Long Covid Doctor: Hormones + Natural Medicines

Dr. Nicole Sundene

Scottsdale Naturopathic Doctor

Long Covid symptoms and other chronic conditions such as West Nile virus, are challenging for both the patient and the doctor. There are currently no miracle cures that exist and Naturopathic Doctors such as myself are left with zero research to support our questions and needs, and thus are literally left to establish our own Long Covid treatments via limited research studies, collaboration with other Naturopaths, and a lot of trial and error. My previous "post viral" protocol was minimal compared to this.

So first and foremost be careful when you are buying things listed as helpful for "Long Covid." Anyone in holistic medicine professing a one sized fits all magical long COVID cure is likely making false promises. As a Doctor that has treated many long COVID patients over the past few years I know that is a fallacy, that my treatments require multiple products and nutritional changes for my patients to improve.

I have also seen it impact my previously healthy patients hormones and cause sudden onset thyroid, adrenal, perimenopausal and menopausal changes.

I also know, that some of my patients will need to remain on the natural supplements and will not be able to go off them without rebound worsening, so I am unaware of anything natural that is completely curative in those with severe long COVID.

I am posting today for my potential long COVID patients to understand what we will be doing if we are working together, and also sharing my over the counter, non prescription containing long COVID protocol below that I will continue to update with new research studies.

Otherwise my protocols are a hybrid of treating many patients over the years with chronic mono or "EBV", chronic Herpes, shingles, hepatitis and HIV. There is very little evidence concluding what is effective so my position as a Naturopathic Doctor is to generally use time tested natural remedies that I trust are safe for the long run and good for reducing inflammation, pain, and improving immune function as I will discuss later in great detail.

My long covid protocols are from the existing evidence based research I have listed below, as well as trial and error. Successful outcomes require a highly compliant patient and/or care team to support my patient. Today I would like to walk you through what I generally do to achieve successful outcomes with my Long Covid patients, as I am constantly asked this question as more and more women are diagnosed with Long covid.

Since this does require some work on the patients end, I hate for anyone to sign up to work with me and not be willing or able to do the detective work we will need to do together that generally requires testing for hormones, nutrition, blood clotting, inflammation, as well as specialty testing with a Neurologist, Cardiologist, Hematologist, or Infectious Disease Doctor to assist me in each patient's individualized diagnosis resulting from an initial symptomatic or asymptomatic Covid infection.

My Goals when treating patients with long Covid as a Doctor are:

1. Reduce inflammation
2. Improve mitochondria function
3. Boost/Balance the Immune System
4. Balance Hormones especially adrenal, thyroid, and female hormones
5. Use blood thinning medications, supplements, or herbs
6. Support and understand my patients individualized needs ie: Neuro, Cardio, Psych, Pain, etc.
7. Reassure my patient they are not going crazy, are not lazy, need to rest and follow their holistic protocol, and allow it proper time to work to ensure a successful outcome.

Recent research found that biopsies of muscles in long COVID patients had blood clots forming in the muscles as well as lack of mitochondria or "fuel" aka "energy" for the cell to be able to properly function.

Think of mitochondria as the battery that makes a child's toy work. It still looks cute, but it does not function properly without it's battery. Many patients with "Chronic Fatigue Syndrome" are suffering from lack of Mitochondrial Support and their cellular batteries are running on empty.

When treating Long Covid we must understand that the symptoms are vast, and the presentation is quite different for many women, although I do commonly see certain patterns and risk factors.

LONG COVID SYMPTOMS: RISK FACTORS

As a Women’s Health Doctor, I was concerned to read the research study concluding that women are much more likely to develop Long Covid symptoms than men! First women must have periods, pap smears, and birth babies, and now bear the brunt of Long Covid! I find this the perfect excuse for women everywhere to never have to go to the grocery store, or run errands again (unless they want to. 😉

Other risk factors for Long Covid include being overweight, old age, diabetes, smoking, and pre-existing chronic disease conditions. Whether or not a patient has been hospitalized and also required oxygen while hospitalized is also a #1 increased risk factor. 

