Buchinger Wilhelmi - My Experience as a Long Covid Patient

In December of 2022, I attended a 10-day fasting program at Buchinger Wilhelmi in Marbella, Spain. After reading about symptom reductions and even full recoveries with both water fasting and fasting-mimicking diets, I was curious to try this for myself. As I currently feel best on an animal protein-rich diet that is low-histamine, low-oxalate, and lectin-free, I was skeptical of their pescatarian and lacto-ovo vegetarian meals that are heavy on spinach, potatoes, squashes, and grains, but enticed by the fact that they had so much experience with fasting (over a century), offer medical monitoring throughout the program, and, as a bonus, have resort-like facilities.

As it was difficult to get precise information in advance on what completing the program might be like for a long covid patient, I thought it might be helpful to write about my experience here. Unfortunately, I caught Covid during my trip, which likely negated many of the potential benefits, but thought this still might be helpful to outline answers to questions an individual with long covid might have.

This is a fairly lengthy post, but you can skip to the bottom paragraph if you’re just looking for the tl;dr.

Booking

The clinic offers four different packages, ranging from 7 to 28 days. They indicate that a 7-day program doesn’t offer enough time to fast; 10 days is the minimum that can be booked to fast. 

The room options is where it gets more complicated. I was told that there is only one room of the least-expensive option, Standard, in Marbella, and it had already been booked by the time I reserved. 

It should be noted for anyone who is sensitive to older buildings (you know who you are) that all of the rooms at the level of Superior and below in Marbella are in the main building, which is an older building. Rooms at the Executive level and above are in the Villa Maria, which is newer. The majority of the services are offered from the main building, but the Villa Maria is just a few steps away.

The other consideration is sun exposure. Within the main building, only the Superior rooms are south-facing, and all of these had been booked by the time I reserved. The south-facing rooms in Villa Maria were out of my price range. I ended up choosing a west-facing Comfort room, and was more than a bit jealous when I saw individuals sunbathing from the comfort of their terrace in the south-facing Superior rooms.

Travel from the United States

Ideally there would be a clinic with similar offerings in the same time zone, but alas, there is not. 

My flight was essentially a red-eye. It departed at 4:30pm and arrived at 12:10pm the next day, with a ~3.5-hour layover at Charles de Gualle.

Prior to traveling, I had recently made a significant change to my supplement routine and had also been fairly active (out all over New York City) the day before. As a result of one or the other (I’m guessing a mineral imbalance due to the former), my dysautonomia was in a flare on the day of travel, and I clocked a whopping 57 “Zone” minutes on my Fitbit (moments where my heart rate was 114 or higher). By the time I checked in for my flight, I knew I was going to arrive a mess if I took the 7.5-hour red eye in coach. A business-class seat was available for the first leg of the trip, and I decided to take it, knowing that I could really use the additional space to rest. 

On the second flight, a 2.5-hour leg, I was unfortunately next to an unmasked sniffling and sneezing individual. I should have asked the flight attended to be moved, but I didn’t want to make a scene, was quite comfortable due to the Pluto Pod, and fell asleep nearly immediately. The time-to-infection table flashed through my mind, and I knew deep down that my KN95 wasn’t enough to protect me. I should have spoken up for myself, but failed to; the incident was indicative of things to come.

Arrival 

The clinic is a 35-minute (roughly $70) Uber from the Malaga airport, and I arrived sometime after 2pm. The typical recommendation is to use the arrival day as the “preparation” day, during which you consume a light vegetarian menu of fruit, rice, and vegetables to prepare your digestive system for the fast. As I was concerned about diving into the fast right away due to jet lag and a relatively poor night’s sleep (and as both my breakfast and lunch had contained a fair amount of animal protein), I asked whether it might make sense to have the transition day on the following day. I was told this was common and would not be a problem. 

On the evening of the arrival day, I went to what I had thought was the dining hall at 7:30pm for dinner, and was disappointed to find that they only had soup and juice; none of the fanciful cuisine I had heard others mention. 

Later that evening, just before the dining hall closed, an employee dialed my room, somewhat angrily asking where I was.

“We have your food waiting for you!” 

I learned that I had mistakenly visited not the dining hall, but the fasting salon. The fanciful cuisine I had imagined earlier had been ready and waiting for me after all, just one floor below. 

