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6 Pointers on Long Covid

Major caveat here, I’m a Psychotherapist signposting readers to the working theories, research, and professional voices that I have personally found most useful in supporting my own healing from post-viral health challenges. I’m not a medical doctor giving out health advice! I’ve linked all my sources in the text. With the absence of any allopathic cure or treatment for Long Covid yet, we have to turn elsewhere to find symptom relief, management, and healing.

This is by no means comprehensive guide. I am writing this because some of what I have most useful seems the least known about. When I have spoken with people about it, they ask me for more information, and so I am collating it in one place. Before launching into specifics, I believe it’s important to flesh out my own personal mindset that I developed through this healing journey. Should you wish to read more, Gabor Maté, whom I greatly draw from, explores in great depth how mind and environment affects into physical health and disease.

1. Mindset

What can I change? There is a statement that is used a lot in the addiction recovery community. Well, actually, it’s a prayer. If the word God brings you out in hives, or immediately switches you off, please bear with me. There may still be wisdom in it for you regardless of your beliefs.

“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

In hindsight, this maxim has guided me through the pursuit with Long Covid recovery. Ultimately, there is still so much unknown about Long Covid treatment, and so there are things we need to accept that we might not be able to change right now. However, there is lots about our lifestyles that we can change, but we often lack the courage, will power, or motivation to do anything about it. It can be very hard to distinguish what we can and cannot change at the best of times. Perhaps harder so in the face of a new health condition. Onto of all that, sometimes a lack of knowledge hinders our ability to identify when, despite thinking something is permanent, actually we can change it. And so, using what little wisdom I have, I have chosen to focus my efforts on endeavours that I know I can change.

Acknowledge complex systems. Reductionism tries to explain complexity by dividing everything up and zooming in on the individual parts, or compartmentalising. E.G. If we zoom in on, say, a dandelion, we’ll learn more about the dandelion, and it’s petals, it’s molecular structures, e.t.c. We are very familiar with this way of approaching the world: zoom in to find out more. This often works, but not all the time. Medical science is not there yet with Long Covid.

An alternative way of learning more about the world is to acknowledge the vastly complex array of systems that are at a constant interplay in any given body and moment, and that these systems do not operate in a vacuum but it exist and operate within an environmental context that relate bidirectionally. We can learn a lot about a dandelion by zooming out, and looking at it’s place within the field, it’s relation to other plants, and how it changes throughout the day and life cycle. Imagine now instead of a dandelion, we’ve got a human being instead.

When diving into the sea of research and articles about Long Covid, so much of what I was reading was people scientific reductionism, or people on reddit attempting their own one person research trials on themselves. This often comes with lots of costly trial and error, following crowd wisdom rather than solid scientific research. My reaction was frustrated awe at complexity of it all, and how I was unlikely to find the magic cure through reductionism, and that perhaps my efforts were better placed with finding broad strokes.

My personal filter for what I was going to try had to somehow acknowledge and work with the complex systems of the body and it’s environment, rather than a series of minute, zoomed in interventions. Basically, I chose to try the Long Covid related interventions that I observed as being broadly good for general health regardless of viruses and symptoms. These are low risk lifestyle modifications that have high potential upside rewards and crucially, that I could get on with by myself. Perhaps, I thought, by creating more optimum conditions in a general sense, it will be the best support I can give to the natural regenerative capacities of my body.

2) Low PRAL diet

There is a new working theory that all post viral symptoms can be linked to the bodies inability to regulate acidity in the body. There are two simple to understand videos that interviews the researchers and their personal experiences with Long Covid. Part 1. Part 2. (Ged Mezinger’s Youtube channel is generally a brilliant resource for informal interviews with medical professionals and researchers in the Long Covid field).

After publishing on Frontiers, Vicky van der Todt took to Twitter in April 2023 to tell people how they can get started now, rather than wait years for the research. Broadly speaking the aim is to consume more foods and do more things that have an overall alkalising effect on the body, whilst also reducing foods that are overall acid forming. It is not as simple as cut out acid and just consume alkaline, as some foods that are not acidic in their consistency, require the body to produce lots of acid to digest. Likewise some foods that are acidic in nature actually have an overall alkalising effect. To help with this, each food has a been tested and given a PRAL value, there’s a useful table and PDF explaining it more here.

