Long COVID Treatments Webinar Summary
Mar 27
This post summarizes the expert panel discussion from the Long COVID Treatments Webinar. Panelists Dr. David Putrino, Dr. Leo Galland, Dr. Stuart Malcolm and Dr. Jennifer Curtin provided insights—organized by treatment categories and timestamps—covering foundational strategies, targeted approaches for ME/CFS/PEM, mast cell and migraine management, POTS treatments, experimental therapies, and answers to audience questions.
The treatment list presented here is not comprehensive. It reflects the information discussed during the webinar and should not be taken as medical advice. Always consult with a healthcare professional before starting any treatment.
Initial Go-To Treatments for Long COVID
Pacing and Self-Management: Emphasize pacing, identifying triggers, temperature regulation, and good hydration.
Dr. Putrino: Emphasized the importance of pacing, identifying triggers (like temperature), and maintaining proper hydration as foundational approaches.
Dr. Galland: Agreed that self-management is essential and stressed that patients must understand their responses to various stressors, exercise, and food.
Mitochondrial Support: Use supplements such as CoQ10, alpha lipoic acid, NAC, and NAD+ to support mitochondrial function and reduce oxidative stress.
Dr. Putrino: Mentioned CoQ10, alpha lipoic acid, NAC, and NAD+ to bolster mitochondrial function.
Dr. Galland: Seconded CoQ10 and antioxidants like alpha lipoic acid and NAC; he also added that curcumin and resveratrol can be useful for reducing inflammation and supporting brain function.
Dr. Malcolm: Mentioned oxaloacetate—backed by a randomized trial from the Bateman Horn Center—and recommended NAD+ supplements available via intranasal, patch, or injection.
Other First-Line Approaches: Incorporate treatments like nattokinase for microclotting, prioritize sleep optimization, and investigate food sensitivities.
Dr. Malcolm: Suggested nattokinase to address microclotting issues
Dr. Galland: Emphasized the importance of optimizing sleep and assessing food sensitivities as part of first-line management.
ME/CFS and Post-Exertional Malaise (PEM)
Low-Dose Naltrexone: Offers a modest (10–20%) symptom improvement; dosing should be gradual due to medication sensitivities.
Dr. Putrino: Noted that many patients experience modest benefits with low-dose naltrexone but cautioned about medication sensitivities and stressed gradual dosing.
Antivirals: Valtrex can be effective, especially when EBV or other herpes viruses are involved.
Dr. Putrino: Mentioned that some patients respond well to Valtrex, likely due to its effect on EBV or other herpes viruses.
Oxygen Supplementation: Utilizing air compressors, rebreather masks in clinical trials, and home oxygen concentrators.
Dr. Putrino: Discussed using air compressors and rebreather masks in clinical trials, with promising initial results.
Dr. Galland: Mentioned that home oxygen concentrators are also a viable option.
Ischemia-Reperfusion Treatments: Address tissue oxygen deficiency with interventions like oxaloacetate (pre-exercise), chrysin, PQQ (for recovery), hydrogen water, red light therapy, and circulation support (nattokinase, vinpocetine, ginkgo biloba, aspirin, pycnogenol).
Dr. Galland: Explained his theory that PEM involves ischemia-reperfusion injury due to inadequate oxygen supply and recommended these targeted interventions.
Additional PEM Treatments: Use empagliflozin (Jardiance) for reperfusion injury and saffron for sleep and reperfusion support.
Dr. Malcolm: Discussed the use of empagliflozin—which may cause glucose excretion but help with reperfusion injury—and mentioned saffron as beneficial for sleep and reperfusion.
Mast Cell Activation Syndrome (MCAS) & Migraines
MCAS Management: A two-pronged approach—blocking circulating histamine and preventing mast cell degranulation—with attention to hormonal regulation (especially in menstruating patients).
Dr. Putrino: Described the importance of both blocking histamine and preventing mast cell degranulation, noting the influence of estrogen on histamine metabolism.
Dr. Malcolm: Listed treatments including H1 blockers (Cetirizine, Claritin, Allegra), ketotifen, H2 blocker (Pepcid), montelukast, luteolin with PEA (Mirica), diamine oxidase enzyme, amlexanox, statins, prickly pear, and perilla seed extract, and recommended resources like the mast cell 360 website.
Migraine Management: Utilize supplements and medications—CoQ10 (400 mg daily), riboflavin (100–400 mg daily), magnesium (300 mg daily); for mast cell-related issues, quercetin (1500–2000 mg daily), quercetin plus luteolin, and pycnogenol (100–200 mg daily); and consider CGRP antagonists.
Dr. Galland: Noted that migraines may not always present as headaches and recommended these dosages and combinations for migraine and mast cell management.
