COVID-19 News: Study Review And Case Series Shows That Long-Term Fasting Helps Improve Long COVID-19 Issues!
: The COVID-19 pandemic has had a profound impact on people's lives across the globe, with millions suffering from the debilitating effects of long COVID, officially known as "post-acute sequelae of COVID-19" (PASC). This condition affects at least 10% of individuals who have recovered from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, leading to a wide array of symptoms that span multiple systems, including the respiratory, cardiovascular, neurological, gastrointestinal, and musculoskeletal systems, as well as mood disorders. Some of the most prevalent symptoms include fatigue, breathlessness, cognitive impairment, and various types of pain, such as chest pain or headaches.
Long COVID can develop in two distinct phases depending on the duration of symptoms. Symptoms persisting for 4 to 12 weeks after the acute infection are considered part of the early phase, while if they extend beyond 12 weeks, the condition is classified as long COVID. According to the World Health Organization, long COVID is characterized by symptoms lasting at least 2 months and not being explainable by an alternative diagnosis. These symptoms can either persist consistently or re-emerge despite an initial recovery from an acute COVID-19 episode.
The SARS-CoV-2 virus enters human cells through the angiotensin-converting enzyme 2 receptor, which is present in various cell types throughout the body. This leads to an inflammatory response that can impair organ function. The exact mechanisms by which this infection results in tissue damage are not fully understood, but research suggests that chronic inflammation and oxidative stress play a role. Furthermore, factors such as persistent viral antigens, reactivation of human herpesviruses (e.g., Epstein–Barr), a higher viral load, and autoreactive immunity are associated with immunologic perturbations that can predict the development of long COVID. Oxidative stress can lead to mitochondrial dysfunction, affecting cellular energy balance. The increased production of reactive oxygen species during COVID-19 can lead to endothelial dysfunction, microclots in plasma, and impaired oxygen exchange. Inflammation in the brain can result in neurological complications, including myelin loss and tau hyperphosphorylation akin to Alzheimer's disease. Dysbiosis of the gut microbiota may even contribute to the pathogenesis of long COVID.
The complexity and variability of long COVID symptoms have made it challenging to identify effective treatments. Common pharmacological interventions are often inadequate, as they are based on a one-symptom-one-medication model. Non-pharmacological interventions, such as fasting or dietary strategies, have the potential to address the multi-system nature of long COVID by impacting various metabolic processes, leading to global improvements in metabolic health.
This COVID-19 News
report covers a recent study review and case series presented by researchers from Buchinger Wilhelmi Clinic, Überlingen-Germany, King’s College London-United Kingdom and Buchinger Wilhelmi Clinic, Marbella-Spain.
Long-term fasting (LF), defined as the voluntary abstention from food for a period ranging from 5 days to several weeks, off
ers a promising approach. The Buchinger Wilhelmi fasting program, which provides minimal supplementation with up to 250 kcal through fruit juice and honey, has demonstrated multiple effects on pathological mechanisms involved in COVID-19 infections. These effects include reduced inflammation, lower oxidative stress, and improvements in risk factors associated with severe COVID-19, such as weight loss, waist circumference reduction, normalized blood pressure, and improved glucose and lipid profiles linked to comorbidities like obesity, hypertension, diabetes, and dyslipidemia. Additionally, LF can positively impact gut microbiota and enhance overall well-being.
Despite the promising theoretical basis, clinical trials assessing the effects of LF on long COVID have been notably absent. This article presents the first documented evidence of improvements in self-reported symptoms and blood parameters in long COVID patients who underwent LF.
Fourteen patients, comprising five women and nine men, with persistent post-COVID-19 symptoms were admitted for this case series. Their ages ranged from 33 to 74 years. During the acute phase of the illness, one patient was asymptomatic, three had mild symptoms, five had moderate symptoms, and five had severe symptoms. The duration of acute symptoms varied from 1 day to 1.5 years. Hospitalization was necessary for four of the patients, with three of them receiving oxygen treatment. The time span between the acute infection and the initiation of the fasting intervention ranged from 5 to 22 months.
