How Long COVID Can Destroy Your Ability to Exercise: A Closer Look at Mitochondrial Dysfunction & PEM. Ways to Counter the Damage & Reduce Risk

Oct 03, 2024

Long COVID can severely impact one's ability to exercise, and recent research provides insight into why this occurs. For some sufferers, the culprit lies in muscle damage and the body's impaired ability to produce energy efficiently. This post dives into the scientific findings on post-exertional malaise, mitochondrial dysfunction, and potential recovery strategies for those battling long COVID.

Post-Exertional Malaise and Muscle Damage

A study published in January 2024 identified key metabolic disturbances and exercise-induced muscle damage in individuals with Long COVID. This research revealed that long COVID sufferers exhibit severe myopathy, amyloid-containing deposits, and immune cell infiltration in their skeletal muscles, all of which contribute to post-exertional malaise.

They found SARS-CoV-2 nucleocapsid protein in almost all patients and healthy controls. Their results showed that the presence of residual SARS-CoV-2 nucleocapsid protein was similar between patients and healthy controls, and therefore didn’t explain the limited exercise capacity or development of post-exertional malaise (PEM) in patients with Long COVID.

The inability to recover properly from exercise exacerbates symptoms, leaving individuals fatigued and in pain after even minimal physical exertion. However, while the muscle abnormalities and metabolic disruptions explain the symptoms, the molecular mechanisms driving these changes remain unclear.

The suggested response to PEM is to pace yourself. There are varying levels of fatigue after COVID and we are presenting some options to limit the risk and repair the damage. We’ll explore some options in this well-sourced review.

If you're able, please consider upgrading to a paid subscription to help sustain this work. Many articles are shared with all subscribers right away, but for more time-intensive research, paid subscribers receive early access until we can expand the base. By becoming a paid subscriber today, you’re helping towards the goal of making every article available to everyone as soon as it's published. Your support truly makes a difference!

Disclaimer: This blog post is intended for informational purposes only and does not constitute medical advice. Always consult with your healthcare provider before making any decisions related to your health or treatment.

The Role of Mitochondrial Dysfunction

Mitochondria, the powerhouse of the cell, play a vital role in generating energy through oxidative phosphorylation. When mitochondrial function is disrupted, the body struggles to produce the energy required to power cellular processes. Muscle, brain, and kidney cells, which have high energy demands, are particularly vulnerable to mitochondrial dysfunction.

Studies have shown that COVID-19 can directly damage mitochondrial function, leading to oxidative stress and the loss of cellular energy. This disruption also impacts calcium regulation, cellular signaling, and the immune response. SARS-CoV-2 proteins, which reside in the mitochondrial matrix, contribute to this dysfunction, leading to a cascade of effects, including cell death and widespread inflammation.

Coenzyme Q10 (CoQ10) and Mitochondrial Recovery

Research suggests that CoQ10 may play a crucial role in restoring mitochondrial function. As an essential electron carrier in the mitochondrial respiratory chain, CoQ10 helps to maintain energy production and protect cells from oxidative damage. Supplementation with CoQ10 has been shown to activate mitochondrial functions, delay cellular aging, and boost antioxidant defenses.

A study on patients with long COVID revealed that 62% experienced mitochondrial changes, including a loss of cytochrome c oxidase activity, which is essential for ATP production. By enhancing mitochondrial function and offering antioxidant protection, CoQ10 supplementation may support recovery in individuals with Long COVID .

PQQ and Mitochondrial Biogenesis

Pyrroloquinoline quinone (PQQ) is another promising nutrient for supporting mitochondrial health. PQQ promotes mitochondrial biogenesis, the process by which new mitochondria are created. In both animal and human studies, PQQ has been shown to increase mitochondrial numbers, enhance lipid metabolism, and protect against oxidative stress.

In individuals with Long COVID, where mitochondrial function is compromised, PQQ may help boost energy production and reduce the oxidative damage that impairs cellular performance. This combination of CoQ10 and PQQ could be a potential therapeutic strategy for alleviating Long COVID symptoms.

Plants absorb PQQ from the bacteria in the soil. They use it to grow, which is then found in fruits and vegetables. It naturally exists in lots of different foods, including:

Fermented soybeans, or natto
Green peppers
Kiwi
Parsley
Tea
Papaya
Spinach
Celery

It’s also often found in breast milk. This is probably because it is absorbed from the fruits and vegetables consumed and passed into milk.

