Understanding Long Covid: A Deep Dive into Causes, Symptoms, and Treatment Strategies

Dr. Leo Galland, a leading expert in functional and integrative medicine, shares his extensive research on Long Covid—a complex condition affecting millions worldwide. He breaks down the physiological mechanisms behind persistent symptoms, highlights the role of gut health and immune dysfunction, and provides science-backed strategies for recovery.

The Root Causes of Long Covid

Dr. Galland presents a visual "spider web" model to explain how various physiological disruptions are interconnected in Long Covid. At the core of this web are two major issues:

1. ACE2 Deficiency

• ACE2 (Angiotensin-Converting Enzyme 2) is the receptor that SARS-CoV-2 uses to enter human cells.

• Beyond viral entry, ACE2 plays a vital role in heart, lung, kidney, gut, immune, and nervous system function.

• Covid-19 reduces ACE2 levels, leading to widespread inflammation, poor circulation, and immune dysfunction.

2. Mitochondrial Dysfunction

• Mitochondria are the powerhouses of cells, responsible for energy production.

• Covid-19 stresses and damages mitochondria, leading to fatigue, brain fog, muscle weakness, and immune dysfunction.

• Mitochondrial dysfunction can persist for months after infection, contributing to ongoing Long Covid symptoms.

Key Pathways That Drive Long Covid Symptoms

Dr. Galland explains that ACE2 deficiency and mitochondrial stress trigger a cascade of secondary problems that sustain Long Covid.

1. Blood Vessel Inflammation & Microclots

• Covid-19 damages blood vessels, leading to:

  • Endothelitis (inflammation of the vascular lining)

  • Microthromboses (tiny blood clots that block oxygen delivery to organs and the brain)

• These factors may explain symptoms like brain fog, dizziness, and chronic fatigue.

• Potential treatments:

  • Aspirin (325 mg/day) to reduce clotting

  • Ginkgo biloba & Dan Shen (Chinese herb) for blood vessel protection

  • Resveratrol (1,200 mg/day) to enhance circulation

2. Mast Cell Activation Syndrome (MCAS)

• Mast cells release histamine and inflammatory chemicals, which can trigger:

  • Flushing, hives, and allergic-like symptoms

  • Dizziness and heart palpitations

  • Worsening brain fog and fatigue

• Natural Mast Cell Stabilizers:

  • Quercetin, Luteolin, and Thymoquinone (from black cumin seed)

  • Antihistamines (H1 and H2 blockers) to reduce inflammation

3. Autoimmune Reactions & T-Cell Dysfunction

• Many Long Covid patients develop autoantibodies, which attack their own cells.

• T-cell exhaustion and dysfunction impair the immune system’s ability to clear lingering viral particles.

• Ways to Restore Immune Balance:

  • Omega-3 fatty acids (3,000 mg/day) to regulate inflammation

  • NAC (N-acetylcysteine) & Alpha Lipoic Acid to support immune cell function

  • Vitamin D (5,000–10,000 IU/day) to enhance immune resilience

4. Viral Persistence & Gut Dysbiosis

• Covid-19 may persist in the body long after the initial infection, especially in the gut, lymph nodes, and tissues.

• Studies have found viral proteins in the intestines of Long Covid patients, even months later.

• Covid-19 also disrupts the gut microbiome, reducing levels of butyrate-producing bacteria that are essential for brain and immune health.

✅ How to Restore Gut Health & Reduce Viral Load

• Increase butyrate production (a postbiotic that reduces inflammation & improves brain function)

  • Eat high-fiber foods (vegetables, legumes, nuts, seeds)

  • Take butyrate supplements or consume fermented foods

• Probiotics & Prebiotics:

  • Lactobacillus plantarum (from fermented vegetables, yogurt) improves gut barrier function

  • Black raspberry extract enhances gut and immune health

• Potential antiviral strategies:

  • L-Carnitine (500–1,000 mg twice daily) to support T-cell function

  • Polyphenols like Resveratrol & Black Raspberry Concentrate

Recommended Supplements & Natural Therapies for Long Covid

Dr. Galland has found several supplements that enhance ACE2 function, support mitochondria, and improve immune balance in Long Covid patients.

SupplementRecommended DoseKey BenefitsVitamin D5,000–10,000 IU/daySupports immune function & ACE2 balanceCurcumin (from Turmeric)1,000 mg/dayReduces inflammation & supports brain functionResveratrol1,200 mg/dayImproves blood vessel health & mitochondrial functionOmega-3 (EPA/DHA)3,000 mg/daySupports brain, heart, & immune healthCoQ10 (Ubiquinol)200–400 mg/dayEnhances mitochondrial energy productionNAC (N-Acetylcysteine)600 mg 2x/dayBoosts glutathione & reduces oxidative stressAlpha Lipoic Acid600 mg/daySupports nerve health & antioxidant functionButyrate (Postbiotic)300–600 mg/dayReduces gut inflammation & supports immune functionL-Carnitine500–1,000 mg 2x/dayBoosts T-cell function & energy productionLactobacillus PlantarumDaily probioticImproves gut health & immune regulation

The Role of Lifestyle in Long Covid Recovery

1. Nutrition & Diet

• High-fiber, polyphenol-rich diets support gut health, reduce inflammation, and improve cognitive function.

• Key Foods:

  • Fermented foods (yogurt, sauerkraut, kimchi) for probiotics

  • Berries, green tea, turmeric for polyphenols

  • Olive oil, walnuts, flaxseeds for healthy fats

2. Exercise (But with Caution!)

• Gentle exercise like swimming and walking can support recovery.

• Overexertion can worsen symptoms—patients should start slowly and gradually increase activity.

3. Sleep & Stress Management

• Quality sleep enhances mitochondrial repair and immune function.

• Breathwork, meditation, and avoiding blue light before bed can improve sleep quality.

Final Takeaways: How to Recover from Long Covid

✅ Support ACE2 function with Vitamin D, Curcumin, and Resveratrol
✅ Enhance mitochondrial health with CoQ10, Omega-3s, and L-Carnitine
✅ Reduce blood clot risk with Aspirin, Ginkgo Biloba, and Dan Shen
✅ Balance the gut microbiome with butyrate, probiotics, and polyphenol-rich foods
✅ Stabilize Mast Cells with Quercetin, Luteolin, and Antihistamines
✅ Reduce viral persistence by supporting T-cell function with NAC, L-Carnitine, and fermented foods

Looking Ahead: The Future of Long Covid Research

• More studies are needed to determine how long viral persistence lasts and the best ways to clear it.

• The gut-brain-immune connection plays a crucial role in Long Covid recovery and should be a key focus of future treatment strategies.

By targeting the root causes of Long Covid—ACE2 deficiency, mitochondrial dysfunction, inflammation, and gut dysbiosis—patients can take proactive steps toward healing and recovery.