Dealing With Long COVID

The Post-Pandemic Epidemic Part II: Risk Factors for Post COVID Inflammatory Syndrome

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This entry is part 2 of 3 in the series Long COVID

The current trending messaging that we’re hearing in the media is that there are no risk factors for Long COVID and there are seemingly healthy individuals with no apparent risk factors that all of a sudden got this unknown disease and now have lingering symptoms that won’t go away.

Well, this just isn’t true.

Just because a person looks healthy, that doesn’t mean they don’t have a risk factor for long COVID lingering below the surface.

In the functional medicine model, we know that inflammation, environmental factors, and low rate infections are a source for low rate inflammation that can set people up for severe COVID, as well as Long COVID. We refer to these as auto-inflammatory syndromes, or syndromes that once inflammation starts, maintain the burning or the inflammation.

This concept is not new. We have traditional risk factors, traditional pre-existing conditions, traditional environmental conditions and other things that we look in the functional medicine world that can set people up to be at risk.

So, what are those traditional conditions and risk factors, and who’s at risk? Let’s take a look.


The first major thing putting people at risk for long haul COVID is low grade inflammation. As mentioned above, everything really all comes back to inflammation.

Related: How To Treat Inflammation

It’s interesting to see that obesity, diabetes, hypertension, renal disease, etc are being popularly mentioned as pre-existing conditions that increase risk for having severe COVID and Long COVID, but the reality is that all these have underlying inflammation as the root cause for these conditions.

Being overweight by itself increases leptin and inflammatory cytokines, hypertension, cardiovascular disease, and inflammatory conditions of the endothelium or the cell lining of all your arteries.

Nutritional Deficiencies

So we know inflammation is a big deal with COVID and post COVID, but this can also be exacerbated or made worse by nutritional deficiencies— the most important of which is Vitamin D. Other nutritional elements (such as Vitamin C, Zinc, trace minerals, and B Vitamins) are also important, but the most important one is Vitamin D by far.

It’s interesting how important Vitamin D is for fighting viral infections, for your body making antibodies, as well for controlling inflammation and cutting it down.

Exposure to Poor Air Quality

Something we observed during the summer of 2020 was environmental conditions that increase the risk for COVID. This was mainly air. Air quality was a big issue.

We saw that air particles, micro-particles or PM 2.5, were associated with severe lung disease. This was mainly seen in people living in Wuhan, as well as in Italy and London—but it’s really easy to see how New York City has air with a lot of micro particulates. Clearly,

In the functional medicine world, we’ve been looking at air quality for inflammatory conditions for years, and research from NOAA, and now at the Buck Institute in California, shows air particulates can be associated with inflammatory conditions such as Alzheimer’s.

So, these ideas are not new to us.

Also air volatile organic compounds (VOC), CO2, and mold particulates, all can cause low-grade lung inflammation, which opens up the lungs to take in the virus and cause low-rate inflammation in the lungs.

Certain Medical Conditions

There are certain conditions that groups deal with that we commonly treat in the functional medicine world that seem to be risk factors for Long COVID.

  • Hypermobility: This is a big one. Those that are hypermobile tend to have more inflammatory conditions
  • SIBO: Small intestinal bacterial overgrowth is a gut immune system, autoimmune spectrum disorder associated with multiple other inflammatory conditions
  • Mast Cell Activation Syndrome: This is a neuroimmune inflammatory condition that about 20 to 23% of the population has
  • IBS
  • Chronic Inflammatory Response Syndrome
  • POTS  and Dysautonomia

The point is, there are multiple conditions that we treat in the functional medicine paradigm that are risk factors for severe COVID and post COVID that we are able to address.


And finally, mediators, what are the things that keep you sick? Well, they’re actually all the same things I’ve already mentioned. So finding someone that can help a patient walk through this, figure out if they’re having any of these issues listed above,  and start to peel away these layers is going to be incredibly important for those with Long COVID.

So there you have it, short and sweet: The main risk factors for post COVID or long haul COVID.  In the next section if this three part series on Long COVID, we’re going to talk about some management options to discuss and address with your primary care provider in your treatment of Long COVID.

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