FUNCTIONAL MEDICINE SOLUTIONS FOR LONG COVID

I have spent over a decade specializing in hard-to-treat, complex, and chronic illnesses. This experience has taught me that almost any serious infection can leave behind long-term symptoms.

I was not surprised when, soon after the pandemic started, thousands of people began to experience long-term symptoms following a Covid (SARS-CoV-2) infection.

Long Covid is a broad term that can encompass everything from persistent fatigue more than 4 weeks after an initial infection to symptoms like widespread pain, heart palpitations, digestive issues, muscle twitches, headaches, migraines, depression, shortness of breath, diaphragm/solar plexus tightness, anxiety, depression and insomnia in more complex cases.

Prolonged, debilitating symptoms that stretch far beyond an original infection are not uncommon in other viral infections like the flu, malaria, Lyme disease, and various parasitic and bacterial infections.

Functional medicine is uniquely suited to support healing in those experiencing the long-term effects of a Covid infection.

Drastic improvements and full symptom resolution in Long Covid patients are common in my practice. These results are achieved without the use of immune-suppressing steroids.

PERSONAL EXPERIENCE WITH LONG COVID

I have intimate knowledge of Long Covid because my wife and I got sick with Covid in the first wave of infections in March of 2020. While I recovered quickly, my wife developed Long Covid, which lasted for many months.

Her case was severe, and from it, I learned how to alleviate the symptoms of Long Covid and have acquired additional diagnostic tools to help restore the health of those afflicted.

I have also learned from my wife how to make weathering the unique symptoms of Long Covid easier.

Below I will outline common (and uncommon) symptoms of Long Covid, the latest research theorizing what may be behind these symptoms, and some tips that patients have found helpful in their recovery.

If you are experiencing many of these symptoms or would like my help, please schedule a Free 15 Minute Consultation. I am currently accepting new patients worldwide through video or phone consultations.

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COMMON (AND UNCOMMON) SYMPTOMS OF LONG COVID

Below you will find more information about just a few of the symptoms we see often in patients with Long Covid.

HEART PALPITATIONS, RACING HEART, HEART POUNDING
SOLAR PLEXUS/DIAPHRAGM TIGHTNESS
POST-COVID ANXIETY/ INFLAMMATION-BASED ANXIETY
NEW FOOD ALLERGIES AND SENSITIVITIES
NEW ENVIRONMENTAL SENSITIVITIES
HYPERSENSITIVITY TO SMELLS
LOSS OF SMELL AND TASTE
FOOD AVERSIONS AND NAUSEA
MUSCLE TWITCHES
INCONSISTENT RECOVERY (A GOOD DAY, FOLLOWED BY A RECURRENCE OF SYMPTOMS)
CYCLICAL SYMPTOMS (RECURRENT SYMPTOMS IN A SPECIFIC ORDER)
BRAIN FOG
INSOMNIA
HISTAMINE INTOLERANCE

WHOLE BODY SUPPORT FOR SYMPTOM RESOLUTION

Below the list of symptoms, you will find helpful tips and techniques that have been crucial to my patient's recovery.

FUNCTIONAL MEDICINE DIAGNOSTICS AND TREATMENT
QIGONG HEALING (SPRING FOREST QIGONG)
DIETARY GUIDELINES

The information in this article and on this website are intended for informational purposes only and does not take the place of seeing a doctor and should not be used for the purposes of diagnosis. If you are experiencing severe symptoms, have chest pain, or have trouble breathing, go to a hospital right away. Consult a doctor before beginning or stopping any medications or interventions.

USUAL (AND UNUSUAL) SYMPTOMS OF LONG COVID

HEART PALPITATIONS, RACING HEART, HEART POUNDING

A frequently reported symptom among Long Covid patients is a feeling that their heart is beating out of their chest even from minor exertions (like walking or showering). This can be very frightening.

After getting serious conditions ruled out by their primary care doctor, these patients are often left with persistent and inexplicable heart palpitations. Unfortunately, this is often because they are dismissed as a result of general anxiety.

