Long-COVID Syndrome (LCS) and the Brain

By Andrea Bartels CNP NNCP RNT Registered Nutritional Therapist 14 Jan 2022

Long-COVID Syndrome (LCS) and the Brain

By Andrea Bartels CNP NNCP RNT Registered Nutritional Therapist

If you’ve overcome COVID-19 infection you may be wondering why you’ve not bounced back as quickly as you were hoping to.  Dozens of chronic symptoms have been reported post-infection, while some individuals seem to recover scot-free of these problems. But what if you’re still suffering? Two years into this pandemic, enough research and data collection has been amassed to validate the phenomenon of Long-haul COVID Syndrome (LCS). We’re talking about symptoms that begin during infection that still remain weeks or months after the infection has cleared.

“Brain fog” is a common complain of long-haulers. What is it? What causes it? Who gets it? Is there any nutritional support available for the individuals suffering from it? Let’s explore these questions.

What neurological symptoms are part of LCS?

While LCS often includes physical symptoms such as persisting shortness of breath/poor stamina, loss of smell or taste, and muscle pain, mental fatigue and brain fog are also common.  “Brain fog” is a term used to describe cognitive problems such as poor concentration, confusion, slower or unclear thinking, forgetfulness, lost words, and mental fatigue.  While these symptoms are common to neurological diseases such as dementia and Alzheimer’s, the good news is that having these symptoms as part of LCS does not necessarily reflect or suggest permanent structural damage to the brain. 

Who Gets LCS-related Brain Fog?

An Iranian study of 2696 patients with long-COVID found that the greatest risk factors for the phenomenon of brain-fog were being female, having respiratory symptoms at the onset of the infection, and admission to ICU with the virus.  However, being elderly is another big factor, suggests a smaller, Argentinian study.  In that study, 234 COVID-recovered seniors found that more than half of them were showing cognitive impairment months later, with one-third of the seniors having “severe, ‘dementia-like’ impairments in memory attention and executive function—a much higher proportion than the 5%-8% of seniors in the general population who have dementia at a given time.” (Duong, 2021)

Meanwhile, in a British study that analysed electronic data from 236 379 patients diagnosed with COVID-19, incidence of a neurological or psychiatric diagnosis within 6 months of the infection was highest in patients who had more severe infection (i.e. admitted to ICU). 

Why Does it Happen?

Several theories about why brain fog and its associated symptoms develop in COVID patients and long-haulers are being investigated further.  One of the most popular among researchers is that COVID-19 infection triggers a cascade of inflammatory responses that are injurious to brain cells.  Specifically, the virus seems to infect astrocytes more than other types of brain cells. Astrocytes supply nutrients to neurons, among other tasks, and both cell types are important for a myriad of brain functions. So, if they are injured, this could explain some of the neurological symptoms associated with the virus.

Another theory about why COVID-19 causes brain fog relates to auto-immunity. That is, in some individuals, the immune system’s over-zealous response to a virus generates antibodies not only against the virus, but also against certain body tissues like the brain. Researches think this is more likely to happen in those with a ‘leaky’ blood-brain barrier---where this selectively permeable membrane that allows certain substances through to the brain and denies access to others has become dysfunctional. However, research still needs to be carried out to find out if auto-immunity is a cause or consequence of COVID infection.

Finally, a third theory about brain fog and COVID-19 is that the virus decreases blood flow to neurons of the brain, which deprives them of essential nutrients and oxygen, causing brain cell death.  Specifically, it damages receptors on cells called pericytes--which are found on the inside of blood vessels—with the net result being vasoconstriction of the blood vessel. The resulting lack of blood flow to the neurons and their eventual death is then thought to be the process that disrupts overall cognition in COVID-infected patients that can take time to recover from.

