The Ayurvedic Approach to Long Covid, Part 2: The GIAM Post-COVID Āyurvedic Care Program, By Dr. Scott Gerson, M.D., Ph.D. (Ayu)
The Lingering Effects of Covid from an Āyurvedic Perspective
COVID-19 can result in prolonged illness and persistent symptoms, even in young adults and persons with no underlying medical conditions who were not hospitalized. Part 1 of this Blog summarizes the symptomatology, pathophysiology, and tissue/organ damage that can manifest from long covid. According to Āyurveda concepts, in the period of post-acute COVID 19 infection (i.e. long covid) there will be:
i. Agnimandya Avastha – literally “a state of low agni” (digestive fire)
ii. Visharoga – accumulation of toxic substances (visha = toxin) which cause cellular dysfunction and in extreme cases death
iii. Dhatu-Kshaya – weakening and loss of bodily tissues or dhatus
iv. Ojakshaya – Loss of ojas (vital force). This is the most devastating and disabling effect of long covid.
Four Facets of Ayurvedic Treatment of Long Covid
Hence, for the comprehensive recovery and prevention of the lingering effects of SARS-CoV-2 infection, four facets of treatment are necessary and effective:
1) Deepana-Pachana Chikitsa. Purpose: to correct agnimandya avastha. The administration of gentle spices and medicinal herbs to re-constitute and re-strengthen the Jatharāgni (principal digestive fire), and dhatwagis (tissue-level digestion and assimilation) as well as remove accumulated ama from the tissues. Ama is a sticky endogenous metabolic poisonous substance that is the result of improper or incomplete digestion. Because long covid involves the accumulation of ama, deepana-pachana treatment is essential. Any efforts to administer purification therapies (i.e., panchakarma) without prior deepana-pachana will result in damage and further destruction of the tissues. The analogy given in the Ashtanga Hridaya (an ancient text) is that it is like trying to extract juice by squeezing an unripe fruit: you will only succeed in mangling the fruit and not get much juice. Here is the original text giving this analogy.
सर्वदेह प्रविसृतान् सामान् दोषान् न निर्हरेत्
लीनान् धातुषु अनुत्क्लिष्टान् फलादामाद्रसानिव
आश्रयस्य हि नाशाय ते स्युः दुर्निर्हरत्वतः (AH. 13, 28-29)
“The Sama Doshas which are spread all over the body, which are lurking in the Dhatus and which are not moving out of their places of accumulation, should not be forced out by purification Panchakarma therapies like emesis, purgations etc. Just as attempts of extracting juice from an unripe fruit leads to destruction, the dwelling place itself will get destroyed if Doshas are tried to expel out along with Ama.”
2) Panchakarma. Purpose: to correct both visharoga and ama accumulation. These two are closely related. The five purificatory procedures have to be individually adopted to purify and reestablish proper function of cells, organs, and body systems and organs that have been or potentially can be affected. There are specific procedures which are indicated in long covid detailed below.
Panchakarma includes vishachikitsa or general treatments for the removal of residual cellular and metabolic poisons which have accumulated and vishaghna yogas, or specific herbomineral formulations traditionally including Shirisha (Albizia lebbeck) and Haridra churna, i.e., turmeric root powder (Curcuma longa) which are recommended to be started following panchakarma and after clinical recovery from the acute condition.
3) Pathya vyavastha or regulation (vyavastha) of the diet (pathya). Āyurveda considers food as the first and foremost factor in the tripod of life (food, sleep, brahmacharya [control of sexual activity]). A proper diet is vital and mandatory for maintenance of good health, resistance to disease, and for the healing from disease. Pathya vyavastha mainly is knowledge about appropriate and inappropriate foods for different diseases. It is knowledge of how to enhance the therapeutic effect of diet, maintain digestion power, and aid in the assimilation of nutrients and prana from the diet.
The SARS CoV-2 crisis is being described as a world-wide “sudden”, acute pandemic. However, more accurately it is clear that to some extent it is an exacerbating factor of a much slower and more insidious pandemic: the pandemic of chronic, unhealthy lifestyle-related diseases. This global pandemic has been stressing and deteriorating our individual immunity as well as our collective herd immunity for many, many decades. In the Āyurvedic viewpoint, certainly even before the Covid-19 trigger in 2019, the world was already in a very vulnerable condition and ripe for a widespread disease.
The general reason behind this is because western medicine, and western society, have no effective strategy of health promotion; and even the notion of prevention is very rudimentary and undeveloped.
And the specific reason and the biggest driver of this global vulnerability to both acute and chronic immunity-related diseases: poor diet.
