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How mitochondrial nutrients may help with lingering effects of the virus
Viral infections can produce long-range symptoms well after the virus has passed through the body. Just ask the millions of people suffering from “long COVID” who are still struggling from fatigue and brain fog for months after contracting COVID-19.,
Remarkably, long COVID doesn’t just affect people who were very ill with the virus, but also those who had seemingly mild cases of the virus initially., Many people who suffer from long COVID were previously healthy and are extremely frustrated by this lingering condition.
People’s descriptions of their long COVID experiences have several common themes:
(1) The long COVID symptoms are numerous, hard to describe, and debilitating;
(2) All (or many) aspects of one’s day-to-day functioning are impacted;
(3) The affected individuals can no longer be physically active; and
(4) They keep asking for help but no one seems to be listening, and very little is helping.
A prospective study followed 96 individuals for a year after their COVID diagnosis and found that the majority of respondents still had at least one symptom after 12 months. The symptoms of long COVID included reduced capacity for exercise (56%), fatigue (53%), breathing difficulties (37%), concentration problems (39%), problems finding words (32%), and poor sleep (26%).
Today we’ll discuss the role of the mitochondria in long COVID and the use of mitochondrial nutrients for nutritional support.
How the SARS-CoV-2 virus hijacks the mitochondria
Supplemental mitochondrial nutrients can help alleviate the fatigue associated with CFS, so they may be useful for long COVID as well.
To understand the mechanisms underlying this condition, one research team conducted cardiopulmonary (heart and lung) exercise tests in men and women with long COVID. The results showed a reduction in fatty acid oxidation (one of the main sources of cellular energy) and an abnormal buildup of lactic acid, as compared to previously-tested controls. This points to a problem with the mitochondria, the cellular structures (organelles) that provide 95% of the body’s energy needs.
Viruses, including SARS-CoV-2, act as intracellular “parasites” that hijack mitochondrial pathways to drive viral replication.,, Consequently, the infection depletes human cells of the antioxidants and mitochondrial cofactors they need for good health.,,,
Some authors believe that long COVID syndrome is another form of chronic fatigue syndrome (CFS), since both conditions are very similar clinically.,,, Viral infections can trigger CFS, although it is not exclusively considered a post-infectious illness.
Supplemental mitochondrial nutrients can help alleviate the fatigue associated with CFS, so they may be useful for long COVID as well. The mitochondrial nutrients of interest for this purpose include Coenzyme Q10, carnitine, NADH, melatonin, and alpha-lipoic acid.
CoQ10 is produced in the body, but the amount produced is often insufficient to meet the demands during illnesses and infections.
Coenzyme Q10 (CoQ10, also known as ubiquinone or ubiquinol) is a mitochondrial cofactor that has both antioxidant and bioenergetic properties.,, Although CoQ10 is produced in the body, the amount produced is often insufficient to meet the demands during illnesses and infections.,,
In patients with CFS, lower levels of CoQ10 are associated with fatigue and with oxidative stress., Therefore, restoring normal antioxidant and CoQ10 levels may help alleviate chronic fatigue.,,, In studies of CFS, CoQ10 (200 mg/day) has been used in conjunction with NADH (20 mg/day), as discussed later in this article.
Viral infections, including COVID-19, deplete CoQ10 and total antioxidant levels.,, By correcting this deficit, supplemental CoQ10 may help support recovery after infections. According to preliminary studies, the use of CoQ10 (10 mg three times daily) in conjunction with standard treatments improved the recovery of cardiac function in patients with viral myocarditis (inflammation of the heart following viral infection).,
Increasing skeletal muscle carnitine content increases whole-body fat oxidation during moderate-intensity exercise.
Carnitine is found in nearly all cells of the body. It enables fatty acids to enter the mitochondria where they can be burned to generate energy.,, Supplemental carnitine (at a dose of 2-4 grams daily) has been shown to improve fatigue and exercise performance in healthy adults and in those suffering from chronic fatigue.,,,,
Increasing skeletal muscle carnitine content increases whole-body fat oxidation during moderate-intensity exercise,, suggesting that it may improve energy metabolism in people with long COVID as well. People with naturally higher carnitine levels were found to have less severe outcomes from COVID-19 infections.
Supplemental melatonin may improve fatigue and accelerate the return to baseline health.