Since the pandemic, I have received a sharp influx of patients reporting that their heart "feels like it's beating out of their chest" or that their "heart pounds even when they get up from a chair or go up the stairs." They feel that the palpitations are not related to anxiety and can happen randomly throughout the day, even when their mind is calm.

It's also common to hear from patients that their heartbeat feels irregular to them, despite them having it checked out by a cardiologist.

These symptoms are very common in patients recovering from a serious illness.

One thing that could be happening is that the heart may be working harder to move your blood through your detoxification organs. Infection can result in the liver system (including the gallbladder and spleen) becoming overburdened from viral debris from the initial infection - this debris can then result in pathological/systemic inflammation. [1]

Heart palpitations, accompanied by a feeling of breathlessness, dizziness, and loss of balance (in this case due to the loss of blood volume upon standing) could be also attributed to Long Covid postural tachycardia syndrome. [2]

These heart symptoms can persist for months, or even years, after the initial infection. While symptoms generally improve on their own over time, the pace of recovery can be agonizingly slow.

In many cases, once the cause is determined and appropriate support is given and steps are taken to reduce oxidative stress, these symptoms can improve or disappear altogether. [3]

Patient Example:

I had a Long Covid patient with reported 'heart pounding' palpitations accompanied by insomnia. This sensation increased around 9 pm and persisted until 7 am the next morning.

Essentially, the immune and nervous systems were in a state of low-grade chronic inflammation, which was also triggering the release of too much histamine and was exacerbated by histamine-releasing foods.

We focused on stabilizing the cells that release histamine (called mast cells). We used targeted nutritional medicines to stop the chronic inflammatory cycle so that the brain and the nerves going to the heart could go back to a healthy normal baseline.

We also supported the three stages of liver detoxification which is vital when resolving histamine issues. She noticed right away that she started to sleep much deeper and stay asleep for longer periods of time.

We incorporated a movement-based meditation (called Spring Forest Qigong) to help support her nervous system and reduce oxidative stress which sped up her recovery.

After 10 weeks, her sleep was back to normal and she no longer experienced heart palpitations or sensations of heart pounding. Her energy levels also were back to where they were before the infection.

SOLAR PLEXUS OR DIAPHRAGM TIGHTNESS

a 3d anatomical image with the diaphram highlighted.jpg

This is one of the most persistent and annoying symptoms my patients (and my wife) experienced. After Covid, there is often a tightness in the soft hollow below your sternum (also called the solar plexus).

This tightness can prevent you from taking a natural deep breath. Patients often compensate by raising their shoulders and 'manually' taking deep breaths themselves.

It can feel like they never get enough oxygen when they rely on their natural breathing rhythm. This feeling persists despite these patients' O2 levels being monitored in a hospital setting to confirm that they are getting enough oxygen.

This could be due to the pathological changes in the muscle tissue of the diaphragm during a covid infection, which has been shown to result in fibrosis (scar tissue). [4]

This symptom could also be correlated to changes in mitochondrial function post Covid, which results in compromised oxygen exchange. [5]

Another potential cause is lymphatic congestion - the lymphatic system is the organization of vessels responsible for 'cleaning up' the body from head to toe. In Long Covid patients, the lymphatic system can be overburdened and benefit from external stimulation to restore flow. [6]

Most patients report that laying down (especially with their arms over the head) helps with the tightness and that 'overdoing it' - either physically or emotionally - generally makes the tightness worse.

Early in your recovery, 'overdoing it' can mean just getting out of bed and doing some light cleaning.

Later in your recovery, you may notice the tightness after walking briskly or getting upset. Gradually, this sensation can go away on its own, but there are interventions that can help speed up recovery significantly. [7]

Notes:

Particularly early in your recovery, do not push physical or emotional exertion.

Gently massaging the solar plexus area with your index and middle finger in a circular motion (with the abdominal muscles relaxed and you leaning slightly forward in a seated position) can also provide relief.

Another area to massage gently is the spot in the abdomen halfway between the end of the chest bone (sternum) and your belly button. Often this area is tight and tender to the touch as well. When massaged, it can stimulate the restoration of lymphatic flow in the torso.

