Reference: article by nutritionist Dr Danielle Crida MBChB, Dip Nutr.
Covid-19 differs from ‘ordinary influenza’ in that the fatigue is more likely to be accompanied by other distressing symptoms such as ‘brain fog’, a term used to describe a feeling that one just isn’t ‘oneself’ in terms of clear thinking, memory and focus. Long-term effects can be Chronic Fatigue Syndrome, as experienced in cases of Epstein-Barr infection (Glandular Fever).
Chronic fatigue syndrome (CFS)
CFS is a long-term illness characterised by extreme fatigue for at least 6 months, that doesn’t resolve with rest. It’s often accompanied by other symptoms such as muscle aches, headaches, difficulty thinking, remembering or concentrating, dizziness and insomnia. Symptoms vary from day to day and most sufferers find that over-exerting themselves makes them feel worse for a day or more afterwards. There are many possible triggers for CFS, such as viral & bacterial infections, emotional trauma, hormonal or immune system imbalance and mitochondrial dysfunction. Long-term Covid fatigue and other symptoms are very similar to those of CFS, and we may see many new cases of chronic fatigue being linked to coronavirus in the future. However, as one needs to be affected for half a year or more to entertain this diagnosis, it’s really too early to establish a trend.
There has been significant research into the cause of Chronic fatigue – factors that may cause mitochondria, the tiny energy-generating organelles present in each cell, to malfunction. What’s good for mitochondria is often also good for the brain and muscles; therefore, focusing on supporting mitochondria may benefit multiple symptoms of the post-viral syndrome.
Mitochondria are membrane-bound cell organelles that generate most of the chemical energy needed to power the cell’s biochemical reactions.
Energy production by the mitochondria inevitably generates ‘free radicals’ which can damage cell membranes. This is compensated for by antioxidants in our diet. ‘Oxidative stress’ occurs when the antioxidant system becomes overwhelmed.
Viruses are able to ‘hijack’ mitochondria and disrupt the function & communication of mitochondria, to the virus’s advantage. Just as one can develop increased gut permeability, so-called ‘leaky gut’, so too can nutrient deficiencies cause the ‘pores’ in the mitochondrial membrane to become leaky, leading to inefficient energy production and distribution to the cell, and ultimately to mitochondrial and cell death.
What nutrients do mitochondria need to generate energy?
Coenzyme Q10: the master antioxidant protecting mitochondria from damage. When CoQ10 is lacking (such as in those taking statin medication), less energy is produced, causing tiredness, and oxidative stress in the cells.
Resveratrol, selenium and vitamins A, C and E assist as antioxidants.
Glutathione (made from the amino acids cysteine, glutamine & glycine) ensure energy production by keeping the mitochondrial membrane intact and protected from oxidative damage, as well as playing a vital role in detoxification.
Most of the B vitamins are crucial too – B1, 2 &3 assist enzymes in several steps of energy production; B6 & 12 are essential for turning homocysteine into glutathione.
Magnesium – Magnesium deficiency results in the mitochondria not being able to pump ATP (energy source) out into the cell for energy use.
Alpha-Lipoic Acid & l-carnitine: carnitine carries fats into the mitochondria to be burned for energy, while alpha-lipoic acid assists in energy production and as an antioxidant. Used together, these nutrients increase ATP production. L-carnitine is found in significant amounts in red meat, while α-Lipoic Acid is present in small amounts in organ & red meat, spinach, broccoli, sweet potatoes, tomatoes and Brussels sprouts.
How to keep your mitochondria healthy
Mitochondria are vulnerable to nutrient deficiencies, toxins and oxidative damage. Eating a balanced, nutrient-dense wholefood diet provides a steady supply of vitamins, minerals and fuel for mitochondria to perform the vital task of converting food into cellular energy. Brightly coloured vegetables & fruit contain an array of different antioxidants that protect mitochondria from oxidative stress and decrease inflammation in the body, so aim to ‘eat a rainbow’ every day.
Minerals can be found in legumes, nuts & seeds and animal products. Organ meats, one of the most nutrient-dense foods, are a rich source of micronutrients and coenzyme Q10. Ensure you’re getting enough protein to support production of glutathione, especially if you’re following a vegan or vegetarian diet. Cysteine, which can boost glutathione, is found in poultry, sunflower seeds and legumes. Most of us lack magnesium, which is further depleted during times of stress. Rich sources of this mineral are dark leafy greens, nuts and wholegrains.
Resveratrol can be enjoyed in grapes, blueberries, peanuts and cocoa (and red wine, although alcohol is toxic to mitochondria). A couple of Brazil nuts a day satisfy your selenium needs.
To minimise mitochondrial damage by environmental toxins, substitute conventional beauty and cleaning products for natural alternatives, and avoid polluted air and cigarette smoke. Support detoxification with plenty of cruciferous vegetables such as broccoli and kale, and sulphur-rich foods such as onions, garlic and eggs.
Strategies to cope with tiredness
It’s important not to over-exert yourself physically or mentally. Each day, decide what tasks are the most important to achieve, even if only preparing food and basic hygiene, and don’t feel like a failure if nothing else gets done. Even watching TV and spending time on your phone can be mentally taxing, so take frequent breaks for relaxing ‘screen-free’ activities such as listening to calming music, gentle breathing and meditation or just sitting quietly outside.
Be reassured that the fatigue is not ‘in your head’ and that most cases improve with time. Let family and friends know what you’re experiencing so that they are better able to support you. If you can get help with some of the more mundane tasks such as shopping and cooking, you may be able to plan an activity or two that you enjoy, to keep a bit of joy in your life.
Night-time insomnia can be helped by avoiding caffeinated drinks and long daytime naps.
If you have a job, when you feel ready to restart work negotiate a gradual return, working only a couple of hours per day at first.
Be kind to your health by supplying your body with wholesome nutrition and be realistic about how much you can take on each day as you gradually return to health.
Key reference: Igennus Healthcare Nutrition Sep 2020