Several pre-existing conditions were diagnosed in these patients at the time of the fasting intervention, including obesity, dyslipidemia, digestive disorders, and heart disease. The patients stayed at the clinic for 10 to 21 days and underwent a fasting therapy for over 6 days up to 16 days, followed by a food reintroduction period of 3 to 5 days.
The LF induced significant weight loss in all patients. Systolic and diastolic blood pressure levels were either reduced or remained stable. Blood tests revealed a reduction in blood glucose levels, while glycated hemoglobin remained unchanged. Lipid parameters, such as total cholesterol and triglycerides, were predominantly reduced. Inflammatory conditions, as assessed by erythrocyte sedimentation rate (ESR) and high-sensitive C-reactive protein (hs CRP), showed variable changes. ESR levels were inconsistent, with some patients experiencing reductions, some showing increased levels, and others remaining unchanged. Hs CRP levels were reduced in some patients but increased in others.
Participants' health perception, as assessed using the EQ-5D index score and visual analogue scale, improved for most patients after fasting. Overall, 13 out of 14 patients reported an improvement in their health status. When asked about the therapies and activities that helped the most to alleviate their symptoms, fasting was mentioned by 10 of the 14 patients. Other treatments mentioned included physiotherapy, ozone therapy, acupuncture, psychotherapy, and osteopathy. Notably, no adverse events were observed during the fasting intervention.
The case series presented here highlights the beneficial effects of LF in 14 patients suffering from long COVID. Patients reported an improvement in their overall health and a reduction in common symptoms, including fatigue, breathlessness, muscle pain, weakness, headaches, joint pain, and sleep difficulties. Even less frequent but classic COVID symptoms, such as cognitive impairments and smell and taste disorders, were ameliorated. Given the absence of established therapeutic approaches for long COVID, these observations suggest that long-term fasting could be a non-pharmacological strategy to manage and treat this condition. Multiple mechanisms and processes support the potential effectiveness of fasting in addressing long COVID, as discussed below.
Fasting as an Adaptive Defense Mechanism
The concept of fasting as a therapeutic intervention during acute infections is not new. It has been documented in historical case reports for infectious diseases such as typhoid, scarlet fever, and tonsillitis. Controlled laboratory studies have shown that fasting can improve survival rates in response to certain infections. For example, when mice were infected with Listeria monocytogenes, only 5% of previously starved mice died, while 95% of normally fed mice succumbed. The benefits of fasting in these cases are attributed to adaptive defense mechanisms triggered by the fasting process. When food intake is suspended, the body shifts to burning fat as its primary energy source, leading to the production of ketone bodies.
Ketone Bodies and Antiviral Immunity
Recent research has indicated that nutritional ketosis can enhance antiviral immunity in the lungs. The ketone body β-hydroxybutyrate (BHB) has been shown to increase the production of cytokines by CD8+ T effector cells. These cytokines play a crucial role in immune responses to infections. BHB affects histone acetylation, directly boosting the production of these cytokines. This mechanism suggests that fasting could enhance the body's ability to mount an antiviral immune response.
Beneficial Effects on Brain Function
Fasting has been associated with improved brain function. It can reduce oxidative stress and enhance mitochondrial oxidative metabolism in the rodent brain. BHB, a ketone body produced during fasting, plays a central role in these improvements. It triggers the release of brain-derived neurotrophic factor (BDNF), which enhances cognitive performance, memory, synaptic plasticity, neurogenesis, and resistance to injury and disease. Additionally, fasting can stimulate the hypothalamic-pituitary–adrenal axis, conferring a pain-relieving effect. This might explain the reduction in muscle and joint pain, as well as headaches, reported by patients in this case series.
Improved Muscle Function and Well-Being
Studies have shown that fasting can improve muscle function. In one study, a 10-day fast resulted in increased leg muscle power and strength. Additionally, a larger group of 1,422 individuals fasting for 4 to 21 days reported increased emotional and physical well-being and higher energy levels. The marked improvements in muscle pain and weakness observed in this case series are consistent with these findings.
Fasting and Its Impact on Inflammation and Coagulation
Fasting has been shown to influence coagulation parameters in adults, which could help counteract the clotting tendency observed in some long COVID patients. Additionally, fasting can promote vasodilatation through the production of adiponectin-mediated endothelial nitric oxide in rats. This effect could mitigate endothelial dysfunction, potentially reducing cardiovascular risk factors.
