Long Covid Roundtable with Drs Virender Sodhi, Jacob Teitelbaum, and Edythe Vickers

Nearly 1 in 5 adults who have had Covid currently experience symptoms of “long Covid,” according to the US government’s Household Pulse Survey.¹ Long Covid is defined as symptoms lasting 3 months or more after first contracting SARS-CoV-2.

Natural Medicine Journal Editor-in-Chief Tina Kaczor, ND, FABNO, recently discussed prevention of long Covid with 3 colleagues, each of whom has been practicing as a clinician for at least 25 years.

Kaczor posed 4 important questions to these experts:

1. What do you think the cause of long Covid is, and how is it related to other chronic fatigue syndromes?
2. What do you do across the board for your patients for acute Covid and long Covid?
3. Are there any certain labs that you use?
4. And do you consider long Covid curable, or is it something people have to manage for the rest of their lives?

The experts who weighed in are:

• Edythe Vickers, ND, LAc, a naturopathic physician and licensed acupuncturist with expertise in seamlessly combining Chinese medicine and naturopathic medicine to create personalized treatments for each patient. Vickers is the clinical director of An Hao Natural Health Care Clinic, a division of the Institute for Traditional Medicine (ITM), a nonprofit organization dedicated to keeping traditional medicine relevant in the modern setting. She practices in Portland, Oregon.
• Virender Sodhi, MD (Ayurveda), ND, has been practicing since 1988. He is founder and current CEO of Ayush Herbs, offering the highest quality Ayurvedic herbal products and supplements worldwide. He practices at his clinic in Bellevue, Washington, which is fittingly called the Ayurvedic and Naturopathic Medical Clinic.
• Jacob Teitelbaum, MD, is a medical doctor who is board certified in internal medicine and is known for his work in chronic fatigue syndrome, fibromyalgia, sleep, and pain. He has authored numerous books, including the best-selling From Fatigued to Fantastic, which is now in its fourth edition. He has also developed the popular free smartphone app CuresA-Z. Teitelbaum currently resides in Kona, Hawaii.

What follows is a condensed and edited version of the discussion. The full episode, which includes specific approaches, supplements, and treatments, is available on the Natural Medicine Journal Podcast.

Kaczor: Let's begin with Dr Teitelbaum. Dr Teitelbaum, what do you think is the cause of long Covid, and how is it related to other chronic fatigue syndromes?

Teitelbaum: Long Covid is simply one more form of postviral chronic fatigue syndrome (CFS) and fibromyalgia. Fibromyalgia and CFS reflect an energy crisis, where the hypothalamus in the brain, which controls various functions, malfunctions due to a drop in energy production in the body. This can be triggered by various infections, as many viruses trigger the lowering of energy production and this can lead to malfunctioning of the hypothalamus, which uses an inordinate amount of energy itself. The body's energy production slows down to starve out infections, but sometimes it gets stuck in this process, resulting in insufficient energy production in muscles and other long-lasting symptoms. Our research shows that it is possible to restore the proper functioning of the hypothalamus, with 91% of people recovering and experiencing a 90% increase in their quality of life.

Kaczor: Thank you, Dr Teitelbaum. Dr Sodhi, what are your thoughts on the matter?

Sodhi: I believe there are similarities between long Covid and other chronic fatigue syndromes. From an Ayurvedic perspective, imbalances in the body can lead to a toxic load. These imbalances can arise from various factors, including mental and emotional aspects. When the body is overwhelmed by toxins, it becomes more susceptible to infections. The imbalances affect different systems in the body, leading to a range of symptoms, and precisely which symptoms arise depends on the person’s constitution. Restoring balance through addressing mental, emotional, physical, and nutritional factors is crucial to bringing the person back into a state of balance.

Kaczor: That's intriguing, Dr Sodhi. Dr Vickers, could you share your perspective?

Vickers: From a naturopathic medicine viewpoint, long Covid can result from immune dysfunction or residual inflammation. In Chinese medicine, it is seen as a wind invasion that transforms into internal heat and pathogenic responses. These toxins accumulate between the heart and diaphragm, causing deficiencies in different organs based on the individual's weaknesses. The symptoms manifest depending on the affected areas, such as the lungs, digestive system, or musculoskeletal system. Long Covid shares similarities with other chronic conditions like chronic fatigue syndrome, chronic Lyme, and chronic viral infections. The underlying constitution of the patient, external forces, and nutrient deficiencies all play a significant role in understanding and addressing these conditions.

