a fatigued woman in a mask working from home

Effectively Treating Persistent Post-COVID-19 Symptoms

Dr. Jacob Teitelbaum, MD
This content originally appeared on 

Finding yourself with insomnia despite being exhausted? Have cognitive dysfunction (which has been termed “brain fog”)? Widespread achiness?

These are symptoms of chronic fatigue syndrome and fibromyalgia (CFS/FMS), which can be caused by dozens of infections. Unfortunately, the research is suggesting that, in a large percentage of cases, COVID-19 is triggering persistent symptoms and debilitation. This has been termed Long Hauler Syndrome.

In the majority of cases, COVID symptoms should mostly be gone after six weeks. If you continue to feel poorly beyond two months, the COVID-19 virus may have tripped a circuit breaker in your brain called the hypothalamus. This circuit breaker controls sleep, hormones, and numerous other systems.

The classic symptoms? Severe exhaustion and insomnia, especially if combined with brain fog and even widespread pain. This combination is fairly diagnostic for chronic fatigue syndrome and fibromyalgia. Dozens of other symptoms may also be present, including shortness of breath and heart palpitations.

People generally feel like a train wreck. I know I did when I came down with postviral CFS/FMS while in medical school in 1975. It knocked me out of school and left me homeless for a good part of a year. Fortunately, I learned on my own how to recover. Since then, I have published numerous books, textbook chapters, and studies on how to effectively treat postviral chronic fatigue syndrome. I have also successfully treated thousands of people worldwide with this condition.

Begin with the SHINE Protocol

The key is optimizing energy production and addressing other issues triggered by the COVID-19 infection. Optimizing healthy energy production can be done effectively using what we call the SHINE Protocol. This addresses sleep, hormones, infections, nutritional support, and exercise as able. Our published placebo-controlled study showed that by doing so, 91 percent of people improved with an average 90 percent increase in quality of life. Four other studies I have published also show that numerous other treatments can be helpful.

Begin by taking a good high-potency multivitamin with ribose powder (5 grams, two to three times a day). A free online quiz can assess your symptoms, and even lab tests if available, to tailor a protocol for you using the SHINE Protocol. Bring the printout to your local health food store so they can help you get the supplements you need.

The new fourth edition of my book From Fatigued to Fantastic ($22, Penguin/Avery, 2020) will offer more guidance on how to recover.

Optimizing Heart and Lung Function

Addressing persistent immune, lung, and heart dysfunction is also important. This can be done using a mix of natural and prescription treatments. For example, you can obtain a very low dose of naltrexone—3 to 4.5 milligrams (mg) a night—from a holistic physician to help rebalance immunity.

Support to settle down the immune system can also be helpful. For this, I recommend bioavailable forms of curcumin as well as 20 to 40 mg of zinc a day.

Cardiac involvement is seen in 78 percent of COVID-19 cases. For persistent heart dysfunction, ribose combined with coenzyme Q10 (CoQ10), magnesium, and high dose B vitamins can markedly improve cardiac function. Antioxidant support is also important.

For those who experienced neurologic symptoms, micro bleeds and clots along with microglial activation in the brain may have occurred. Recovery can be improved with a mix of antioxidants, omega-3 fatty acids to thin the blood, and the low dose naltrexone mentioned earlier.

These represent the tip of the treatment iceberg. There is much that can be done. It requires a comprehensive assessment of each individual case, which usually takes at least three hours of the physician’s time.

Unfortunately, being a complex condition, it may take several years for most physicians to be properly trained in addressing persistent post COVID-19 symptoms. It is best to look for a specialist who specifically works with fibromyalgia, as they may be much more familiar with the area and treatments. Generally, you are much more likely to be able to be helped by a holistic physician.

A large body of helpful information can also be found online at Vitality 101.

Persistent post COVID-19 symptoms can be treated effectively but require a large degree of experience on the part of the physician. Fortunately, much of what is needed to help you recover can be done on your own.