Q&A with Dr. Galland about the Microbiome and Long Covid

Hello and welcome to the Long Covid Foundation Podcast. This is the channel where we discuss the most relevant information on Long Covid. For those who missed our interview on gut health with Dr. Leo Galland, I would encourage you to watch our previous session from start to finish, as it will help you learn more.

If you're new to the channel, do not forget to subscribe. This can help you get answers relevant to your symptoms. Thank you very much, and let's jump into our Q&A session on gut health.

I would like to go to part two of our interview, where we take questions from our community members who suffer from Long Covid and are at different stages of recovery. The majority of people still have lingering symptoms for more than a year.

Dr. Galland, we would really love for you to share your expertise with those who are still struggling. It has been a great pleasure to inform our audience that we would be hosting this interview with you on gut health, and we received a huge influx of questions. Due to time constraints, I will cover the most common ones, as I believe you've already addressed many aspects in your presentation.

One of the most common questions is about balancing fermented foods that are beneficial for the gut but may trigger histamine intolerance. You've partially covered this, but is there anything you'd like to add?

Dr. Galland: If there is a definite histamine intolerance, there are supplements that can help control histamine and mast cells. Quercetin is probably at the top of the list. Another helpful compound is PEA (palmitoylethanolamide). There are also peptides, such as BPC-157, which has been very helpful.

Some people also benefit from taking antihistaminic drugs. In fact, there was a study where people with Long Covid were given a combination of a regular antihistamine (typically used for allergies) and famotidine (an H2 antihistamine used for heartburn). After a month, there were significant changes in the function of T lymphocytes, which were associated with improvements in symptoms like fatigue. So those are all possible ways to address histamine and mast cell issues.

Thank you so much. Another question we received was: is having a high level of Akkermansia a good thing or not?

Dr. Galland: Akkermansia is a very interesting organism and possibly a keystone species. However, no one has really demonstrated any Akkermansia disturbances or issues in Covid-19. Akkermansia seems to be protective in certain conditions, but there have been concerns about its role in others.

For example, in multiple sclerosis (MS), there is concern that Akkermansia may be too immune-stimulating and could potentially aggravate the disease. Similarly, in Parkinson’s disease, higher levels of Akkermansia have been associated with a worse prognosis. So when I consider whether to boost or inhibit Akkermansia, I base it on the individual's condition.

How do you reduce Desulfovibrio?

Dr. Galland: Desulfovibrio is a type of bacteria that metabolizes sulfur. Sulfur is present in many foods, particularly in protein sources. There are also supplements that contain sulfur, such as N-acetylcysteine (NAC) and glutathione.

Certain bacteria, including Desulfovibrio, reduce sulfur by adding hydrogen to it. This creates hydrogen sulfide gas, which has a rotten egg smell. At certain levels, hydrogen sulfide can be protective and anti-inflammatory. It may even be beneficial for neurodegenerative diseases like Parkinson’s. However, at higher levels, it can increase inflammation, slow gut motility, and potentially increase cancer risk.

To inhibit Desulfovibrio and the production of hydrogen sulfide, I recommend peppermint, which is both palatable and widely available. Peppermint capsules and peppermint tea (brewed strongly for 10 minutes) can be helpful. Another effective compound is oregano. However, cooking oregano may destroy some of its antibacterial properties.

I also have a specific protocol that includes other specialized teas. If anyone is interested, they can reach out to me for more details.

For those following a low-histamine diet, some people struggle with significant weight loss after Covid and have difficulty gaining it back. Most foods seem to make gut issues worse. Do you have any advice?

Dr. Galland: If someone is struggling to gain weight while dealing with multiple food intolerances, I recommend looking at the gut microbiome through stool tests. It’s also important to check for small intestinal permeability and nutrient absorption.

You don’t cure histamine intolerance with a diet—you can only control the symptoms. However, in order to truly resolve histamine intolerance, you need good nutrition. This can be a challenge if you have difficulty finding the right foods.

I would also recommend looking at adrenal function, as the adrenal glands play an important role in suppressing inflammation when they function properly.

What are your thoughts on FMT (Fecal Microbiota Transplants) for Long Covid?

Dr. Galland: I have recommended FMTs to many patients over the years. However, I have not seen any data on FMT in the context of Covid-19.

There are two key components to an FMT: the preparation phase, where you attempt to wipe out or alter the existing bacteria in the gut, and the donor selection process. The donor is extremely important—probably the most crucial factor in a successful FMT.

FMT procedures largely came to a halt during the pandemic, and I am not sure if they are widely available again.

What type of elimination diet would be most beneficial after Covid? There are many different elimination diets, so it’s difficult to determine which would be best.

Dr. Galland: You don’t necessarily need an allergy elimination diet. However, I do strongly recommend eliminating alcohol, sugar, and highly processed foods. This is something I would suggest for almost everyone, but it’s especially important after Covid because of its impact on gut health.

The best approach is to cut out foods with artificial ingredients, added sugar, and processed fats. Try to eat as many whole foods as possible, with plenty of vegetables and healthy fruits.

If you find that eating a whole-food diet upsets your stomach or worsens your symptoms, then you will likely need a personalized evaluation to determine the best dietary approach.

Which fruits and vegetables are okay to buy if they are not organic? Is there a preference for thick-skinned produce like oranges, bananas, and watermelon, or does it not make a difference?

Dr. Galland: If you can peel the fruit or vegetable, you will remove most of the pesticide residues. Thick-skinned produce, such as bananas, oranges, and watermelon, tend to have lower pesticide contamination compared to thin-skinned produce.

Thank you very much for this interview. It has been amazing to have you share this knowledge with us. I’m sure our listeners will appreciate this information and share it among practitioners, as our goal is to educate both Long Covid sufferers and healthcare professionals.

Dr. Galland: Thank you for giving me the opportunity to share this information. It’s always a pleasure speaking with you.