and chest tightness.

Speaker 1:

I brought in NAC very quickly into our office in like April 2020 for my senior patients. I was worried about them. I was like man, these people are going to hospital, there's respiratory distress. So we brought in NAC Some people call it NAC and they started taking this and I swear At the end of the year I was sending out surveys to patients and asking them how they're doing. We had zero hospitalizations in our patient base in our office in all of 2020. Zero people went to hospital Zero spouses went to hospital and zero kids went to hospital for COVID. Don't know what that means, but I saw the news and I saw everyone going there. But I was like who has been to the hospital? And I did as much as I could checking in on our patient base and it was amazing that no one was going to the hospital. I'm like, okay, well, people that are out taking care of themselves or doing better than the people, maybe other people who maybe don't have a chance to do that, so I don't know. But that was that. And NAC so up to today, I always like, I'm like man. That was probably one of the smartest things I've done in my career is bring in NAC so people could grab it right off the shelf and start taking it right away, whether they were coughing or whatever. I just told them take it and I think that's been in the literature now showing to be very beneficial.

Speaker 1:

Shortness of breath and chest tightness this is like we were talking. Possible micro clots in the lung vascular, you know, endothelial injury, impaired gas this is pulmonology, this is cardiology. I highly recommend getting those tests done. It could be a angiogram CT with dye of the chest, whatever it is, to find any micro clotting, um. And then medicine can really help with this, with coagulants and things that can help remove the stress of the vascular system so that you can continue doing what you need to do to repair the vascular system through exercise and good diet. That could be the step for that one. So we don't have the answers for everyone. Palpitations, dizziness, orthostatic intolerance this comes from the autonomic dysfunction, dysautonomia, vascular tone, instability, 100%. Get adjusted, get the atlas check, get the vagal response synthesized there with chiropractic adjustments. And there's other techniques as well cranial, sacral technique, kinesiology. There's a lot of things you can do for that one as well.

Speaker 1:

Pain in the joint, aches, muscle weakness that's from chronic inflammation that the spike proteins have been shown to do, that it could be autoimmune response, nervous system sensitization to that. Again, red light therapy, cold laser or class four laser on the joints that are sore has been very successful. In our office We've been putting class four laser right on the joints. Immediately decreases inflammation, decreases pain. People feel good there and I think some studies have shown that by pushing that inflammation out of the joint and stimulating mitochondrial function in the joints that the pain doesn't return to the joints too. That was cool too.

Speaker 1:

So some people are getting permanent improvement from that GI symptoms bloating, diarrhea, nausea this is from the dysbiosis that we're talking about. So some people react to the gut lining with the spike proteins as well, got barrier leak, immune activation in the gut. Then we have the mood swings, anxiety and sleep disruption. That's from chronic inflammation the HPA axis that we talked about from the brain and the gut, and then the brain network and oxidative stresses. So we have to repair diet, we have to get probiotics in there, and these all can be tested for in one way, shape or form. But because we've seen so many post COVID patients, we've blanketed them into these seven groups that we know straight to where to go to to help them to save not only cost and testing but time to get them feeling better faster. So that's really cool too.

Speaker 1:

So this is where functional medicine really kicks in and you can reach out to us at info at fulllifetampacom to get started virtually on many of these things and we can guide you in the right direction on that as well. So here's some strategies to support this, to help yourself move forward. These are evidence-based and logical, grounded strategies that I always encourage you know the listeners for these types of things to find medical professional to help you with this. Doing this on your own, especially long COVID If you've been suffering with it, you know this isn't like getting better. You need help with this and a lot of people say they help with long COVID but they have to go through these steps to figure it out.

