Journal Club: Key Nutrients for Long Covid
Article Title: Precision nutrition to reset virus-induced human metabolic reprogramming and dysregulation (HMRD) in long-COVID
Authors: A. Satyanarayan Naidu, Chin-Kun Wang, Pingfan Rao, Fabrizio Mancini, Roger A. Clemens, Aman Wirakartakusumah, Hui-Fang Chiu, Chi-Hua Yen, Sebastiano Porretta, Issac Mathai & Sreus A. G. Naidu
Journal: NPJ Science of Food
Type of Research: Review
TL;DR:
- SARS-CoV-2 hijacks our body's energy systems, leading to ongoing metabolic issues in many COVID-19 survivors, known as "long COVID."
- Long COVID can be grouped into heart/kidney issues, breathing/sleep problems, muscle/nerve issues, and digestive/lung problems.
- Specific nutrients can help reset various metabolic dysfunctions caused by COVID-19, including those related to the Warburg effect, iron dysregulation, mitochondrial dysfunction, oxidative stress, immune impairment, gut dysbiosis, and virus-hijacked processes like serine proteases, NRP1, and ACE2/RAAS.
- Examples of beneficial nutrients include L-arginine, quercetin, NAC, NAD+, vitamin D3, probiotics, ECGC (green tea), Omega-3 PUFAS, sulforaphane (broccoli sprouts), and polyphenols.
These nutrients can potentially aid in recovery and management of long COVID symptoms by targeting specific metabolic pathways affected by the virus.
Key Scientific Findings
1) SARS-CoV-2, the virus causing Covid-19, doesn't have its own way to create energy, so it takes over our body's systems to survive.
2) Even after recovering from Covid-19, many people (up to 70%) experience ongoing metabolic issues, leading to long-lasting symptoms known as "post-acute sequelae of COVID-19" (PASC) "long covid." This is called human metabolic reprogramming/dysregulation (HMRD). This article talks about some of the reasons behind these issues and suggests some ways to help.
3) Long covid can be divided into four different groups:
Group 1: Problems with the heart and kidneys (33.8%)
Group 2: Issues with breathing, sleep, and anxiety(32.8%)
Group 3: Muscle and nerve problems(23.4%)
Group 4: Digestive and lung problems(10.1%)
Each group has its own specific reasons for the ongoing symptoms.
Key Mechanisms and Nutrients
Nutritional reset of hypoxia/Warburg effect
The Warburg effect refers to a change in how cells produce energy. Under normal conditions cells will favor oxidative phosphorylation as it is the most efficient way, however with the Warburg effect cells will use glycolysis to produce ATP even when oxygen is available. The shift can help cells survive short- term in challenging conditions, but long-term may lead to inflammation and tissue damage. In long COVID, this may lead to diabetes, fatigue, malaise, heart, lung, and brain issues.
The following nutrients have been studied to change the impact of this
- L-Arginine
- L-Tryptophan
- Serotonin
Nutritional reset of Iron (Fe)-Redox dysregulation (FeRD)
When someone gets a severe lung injury from Covid, they are subject to iron(Fe)- redox dysregulation(FeRD). This means that their iron metabolism is impaired which can have consques for how severe their covid may become. There are several markers of iron metabolism including erythropoietin, haptoglobin, ferritin, TF, LF, and Hb. These could provide risk stratification stratgeis for COVID-19 management. For example, elevated ferritin/TF ratio predicts insufficient pulmonary oxygenation. Resetting FeRD with Fe-redox regulators may be useful in these cases of Covid and from developing long-covid.
The following nutrients have been studied to change the impact of this
- Lactoferrin(found in milk/colostrum)
- Heme Oxygenase-1(HO-1)
- Nimbolide(found in Neem plant)
- Curcumin(turmeric)
- Resvertrol
- Quercetin
- Vitamin E
- Glycyrrhizin(found in licorice)
Nutritional reset of mitochondrial dysfunction (m-Dys)
Mitochondrial dysfunction from covid-19 results in altered bioenergetics/low energy production and can contribute to symptoms such as chronic fatigue, exercise intolerance, inflammation, etc.
The following nutrients have been studied to change the impact of this
- NAD+
- ALA
- CoQ10
- Creatine
- Vitamin B12
Nutritional reset of Oxidative Stress
Oxidative stress refers to increased number of free radicals(ROS) and antioxidants. This contributes to multiple organ systems including GI, brain, heart, lungs, and more. This mechanism is important for many clinical manfiestations of long covid.
The following nutrients have been studied to change the impact of this
- Superoxide dismutase and SOD mimetics
- Catalase
- Lactic acid bacteria
- Gluthathione
- NAC
- Glutamine
- Quercetin
Nutritional reset of Immune Impairment
When you get infected with the SARS-CoV-2 virus, your body's immune system kicks into action to fight off the virus and keep you healthy. This is a normal response to infection and helps prevent the virus from causing too much harm. However, in some cases, especially if your immune system is weak or overwhelmed, the virus can become more aggressive and cause serious problems. This can lead to things like Mast Cell Activation Syndrome and hyperinflammation.
The following nutrients have been studied to change the impact of this
- Vitamin D3
- Omega-3 PUFAS
- Vitamin C
Nutritional reset of gut dysbiosis
Covid alters our gut microbiome which has many negative consequences. One notable consequence includes disrupting the gut-brain access leading to neuropsychiatric disorders such as depression, anxiety, brain fog, and more. It can also lead to things like hyperinflammation and dysregulated immune activation.
The following nutrients have been studied to change the impact of this
- Probiotics/lactic acid bacteria(LAB)
o Streptococcus thermophilius
o L. Acidophilus
o L. helveticus
o L. paracasei
o L. brevis
o B. lactic
o L. plantarum
o Loigolactobacillus coryniformis K8(vaccine induced immune response)
Nutritional reset of virus-hijacked serine proteases
In healthy lungs, transmembrane serine proteases(TMPRSS2), play a major role. However, when this balance gets thrown off and the activity is upregulated, lung disorders such as COPD and emphysema may occur. In covid, this makes an individual more susceptible to infection and severity of lung involvement.
The following nutrients have been studied to change the impact of this
- ECGC(Green Tea)
- Sulforaphane(broccoli sprouts, cruciferous vegs)
Nutritional reset of virus-hijacked NRP1/neuro-cognitive impairment
NPR1 is expressed in central nervous system cells such as olfactory epithelium, astrocytes, and neuroal cells. This leads to covid/long covid symptoms such as loss of smell, altered sense of smell, headaches, confusion, Guillain Barré syndrome, myelitis, myositis, and cognitive impairments.
Nutrients that target NRP1 are not as well studied however include:
- Melatonin
Nutritional reset of ACE2/RAASonal reset of virus-hijacked ACE2/RAAS
ACE2 is a key component of the RAAS system which regulates blood pressure, vasoconstriction, sodium retention, and tissue remodeling.
The following nutrients have been studied to change the impact of this
- L-Carnitine
Nutritional reset of virus-induced metabolic disorders
Nutritional reset of virus-induced metabolic disorders
Not only can covid worsen metabolic disorders such as type 2 diabetes, it can also lead to new onset metabolic disorders such as diabetes and obesity.
The following nutrients have been studied to change the impact of this
- Liposomal SOD and reducing glucose/lipid intake
