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Reversing Long COVID

More than 40% of people who survived a COVID-19 infection now experience the long-term effects of Long COVID. This condition encompasses a wide range of symptoms, from brain fog and memory problems to difficulty breathing and chest pain.

But luckily, doctors have begun to develop a comprehensive protocol to reverse symptoms and allow you to regain optimal health.

Long COVID, a review:

Long COVID is a complex disorder with no simple quick fix. Scientists are just beginning to understand what COVID-19 does to the body and how the effects may persist after recovering from the infection.

There are certain and unique characteristics of long COVID that distinguish it from other post-viral syndromes. The virus that causes COVID-19, Sars-CoV-2, enters the body as a respiratory infection but has a high affinity for the cells that line the blood vessels also known as endothelial cells. When the virus attaches to the vascular endothelium, it causes damage that produces inflammation and microscopic blood clots.

These blood clots and increased inflammation interfere with circulation and the delivery of nutrients and oxygen to your tissues. As we know, vital organs depend on oxygen delivery and circulation. This is why COVID-19 can impact your entire body, and why Long COVID syndrome may impact all of your organs and produce a wide variety of symptoms.

But, even before COVID-19 enters your cells and wreaks havoc throughout your body, it’s important to understand how COVID-19 does so.

The role of ACE2:

To enter your cells, a virus must find an entry point- a gateway on the cell surface that matches its own proteins. For COVID-19, this gateway is ACE2. ACE2 is a vitally important enzyme that has numerous healing effects on the body. But it also matches the proteins of the COVID-19 virus.

When the virus attaches to ACE2 and uses it to enter other cells, ACE2 is subsequently destroyed- thus halting all the beneficial, healing effects of ACE2. But, this is where it gets interesting. Virtually all the complications linked to COVID-19 can be traced to a deficiency of ACE2.

The research:

Scientists at Salk University sought to discover exactly when happens what COVID-19 attaches to ACE2. They found that the subsequent damage and inflammation cause impairment to the mitochondria. As we know, the mitochondria are vitally important to your cells and generate the energy you need to live. In fact, over 90% of the energy used by the body originates in the mitochondria.

Moreover, the scientists at the Salk Institute demonstrated that the mitochondria distress caused by the destruction of ACE2 continues after recovery from acute COVID and into the phase of Long COVID. Such ACE2 abnormalities are not limited to those who were sick enough to be hospitalized- it can also occur in people who only had a mild COVID-19 infection.

Reversing Long COVID:

Nearly 40% of the population has been diagnosed with Long Covid. However, these numbers are likely much higher, as many people are undiagnosed. The key to preventing Long COVID infection is to follow a scientifically proven regimen as soon as you are diagnosed with COVID-19. These supplements and lifestyle factors will help to reduce mitochondrial damage.

In the following sections, we’ll break down what you need to do. Mainly, this protocol works to enhance ACE2 activity and restore healthy mitochondrial function in order to regain health.

This list of potential molecular interventions is long, and you may not need them all. The best way to determine which are necessary is through metabolic testing to determine your inflammation levels and mitochondrial health. Checking with your doctor is also important to determine which products will work based on your symptoms.

ACE2 enhancement:

  • Herbs and spices are an important component due to their anti-inflammatory effects from the flavonoids.

    • The 2 most important are curcumin and rosmarinic acid:

      • Curcumin is found in the herb turmeric and has the most anti-inflammatory effects of any food that has been studied. Also available as a dietary supplement.

      • Rosmarinic acid is found in herbs like rosemary, thyme, sage, oregano, spearmint, and lemon balm.

  • Using these in your cooking will help to enhance ACE2 activity.

Supplements that enhance ACE2 in laboratory studies and clinical studies in humans.

  • Vitamin D is at the top of the list. The dose depends on the season and individual biochemical variability. It is best absorbed after your main meal.

  • Resveratrol. Found in the skin of red grapes and red wine. Also found in vegetables like sulfur vegetables. Has documented anti-inflammatory and anti-aging effects. Enhances ACE2 levels and activity and the effect on circulation very much mimic the effects of ACE2. The dose is 600 to 1000mg daily with food.