POST-COVID ANXIETY & DEPRESSION /

INFLAMMATION-BASED ANXIETY & DEPRESSION

The Long Covid patients who experience anxiety and depression are remarkably similar to each other. Even to patients who have had anxiety and depression in the past, the 'post-covid' version can feel very different and significantly more severe. [8]

Patients often experience many hours of consecutive anxiety, usually at night, accompanied by heart pounding or heart palpitations and insomnia. These anxious episodes usually occur after exertion or after eating food sensitivities.

Depression is often experienced throughout the day and frequently gets worse at night.

Whereas normal periods of stress before a Covid infection could be handled with relative ease, Post-Covid, patients report having a much lower capacity to handle stress of any kind - emotional, environmental, or physical.

Patients report having very dark thoughts during these episodes, including thoughts that they will never be healthy again. These thoughts are often accompanied by an intense fear of death.

The mechanism at work is likely a combination of many different variables.

Hemorrhagic, hypoxic, and inflammatory damages of the central nervous system, metabolic changes, and systemic inflammation due to the initial infection could all potentially be factors in ramping up anxiety, while high levels of histamine circulating in the bloodstream can greatly amplify anxious thoughts. [9]

Another potential cause is Covid viral debris often is not effectively cleared from the body and can stimulate the release of additional cytokines, which can perpetuate Long Covid symptoms. [10]

This debris/toxic material is often stored in the muscle tissue and lymphatic system. This may be why many of our long covid patients say that their anxiety, heart palpitations, and other symptoms get worse after physical movement (everything from running to just moving their arms while in bed all day).

When you move your body, you manually stimulate your lymphatic system of detoxification. This is necessary for health, but when recovering from illness, it can cause debris stored in your tissues to enter the blood and lymphatic system, triggering a release of histamine as your body tries to protect itself from what it perceives to be an invader.

Histamine is naturally released at night and after meals, which coincides with the timing of peaks of anxiety and depression symptoms in many patients.

Identifying food allergies and sensitivities acquired due to infection and temporarily removing them from your diet, helping your body to process histamine naturally, and lowering levels of inflammation and oxidative stress can all have a dramatic effect on these severe symptoms.

We do this in a wide range of ways which depend heavily on underlying health conditions, other symptoms present, and what we find in test results.

Notes:

With any patient with anxiety or depression (which often has a histamine component), it is important to pay close attention to their diet. Often, Long Covid patients have newly acquired food allergies and sensitivities. Identifying and removing those foods while supporting balanced histamine production will be key steps in regaining equilibrium.

A healthy diet (high in fruits and vegetables and low in processed foods) has been shown to decrease symptoms and benefit those experiencing anxiety. [11]

Very low carbohydrate/Keto diets can sometimes exacerbate anxiety and depression symptoms due to the very low intake of carbohydrates. Some patients have found significant relief in consuming high-quality, complex carbohydrates before bed (like a sweet potato with dinner).

NEW FOOD ALLERGIES AND FOOD SENSITIVITIES

After infection, it is common for food allergies or sensitivities to increase in severity or in number. An allergy is a more severe reaction and could potentially be life-threatening, as a peanut allergy can cause an anaphylaxis reaction.

Developing a dairy allergy or sensitivity, in particular, is often reported. Gluten intolerance after a Covid infection is also frequently reported.

Food allergies and sensitivities can be accompanied by hives, rashes, eye swelling, insomnia, severe anxiety, digestive problems, and mood swings.

This is partially due to the body's compromised ability to process excess histamine. It can also be due to a compromised gastrointestinal tract.

Notes:

Eliminating dairy and gluten for two weeks as a trial to see if your symptoms improve is helpful. If you experience rapid improvement, then the next step is to repair your digestive system to allow you to reincorporate those foods eventually.

In the short term, particularly if you are experiencing anxiety, hives, or trouble sleeping, patients have taken activated charcoal at night to absorb excess histamine. Since activated charcoal absorbs nutrients, minerals, and medication along with excess histamine, this is only a short-term solution (once you check with your primary care physician to see if it is safe to try). A more sustainable approach to lowering overall histamine will require a comprehensive patient assessment.