Practical Recovery Strategies and Preventative Measures

For those recovering from or aiming to prevent long COVID, several lifestyle and dietary strategies can help:

Supplementation: Taking CoQ10, PQQ, zinc, quercetin, and vitamins D3/K2, C, and B-complex may support immune function and aid mitochondrial recovery.
Masking and Ventilation: High-quality N95 masks remain a crucial defense against infection, and improving ventilation in indoor spaces can reduce the risk of viral spread.
Pharmacological Interventions: Metformin has been found to reduce the risk of Long COVID by up to 60% when taken early after infection, offering a potential way to mitigate the risk if infected. “People with COVID-19 who took metformin were 42% less likely to end up in the emergency department, hospitalized, or dead. The effect was even greater when the researchers focused on the numbers for hospitalization or death — a 53% reduction with metformin.”(14)

Conclusion

Long COVID’s impact on exercise ability can largely be traced back to muscle damage and mitochondrial dysfunction. With ongoing research uncovering the molecular mechanisms behind these effects, strategies like CoQ10 and PQQ supplementation, alongside preventative measures to avoid making symptoms worse, offers hope for reducing risk and aiding recovery. As we continue to learn more about Long COVID, understanding these biological processes will be key to developing effective treatments. While more research is needed to definitively establish their effectiveness in treating Long COVID-related PEM, CoQ10, and PQQ offer hope for restoring mitochondrial function and improving energy levels.

Staying Safe and Informed:

The COVID-19 pandemic is still ongoing, and protecting yourself remains crucial. N-95 or similar quality masks offer the best personal protection. If you test positive, consider these tips:

Ventilate your space: Open windows to improve air circulation.
Use Air Purifiers with HEPA filters: Reduce the risk of infection by 20% in classrooms and if infected help reduce the amount of virus people are exposed to.
Gargle with a mouthwash that has CPC: This may help reduce viral load in the mouth and throat.
Use saline nasal spray before being around people: this can help prevent infection.
Use saline nasal rinse: This can help flush out the virus from the nasal passages.
Prioritize hydration and sleep: These are essential for immune function.
Consider supplements: Zinc, quercetin, Vitamins D3/K2, Vitamin B complex, and Vitamin C may offer immune support.
Talk to your doctor about Metformin: Studies suggest it may reduce the risk of Long COVID.

National Geographic: Long COVID can destroy your ability to exercise. Now we know why. (February 15, 2024) https://archive.ph/2024.02.15-175415/https://www.nationalgeographic.com/premium/article/post-exertional-malaise-me-cfs-exercise-energy
"Muscle abnormalities worsen after post-exertional malaise in long COVID," (January 4, 2024). https://archive.ph/dWwok
"Mitochondrial Dysfunction in Long COVID," NCBI (2023). Link
"Possible Pathogenesis and Prevention of Long COVID: SARS-CoV-2-Induced Mitochondrial Disorder," NCBI (2023). Link
"Mitochondrial Changes and Recovery in Long COVID Patients," NCBI (2022). Link
Coenzyme Q10 as a therapy for mitochondrial disease Link: https://pubmed.ncbi.nlm.nih.gov/24495877/
Coenzyme Q10 Supplementation in Aging and Disease (Feb 4 2018) https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2018.00044/full
"CoQ10 and Mitochondrial Recovery," Research on CoQ10 (2024).
"The Benefits of PQQ for Mitochondrial Health," PQQ Research (2024).
Dietary pyrroloquinoline quinone hinders aging progression in male mice and D-galactose-induced cells (February 28, 2024) https://www.frontiersin.org/journals/aging/articles/10.3389/fragi.2024.1351860/full
Pyrroloquinoline quinone (PQQ) protects mitochondrial function of HEI-OC1 cells under premature senescence (April 19, 2022) https://www.nature.com/articles/s41514-022-00083-0
"Preventative Strategies and Recovery Tips for COVID," Metformin and COVID (2024).
What to Know About PQQ Supplements (May 12, 2023) https://www.webmd.com/vitamins-and-supplements/what-to-know-about-pqq-supplements
“Can Metformin Treat COVID-19 and Prevent Long COVID? NCATS and Partners Pursue Answers” (Sept 18, 2023) https://ncats.nih.gov/news-events/news/can-metformin-treat-COVID-19-and-prevent-long-COVID-NCATS-and-partners-pursue-answers