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Cause of long COVID has finally been identified

Ever feel like you just can’t shake off that lingering fatigue even after recovering from COVID? You’re not alone. Millions of people experience long COVID, a frustrating collection of symptoms that persist long after the initial infection. Now, research from the University of Cambridge suggests a surprising culprit: low iron levels.

Sources of iron

Iron is an essential mineral that plays a crucial role in the production of hemoglobin, a protein in red blood cells that carries oxygen from the lungs to the rest of the body. Iron is also important for growth, development, normal cellular functioning, and synthesis of some hormones and connective tissue.

We get iron from certain plant and animal foods, such as red meat and poultry. Plant-based sources contain non-heme iron, which is not absorbed as efficiently as the heme iron found in animal products.

However, you can enhance the absorption of non-heme iron by consuming it with vitamin C or with animal proteins. COVID can disrupt how the body manages iron, causing either iron deficiency or abnormal iron storage. This can make the infection worse and affect recovery.

Characteristics of long COVID

The researchers closely studied a group of 214 people for one year after they first experienced symptoms of COVID-19. 

The experts analyzed various aspects of the participants’ health, including how much inflammation they had, how much iron was in their blood, how genes related to iron management were working, and how well red blood cells were being produced. 

By comparing this information, the researchers were able to identify a specific set of characteristics of long-term COVID-19.

Inflammation and anemia

Many people involved in the study continued to have inflammation and signs of anemia, a condition where the body has fewer red blood cells, for up to a year. 

Anemia can make people feel tired and weak because the body’s tissues do not get enough oxygen. This is a frequent complaint among people with long COVID.

The ongoing inflammation suggests that the body’s immune system is still active even though the initial infection is gone.

COVID and abnormal iron levels 

The study revealed that individuals with long COVID had abnormal iron levels, suggesting an imbalance in how their bodies handle iron.

Additionally, the researchers identified changes in genes that control iron management, indicating that COVID-19 might disrupt these regulatory mechanisms.

This link implies that problems with iron management might play a role in how long COVID develops and how severe the symptoms become. 

Low iron and COVID recovery

The study showed signs of a process called “stress erythropoiesis” in people with long COVID. This is when the body tries to quickly make more red blood cells in response to stress or inflammation, like an infection. The study suggests this process might not work properly in some people after a COVID-19 infection. 

“If this goes on for a long time, there is less iron for red blood cells, so oxygen is transported less efficiently, affecting metabolism and energy production, and for white blood cells, which need iron to work properly,” said study co-author Hal Drakesmith from the University of Oxford. “The protective mechanism ends up becoming a problem.”

The researchers noted that there could be a role for iron supplementation during the acute phase of COVID-19 infection, as well as a role as potential treatment for long COVID.

Symptoms of long COVID

The condition can cause a variety of health problems that last for months. Many people with long COVID experience extreme tiredness, even after they rest. They may also have trouble concentrating, remembering things, and focusing, which is sometimes called brain fog

Other common symptoms include shortness of breath, chest pain, and difficulty doing activities that were easy before, like walking or climbing stairs. Individuals with long COVID may experience heart problems like heart palpitations, chest pain, or a fast heart rate. It can also cause ongoing pain and aches in muscles and joints.

Some people lose their sense of taste or smell, and these senses may not come back completely. Others have trouble sleeping, either because they have trouble falling asleep, staying asleep, or their sleep is not refreshing. They may also experience mood swings, anxiety, or depression. In addition, digestive problems like nausea, diarrhea, stomach aches, or loss of appetite may also persist.

Another symptom of long COVID is post-exertional malaise, which means that a person’s symptoms get worse after they do physical or mental activities. All of these problems can make it difficult for people to participate in daily activities.

Recovering from long COVID

If you’re experiencing long COVID, here are some steps you can take to improve your overall well-being:

Talk to your doctor

It’s important to get a complete evaluation from a healthcare professional to rule out other possible conditions and develop a personalized treatment plan tailored to your specific needs.

Manage your symptoms

This may involve using medication for pain relief, breathing exercises to improve lung function, or other therapies depending on your specific symptoms.

Consider physical and cognitive rehabilitation

Physical therapy and graded exercise programs can help manage fatigue and improve physical function, while cognitive rehabilitation techniques can address brain fog and other cognitive issues.

Prioritize a balanced diet

Eating a healthy and balanced diet can help manage your symptoms and support your overall health. In some cases, your doctor may recommend supplements to address any nutritional deficiencies.

Seek mental health support

Don’t hesitate to seek help if you’re struggling with anxiety, depression, or other emotional challenges associated with long COVID. Therapies like Cognitive Behavioral Therapy (CBT) can be very helpful.

Pace yourself and manage your energy

Learn to listen to your body and pace your activities to avoid pushing yourself too hard and experiencing worsening symptoms. Balance rest and activity to manage your energy levels effectively.

Be patient and adaptable

Long COVID can be unpredictable, and your symptoms may fluctuate over time. It’s important to monitor your progress and adjust your treatment plan as needed in collaboration with your doctor.

Stay informed

Research on long COVID is ongoing, and new treatment options may become available in the future. Stay informed about the latest developments through reliable sources.

Remember, long COVID affects everyone differently. The key is to find a personalized approach that helps you manage your symptoms and improve your quality of life.

The study is published in the journal Nature Immunology.


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