Why Does Post-Viral syndrome Occur?

The short answer is, we don’t know. In some cases, organ and tissue damage caused by the virus or the body’s immune response to the virus may cause lingering symptoms while the damage heals. A virus may cause immune system dysregulation, which may in turn stimulate or cause a chronic inflammatory state. In response to an infection, the immune system uses free radicals to destroy viruses and bacteria. In cases of post-viral syndrome, the body may not be adequately able to clear these free radicals, leading to a state of oxidative stress (which also causes inflammation). It is likely that the chronic symptoms felt by many after a virus are a result of several processes gone awry.   

The good news is that, with a worldwide focus on COVID-19 and potentially millions of people who will suffer from long-COVID, it is likely we will see research that improves our knowledge of post-viral syndrome from other illnesses as well—a topic that has generally been ignored or written off as psychosomatic by allopathic medicine.

How is Post-Viral Syndrome Connected to Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS)?

Again, we don’t really know, but we do know that many people who suffer from ME/CFS report that their symptoms began suddenly after what appeared to be an infectious illness, and often a mild one at that. In some cases, post-viral syndrome that lasts longer than six months may end up getting a diagnosis of ME/CFS. Regardless of the specific connection, ME/CFS and post-viral syndrome look an awful lot alike and can often be treated in a similar way.  

How to Address Post-Viral Syndrome

While managing symptoms is important for comfort and day to day function, it is critical to address any underlying imbalances that may have predisposed you to a post-viral syndrome in the first place and may be perpetuating it. Functional medicine doctors report that they rarely see a person with post-viral syndrome who doesn’t have some imbalance, so take a long hard look at your current state of health.⁴ Even if you are free of any diagnosed disease, such as diabetes or heart disease, you may still have underlying imbalances that need to be addressed. For instance, it's estimated that only about 12% of Americans have optimal levels of key cardiometabolic risk factors (waist circumference, blood pressure, blood glucose, hemoglobin A1c—a measure of inflammation, triglycerides, and HDL cholesterol) without the help of prescription medications.⁵ That means that nearly 88% of us have some work to do!

Start building your foundation of health by optimizing each of the following components, adding supplements as necessary to support you.

Enjoy a Healthy Diet

It is easy to let a healthy diet slip when you don’t feel well and have no energy, but, unsurprisingly, how you eat affects how you feel and how well you recover from an illness. Be sure to load up on a rainbow of organic fruits and veggies every day. They not only supply vitamins, minerals, and fiber, but also a wide array of phytonutrients that support immune function. Next make sure to get healthy fats in the form of nuts, seeds, olives and olive oil, coconut oil, and butter or ghee from pasture-raised cows. Equally important is to ditch the fats and oil that cause inflammation like soy, corn, cottonseed, vegetable oil blends, fried foods, and chemically modified fats, like interesterified fats. From there, add quality protein from pasture-raised chicken, cold-water fatty fish, grass-fed meats, and pasture-raised eggs. And for those who need a little extra carb, top it all off with gluten-free whole grains and legumes to balance out your daily energy expenditure.

• A multivitamin helps to safeguard against possible holes in your diet.
• EPA and DHA, either from fish oil or algae, help modulate inflammation.
• Vitamin D supports healthy immune function.

Lingering Anosmia?

While not necessarily life-threatening, losing your sense of taste and/or smell is no fun! Even though most people will regain their senses as they recover, if you are left with a lingering loss, you may want to try smell retraining therapy. This simple and easily accessible tool helps to improve the sense of smell though frequent exposure to strong smells by stimulating the re-growth and activation of olfactory receptors. To try it, you will need at least four essential oils from different categories. Good choices would be lavender (flowery), lemon or orange (fruity), cloves or cinnamon (spicy/aromatic), and eucalyptus (resinous). Smell each oil, one at a time, for 10-20 seconds, concentrating on your memory of each scent as you smell the oil. Do this at least twice a day or up to 5 times a day until your sense of smell returns, or for at least 12 weeks.^{20 21} Alpha lipoic acid (600 mg/daily) has also been found to be helpful in restoring sense of smell after upper respiratory tract infections.²² Both of these methods help to improve sense of smell by stimulating the re-growth and activation of olfactory receptors.

Balance Blood Sugar

It’s almost shocking how far reaching blood sugar imbalance can go. In addition to increasing the risk of nearly every chronic disease, imbalanced blood sugar affects mood, increases inflammation, ages the skin, and impairs immune function. Eating a healthy diet like the one mentioned above is the absolute first step, but supplements can also be supportive.

• Berberine supports balanced blood sugar and helps to modulate inflammation.
• Alpha lipoic acid supports mitochondrial function in addition to its blood sugar balancing effects.

Breathwork to Retrain the Lungs and Nervous System

Symptoms such as fatigue, shortness of breath, dizziness, and a racing heart can plague some people suffering from post-viral syndrome. One possible reason might be that lung inflammation and/or autonomic nervous system damage caused by an infection may alter how a person breathes, shifting from deep breaths through the nose to shallow breaths through the mouth. To retrain the diaphragm and the nervous system, a Navy Special Operations veteran, named Josh Duntz, developed a breathwork program that has been incorporated into the Mount Sinai Center for Post COVID protocol.²³ To access Duntz’s breathwork protocol for free go to https://stasisperformance.com/ and sign up.

