Why Blood Vessels Are So Swollen in Covid-19 Long-Haulers and What We Can Do About It

Disclaimer: I am not a doctor or medical researcher. I am a trained journalist and author who has recovered from the novel coronavirus after more than four months of illness. The opinions expressed here are mine, gleaned from my own research and educated guesswork. By reading this post you agree that I am not responsible for any choices anyone else makes regarding their own healthcare.

What's Going on in There?

It has been more than 150 days since I first came down with covid-19, and even though I consider myself fully recovered from the active virus I, like many fellow long-haulters, have some residual damage and symptoms that will take some time to heal. This damage includes today's topic: Swollen blood vessels.

Our blood vessels are (probably) swollen because of ongoing dysfunction in the production and mediation of two substances made in our vessels: endothelium-derived relaxing factor (EDRF) and nitric oxide (NO). This dysfunction was (likely) caused by damage to the endothelium. That damage, in turn, was (likely) caused by the coronavirus itself, as well as by an autoimmune hyper-response, in some people. To simplify: the virus damaged the lining of our blood vessels, and until that lining is fully healed those vessels won't be good at regulating dilation and constriction.

Interesting aside: Without adequate nitric oxide, the body doesn't produce insulin well. This could explain why some people are developing temporary diabetes post-covid.

To simplify: the virus damaged the lining of our blood vessels, and until that lining is fully healed those vessels won't be good at regulating dilation and constriction.


SARS-COV-2 was poorly named, because scientists made wrong presumptions at the start. It's not an acute respiratory disease, after all. SARS-COV-2, it turns out, is an infectious vasculitis and endotheliitis, meaning it infects the blood vessels and anywhere else in the body you find endothelial cells. SARS-COV-2 is not a respiratory disease, but it can have respiratory manifestations in some people. It can also infect and harm any other organ system, too. Some have suggested we change the name of the disease to Covid Endotheliitis, and I wholeheartedly support the idea.

There are 100,000 miles worth of blood vessels in the average adult human body, enough to wrap around the earth four times. Each of those vessels is lined with a one-cell-thick layer of endothelium, or interconnected endothelial cells. These cells contain the ACE2 receptors the coronavirus uses to enter the body. It is this vast surface area of endothelium that is attacked and injured in Covid-19, and because blood vessels are present everywhere in the body, this also explains the stunning variety and diversity of symptoms caused by this virus.


Endothelial cells are capable of regeneration and repair in some people, with a few caveats:

  • Endothelial cells are only able to regenerate if there are nearby healthy endothelial cells that can release signals to initiate repair. This is why those most at risk of death from this disease are people who, for whatever reason, already have extensive damage to their endothelium. Diabetes, obesity, old age, cardiovascular disease, poor diet, all cause what's called oxidative stress to the endothelium. If there are no healthy nearby cells, the repair will either not happen or it will be spotty.

  • Endothelial cell regeneration takes a very, very long time. It's not like when you get a cut and you scab over. The endothelium has to signal that a repair needs to be made, and that signal has to reach your bone marrow, where new cells will be made and sent where they need to go. This can take up to six months. Maybe longer, if the damage is extensive.

  • New endothelial cells might not work as well as the originals.

The endothelium is more than just the lining of the blood vessels. Collectively, it is a sensing, mediating organ responsible for regulating many of the body's automatic functions, including but not limited to vasoconstriction and vasodilation. So, our vessels are swollen because they have lost - hopefully temporarily - the ability to regulate how wide or narrow they need to. This is likely part of the reason many covid-10 survivors are developing problems with blood pressure and heart rate as well.

So, what can we do about it?

If you are lucky enough to have an informed and experimental doctor willing to help you, you might be able to get prescription medications aimed at protecting and healing the endothelium and regulating vascular constriction and dilation in the absence of the natural mediators no longer being produced in adequate amounts by the endothelium.

But most of us aren't that lucky. I'm certainly not.

The next best thing we can do is support our endothelium by protecting it from further oxidative stress, provide it with some of the elements missing during healing, and encourage steady regeneration of healthy endothelial cells. We do this through diet and supplementation.


Starting immediately, eliminate all food, drink and habits that causes oxidative stress. Don't whine about it. Don't complain about how much you'll miss crap that's literally doing its best to kill you.

Say goodbye, immediately, to:

  • refined sugar including added sugar (read labels, please)

  • refined carbohydrates (white flour, white rice)

  • high-fat and fried foods

  • junk food of any kind

  • processed foods of any kind

  • alcohol

  • smoking

Increase Nitric Oxide in the Body

Eat foods high in nitrates. This means leafy greens, celery, beets, garlic, citrus fruits, nuts and some meats.

Instead, eat a low-inflammatory, mostly or totally plant-based diet.

This is the diet scientifically shown to be best for healing the endothelium. Period. Furthermore, many of us who are in the post-covid phase are making too many white cells, and having too much inflammation; both issues can be solved with a vegan diet.

Eat whole, organic, real food that you could have grown, picked or, if you choose to continue to eat meat and dairy, killed or milked, without added hormones, coloring or preservatives. Get away from bread. Eat colorful vegetables, fruits and lean proteins. Never, ever eat margarine.

If it was made in a factory or comes from a fast food restaurant, don't eat it.


There are two specific nutrients that specifically foster the regeneration of the endothelium: Resveratrol and Genistein. Both are available as supplements, but also can be found in many foods. Resveratrol is a stilbenoid, a natural phenol, found in the skins of dark grapes, in blueberries, mulberries and peanuts. Genistein is a phytoestrogen found in soy products.

Hey long-hauler! Do you find these posts interesting but feel overwhelmed by all the data and planning? I am available as a wellness coach to help you put together a post-covid diet, supplement and activity plan. I try to provide as much information as I can to the public, but am happy to help you one-on-one if you prefer. I work on a sliding scale. Please contact me for rates at alisavaldeswriter@gmail.com.

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