Nutritional Support for those with Brain Fog

During any infection, the immune system has higher demands for nutrients such as zinc, vitamin C, vitamin D and iron, leaving us with depleted levels post-infection. These must be corrected as quickly as possible in order to lower incidence of subsequent infections and other problems related to nutritional deficiencies. Achieving immune-system nutrient top-ups should include a diet rich in fruit, vegetables, complex carbohydrates, protein and healthy fats while devoid of sugars and fried foods. The traditional Mediterranean Diet is an anti-inflammatory diet based on such a diet that has been used clinically to reduce histamine and other inflammatory chemicals involved in host of chronic health problems, resulting in improvements for many.  However, supplementation should be considered for some nutrients, especially the ones not found directly in foods that depend on many physiological factors to be working optimally.

For example, NADH is a nutrient made in the body from vitamin B-3 and is important for not just the brain’s energy supply, but also its cognitive functions. Levels of NADH decline with age, and the aged have been found to have more severe outcomes with COVID-19. It is also interesting that NADH levels are lower in adults with diabetes, hypertension and obesity—the very co-morbidities that COVID-19 found in those injured and killed by complications of the virus more often.

NADH has already been studied globally for its potential in Parkinson’s and Alzheimer’s, with which many LCS neurological symptoms are shared.  Since NADH has also shown promise in the treatment of Lyme-disease-associated Chronic Fatigue Syndrome (CFS), and Lyme has known neurological consequences, it may be helpful in managing persistent mental fatigue from LCS as well. In fact, any individual who is concerned about neurodegenerative diseases or cognitive impairment may benefit from NADH supplementation.

CoEnzyme Q10 and its biologically active form, ubiquinol work with NADH in the heart and brain tissues to produce cellular energy.  Since chronic physical and mental fatigue are so common with long-haul COVID syndrome, it makes sense to support energy production in this way. In addition, ubiquinol is also an antioxidant, so helps protect against the excessive oxidative damage that occurs in inflammatory processes.

No Over-stimulation; Just Energy

Note that utilizing supplementary ubiquinol/coenzyme Q10 and NADH does not have the stimulating effects that other energy-boosters have. Unlike caffeine and nicotine (non-nutrients) and various herbals, these nutrients are not stimulating to the nervous system. Instead, they support energy produced at the cellular level by supplying the building blocks for the process.

While much research remains to be done on the subject of neurological effects of COVID-infection and long-haul syndrome, knowing your risk factors and supporting your nutritional status provide a sensible start to overcoming these challenges.

References

Andrews MG, Mukhtar T, Eze UC, et al. Tropism of SARS-CoV-2 for Developing Human Cortical Astrocytes. Preprint. bioRxiv. 2021;2021.01.17.427024. Published 2021 Jan 18.

Asadi-Pooya AA, Akbari A, Emami A, et al. Long COVID syndrome-associated brain fog [published online ahead of print, 2021 Oct 21]. J Med Virol. 2021;10.

Duong, Diana. “Even mild COVID-19 may have long-term brain impacts.” Canadian Medical Association Journal, August 30, 2021: 193 (34) E1360-E1361. Accessed online January 10^th 2022.

Ling V, Zabetakis I. The Role of an Anti-Inflammatory Diet in Conjunction to COVID-19. Diseases. 2021;9(4):76. Published 2021 Oct 29.

Marshall, Michael. “COVID and the brain: researchers zero in on how damage occurs.” Nature: News, July 7^th 2021. Accessed online January 10^th 2022.

Miller R, Wentzel AR, Richards GA. COVID-19: NAD⁺ deficiency may predispose the aged, obese and type2 diabetics to mortality through its effect on SIRT1 activity. Med Hypotheses. 2020;144:110044.

Mayo Clinic. “COVID-19 (coronavirus): Long-term effects.” Accessed online January 10^th 2022.

Nicolson GL, Settineri R, Ellithorpe R. Lipid replacement therapy with a glycophospholipid formulation with NADH and CoQ10 significantly reduces fatigue in intractable chronic fatiguing illnesses and chronic Lyme disease patients. Int J Clin Med. 2012;3(3):163–170.

Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry. 2021;8(5):416-427.

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