Speaker 1:

So, pacing and energy management we want to adopt a listen to your body approach. We have to avoid pushing past our limits right now just because of the mitochondrial fatigue. Use activity pacing, so breaks into small portions. Rest. You can't work out like you used to. You're going to have to do short bursts or short, less intense exercises or maybe just some lifting for now, without the cardio burden, and avoid and avoid the boom bust cycle that exacerbates symptoms. You know what I'm talking about. If you're suffering from that. Uh, gentle movement and rehabilitation, low impact practices, walking mildly um, autoimmune tolerances improve when we do this. And uh, be watchful in an activity worsens symptoms over 24 to 48 hours after you do it. You got to stop doing it. It's just the way that you got to switch it. You got to do something else.

Speaker 1:

We need to prioritize sleep. Sleep's now got to become top of the list. You have to have a consistent bedtime and awake times seven days a week. You're just going to have to fit in the time to get restful sleep. Whether you can fall asleep or not, whether you have insomnia or difficult fallings, it doesn't matter. You're going to bed at 10 and you're waking up at six. It's just you have to set up that schedule to get the circadian rhythm back. That's some things that you can control and that's one of them. Inflammation plus autonomic stress can impair sleep. That's what makes it poor. But if you create the sleep as a priority, you we do see improvement quite quickly.

Speaker 1:

We have to get into anti-inflammatory nutrition and gut support. Focus on whole foods, phytonutrient rich vegetables, omega-3 fatty acids and antioxidants into the diet. Avoid processed processed sugar, refined carbs, trans fats, because these just worsen inflammation every single time. Support your gut health with prebiotics, postbiotics, probiotics, fermented foods and fiber, as tolerated, of course. And work with functional or integrative practitioners If the barrier repair, like supplements like glutamine and zinc, are indicated. You don't want to dose that stuff on your own or try and guess. Have someone give the right protocol for you.

Speaker 1:

Stress management, mind and body practices, breathing exercises, vagus nerve stimulation techniques like slow, diaphragmatic breathing, meditation, guided imagery, journaling offloading your mental stress in one way, shape or form is going to truly help Grounding. Guided imagery, journaling offloading your mental stress in one way, shape or form is going to truly help Grounding nature, exposure, gentle social connection these things are all really good ideas and these are targeted therapies and clinical options when they're appropriate. For dysautonomia would be like increasing water and salt intake, compression garments and medications guided by a physician to help with this autonomia. On that way, trials of low-dose anti-inflammatories or neuroimmune modulators these are still in research but have been effective. Treatable trait approaches are like focused on dominant mechanisms in each person, like clotting markers are abnormal, or therapies targeting microclots, like we talked about with CT imaging, and then monitoring and addressing co-infections or reactivated viruses if present. This is where gut testing can really bring out the virus load that's in the body and some blood testing to show what antibodies are fighting for what. You may be fighting two or three different viruses at the same time because the spike proteins brought them all out, so that could be an issue too.

Speaker 1:

So physical rehabilitation under supervision as well, like PTs, that no long COVID will put you through minimalistic joint loading so that you can have movement and therapy to help you with with that as well, and then just keep symptoms. You got to journal this stuff, see what's going on there If you're truly struggling with this and want to get to the bottom of it journal. We got to mark the triggers and responses, like after exertion how you feel, or after eating certain foods how you feel, and just work with practitioners that monitor your labs. So inflammatory markers, vitamin D levels, thyroid and mitochondrial function are all really important to test. Progress will be slow. This is a slow and steady recovery. You got to be patient. We'll be compassionate for you and we'll help you each step of the way through that.

Speaker 1:

So lots of information. I tried to keep it scientific for you so you know that there's mechanisms that are not, so that you know you're not crazy. If you know someone's suffering with long COVID or you think it's long COVID, reach out to us so we can guide you in the right direction. Some people do need in-depth medical care from an MD professional that does this, but many other functional medicine practitioners like NPs and chiropractors that are internists that know this stuff can help you as well, we got resources for you all over the place. Info at fulllifetampacom. Have a healthy week, stay well, stay healthy and take care.

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Dr. Enrico Dolcecore

Host
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Dr. Christine Hafer

Co-host