When faced with health challenges after exposure to Sars-Cov-2 or one of the vaccines, there are many areas of one’s health and lifestyle to take into consideration. The following lists of baseline tests, lifestyle modifications, professional-grade supplements, and other therapies are some of the important considerations that your doctor and you may want to look into. Dr. Jim Meyer, PharmD, CCN has compiled this information based on his extensive research as well as his own clinical observations. Please consult your qualified healthcare professional for any medical advice, diagnosis, or treatment.
Where clinically indicated, the following tests should be considered:
- CBC with differential and platelet count
- CMP with liver function tests
- D-Dimer as a marker of clotting activation
- CRP as a marker of ongoing inflammation
- Morning cortisol to assess adrenal function
- Troponin and pro-BNP to exclude ongoing cardiac disease
- Coinfection testing, CMV, EBV, HSV, to rule out reactivation of other viruses Vitamin D (25 OH vitamin D)
- ANA and autoantibodies may also need to be tested for to rule out new or reactivated auto-immune activity
- Thyroid panel to rule out thyroid disease
- Homocysteine level
- HbA1c to rule out diabetes
Diet & Lifestyle Considerations
Lifestyle modifications may greatly improve recovery time and help to minimize symptoms. It is important to move towards an anti-inflammatory diet (ie. Paleo, Keto, eliminating gluten, dairy, and processed sugar). Eat real (not processed) food, as in meat, vegetables, fruit, seeds and nuts. Avoid any foods that you know you are allergic to or sensitive to. Avoid processed foods. Avoid artificial sweeteners and high fructose corn syrup.
Intermittent fasting/time-restricted eating can be beneficial for improving autophagy, cellular recycling, rebuilding, and cellular healing. Intermittent fasting days should be non-consecutive initially: Monday, Wednesday, and Friday, for example. The fasting window can start at 8 hours and gradually increase to 12-16 hours. Note: It is important to consult your doctor or nutritionist to determine if this would be safe for you.
It is essential to stay hydrated. Aim to drink at least a half ounce of water per pound of body weight per day, unless you are fluid restricted by your physician or morbidly obese. (Check with your physician if either of these restrictions apply to you). For example, if you weigh 150 pounds, the goal would be to drink 75 ounces of water.
Moderate physical activity helps with recovery, as it improves mitochondrial recovery and energy production. The goal should be moderate activity to tolerable levels that do not worsen symptoms. Stretching and low-level resistance exercises are preferred initially over aerobic exercise to reduce the amount of oxidative stress. Keeping the heart rate below 110 beats per minute initially is ideal. As symptoms and recovery rate improve, the amount of exercise can be adjusted.
Seven and a half to eight hours of quality sleep per night is recommended to improve recovery time.
Nutritional Supplemental Support
If CRP and D-Dimer testing provides evidence of blood vessel inflammation or the potential for abnormal clotting, systemic enzymes may be of value. Nattokinase has potent fibrinolytic, antithrombotic, and antiplatelet activity. Typical dosing is (4000-8000 FU) twice daily. Lumbrokinase (Bulouke) is another systemic enzyme with similar activity. Typical dosing is (300,000 to 600,000 IU) per day.
Nattokinase has been more extensively used because there have been more clinical studies done with it to establish safety and efficacy. I like to use Neprinol (AFD). It is a combination of nattokinase, serrapeptase, lipase, bromelain, and papain for inflammation and fibrinolytic activity to maintain normal blood viscosity. It is also useful for workout recovery. Dosing is 2 capsules twice daily on an empty stomach. The dose can be increased to 6-8 capsules per day if symptoms and lab values warrant the increase.
Resveratrol 400-500mg daily. Resveratrol (a beneficial compound found in red wine) most importantly activates autophagy. It also has anti-inflammatory, antiviral, antioxidant, and anticoagulant properties. Pterostilbene is a potent, better absorbed derivative of resveratrol with similar activity but a much longer half life and greater effect on oxidative stress. Resveratrol Ultra HP and Resveratin Plus are both resveratrol products combined with quercetin to enhance absorption and activity. Resveratin Plus also contains pterostilbene.
Spermidine 3-6mg daily. Spermidine, like resveratrol, has anti-inflammatory and antioxidant properties. It has been shown to preserve mitochondrial function (generation of the energy the cell needs) and reduce cardiovascular disease. It has also been shown to activate autophagy like resveratrol but through different metabolic pathways.