  • Curcumin. The dose is 750-1000mg/day taken with food. The liposomal form is better absorbed and you only need ½ the dose.

  • Rosmarinic acid dose is 150mg/day. Take once or twice a day with food.

  • Omega 3 fats are found in fish oils and some vegetables. The dose is very important. The form most studied is the fish oils – EPA and DHA. The effect of fish oil in humans is that they raise the levels of a peptide hormone called Apelin. Apelin enhances the effects of ACE2 and raises ACE2 levels.

    • Apelin has been investigated as a possible treatment for COVID-19.

    • CBD also raises apelin levels and in lab studies, was found to be highly protective against cellular damage.

  • Omega 3s independently have anti-inflammatory effects and beneficial effects on the brain. And so does curcumin.

  • Alpha-lipoic Acid. Enhances ACE2 activity by a different indirect method. Inflammation has a generally negative effect on ACE2 and causes the ACE2 molecule to be shed from cells, so it is much less active. This impact of inflammation can be prevented by ALA. The dose is 300mg twice a day with food.

    • There are over 200 studies on ALA in the National library of medicine in human clinical trials.

    • Most of the studies show benefits as an anti-oxidant

    • Also enhances the effects of Omega 3 fats in protecting the brain.

Intermittent fasting also raises and enhances ACE2

  • Only eat between certain hours of the day. Try to at within an 8-hour window. Coffee and water and tea are allowed for the other 16 hours.

Mitochondrial Rescue

There are no drugs that work for mitochondrial rescue, however, supplements do work.

  • CoQ10

    • Coq10 is the most studied supplement in mitochondrial function. CoQ10 is available as a supplement but is also normally made in your body.

    • There are two major forms: Ubiquinone and ubiquinol (CoQH)

    • The advantage of Ubiquinol is that it is better absorbed and more effective at a lower dose.

    • The dose needed to enhance mitochondrial function in human clinical trials is 100mg 2-3 times a day taken with food.

  • Carnitine

    • Also made in your body but available as a supplement. Works hand-in-hand with CoQ10.

    • Two forms are available

    • Carnitine esters such as Acetyl-L-carnitine and propionyl-L-carnitine. Dose for either is 500mg BID. Acetyl-L-carnitine is the better option.

    • Should always use L-carnitine which is the form that works naturally in the body.

  • B Vitamins are very important for mitochondrial function. The 3 most important are:

    • Vitamin B1 – Thiamine. The dose is around 100mg QD or bid. The best form is a fat-soluble form called lipothiamine. B1 is being used in the MATH+ protocol for those with COVID-19 who are severely ill. These people become very deficient in B1. The dose for lipothiamine is 100mg daily.

    • Vitamin B2 – Riboflavin. The dose is 100mg daily or 4x a day. At a dose of 400mg a day, Riboflavin has been shown to prevent migraine headaches which is a disorder associated with mitochondrial dysfunction. It is the excess riboflavin that turns urine yellow.

    • Vitamin B3 – Niacin. This one may be the most important. B3 is essential for the Electron Chain Complex 1 which initiates the process of energy generation. Complex 1 converts niacin into NAD+. Niacin can cause flushing- it's unpleasant but not necessarily concerning. Doses higher than 25mg can cause flushing for some people but for others 100mg or more are needed. The niacin flush can be blocked with aspirin, either 81mg or 325mg, 30 minutes before niacin. Or by using quercetin at 300-500mg before taking Niacin

  • N-Acetylcysteine:

    • Enhances the effects of niacin to stimulate complex 1

    • Extensively studied in humans for its anti-inflammatory and immune-stimulating effects

    • The typical dose is 900mg bid or tid. Doses up to 3600mg a day are safe.

    • Both niacin and NAC have direct benefits in the brain. Niacin can stimulate brain repair independent on the mitochondrial effects and NAC has been used for the treatment of psychiatric disorders due to the calming effect on the brain, especially at higher dose levels.

