During the ongoing Covid-19 pandemic, researchers estimate that the prevalence of long Covid among the general population could be anywhere between 20% to 40%. Around 8 million to 23 million Americans have developed long Covid after surviving waves of infections.

While the condition is more common among women, each individual could experience long Covid through a wide range of symptoms that could be neurological and psychiatric with manifestations like brain fog, inattention, and memory issues. Other long Covid patients could suffer from respiratory distress or have gastrointestinal or cardiovascular problems for months on end.

In a recent study published in JAMA Internal Medicine, a group of researchers found that women who had a healthy lifestyle before a Covid-19 infection had a substantially lower risk of long Covid. “Persistent inflammation has been implicated in post Covid-19-condition (PCC) or long Covid symptoms related to multiple organs. Inflammatory factors have also been associated with other post-infection syndromes, such as post-viral fatigue syndrome,” the researchers wrote in their study.

“Healthy lifestyle factors, including healthy body mass index, abstinence from cigarette smoking, a healthy diet, moderate alcohol consumption, regular exercise, and adequate sleep, have been identified as protective against inflammation,” they added.

To investigate the association between a healthy lifestyle before individuals tested positive for Covid and their risk of later developing long Covid, the team enrolled participants from the Nurses’ Health Study II. In 1989, that study had enrolled 116,429 nurses who resided in the United States and were between 25 to 42 years old. The researchers used the data of 32,000 women nurses who had answered questionnaires that delved into their lifestyle habits from 2015 to 2017 and had also provided a history of any Covid-19 infection from April 2020 to November 2021. More than 97% of them were white.

In that time span, 1900 nurses had tested positive for Covid-19. Out of that, 44% of them had long Covid symptoms. Among them, 87% or 758 nurses had reported symptoms that lasted at least 2 months. Another 56.5% reported that they occasionally experienced impairment in their day-to-day life that was related to long Covid. “The most common symptoms were fatigue (57.1%), smell or taste problems (40.9%), shortness of breath (25.3%), confusion, disorientation or brain fog (21.6%), and memory issues (20%),” the researchers further observed after analyzing the data.

“Compared with women who did not adhere to any healthy lifestyle factors, those having five or six healthy lifestyle factors had a 49% lower risk of long Covid. These associations were mainly driven by healthy body weight and adequate sleep,” they added.

The researchers further explained that different types of biological mechanisms could explain the associations that they observed. To begin with, every unhealthy lifestyle factor that they had examined has repeatedly been associated with a higher risk of chronic inflammation in previous studies.

“Sustained systemic inflammation has been implicated in the development of long Covid. Chronic inflammation may predispose individuals to excessive release of cytokines after infection, subsequently increasing risk for long-term complications in multiple organs,” the researchers explained. “These unhealthy lifestyle factors dysregulate adaptive autoimmunity, which has been found in individuals with long Covid. Also, unhealthy lifestyle factors (obesity, smoking, physical inactivity, and excessive alcohol intake) predispose to blood clotting abnormalities, another pathophysiological change observed in persons with long Covid.”

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