Manage Stress

Being chronically sick is stressful in and of itself. Couple that with life’s everyday stresses and bigger things going on in the world that you may have no control over, and you’ve got a recipe for some major stress. Left unchecked, chronic stress causes inflammation, so it is critically important that you take steps to reduce the impact of stress on your body.⁶ We can’t make all the stress in our lives go away, but we you can change how we respond to it. Try breathing exercises, meditation, tai chi, yoga, or any number of other techniques and allow yourself downtime to relax and do enjoyable things like play games with your kids, take a hot bath, watch your favorite show or sit under a tree and read.

• Adaptogenic herbs like ashwagandha, rhodiola, and ginseng help to bring balance to the body during times of physiological and psychological stress. They also support immune function and good sleep.  
• Vitamin B1 (thiamine), sometimes called an “anti-stress” vitamin, improves the body’s ability to cope with stress and has been used to treat people with anxiety and the symptoms that come with it, including chronic fatigue, insomnia, digestive complaints, and depression. It may also strengthen immunity.^{7 8}

Get Deep, Restorative Sleep

When we are sleeping, our body is busy repairing, detoxifying, making hormones, and much more. Sleep deprivation leads to decreased insulin function and increased inflammation. Despite how important it is, sleep can be elusive for fatigued people with post-viral syndrome, so pull out all the stops: practice good sleep hygiene; sleep in a dark, cool room; turn off all electronics at least one hour before bed; and use supplements as necessary.  

• Melatonin is of course well recognized as the hormone that makes us sleepy at night, but it is also an antioxidant and it supports immune function.

Move Your Body Appropriately

Notice I didn’t say exercise here, for fear of conjuring up images of treadmills or cross-fit gyms. While exercise is great, for someone recovering from post-viral syndrome, it might not be an option. But movement that is appropriate to your body and energy level is still important, whether it is a walk, some stretching, or exercises done exclusively lying down.

The above five components are the foundation of all health, and together they influence every aspect of healing and recovery, including a balanced inflammatory response and immune system healing and restoration. If you’ve mastered these facets and are still struggling, consider adding additional support in the following areas:

Modulate Inflammation 

A buildup of pro-inflammatory compounds from the body’s response to a virus may be contributing to post-viral symptoms.

• Turmeric is well known as a potent antioxidant and anti-inflammatory herb.
• Resveratrol is a potent antioxidant that not only modulates inflammation, but also supports mitochondrial health.

Support Mitochondrial Health

Nearly every cell has mitochondria that produce the energy needed to run the body. Mitochondrial dysfunction is believed to be at the heart of many post-viral symptoms.^{9 10}

• PQQ (aka pyrroloquinoline quinone) is involved in energy production and supports the health and function of the mitochondria.^{11 12 13}
• CoQ10 is required for energy production and supports the health and function of the mitochondria, including reducing oxidative damage.^{14 15}
• B-vitamins are intricately involved in mitochondrial energy production. They are also necessary for maintaining mitochondrial structure and function.¹⁶
• Intermittent fasting and/or a ketogenic diet have been shown to improve mitochondrial function.^{17 18}

Balance the Gut Microbiota – Having a healthy balance of bacteria in the gut supports optimal immune function as well as a healthy inflammatory response throughout the body.¹⁹

• Probiotics help to repopulate the gut microbiome with beneficial bacteria.
• Prebiotics can be thought of as food for the probiotics and include most high fiber foods, but also sources like FOS (fructooligosaccharide) and inulin in supplemental form.

Finally, don’t go it alone. Seek out support groups, either virtual or in your area, and find a practitioner with experience treating post-viral syndrome. Functional and integrative doctors have been successfully helping people overcome post-viral syndrome for decades and you can find directories of natural practitioners who may be better equipped to help on the following websites:

• Institute for Functional Medicine at https://www.functionalmedicine.org/
• American Association of Naturopathic Physicians at www.naturopathic.org
• Academy of Integrative Health & Medicine at http://aihm.org/  

