Probiotics for long covid?
COVID and the microbiome
There is now clear scientific evidence that SARS-CoV-2 infection can lead to a long-term disruption of the friendly bacteria in our digestive tracts. These billions of bacteria and other microbes living in the intestinal tract are known as the ‘microbiome’, and they help control our immune system, regulate inflammation and generally support our health.
When the microbiome is disrupted by COVID-19, it consists of a change in the number and types of bacteria present in the digestive tract. Beneficial bacteria (commensals) tend to decrease, and potentially harmful bacteria (pathogens) tend to increase. As a direct result of fewer beneficial bacteria, fewer short-chain fatty acids are produced, which then leads to increased inflammation in the gut.
Having more harmful bacteria in the gut can lead to opportunistic infections, for instance post-COVID subjects have been shown to have more antibiotic-resistant Enterobacter and Klebsiella bacteria in their digestive tracts.
A very recent study showed that severe COVID-19 not only resulted in gut microbiome dysbiosis, but also a compromised intestinal mucosal barrier, often referred to as ‘leaky gut’. When this happens, harmful proteins, toxins and bacteria can pass from the digestive tract into the bloodstream.
What are probiotics?
Probiotics contain live microorganisms that, when consumed in adequate amounts, provide health benefits, particularly by improving gut health. The beneficial properties of consumed probiotics have been demonstrated in the treatment of several conditions and diseases, including allergies, diarrhoea, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), infections, and infant colic, as well as certain forms of cancer. Anyone interested in taking a deep dive into the latest science behind probiotics should take a look at this 2023 research paper.
Is there a role for probiotics to help with long covid?
There is some solid evidence that taking probiotics can help with acute SARS-CoV-2 infection. Studies have shown that probiotics can help reduce diarrhoea, decrease time in hospital , shorten viral clearance time and reduce overall mortality.
Whilst there is currently less evidence showing that probiotics help with long covid, there has been some promising research.
One study in March 2024 in Hong Kong used a combination of probiotics and prebiotics to treat long covid patients. After 6 months, the patients taking the combination experienced improvements in their fatigue, memory loss, concentration difficulty, gastrointestinal difficulties and general wellness.
The probiotic used in the study was a commercial product called SIM01 , which contains three types of Bifidobacterium (Adolescentis, bifidum, and longum) The prebiotic, which was included to help the beneficial bacteria grow, included galacto-oligosaccharides, xylo-oligosaccharides, and resistant dextrin.
Another 2021 study in the UK looked at using probiotics with people who had been suffering from ongoing symptoms following COVID infections for an average of about 4 months. Like the previous study, they used both a probiotic and a prebiotic. This time the probiotic contained different strains of lactobacillus, and the prebiotic used was called inulin.
The study showed that cough, fatigue and subjective well-being scores significantly improved in patients who took the combination for 30 days.
The daily dose (from 2 capsules) was 200 mg of Inulin and 10 Billion Colony Forming Units (CFU’s) of Lactobacillus plantarum (Lp90), Lactobacillus rhamnosus (LRa05), Lactobacillus bulgaricus (LB42), Lactococcus lactis (La61), Lactobacillus paracasei (LC86).
In addition to the 2 studies above, there is also some less direct supporting evidence for probiotics and long covid. One study in 2022 suggested that probiotics would help with the psychiatric manifestations of long COVID, particularly anxiety, depression, and post-traumatic stress disorder (PTSD). This was because there is already lots of published research showing the success of probiotics in improving mental health.
Similarly, researchers have highlighted that there has been some success with helping patients with the gut dysbiosis seen with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). As long covid has many symptoms shared with ME/CFS, on this basis it is believed that probiotics will also prove useful for long covid patients.
Importantly, as I’ve covered in previous blogs, I regard the research looking at acute SARS-CoV-2 infection relevant to long covid as well. This is because a leading theory for the mechanism of long covid is the persistence of small pieces of the SarsCov2 virus (the spike proteins) remaining in the body long after the initial infection is over. In a scientific paper published only last month, this is still regarded as one of the leading theories, and is referred to as ‘the presence of remnants of viral elements’.
As I’ve also covered in previous blogs, it is possible that spike proteins from both covid infection and covid vaccines can linger in people’s bodies for months and even years.
Which probiotics might be useful?
Research has shown that the following types of friendly bacteria are less plentiful in patients following a SARS-CoV-2 infection, it follows therefore, that you should be looking to replenish these specific types of bacteria;
Bifidobacterium
Faecalibacterium
Lactobacillus
There are a number of possible sources for these bacteria, some natural and some found in commercial probiotic products. Natural sources include fermented foods, for which there is ample evidence of general health promoting effects, but currently no specific evidence with regard to helping with long covid.
Kefir - Bifidobacterium & Lactobacillus
Kimchi - Lactobacillus
Kombucha - Bifidobacterium & Lactobacillus
As for commercial probiotic products, research has also shown that supplementing with products containing the following types of bacteria has proven helpful with COVID patients;
Bifidobacterium
Lacticaseibacillus
Lactobacillus
Streptococcus (thermophiles)
Bacillus (cereus & subtilis)
Enterococcus faecium
Regarding which brand of commercial probiotic to try, most brands include strains of lactobacillus and bifidobacterium bacteria, so most in theory should be appropriate. In the 2 studies covered earlier, one study used multiple Bifidobacterium strains, and another used multiple Lactobacillus strains.
As for daily dosage, 10 Billion Colony Forming Units (CFU) was used in one study, and 20 Billion CFU in the other.
Both studies used their probiotics in combination with prebiotic compounds to help support the growth of the beneficial bacteria. One study used a prebiotic called Inulin, which is widely available and is inexpensive.
For those people looking for commercial probiotics backed by some scientific research, one of the studies shown earlier used a product called SIM01, which is available in the UK, but is quite expensive. In addition, one of the most heavily researched probiotic products is called Visbiome, which used to be called VSL#3. This product contains one strain of Streptococcus thermophiles, three strains of Bifidobacteria, and four strains of Lactobacilli.
Safety of probiotics
Probiotic supplements are generally considered safe for most people, but they can have side effects, particularly in the initial stages of use or in individuals with certain health conditions.
In the UK long covid study mentioned earlier, the only adverse reactions noted were mild increased bloating and diarrhoea which happened to 1.5% of the patients involved.
In particular, immunocompromised people need to be cautious about using probiotics as they contain live bacteria. If you are unsure about whether you should try probiotics then consult your doctor first.
If someone is unable to take probiotics, they could consider using something called ‘parabiotics’ which instead of live bacteria use inactivated parts of bacteria instead. There is even some evidence that parabiotics help long covid patients with neurologic symptoms like dysautonomia, fatigue, and depression.
Summary
There is now strong evidence that following SARS-CoV-2 infection the balance of our microbiomes (the bacteria in our digestive tracts) is upset, often on a long-term basis. Studies have shown that using probiotics can help address acute covid infections, and evidence is beginning to emerge that also supports probiotic use for long covid (Post-Acute COVID-19 Syndrome (PACS)) The research so far has supported combining probiotics with prebiotics to help the beneficial bacteria grow.
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Cliff Russell, Registered Osteopath
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