*When we push ourselves too hard, our immune system cannot keep us healthy. This article gives practical advice on recognizing stress and what to do about it.*

February 14, 2024

Self-care is essential for Long COVID recovery, symptom management, and to minimize the risk of additional or worsening complications.

Things you can do to help yourself.

**Nutrition: Try to eat protein and fresh vitamin rich foods daily and avoid chemicals, preservatives, sugars, fast foods, prepared foods and high histamine foods.** Don’t skip meals. Your body needs protein , vitamin C, and vitamin D to heal from any injury or illness. A low histamine or low carbohydrate (sugar) diet is recommended by doctors treating Long COVID (PASC), and many people report a reduction in symptoms within 1-3 days of the diet change, including decreases in sneezing, itching or hives, irritable bowel syndrome, body pain, along with a reduction in swelling and inflammation.

**Hydration: A minimum of eight 8 oz glasses of plain water daily is recommended.** Avoid drinks with chemical additives. You can easily make a fresh electrolyte drink yourself by adding a dash of mineral rich Epsom salt and a piece a fruit like a raspberry for flavor instead of spending money on commercial drinks like Gatorade that contain chemicals and sit in plastic bottles for long periods of time. Remember that caffeine and alcohol have dehydrating effects.
**Sleep hygiene**: **Getting 7-9 hours of sleep so your body can repair itself. You need at least 4 hours of uninterrupted sleep to get into the restorative phase of sleep.** Avoid stimulating activities after dinner like thrilling movies or books, arguments, negative news or frustrating stimuli.
If you wake up frequently or with a startle, you may be experiencing drops in your oxygen level, which signal your brain to release adrenaline to force you to take a breath. This could be a temporary inflammation issue or more enduring ***sleep apnea***. Ask your doctor for a sleep study to evaluate your need for a CPAP or BiPAP, a machine that pushes air into your lungs when it senses an apneic episode (periods of not breathing).
**Stress management:** **Stress affects every component of your life.** The only thing you can control about stress is your reaction to it. Try to avoid or minimize your exposure to stressful situations: Turn off the news, make family visits that end unpleasantly short, wait for the morning to have intense discussions, let go of things that annoy you but don’t really matter in the big scheme of things, avoid intense conversations or entertainment in the evening.
**Exercise within tolerance**: **Pace yourself and do not push your body to extremes in any way.** For some this may mean seated breathing exercises, walking to the mailbox. Rest when your body says to slow down. Gradually build on your activity endurance as your body cues you to progress. This can be hard to gauge, because when you feel good you naturally do more, but if you do too much you may experience symptom flare ups 1-3 days later as the post exertion inflammation builds. Some people describe this as post exertional malaise, others experience severe recovery set backs.
**Breathwork**: **You can literally *stop the fight or flight reaction* by taking slow deep breaths.** Deep slow breathing shuts down the adrenaline flow, slows your heart rate, lowers your blood pressure and decreases stress related histamine release. When you do this, your blood reroutes back to your brain and nervous system to allow you to think clearly. It also allows your body to use its energy and oxygen to heal your inflamed nerves and organs.

Minimize physical and mental stress

Minimizing stress is critical because your body cannot heal when it is using its energy to cope with stress because it senses a physical or psychological threat.

No matter what the stressor is, your body reacts the same way, by releasing adrenaline and other stress hormones that change the way your body is functioning. This is called the fight or flight reaction, which is a protective response to danger, regardless of what the danger is such as:

Reading an upsetting article
Arguing with someone
An accident or a threat of an accident
A threat to your life
Fear about being sick, losing your job, an animal… anything that causes fear
Frustration, concern or worry about family, kids or friends
Extreme or rigorous exercise
Small things you react to quickly like spilled milk or burning your finger.

No matter what the stressor is, the fight or flight activation is physically triggering histamine release and diverting your energy and oxygen from its normal pathways that supply your brain and organs with oxygen to you large muscles in preparing to run or defend yourself.

How does COVID-19 cause this?

COVID triggers an immune response that releases of cytokines, the chemicals that normally fight infection and keep you healthy. But COVID interferes with the cytokine control mechanism, so it doesn’t know when to turn off, leading to cytokine storm.

In turn, the cytokine storm leads to mast cell activation syndrome (MCAS) and the body starts to over produce histamines that cause inflammation of the brain, nervous system, organs and tissues. This is called multiorgan inflammation syndrome (MIS). MIS-C refers to children, MIS-A refers to adults.

Histamines are chemicals that occurs naturally in the body and some foods. They normally regulate the body’s response to foreign substances and injury, and are involved in things like allergies, stress reactions and inflammation in the human body.

Minimizing physical and psychological stressors is essential in recovery from Long COVID.

Take control of your health care.

There are proactive actions you can take to support your own health.

You can ask your doctor to check your bloodwork including complete blood count (CBC), electrolytes, ferritin, a full iron panel, a full thyroid panel including reverse T3 and reverse T4, metabolic profile, cholersterol , C-reactive protein (CRP), ANA, rheumatoid factor, D-dimer, cytokine inflammatory markers interleukin-6 and interleukin-1b, along with kidney function tests.

Most Western medicine doctors are experts in diseases, medications, diagnostic testing, and surgery. They may not be aware of alternative or natural options.

It’s important to take a collaborative approach in which you advocate for yourself, ask questions, and bring your ideas based on scholarly research you have found to the MD.

Keep in mind, you cannot expect them to have expertise in areas like herbal and homeopathic remedies. Think of it like this - you wouldn’t ask your doctor to fix your car or your mechanic to perform surgery on you. That is not their specialty.

If your MD doesn’t have answers to your questions, it can be a good idea to look for functional medicine providers or complimentary health approaches such as Chinese Medicine, acupuncture, chiropractic, massage therapy. For example, if you want to know about herbs and supplements, talk to a Chinese medicine doctor, naturopath or nutritionist. If you need doctors who understand and treat long COVID in the US and Canada, consider our providers of choice, The Wellness Company .

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Keep moving, keep breathing.

Brought to you by covidCAREgroup, connecting the dots of long COVID through education, research and resources.

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COVID Care Group, LLC is not a healthcare provider and does not provide medical advice, diagnosis, or treatment. If seeking medical treatment, contact The Wellness Company.