Melatonin plays a key role in mitochondrial energy production, both at rest and during exercise.,,,, It also activates the Nrf2 pathway, which regulates cell survival in response to injury and inflammation.,
However, viruses that invade the mitochondria disrupt melatonin synthesis and impair these vital functions, leading to a buildup of dysfunctional mitochondria.,, Controlled trials suggest that supplemental melatonin may improve fatigue and accelerate the return of patients to baseline health after COVID.,, The suggested doses in these studies ranged from 3 to 12 mg/day, although far higher doses of 100 to 400 mg/day are being investigated for individuals with active infections.
ALA is a powerful antioxidant that protects the brain and heart from oxidative damage.
Alpha-lipoic acid (ALA), a cofactor for four enzyme complexes exclusively located in mitochondria, is essential for energy production. It is a powerful antioxidant that protects the brain and heart from oxidative damage during illness.,,, Oral doses of ALA generally range from 300 to 1200 mg/day in human studies.,
Due the role played by oxidative stress in viral infections, supplemental ALA has been suggested as an adjunct to standard care during and after COVID., ALA may be particularly valuable for individuals with diabetes, who are highly susceptible to the effects of COVID. Further clinical studies are needed to confirm these findings.
Nicotinamide adenine dinucleotide (NAD/NADH)
NADH and CoQ10 improved fatigue, mental clarity, and health-related quality of life for people with chronic fatigue.
Mitochondrial supplements often include nicotinamide adenine dinucleotide (NAD), another essential cofactor for energy production. In a double-blind trial of people with CFS, supplementation with NADH relieved fatigue in 31% of cases, compared with only 8% of those in the placebo group.
Three double-blind, placebo-controlled trials showed that supplemental NADH (20 mg per day) along with CoQ10 (200 mg per day) improved fatigue, mental clarity, and health-related quality of life for people with chronic fatigue.,,
COVID-19 is associated with deficiencies in nicotinamide adenine dinucleotide (NAD+) and glutathione metabolism, so replenishing these cofactors may be helpful., A placebo-controlled trial assessed the effects of supplementation as an adjunct to standard care for individuals with mild to moderate COVID infections. The supplement contained carnitine along with NADH (as nicotinamide riboside) and glutathione precursors. The combined nutrients helped relieve inflammation and oxidative stress, and hastened the recovery from the infection as compared to placebo.
In closing, viral infections such as COVID often deplete mitochondrial nutrients and antioxidants. This contributes to the clinical manifestations of the infection and is detrimental to healing processes. CoQ10, carnitine, melatonin, alpha-lipoic acid, and NADH are promising adjuncts for people recovering from COVID.,,,
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- Melatonin, the Antioxidant Recycler: Beyond sleep, melatonin protects against free radicals.
- Health Benefits of Alpha-Lipoic Acid: Its use in weight management, metabolic syndrome, and diabetes.
- NAD+: Health or Hype? What the research says about nicotinamide adenine dinucleotide.
- How the Gut Microbiome Influences COVID-19: Can probiotics reduce the risk?
- What Everyone Should Know about Vitamin D and COVID-19: Vitamin D insufficiency increases risk of illness.
- Fighting COVID-19, Pneumonia, and Inflammation with Medicinal Mushrooms: Fungi friends to the rescue!
 Pliss A, et al. Mitochondrial dysfunction: a prelude to neuropathogenesis of SARS-CoV-2. ACS Chem Neurosci. 2022 Feb 2;13(3):308-12.
 Groff D, et al. Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: a systematic review. JAMA Netw Open. 2021 Oct 1;4(10):e2128568.
 Rivas-Vazquez RA, et al. Assessment and management of Long COVID. J Health Service Psychol. 2022 Feb 9:1-0.
 Johns Hopkins Medicine. COVID ‘Long Haulers’: Long-Term Effects of COVID-19 [Internet]. Boston (MA): The Johns Hopkins University; 2021 [cited 2022 Feb 27]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-long-haulers-long-term-effects-of-covid19
 Wurz A, et al. “I feel like my body is broken”: exploring the experiences of people living with long COVID. medRxiv. 2022 Jan 1 [Preprint]. DOI: 10.1101/2022.01.20.22269617
 Seeßle J, et al. Persistent symptoms in adult patients one year after COVID-19: a prospective cohort study. Clin Infect Dis. 2021 Jul 5;ciab611.
 De Boer E, et al. Decreased fatty acid oxidation and altered lactate production during exercise in patients with post-acute COVID-19 syndrome. Am J Respir Crit Care Med. 2022 Jan 1;205(1):126-9.
 Claus C, Liebert UG. A renewed focus on the interplay between viruses and mitochondrial metabolism. Arch Virol. 2014 Jun;159(6):1267-77.
 Soria-Castro E, et al. The kidnapping of mitochondrial function associated with the SARS-CoV-2 infection. Histol Histopathol. 2021 Sep;36(9):947-65.
