Many who have suffered a moderate to severe infection from seasonal flu’ or COVID-19 complain of chronic fatigue — a debilitating condition that stands in the way of a return to vibrant health. Fatigue and exhaustion are the primary symptoms, but there are many more. Those suffering from Post Viral Fatigue Syndrome (PVCFS) present a picture of ‘something retained’ after the crisis subsides . It would appear that the virus has left its imprint. When associated with Covid-19, this condition is now referred to as Long Covid. For clarity, I will include Long Covid within Post Viral Chronic Fatigue Syndrome (PVCFS). Many medics who formerly dismissed chronic fatigue syndrome as ‘all in the mind’, have had to think again in the face of Long Covid.
On December 3rd 2020, I attended an international Zoom seminar on Long Covid conducted by two medical professionals. The stark facts are grim and underscores the old adage: ‘an ounce of prevention is better than a ton of cure’! If we succumb to a common cold or a bout of ‘flu, how we manage it makes all the difference and can prevent long-lasting symptoms including PVCFS. All evidence points to PVCFS arising as a sequel to a serious bout of the ‘flu or Covid-19. A mild infection will not lead to PVCFS. Also, and of great importance is the observation that PVCFS can develop by being careless when symptoms of an infection show up. By ‘carrying on as usual’ what could have been a small inconvenience, can morph into PVCFS.
The common cold (a corona virus!) is an acute phase of toxic release and should be seen as such and not suppressed. Influenza, however, is a rapidly prostrating illness and must be managed by bed rest. Working through a serious virus is not an option and can have long-lasting consequences including PVCFS and worse. We are starkly reminded of the findings of Dr D.A. Richardson, physician in attendance to the indigenous people in their pueblos at Albuquerque during the 1918 Spanish ‘flu pandemic: “Those who remain prostrate in bed and eat only a liquid diet, mostly recover, but those who get dressed and eat solid food, mostly die”.
According to the U.S. Department of Health & Human Services in a 2019 posting: “The majority of deaths during the influenza pandemic of 1918-1919 were not caused by the influenza virus acting alone, report researchers from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Instead, most victims succumbed to bacterial pneumonia1 following influenza virus infection. The pneumonia was caused when bacteria that normally inhabit the nose and throat invaded the lungs along a pathway created when the virus destroyed the cells that line the bronchial tubes and lungs.” During the 1918 pandemic, the average age on death was 30, thus cutting short an expected further lifespan of about 45 years. Whereas Covid-19 average age at death is 83 years, thus cutting short just a few useful years by contrast.
Unfortunately, we have forgotten the bygone adage: ‘feed a cold and you will get a fever’ – and have replaced it by the erroneous modern distortion: ‘feed a cold and starve a fever’. In times gone by, fasting was acknowledged and seen as part of healing, but in line with corruption in the food chain, including the ‘deliciousness factor’ — an achievement of food chemists — we eat, eat and eat until we are stuffed and on the road to obesity. Obesity is a condition of inflammation causing lowered immunity. Fasting is a relic for most people. However, in recent times, many health professionals now see fasting, and specifically a ‘fasting-mimicking diet’ as a powerful technique to tackle obesity and improve general health.
The common cold and especially ‘flu rapidly depletes vital reserves of Vitamins C and D, so these should be supplemented from the outset. It has been found that a virus depletes vitamin C to ‘scurvy’ levels! Fever management is important but since this should be individually instructed, little more will be said other to refer to our ‘Break-Fever Infusion2’ which serves to turn a hot and miserable fever into a relieving and cooling sweat.
Of late, there has been much medical emphasis on the connection between mitochondrial function and chronic fatigue syndrome. (Mitochondria are the cellular powerhouses of our cells). This is a huge subject and one we are only on the threshold of understanding, but this we know, mitochondrial depletion is at the core of chronic fatigue.
Whilst it is impossible to give specific advice on PVCFS — which will need professional help — certain principles can be considered.
To understand what is going on at a deeper level, we need to review a fundamental physiological cycle central to life and health. I refer to the catabolic and anabolic cycles of metabolism. This again is a very complex subject but basically catabolism refers to the breakdown of large molecules into smaller ones whilst anabolism refers to the building up of complex molecules from smaller ones. Broadly, metabolism is about how our cells get energy and removes waste. However — and vital in connecting the dots to PVCFS — we need to visualise metabolism as a biological cycle driven by daylight. Put simply, optimum health derives from natural rhythmicity. Our catabolic cycle starts early in the morning, driven by the rise of cortisol from our adrenal glands. This is a time for energy release and work. By late afternoon the anabolic cycle is rising to prepare us for relaxation and restorative sleep some hours later. The catabolic and anabolic cycles seamlessly ebb and flow and mesh, similar to the tides of the oceans. This was called ‘dualism’ by Emanual Revci, MD1. Revici was a remarkable doctor who passed away just a few years ago, working till he was over 100 in New York, USA. He attributed serious disease to an imbalance between catabolism and anabolism.