LONG COVID SYMPTOMS

• Chronic Fatigue
• Chronic Pain, Joint Pain, or Headaches
• Impaired Daily Function and Mobility
• Hair Loss
• Anxiety, Paranoia, Panic Attacks
• Depression and Suicidal Ideation
• Anger and Rage
• Brain Fog and Cloudy Thinking
• New or Worsened Seasonal Allergies or Food Allergies
• Chest Pain, Heart Racing with Position Changes or POTS
• Atrial Fibrillation, Palpitations, Tachycardia
• Breast Pain from inflamed Lymph Nodes
• Lab Marker Elevations: Liver Enzymes, Ferritin, CRP, Glucose, A1c, and Insulin
• Autoimmunity or Positive Autoimmune Markers
• Insomnia
• Nightsweats, Fevers, or Chills
• Frequent Cold or Flu Symptoms
• Post-Exertional Fatigue, Feeling Sick after Exercise
• Diabetes, Pre-diabetes, and Insulin Resistance
• Liver Disease or Elevated Liver Enzymes
• Kidney Failure, Decreased Kidney Filtration, or Elevated Creatinine
• Neuropathy, Tingling, Numbness, or Paresthesia
• Diarrhea and Abdominal Pain
• Rash, Hives, and Dermatology Conditions
• Dizziness, Lightheadedness, or Fainting
• Loss of Taste, Smell, or Anosmia
• Abnormal Menstrual cycle, Heavy Bleeding, Spotting, or Lack of Period
• Shortness of Breath, Cough, and Asthma
• Pulmonary Fibrosis and Myocarditis 
• Reactivation of Epstein Barr Virus aka Mono

According to the CDC, a cluster of the above symptoms must persist for longer than four weeks to fit the criteria for Long Covid. Patients generally have a few of the above symptoms and don’t need to have every Long Covid symptom to benefit from treatment. 

WHAT ARE THE MOST COMMON LONG COVID SYMPTOMS? 

After twenty-three years of listening to patients complain about their health, I am now regularly hearing the same type of post covid complaints.  Patients describe to me that they feel “rapidly aged, poisoned, sick with something I cannot shake," or state “I feel nasty, dirty, polluted, and rapidly aged like I am suddenly 100 years old. My brain feels like it's 100 years old.” In addition to feeling “exhausted, moody, struggling to remember tasks, easily overwhelmed,  constantly tired, achy, sore throats that come and go, and in chronic pain.” 

Of greater concern are the patients developing liver and kidney failure due to long covid. I have been taking care of many of the same women for fifteen years and have suddenly seen their kidney and liver function become impaired, as well as elevated ferritin or iron stores as it is an "acute phase reactant" that shows us the patient is inflamed when elevated.

Hair loss is one of the #1 most common symptoms women complain of after Covid, and while hair can grow back, we must preserve kidney and liver function by taking this seriously, taking daily antiviral immune boosting support, and properly addressing Long Covid from an aggressive nutrition and herbal medicine approach.  

From Silver to Singing for covid....I have heard it all, read it all, and am here to confirm what is considered safe and trusted by myself and many colleagues. Many of us have been working with similar protocols and are seeing similar patterns of efficacy.

I also don't want anyone to fall victim to misinformation or scam herbal medicine products. There are many snake oil salesmen in the alternative industry making false claims not backed by research, that are profiteering off expensive sales of products. Please work with your own doctor when treating covid or long covid, and be very skeptical of taking any advice from people that sell supplements and lack research to support their statements.

If the person advising you is not a doctor working in the trenches against covid but just selling supplements....please be concerned about their motives.

While I have read some terrifying misinformation on alternative medicine, I will also confirm that using herbal medicine for Long Covid symptoms will likely be the most successful, and also the least harmful for the patient. Herbal medicine is generally inexpensive and ineffective at the worst-case scenario.

As a doctor working on the front lines, I developed Long Covid in April of 2020. So my recommendations are based on my own experience as an autoimmune patient battling Long Covid for eight LONG months in 2020. From what I know now I should have taken the immune support supplements for a month past my covid infection, but I was not that concerned because my initial symptoms were not that bad. I had a fever, mild cough, chest pain, and fatigue but otherwise I would normally have gone to work feeling like that if it was anything but Covid.

PREVENTING LONG COVID

My patients that I instruct to continue their immune support past their infection are not developing Long Covid. This is also what we do when someone is first exposed to Herpes or HIV. We treat immediately and agressively with antiviral medications and supplements.