 Singh KK, et al. Decoding SARS-CoV-2 hijacking of host mitochondria in COVID-19 pathogenesis. Am J Physiol Cell Physiol. 2020 Aug 1;319(2):C258-67.
 Lage SL, et al. Persistent oxidative stress and inflammasome activation in CD14 high CD16 – monocytes from COVID-19 patients. Front Immunol. 2022 Jan 14;12:799558.
 Shang C, et al. SARS-CoV-2 causes mitochondrial dysfunction and mitophagy impairment. Front Microbiol. 2022 Jan 6;12:780768.
 Paul BD, et al. Redox imbalance links COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome. Proc Natl Acad Sci U S A. 2021 Aug 24;118(34):e2024358118.
 Karkhanei B, et al. Evaluation of oxidative stress level: total antioxidant capacity, total oxidant status and glutathione activity in patients with COVID-19. New Microbes New Infect. 2021 Jul;42:100897.
 Valdés-Aguayo JJ, et al. Mitochondria and mitochondrial DNA: key elements in the pathogenesis and exacerbation of the inflammatory state caused by COVID-19. Medicina (Kaunas). 2021 Sep 3;57(9):928.
 Stefano GB, et al. Selective neuronal mitochondrial targeting in SARS-CoV-2 infection affects cognitive processes to induce ‘brain fog’ and results in behavioral changes that favor viral survival. Med Sci Monit. 2021 Jan 25;27:e930886.
 Cumpstey AF, et al. COVID-19: a redox disease-what a stress pandemic can teach us about resilience and what we may learn from the reactive species interactome about its treatment. Antioxid Redox Signal. 2021 Nov 10;35(14):1226-68.
 Komaroff AL, Lipkin WI. Insights from myalgic encephalomyelitis/chronic fatigue syndrome may help unravel the pathogenesis of postacute COVID-19 syndrome. Trends Mol Med. 2021 Sep;27(9):895-906.
 Wood E, et al. Role of mitochondria, oxidative stress and the response to antioxidants in myalgic encephalomyelitis/chronic fatigue syndrome: a possible approach to SARS-CoV-2 ‘long-haulers’? Chronic Dis Transl Med. 2021 Mar;7(1):14-26.
 Campen CL, et al. Orthostatic symptoms and reductions in cerebral blood flow in long-haul COVID-19 patients: similarities with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Medicina. 2022 Jan;58(1):28.
 Davenport TE, et al. Lessons from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome for Long COVID: postexertional symptom exacerbation is an abnormal response to exercise/activity. J Orthop Sports Phys Ther. 2022 Feb [Online]. Available from: https://www.jospt.org/do/10.2519/jospt.blog.20220202/
 Nicolson GL. Mitochondrial dysfunction and chronic disease: treatment with natural supplements. Altern Ther Health Med. 2014 Aug;13(4):35.
 Hernández-Camacho JD, et al. Coenzyme Q10 supplementation in aging and disease. Front Physiol. 2018 Feb 5;9:44.
 Barbiroli B, et al. Improved brain and muscle mitochondrial respiration with CoQ. An in vivo study by 31P-MR spectroscopy in patients with mitochondrial cytopathies. Biofactors. 1999;9(2-4):253-60.
 Hargreaves IP. Coenzyme Q10 as a therapy for mitochondrial disease. Int J Biochem Cell Biol. 2014 Apr;49:105-11.
 Chase M, et al. Coenzyme Q10 in acute influenza. Influenza Other Respir Viruses. 2019 Jan;13(1):64-70.
 Bjørklund G, et al. Chronic fatigue syndrome (CFS): suggestions for a nutritional treatment in the therapeutic approach. Biomed Pharmacother. 2019 Jan;109:1000-7.
 Yaghoubi N, et al. Total antioxidant capacity as a marker of severity of COVID-19 infection: possible prognostic and therapeutic clinical application. J Med Virol. 2022 Apr;94(4):1558-65.
 Maes M, et al. Coenzyme Q10 deficiency in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is related to fatigue, autonomic and neurocognitive symptoms and is another risk factor explaining the early mortality in ME/CFS due to cardiovascular disorder. Neuro Endocrinol Lett. 2009;30(4):470-6.
 Richards RS, et al. Blood parameters indicative of oxidative stress are associated with symptom expression in chronic fatigue syndrome. Redox Rep. 2000;5(1):35-41.
 Castro-Marrero J, et al. Could mitochondrial dysfunction be a differentiating marker between chronic fatigue syndrome and fibromyalgia? Antioxid Redox Signal. 2013 Nov 20;19(15):1855-60.
