2020 was a year like no other. We’ve all had very different experiences and challenges that have profoundly changed our lives.
The UK has recorded over 4 million positive cases of COVID so far and now approximately 400,000 people in the UK will continue to live with long-term effects of the coronavirus for many months, if not years, to come. The colloquially termed ‘long COVID’ is undoubtedly becoming the hidden health crisis of the Covid-19 pandemic. This is the first post-viral syndrome to be recognised by mainstream medics, researchers and politicians and has received a lot of media attention. Despite the hysteria around COVID, we need to keep our feet on the ground and focus on what has been highlighted by the pandemic: the importance of our physical and mental health.
Here at the London Clinic of Nutrition, as functional medicine practitioners, we can use the available data from the NHS trust, consider each patient’s unique physiology and look for possible mechanisms of your persisting symptoms. With this framework, we can help you find answers and empower you with useful tools to take your health back.
What is “Long Covid”
Long COVID, also known as chronic COVID syndrome (CCS) and long-haul COVID, is a condition characterised by long-term complications caused by coronavirus. According to the guidelines set by the National Institute for Health and Care Excellence (NICE) the term long COVID is commonly used to describe signs and symptoms that continue or develop after the acute phase of COVID. It includes both ongoing symptomatic COVID (from 4 to 12 weeks) and post COVID-19 syndrome (12 weeks or more) :
We don’t fully know the magnitude of the problem, but given the number of individuals of all ages who have been or will be infected, the public health impact could be profound. This is what we know from the Office for National Statistics data  :
- Around 1 in 5 people who tested positive for coronavirus exhibit symptoms for a period of 5 weeks or longer.
- Around 1 in 10 people who tested positive for coronavirus exhibit symptoms for a period of 12 weeks or longer.
About long COVID
The symptoms of long covid seem to be unique to the individuals, rather than fitting a common symptom picture. People affected by long covid appear to be from different age groups and include those noted to be high risk for covid, as well as those who have underlying conditions. Interestingly, some individuals who appear to be healthy pre-infection have been affected too.
A range of multiorgan complications has been noted following the COVID-19 infection including respiratory, cardiovascular, gastrointestinal, metabolic and renal impairments. Important to note that the severity of the acute phase of covid and hospital stay doesn’t give us prediction for long term outcome. It seems that all of these symptoms rely on the individual’s health, pre-infection.
How long does it take to recover from long Covid?
As Covid and long covid are such new conditions, there isn’t robust evidence available on the exact length of recovery. Due to its wide range of symptoms and individuality, the speed and length of recovery seem to vary from person to person. Experience from other coronavirus strains suggests that most symptoms should go within three months, while tiredness may last up to six months. However, for a small group of people recovery may last much longer .
There have been two clinical trials specifically investigating the symptoms and the length of recovery:
- In the largest and longest study yet on Long Covid, researchers found that of about 1,700 patients, 63 percent said they still had fatigue or muscle weakness six months later, and roughly a quarter reported lingering anxiety or depression, as well as trouble sleeping .
- Findings from an international, web-based survey of 3,762 people from 56 countries also indicates that Long Covid is both common and potentially life-altering. Most had not returned to previous levels of work by 6 months and continued to experience significant symptoms .
The acute threat of COVID -19 is the primary concern in many countries but the long-term impact may be much greater. We urgently need further research and focus here.
Is long Covid contagious?
Long Covid is not contagious. Long Covid symptoms are caused by the body’s response to coronavirus continuing beyond the infectious and acute phase of the initial illness.
What are the symptoms of Long Covid?
Most people who had coronavirus related symptoms recover relatively quickly and can resume their normal lives after a few days. Unfortunately, for some, the effects of coronavirus can last for weeks or months, sometimes longer.
The current guidance of the Public Health of England notes the following physical and psychiatric symptoms :
|Physical vs psychiatric||Psychiatric|
|Chest Pains||Anxiety and depression|
|Joint and muscle pains|
|Loss of smell|
|Liver and kidney disfunction|
Some experts have compared long covid with chronic fatigue syndrome caused by the Epstein Barr virus which can be life-changing with many long-lasting effects .
There is also growing debate around genetic predispositions and variations playing a role in the short- and long-term outcome of Covid- 19. It makes sense, as our health is directly linked to our gene expression which of course is influenced by our environment and lifestyle factors .
As the condition seems to be unique to the individual and affect different body systems in different people, we believe the functional medicine approach may offer the best hope. Functional medicine utilises the most current scientific knowledge regarding how our genetics, environment and lifestyle interact as a whole system and allows us to treat diseases based on patterns of dysfunction and imbalance. Thus, this framework might offer us the most appropriate and successful approach when it comes to post-viral conditions, such as long covid.
How is long covid diagnosed?
The current guidelines of the National Institute for Health and Care Excellence (NICE) recommend to further investigate coronavirus related symptoms that may persist beyond 4 weeks after the acute phase of the infection. At the time of writing (Feb 2021) two definitions of post-acute COVID-19 were available :
- Ongoing symptomatic COVID-19 for people who still have symptoms between 4 and 12 weeks after the start of acute symptoms.
- Post COVID-19 syndrome for people who still have symptoms for more than 12 weeks after the start of acute symptoms.
