The Long COVID Gastrointestinal Crisis: Symptoms Overlooked and Effective Solutions
Not Just a Respiratory Disease
While COVID-19 is considered a respiratory disease, a common misconception is that it only affects the respiratory system. Cold and flu-like symptoms are often the first signs of an infection, but COVID’s impact can easily become widespread, affecting many other systems in the body like the gut. This is because the enzyme SARS-CoV-2 uses to enter cells is not only expressed in the lungs but in the digestive system, heart, arteries, kidneys and reproductive tract too.¹
Manifestations of Gastrointestinal Long COVID
When COVID affects the gastrointestinal system, it can manifest as a loss of appetite, nausea, vomiting, belching, abdominal pain, and/or diarrhea. These symptoms may occur simultaneously with the typical upper respiratory ones, but they can also be the only signs of an infection. This is why new cases often go unrecognized; many people don’t realize COVID can manifest as simply as a loss of appetite or mimic a stomach bug. But perhaps what is most alarming is that in many people these symptoms linger, and, in some cases, develop into long-COVID.
According to the New England Journal of Medicine,² long COVID is defined as a chronic, post-viral disease that affects one or more organ systems in which symptoms persist for at least three months. Gastrointestinal symptoms are often coupled with other long COVID symptoms such as fatigue, dizziness, shortness of breath, elevated heart rate, problems with concentration, poor memory, difficulty understanding spoken and written language, and trouble planning and making decisions. These often worsen with exertion and can be exacerbated by things like premature return to exercise, lack of sleep, stress, and work and home demands.
What Causes Gastrointestinal Long COVID?
While mechanisms remain to be fully explained, it is thought that incomplete viral clearance, immune dysregulation, chronic inflammation and viral-induced tissue damage in the gut underlie gastrointestinal long COVID.³ When the body isn’t able to adequately fight the virus and swiftly repair the tissue damage it causes, the immune system kicks into overdrive. Inflammation, a natural part of the immune response, becomes chronic and problematic. COVID can also damage the nerve supply to the digestive system, resulting in autonomic dysfunction such as delayed gastric emptying (gastroparesis) and intestinal motility issues.⁴ Overtime, as damage in the GI tract goes unrepaired and the immune, endocrine and nervous systems become dysregulated, there can be serious problems.
Chinese Medicine considers gastrointestinal long COVID to be the result of an unresolved, external pathogenic (viral) invasion, with primary involvement of the Spleen and Stomach (digestive) organ systems. The resulting pathogenic factor (virus) lingers in the body, generating internal accumulations of phlegm-dampness, toxic-heat, damp-heat and/or blood stagnation (inflammation and tissue damage). Cases affecting the Stomach cause counterflow Qi (e.g. belching, nausea and vomiting) and those with Spleen involvement affect the bowels (e.g. diarrhea). Deficiencies of Qi, blood, Yin and/or Yang are also prevalent, reflected in fatigue, exercise intolerance and the inability to heal.
Symptoms of long COVID are a reflection of internal damage and are the body’s cry for help. The body needs help suppressing and clearing the virus, repairing tissues and restoring system-wide balance. Enter Chinese Medicine, the full court press on long COVID.
Treatment of Long COVID with Chinese Herbal Medicine
Herbal medicine is a cornerstone of long COVID treatment. It is an internal problem that, in the vast majority of cases, requires an internal solution. We use classical antiviral Chinese herbal formulas to tackle COVID (ones that have been used to treat viral gastrointestinal infections for thousands of years with great success) in combination with research-backed supplements (e.g. plant-derived supplements like quercetin and curcumin can inhibit viral replication and reduce oxidative stress in the digestive tract).⁵
In addition to antiviral formulas, we use additional herbs and supplements to address specific facets of long COVID. For example, a common manifestation of long COVID is impaired blood flow. COVID can trigger fibrinaloid microclots that can damage blood vessels and reduce oxygen flow to the brain and other tissues (research suggests ongoing cognitive problems in long COVID may be due to these microclots).⁶ In these cases, we would combine an antiviral formula with blood-invigorating herbs with antiplatelet and/or anticoagulant properties to dissolve clots and improve circulation.