Fasting and Sleep Quality
Improvements in sleep quality have been observed after fasting. This aligns with the reduction in sleep difficulties reported by long COVID patients in other studies.
Fasting, mTOR, and Inflammation
Fasting results in a metabolic shift from glucose to fat and ketone utilization. At the molecular level, this is reflected in the inactivation of the nutrient-sensitive mammalian target of rapamycin (mTOR) pathway. Fasting might have effects on COVID through the regulation of mTOR, which plays a role in activating the inflammasome—a process associated with the cytokine storm in severe COVID-19. Notably, individuals with obesity, where mTOR signaling is already elevated, are at greater risk for severe COVID-19 outcomes characterized by a strong inflammatory response in adipose tissue.
Modulation of Immune Function
The dysregulation of the immune function is a hallmark of COVID-19. Fasting might enhance antiviral immune function and the survival of activated T cells through the production of BHB, which has been shown to serve as a more efficient alternative fuel for T cells. Ketogenic diets, which produce similar effects, have been reported to ameliorate clinical symptoms of pulmonary health conditions. Fasting can also reduce inflammation by reducing adipose tissue volume, as observed in the presented cases and previous studies, and by reducing visceral fat. Further anti-inflammatory mechanisms might be triggered by the activation of the Nuclear factor erythroid 2-related factor (Nrf)-2/heme oxygenase (HO)-1 signaling pathway. Fasting has been shown to have anti-inflammatory effects in diseases like rheumatoid arthritis, as evidenced by reductions in parameters like tumor necrosis factor-α or interleukin-6. Additionally, the inactivation of the mTOR cascade promotes autophagy, which may help clear viral RNA and repair damage caused by post-acute illness.
Cellular Stress Adaptation and Antioxidant Capacity
Fasting can improve cellular stress adaptation by eliminating free radicals. For example, a 10-day fast increased total antioxidant capacity and reduced lipid peroxidation damage. Asthmatic patients exhibited reduced oxidative stress after 8 weeks of alternate-day fasting. Fasting promotes a protective mode in cells, preventing DNA damage and inducing DNA repair. In mice, fasting activated hematopoietic stem cells, enhancing their self-renewal and lineage-balanced regeneration of immune cells. These findings suggest that fasting could reverse immunosuppressive states and strengthen the innate immune system.
Cardiovascular Risk Factors
Patients with COVID-19 have an increased risk of developing cardiovascular diseases, and alterations in lipid profiles have been demonstrated in COVID-19 patients. Fasting studies have shown preventive and therapeutic improvements in glucose and insulin levels, cholesterol and triglyceride levels, high blood pressure, and fatty liver. The patients in this case series also displayed improvements in blood results and blood pressure measurements.
The Gut Microbiome
Studies have linked dysbiosis of the gut microbiome to SARS-CoV-2 infections and increased mortality. Fasting has been shown to influence gut microbiome composition, increase the production of short-chain fatty acids, and reduce gut permeability. The impact of fasting on health effects during long COVID requires further investigation.
Safety and Optimal Fasting Parameters
The safety of fasting during acute viral infections raises concerns due to conflicting findings in mouse experiments. While fasting improved survival in models of bacterial inflammation, glucose utilization was found to be crucial for survival in models of viral inflammation. Further studies are needed to assess the safety of fasting during acute infections. Additionally, determining the optimal timing for initiating fasting therapy after an acute infection and the ideal duration of fasting are essential aspects that warrant further investigation.
In conclusion, while further research is needed to fully understand the mechanisms and optimize the application of long-term fasting in addressing long COVID, the observed improvements in well-being and reductions in physical complaints among patients in this case series suggest that long-term fasting could be a potent non-pharmacological approach for reclaiming health after contracting serious infectious diseases. This approach addresses multiple aspects of long COVID, including its impact on inflammation, oxidative stress, immune function, and cardiovascular risk factors. As we continue to grapple with the lingering effects of the COVID-19 pandemic, exploring non-pharmacological interventions like fasting can offer new hope for those suffering from long COVID.
The study findings were published in the peer reviewed journal: Frontiers in Nutrition.
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