Kaczor: So, Dr Vickers, would it be fair to say that external forces, including pathogens, emotions, and stressors, can affect individuals based on their vulnerabilities?

Vickers: Indeed, external forces such as pathogens, emotions, and stressors can impact individuals differently based on their vulnerabilities and constitutions. A subset of individuals may be more susceptible to long Covid based on their constitutional weaknesses. For example, individuals with more of a “Metal”  constitution may experience symptoms related to the respiratory system, such as asthma in childhood or develop pneumonia more easily. It is also possible that the Large intestine manifests symptoms,  in which case symptomslike chronic diarrhea or colitis can appear. The vulnerability of an individual to long Covid depends on their unique constitutional makeup and how it interacts with the effects of the virus. It's important to consider these individual factors when managing and treating long Covid.

Kaczor: As Dr Vickers mentioned, the constitution of the patient from a Chinese medicine perspective can dictate not only the pathology direction but also the vulnerability of the patient. Dr Sodhi, could you explain this further from an Ayurvedic perspective?

Sodhi: Certainly. In Ayurveda, we recognize different constitutional types known as Vata, Pitta, and Kapha. Each type has its own characteristics and tendencies. For example, individuals with a Vata type are always moving and can experience anxiety and fear easily. Pitta individuals are energetic and driven, they are go-getters but may also struggle with anger and frustration. Kapha individuals tend to be slower and can lack movement or motivation, they can be stuck in their ideas, and they are more prone to laziness and weight gain. When there is imbalance in the doshas, health problems can occur. By understanding one’s constitution and making lifestyle and dietary adjustments accordingly, we can promote balance and prevent issues from arising.

Kaczor: Thank you, Dr Sodhi. It seems that both Chinese medicine and Ayurveda emphasize the importance of considering individual constitution and imbalances when addressing health conditions. This holistic approach provides valuable insights into managing long Covid and other chronic conditions.

Q: What do you do across the board for your patients for acute Covid and to prevent long Covid?

Sodhi: For both acute and long Covid, I recommend simple and free remedies. Rest is crucial, along with maintaining a healthy diet and staying hydrated. Breathing exercises and cleansing programs can also support the body's natural healing processes.

Vickers: In Chinese medicine, we treat the specific symptoms caused by Covid. For acute cases, we focus on clearing toxic heat, and once that's resolved, we introduce tonic herbs to prevent long Covid. I use a combination of acupuncture, herbs, nutraceuticals, and specific antiviral formulas.

Teitelbaum: Rest is vital during acute Covid. To prevent long Covid, I recommend taking a multivitamin high in zinc, and a mix of elderberries.. Metformin can be beneficial in the early stages to improve energy production and overcome insulin resistance.

Kaczor: Is resuming normal life too quickly a risk factor for developing long Covid?

Vickers: Yes, it is. People should avoid rushing back into their daily routines too soon after feeling better. Adequate rest and avoiding excessive physical exertion for at least 2 weeks after the symptoms have resolved comepletley can help prevent the evolution into long Covid.

Sodhi: I absolutely agree. People who lead highly active or stressful lives are more prone to developing long Covid. It's essential to prioritize rest and make necessary lifestyle changes.

Kaczor: Dr Teitelbaum, how do you approach chronic fatigue in patients who previously had Covid?

Teitelbaum: I recommend the SHINE protocol, which focuses on restoring energy production. This involves optimizing Sleep, addressing Hormonal deficiencies, treating Infections, and providing Nutritional support. Exercise should also be incorporated to prevent deconditioning.

Kaczor: What treatments do you suggest for long Covid?

Teitelbaum: For the fatigue, body aches, and brain fog associated with long Covid, I recommend the SHINE protocol. Additionally, curcumin supplements can help reduce inflammation, and specific formulas like Cura Pro can target organ damage. Nutritional support, including B vitamins, magnesium, and ribose, along with exercise, are crucial for recovery.

Vickers: I utilize various treatments such as antiviral herbs, like Istatis and others, low-dose naltrexone for brain fog and inflammation, and acupuncture to address long Covid symptoms. Specific herbs like Boswellia can help with lung inflammation. There are many more herbal combinations that are individualized based on the patient’s symptoms and constitution.