NEW ENVIRONMENTAL SENSITIVITIES (MOLD)

My practice often sees patients with extreme environmental allergies. I have seen patients who are so reactive to seasonal allergies that they have been forced to move across the country and a patient with such severe chemical sensitivities that she was confined to a single room in her house.

Post-Covid environmental sensitivities are a pervasive problem. I have often seen that it can take months for a patient to narrow down the source of their symptoms.

In this case, advanced functional medicine testing can be very helpful. We offer a mycotoxin test (which tests for mold toxicity), a micronutrient test (to see if you are missing key detoxification nutrients which would make you more sensitive to your environment), and an organic acids test (which evaluates metabolic status, gut health, and general detoxification capability). We can also directly test for other environmental toxins.

By utilizing this testing, particularly in cases where I suspect multiple sensitivities, we can save the patient weeks or months of trial and error and begin the healing process immediately.

Increased reactivity to mold is the environmental sensitivity we see most often, but we have also seen new serious reactions to dust, fragrances, food smells, pet dander, seasonal allergies like pollen, and volatile organic compounds (VOCs) in furniture and in building materials.

Notes:

Remember that you don't have to see mold in your house to have it be a problem. Mold can be lurking behind bathroom tiles or in a leaky roof. Be mindful of how you feel in different environments. If you feel like a new person outside of your house, there could be an environmental allergen causing your lingering symptoms.

HYPERSENSITIVITY TO SMELL

Interestingly, as many Long Covid patients report a loss of smell, many other patients have experienced a new, almost superhuman sensitivity to smells.

Things like perfumes can now be unbearably strong even with the bottle sitting in the drawer, and a slightly overused t-shirt can be smelled practically through the wall.

These changes have been observed to recede as the patient regains health after the initial infection. [12]

This symptom can be due to the cranial nerve/olfactory nerve becoming inflamed after the infection. This kind of neuroinflammation can be treated by using target nutritional therapies.

LOSS OF SMELL AND TASTE

Loss of smell and taste was one of the first known symptoms that distinguished Covid from other infections. Unfortunately for some, this symptom has lingered for months or even years.

The latest research contends that a SARS-CoV-2 infection reduces the action of olfactory cells, proteins on the surface of nerve cells in the nose responsible for detecting smells. [13]

This, too, can be treated using a combination of techniques depending on a patient's other symptoms.

FOOD AVERSIONS AND NAUSEA

Food aversions are usually accompanied by nausea or a feeling that the digestive system is not optimal. The patient reports that they just don't feel like they are digesting things well and have no desire to eat. This is an instance where the patient's intuition is right (it usually is).

Due to the effects of an acute infection, digestion has been impaired on a fundamental level. When this symptom is present, there is usually extremely low stomach acid, excessive gut permeability, or small intestine bacterial overgrowth (SIBO) that makes normal digestion very hard.

Fortunately, with functional medicine, we can quickly isolate the cause of this aversion and restore digestive function. With restored digestive function, the food aversions typically go away.

Another potential cause of food aversions is the presence of a newly acquired food sensitivity. As always, identifying and removing food sensitivities will help reduce symptoms quickly.

MUSCLE TWITCHES

Muscle twitches are also very common after a covid infection. These can migrate all over the body but are more common at the 'origin' and 'insertion' points of your muscles.

These terms (origin and insertion) refer to where the muscle attaches to the bone - essentially where the muscle begins and ends.

For your bicep muscle, the origin would be at the scapula (shoulder) and the insertion is at the radius of the biceps brachii (elbow joint).

Twitches can often be alleviated at these origin and insertion points by massaging those points - but be careful.

Overstimulation of areas where the twitches are often result in more symptoms (anxiety, hives, heart pounding, diaphragm tightness) due to the excessive release of viral debris collected in that area which, in turn, can cause an inflammatory reaction.

These twitches can feel very strong and persist throughout the day. If you have muscle twitches that keep you awake or ones that jerk you awake when trying to fall asleep, these are called 'hypnic jerks.'

Notes:

Whereas getting lymphatic massages can assist some people in healing faster, be very careful, and go extremely slowly.

Start with gently massaging your legs and arms for a few minutes with some organic oil or lotion, then wait 24 hours to see if your symptoms flare.

