Case Reports of Long Haul Syndrome
by Dr. Dan Kalish
Long Haul Syndrome patients are now coming into integrative medicine clinics looking for answers to their fatigue and related post-COVID symptoms. Interestingly, functional medicine has, since its inception in the 1970's and 1980's, always looked at the impact of chronic infections on the various body systems.
From the book "The Yeast Connection" and "Guess Who Came to Dinner," the role of candida and parasites in chronic illness has occupied thousands of practitioners, including myself. Differentiating acute from chronic infections, and how each impacts the various systems of the body has long been a focus of our field. We certainly all have more questions than answers on how to best work with those suffering from Long Haul Syndrome (commonly referred to as "Long COVID"). In my practice today, we are looking at lab findings, including fatty acid and amino acid testing as well the all important markers of cytokine function such as kynurenate and quinolinate found on organic acids, to find solutions.
Functional medicine practitioners have long been ridiculed and sidelined by critics who don't "believe" chronic infections can trigger chronic symptoms. In my practice, I have personally seen thousands of patients suffering from parasitic infections such as giardia, cryptosporidium, e. histo, blastocystis, alongside thousands of patients suffering from chronic candida or fungal overgrowth. While these infections are often treated if the patients present with an acute, early onset version of the organism, the mere concept of chronic low grade candida albicans or d. fragilis causing chronic fatigue has never been widely accepted.
However, now we are presented worldwide, with a sudden and dramatic moment, where it's clear to everyone that what is a life-threatening, acute infection, COVID, can also present in a chronic form. Whether that means people harbor a low-level of the virus, or whether the virus sets of some type of inflammatory cascade in the lining of the blood vessels, or has other mechanisms of causing the variety of symptoms we are seeing, from GI upset to cognitive issues surrounding energy, mood and memory all the way to autoimmune-like syndromes. I'm sure as with HIV/AIDS, the mechanisms and actions of these long-term reactions will eventually be revealed.
In the meantime, while we wait for the science to verify what potential medical treatments may eventually become available, we can certainly look a the basics of the biochemistry of cells and fix what we find in a true-to-our-roots, functional medicine way.
Fatty acids, used to produce energy such as palmitic, must be assessed. Each and every step of mitochondrial energy production needs to be tested and corrected using nutrients such as magnesium CoQ10 and pantothenic acid amongst others. We need to look at neuroinflammation and of course, the most important area of all perhaps, examine the patients glutathione status and see what are the best methods for establishing healthy glutathione levels.
Perhaps vitamin D or vitamin A may be low, either of which could cause challenges for a full and robust immune system response to any infection, acute or chronic. In fact, when I look at the standard functional medicine workup I run on every new patient and apply a lens of "immune health and immune recovery," I see literally dozens of golden opportunities for us to really make a difference in people's lives.
When COVID first hit, back in March of 2020, I was speaking with a good friend and colleague of mine who has been in integrative practice for 15-20 years, and expressed horror and disbelief at what I saw coming; My good friend looked at me and said "Dan, what do you think you and I have been doing all these years? How many people have you worked with that have had chronic infections, and how many have you helped recover?"
At the time, it took me a few weeks to really let all this sink in. The response to acute infections such as COVID always requires medical intervention offered through prescription medications, vaccines, the resources found in a hospital such as high-level respiratory care, ICU doctors and all of those resources. But when the dust settles, and the walking wounded emerge with chronic disease manifestations, the load falls to those of us in the integrative arena first of all to believe these patients are suffering something real, and secondly to innovate and problem solve what will be the best potential ways to restore health.