 Morris G, Maes M. Oxidative and nitrosative stress and immune-inflammatory pathways in patients with Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS). Curr Neuropharmacol. 2014 Mar;12(2):168-85.
 Fukuda S, et al. Ubiquinol‐10 supplementation improves autonomic nervous function and cognitive function in chronic fatigue syndrome. Biofactors. 2016 Jul 8;42(4):431-40.
 Sumbalova Z, et al. Platelet mitochondrial function and endogenous coenzyme Q10 levels are reduced in patients after COVID-19. Bratisl Lek Listy. 2022;123(1):9-15.
 Shao L, et al. Combination therapy with coenzyme Q10 and trimetazidine in patients with acute viral myocarditis. J Cardiovasc Pharmacol. 2016 Aug;68(2):150-4.
 Yin YJ, et al. The effect of coenzyme Q10 plus trimetazidine on acute viral myocarditis treatment. Am J Transl Res. 2021 Dec 15;13(12):13854-61.
 Madsen KL, et al. L-carnitine improves skeletal muscle fat oxidation in primary carnitine deficiency. J Clin Endocrinol Metab. 2018 Dec 1;103(12):4580-8.
 Chee C, et al. Increasing skeletal muscle carnitine content in older individuals increases whole-body fat oxidation during moderate-intensity exercise. Aging Cell. 2021 Feb;20(2):e13303.
 Reuter SE, Evans AM. Carnitine and acylcarnitines: pharmacokinetic, pharmacological and clinical aspects. Clin Pharmacokinet. 2012;51(9):553-72.
 Vermeulen RC, Scholte HR. Exploratory open label, randomized study of acetyl-and propionylcarnitine in chronic fatigue syndrome. Psychosom Med. 2004 Mar 1;66(2):276-82.
 Malaguarnera M, et al. Acetyl L-carnitine (ALC) treatment in elderly patients with fatigue. Arch Gerontol Geriatr. 2008 Mar 1;46(2):181-90.
 An JH, et al. L-carnitine supplementation for the management of fatigue in patients with hypothyroidism on levothyroxine treatment: a randomized, double-blind, placebo-controlled trial. Endocr J. 2016 Oct 29;63(10):885-95.
 Wall BT, et al. Chronic oral ingestion of L-carnitine and carbohydrate increases muscle carnitine content and alters muscle fuel metabolism during exercise in humans. J Physiol. 2011;589:963-73.
 Stefan M, et al. L-Carnitine tartrate supplementation for 5 weeks improves exercise recovery in men and women: a randomized, double-blind, placebo-controlled trial. Nutrients. 2021 Sep 28;13(10):3432.
 Vaziri-Harami R, Delkash P. Can l-carnitine reduce post-COVID-19 fatigue? Ann Med Surg (Lond). 2022 Jan;73:103145.
 Li C, et al. Carnitine and COVID-19 susceptibility and severity: a Mendelian randomization study. Front Nutr. 2021 Nov 25;8:780205.
 Jarrott B, et al. “LONG COVID”- a hypothesis for understanding the biological basis and pharmacological treatment strategy. Pharmacol Res Perspect. 2022 Feb;10(1):e00911.
 Reiter RJ, et al. Mitochondria: central organelles for melatonin’s antioxidant and anti-aging actions. Molecules. 2018 Feb 24;23(2):509.
 Mehrzadi S, et al. SARS-CoV-2 and other coronaviruses negatively influence mitochondrial quality control: beneficial effects of melatonin. Pharmacol Ther. 2021 Aug;224:107825.
 Reiter RJ, et al. Melatonin: highlighting its use as a potential treatment for SARS-CoV-2 infection. Cell Mol Life Sci. 2022 Feb 20;79(3):143.
 Stacchiotti A, et al. Impact of melatonin on skeletal muscle and exercise. Cells. 2020 Jan 24;9(2):288.
 Basha FH, Hemalatha S. Screening the efficacy of melatonin on neurodegeneration mediated by endoplasmic reticulum stress, inflammation, and oxidative damage. Appl Biochem Biotechnol. 2022 Mar;194(3):1105-19.
 Gimenez VMM, et al. Potential effects of melatonin and micronutrients on mitochondrial dysfunction during a cytokine storm typical of oxidative/inflammatory diseases. Diseases. 2021 Apr 14;9(2):30.
 Tan DX, Hardeland R. Targeting host defense system and rescuing compromised mitochondria to increase tolerance against pathogens by melatonin may impact outcome of deadly virus infection pertinent to COVID-19. Molecules. 2020 Sep 25;25(19):4410.