Dr. Malcolm: Mentioned CGRP antagonists (such as Aimovig, Ajovy, and Emgality) as an option for treating mast cell-related migraine symptoms.
POTS (Postural Orthostatic Tachycardia Syndrome)
First-Line POTS Management: Includes a 10-minute lean test for diagnosis and first-line treatments such as hydration, salt, support hose, and supine exercise.
Dr. Galland: Mentioned the 10-minute lean test and first-line interventions like adequate hydration, salt intake, support hose, and supine exercise.
POTS Medications: Use beta blockers for hyperadrenergic POTS (with caution if MCAS/asthma are present), ivabradine (Corlanor) as second-line therapy, natural options (vitamin B1 100–200 mg daily, melatonin, gluten-free diet), and midodrine for neuropathic types.
Dr. Galland: Discussed the differences in POTS mechanisms and recommended beta blockers, ivabradine, vitamin B1, melatonin, a gluten-free diet, and midodrine.
Dr. Malcolm: Added pyridostigmine as another medication that can be helpful for some patients.
Non-Medication POTS Management: Includes breathwork to regulate autonomic function, cold therapy, avoiding hot showers (which trigger sympathetic activity), and autonomic rehabilitation.
Dr. Putrino: Emphasized the benefits of breathwork (noting that it is not neutral and requires gradual implementation), mentioned cold therapy, avoiding hot showers, and recommended autonomic rehabilitation materials (available on their YouTube channel).
Experimental and Emerging Treatments
Antivirals and Immune Modulators: Explore the use of Truvada for CMV/EBV reactivation and maraviroc (a CCR5 receptor antagonist) combined with statins.
Dr. Malcolm: Discussed benefits observed with Truvada and mentioned maraviroc in combination with statins.
Dr. Galland: Emphasized the importance of exploring viral persistence and reactivation in long COVID.
Other Experimental Options: Consider sofosbuvir, phosphatidylcholine, plasmalogens, Vascepa (icosapent ethyl), and minocycline; pursue personalized treatment approaches including combination therapies; and explore ongoing studies with rapamycin and lumbrokinase; also, gut microbiome approaches such as rifaximin with Bacillus subtilis probiotics.
Dr. Malcolm: Mentioned sofosbuvir, phosphatidylcholine, plasmalogens, Vascepa, and minocycline as potential options.
Dr. Putrino: Highlighted the need for personalized combination therapies and noted ongoing studies with rapamycin and lumbrokinase.
Dr. Galland: Discussed gut microbiome approaches, including a protocol using rifaximin with Bacillus subtilis probiotics from Milan.
Audience Questions
Nicotine: Theory that nicotine may displace the virus from receptors and help with cognitive dysfunction, though results are mixed.
Dr. Galland: Explained the theory, expressed skepticism, but noted it might help with cognitive dysfunction.
Dr. Malcolm: Reported observing both benefits and crashes in patients using nicotine.
JAK-STAT Inhibitors: May reduce inflammation but pose risks of immunosuppression in patients with viral persistence.
Dr. Putrino: Noted potential benefits for reducing inflammation but expressed concerns regarding immunosuppression.
Peptides and GLP-1s: GLP-1s show clinical benefits for MCAS symptoms; peptides such as MOTS‑c, TB‑4 Fragment, and Thymosin Beta‑4 may help (with Thymosin Beta‑4 being particularly beneficial for head trauma).
Dr. Malcolm: Noted clinical benefits with GLP‑1s and mentioned various peptides.
Dr. Galland: Found Thymosin Beta‑4 to be helpful for patients with head trauma.
Stellate Ganglion Blocks: Typically yield small, short-lived benefits; results vary and cost can be high.
Dr. Putrino: Reported that most patients receive only small, transient benefits, although some experience significant recovery.
Dr. Malcolm: Noted variable outcomes and expressed concerns regarding high cost.
Other Briefly Discussed Interventions
EBoO/Ozone Therapy: Discussed potential benefits and risks.
CO₂ Rebreather Masks: Stuart Malcolm mentioned benefits for improving brain fog.
Apheresis: Dr. Putrino noted that while apheresis can provide temporary benefits, it does not address underlying causes.
Monoclonal Antibodies: Highlighted the need for further pharmaceutical involvement.
Fecal Microbiome Transplant: Dr. Galland emphasized the critical importance of donor selection and proper preparation.
Key Takeaways and Insights
Combination and Personalization: A recurring theme throughout the webinar was the need for combination approaches tailored to individual patient needs.
Dr. Putrino remarked, "I really wish that we could get some of these combination trials going very, very quickly..."
Balancing Established Evidence with Emerging Therapies: First-line treatments provide a solid foundation, while experimental therapies offer hope for patients with refractory symptoms.
Safety and Adaptability: The panel stressed starting with less invasive, natural approaches and gradually integrating more targeted treatments based on individual responses.