    • NAC is an amino acid that is a precursor of the body’s major intracellular antioxidant called glutathione

  • Glutathione:

    • Glutathione is very important for mitochondrial function.

    • Inflammation destroys both mitochondrial functions and glutathione.

    • Glutathione can rescue mitochondria and restore normal function, especially for complex 1. GSH has to be recycled to stay active.

    • B2 is essential for the recycling of GSH.

    • Melatonin also helps GSH recycle itself to remain active.

    • The most potent way to get GSH is IV. The dose is 2000mg. IV Glutathione is very important for patients suffering from Long Covid.

    • Liposomal GSH can be absorbed and the dose is 400-1000mg daily.

Here's a summary of dietary supplements that can increase ACE2 activity and for mitochondrial rescue. These may be expensive. The list starts with the least expensive.

  1. Vitamin D3 1000-6000iu daily with the main meal

  2. Niacin 100mg a day combined with NAC 600mg twice a day with main meal

  3. Riboflavin. 100-400mg a day

  4. Melatonin as tolerated. 1-10mg day

  5. Thiamine. Lipothiaine 100mg day.

  6. Resveratrol 75-1000mg day. Start with around 200mg. Take with food

  7. Liposomal curcumin. 750-1000mg day

  8. Rosmarinic acid 150mg a day

  9. CoQ10 100mg 2-3x day depending on CoQ10 or CoQH

  10. L-Carnitine is available as a prescription drug in pills of 330mg. Take 3 pills twice a day.

    1. Acetyl L carnitine is a highly effective carnitine ester and stimulates the nervous system. Take 500-1000mg a day and don’t take it too late in the day.

  11. Omega 3 fats 1200-200mg a day

  12. Alpha-lipoic acid 300mg twice a day

The Gut Microbiome

Covid-19 frequently impacts the GI tract. Symptoms like abdominal pain and diarrhea are very common among Long COVID sufferers. This is partially due to the large role of ACE2 in the GI tract- it acts as a chaperone that enables the transport of amino acids into the body. Tryptophan is one of the most important amino acids aided by ACE2. This amino acid is the precursor of serotonin and is also used when there is an increased need for niacin in the body. Tryptophan is also the precursor molecule to make vitamin B3.

When COVID-19 enters the GI tract, it impairs amino acid transport- causing a deficiency of tryptophan. This creates an alteration in the immune system within the gut which subsequently affects the gut microbiome. (This is because microbes in your gut are controlled by the immune system.)

Researchers have found that the negative impact of COVID-19 on the gut is very similar to that of chronic fatigue syndrome. There is a loss of beneficial, anti-bacterial bacteria and an increase in pro-inflammatory bacteria. It also leads to a general loss of bacterial diversity, which is also a bad thing.

Often, the number of fungi and yeast within the gut increase following COVID-19. The most common yeast overgrowth associated with COVID-19 is Candida Albicans and Candida Aurus. C. Aurus is deadly and often resistant to treatment. The most common fungi found after COVID-19 is an allergenic fungus, aspergillus flavus, which can produce mold toxins. Black mold has also been seen in the gut of some COVID-19 survivors. It is essential to reduce yeast and fungus numbers to heal the gut.

Curing your gut imbalances involves diet, prebiotics, and herbal antibiotics for rebalancing the intestinal bacteria for those with COVID-19. See the COVID19 guide.

Chronic COVID is not something you have to suffer through for the rest of your life. The solution lies in enhancing mitochondrial function, boosting gut microbiome health, and restoring the ACE2 protein. At the Johnson Center, we will work with you to find a comprehensive plan that will work best for you.

To learn more about the Johnson's Center and Chronic COVID-19, click here to contact us! If you have any more questions about your path to optimal health, email our office at or call 276-235-3205.

To learn more about who’s at risk for chronic COVID, click here.

To learn more about the symptoms of long COVID, click here.

To learn more about the neurological symptoms of chronic COVID, click here.

To learn more about an overview of chronic COVID, click here.

The Johnson Center for Health services patients in-person in our Blacksburg and Virginia Beach / Norfolk locations. We also offer telemedicine for residents of Virginia and North Carolina!


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