Some people seem to have more difficulty processing the viral debris released during a massage. If you previously have got headaches or felt nauseous after getting a massage pre-covid, getting one post-covid should be undertaken with extreme care.

INCONSISTENT RECOVERY (A GOOD DAY, FOLLOWED BY A RECURRENCE OF SYMPTOMS)

It is common for patients to report feeling unbelievably great for a day or two and think that they have fully recovered, only to have all of their symptoms rebound and feel worse than ever.

My wife, along with other patients that have had long covid, have said that the brief experience of normality, followed by a recurrence of symptoms, is far worse as it gives you a taste of health only to have it taken away. I want to tell you that this cycle is common, and it does not mean you will be in this cycle forever.

This pattern of slow recovery with many 'rebound' periods is very common with complex, chronic illnesses.

There are many reasons this could be happening. One possible reason is that impaired mitochondrial function is hampering the body's ability to recover consistently. [14]

Another potential reason is that on 'good days' people overexert themselves when their body is not yet able to process the high levels of viral debris still present in their tissues. This accumulation of viral debris results in an inflammatory reaction which causes the rebound symptoms. [15]

CYCLICAL SYMPTOMS (SYMPTOMS REOCCUR IN A SPECIFIC ORDER)

A companion symptom of 'inconsistent recovery,' cyclical symptoms refer to the strange consistency of the order of the recurrence of symptoms.

Cyclical symptoms are easiest to notice when a patient is on their way to recovery. These patients will experience a few good weeks (or hours), and then test the limits of their recovery in some way (going on a long run or getting into a fight with a family member). Importantly, symptoms can recur even if they do not do anything unusual.

Generally, over weeks or months, symptoms will become less severe and less frequent. Cycles that used to take weeks to cycle through eventually take only hours before they disappear entirely.

A Patient Example:

One patient's symptom cycle started with insomnia (characterized by strong hypnic jerks with the feeling of hot skin with chills at night) for a few days, followed by renewed diaphragm tightness and fatigue for about two days, which was followed by a sensation of a swollen tongue and anxiety for about two days.

As recovery continues, these relapses cycle through symptoms faster and faster. Days turn into hours or even minutes before they disappear altogether.

In this case, this patient's recovery was assisted by consistent Spring Forest Qigong practice (more about that below). [16]

BRAIN FOG

Brain fog refers to memory problems, trouble concentrating, and overall feeling of mental sluggishness and has been reported in those recovering from COVID-19. This can be due to the fact that the COVID-19 infection directly affects the function of your mitochondria, which is responsible for producing cellular energy. [17]

This is combined with a prolonged inflammatory response in the body, and the impairment of certain neural processes can create brain fog symptoms. [18]

A Patient Example:

This is where functional medicine testing really has an advantage in finding the root cause of hard-to-treat symptoms.

Often, there are underlying functional impairments due to a Covid infection (like mitochondrial dysfunction), but through testing, we can uncover things like severe vitamin deficiencies or a lack of glutathione - these things can make symptoms far worse.

INSOMNIA

While Insomnia is usually not considered a 'serious' symptom by most doctors because it is not considered dangerous, it is always ranked high on the list of priorities by new patients. Insomnia can be incredibly disruptive and can greatly reduce quality of life.

It is also common in Long Covid and is usually correlated with high histamine/histamine intolerance.

Chances of developing insomnia are greater if you have experienced insomnia before a Covid infection and have about a 60% incidence rate among Long Covid sufferers. [19] Fortunately, insomnia is highly responsive to functional medicine, lifestyle changes, and Cognitive Behavioral Therapy.

Our approach will vary based on your other symptoms, but the tips below can be helpful as well.

Notes:

Pay attention to your diet and keep a journal. The development of food sensitivities after the onset of Long Covid is very common yet can be hard to recognize because of a general feeling of overall ill health. Also, be mindful of high-histamine and histamine-releasing foods, as the consumption of these can result in a sleepless night when your histamine levels are already high.

Taking activated charcoal at night can lead to much better sleep when we have determined that the patient has persistent high levels of histamine. This, however, is a temporary solution because activated charcoal can absorb vitamins and minerals over time and can be disruptive to the absorption of other forms of medication.

