How Covid-19 and Long Covid Wreck Your Digestive System

15 Feb

Introduction to COVID-19 digestive symptoms

It would be safe to say by now we are all familiar with Covid-19, also known as Sars Cov-2, and the common symptoms it causes.

As a reminder, these symptoms include a high temperature, cough, breathlessness, and sore throat.

Although the above symptoms are largely respiratory, Covid-19 also causes gut symptoms.

Some studies show that up to a third of patients present with common gut symptoms like loss of appetite, diarrhoea, vomiting, and stomach pain.

Common gut symptoms caused by Covid-19 include loss of appetite, bloating, diarrhoea, vomiting, and stomach pain.

Because these are widespread symptoms, it might sometimes be difficult to say for sure if they have been caused by Covid-19.

Gut Symptoms Without Covid-19 Infection

Before we proceed, it is worth pointing out that the uncertainty and worry during the pandemic have the potential to cause stress and anxiety.

This in itself can have a negative impact on your brain and microbiome, thus leading to some of the gut symptoms we will discuss in the coming sections.

Why Does Covid-19 Make Me ill?

We know Covid-19 triggers the immune system to cause widespread or systemic inflammation.

This can in turn affect multiple body systems to varying degrees and severity based on age and risk factors.

How Does Covid-19 Cause Gut Symptoms?

We know that Covid-19 gains entry into our cells using a receptor called ACE2.

The ACE2 receptor is also found in gut cells, and so naturally enters these as well.

Also, Covid-19's genetic material (mRNA) has been found in stool samples, although we still aren't sure (at the time of writing) if transmission of the virus could occur via the faecal-oral route.

Interestingly, some patients only have the above gut symptoms without ever developing the classic respiratory symptoms.

In some cases, patients present with both gut and respiratory symptoms either at once or days apart.

I remember a few of my disgruntled NHS patients whom I had advised they get tested after presenting with gut symptoms.

"I know it is not Covid Dr"

To fully appreciate how Covid-19 affects the gut, it is helpful to describe various clinical scenarios based on the severity of the disease.

Mild Infection

This is a common scenario that occurs without you even realising your symptoms are Covid-19-related.

You might get a few days of either loss of appetite, bloating, diarrhoea, vomiting, or stomach ache.

Your symptoms then resolve after a few days and you are in the clear.

Moderate Infection

With moderate infection, your symptoms are a little more severe and you might end up in the hospital for either a chest infection (pneumonia), continuous diarrhoea, vomiting, or stomach pain.

Many patients get prescribed antibiotics and steroids (prednisolone) for a chest infection, proton pump inhibitors (Eg, Omeprazole, Lansoprazole) to help settle the stomach, or painkillers usually to take home.

Some studies have shown that even a single course of antibiotics has the potential to cause lasting deleterious effects on your microbiome.

However, this is a case where antibiotics are warranted!

Also taking proton pump inhibitors long term can lead to chronic low acid, (achlorhydria), potentially resulting in mineral deficiencies especially B12, dysbiosis, and small intestinal overgrowth (SIBO)

So in essence, you might end up with gut symptoms not directly from Covid-19, but indirectly from the drugs used to treat you while in hospital.

Severe Infection

Symptoms here are much more severe, often requiring admission to the hospital or the intensive care unit. (ICU)

Typically, you will be prescribed high doses of antibiotics, proton pump inhibitors, steroids (Dexamethasone), and an antiviral, like Remdesevir.

In addition to the potential side effects of antibiotics and proton pump inhibitors already discussed above, you might also develop side effects from the steroids.

Steroids like prednisolone can lead to chronic lack of sleep (insomnia), which can alter the gut microbiota, leading to systemic inflammation and insulin resistance.

Lack of sleep also affects two hormones in the body that regulate hunger, namely ghrelin and leptin.

Ghrelin and leptin have opposite effects. Ghrelin stimulates appetite, while leptin suppresses it.

If you are sleep-deprived, your level of ghrelin increases, while your level of leptin reduces.

The overall result is an increase in hunger, and consequently weight gain.

Lastly, high dose steroids can increase blood sugar levels, leading to insulin resistance and even diabetes.

This can ironically further weaken your immune system and make you prone to even more infections either by Covid-19 or others.

I have personally seen three of my NHS patients end up diabetic after prolonged steroids during this pandemic alone.

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Long Covid and Gut Symptoms

First, it is important to understand what long Covid is.

The term long Covid is used to describe a cluster of ongoing symptoms that carry on for weeks or months after the initial acute symptoms have subsided.

A commonly used term to describe patients with long Covid is long haulers.

Typically, a patient with long Covid would have largely recovered and even tested negative, only to start getting ongoing brewing symptoms spanning all body systems.

Long Covid symptoms have been likened to the clinical picture seen in mast cell activation syndrome (MCAS), chronic fatigue syndrome (CFS)/myalgic encephalitis (ME) as well autoimmune disorders.

Although these symptoms might seem baffling to many conventional doctors, millions of patients have complained for years with similar symptoms following other viral or even bacterial infections.

Unfortunately, many have been dismissed as being depressed or even insinuating it was all in their head.

Now, we know Covid-19 does cause gut inflammation and likely to affect the gut's microbiome to cause dysbiosis.

The term dysbiosis describes an alteration in the balance of your gut bacteria, causing harmful species of bacteria and fungi like Candida Albicans to overgrow.

Dysbiosis can lead to multiple issues from food cravings, obesity, and autoimmune conditions like inflammatory bowel diseases, diabetes, as well as anxiety, and depression.

Over the last 6 months or so in my private practice, I have seen numerous altered microbiome profiles in many of my clients who were previously fit and healthy before infection with the virus.

Many had now presented exhausted, with a list of complaints, including gut symptoms.

How Do I Treat My Gut Symptoms From Covid-19?

Chronic gut symptoms in general can be a challenging area, especially from a conventional medicine point of view.

This is because, between GPs and specialists, we have limited tools at our disposition besides a few blood tests, standard stool tests, and camera tests (Sigmoidoscopy or colonoscopy)

As both a GP and functional medicine doctor, I can say with absolute certainty you will get the best results using the functional medicine approach.

To successfully treat your gut symptoms from Covid-19, you will need an appreciation of the fact that the human body operates as a whole, while also employing a personalised approach.

In essence, this means a thorough history, exploring not only your gut symptoms but further exploring your medical history starting from birth.

In all cases, you will need an advanced comprehensive polymerase chain reaction (PCR) stool test that provides a complete picture of your microbiome.

In my opinion, this forms the foundation, over which you can add any other relevant tests depending on what you uncover.

Your treatment plan then follows that would be personalised for you.

Conclusion

As we have seen, Covid-19 can cause a myriad of symptoms including gut symptoms.

These occur due to stress during the pandemic, as well as infection from covid-19, ranging from mild to severe.

So, healthy eating, mindfulness, and exercise will go a long way to help reduce stress levels, boost resilience, and ultimately protect your gut.

Please share this article with anyone you know might benefit, and if you have any questions, please feel free to get in touch.

Thank you!