Patient Convalescence and Recovery in a Post COVID-19
Patient Convalescence and Recovery in a Post COVID-19 World
It’s fair to say that “I’m not well since COVID” may be a regular future presentation.
Traditional treatments focus on recovery from life threatening respiratory symptoms as well as the physiotherapy for patients severely weakened through their hospitalisation, but what about the broader convalescence from symptoms such as fatigue, depression, lung fibrosis and pain that our patients may be experiencing once the worst is over?
At INL we expect these patients, like others slow at recovery, be supported with antioxidants such as glutathione, vitamin C with polyphenolics along with fat-soluble anti-oxidants D and E, plus magnesium and potassium and B complex based formulations at the top of the list.
Beyond these basic nutrient supports the phytonutrients berberine and quercetin have important roles to play in overcoming lung fibrosis and vascular damage, and are worthwhile understanding.
Will we see an increase in incidence of post-viral syndrome and myalgic encephalomyelitis?
Post viral-syndrome (PVS) and myalgic encephalomyelitis (ME) have become better diagnosed since the aetiological connections were made with viral infections such as Epstein Barr virus. Whilst still poorly understood, looking back at SARS gives hints that an upsurge in cases of PSV and ME is on the way.
After the SARS outbreak in Toronto, Canada, a small cohort of people studied experienced post-viral syndrome like symptoms such as fatigue, muscle weakness and sleep problems up to three years later. (1)
What are the key presentations that we can expect to see?
Key hallmarks that we can expect to see in our post-viral patients are post-exertional fatigue, orthostatic hypotension, brain fog, fibromyalgia pains along with some depressive behavioural characteristics that coincide with the concept of “sickness behaviour.”
An important origin to all of these symptoms is the viral-induced disruption of the mitochondrial energy system. The mitochondrial components of our cells, in normal conditions, generate ATP and play a key role as regulators of longevity.
Oxidative stress causes mitochondrial hypofunction, also known as the “cell danger response.” A low energy state that’s purposed to protect the body under viral load. Designed as a mechanism that limits replication via the reduced capability for RNA production, this slowed energy metabolism caused by the viral infection can get stuck, and fail to normalise. A consequence of this from a recovery standpoint sees new muscle growth inhibited playing a partial role in the post-exertional fatigue of post-viral syndrome.
Robert Naviaux’s work shows how “electron steal” from mitochondria by viruses rapidly affects cellular oxygen consumption, electron flow and cellular redox chemistry, which becomes more oxidising. Oxidising conditions also result in less protective SAM, glutathione, and also coenzyme A, the latter essential for the citric acid cycle metabolism. (2)
Lung damage and severe systemic micro-vascular damage is a unique component to consider
As we see more patients recover from COVID-19 infections, pulmonary symptoms and complications that create longer term lung damage will be part of the convalescence intervention strategies.
As a mechanism of action, it is believed that excessive neutrophil activity contributes to thrombosis, with IL-6 and IL-17 increases driving this. The thrombosis has a follow on effect which sees microvascular damage in the lungs. From here further inflammatory processes build via the activation of coagulation pathways. (3)
An extension of this can be the pulmonary fibrosis seen as a result of the chronic inflammatory exposure and connective tissue deposition in the airway walls. COVID researchers have seen that inflammatory cytokines, such as NF-kB, IL-6, IL-8, and TNF-A, and the inflammasome (a component of the innate immune system that detects pathogenic microorganisms) NLRP3 are markedly increased, while anti-inflammatory cytokines such as IL-10 were decreased in response to the viral infection.
Normalisation of NLRP3 and NF-kB with natural therapeutics is possible with Berberine, Quercetin and vitamin C and probably 2mg melatonin several times daily will assist in normalising NLRP3 (4) (5). Of these perhaps Quercetin has the more universally applied benefits, and with good evidence in lung fibrosis and vascular recovery. (6)
What is the basis of post-viral therapy?
Recovery strategies on the basis of the issues presented fall into two categories. In one stream we see the need to aid restoration of the lung tissue and in the other we look at the longer term recovery of the cellular energy system.
Glutathione (GSH) plays a key role in the lung, with the levels of GSH in the epithelial lining strongly influencing the extent of lung inflammation. (7) GSH, in addition to it known anti-oxidant functions and anti-inflammatory functions, is essential for other roles within the innate and adaptive immunity. (8)
GSH can also play a key role in the repair of mitochondrial energy production together with Citocholine and fat soluble vitamins such as Vitamin E ( an important note here is that gamma tocotrienol found in Annatto-E is up to 50 times better as a membrane-soluble antioxidant).
Mineral rebalancing is also essential when improving stability in the cells. Magnesium and Vitamin K offer options to both cover the stabilisation of Calcium and important co-factor reactions for mitochondrial enzymes.
To see INL's top 6 choices for mitochondrial resuscitation and viral recovery complete with doses? Scroll down!
INL's Dose: 1 capsule with each meal
Quercetin has been shown to be one of the most useful and physiologically active flavonoids.* It can be used for maintaining or supporting the proper levels of enzymes and physiologic factors necessary for normal respiratory and sinus function.* (Link to Product)
INL's dose: 1 capsule in the morning with food
Annatto-E™ 300 is a unique tocopherol-free, tocotrienols-only product, featuring tocotrienols sourced from the annatto tree. Annatto is the richest known source of tocotrienols, containing 100% tocotrienols (90% delta and 10% gamma isomers), with no tocopherols. (Link to Product)
INL's Dose: 2 grams daily with phospholipids
UltraClean Krill Oil Concentrate contains a highly concentrated form of deodourised krill oil. Krill oil contains phospholipids, which are structural components of cell walls, as well as astaxanthin, an antioxidant. (Link to Product)
INL's Dose: 1 scoop in the morning with coconut water for potassium
Ultra Muscleze® Energy provides a high dose of magnesium, a mineral necessary for the healthy functioning of muscles and the nervous system. Includes vitamins B1, B2, B3, B5, B6, B12, C and CoQ10 which support energy levels. (Link to Product)
Graeme's Dose: 3 squirts twice daily with meals
Readily absorbed across the oral mucosa and utilised by the body. Using specialised technology, the Liposomal Range provides nutrients in nano-sized vesicles constructed of either a phospholipid bi-layer (for water-soluble nutrients with or without fat-soluble nutrients) or a phospholipid mono-layer (for fat-soluble nutrients). (Link to Product)
Graeme's Dose: 1 at night with food
Potent antioxidant formulated to minimise oxidative stress and reduce free radical-induced cellular damage and LDL oxidation. (Link to Product)
Medlab Nanocelle CBD has arrived!
INL is the first oro-buccal Nanocelle CBD spray in Hong Kong. An oral-buccal spray format delivers NanocelleTM particles to an area of high absorption capacity inside the cheeks allowing superior delivery. This further improves bioavailability and compliance, along with a greater potential for lesser doses offering a better therapeutic effect enhancing overall patient satisfaction.
NanoCBD is a formulation containing 16.67 mg/mL cannabidiol (CBD) as active ingredient, in a sub-micron spray applied to the oro-buccal membrane.
The CBD is sourced from cannabis (hemp) strains and extracted from plant parts that produce high levels of CBD, but no THC.
With 5mg of broad-spectrum CBD in 2 sprays, Nanocelle CBD offers a unique way to help your patients by unlocking the power of the endocannabinoid system.
(Go to NanoCBD page)