Ultra-processed food, which is the heart of the problem, is now about 60% of the calorie consumption in the United States. Sixty percent!!! This includes white bread, white rice, plain white pasta, noodles, regular flour products, foods made from refined grains, cereals, crackers, sugary cakes, donuts, cookies, candy, ice cream, soft drinks, energy bars, flavored yogurt. “Processed food” and “ultra-processed food” sound similar but are very different. A “processed food” refers to any food that has undergone a physical change before it’s consumed. This can include canning, smoking, pasteurizing, crushing, boiling, freezing and drying. Examples of processed foods include canned vegetables, canned broths, salted nuts, canned tuna fish, canned salmon, canned sardines, plain yogurt, tofu, cheese, or smoked meats. While some of these foods may contain unhealthy additives, they can be part of a healthy diet in very small amounts.
So processing changes a food from its natural state. Unprocessed or minimally processed foods would include apples, bell peppers, spinach, ,bananas, unsalted nuts, or fresh salmon, and any food in its natural state.
Ultra-processed food takes this detrimental process exponentially further by incorporating chemical additives such as added sugar, sodium, unpronounceable preservatives, artificial flavoring, and artificial food coloring. Sometimes laboratory-synthesized vitamins are added back in excessive extra-physiologic quantities and unnatural proportions.
Because ultra-processing makes foods more tasty and convenient, the main effect is to make people who consume them overweight and obese.
There’s a very clear correlation already countries that had 50% or more of the population overweight or obese are having more severe illness and deaths from COVID-19. So, poor metabolic health means poor immune health and susceptibility to infectious and other chronic disease.
In addition to obesity and severe covid disease from eating ultra-processed foods, these foods have many other health risks associated with them. A February 2018 study in the British Medical Journal found that eating a diet consisting of heavily processed foods may increase the odds of developing cancer, including breast cancer, by 10 percent. (Fiolet T, et.al. Consumption of ultra-processed foods and cancer risk: NutriNet-Sante perspective cohort, BMJ 2018, 360, k322.)
Also, people whose diets are high in ultra-processed foods have a 13% higher risk of coronary heart disease. By contrast, those who consume mostly unprocessed foods are at a much lower risk of cardiac events.
4) Dhatu-ojo-poshana or systematic re-nourishment of the bodily tissues and replenishment of Ojas (including the administration of formulations of Covid-specific Rasayana drugs).
Although a healthy, balanced diet is the primary tool for this, a considerable amount of recent research strongly indicates that both some already well-known and characterized plant medicines as well as other less familiar medicinal plants around the world, can play an important role in creating healthy tissues and organ systems which are resistant to disease. This is especially true in preventing and protecting against long covid.
Some of the plant medicines which are emerging as preventive and therapeutic are well-known species which have been used for similar indications in the past. For example, one formulation found to be effective for many people is a decoction made from Draksha (Vitis vinifera), Amalaki (Emblica officinalis), Guduchi (Tinospora cordifolia), Vasa (Justicia adhatoda), and Ashwagandha (Withania somnifera) for at-least 45 days. Others are being newly identified as active specifically against SAR CoV-2 infection. Either the whole plant, whole plant part (e.g. whole roots, whole rhizomes, whole leaves, etc.) or crude extracts from these plants (using the traditional maceration method of preparation) are showing very convincing evidence as therapy against covid infection and its long term sequelae. However, the evidence for isolated “bioactive compounds” is less effective in vivo. Several compounds such as TGG, emodin, glycyrrhizin, aurantiamide acetate, and caffeic acid have nevertheless been identified to have inhibition on viral attachment and penetration in vitro.
Several plants such as Sanguisorba officinalis L., Stephania tetrandra S. Moore (tetrandrine, fangchinoline, and cepharanthine), and Strobilanthes cusia (Nees) Kuntze (tryptanthrin), and F. suspensa (Thunb.) Vahl (forsythoside A) are able to inhibit the viral RNA and protein synthesis.
Other compounds such as kaempferol, N-cis-feruloyltyramine, and quercetin have targeted and inhibited the viral proteases such as 3CLpro and PLpro, important enzymes for the co-translation of non-structural proteins required for viral entry into cells.
