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How to Treat Long Covid from a Functional Medicine Perspective

Long Covid is a term that has been used to describe people who have persistent symptoms after a recent documented Covid-19 infection.  With more than 43 million reported cases of Covid-19 in the U.S. alone, a number that keeps increasing daily, many are still experiencing symptoms for weeks and even months after the infection has cleared. 

It is believed that 15-30% of people who recover from Covid-19 experience Long Covid or what Dr. Fauci has coined post-acute sequelae of SARS-CoV2 infection (PASC).  This means that up to 30% of people who get sick with Covid-19 (mild or severe, it doesn’t matter) will have ongoing symptoms for months, including fatigue, brain fog, gut issues, shortness of breath, palpitations, muscle aches and headaches.  There is also an increased risk of Diabetes, high blood pressure, sleep apnea, new neuro or psychiatric diagnosis, and adrenal insufficiency.  

So far, we are just beginning to understand the underlying causes of all these symptoms.  Some are caused by direct damage to organs, such as the lungs.  But others are caused by deeper issues that we are now learning are related to damage to the mitochondria and to ACE2 enzyme activity, and also persistent inflammation in the body, all of which have a widespread effect in the body on multiple organs and systems.  

The Role of Mitochondria in Long Covid 

Mitochondrial dysfunction may also play a role in the difficulty recovering from COVID-19 infection. Your mitochondria make all the energy for all your cells and are concentrated highest in the brain (nervous system) and heart (muscle).  The free radical damage (also called oxidative stress) caused by a significant viral infection can cause destruction of these critical structures and this may contribute to the many symptoms that people experience, especially fatigue and cognitive impairment.  

Therefore to treat Long Covid, from a functional medicine perspective, in addition to reducing inflammation and rebalancing the immune system, we also need to work on restoring and improving function of the mitochondria.

Here is how to help your mitochondria recover and combat free radicals.

FOOD:

Eating a diet rich in plants, especially antioxidants is key!  Antioxidants are found as the usual known suspects like vitamin A, beta carotene, Vitamin C and E and polyphenols found in the rich colors of a rainbow diet.  Additionally, mitochondria love a compound called PQQ. Eating PQQ rich foods is a great idea. These include parsley, green peppers, kiwi fruit, papaya, green tea and tofu. 

EXERCISE:

While it’s important to exercise, make sure to focus on reconditioning and do not engage in strenuous exercise that causes a crash the next day.  That is counter productive.  Best to slowly gain your stamina back and only exercise to the level that you can sustain, day after day, without crashing.

STRESS & SLEEP:

Critical repair happens at night so make sure to get a good night sleep.  The goal should be to go to bed before 11pm and if you are having trouble falling asleep or staying asleep, you might benefit from a health coaching session to focus on improving this!

INTRAVENOUS VITAMINS:

In conjunction with the right diet, proper sleep, and easing into exercise, our new Long Covid Infusion Protocol of intravenous vitamins and amino acids work deep within the cells to help recover and repair any damage done to the mitochondria.  We’ve paired healing the mitochondria with powerful antioxidants to bring down inflammation and give your immune system and cells a reboot after fighting to clear a Covid-19 infection.

With so many people experiencing gut issues after a Covid-19 infection, we believe the best way to receive these nutrients is through an IV. An infusion bypasses the GI tract, ensuring your cells absorb 100% of our targeted formulation to help you recover and feel like your old self. 

Our innovative new protocol created by Dr. Blum, includes three infusion bags and an injection. The first IV bag is a foundational Myers cocktail with added L-Carnitine, NAC and Selenium.  Bag 2 is Alpha Lipoic Acid; Bag 3 is Glutathione; and the final injection is CoQ10.  All items are available a la carte, but bundled together gives you a 20% discount.

SUPPLEMENTS:

If you live far away and can’t come in for an Infusion, check our Dr Blum’s Long Covid Supplement Protocol here on Fullscript.  Please note you will need to set up a free account in Fullscript in order to view the supplement recommendations.  

For more information on our Long Covid drip, contact your practitioner or schedule a consultation with our Infusion Director at 914.652.7800.  We are open to existing patients and the public alike! 

 

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Fall Update on Supplement Usage During the Coronavirus Pandemic

As of 10.1.2020

By the team at Blum Center for Health:  Susan S. Blum, MD, MPH; Pamela Yee, MD; Elizabeth Greig MSN, FNP 

As the pandemic wears on and the seasons change, we find ourselves preparing for winter, a time when we will be back inside with less opportunity to see people, connect and socialize, as we might have been doing in warmer weather.  I can say that for me, I am not looking forward to this and am trying to stay focused on and appreciate this moment, when we have beautiful fall weather in the Northeast.  I encourage you all to spend as much time outdoors as possible while you still can!  Of course I am also making a commitment to myself to bundle up and still make myself go outside this winter…we will see!  