The current NICE guidelines recommend the following clinical assessment tools to investigate the health of the patient :
- Full blood count
- Kidney and liver function tests
- C-reactive protein test – a key marker for inflammation
- Ferritin levels- for iron deficiency
- Thyroid function
- Exercise tolerance test (recording level of breathlessness, heart rate, and O2 saturation).
- Chest x-ray is also offered to all patients by 12 weeks after acute infection if they have continuing respiratory symptoms
Important to note that as COVID-19 and long COVID are still such new conditions, the current guidelines for diagnosis are adaptive and continue to be revised as new evidence becomes available from scientific and clinical studies.
As we are an independent private clinic, we won’t be able to diagnose Long Covid, but with the use of functional testing and nutrition, we’ll be able to investigate the possible root cause of the symptoms unique to your biology and support your overall health.
The London Clinic of Nutrition is the largest functional medicine clinic in Europe. We are an award-winning clinic having received the UK’s highest award from Integrative Health Care & Applied Nutrition (IHCAN). We have built a reputation for ‘treating the untreatable’. We combine industry-leading nutrition and functional medicine expertise, alongside the latest in-house testing, so we can attend to all your health needs in one trip.
What are the treatments for long covid?
Everything has shifted in light of COVID-19, and the pursuit of our physical and mental health has never been so important. The coronavirus pandemic has been fundamental in turning the floodlight on all the health issues that might increase our vulnerability and susceptibility to viral (and other) diseases. The pandemic has offered us an opportunity to put our health and wellbeing first. There is no better time to take charge of our health.
Some tips for managing your symptoms:
As the COVID -19 pandemic continues to progress, one thing is becoming evident; the severity of symptoms of COVID-19 and its long-term effects all depend on our state of health pre-infection, our genetic predisposition, stress levels and general metabolic and immune resilience.
Lifestyle interventions from a Functional Medicine perspective include nutrition, sleep, exercise, stress reduction, and connection. These factors, when in balance, provide a foundation for optimal health and immune function .
We would always recommend working with one of our practitioners for a tailored and personalised support but here are some of the basic steps you may want to consider :
- Eat plenty of fruits and vegetables. Aim for 9-13 servings per day of a variety of types for a wide array of phytonutrients to enhance the gut microbiome. Think eating for the rainbow!
- Consume dietary fibre, a minimum of 28-35 grams daily, preferably from whole foods.
- Eat fermented vegetables or other probiotic-containing foods such as kimchi, sauerkraut, kefir, kombucha to maintain epithelial health and gut barrier function.
- Reduce or avoid immune offenders such as added sugars and salt, high-glycaemic foods (including processed carbohydrates), and excessive saturated fat.
- Supplement with vitamin D, C and zinc .
- Positive thinking, meditation and building physical and mental resilience are essential in the recovery period.
- If/when mitochondrial function has been restored and exercise is accessible to you, try gentle walks and yoga and stretches.
Treatment and support
Further to your doctor’s diagnosis and investigations, we may be able to support your recovery through our functional medicine approach. During your treatment with us, we would be focusing on the key mechanisms that seem to be involved in the body’s response to coronavirus:
- Gastrointestinal restoration – the gut-immune connection is intimately involved in chronic inflammatory states . We will ensure to rebalance and re-inoculate your gut flora, where over 70% of your immunity is located.
- Detoxification – we will work with you to support the liver and other organs involved in detoxification to convert toxic substances for successful elimination.
- Reduce inflammation – it’s very common to be left with a level of systemic, or localised, inflammation after a severe infection and the ensuing ‘cytokine storm’. So many components of the immune system need to play their role perfectly in the response of a viral attack . To ensure your immune system is functioning optimally we would investigate and correct some of the nutrient deficiencies, particularly the immune nutrients such as vitamins A, D, E, K and C; minerals zinc, selenium, iodine, plus essential fatty acids .
- Reduce oxidative damage by encouraging a colourful plant-based diet high in phytonutrients.
- Restore mitochondrial function – Mitochondrial fatigue is a common side-effect of inflammation and immune challenge because of the massive demand that both place on the mitochondria, the energy factories in our cells. Using nutritional and lifestyle support to improve energy production in cells to combat fatigue is going to be a very important part of the protocol, especially for those who have been hit by debilitating fatigue.
Please note, we would always recommend consulting with a trained practitioner before starting any programme to appropriately address long covid. It’s very important that each programme is fully individualised.
What happens at your appointment?
At the London Clinic of Nutrition, our practitioners will always ensure that all routes to health and recovery are addressed with our patients. Here are the key steps of our functional medicine model:
- Extensive surveys and questionnaires to take your full history.
- Laboratory testing to identify and address your lifestyle factors and environmental exposures.
- Functional biomarkers to understand your clinical imbalances and underlying causes of disease.
- Genomics to understand and create a patient-centred approach based on your genetic make-ups.
What support can I get for long Covid?
The London Clinic of Nutrition is the first clinic of its kind in the UK, offering a full holistic experience. We pride ourselves as the biggest functional medicine practice in England and we are renowned for ‘treating the untreatable’. Over the last 10 years, we have managed to turn many of our patients’ lives around by successfully treating complex chronic illnesses. We specialise in Lyme disease, autoimmune disease, gut health, hormone health and unexplained illness.
If you live in England, UK, the NHS trust recommends patients recovering from COVID-19 infection to speak to their GP to explore local care pathways for support and assessment of any long-term symptoms or health problems. Health care providers and the NHS trust may also refer patients to the online COVID recovery programme.