References

1. Collins, F. (2021, Feb 23). NIH launches new initiative to study “Long COVID”. Retrieved May 18, 2021 from https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-launches-new-initiative-study-long-covid
2. Komaroff, A.L., Bateman, L. (2021, Jan 18). Will COVID-19 lead to myalgic encephalomyelitis/chronic fatigue syndrome? Front Med, y, 606824. https://doi.org/10.3389/fmed.2020.606824
3. Johnson, J. (2019, October 10). Post-viral syndrome: Symptoms, causes, and treatment. Medical News Today. https://www.medicalnewstoday.com/articles/326619?c=1275091336035.
4. Hyman, M. (Host). (2020, Dec 23). Functional Medicine Approach to Treating Covid-10 and Post Covid-19 Syndrome (no. 150) [podcast]. In The Doctor’s Farmacy. https://drhyman.com/blog/2020/12/23/podcast-ep150/
5. Araújo, J., Cai, J., Stevens, J. (2019, Nov 1). Prevalence of optimal health in American Adults: National Health and Nutrition Examination Survey 2009-2016. https://doi.org/10.1089/met.2018.0105
6. Carnegie Mellon University. (2012, April 2). How stress influences disease: Study reveals inflammation as the culprit. ScienceDaily. Retrieved May 26, 2021 from www.sciencedaily.com/releases/2012/04/120402162546.htm
7. Cornish S and Mehl-Madrona L. “The Role of Vitamins and Minerals in Psychiatry.” Integr Med Insights. Sept 24, 2008; 3:33-42 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046018/
8. Bradford A. “What is Thiamine (Vitamin B1)?” Live Science, Aug 1, 2015. https://www.livescience.com/51721-vitamin-b1-thiamine.html
9. Hyman, M. (Host). (2020, Dec 23). Functional Medicine Approach to Treating Covid-10 and Post Covid-19 Syndrome (no. 150) [podcast]. In The Doctor’s Farmacy. https://drhyman.com/blog/2020/12/23/podcast-ep150/
10. Bland J. S. (2020). The Long Haul of COVID-19 Recovery: Immune Rejuvenation versus Immune Support. Integrative medicine (Encinitas, Calif.), 19(6), 18–22. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819497/
11. Saihara, K., Kamikubo, R., Ikemoto, K., Uchida, K., Akagawa, M. (2017). Pyrroloquinoline quinone, a redox-active o-quinone, stimulates mitochondrial biogenesis by activating the SIRT1-PGC-1α signaling pathway. Biochemistry, 56(50), 6615-6625. doi: 10.1021/acs.biochem.7b01185
12. Stites, T., Storms, D., Bauerly, K., Mah, J., Harris, C., Fascetti, A., …Rucker, R.B. (2006). Pyrroloquinoline quinone modulates mitochondrial quantity and function in mice. J Nutr, 136(2), 390-396. DOI: 10.1093/jn/136.2.390
13. Bauerly, K., Harris, C., Chawanadisai, W., Graham, J., Havel, P.J., Tchaparian, E., …Rucker, R.B. (2011). Altering pyrroloquinoline quinone nutritional status modulates mitochondrial, lipid, and energy metabolism in rats. PLoSOne, 6(7), e21779. doi: 10.1371/journal.pone.0021779
14. Hernandez-Camacho JD, Bernier M, Lopez-Lluch G, and Navas P. “Coenzyme Q10 Supplementation in Aging and Disease.” Front Physiol. Feb 5, 2018. https://www.frontiersin.org/articles/10.3389/fphys.2018.00044/full
15. Tian G, Sawashita J, Kubo H, et al. “Ubiquinol-10 Supplementation Activates Mitochondria Functions to Decelerate Senescence in Senescence-Accelerated Mice.” Antioxid Redox Signal. June 1, 2014; 20(16): 2606-2620. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025630/
16. Axe, J. (2018, May). Could mitochondrial health be the key to health and longevity? Natural Grocers Health Hotline. Available at: https://www.naturalgrocers.com/health-hotline-article/could-your-mitochondria-hold-key-health-and-longevity
17. Institute for Functional Medicine. (2021, May). IFM’s COVID-19 Update: Cardiac, Vascular, and Pulmonary Complications of Post-acute Sequelae of SARS-CoV-2 (PASC) [webinar]. Retrieved from: https://www.ifm.org/news-insights/covid-19-vaccines-in-phase-3-trials/
18. Axe, J. (2018, May). Could mitochondrial health be the key to health and longevity? Natural Grocers Health Hotline. Available at: https://www.naturalgrocers.com/health-hotline-article/could-your-mitochondria-hold-key-health-and-longevity
19. Yanuck, S.F., Pizzorno, J., Messier, H. Fitzgerald, K.N. (2020 May 9). Evidence supporting a phased immune-physiological approach to COVID-19 from prevention through recovery. Integr Med (Encinitas), 19 (suppl 1), 8-35. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190003/
20. Evans, J., Carter, J., Stone, M., Class, M., Lobisco, S., Den Boer, A., …Pizzorno, J. (2021, April). Post-acute sequelae of SARS-CoV-2 infection (PASC): the functional medicine approach [webinar]. Retrieved from:  https://www.ifm.org/news-insights/covid-19-vaccines-in-phase-3-trials/
21. ENT Health. (n.d.). Smell Retraining Therapy. https://www.enthealth.org/be_ent_smart/smell-retraining-therapy/.
22. Hummel T MD, Heilmann S MD, and Huttenbriuk K-B MD. “Lipoic Acid in theTreatment of Smell Dysfunction Following Viral Infection of the Upper Respiratory Tract.” The Laryngoscope, Nov 2002; 112(11): 2076-2080 https://onlinelibrary.wiley.com/doi/abs/10.1097/00005537-200211000-00031
23. O’Rourke, M. (2021, April). Unlocking the mysteries of long COVID. The Atlantic. https://www.theatlantic.com/magazine/archive/2021/04/unlocking-the-mysteries-of-long-covid/618076/