Treating Long COVID

Facing a Real Problem and Moving Forward

Posted in

Dr. Aaron Hartman

April 16, 2024

Woman casting a long shadow

    “Coming together is a beginning; keeping together is progress; working together is success.”

    —Henry Ford

    “Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible.”

    —Francis of Assisi

    Long COVID is a very real problem. Unfortunately, there has been a lot of misinformation about COVID. Fortunately, we can untangle that together.

    What is Long COVID?

    The majority of people who contract COVID-19 get better and move on. For some people, however, symptoms persist long-after you’re supposed to have “gotten better.” This is sometimes called Long COVID or Post-COVID Inflammatory Syndrome.

    What this means is that when someone gets a virus and clears the virus, sometimes they remain inflamed. And we’re not just talking about a handful of patients, here.

    • 10% of people who get COVID will have at least one symptom 6 months later
    • 70% of patients hospitalized due to COVID will have at least one symptom 6 months later

    I’m going to quote the NIH COVID Treatment Guidelines. It’s a little wordy, but important:

    “Two main processes are thought to drive the pathogenesis of COVID-19. Early in the clinical course, the disease is primarily driven by the replication of SARS-CoV-2. Later in the clinical course, the disease is driven by a dysregulated immune/inflammatory response to SARS-CoV-2 infection that may lead to further tissue damage and thrombosis. Based on this understanding, therapies that directly target SARS-CoV-2 are anticipated to have the greatest effect early in the course of the disease, whereas immunosuppressive, anti-inflammatory, and antithrombotic therapies are likely to be more beneficial after COVID-19 has progressed to stages characterized by hypoxemia, endothelial dysfunction, and immunothrombosis.”

    In other words, late stage COVID issues (aka Long COVID) are primarily an inflammatory response to the original infection. That’s important because post-infectious inflammatory complications are not new to functional medicine.

    Long COVID is primarily an inflammatory response to the original infection. That’s important because post-infectious inflammatory complications are not new to functional medicine.

    While Long COVID is a new concept for all of us, post-infectious inflammatory diseases and complications as a whole are not. We have many other examples and paradigms to help us address Long COVID. To get a better understanding of Post-COVID Inflammatory syndrome, we can study these other illnesses that we have more experience with.

    Other Post-Infectious Inflammatory Diseases

    1. Chronic Inflammatory Response Syndrome (CIRS)

      Chronic Inflammatory Response Syndrome (CIRS) is a complex, multi-system, multi-symptom disease resulting from a deficient immune response to biotoxin exposure. CIRS is commonly associated with mold, but can result from several biotoxins like Pfiesteria or Lyme Disease. In fact, CIRS is sometimes diagnosed as Post-Lyme Syndrome (sound familiar?). Moreover, CIRS symptoms (e.g. chest pain, shortness of breath, palpitations, brain fog) overlap significantly with Long COVID. At their root, both Long COVID and CIRS are an inflammatory response.

    2. Post-ICU Syndrome or PCIS

      Post-ICU Syndrome patients are people who have residual symptoms for months and months (sometimes even years) after being in the intensive care unit. Symptoms include fatigue, brain fog, muscle aches, shortness of breath, memory lapses.

    3. Autoinflammatory Syndromes

      Autoinflammatory Syndromes can be caused by traumatic brain injuries, chronic fatigue, fibromyalgia, or myalgic encephalomyelitis.

    4. ASIA Syndrome

      ASIA stands for Autoimmune/Inflammatory Syndrome Induced by Adjuvants. It can be brought on by metals, substances in vaccines or even breast implants.

    The point is, is that we have other examples of inflammatory syndromes that are very, very similar to Long COVID. Long COVID is real, but it’s not entirely new. That’s good news. We’ve been here before. We’ve been helping people with multi-system, multi-symptom maladies for years and years and years.

    We have all kinds of tools in our toolkit to deal with inflammatory syndromes. There is hope!

    Long COVID is real, but it’s not entirely new. That’s good news. We’ve been here before.

