Over 65 million people worldwide are said to have Long Covid. Long Covid has been associated with symptoms such as chronic coughing, digestive symptoms, nausea, fatigue, memory loss, tinnitus, disordered sleep, irregular menstruation, and erectile dysfunction. It is hypothesised that a disruption in the microbiome caused by Covid, immune dysregulation, and dysfunctional vagus nerve signalling are all thought to contribute to the development of long Covid (1).
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Below I will outline some supplements that show promise in improving Long Covid symptoms:
One study assessed 33 people who were experiencing Long Covid symptoms for between 3-12 months (2). Most participants experienced limitations in their daily activities, and some were dependant on nursing care to look after themselves. After 600mg twice daily of PEA for 3 months most symptoms were 'remarkably improved', and several people went from needing nursing care for daily tasks to being entirely symptom free. Based on this, 600mg of PEA 2-3x daily may be beneficial.
A recent study assessed the use of 1.66 grams of l-arginine daily with 500mg liposomal vitamin C compared to placebo (3). After 28 days the l-arginine + liposomal vitamin C group improved walking performance, muscle strength, endothelial function, and fatigue significantly more than the control group (in fact, fatigue was only reported in 8% of the l-arginine + vitamin C group at the conclusion, compared to 80% of the placebo group). Supplementing with ~1.5 grams of l-arginine + 500mg of liposomal vitamin C daily until performance improves may be beneficial.
Lactoferrin is anti inflammatory, anti viral, and helps protect and modulate the gut microbiome. Some published case studies have found that lactoferrin was able to resolve ongoing digestive symptoms after Covid infection in children with around 600mg daily, while other research has shown it has benefit in treatment, prevention, and recovery from Covid (4,5,6). 400mg 1-2x daily of Lactoferrin may be worth implementing for its anti inflammatory and gut regulating effects.
The correlation with Vitamin D status and Covid outcomes and Long Covid ocurrence is well documented (7,8). While I am unaware of trials that have used Vitamin D supplementation in the treatment of Long Covid, the clear association with low levels would suggest that improving Vitamin D status may be beneficial. Consider 5,000-10,000IU of Vitamin D (ideally with K2 added) until Vitamin D levels are within the optimal range.
While I have not seen any direct research on BPC-157 and Long Covid, BPC is known to exert anti-inflammatory, cytoprotective, and endothelial-protective effects, all of which would theoretically offer benefit in cases of Long Covid (9). Because of its far reaching benefits, I personally think a month of BPC-157 (e.g. 500-1,000mcg daily) in conjunction with other supplements mentioned here could be beneficial.
Luteolin is a natural flavonoid that reduces inflammation / mast cells and neural inflammation (10). There is some speculation that Luteolin could provide significant relief to brain fog and neurological symptoms associated with Long Covid (however the author of this journal article has a declared conflict of interest) (10). Interestingly, one study did combine Luteolin with PEA and olfactory training and found improvements in olfactory (smell) dysfunction related to Long Covid (11). Quercetin has similar mechanisms to Luteolin, and while more research would be preferable, I think using one of these in severe Long Covid cases could be beneficial.
Alterations in the microbiome have been reported post Covid infection, and dysbiosis appears to be a risk factor for both Covid severity and Long Covid (12,13). A range of bacterial strains have been identified as potentially beneficial in reducing the burden of Covid, and an imbalance in good bacteria has been associated with Long Covid. In those experiencing digestive symptoms, it is possible a probiotic may provide relief. One probiotic that contains most of the strains that appear to be beneficial is Dr Mercola's Complete Probiotic for Women.