There are also several compounds found in plants that may act on the viral release mechanism through the 3a ion channel (emodin and kaempferol). Kaempferol is among the most intriguing of these naturally occurring substances. It already is being widely used as a cancer treatment and numerous high-quality studies have demonstrated its wide range of pharmacological activities including antioxidant, anti-inflammatory, neuroprotective, anti-diabetic, anti-osteoporotic, and immunomodulating activities. Kaempferol (3,4′,5,7-tetrahydroxyflavone) is a natural flavonol, a type of flavonoid, found in a variety of plants and plant-derived foods. As is the recurring theme in all my writings, it is most effective to obtain kaempferol or any medicinal substance from a whole plant or whole food preparation and not as an isolated chemical entity. This cannot be stressed enough. The highest kaempferol content in Nature is found in two available but seldom used seasonings: capers (Capparis spinosa berries) and saffron (Crocus sativus the crimson red stigmas and styles). Other common foods that contain biologically significant amounts of Kaempferol include kale, beans, tea, garlic, apples, grapes, tomatoes, green tea, potatoes, onions, green chili, carrot, white radish, broccoli, Brussels sprouts, squash, tomato, cucumbers, lettuce, peaches, blackberries, raspberries, and spinach.
A partial list of medicinal plants which contain it include: turmeric root (Curcuma longa), gingko leaf (Gingko biloba), Aloe vera, Shigru (Moringa oleifera), Rosemary (Rosmarinus officinalis), Dugdhika (Euphorbia hirta), and the European plant St. John’s Wort (Hypericum perforatum).
Last but not least, several plants such as L. radiata (L'Héritier.) Herbert (Sanskrit, manjushaka), Strobilanthes cusia (Nees) Kuntze (Sanskrit, sahacharya) [methanol extract, tryptanthrin and indigodole B], and Isatis indigotica (hesperetin), A. sativum L., E. neriifolia L., P. sidoides DC., and T. sinensis (Juss.) M. Roem. have also been discovered to have anti-coronavirus activity, yet in most cases their exact mechanisms of targeting the coronavirus infection are still unknown. Nevertheless, their observed anti-coronavirus activity makes them exciting candidates for the development of new anti-coronavirus multi-herbal formulations. Also I must add that various herbs that contain quercitin and kaempferol are also candidates for being rasayana plants to protect against covid infection.
However, although they appear safe and effective more laboratory and clinical studies are needed to justify their use and efficacy against the current SARS-CoV-2 virus. It is clear that all of these plants have evidence of great potential for protection against and treatment of this devastating pandemic.
Conclusion
COVID-19 is not the world’s first pandemic. The human immune system has evolved to cope with constant infections since the appearance of Homo sapiens 200,000 years ago. Traces of viral genetic material embedded in our own genomes from ancient viral infections, are evidence of such evolutionary battles. The SARS-CoV-2 virus is our most recent adversary—and unfortunately a very worthy opponent.
There is a widespread, rosy misconception that viruses evolve over time to become more benign and then somehow fade away. Similarly, many people think that once an acute viral infection has resolved, all effects of that infection will disappear. This is not true. There is no predetermined evolutionary reason for a virus to mutate into more benign variations or for their biological effects to always completely resolve. Long covid is a very real condition in which multiple symptoms (i.e., fatigue, headache, brain fog, cough, anosmia, palpitations) originating in multiple organ systems are present. Some people are so fatigued they cannot perform normal daily activities, others are having challenges with word retrieval, focus, and concentration; others do not regain their sense of smell or taste; others develop palpitations or shortness of breath. Rather than addressing a single symptom or organ system (i.e., respiratory, nervous, renal, or immune system, etc.), a comprehensive holistic approach is required. Āyurvedic medicine contains within its knowledge a multidisciplinary approach to disease. Modern science currently lacks a full understanding of the many, many precise intricate pathological mechanisms which cause Post-Acute Sequelae of Covid (PASC), or long covid. We likely will never fully understand them all through the reductionist approach of modern science and medicine. Āyurveda does not require or rely on such mechanistic knowledge in order to effectively treat a human being. Nor does Āyurveda rely on one magic bullet, one therapy, or one drug but rather applies a spectrum of therapeutic inputs to address each individual holistically and uniquely.
Here in Florida, The Gerson Institute of Āyurvedic Medicine has had the task—I would say the privilege—to deal with the aftermath of a tsunami of long covid patients. As a result, I have gradually developed the post-COVID Āyurvedic Care Program outlined above which includes a specialized form of Panchakarma, attention to dietary principles, and a carefully designed program of herbal mediicnes. A very important part of how this program developed has been through hearing the stories and experiences of our patients. Together with the enduring ancient wisdom of Āyurveda, these insights from our patients have created the Āyurvedic approach to long Covid, personally titrated for each individual, which we are implementing with great success today.
For more information or to inquire about receiving GIAM Post-Covid Ayurvedic Care, please call 727-371-1000 or email giam@gersonayurveda.com.