In my opinion, the ‘retention factor’ in post PVCFS relates to anabolic imbalance. To assure good health, the catabolic flow should not be impeded by anabolic activities and vice versa. For example a hot bath in the morning is ‘anabolic’ and proviral, whereas a warm shower is fine as it is catabolic and stimulating. Oppositely, a short warm bath in the evening aids anabolism and encourages sleep. I well remember a young woman consulting with me many years ago suffering continuous flu-like symptoms. Once she stopped taking a morning hot bath she completely recovered.
By all means, be sure to maintain a robust defence by ensuring supplementation with Vitamins C and D and Zinc plus a good quality Echinacea and/or Elderberry elixir. As valuable as these supplements are in supporting immunity, they should be used within a lifestyle framework of good nutrition, adequate relaxation and restorative sleep, moderate exercise and avoidance of emotional strife. And an essential abstinence from food at the onset of a cold or ‘flu with the caveat that diabetics will be mindful of their condition.
So let’s take a look at the subject of convalescence. In days long gone, there were convalescence homes throughout the U.K. where patients were enabled to recover in peace from a wide range of illnesses. They have all gone. A few years ago, I was discharged from hospital at 9 at night after a hernia operation under general anaesthetic. I became seriously debilitated and ill at home for over a week needing nursing care from my daughter. Some 30 years ago a friend, after a similar procedure, received nursing care for a week in a local hospital dedicated to convalescence. Basics don’t change!
So what might be a naturopathic approach to post-viral chronic fatigue? Primarily convalescence. One must then get in phase with the catabolic/anabolic cycle. After the acute phase is over, one should arise from bed at the same time as when previously well and not go back to bed during the day unless essential (an anabolic regression). Cat naps of about 20 minutes are valuable as long as they are not taken in bed. Eating only when hungry and making sure to eat during a time slot of no more than 8 hours — lesser the better. Stimulating foods (even garlic!), and hot spices should be avoided during the early stage of chronic fatigue. Green, lapsang or oolong teas are acceptable whereas coffee and strong black tea is not advised.
This is not the time to take multivitamins as a sort of scattergun solution — unless advised by a practitioner. On the other hand, herbal medicines can make all the difference. The reason for this is that well chosen herbal remedies can act to cleanse, detoxify and revitalise. A consultation with a professional medical herbalist provides the best option. Failing this, my first choice is a heroic infusion of dried dandelion leaf for the following reasons: dandelion leaf opposes the anabolic feature of chronic fatigue. It is a depurative — acting to cleanse the body of impurities — by stimulating the liver and kidneys whilst providing a gentle laxative action. Even more, dandelion aids digestion and is a potent anti-viral agent. Here is a suggested adult preparation. Add about 30g dried herb to a large carafe and fill with boiling water. Allow to cool, strain and drink over the day making sure to start early in the morning. Frugal eating will add efficacy. The dandelion cleanse may be repeated every other day for a total of three infusions. My second choice of herb is Astragalus root, a tonic herb in the Chinese tradition. Whilst this is best prescribed professionally, as long as precautionary care is taken, astragalus is safe and enjoys a long tradition of use. Moderate interaction may occur when taking the following pharmaceutical drugs: immune system suppressants and lithium. There is no research on the use of astragalus during pregnancy or breastfeeding but caution is the best option. My first choice is a liquid extract of astragalus as it is most bioavailable in this form and can be tailored down as symptoms lessen. A extract of the leaves of Sweet Chestnut (Castanea sativa) has been shown to act against bacterial infections of the lungs and is therefore valuable. The Ayurvedic herb Tulsi or Holy Basil (Ocimum sanctum) also acts favourably on the lungs and Tulsi is available as an infusion blended with spices to provide a pleasant and therapeutic tea. To conclude: we have an awesome immune system so by all means support it by a healthy lifestyle. If and when immunity is breached, listen to your body. A sore throat surely wants relief from food. A sore head needs respite from TV and cell phones. A rising temperature demands bed rest. A chest infection warrants medical attention. These are timeless observations and can prevent the development of chronic fatigue.
- Emanuel Revici, MD. Research in Physiopathology As Basis of Guided Chemotherapy (self published)
Article by Brian Lamb Medical Herbalist
Image: Ivan Gorokhov. At the Bedside of a Convalescent. 1886