    Long COVID Symptoms

    Long COVID symptoms include (but are not limited to):

    • Shortness of breath
    • Fatigue
    • Palpitations and heart racing (all from just walking up a flight of stairs)
    • Gut symptoms (diarrhea, nausea, slowing of stomach functions)
    • Aches and pains
    • Recurrent fevers
    • Lymph node swelling
    • Blood pressure fluctuations
    • A whole slew of skin symptoms and rashes
    • Skin flushing

    Long COVID Risk Factors

    Several risk factors can increase your likelihood of experiencing Long COVID.

    • Pre-existing Inflammation
    • Nutritional Deficiencies
    • Environmental Factors (especially air quality)
    • Pre-existing Medical Conditions

    I’ll briefly touch on each.


    The first major thing putting people at risk for Long COVID is low-grade inflammation. Everything comes back to inflammation. I’ve shared many times that inflammation is the underlying cause of chronic health issues, and Long COVID is no exception. The NIH statement on Long COVID (quoted above) reinforces this assessment.

    Related: How To Treat Inflammation
    (Chronic Health Issues? Solutions & Support)

    Nutritional Deficiencies

    So we know inflammation is a big deal with Long COVID, but this can also be exacerbated 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 by far is Vitamin D. 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

    During the summer of 2020, we observed that environmental conditions increased the risk for COVID.

    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.

    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.

    The street is filled with houses and beautiful trees during the fall season

    Related: Creating a Healthy Home (Free Micro Course)

    Pre-Existing 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.

    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.

    Long COVID Treatment

    This is not an exhaustive list of all the treatment options. My goal is to equip you with intelligent talking points to bring to your primary care provider. Where appropriate, I’ve linked to supplements and resources sold through our dispensary. For the most part, however, I’ve linked out to studies for your further research.

    Over-the-Counter Medications with a Big Impact on Long COVID

    Both acute COVID and post COVID-19 can be categorized as a form of mast cell activation syndrome (MCAS). While this sounds a little scary, what this actually means is simple H1 and H2 histamine blockers can be very helpful in easing symptoms. Good ol’ Pepcid is an H2 blocker already used in hospitals to prevent and treat severe COVID.

    We’re now coming to realize that H2 blockers (like Pepcid) can also be used in combination with H1 blockers (like Zyrtec, Claritin and Allegra) as an outpatient solution for Long COVID.

    Repurposing Medications

    Low-Dose Naltrexone is being repurposed to good effect treating COVID-19 and Long COVID. It’s being studied as a stand alone medication for Long COVID. It’s an immune modulator that helps balance your innate and your adaptive immune system, and has been used with chronic fatigue, fibromyalgia, dysautonomia, POTS, SIBO, IBS, and a host of other auto-inflammatory syndromes.

    Natural Alternatives

    When dealing with Long COVID, it’s also helpful to take a holistic approach to recovery. By addressing the underlying causes inflammation, gut health, and nutritional deficiencies, you can make significant progress in recovery.

    Anti-Inflammatory Support

    • Quercetin: Quercetin is an onion extract that can stabilize mast cells, helps with gut inflammation and boosts immune reactivity
    • Luteolin:  Luteolin is an anti-inflammatory molecule many people associate with eye Health, but it also helps stabilize mast cells.
    • OAA: Enol-oxaloacetic acid (or OAA) is a metabolism precursor that can help patients with fatigue. Researchers also use OAA to address mast cell activation syndrome.
    • Vitamin D & Vitamin C: I’ll address these below in nutrient deficiencies, but the also belong up here in anti-inflammatory support.

