Long COVID: Your New or Chronic Health Issues Could Be This! (Part 1)

Months—or even years—after an initial infection with COVID-19, many patients continue to experience lingering symptoms, or even develop new ones. This condition, often called “long COVID,” is increasingly recognized in both conventional and functional medicine. Clinicians like Dr. Paul Anderson and Dr. Mark Hyman have helped clarify what can otherwise feel like a confusing and frustrating condition. We want to explore long COVID, including the patterns, risks, and why healing takes time.

From a functional medicine perspective, long COVID is less about one single problem and more about a constellation of imbalances that persist after the acute infection has passed.

A Constellation of Symptoms

Long COVID does not look the same for everyone. Instead, it presents as a wide range of symptoms that can fluctuate over time:

• Persistent fatigue or post-exertional exhaustion
• Brain fog, memory issues, and difficulty concentrating
• Shortness of breath or lingering cough
• Heart palpitations or irregular heart rhythms
• Joint and muscle pain (pain syndromes)
• Headaches and dizziness
• Peripheral neuropathy
• Sleep disturbances
• Loss of taste or smell
• Anxiety, depression, or mood changes

These symptoms reflect underlying system dysregulation—particularly involving immune, neurological, and vascular pathways (Nalbandian et al., 2021; Davis et al., 2023).

Common Comorbidities

Pre-existing inflammation and metabolic dysfunction can amplify the body’s response to infection, increasing the risk of long COVID and complicating recovery. Pre-existing examples include:

Metabolic dysfunction (insulin resistance, obesity)

• Cardiovascular disease
• Autoimmune conditions
• Chronic infections (such as Epstein-Barr or Varicella-Zoster/Shingles virus reactivation)
• Mast cell activation and histamine intolerance

Why Is Recovery So Difficult?

Recovery from long COVID is rarely linear due to multiple overlapping biological mechanisms:

• Persistent Immune Activation
• Even after viral clearance, the immune system may remain activated, contributing to chronic inflammation (Peluso et al., 2021).
• Viral Debris and Reservoirs
• Residual viral particles in tissues may continue to stimulate immune responses (Chertow et al., 2021).
• Mitochondrial Dysfunction
• Impaired cellular energy production is thought to underlie persistent fatigue and exercise intolerance.
• Autonomic Nervous System Imbalance
• Dysautonomia—including conditions like Postural Orthostatic Tachycardia Syndrome, or POTS—can lead to dizziness, rapid heart rate, and fatigue.
• Microbiome Disruption
• Alterations in the gut microbiome may perpetuate inflammation and immune dysregulation (Zhang et al., 2022).

A Critical Concern: Microclotting

A growing area of concern in long COVID is abnormal clotting creating a higher risk for cardiovascular problems even among younger adults, who were never even hospitalized for COVID. Some patients appear to develop microclots—tiny, persistent clots that impair oxygen delivery at the capillary level.

These may affect:

• The lungs (contributing to breathlessness)
• The brain (impacting cognition and “brain fog”)
• The heart (leading to chest discomfort or palpitations)
• The eyes (vision changes)
• The kidneys (impaired function)
• The extremities – fingers and toes (neuropathy)

Dr. Paul Anderson has discussed how these microclots may resist normal breakdown processes, potentially contributing to prolonged symptoms. Emerging research supports the presence of fibrin amyloid microclots and endothelial dysfunction in long COVID (Pretorius et al., 2021; Kell et al., 2022).

A Functional Medicine Lens

At The Woodlands Institute for Health & Wellness, we are seeing impressive recoveries using a systems approach and a wide variety of protocols.

Rather than focusing solely on symptom management, this perspective emphasizes:

• Reducing inflammation
• Supporting immune balance
• Restoring mitochondrial function
• Healing the gut microbiome
• Supporting vascular health and circulation
• Addressing chronic infections (such as EBV and Varicella-Zoster)

Coming Next: Part 2 — A Roadmap to Recovery

In Part 2, next week, we’ll explore practical, evidence-informed strategies to support recovery, including nutrition, targeted supplementation, nervous system regulation, and safe approaches to rebuilding energy.

In the meantime, be well.

References

• Anderson, P. (2021–2024). Clinical presentations and educational webinars on long COVID and post-viral syndromes.
• Chertow, D., Stein, S., Ramelli, S., et al. (2021). SARS-CoV-2 infection and persistence throughout the human body and brain. Research Square (preprint).
• Davis, H. E., McCorkell, L., Vogel, J. M., & Topol, E. J. (2023). Long COVID: Major findings, mechanisms and recommendations. Nature Reviews Microbiology, 21, 133–146.
• HealthDay News. (2024, April 8). People with long COVID face higher risk for serious heart problems.
• Hyman, M. (2022–2024). Clinical insights and educational materials on long COVID. The UltraWellness Center.
• Kell, D. B., & Pretorius, E. (2022). The potential role of fibrin amyloid microclots in long COVID. Biochemical Journal, 479(4), 537–559.
• Nalbandian, A., Sehgal, K., Gupta, A., et al. (2021). Post-acute COVID-19 syndrome. Nature Medicine, 27(4), 601–615.
• Peluso, M. J., Deitchman, A. N., Torres, L., et al. (2021). Long-term SARS-CoV-2-specific immune and inflammatory responses. JCI Insight, 6(24).
• Pretorius, E., Venter, C., Laubscher, G. J., et al. (2021). Persistent clotting protein pathology in long COVID. Cardiovascular Diabetology, 20, 172.
• Zhang, F., Wan, Y., Zuo, T., et al. (2022). Prolonged impairment of short-chain fatty acid and L-isoleucine biosynthesis in the gut microbiome of COVID-19 patients. Gut, 71(5), 894–905.

The Woodlands Institute for Health & Wellness - Mila McManus MD

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