Since the pandemic began, I have been updating my recommendations for using supplements to support your immune system.  As time keeps marching on, and we prepare for month #8, and the likelihood of a surge in COVID during the winter months, I thought I would go back and update my supplement recommendations.  It’s really important that we step up our game and renew our vigilance for protecting ourselves from getting sick, and if we do get COVID, to have a mild course of illness and recover quickly.  From a Functional/Integrative medicine perspective, we continue to focus on nutrients and herbs that have been well studied, for their ability to support, modify or boost the immune system, or to fight viruses.  

**Please note that these recommendations are NOT medical advice.  Most are not safe for pregnant women, and if you are taking medication or have any serious health condition, please check with your doctor.

Immune Boosting Supplements 

These are generally safe for those with Autoimmune Conditions. For pregnancy check dosing with your doctor.  We recommend that you take Vitamins D and C now at a minimum, and add Vitamin A and NAC if you are exposed or get sick. 

  • Vitamin D: 5000 IU daily in absence of serum levels from blood test   
  • Vitamin C: 1-3 grams daily
  • N-Acetylcysteine (NAC): 600 – 900 mg twice/day (precursor for Glutathione (GSH), or can take GSH
  • Vitamin A: up to 10,000 – 25,000 IU/day (not safe for pregnancy)

We do not recommend the following supplements for those with Autoimmune Conditions or pregnancy.We recommend that you take 1 of the following at the recommended dose, or a blend that includes several of these, in which a lower dose of each are typically used:

  • Elderberry: 500 mg daily (of USP standard of 17% anthocyanosides)
  • Beta Glucans: 250 – 500 mg daily
  • Mushrooms: Shiitake, Lion’s mane, Maitake, Reishi. D Mushrooms: Shiitake, Lion’s mane, Maitake, Reishi. Dose depends on preparation
  • Astragalus: Dose depends on preparation
  • Echinacea: Dose depends on preparation
  • Andrographis: 200 mg/day

To make this easy for you, we added our favorite herbal blend to our store, called Immune Support. You can read more about it HERE.

Anti-Viral Supplements

These are generally safe for those with Autoimmune Conditions. For pregnancy, check dosing with your doctor.
We recommend that you take Zinc and add Quercetin if you are exposed or get sick:

  • Zinc: 30 – 60 mg daily in divided doses
  • Quercetin: 1 gram twice/day. Phytosome: 500 mg twice/day

At BlumHealthMD.com we offer our signature Antiviral Bundle, with all the supplements you need to keep your immune system strong, plus a Mediterranean Food Plan to follow! Check it out here.

Reduce Cytokine Storm

The illness caused by coronavirus, COVID-19, can cause a “runaway train” of inflammation in some people, causing terrible tissue and organ damage that can lead to the worst outcomes. This group of herbs and supplements appear effective in turning off this overactive immune response and helping bring the immune system back into balance. 

These are generally safe to use for those with Autoimmune Conditions. For pregnancy check dosing with your doctor.

We recommend that you choose a minimum of 1 of the following and add more if you get sick:

  • Curcumin: 500 – 1000 mg twice/day. Choose absorption enhanced.  
  • EGCG: 4 cups daily or 225 mg daily.
  • Resveratrol: 100 – 150 mg/day
  • Melatonin: 5-20 mg/day

Remember, you should also be focused on improving the functioning of your immune foundations.  Here are the things you should continue to do for risk reduction:

  • Good gut health: which means lots of beneficial bacteria. Take a probiotic every day with at least 20 billion cfu of mixed strains lactobacillus and bifidus species and join our 10-Day Spring HealMyGut Coaching Program
  • Balanced stress hormones: Get a good night’s sleep and don’t overwork yourself during flu season. Stress harms your ability to fight viruses.  Practice some form of mediation daily.  Melissa, Blum Center’s Health Coachwrote a great blog with tips for managing stress during this time. 
  • Eat foods that are good for your immune system: Avoid processed foods and focus on fruits and veggies that are rich in antioxidants and vitamins. Support the removal of toxins by eating lots of cruciferous veggies, which boost the detox system in your liver.

Sending prayers and good wishes for you and all of us to stay safe and well during this challenging time!

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It’s Flu Season – Is the Flu Shot Right for You

Every year, this is a common question I get asked from our patients and also submitted by the public on social media and online. This year it’s even more confusing and the answers aren’t easy for many with chronic illness or autoimmune conditions.  It doesn’t help that public health officials and the media are promoting the flu shot as a critical part of the fight against COVID-19.  The main concern is that people could get both illnesses at the same time, which would increase the risks of severe complications or death if this happened.  

However, let me just add a few words of calm into this storm.  First, if you are a high risk person and quarantining this winter, or at least being extremely cautious and wearing a mask and maintaining social distance guidelines when outside your home or your “quarantine bubble”, then you are unlikely to get either the flu or Covid.  The same measures you are doing not to get coronavirus will drastically reduce your likelihood of getting the flu.  

I think we need to continue to discuss the flu shot in the same context that I have talked about it for years.  In my opinion, all medical decisions should be based on comparing the risks vs. benefits of any medication or treatment for each individual person. This approach is called Personalized Medicine, and how we approach all treatment decisions through the lens of Functional Medicine at Blum Center for Health.  What is good for your friend might not be good for you.