This compilation of information is from my own personal experience, as well as reading numerous research studies, and collaborating with other Naturopathic Doctors treating Long Covid symptoms. Keep in mind these treatments are in developmental stages, this is a fluid situation that can change at any moment, and that I expect anyone reading this to work with their own doctor or me, as you should not attempt to self treat your Long Covid.

Print this article, highlight the vitamins, minerals, herbs and diet recommendations and take it to your own doctor to determine if the treatments are safe for you to do. The last thing you should do is self treat your own Long Covid symptoms. I always want patients with chronic disease to have a safe and successful outcome.

LONG COVID SYMPTOMS: COMMON MISCONCEPTIONS

Long Covid symptoms are even more confusing to diagnose and treat due to the plethora of misinformation propogating about the internet. Many patients falsely believe they cannot develop long covid if they are vaccinated, have mild symptoms, or have had no symptoms or no known exposure to covid. While these scenarios are less likely to result in Long Covid, it is not always 100% true.

Generally, my Long Covid patients improve within a few months with treatment, but without proper diagnosis and treatment, Long Covid symptoms can actually continue to progressively worsen. Optomistic patience with Long Covid symptoms is 100% the wrong approach. I am now treating new patients with Long Covid symptoms that progressively have become worse since onset in 2020.

Instead of the covid symptoms going away with time, they have turned into worse fatigue, worse pain, worse brain fog, and overall worse health. It is not until Long Covid patients seek out treatment that we can begin to halt and resolve the symptoms that are otherwise persistent and progressive. Many patients will resolve without treatment, but symptoms like neuropathy, heart, lung, and brain issues should be treated.

I have already tried and failed with many popular treatments in the media. Ivermectin and Plaquenil are essentially useless in my experience treating Long Covid symptoms. And also now confirmed per recent research studies. 

When I first heard of Covid in 2020 I thought, "Well that is going to be a nightmare for doctors in the ER. It is a good thing I don't work for a hospital anymore." At the time I didn't know that Long Covid symptoms could persist. I also didn't know that the Herbal Medicine and Naturopathy I practice is some of the best medicine for Long Covid patients.

Herbal Medicine is inexpensive, anti-inflammatory, relatively harmless, and actually seems to be the most efficaceous approach between all the different antiviral medications herbs, and supplements I have personally tried on myself and my patients. My experience working at Bastyr University clinic on the Ryan White HIV shift taught me a lot about how herbal antivirals can be just as effective if not even more effective than many antiviral medications.

Plants have to constantly upgrade their antiviral mechanisms to survive in nature and therefore we see less antibiotic and antiviral resistance because plants that are not able to upgrade to fight off the latest virus will simply die.

LONG COVID TESTING

Lab Testing for long covid should include Complete Blood Count, Comprehensive Metabolic Panel including glucose and liver enzymes, TSH, Ferritin, EBV Titers, CRP, and if the patient is vaccinated and unsure if they have been exposed to covid: SARS-Cov-2 nucleocapsid. If this test is positive this differentiates antibodies formed by the vaccine vs a natural infection. If a woman has had a change to her menstrual pattern after having covid or a covid vaccine then hormone testing should also be conducted. Women have reported loss of period, abnormal period, painful periods, heavy bleeding and miscarriage after covid infection.

LONG COVID TREATMENT

Do your research and don't trust anyone making false promises about your Long Covid symptoms. If you feel a fraction of as bad as I once did, then you are already frustrated enough, so I will not lie to you or create false promises with my recommendations.

This is a serious disease and patients deserve my brutal honesty.... Nobody knows the best treatment right now. Even if they did it has not been studied by double blind randomized controlled trials and proven effective and safe. These research studies will take time, and Long Hauler's do not have any time to be wasted.

I am not making any promises, and only sharing what I see working with myself and my patients as a doctor that went through Long Covid and has treated many long covid patients as a result of my horrible experience ever since.

I know many people have become unemployed from Long Covid and cannot afford a Naturopathic Doctor, therefore it is important I share everything I know at this time to help other patients struggling with these annoying symptoms. I also want to bring hope to anyone that is suicidally depressed about their health. It is possible to improve. I am better. I have seen many patients get better.

Preferably you work with me or another experienced Long Covid Doctor, but I want this information to be free and available to the public, and for other doctors searching for my protocols.

