Long Covid Prevention During Covid infection

General Immunity Good to Take:

Vitamin C

Opti-Zinc

Curcumin

Fire Cider

LONG COVID PREVENTION SPECIFIC THINGS TO TAKE:

In no specific order - pulled from Sep 2024 updated version of: https://pharmd.substack.com/p/i-have-covid-what-should-my-kids

(Written by a pharmacist who specializes in Long Covid Prevention and has been thoroughly reviewing the latest research on promising treatments. Note, I leave out one of her top 5 recommendations here - Paxlovid - because I don’t have personal experience with it and she seemed on the fence about its benefits for younger people and especially AFAB folks, and it might have drug interactions with some of these other recommendations. But I’ve also heard great things about it elsewhere so definitely still look into it!) But here is a very abbreviated recap of her Top 5 Recommendations:

1. Nattokinase:

What it does: Prevents microclots common to Long Covid by reducing pro-clotting factors, and degrades fibrin which drives inflammation and neuropathology of Covid. Many Long Covid patients have elevated pro-clotting factors in their blood for months and months after infection! Nattokinase is great at reducing them and keeping a person at healthy levels.

Dosing for Adults: For preventive measures during acute COVID, nattokinase doses ranging from 2000 to 5000 FU twice daily may be sufficient, but based on my Long COVID surveys and the aforementioned Nature study uncovering fibrin’s pathology in COVID, I suspect that minimum doses of 4000 FU twice daily may be warranted. Dose adjustments may be advised depending on the individual's medical history, risk factors, and other medications. Enteric coating contributes to better absorption and fibrinolytic efficacy.

Where to Get/Cost Effective Brand:Doctor's Best 2000FUs or Solaray (1250 FUs but enteric coated)

2. EGCG:

What it does: EGCG inhibits SARS2 replication via inhibition of M-protease—the same enzyme target as Paxlovid—and even more potently via other mechanisms. May reduce relative activity of M-protease by up to 25%!

Dosing for Adults: Maximum dose 800 mg once daily for 10 days, then decrease to 200-400 mg once daily for 8-12 weeks. TIPS: To improve absorption, drink green tea or take EGCG supplement on an empty stomach along with ≥10 mg of vitamin C. Vitamin C reportedly increases absorption of gallated tea catechins including EGCG “extraordinarily.” You can simply sprinkle a tiny bit of vitamin C powder directly into your water or tea or supplement with <100 mg (~1/4 tsp or 1.25mLs) of liposomal liquid vitamin C. I don’t recommend a higher dose of vitamin C on an empty stomach as it could cause nausea or even vomiting.

Where to Get/Cost Effective Brand: NOW Foods EGCG 400mg

3. Lactoferrin:

What it does: Covid patients treated with lactoferrin showed both clinically & statistically significant improvements over the other two groups, including shorter time to test negative, superior symptom resolution, and reductions in ferritin, D-dimer and IL-6. It is well-established that COVID often leads to reactivation of latent pathogens. As a result, for some, Long COVID may actually involve symptoms caused by these reawakened pathogens. Lactoferrin may exert action against not only SARS-CoV-2 but also many other viruses and bacteria via several routes as noted below.

1. competes with SARS-CoV-2, HSV-1, HPV, and even HIV for cell receptor occupancy — namely HSPGs on cell membranes — thereby blocking viral docking and entrance into cells.
2. prevents iron utilization by many harmful pathogens—including SARS-CoV-2— which need iron for replication/growth
3. promotes innate immunity via natural killer cell recruitment
4. enhances humoral immunity by stimulating B and T cells (so if you’re getting a booster, lactoferrin may provide an added “boost” to the booster!)
5. may diminish cytokine storm
6. improves gut microbiome

Dosing for Adults: Recommended dosing is 500 mg twice daily on an empty stomach for 28 days, then may reduce to 500 mg once daily or 250 mg twice daily for another 8 weeks minimum.

Where to get: Enteric coating is recommended, Gluten Free Remedies Brand

4. Metformin:

What it does: Significantly reduces viral load over the course of 10 days, viral load rebound, and progression to Long COVID. Helps speed up viral clearance, and also shown to have strong relevant anti-inflammatory effects, inhibiting inflammasome activation and reducing inflammation factors especially in the lungs during Covid infection. It is a very safe drug to take that is typically prescribed for Diabetes. Metformin has a low risk of hypoglycemia but does exert significant gastrointestinal side effects, especially diarrhea, nausea, and vomiting. Careful dose titration may reduce these adverse effects. Lactic acidosis is very rare but possible. While metformin may cause vitamin B12 deficiency, it is very unlikely to occur over a short 14-day course. However, one could supplement with B12 if concerned. Discuss metformin with your physician and ask if a standy-by prescription for a 14-day course might be appropriate for you.  

Dosing for Adults: To aid tolerability, the metformin dose was titrated up, starting at 500 mg on day 1, then 500 mg twice daily for 4 days; then 500 mg mornings and 1000 mg evening through 14 days.

Where to get: Need prescription from a doctor for a course of it

5. EPA (This was an honorable mention on her list, but was part of the top 5 a year ago):

What it does: Preclinical data and clinical observations suggest that IPE (concentrated EPA) may have pleiotropic effects including antiviral and anti-inflammatory properties that may prevent or reduce the downstream sequelae and cardiopulmonary consequences of viral [upper respiratory infections].” Anecdotally, one doctor reported to me that none of his ~160 acute COVID patients who took Vascepa (a high-dose brand of IPE) developed Long COVID.

Adult Dosing: Take at least 500 mg to 2 g twice daily with the fattiest meals of the day to increase systemic absorption. Please be advised that in doses above 1 g, risk of atrial fibrillation & flutter slightly increases, especially in those with history of AFib or AFlutter. If you have a history of AFib or AFlutter, avoid use, or speak with your doctor before starting.

Where to Get: Carlson Elite EPA Gems most cost effective brand based on her chart

Putting it all together- LONG COVID PREVENTION REGIMEN:

 at least 4 weeks, preferably 8-12 weeks, except as noted:

>1 hr before breakfast (empty stomach):

1. Lactoferrin 500 mg
2. Nattokinase 2000-4000 FU (4000 FU preferred if tolerated)
3. EGCG capsule - 400mg - take with a lil sprinkle of vitamin C in ur drink for better absorption!

• Not to exceed 800 mg total daily dose including tea
• 800 mg daily studied for treatment duration of 10 days. Since 800 mg is the max doses and liver enzymes could increase with longer administration, recommend dose decrease to 200-400 mg after 10 days.

With breakfast:

1. (if prescribed) Metformin 500 mg (14 days total)

With lunch:

1. EPA gems 1000mg

• Take at lunch or breakfast — whichever meal is fattier.

2. EGCG capsule - 400 mg - take with a lil sprinkle of vitamin C in ur drink for better absorption!
3. Curcumin (try to not take Curcumin at same time as Nattokinase; Curcumin may have drug interactions with Nattokinase but no research yet)

With dinner:

1. EPA 1000mg

• total daily dose not to exceed 4 grams

2. Vitamin C 1000 mg
3. (if prescribed) Metformin 500mg for first 4 days, then up to 1000 mg for final 10 days (14 days total)

≥2 hours after dinner OR 1 hr before bed (whichever is farther from food and/or more convenient):

1. Lactoferrin 500 mg
2. Nattokinase 2000-4000 FU