In the blog category “From our community”, we address treatments that are being discussed controversially by people affected by Long COVID and health care professionals. In the Altea forum, in stories, and in discussions with those affected, we have seen a number of treatment suggestions that are not officially recommended (yet). To help judge the safety and effectiveness of these treatments, we are exploring the science behind them. We are aiming to provide an overview of the available evidence, evaluate whether or not the available data is reliable, and summarize which risks might be associated with these treatments. Today we want to assess dietary supplements.
Dietary supplements are highly concentrated preparations of compounds like vitamins, minerals, amino acids, probiotics, and herbs that are typically used to meet nutritional requirements.
In general, a healthy diet may help relieving symptoms and supplements may support this effect. However, benefits might be rather subtle and additional treatments might be necessary. Here we discuss the available clinical evidence for supplementation with vitamin D, creatine, and probiotics.
Can vitamin D supplements improve Long COVID symptoms?
D Vitamins are a group of fat-soluble molecules that are needed for healthy bones and the immune system. Over the last three years, several studies have shown that a low level of vitamin D is associated with an increased risk of infection with SARS-CoV-2 and that vitamin D supplementation is an effective method for reducing COVID-19 severity. Despite this negative impact of vitamin D deficiency on the clinical course of acute COVID-19, little is known about the role of vitamin D in Long COVID.
A recent study therefore retrospectively investigated whether there is a link between low levels of vitamin D and Long COVID in 50 adult patients with Long COVID and 50 individuals without Long COVID. Results showed that patients with Long COVID had markedly lower levels of vitamin D than patients who had completely recovered from COVID-19. This indicates that taking vitamin D supplements may help prevent or ease Long COVID symptoms but only in patients with hypovitaminosis D (low levels of vitamin D). The authors noted that vitamin D levels should be evaluated in COVID-19 survivors; if levels are low, treatment under medical supervision could be considered.
Data from another study are not very promising. The findings showed no significant association between Long COVID symptoms and low levels of vitamin D. This suggests that Long COVID has a complex pathophysiology and is more difficult to treat than we assume.
It remains unclear whether vitamin D supplements could improve the symptoms or reduce the risk of developing Long COVID altogether. The main issue arises due to the lack of adequate clinical trials that could investigate the therapeutic role of vitamin D in managing Long COVID symptoms.
Probiotics may improve digestive and neurocognitive symptoms
Although there are numerous probiotic preparations available on the market, their safety and effectiveness are not fully established. Probiotics are promoted as having health benefits by improving the gut microbiota, but we still need more clinical studies to prove these claims.
As reported in a previous blog, a disturbed gut microbiome may be responsible for Long COVID onset and there is ongoing research on the effects of probiotic bacteria on this condition. For example, a study from Hong Kong, presented at the “Digestive Disease Week 2023” in May, showed that patients with Long COVID experienced remarkable improvements in various digestive and neurocognitive symptoms after receiving capsules with live probiotic bacteria for 6 months. Although these results are encouraging, the study had some significant shortcomings that could affect its validity. In addition, the specific product investigated in the study is available only in Hong Kong.
In a study conducted a bit earlier in the United Kingdom, two capsules a day containing a probiotic combination of five Lactobacillus bacteria also resulted in lessening Long COVID symptoms of cough and fatigue. This product is commercially available in Europe. However, this was not a high-quality study as it lacked a control group to determine if these improvements could occur naturally without any intervention. Furthermore, the improvements were based on self-reported data without objective tests for assessment.
What about creatine?
In September this year, a study reported that dietary creatine may have a positive effect on chronic fatigue and other symptoms associated with Long COVID. Creatine is an amino acid that naturally occurs in the body and supplies energy to our muscles (and is therefore a popular workout supplement).
This study included 12 patients with at least one Long COVID symptom; half of them received creatine and half of them received a placebo. After three months of taking creatine, patients fatigue significantly improved, and by six months, improvements were reported for taste loss, breathing issues, body aches, headache, and problems concentrating, compared with patients taking placebo. Importantly, although patients taking creatine had higher levels of creatine in their muscles and brain compared with patients taking placebo at six months, there was no longer a difference in fatigue symptoms between these two groups.
These results should be interpreted cautiously as the study has several limitations, including the very low number of participants and the inability of the researchers to consider dietary creatine intake which might have impacted overall creatine exposure. Nonetheless, the study authors pointed out that the patients experienced no major side effects and creatine supplementation appears safe.
Dietary supplements rarely have negative side effects; therefore, it might be worth trying out what helps reducing your symptoms. However, supplements do not undergo the rigorous controls and tests as food or medication and may thus be contaminated or not contain the advertised amount of active ingredients. We recommend products that have undergone third-party testing and discussing your diet and supplements with a health care professional or a nutritionist.