Plate of fruit served on the afternoon of the arrival day

Labwork 

On the morning of the first full day, I was instructed to go first to the lab for bloodwork and urine tests. I mentioned to the nurse that I had long covid, and she indicated that she’d draw an extra vial of blood (without specifying exactly what it was for). The resulting labwork included a fairly comprehensive set of markers: a CBC, glucose and A1C, a lipid panel, renal function tests (uric acid, creatinine, urea), mineral status (sodium, potassium, magnesium, calcium), liver function tests, vitamin B12, vitamin D, TSH, and CRP. Urine was tested for pH, specific gravity, glucose, total proteins, urobiligen, ketones, nitrates, and the presence of red or white blood cells. 

I then made what would be a daily morning visit to the nurse on my floor, to have my pulse, blood pressure, pulse oxygen saturation, and weight checked.

Doctor Visit

At 11am, I met with the doctor. Given that I had chosen to use the first day as the preparation day (rather than going straight into the fast), she suggested that I fast for 6 days, rather than 7 (hinting that 6 days would be “plenty” for me as she gave me a once-over). The preparation day, which had began with only three small pieces of fruit for “breakfast,” had already felt so restrictive that I did not protest. 

As many with long covid, I had been taking a significant quantity of supplements for the past 2+ years, and had hoped to have an opportunity to discuss in detail which supplements should be continued during the fast. The doctor merely waved it off, and suggested that I would take their supplements while I was here. As I never was offered any specific supplements other than vitamin D (based on blood test results), I’m not sure exactly what this was referring to, and was a bit disappointed in the response. I had met with my primary care provider just prior to travel, and while we hadn’t gone through my supplement list in detail, she had indicated that it would likely be a bad idea to stop everything cold turkey. Without any more specific medical guidance, I decided to continue taking 36mg of riboflavin with each meal, 150mg of benfotiamine with the midday broth, and glycine, LDN, Zyrtec, and melatonin prior to bed. 

The clinic provides a certain allowance for treatments depending on the length of your stay, and the doctor suggested that a colonic and intravenous ozone would both be appropriate, given my diagnosis of long covid. I scheduled the colonic, but declined the ozone (in the end, I ended up getting neither). 

Food Sensitivities

I had provided the clinic a list of my food sensitivities in advance, and had doubly reviewed it with a nurse upon arrival. As the list was quite extensive and not very compatible what is typically served at the clinic, my biggest concern about the trip was that they may not be able to honor it. 

This concern turned out to be unfounded. The clinic has a number of nutritionists on staff, and despite the fact that almost everything they typically serve would have been a problem for me, they were able to create a custom menu that took all of my listed sensitivities into account. On the first day, this meant that I was served a menu of fruit and vegetables, rather than the rice-based dishes that are typically served. On fasting days, this meant that the soup was prepared separately for me, as the regularly-served soup has ingredients which I react poorly to. 

As the nutritionists at the clinic are not familiar with concepts like “lectins” or “low-oxalate,” this was not as simple as stating that foods containing certain things needed to be avoided: I needed to create a complete list of any food I could not tolerate. I had created a list which included the most common offenders, but had inadvertently missed one or two items. When I reached out to the nutritionist to correct one of such mistakes (after one such food had been served), she expressed frustration and told me that it was difficult to design a nutritionally-complete menu around such restrictions. 

Frustrating moments aside, I was very grateful they were able to design a complete menu around my list of sensitivities.

The Fast

The structure of the fasting days are as follows, with the total intake designed to be roughly 250kcal per day:

• 9:30am: herbal tea with honey

• 12:30pm: 250mL fruit juice and/or vegetable broth

• 3:30pm: herbal tea with lemon

• 7:30pm: 250mL fruit juice and/or vegetable broth

On the first day of the fast, you are instructed to take a glass of Glauber’s salt dissolved in water, which has a laxative effect. In the afternoons, patients are instructed to take a nap with the “liver pack,” a hot water pack designed to stimulate liver function.

I had some experience water with water fasting pre-covid, and found that I felt similarly to those past experiences on the first day (i.e. not too terrible, despite my long covid status). The clinic offers a menu of daily activities, and I chose to take the bus downtown to explore Marbella in the afternoon and attended a traditional holiday choral concert in the evening. 

Carrot soup served during the fast

Positive Covid Test

The morning of the second day of the fast, I woke up feeling terrible. I had slept terribly, had full-body aches, and my heart rate was relatively high, even lying down. I was thankful that it was only a short walk to the nurse’s station on my floor to get my vitals checked. 

After checking my blood pressure and glucose levels, the nurse offered me a juice box and a packet of honey with salt to raise my blood sugar. She asked if I drank coffee, and, when I said I did, requested coffee to be delivered to my room to raise my blood pressure. She then doubled-back to the Covid test I had requested, which she had initially interpreted as negative. There was a faint second line. 