'The Insomnia Coach' has some very helpful videos for those seeking to address insomnia naturally. These tips have been very useful to many patients. [The Insomnia Coach]

HISTAMINE INTOLERANCE

Many patients end up looking up their Long Covid symptoms to find that they correlate with search results on 'Histamine Intolerance,' 'Histamine Sensitivity,' and 'Mast Cell Activation Syndrome.' These classifications refer to symptoms like skin itchiness, hives, anxiety, insomnia, and digestive complaints.

The ACE 2 receptor that Covid uses for viral replication to infect the body is also present on mast cells, which can potentially be one of the causes of increased histamine response in Covid and Long Covid patients. (20)

Fortunately, Functional Medicine is well-suited to aid in the recovery of histamine-related Long Covid symptoms.

You can read more about histamine-related Long Covid symptoms in our blog article below.

WHOLE BODY SUPPORT FOR LONG COVID PATIENTS

HIGH-QUALITY, TAILORED SUPPLEMENTATION & FUNCTIONAL MEDICINE TESTING

Functional medicine is about harnessing natural, effective medicine using the latest diagnostic tools. I do not recommend the same supplement for everyone, nor do I recommend the same diet for everyone. Everyone's unique needs are different, especially for those recovering from Covid.

Many people have a natural aversion to taking pharmaceuticals because of the concern of side effects, but a heavy metal-contaminated supplement or one that is taken at the wrong time or at the wrong dose can cause significant side effects and hinder recovery as well.

The right type of medicine, at the right dose, at the right time, in the form closest to natural as possible, is the goal. If any of those factors are ill-suited to your health condition, especially when recovering from Long Covid, a medicine can be ineffective or slow down your recovery.

Just because there is a peer-reviewed article saying something could potentially be used to treat COVID-19 does not necessarily mean that that supplement or lifestyle intervention is good for you at this time. The same goes for a supplement that is widely considered to be beneficial.

There is no replacement for good diagnostics, which always includes a thorough patient evaluation, patient history, and a review of previous testing.

Below are a few things that most of my patients have found beneficial as they improve.

SPRING FOREST QIGONG

Spring Forest Qigong was developed for people dealing with illness to help them remove the energetic blockages impeding their recovery.

Through focus, meditation, and slow movements, Qigong has been clinically shown to help heal patients faster and more completely than conventional treatments alone. [21]

I specifically recommend the practice of Spring Forest Qigong which has been demonstrated in medical studies to be particularly effective. [22] It is a practice of moving meditations which you can do sitting or lying down if necessary.

Physician-led External Qigong can also be added to your regular appointments.

All patients trying to recover from Long Covid would benefit from cutting out processed foods as much as possible. Removing soda, candy, and high-sugar foods is also a great starting point, as it will help you significantly reduce your overall inflammation.

Specific recommendations will depend on your symptoms and constitutions. My wife, for instance, was experiencing severe chills during the initial phase of her recovery. She got a recommendation from Dr. Hon Lee (a Doctor of Medical Qigong and a Master of Spring Forest Qigong) to make Congee and have it every morning. A great recipe can be found here.

Different constitutions, different symptoms, and even different seasons of the year can call for very different dietary protocols.

This recommendation was made because her spleen needed support. Within three days, her chills disappeared, and her powers of digestion were greatly improved.

Notes:

Particularly if you are experiencing chills, all of your food should be cooked or, at the very least, warm. Avoid things like ice water and ice cream - if you react adversely, avoid them during your recovery.

Eliminate processed foods and refined sugars.

Be mindful that you may have developed new food sensitivities. If you experience new symptoms (like hives or stomach upset) when you eat food, make note of it and avoid it until you consult a functional medicine practitioner.

Moderation is everything during this time, be wary of extreme diets like Keto, as too few carbohydrates can make it harder for you to heal.

WORLDWIDE FUNCTIONAL MEDICINE CONSULTATION

Diagnosis ambiguity and complex symptoms are nothing new to functional medicine. In my practice, diagnosis is merely the beginning, not the end, of medical inquiry.