    Restoring Nutrient Deficiencies

    A nutritional evaluation can be valuable, but it can also be costly. Even without a personalized evaluation, however, we can establish a reasonable baseline. We already know through statistics that most Americans are deficient in a common set of nutrients:

    • B Vitamins: These include thymine (B1), riboflavin (B2), B12, folic acid (B9), pyridoxine (B6). Interesting fact:  Thymine was one of the vitamins used in the hospital at Eastern Virginia Medical School with their COVID patients.
    • Trace minerals: Zinc is probably the most important of the trace minerals, but selenium, manganese, copper, a host of other minerals are important. Many Americans are deficient in these.
    • Ultra-trace minerals: These are the things you get from bones, organ meat and, seaweed. Most Americans are deficient in ultra-trace minerals due to consuming processed foods rather than eating them in their natural whole food form.
    • Vitamin D & Vitamin C: As we mentioned above, D and C can help deal with COVID—and most of the population are deficient.

    Since nutritional deficiencies are a root cause of Long COVID, you should fortify these nutrients through improved diet and (if necessary) additional supplements.

    Addressing Disease-Specific Symptoms from Long COVID

    When approaching post-COVID care, I also want to offer solutions for disease-specific symptoms. Some of these symptoms (and solutions) include:

    Shortness of breath

    This common post-COVID symptom tends to be related to small arteries in the lungs not getting appropriate blood supply and having small micro clots. Specific interventions including Inositol,Cysteine, and NAC Supplements have been shown to break down these micro clots. The NLRPe stabilizer Resveratrol also treats inflammation here.


    As noted above, low-dose naltrexone is being repurposed to address Long COVID. In terms of managing pain, low-dose naltrexone can have a lot of impact.


    Fatigue is a very common symptom for Long COVID. Melatonin is a great anti-inflammatory as well as a sleep supplement. It’s one of the preventatives and treatment supplements we recommended during the pandemic. It’s also used at Eastern Virginia Medical School. Magnesium glycinate is another great solution to help you sleep soundly and battle fatigue. Magnesium is a great calming mineral. It also helps block the NMDA receptor, which is a brain inflammatory receptor. The glycinate (or glycine amino acid) in it, has a detoxifying factor and helps with the body’s production of glutathione.


    Patients who have any form of dysautonomia or POTS, are not going to have enough blood flow to their organs, brain, or heart. So just increasing blood flow to these organs will help you feel better. The Children’s Hospital of Philadelphia has a whole host of exercises that can be helpful to increase blood flow to your organs. Compression clothing and compression stockings can be helpful to increase blood flow to your core organs. Balancing minerals with sodium chloride and lots of hydration is super important. More information on POTS from RIFM.

    Treating Underlying Conditions

    When dealing with Long COVID, it’s truly helpful to treat some underlying functional conditions.

    This includes looking at the gut/brain immune access. Does the patient have gut symptoms? That’s a sign that immune symptoms need to be addressed. This is a big, deep dive in itself, and I’ll only mention it briefly here.

    Let’s go further into a great way to address a host of underlying functional conditions: Detoxification. Detoxing is a huge part of dealing with the inflammation factor with Long Haulers. Here are some things you can look at in your own life:

    • Air quality: How clean is your air? Check your house and your environment out, looking for the quality of your air. Why is this a big deal? We know micro particulates have a huge lung inflammatory aspect, and they also cause inflammation in the small arteries and endothelium. Something as simple as a HEPA filter can be a nice way to start this.
    • Water quality: We inhale clarets, chloroform, chloromethanes and a whole host of chemicals routinely when we take showers. If you want to learn about the water quality of your house, check out the environmental working group’s tap water database at Check in your zip code there and you’ll have a whole host of information on how clean your water is.
    • Diet: And finally, food. Food is just a really, really big deal when it comes to post-COVID care and treating inflammation in general. . If you’re inflamed and you don’t address the way you eat, it’s going to be hard to recover and this applies to long-COVID too.. Start with a clean anti-inflammatory diet.

    If you’re wondering how to get started eating clean, real food, try my free micro-course: Real Food Diaries.

    We’ve Updated Our Popular Food Sourcing Guide

    • Food Sourcing Principles
    • Local Sourcing Options for Central VA
    • Non-Local Sourcing Solutions & Principles

    And we’ve added it to our FREE micro course “Real Food Diaries.” Register for the free course to access the updated guide.