If you are going to get sick, this is at least a nice place to do so. She walked me back to my room (I was afraid I might faint) and literally tucked me into bed. The coffee came, my morning tea with honey came, and I was then attended to by what felt like a swarm of doctors and nurses, asking how I felt and what I might need. 

After some conversation, it was determined that I would be moved to the Mariposa house, a small, private residence separate from the main campus, to quarantine. 

I at first assumed I would need to forgo the fast, but the doctor (as well as several support group respondents) indicated that it would be fine to continue.

Pool outside the “casita” where I was quarantined

Covid Progression 

While this first morning had been quite bad, things only improved from there. With the coffee, juice, and honey intervention, my blood pressure soon returned to a reasonable range. I continued to experience body aches throughout the first two days, but these subsided thereafter. After 2-3 days with lots of rest, I was feeling much better. My sleep stabilized, my resting heart rate and HRV came back to my normal range, and I started going out for long walks. I felt (dare I say it) healthy - that is, I felt as though I did not even have long covid.

The PCR test I took on the second day had a CT value of 17, indicating that I had a very high viral load. I do believe that I was able to start feeling better relatively quickly despite this, due to the fact that I was fasting. 

Electrolytes

Each room has a “water bar,” with four different types of mineral water and a menu describing them. Relative to mineral waters I’ve had in the past, these are quite high in minerals, offering up to 50-80mg of calcium and magnesium per serving.

Water bar

These waters are very low in potassium, however, and outside of the mineral water, there are no electrolytes regularly on offer. Given the clinic’s view that a high-salt diet is unhealthy, meals and broths alike are also very low in salt. None of the nurses or doctors I spoke with seemed to understand the term “dysautonomia,” so having discussions around having additional salt with my meals were difficult.

I experienced some cramping in my quads throughout the first few days in a way that indicated an electrolyte imbalance. Upon request, I was provided some tablets to dissolve in water which contained 375mg each of magnesium and potassium. 

This was not enough potassium to resolve the cramping, however, and as I didn’t want to take too much magnesium, I had to take a trip to a local pharmacy to procure additional potassium. Managing potassium status can be tricky, but if you feel comfortable doing so, I would recommend bringing your own potassium chloride or citrate, as well as your own salt for meals, in addition to whichever sugar-free electrolytes you regularly consume.  

Breaking the Fast

On the first day following the fast, a patient is fed the following menu, which is intended to be around 300kcal:

• Breakfast: Tea with honey

• Lunch: Apple compote with nuts (4 almonds, 4 cashews, or one walnut)

• Afternoon snack: Apple (first solid food)

• Dinner: Vegetable soup

A specialized transition menu over the following 3-4 days then prepares the patient for a regular diet:

• 1st day: 700-800kcal

• 2nd day: 800-1000kcal

• 3rd day: 800-1100kcal

• 4th day: 800-1500kcal

Buchinger Wilhelmi Readaptation Menu, Winter 2022-2023

While I expected to feel better upon reintroducing food, I actually felt a bit worse. Some of the foods on my readaptation menu were slightly higher in histamine (i.e. vinegar in the salad dressing), and I found that I was more sensitive to this than I had been prior to the trip. I am guessing the sensitivity was due to the recent Covid infection: a recent study found that histamine facilitates spike protein entry into endothelial cells. While I felt very stable and well prior to the readaptation phase, I felt that some of my acute Covid symptoms flared up following my first meal with slightly higher-histamine foods.

A transition-day meal.

Summary: One week post-fast

Unfortunately, catching Covid on my way to the clinic set me back and likely negated many of the potential long covid-related benefits. I believe that fasting did help me get over the acute Covid infection more quickly, however, and believe I may have fared even better if I had been able to prolong the fast for a few more days. My biggest fear prior to the fast was that it would be too stressful on my body given long covid, but this turned out not to be the case, even with an active acute infection layered on top.

If you are interested in a supervised fast and have the budget to visit, I do believe Buchinger Wilhelmi is worth the trip. While their physicians are not 100% up to speed on the intricacies of managing long covid, the round-the-clock service and medical supervision is nonetheless very valuable. They also are able to accommodate any allergies and food sensitivities, even if you have a long and complex list.

If you do decide to go, I would recommend working with your primary care provider to plan your supplement intake during the program and bringing any supplements and electrolytes that you believe you might need for the duration of your stay.