IS THE FLU SHOT RIGHT FOR YOU?

In general I do recommend the flu shot, especially this year, for people who could likely become hospitalized or die from getting the flu: children, anyone over 65; those with pulmonary or respiratory diseases like asthma and emphysema; and people with any chronic illnesses like cancer or severe/life threatening illnesses.  And for those at high risk of becoming hospitalized or dying from COVID:  people with obesity, diabetes, high blood pressure, cardiovascular disease.  Also important to note, if you are a caretaker for the elderly or anyone at home who fits the criteria above, or if you are a parent to children living at home, these would be additional situations you need to keep in mind as accepted indications for receiving the influenza vaccination.  And this holds true for this winter, during the COVID pandemic.

However, on the flip side, some people with autoimmune conditions, or who take immune suppressing medications, should talk to their doctor before getting the shot.  The aluminum used as adjuvants, and the mercury used as preservatives, can cause side effects or flares for those with autoimmunity, and those on certain immune suppressing medication might not even become immune after getting the vaccine.  For you, it is a personalized decision and I cannot give you medical advice about that here.  But it might be that during this pandemic, your decision might be different than it usually is.

In either case, my approach is to help you build a strong immune foundation so that you don’t get sick from any virus. A strong immune system is the basis for staying healthy in general, and should be a year round strategy…not just during flu season. This is, by far, the best prevention and protection! 

Click here for more on supplement recommendations to strengthen your immune system.

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Tips for Boosting Your Immunity

My anti-viral approach is to help you build a strong immune foundation so that you boost your immunity and don’t get sick from any virus. A strong immune system is the basis for staying healthy in general and should be a year-round strategy…not just during flu season or when there is a threat of a novel previously unknown virus. This is, by far, the best prevention and protection!

Good gut health: which means lots of beneficial bacteria. Take a probiotic every day with at least 20 billion cfu of mixed strains lactobacillus and bifidus species. If you are taking antacids or proton pump inhibitors -stop- because this alters your gut flora in a negative way.

Balanced stress hormones: Get a good night’s sleep to boost your immunity and don’t overwork yourself during flu season. Stress harms your ability to fight viruses.

Eat foods that are good for your immune system: Avoid processed foods and focus on fruits and veggies that are rich in antioxidants and vitamins. Support the removal of toxins by eating lots of cruciferous veggies, which boost the detox system in your liver.

Take your vitamins! Here are some important ones you will need:

a. Vitamin D 2000 iu/day minimum. The dose is based on your blood levels, so if you havelow vitamin D you will need more.

b. Vitamin A retinyl palmitate 5000 iu/day. If you are pregnant or nursing, do not take morethan 5000 iu/day of this kind of Vitamin A (retinyl palmitate).

c. Zinc 30 mg/day.

d. Vitamin C 3-4000 mg/day as an immune booster. 1-2000 mg/day is good for general prevention.

Additional supplements to consider to boost your immunity:

a. N-Acetylcysteine (NAC):  One of my favorites for preventing cold and flu. NAC is widely used in the medical community for a number of conditions , and has terrific clinical data that shows it to be helpful for patients with chronic respiratory illnesses ( and so it is very useful for support treating respiratory viral illnesses). It also converts to Glutathione, the body’s most powerful antioxidant.  I usually recommend 900 milligram capsules or tablets – start with one twice daily and increase to two twice daily if needed. Pharmanac, a Canadian brand that comes in an effervescent form is easy to take as a fizzy drink – even for children!

b. Whey Protein Powder is high in immunoglobulins that boost your immune system. For a non-dairy alternative, try SBI Protect powder from Orthomolecular, packed with immunoglobulins

c. Herbs like Elderberry, Echinacea, Astragalus, and Beta Glucan (mushroom extracts). We love Immunoberry Liquid from Designs for Health, which is a potent and convenient blend of these. 1 dropper each day in your shake, or in a little water, is all you need for ongoing protection. We also love Immune Builder from Mushroom Science: 2 daily for prevention. Both of these supplement doses can be doubled or tripled if you are concerned that you had exposure or feel you have early symptoms of a viral illness.

Lastly, make sure to wash your hands multiple times a day — especially before you eat, and after exposure to public transportation like riding the subway.

 

Check out my FREE 3-part video series! Last month I led live classes on the immune system and I’m happy to share with you the three videos:  How To Boost Your Immunity and Resiliency to Viruses: DOWNLOAD FREE NOW

The items listed are available for purchase from our office, or from our online store:

https://us.fullscript.com/welcome/blumcenter

 

Susan Blum, MD, MPH an Assistant Clinical Professor in the Department of Preventive Medicine at the Icahn School of Medicine at Mount Sinai, has been treating, healing and preventing chronic diseases for nearly two decades. A Preventive Medicine and Chronic Disease Specialist, Dr. Blum is the Founder and Director of Blum Center for Health in Rye Brook, New York, where she leads a multi-specialty team of physicians, nurse practitioners, nutritionists and health coaches, all providing cutting edge Functional and Integrative Medicine services.