Melatonin has anti-inflammatory and antioxidant properties and is a potent regulator of mitochondrial function. The dose should be started at 1 mg extended release and increased as tolerated to 2-6 mg nightly. If the individual is a slow metabolizer higher doses may result in vivid dreams and daytime drowsiness.
Probiotics: Patients with post syndromes are usually dysbiotic with depletion of bifidobacterium resulting in low butyrate production in the gut. This reduction in short-chain fatty acid production results in reduced energy production and poor nutrient absorption. Suggested probiotics include Megasporbiotic, Visbiome, Triflora, and Therabiotic. The dose would start with 1 capsule nightly and increase to 1 capsule twice daily after a week.
NAC 600-2000mg per day. NAC effectively enhances circulating and cellular glutathione levels. It has a broad range of antioxidant, anti-inflammatory, and immune-modulating properties. It can be used in combination with s-acetyl glutathione or liposomal glutathione and vitamin-C in case glutathione production or recycling is genetically compromised.
Nitric oxide support: COVID-19 patients have been shown to have suppressed endothelial nitric oxide synthase activity resulting in a deficiency of nitric oxide. The spike protein may play a major role in inhibiting this enzyme. Nitric oxide deficiency is a major factor causing endothelial dysfunction, and clotting abnormalities. Low plasma arginine levels have been observed post COVID-19 exposure and vaccine exposure. Activation of the nitric oxide cyclic GMP pathway has anti-inflammatory effects. It modulates activated T-cells, reduces cytokine (cells affecting the immune system) release, and stimulates vascular (blood vessel) repair. NOVA Complete is a comprehensive nitric oxide support product containing beetroot and L-citrulline as substrates for nitric oxide conversion. It also contains hawthorn for improving activity of nitric oxide synthase. It contains chlorogenic acid and grape seed extract for antioxidant and anti-inflammatory effects in the vasculature. L-Citrulline is used instead of L-Arginine because L-citrulline has been shown to increase cellular arginine levels more efficiently than giving oral L-arginine without the contraindications that come with L-arginine supplementation. The dose of NOVA complete is one scoop daily in water or juice. If oxygen saturation is compromised, one scoop twice daily is recommended.
Mitochondrial support: Compromised mitochondrial function has been seen both post infection and post vaccination. Extra support to enhance mitochondrial recovery may be necessary. ATP-360 contains coenzyme Q10 and NADH to support ATP (energy) production both aerobically and anaerobically. It also contains pyrroloquinoline quinone (PqQ) for mitochondrial renewal. Phospholipid matrix is included to support the mitochondrial membrane and r-lipoic acid is included to reduce oxidative stress. The daily dose is 3 capsules.
Liver Support: The liver may be compromised due to inflammation or heavily burdened, clearing metabolic waste, inflammatory mediators, oxidative stress etc. Dual-Tox DPO is designed to support and balance Phase I and II liver detoxification. The dose is 4 capsules daily.
Vitamin C has anti-inflammatory, antioxidant, and immune modulating properties. It also helps promote the growth of beneficial bacteria in the microbiome (the group of microorganisms in the body that helps with digestion, destroys harmful bacteria, and helps control your immune system). A dose of 1000 mg orally 2 to 3 times daily is recommended.
Vitamin D3 (4000-5000 units/day) with vitamin K2 (100mcg/day). This can be adjusted based on the baseline Vitamin D level.
Omega 3 fatty acids have anti-inflammatory and cardio-protective effects. They improve endothelial function, limit vascular inflammation, reduce thrombosis (blood clotting), and reduce free radical (unstable, damaging molecule) production. A combination of EPA/DHA is recommended with a starting dose of 2000mg increasing up to 4000 mg daily as tolerated.
Additional Therapeutic Considerations
It seems simple, but exposure to sunlight for even 30 minutes per day has been shown to be immunomodulatory and increase ATP production.
Red light therapy has been shown to have similar effects if one needs to limit UV exposure.
Hyperbaric oxygen therapy has been shown to decrease inflammatory cytokines while increasing IL-10 (an anti-inflammatory cytokine). It has also been shown to improve mitochondrial function and improve tissue oxygenation.
Supplementation should be based on analysis of symptoms and lab work in partnership with a qualified healthcare practitioner to optimize support. Dr. Jim Meyer, PharmD, CCN has helped many individuals struggling with complex medical issues and diagnoses find healing and recovery in their journey towards optimal health. He is available for virtual as well as in-person consultations at Peoples Rx.
If you have comments and/or questions about this blog, email us at email@example.com.
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