We need to give your very sick body the right things it needs to heal, remove the obstacles to cure, and identify the reason why you got Long Covid at the ROOT CAUSE to properly restore health. As many of my patients know I have Lupus, an autoimmune disease. Being immunocompromised is the reason I ended up with Long Covid symptoms. It also took my adrenal function and thyroid function down, and required a greater amount of hormone supplementation, therefore testing hormones is imperative for women with Long Covid symptoms.

My General Holistic Treatment Plan for Long Covid (subject to change based on research.)

• Decrease inflammation in the diet. Eat a clean anti-inflammatory diet. Fruit, vegetables that are raw or lightly steamed without dressing. Eat raw nuts (not cashews or peanuts), beans, legumes, and organic chicken, turkey, beef, and low mercury fish.
• Manage co-infections such as chronic bacterial, fungal, and mold overgrowth that naturally happen when the immune system has been taken out by something serious. Testing for chronic sinusitis, digestive pains, and mold exposure are critical for proper recovery. The immune system is often battling something other than COVID and I need to know what it is to get my patient better.
• STOP HERBS that boost cytokines such as astragalus, ashwagandha, echinacea, and certain medicinal mushrooms. "The Cytokine Storm" is why so many patients are still symptomatic and have brain fog. While we want cytokines to fight the initial infection, that has long passed, and it is the continual presence of "The Cytokine Storm" wreaking havoc over the long term causing issues. So the herbs we use to fight the acute phase of Covid are not the same herbs with Long Covid Symptoms. Always worked with a skilled Herbalist or Naturopathic Doctor that knows the difference!
• Increase foods that decrease cytokines such as Green Tea and Mung Beans
• Ask your doctor if you can take rosemary, ginkgo (helps restore sense of smell but is a blood thinner), liposomal glutathione, PQQ, and fish oil for fatigue, brain fog, blood clots, loss of smell,  and shortness of breath. Although I 100% recommend getting an individualized treatment plan. These are the basics I have my Long Covid patients on.
• Use natural or prescription antihistamines daily until resolved. This cannot be skipped! Allergy symptoms tend to worsen after covid and histamine levels can remain high. Testing histamine levels can be done via bloodwork or urine. If you have brain fog, runny nose, anxiety, itching, rash, or frequent urination you have high histamine levels most likely.
• Candida overgrowth, yeast infections, and thrush aka yeast on the tongue are also common after covid because the immune system struggles to keep this simple organism in check. Eating cultured foods and taking probiotics is critical to Long Covid recovery. Some patients will also need herbal antifungals to rid themselves of the yeast.
• Check with your doctor that you can take the following immune boosting vitamins:  25,000 iu of Vitamin A, 2000-5000 iu of Vitamin D, Vitamin C 500mg-1000mg 2-3 times daily, and 30mg of zinc for women, 50mg for men. Vitamin A is especially important as an antiviral, as is zinc.
• Consider getting vaccinated against covid if you have not already. While the LAST THING I want to do is participate in yet another vaccine debate... keep in mind I am generally an antivaxxer doctor that has not had a vaccine in 22 years. I decided to get vaccinated to prevent future hair loss, long covid, and to see if it would help my symptoms. I am VERY happy to report that my own Long Covid symptoms personally improved after getting fully vaccinated. I have also seen this in many of my Long Covid patients as well. I do not recommend getting vaccinated if your antibody levels are >500-1000 as this may not be necessary and may worsen your symptoms and reaction to the vaccine from my personal experience doctoring patients with long covid symptoms, testing antibodies and listening to people's adverse reactions to their jabs. 
• Follow an antiviral diet. It is easy to shift your diet to the “Herpes Diet” which increases lysine-rich foods that help fight the virus, and limits the amino acid arginine which is needed for viral replication. A study giving lysine in animal feed in the meat industry decreased the amount of coronavirus illnesses occuring in the herd, although this research study was for general coronaviruses and not specific to Covid-19.
• Avoid alcohol, sugar, fried foods, pesticides, and food additives.
• Increase foods and supplements I recommend on my Hair Loss blog if needed. 
• Consider a beta-blocker like propranolol or metoprolol for atrial fibrillation. When I was having atrial fibrillation the beta-blocker helped reduce the anxiety I had after having covid. Each time the chest pain, dizziness, left arm numbness, and palpitations began I would have anxiety I was going to black out, have a stroke or heart attack which did not make anything better.