It all might seem daunting, but in my pursuit for the simple wins I realised that generally meat, hard cheeses, tahini, sugar, and processed foods are the most acid forming. Dark leafy greens, vegetables, and some dried fruits like raisins, dates and banana chips are the most alkalising. Also, in the video, Vicky explains how urinating and breathing are the mechanisms our body recruits to excrete excess acid. So I make it my mission now to drink 3 litres of water a day, and sometimes alkalise the water with drops as she highlights in her tweets.

For me, Low PRAL diet has been the single biggest lever in improving symptoms. Due to it’s hypothesis of the acid deregulation causing a variety of symptoms, it relates to all of the other points below. Complex is the system!

3) Glucose Levels

Energy levels are a such a big factor for lots of people with Long Covid. I needed to improve my energy, and optimise what energy I had. In zooming in on shifting my diet to be more Low PRAL, I noticed that my energy would spike and crash a lot. This is something that I mildly experienced prior to the viruses, but has since exacerbated.

Jessie Inchauspé is a biomedical scientist on a mission to help people balance their glucose with her ’10 hacks’. My gateway into her work was this podcast, where she talked about her own healing journey from a major life threatening back surgery, and her subsequent mental health challenges. She calls herself the Glucose Goddess, and her instagram account is also a great resource. What I like about her approach is she works to make complex academic research findings really simple to understand and directly actionable. I was amazed really so see some of her glucose monitoring graphs, on certain foods, and eating behaviours. She advocates focusing on how and when we are eating and the habits around eating, rather than what we are eating. I have found her hacks very useful in stabilising my energy throughout the day. The main shift for me is having a low-carb, protein and fat rich breakfast, and always combining fat/protein/fibre when eating carbs.

I found it particularly insightful to consider how although fruit is nutritious, agricultural selective breeding and mass production has slowly-bred out a lot of the seeds and fibrousness naturally found in fruit. For example, the bananas you see in Tesco’s look very different to the ones you see naturally growing in tropical places. It is the fibre and seeds in fruit that helps to smooth out glucose spikes. So the fruit we eat today is not as ‘natural’ as it seems, and often spikes glucose levels when eaten on it’s own.

4) Re-regulating the Nervous System

A major cluster of symptoms for lots of people experiencing Long Covid is a dis-regulated nervous system. The medical terms you might have come across related to this is Disautonomia and/or POTS.

Rather usefully for me, I have been understanding and working with Poly Vagal Theory for years, which works with nervous system states to explain mental health challenges and experiences. For context, I will briefly explain Poly Vagal Theory.

The theory is that as we evolved, we developed 3 distinct nervous systems that come on and offline in relation to what is happening in our thoughts, and in our environment. It can be mapped onto a ladder, that acts in a hierarchy. We’re aiming for less time in the bottom two rungs, and more time in the top rung. We move in and out of these three states all the time, in differing speeds and degrees. Sometimes people get stuck in one for long periods, and find it difficult to change states.

My experience has been since contracting two different viruses in six months, the ‘normal’ way in which my nervous system moved between states and interacted with daily life was vastly altered. Instead, it seemed more easily aroused into the lower two sets of boxes and harder to regulate and relax into the top one. The resulting physical symptoms of spending too long in sympathetic and dorsal vagal can also manifest itself as digestive issues, heart palpitations, irregular breathing patterns, to name a few, all of which are listed as symptoms of Long Covid.

Here’s where is gets tricky. This all looks like classic anxiety. So does Long Covid physically cause anxiety somehow, or does all the symptoms and stress associated with Long Covid lead someone to develop anxiety? What came first, chicken or egg? Unfortunately I have read a lot of online reports and have had first hand experience of these nervous system based symptoms being mis-diagnosed, or fobbed off as purely mental health issues. This leaves someone’s sense of their physical symptoms being invalidated, and sometimes under-investigated. The acid disruption, low PRAL diet theory could provide an explanation. In van der Togt and Rossman’s paper they quote other research findings:

‘"altered brain acidity affects multiple neurological conditions, such as anxiety”.

