The Long Covid nutritional protocol developed by the 10-member practitioner working group under the aegis of OvationLab and ANDHealth, is divided into two parts—Foundational Supplements aimed at improving overall health, and Specialty Supplements focused on the five main drivers of Long Covid: ACE2-mediated tissue damage; viral persistence; chronic inflammation; mitochondrial dysfunction; and microbiome/dysbiosis.

The working group is continually re-evaluating and refining the protocol and dosing schedule.

The Foundational Supplement protocol includes:

• MitoCore (Ortho Molecular Products): a comprehensive multivitamin that also contains N-acetyl cysteine (NAC), Glucoraphanin, Alpha lipoic acid (ALA), Resveratrol, Epigallocatechin gallate (EGCG), Acetyl L-carnitine, Manganese, and Zinc. The working group recommends 2 caps, twice daily for 90 days.
• OmegaGenics (Metagenics), a concentrated Omega-3 product containing 710 mg EPA and 290 mg DHA; 1,000 mg twice daily for 90 days.
• Magnesium Glycinate, 200 mg twice daily for 90 days
• Co-Enzyme Q10, 200 mg per day, for 90 days
• Quercetin, 500 mg, twice daily for 90 days
• Vitamin K2 with D3: Up to 10,000 IU daily, with specific dosing based on each patient’s serum levels. If the serum level is below 40 ng/ml, use 10,000 IU. If it’s within 40-60 ng/ml, use 5,000IU. If above 60 ng/ml, the patient does not need supplementation. 

The Specialty Supplement protocol consists of:

Arterosil (Calroy Health Sciences): The main constituent in Arterosil is Rhamnan sulfate, a sulfated polysaccharide from two types of marine algae (Monostroma Latissium and Monostroma Nitidum). Rhamnan sulfate has a similar structure to glycosaminoglycans found in the human endothelial glycocalyx—the thin gel-like layer that coats the luminal surfaces of healthy blood vessels. Glycocalyx damage is one of the earliest steps in the pathogenesis of cardiovascular disease, and it is a common consequence of Covid.

“In order to have any hope of repairing tissue damage, we need optimized blood flow and optimized vessel health. Arterosil targets the regeneration and repair of the endothelial glycocalyx,” said Kristine Burke, MD, a co-chair of the PVRP Working Group, during a webinar outlining the protocols.

ITIS (Return Healthy): This product is a complex of anti-inflammatory herbs, including Skullcap (Scutellaria baicalensis), Curcumin (Curcuma longa), Frankincense (Boswellia serrata) and others. Dr. Burke noted that Scutellaria produces a compound called Baikalin that is able to cross the blood-brain barrier, making the product useful for mitigating the cognitive impairment, mood disturbances, and “brain fog” that many Long Covid patients experience. That’s in addition to the product’s capacity to reduce systemic inflammation, one of the main drivers of the post-viral syndrome.

Tollovid (Todos Medical):  This unique substance is derived from an herb called Lithospermum erthythrorhizon, known colloquially in English as Gromwell root, or Zicao in Traditional Chinese Medicine.

“Tollovid addresses persistent viral infections by blocking viral replication capacity,” explained Dr. Burke.  

It does this by binding tightly to the 3CL protease, an enzyme that coronaviruses use to cleave the long polypeptide chains produced from their mRNA during the replication process. Tollovid is among a number of 3CL inhibitors being explored in the Covid context. Essentially, it shuts down the replication process.

MegaSporeBiotic (Microbiome Labs): This probiotic product delivers spores from five strains of Bacillus subtilis. PVRP Working Group members believe it is ideally suited to address the marked microbiome alterations associated with Covid and sometimes, Covid vaccination. “We want to recondition the gut and bring back a healthier microbiome, especially facilitating the resurgence of those species that are important in immune regulation,” Burke said.

Rather than “seeding” the gut with exogenous probiotic organisms, the goal of treatment with a spore-based product like this is to shift the microbial ecology so that it favors growth and flourishing of a patient’s own endogenous bacterial species.

MegaPre (Microbiome Labs): A prebiotic product containing three different types of non-digestible oligosaccharides derived from kiwi fruit, nonGMO corn cobs, and rBST-free cow’s milk. Supplementation with this combination increases GI microbial diversity and selectively feeds beneficial organisms like Akkermansia muciniphilia, Faecalibacterium prauznitzii, and various species of Bifidbacteria which, Dr. Burke noted, are often decimated by SARS-CoV-2 infection.

“We found ourselves needing a curated suite of nutritional product solutions that were targeted at the five main drivers of Long Covid: ACE2 mediated damage/tissue damage; viral persistence; chronic inflammation; mitochondrial dysfunction; and microbiome/dysbiosis.”

–Kristine Burke, MD

For the first 30 days, in addition to the full array of Foundational supplements, patients should take: Arterosil, 2 caps twice daily; ITIS, 2 caps thrice daily; Tollovid 3 caps 4 times per day; and MegaSpore alone (the prebiotic is added later), 1 cap daily for the first 7 days, and then 2 caps daily until the bottle is finished.

From Day 30 to Day 90, patients can cut the doses to: Arterosil 1 cap twice daily; and Tollovid 1 cap twice daily for 30 days. They should eliminate the MegaSpore probiotic, replacing it with the MegaPre oligosaccharide formula, 3 caps per day.

All products in the protocols are available as a bundle from Fullscript. Practitioners with Fullscript accounts can prescribe the complete protocols for patients, and Fullscript will deliver the full product suite to their homes, along with detailed implementation instructions.

Dr. Burke and members of the Working Group stress that the current protocols, though based on a scientific review of hundreds of potential candidate products, are still a work in progress. The team has established a standardized registry to track outcomes in hundreds of patients now on the protocols, and they will use the data to revise the protocols if necessary.

She added that these regimens are flexible. “There may be some patients for whom we want to add some other tools not on the protocol list. You may choose to add or subtract products. But this is the broadest and simplest set of products and processes that we could develop. We’re not promoting specific brands necessarily. But the ones on the list, we found data to support the use of each of them to target one or more of the five key drivers of long Covid.”

Disclosure: ANDHealth and Calroy Health Sciences are clients of OvationLab.