We're almost two years into the pandemic, and we've certainly learned a lot about treating COVID-19 and its variants. But there's a new chapter in how the virus is impacting women in particular, and how we're defining long COVID treatment. At Parsley Health , our doctors have seen an increasing number of female patients exhibiting long COVID symptoms. A new study at the University of Michigan* found that among COVID-19 survivors, the rate of long COVID was 49% among women and 37% among men.
While there isn’t enough research yet to determine precisely why being a woman is a risk factor, there are certain health conditions that make people more susceptible to long COVID, says Parsley Health’s Senior Director of Medical Affairs Darcy McConnell, MD : its similarities to autoimmune conditions —which women are also more likely to be diagnosed with—sheds some light. Research has shown women generally have a stronger immune response than men, which may be what makes them more vulnerable to prolonged autoimmune-related symptoms after contracting a virus like COVID-19.
With expertise in successfully treating women with autoimmune conditions such as Hashimoto's disease, Parsley doctors have had a unique perspective on treating their long-haul COVID patients—and have developed a protocol to diagnose and successfully treat it.
“We’re accustomed to treating the whole person and doing deep dives of women’s health concerns to find the underlying cause of their symptoms,” says Dr. McConnell. “Maybe someone was more susceptible to the virus because they had an unhealthy gut microbiome or an imbalanced immune system.”
That whole person approach has been key in helping women with long COVID recover from symptoms that can include fatigue, brain fog, insomnia, anxiety, depression , headaches, as well as worsening thyroid function and flares of existing health conditions. Over the past two years as Parsley doctors have treated an increasing number of women suffering from these symptoms, they have successfully helped their patients recover and feel like themselves again. We’re sharing the most important things our clinicians have learned about treating long COVID:
Long COVID has been particularly tricky to treat—especially since COVID-19 itself is a new and unpredictable virus that the medical community is just beginning to learn about. Taking a holistic approach to treating it means asking questions about your health before you tested positive: “Very likely there’s an underlying reason why one person would develop long covid and another wouldn’t,” says Dr. McConnell. According to the CDC*, chronic health conditions such as heart disease and diabetes can increase your risk for severe illness from COVID-19—which in turn increases the likelihood you will develop long COVID.
Dr. McConnell confirms she has seen in her practice that pre-existing conditions such as metabolic syndrome and autoimmune conditions predispose women in particular to developing long COVID. Also “being run down, having fatigue, high levels of stress and not sleeping well predispose you to any viral infection," Dr. McConnell explains. It’s not yet proven whether long COVID exacerbates or causes chronic disease (or will be determined a chronic disease, itself). But the importance of examining the whole history of your health is essential to ensuring you get the type of treatment you need.
One of the not-so-magic keys to unlocking your health —and making sense of your symptoms—is the results that come out of advanced diagnostic testing. At Parsley, this is part of our standard protocol for patients no matter what they are suffering from: in addition to standard bloodwork , our doctors often prescribe specific biomarker tests to piece together the root causes of their patients’ symptoms.
When it comes to long COVID, the results of this bloodwork and biomarkers are essential to treating it. A recent New York Times article confirms that many of long COVID's symptoms are not explainable using conventional lab tests.
One of the most important tests are your baseline inflammation markers, which typically rise after any virus. Our doctors look at these to understand what your inflammation response was to COVID so they can follow the response your body has to the long-COVID treatment plan. We also do a basic nutritional evaluation because “if you don’t have the appropriate nutrients in your body, your immune cells won’t function optimally,” Dr. McConnell explains. And, of course, a COVID antibody test to gather data around how long ago you had the virus and to look quantitatively at your antibody response.
Our doctors run a series of specialty tests including a chronic viral panel to look for the presence of chronic viral infections or a reactivation of a virus such as Epstein Barr, which has been shown to be associated with long COVID. We also measure autoantibodies to assess for autoimmune disease ... Because your immunity truly lies in your gut lining, we often do a stool test to assess the health of your gut microbiome and to ensure you don’t have a yeast overgrowth or parasites that might disrupt your immune response. And finally, a saliva cortisol test to see how well your adrenals are functioning and assess your stress response, which can put you at a higher risk for developing mental health conditions such as depression or even post-COVID insomnia.
Because the gut is so essential to your immune function—60 to 70 percent of your immune cells reside in the gut lining—Parsley doctors pay special attention to it when treating patients with long COVID:
“Long COVID is likely due to chronic inflammation and immune dysregulation, so it’s important to restore your gut health,” says Parsley Health doctor Julie Taw, MD . That entails addressing the patient’s diet by eating anti-inflammatory foods and cutting out processed ingredients, prescribing certain herbs to eradicate the “bad gut bugs” and probiotics to balance out the “good bugs”. And supporting the gut lining by recommending supplements that contain immunoglobulins, which binds to toxins, and glutamine, an amino acid that helps heal the gut lining.
In addition to restoring your gut health , Parsley clinicians like Dr. Taw focus on supporting patients’ immunity in other ways as they recover from long COVID. From a nutritional standpoint, getting more vitamin D, vitamin C and Zinc is essential, whether through your diet and/or supplements. These nutrients help you fight off future infections and modulate your overall immune system, according to Dr. Taw. This is important when fighting a virus like COVID-19 because it can cause your immune system to become over reactive, she explains.
Our immunity-building protocol also includes lowering overall inflammation by taking supplements such as Curcumin, an anti-inflammatory compound found in turmeric. And integrating more fish oils into a patient’s meals through food and Omega 3 supplements to support brain health, heart health, and lower the inflammatory response from COVID-19.
Brain health is, of course, essential to your overall health and mental well-being . In the case of long COVID, it’s critical to recovery. Parsley doctors start by addressing brain health at a cellular level—literally: The mitochondria, the powerhouse organelle inside your cells that generates energy for your entire body, need to be properly nourished so you can properly function. If they’re not, this can lead to the common symptoms of fatigue and brain fog that long haulers experience. To restore mitochondrial health and mitigate neurological symptoms that also include anxiety and depression, our clinicians will recommend antioxidants such as CoQ10, N-acetyl-cysteine and ALA.
In some cases, Parsley doctors will also prescribe one of two types of neurologic brain retraining, which help rewire the limbic part of your brain where the stress response originates. Long-covid patients are often in a sustained state of fight or flight, especially if they have experienced a bad case of Covid. Both “The Gupta Program” and “DNRS” are programs that help you retrain your thoughts so your stress response isn’t perpetually triggered. They help reactivate your parasympathetic nervous system so your body and mind can heal in a relaxation state, explains Dr. Taw.
In addition to these specific protocols, Parsley doctors and our health coaches help their long Covid patients restore a healthy lifestyle by the functional medicine tenets of improving their diet, getting better sleep, integrating more movement and managing stress through techniques such as meditation.
*These recommendations for long Covid treatment are based on the latest research as of March 2022, and we acknowledge that the science surrounding the coronavirus is constantly changing. If you have had severe Covid symptoms, have had to be hospitalized or put on a ventilator, consult your doctor first. Parsley Health doctors see patients who have had mild to moderate cases of Covid or were asymptomatic.