 Crespo I, et al. Melatonin modulates mitophagy, innate immunity and circadian clocks in a model of viral-induced fulminant hepatic failure. J Cell Mol Med. 2020 Jul;24(13):7625-36.
 Farnoosh G, et al. Efficacy of a low dose of melatonin as an adjunctive therapy in hospitalized patients with COVID-19: a randomized, double-blind clinical trial. Arch Med Res. 2022 Jan;53(1):79-85.
 Mousavi SA, et al. Melatonin effects on sleep quality and outcomes of COVID-19 patients: an open-label, randomized, controlled trial. J Med Virol. 2022 Jan;94(1):263-71.
 Wichniak A, et al. Melatonin as a potential adjuvant treatment for COVID-19 beyond sleep disorders. Int J Mol Sci. 2021 Aug 11;22(16):8623.
 Packer L, Cadenas E. Lipoic acid: energy metabolism and redox regulation of transcription and cell signaling. J Clin Biochem Nutr. 2011 Jan;48(1):26-32.
 Salehi B, et al. Insights on the use of α-lipoic acid for therapeutic purposes. Biomolecules. 2019 Aug 9;9(8):356.
 Andrea Moura F, et al. Lipoic acid: its antioxidant and anti-inflammatory role and clinical applications. Curr Top Med Chem. 2015 Mar 1;15(5):458-83.
 Biewenga GP, et al. The pharmacology of the antioxidant lipoic acid. Gen Pharmacol. 1997 Sep;29(3):315-31.
 Packer L. α-Lipoic acid: a metabolic antioxidant which regulates NF-κB signal transduction and protects against oxidative injury. Drug Metab Rev. 1998 Jan 1;30(2):245-75.
 Rochette L, Ghibu S. Mechanics insights of alpha-lipoic acid against cardiovascular diseases during COVID-19 infection. Int J Mol Sci. 2021 Jul 26;22(15):7979.
 Zhong M, et al. A randomized, single-blind, group sequential, active-controlled study to evaluate the clinical efficacy and safety of α-lipoic acid for critically ill patients with Coronavirus Disease 2019 (COVID-19). Front Med (Lausanne). 2022 Feb 4;8:566609.
 Cure E, Cure MC. Alpha-lipoic acid may protect patients with diabetes against COVID-19 infection. Med Hypotheses. 2020 Oct;143:110185.
 Canto C, et al. NAD(+) metabolism and the control of energy homeostasis: a balancing act between mitochondria and the nucleus. Cell Metab. 2015 Jul 7;22(1):31-53.
 Forsyth LM, et al. Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol. 1999 Feb;82(2):185-91.
 Castro-Marrero J, et al. Does oral coenzyme Q10 plus NADH supplementation improve fatigue and biochemical parameters in chronic fatigue syndrome? Antioxid Redox Signal. 2015 Mar 10;22(8):679-85.
 Castro-Marrero J, et al. Effect of coenzyme Q10 plus nicotinamide adenine dinucleotide supplementation on maximum heart rate after exercise testing in chronic fatigue syndrome – a randomized, controlled, double-blind trial. Clin Nutr. 2016 Aug;35(4):826-34.
 Castro-Marrero J, et al. Effect of dietary coenzyme Q10 plus NADH supplementation on fatigue perception and health-related quality of life in individuals with myalgic encephalomyelitis/chronic fatigue syndrome: a prospective, randomized, double-blind, placebo-controlled trial. Nutrients. 2021 Jul 30;13(8):2658.
 Altay O, et al. Combined metabolic activators accelerates recovery in mild-to-moderate COVID-19. Adv Sci (Weinh). 2021 Sep;8(17):e2101222.
 Ouyang L, Gong J. Mitochondrial-targeted ubiquinone: a potential treatment for COVID-19. Med Hypotheses. 2020 Nov;144:110161.
 Yagnik D. Coenzyme Q10 and vitamin D interventions could ameliorate COVID-19 related cellular bioenergetic dysfunction and cytokine storms. J Immunol Sci. 2021 Jul 30;5(3):1-6.
 Pagano G, et al. Potential roles of mitochondrial cofactors in the adjuvant mitigation of proinflammatory acute infections, as in the case of sepsis and COVID-19 pneumonia. Inflamm Res. 2021 Feb;70(2):159-70.
 Shchetinin E, et al. Potential and possible therapeutic effects of melatonin on SARS-CoV-2 infection. Antioxidants (Basel). 2022 Jan 9;11(1):140.
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Marina MacDonald, MS, PhD
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