• Get your body temperature up above 99F for 20-60 minutes every day either with a sauna, hot bath, or vigorous exercise (if you can.) If doing saunas do not exceed 20 minutes. The goal is to do this with exercise. When I first had long covid I could not exercise at all due to the atrial fibrillation and POTS symptoms I developed that caused severe dizziness. Instead, I did sweating work as I know the immune system works best at a hotter temperature which is why it creates a fever when we are sick. After several months of sweating work, I was able to do 5 minutes of cardio at a time without feeling dizzy or weak. I am happy to report I am back to my normal 30 minutes of cardio twice daily now. Work with your doctor on a realistic exercise regime. Over-exercising is just as bad for your body as under-exercising. Covid loves a stagnant system. Sitting around or lying around all the time is NOT good for Long Covid. You have to move, you have to push yourself just a little tiny bit out of your comfort zone to get this out of your system. Doing heavy weight training and running helps to move the lymphatics where the virus can continue to linger. 
• Get outside in the sunlight for at least 30 minutes twice a day. Sunlight and fresh air are important for mental health and the immune system. Vitamin D is synthesized from exposure to light as is serotonin. If the Long Covid patient is immobilized consider wheeling them out to sunshine or a sunny window as light is very important to counteract the depression that can occur with Long Covid Symptoms. 
• Ask your doctor if you can take fish oil, B-12 shots, and alpha lipoic acid in high doses for neuropathy.
• Look into receiving immunoglobulin therapy 
• Work with a skilled Naturopathic Doctor to use antiviral herbs, aromatherapy, and supplements. Licorice was found to be beneficial yet has many drug interactions and should not be used by patients with High Blood Pressure. I generally start the antiviral herbs at a low dose then gradually ramp them up and hold them at a high dose for about a month and then slowly ramp them back down. 
• Singing for Covid? I have heard many patients tell me that singing has helped them regain their lung capacity and help with their shortness of breath. This may be since singing stimulates our Vagus nerve which is thought to boost the immune system, tonify the lungs, and lower heart rate. A small study listed below did find that singing improved depression in patients with chronic pulmonary disease. Otherwise, there is limited data to support this, but it is free to do and harmless to try.
• Work with a Holistic Female Hormone specialist if Covid has caused heavy periods (menorrhagia) or lack of periods (amenorrhea.) I am also seeing a lot of premature menopause or Premature ovarian failure. If something is not right down there please see your women's health doc ASAP.
• Otherwise what people with Long Covid need to most impoertantly understand from my free blog is that we need to constantly rotate antiviral herbs around 4-6 weeks because Covid is smart and will figure quickly figure them out and become immune to them, just like when I worked on the Ryan White HIV shift over twenty years ago. CONSTANT Rotation is Critical!!! The natural medications that provide anti-inflammatory benefits and pain relief do not need to be rotated, but the killing agent that is getting the virus out of the intestinal tract, stomach, joints, muscles, fat, and connective tissue where it has been found to harbor and form biofilms will require constant rotation of antivirals. I use both prescription and natural just like treating my chronic Herpes and Shingles patients.

If you or a loved one need an empathetic doctor to help you work through your Long Covid symptoms I would be happy to help. I promise I will not treat you like you are crazy or lazy, because I know firsthand just how frustrating, scary, and hopeless these Long Covid symptoms can feel.  

Rest assured I am feeling much better from my own Long Covid journey and I have more information and better treatment plans along with a better understanding of this condition than in 2020 when I first was challenged with it myself.

I would be happy to walk you through my basic blueprint and antiviral herbs that should help restore your system back to normal over time. Ordering hormone labs and bloodwork is also important to ensure everything is properly balanced.

Often patients ask if I can help them out of state via telemedicine, and the answer is yes. Treating long covid generally does not require me to prescribe any medications, therefore I can easily order lab testing and treat Long Covid patients in all 50 states. Simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit!

Dr. Nicole Sundene

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause,  Thyroid,  Hashimotos,  PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies,  Digestion, Dermatology, Acne, Psoriasis,  Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. 

She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!

REFERENCES: 

1. "Long Covid For Health Care Workers" CDC.gov
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