Sodhi: I focus on lifestyle changes, including a healthy diet, breathing exercises, and cleansing programs. Supplements like vitamin C, magnesium chloride, and herbal formulations such as Curcumin can also be beneficial.

Q. Kaczor: How do you address specific organ damage caused by Covid?

Teitelbaum: For heart and lung damage, I recommend using supplements like coenzyme Q10, magnesium, and a recipe of specific nutrients for heart failure. Curcumin and glutathione supplements can help reduce inflammation and oxidative stress.

Vickers: I use organ-specific treatments such as Hawthorne for lung inflammation and formulas like Isatis 6 for antiviral support. Acupuncture can also be beneficial for heart and lung conditions.

Sodhi: Specific organ damage requires targeted approaches. For lung inflammation, Boswellia can be effective, and for heart conditions, I recommend supplements like magnesium and coenzyme Q10. Always, the balancing of the doshas is part of the treatment.

Kaczor: What advice do you have for patients recovering from Covid to prevent relapse?

Teitelbaum: It's essential for patients to prioritize activities that bring them joy and avoid falling back into the habits that may have contributed to their initial illness. They should focus on optimizing energy levels, addressing any underlying conditions, and avoiding overexertion. Following a balanced and healthy lifestyle is key to preventing relapse.

Vickers: I echo Dr Teitelbaum's advice. Patients should use their recovery as an opportunity to reassess their priorities and engage in activities that nourish their spirits. It's crucial to avoid returning to a lifestyle that contributed to their illness in the first place.

Sodhi: I completely agree. Patients need to recognize the importance of self-care and make conscious choices to maintain a balanced and healthy lifestyle. Prioritizing rest, nourishing their bodies with healthy food, and managing stress are essential for preventing relapse.

Kaczor: Are there any certain labs that you use?

Teitelbaum: To diagnose long Covid, CFS, and fibromyalgia, bloodwork is not necessary. Normal ranges in blood tests don't indicate if a person is fine or not. I rely on symptoms to guide the diagnosis and the treatment, and there are various tests that can help identify ongoing issues so they can be addressed.

Sodhi: I use basic labs like CBC and ESR, along with tests for inflammatory markers, liver enzymes, kidney function, and thyroid. Depending on the individual, I might run additional tests like ferritin, stool testing, or vitamin D levels. There are many more tests that we naturopathic physicians will run based on the patient’s signs and symptoms.

Vickers: I always run CRP to measure inflammatory markers. I also look at white blood cell counts, RBC, and sometimes perform stool and parasite testing. Vitamin D levels and cortisol testing are important too, especially for sleep and stress-related issues.

Kaczor: Do you consider long Covid curable, or is it something people have to manage for the rest of their lives?

Vickers: It's hard to answer definitively. There seem to be different types of long Covid. In some cases, with proper treatment, it can resolve completely. However, for others, it may persist and fluctuate over time, ebbing and relapsing, similar to chronic conditions like chronic fatigue or Lyme disease.

Sodhi: If we can stop the inflammation cycle triggered by the cytokine storm, we can have a significant impact on long Covid. Natural remedies like turmeric and ashwagandha can help reduce inflammation. Lifestyle factors, such as breathing exercises and stress management, play a crucial role in recovery.

Teitelbaum: Rather than considering it a disease, we should focus on living a balanced and authentic life. By following our true desires and prioritizing self-care, we can prevent relapses and allow the body to heal. Long Covid becomes a non-issue when we live in alignment with our own needs.

Sodhi: Supplements alone are not the solution. Healing requires a holistic approach that addresses the body, mind, and spirit. Consciousness and awareness of our actions and motivations are essential for complete healing.

Kaczor: Any final thoughts or recommendations for patients dealing with acute or long Covid?

Teitelbaum: Remember to be patient with your recovery process. The treatments and lifestyle changes discussed here are highly effective and can greatly improve your quality of life. Don't hesitate to seek professional guidance and support.

Vickers: Each person's journey with Covid is unique, so it's crucial to individualize treatments based on their specific symptoms and needs. Consulting with practitioners who specialize indeveloping  a comprehensive and tailored approach to recovery is ideal.

Sodhi: Embrace the power of natural remedies and the wisdom of your body. Simple lifestyle changes, such as rest, healthy eating, and breathing exercises, can have a profound impact on your well-being. Trust in the body's innate healing abilities.