With the onset of Long Covid in March 2020 I gained substantial constipation, bloating and pain throughout my large intestine. I initially had to go onto a FODMAP diet. Alongside that I found it difficult to eat and I had to eat protein shakes. This is my short take on the things I have found useful and I think have improved my gut function so that I can tolerate more foods today. While I would love to write more with my references to do the topic justice its going to have to be a work in progress and my readers will prefer a brain fog friendly version anyway.

Testing

I did a Biomesight test and this gave me a lot of information on what to improve.

• They were at some point doing a Covid Long hauler study and discount that might be worth looking for to halve the price.
• The overall reports and food/supplement recommendations are useful.
• There is a lot of value in digging into the advanced lists, looking at the bacteria as a very high and low percentage and learning about those species you are most different to normal.
• The overall report and recommendations miss the rare details on particular problems and those matter and will require some research.

Food

Protein Powders

I tried a variety of protein powders as I had too much fatigue to eat real foods quite often.

• Pea and Soya plant based - Very bad so much pain and bloating.
• Whey Protein - Better but still uncomfortable to eat.
• Whey Protein isolate - This is the best I found, I used Bulks protein powders.
• Collagen Peptides - Tolerated well and seem to help joint and upper back pain.

Kefir

Kefir was one of the first probiotic foods I introduced.

• Many store bought Kefirs are low ferment time, have added sugar and other additives and are pasteurized.
• The laws regarding food safety in the EU drive a lot of the issues with real probiotic foods, both quantity of bacteria and species.
• Best off making it yourself in a Kefirko with grains and whole milk.
• The jar needs to let it breath and you need to filter the grains from the yoghurt so I like the Kefirko as it made that easier.
• The lactose gets eaten by the bacteria, if its just getting the point where its splitting most of the lactose will be gone.
• Don’t add honey or any other natural antibacterials as you’ll kill the bacteria.
• Its quite sour but if you want to sweeten it use Dextrose.
• Start with a tiny amount, a teaspoon or even less and work up slowly and throw the rest away.
• It requires making daily you wont need more than half a jar and you’ll need to take it for months.
• This cured my lactose intolerance and improved my gut function overall.

If you find Kefir horrible to drink try making overnight oats.

• Some rolled oats
• Some fruit like blackberries or blueberries
• Chia seeds or flax seeds
• Leave in a sealed jar in the fridge overnight.

Fermented veg

Kimchi

• worked quite well for me. A lot of store bought is pasteurized.
• Get something fresh that goes off in a week not a sealed jar.
• Quite a few studies showing Kimchi helps with gut health and the microbiome.

Sauerkraut

• This didn’t work for me at all, just made me worse. The studies suggest Kefir is better.

Yoghurt

Store bought

• Yoghurt is a defined as a particular pair of species (Streptococcus thermophilus, Lactobacillus often L. bulgaricus) in the EU.
• A lot of store bought yoghurts contain very little bacteria as they are pasteurized.
• Store bought yoghurt is often not fermented very long and instead thickened with emulsifiers since its cheaper.
• They often ferment one cycle (3 hours) then pasteurize and add in tightly controlled species in afterwards.
• This often means store bought yoghurt isn’t very rich in bacteria, for food safety and shelf life reasons.

Making fermented yoghurt like at home

• Super Gut is a great book on this and has some recipes for fermented milk based on human variety bacteria that will colonise the gut and have various positive effects.
• I personally use L Reuetri from Biogaia but I have solid tablets not chewable ones. Not sure if they still make those.
• I crush up the tablet, add 8 teaspoons of Dextrose to about 1L of milk and ferment for 36 hours at 37 C on a homcom yoghurt maker.
• For future yoghurts you just take 8 teaspoons from the previous yoghurt batch in place of the tablets, it works better after a few cycles.
• My biomesight results show this is colonising my gut and is now a resident.

Intolerant foods

• For over a year I was intolerant to a lot of foods.
• Some were fixed by the biotics of various types but some required me to reintroduce them.
• I started in tiny quantities, a teaspoon or less.
• Every day I would eat a sauce pot containing a number of foods I was trying to introduce.
• I made them in a weekly batch and kept them in the freezer, defrosted them in the microwave and ate them alongside another meal.
• If I got issues I would take in something else with the same FODMAP group (Broccoli instead of Cauliflower) that was less impact.

Food preparation generally

• When you have an energy limiting disease with a lot of intolerances you will want to batch food.
• I use 7 glass freezer/microwaveable food containers.
• Use precut frozen vegetables and just split them between the pots.
• Add a sauce, I found a blackbean sauce that I tolerate well, and put them in the freezer.
• Meal time becomes defrost in the microwave and then heat and then top with kefir and anything else you want to add.
• I often just froze the vegetables and sauce and added Sardines, Tuna and ham before heating.
• Sriracha was another common addon as it helped clear my sinuses.

Pills and Powders

Probiotics

• A lot of probiotics are plant based bacteria. They don’t colonise the gut.
• They will travel through and still act on the food we eat and change the biome and then leave within a couple of days.
• A lot of the studies are based on very particular species of probiotic.
• Often when you buy a commercial probiotic its not the right species and this can dramatically change the impact.
• Its expensive and hard work to find the right probiotics like Biogaia.
• To get them in quantity for the long term to colonise you need to work out how to cultivate them in fermented milk to get the quantity you really need.
• Some probiotic products made my gut worse, some better. None of the usual Amazon combinations of bacteria stayed colonising and improving my biome for the longer term.

Prebiotics

• My biomesight recommended various foods and prebiotics that would grow particular species.
• One of the oddest results is that cold Oat bran cold in water helped me quite a bit with headaches, I take 1 teaspoon x3 a day.
• Inulin was 3x a day about a teaspoon helped some beneficial butyrate producers thrive.
• I also take Acacia fibre to boost Bifidobacterium.
• I used Cold potato for a while too, I split it into sauce pots and eat it cold in small quantities. It wont work hot the fibre only feeds the gut cold.

Resources

I have been following a variety of resources for years beyond ME highlighted just papers and studies:

• https://www.reddit.com/r/Microbiome/ a lot of knowledgeable people and a good wiki source and plenty of microbiome papers.
• [Donna Schwenk|https://www.youtube.com/@CulturedFoodLife] does some great podcasts into the practicalities of preparing and using probiotics
• Super Gut by Dr Davis was a great introduction to making “yoghurts”(fermented milk in the EU technically not yoghurt) with particular species of bacteria like L Reuteri. His recipes didn’t work but the approach does once you find the right food for the bacteria, inulin did not work for Reuteri but Dextrose did. I wouldn’t make the Super gut yoghurt with 3 species but rather make one at a time and use for months to colonise and then do another.

Concluding thoughts

• In my experience if you do all these things (Kefir, Kimchi, fermented milk, prebiotics) you can get a decent improvement in gut function.
• However whatever our body or Covid in our gut is doing means it requires constant treatment.
• This wont impact much else about your condition, its not a route to a cure for Long Covid ME/CFS.
• It will take months to a year to really see the impact, its a very slow process.
• Start with very small quantities that don’t cause issues, if you get a reaction always back off never push through bad gut symptoms this causes.