I am accepting new patients worldwide. New patient appointments are done over the phone or via video conference, and testing can be arranged at a hospital or testing location near you.

BIBLIOGRAPHY

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[2] Raj SR, Arnold AC, Barboi A, Claydon VE, Limberg JK, Lucci VM, Numan M, Peltier A, Snapper H, Vernino S; American Autonomic Society. Long-COVID postural tachycardia syndrome: an American Autonomic Society statement. Clin Auton Res. 2021 Jun;31(3):365-368. doi: 10.1007/s10286-021-00798-2. Epub 2021 Mar 19. PMID: 33740207; PMCID: PMC7976723.

[3] Raj SR, Arnold AC, Barboi A, Claydon VE, Limberg JK, Lucci VM, Numan M, Peltier A, Snapper H, Vernino S; American Autonomic Society. Long-COVID postural tachycardia syndrome: an American Autonomic Society statement. Clin Auton Res. 2021 Jun;31(3):365-368. doi: 10.1007/s10286-021-00798-2. Epub 2021 Mar 19. PMID: 33740207; PMCID: PMC7976723.

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[5] The Institute for Functional Medicine. Mitochondrial Impairment in Long Covid-19. https://www.ifm.org/news-insights/mitochondrial-impairment-in-long-covid-19/.

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[9] Tang SW, Leonard BE, Helmeste DM. Long COVID, neuropsychiatric disorders, psychotropics, present and future. Acta Neuropsychiatr. 2022 Jun;34(3):109-126. doi: 10.1017/neu.2022.6. Epub 2022 Mar 3. PMID: 35144718.

[10] Galán M, Vigón L, Fuertes D, Murciano-Antón MA, Casado-Fernández G, Domínguez-Mateos S, Mateos E, Ramos-Martín F, Planelles V, Torres M, Rodríguez-Mora S, López-Huertas MR, Coiras M. Persistent Overactive Cytotoxic Immune Response in a Spanish Cohort of Individuals With Long-COVID: Identification of Diagnostic Biomarkers. Front Immunol. 2022 Mar 25;13:848886. doi: 10.3389/fimmu.2022.848886. PMID: 35401523; PMCID: PMC8990790.

[11] Aucoin M, LaChance L, Naidoo U, Remy D, Shekdar T, Sayar N, Cardozo V, Rawana T, Chan I, Cooley K. Diet and Anxiety: A Scoping Review. Nutrients. 2021 Dec 10;13(12):4418. doi: 10.3390/nu13124418. PMID: 34959972; PMCID: PMC8706568.

[12] Loftus PA, Roland LT, Gurrola JG, Cheung SW, Chang JL. Temporal Profile of Olfactory Dysfunction in COVID-19. OTO Open. 2020;4(4). doi:10.1177/2473974X20978133

[13] Zazhytska et al., 2022, Cell 185, 1052–1064 March 17, 2022 ª 2022 Elsevier Inc. https://doi.org/10.1016/j.cell.2022.01.024

[14] The Institute for Functional Medicine. Mitochondrial Impairment in Long Covid-19. https://www.ifm.org/news-insights/mitochondrial-impairment-in-long-covid-19/.

[15] Galán M, Vigón L, Fuertes D, Murciano-Antón MA, Casado-Fernández G, Domínguez-Mateos S, Mateos E, Ramos-Martín F, Planelles V, Torres M, Rodríguez-Mora S, López-Huertas MR, Coiras M. Persistent Overactive Cytotoxic Immune Response in a Spanish Cohort of Individuals With Long-COVID: Identification of Diagnostic Biomarkers. Front Immunol. 2022 Mar 25;13:848886. doi: 10.3389/fimmu.2022.848886. PMID: 35401523; PMCID: PMC8990790.

[16] Zhang YP, Hu RX, Han M, Lai BY, Liang SB, Chen BJ, Robinson N, Chen K, Liu JP. Evidence Base of Clinical Studies on Qi Gong: A Bibliometric Analysis. Complement Ther Med. 2020 May;50:102392. doi: 10.1016/j.ctim.2020.102392. Epub 2020 Apr 6. PMID: 32444061.

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