Given the complexity of long COVID, herbal treatment often requires multiple steps. For example, in cases of long COVID with nausea and vomiting, there may be significant underlying inflammation of the lining of the stomach (gastritis). In this case, antiviral herbs won’t be assimilated well and they can even cause further irritation. Therefore, treatment must be focused on soothing and heal the stomach lining (marshmallow root is a wonderful herb for this) before stronger antiviral herbs are administered. Commitment and patience are required in order to address each underlying factor.
The Case for Lab Testing in Long COVID
Although common lab tests are not currently reliable for diagnosis of long COVID, they can be a good tool for identifying nutrient deficiencies and potential disease markers that hinder the body’s ability to heal. Deficiencies of certain Vitamins (C, B, D) and minerals (zinc) can cause suboptimal immune function and hinder tissue repair. Risk for blood clots can be assessed with D-dimer and fibrinogen testing. A complete blood count can screen for lowered lymphocytes and immunosuppression. Identifying where the body is struggling and supplementing with the right antioxidant, anti-inflammatory, immune-regulating and tissue-repairing agents can make all the difference in recovery.
Tending to the Physical and Mental Impacts of Long COVID with Acupuncture
Acupuncture is important for treating gastrointestinal long COVID symptoms because it can directly stimulate the nerves that communicate with the digestive system. This makes it particularly helpful for addressing long COVID symptoms like post-viral nausea, vomiting and diarrhea because acupuncture can help regulate and heal the enteric nervous system. It can also encourage healthy blood flow, regulate the immune system, and attenuate inflammation, supporting a body-wide healing response.
In addition to treating physical manifestations of long COVID, acupuncture can be an important avenue of care for supporting mental wellness for long haulers. Being in a prolonged state of illness can have monumental impacts on mental health. Anxiety, depression, sleep disturbances and post-traumatic stress disorder are very common in people who suffer from long COVID.⁷,⁸ Acupuncture can help calm the nervous system, quell anxiety, improve sleep quality and boost feelings of wellbeing. It can offer a safe haven for those struggling to gain mental equilibrium during COVID, reconnecting them to resiliency of both their bodies and minds.
Healing IS possible with long COVID. Contact us to book a free 15 minute phone consultation about how you can support your long COVID recovery with Chinese Medicine and acupuncture.
1. Zhou A. ACE2: Targeting an important receptor in pathogenesis. 2022, December 15
2. Ely EW, Brown LM, Fineberg HV, National Academies of Sciences E, Medicine Committee on Examining the Working Definition for Long C. Long Covid Defined. N Engl J Med. Nov 7 2024;391(18):1746-1753. doi:10.1056/NEJMsb2408466
3. Lineburg KE, Smith C. The Persistence of SARS-CoV-2 and Its Role in Long Covid. NEJM Evid. Sep 2023;2(9):EVIDe2300165. doi:10.1056/EVIDe2300165
4. Elbeltagi R, Al-Beltagi M, Saeed NK, Bediwy AS. COVID-19-induced gastrointestinal autonomic dysfunction: A systematic review. World J Clin Cases. Aug 6 2023;11(22):5252-5272. doi:10.12998/wjcc.v11.i22.5252
5. Matias-Perez D, Antonio-Estrada C, Guerra-Martinez A, Garcia-Melo KS, Hernandez-Bautista E, Garcia-Montalvo IA. Relationship of quercetin intake and oxidative stress in persistent COVID. Front Nutr. 2023;10:1278039. doi:10.3389/fnut.2023.1278039
6. Taquet M, Skorniewska Z, Hampshire A, et al. Acute blood biomarker profiles predict cognitive deficits 6 and 12 months after COVID-19 hospitalization. Nat Med. Oct 2023;29(10):2498-2508. doi:10.1038/s41591-023-02525-y
7. Herring TE, Chopra A, Friedly JL, Bender JA, Gentile NL, Knowles LM. Post traumatic stress and sleep disorders in long COVID: Patient management and treatment. Life Sci. Nov 15 2024;357:123081. doi:10.1016/j.lfs.2024.123081
8. Hossain MM, Das J, Rahman F, et al. Living with "long COVID": A systematic review and meta-synthesis of qualitative evidence. PLoS One. 2023;18(2):e0281884. doi:10.1371/journal.pone.0281884