They are theorising the potential cause for these these nervous system dis-regulation symptoms is acidity dis-regulation. My experience has been that after adopting low PRAL eating, my nervous system symptoms greatly improved. Furthermore, as of writing this article, if I deviate from low PRAL foods consistently for a number of days, some elements of the dis-regulation seems to slowly creep back.

OK, back to Poly Vagal theory. How else can we calm the nervous system? I personally have historically sporadically practiced pranayama, which is an ancient yogic breathe practice, and various forms of meditation. Since being on the Long Covid healing journey I have made that a ideally daily feature in my routine. Breathing exercises and meditation is easy to throw around as a general recommendation for good health, but I know first hand that it’s hard to learn, and hard to stick at doing regularly. Often times health professionals, however well intended, set people up for failure, because it can be really hard if not taught well. I have found a Long Covid specific online yoga community, who have a great looking, affordable, program that works with people right where they are at, even if that is totally bedridden.

There are now even gadgets like Heart Math, that measures your heart rate variability to give bio-feedback on the bodies state of being. This can be a great gadget to learn or re-learn what feeling relaxed and calm actually feels like. However, I personally didn’t find being wired up and staring at my phone screen to be all that calming.

5) Magnesium

The Psychiatrist Dr Tracey Marks explains in this simple video the role of magnesium in anxiety, depression and stress. Here are some of the key messages. Magnesium helps with over 300 bodily processes, including helping the electrical stability of the nervous system. Most of us do not consume enough magnesium with the modern western diet. Even if we do eat healthily, magnesium is increasingly absent food due to industrialised farming practices depleting soil health.

Stress and anxiety, or sympathetic activation as seen in the diagram in point 4, depletes magnesiums levels. Not all magnesium supplements are created equal, and have varying levels of absorption. Magnesium L-Threonate has been shown to be more absorbed in the brain, and I found this double blind placebo trial that has been published since the video, demonstrating that Magnesium L-Threonate improves memory and cognition. Neuroscientist Andrew Huberman recommends taking Magnesium L-Threonate before bed to improve sleep quality.

Across my research into magnesium, there was enough compelling evidence to include good quality L-Threonate supplements into my daily routine. My personal thoughts when deciding to try magnesium were as my nervous system was more dis-regulated, I was more likely to be magnesium deficient. Furthermore, sleep plays such a crucial role in healing and restoration and is closely linked with the dynamics of fatigue and brain fog, that it makes sense to support optimum sleep, in ways that I can. Plus with everything Dr Tracey Marks explains, it also supports good mental health. So it was worth a try. Interestingly enough, pumpkin seeds contain one of the highest levels of magnesium, and also have one of the lowest PRAL values, so they are a double win!

6) Getting Meta-physical

What seems to be a common experience in Long Covid is the varying degrees that people are able to let go of the things they can’t do, and the fear around whether they will ever be able to get back to their old way of doing things. The runner who can no longer run. The film director who can longer handle the 14hr days on set. It only takes a quick read on Reddit to read stories of people’s premature re-uptake in intense exercise which leads to big relapses. For some, that crisis of personal identity, work, past times, and relationships can clog up any process of letting go of the old, and creating space to let in any of the new. This is about letting go of attachment to who we were. Tough stuff.

For me, it might not be possible right now to walk and climb up mountains, or cycle far, and who knows when or even if I will return to that level of capacity. Eventually, after a fair amount of time adopting points 1-5, I realised it was possible to sit in a boat and steer it. I have found joy, nature connection, and community in learning to sail. It is something that I have wanted to do for a long time, but historically never properly made it happen. Perhaps if I had not found myself in this position health-wise, I might never have found this new passion.

When we get existential about the nature of human life and suffering, many of us psychotherapists will ramble on about the potential for suffering to somehow be our teacher, even our guide. Gabor Mate’s books, and I’m sure others, are full of personal stories of people who have chosen not to become a victim of their illnesses, but chosen to allow life to unfold and find the messages of wisdom amidst all the pain. However, it’s no easy feat, I know.

If your reading this and are also on a healing journey with Long Covid, or any other form of suffering for that matter, I hope that by some weird, cruel, or infuriating and round about way, you hear whatever quiet message of teaching that life has thrown at you, even if it has come packaged in the form of physical suffering. I hope you find some serenity and wisdom to figure out what you can and cannot change, and that those life lessons eventually get positively transmuted and help you on your way.

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