Our Approach to Long COVID
A Functional Medicine & Integrative Medicine Approach to Recovery
Why patients with persistent post-COVID symptoms deserve answers beyond “your labs are normal” and what a root-cause approach to recovery looks like.
If you are reading this, there is a good chance someone has already told you that your labs look fine. And yet you are exhausted in a way that sleep does not fix, your brain does not work the way it used to, your heart races when you stand up, and you no longer recognize the body you are living in.
At the Marty Ross MD Clinic for Functional Medicine & Lyme Disease, we see you, and we believe you. What you are experiencing is real, it is measurable in the right hands, and, in our experience, it is treatable.
What is Long COVID?
Long COVID, also called Post-Acute Sequelae of SARS-CoV-2 infection (PASC), is not a single illness with a single cause. It is a final common pathway that the body arrives at through several possible overlapping mechanisms:
lingering COVID viral material that the immune system has not fully cleared,
reactivated infections like Epstein-Barr virus or Bartonella,
a nervous system stuck in a state of threat and inflammation,
hormonal dysregulation,a gut microbiome thrown out of balance,
mitochondria that can no longer keep up with the body’s energy demands,
autonomic dysfunction leading to heart racing or periods of fainting,
mast cell activation syndrome with inflammation and allergies,
and, in many cases, vascular endothelial dysfunction limiting blood flow or causing microscopic blood clots quietly starving tissue of oxygen.
Conventional medicine is very good at ruling out heart attacks, blood clots, and pneumonia. It is far less equipped to find, and thus treat, the more subtle, multisystem dysfunction that drives Long COVID once the acute illness has passed.
This is where functional and integrative medicine comes in. Rather than treating each symptom in isolation, we look for the underlying drivers of your illness and build a recovery plan around correcting them.
Long COVID Treatment: Two Frameworks Working Together
At the Marty Ross MD Clinic in Seattle, our approach rests on two complementary disciplines:
Functional Medicine asks why your body is producing these symptoms in the first place. We look beneath the surface at immune dysregulation, viral persistence, microclot formation, gut health, mitochondrial function, and hormonal balance to identify what’s actually driving your illness.
Integrative Medicine asks how to bring every appropriate tool to bear on your recovery: prescription medications when they are warranted, targeted nutraceuticals and enzyme therapies, and lifestyle and nervous-system interventions, all brought together into a single coherent plan rather than offered piecemeal.
Together, these two approaches give us the full picture: the why behind your illness, and the how of getting you well.
Long COVID Is Not One Condition But Several Overlapping Ones
In our practice, we have come to think of Long COVID less as a diagnosis and more as a description: a label that captures several distinct biological processes that frequently occur together.
A patient whose dominant problem is fatigue and post-exertional crashes may be dealing with mitochondrial dysfunction and a dysregulated nervous system. A patient with brain fog, dizziness, and a racing heart on standing is more likely dealing with autonomic dysfunction and microclot-driven hypoperfusion. A patient with relentless joint pain and new food sensitivities is often dealing with gut dysbiosis and mast cell activation syndrome. Most patients have some combination of all the above.
This is precisely why a one-size-fits-all approach fails so many Long COVID patients. Our evaluation is built to identify which of these processes are active in you, so that the treatment plan reflects your biology rather than a generic checklist.
Our Long COVID Diagnostic Evaluation
At the Marty Ross MD Clinic in Seattle, we begin with a comprehensive evaluation that goes well beyond the standard panel ordered in most primary care or even hospital-based Long COVID clinics.
Foundational Labs: Complete blood count, comprehensive metabolic panel, full thyroid panel including reverse T3, and core nutrient levels including vitamin D.
Gut Microbiome Testing: Comprehensive stool analysis through Jona Health, as COVID-19 infection is strongly associated with reduced microbial diversity and dysbiosis that can drive systemic inflammation.
Mitochondrial & Nutrient Assessment: In order to identify the energy-production deficits that underlie much of the fatigue and post-exertional malaise our patients describe.
Infection Activation: As needed, we test for Epstein-Barr virus activation or evidence of Lyme, Babesia, or Bartonella activation.
Spike Protein Persistence & Viral Reservoir Testing: This is the newest and most rapidly evolving area of Long COVID science. Emerging research has identified persistent spike protein and viral RNA in blood, gut tissue, and other reservoirs months after the initial infection, and several research groups are racing to develop reliable clinical biomarkers for this. We stay current with this research and, where validated and accessible testing exists, we incorporate it into your evaluation.
Your Long COVID Recovery Roadmap
Once we understand which biological processes are driving your illness, we build a personalized treatment plan. For most patients, that plan draws from the following areas:
1. Foundations: Sleep, Diet, & Pacing
Recovery is not possible without a stable foundation. We start by addressing sleep quality, an anti-inflammatory diet tailored to your gut findings, and pacing: learning to live within your current energy envelope so you stop triggering post-exertional crashes while your body heals. This is not the same as graded exercise therapy, which we do not use; pacing means working with your limits, not pushing through them.
2. Restoring the Gut Microbiome
Using your Jona Health stool analysis, we work to rebuild microbial diversity and repair the gut lining with targeted probiotics, prebiotics, and gut-healing nutrients. A healthier gut means less systemic inflammatory signaling reaching the brain and immune system. For many patients, real improvement in brain fog and fatigue follows directly from gut repair.
3. Calming Immune Activation & Microglial Inflammation
Many Long COVID symptoms (brain fog, fatigue, widespread pain, mood changes) trace back to activated microglia, the immune cells of the brain, which kept in a chronically inflamed state by ongoing immune signaling.
Low Dose Naltrexone (LDN): Our first-line prescription approach for immune regulation in Long COVID. At very low doses, naltrexone modulates microglial activation and toll-like receptor signaling, calming neuroinflammation rather than suppressing the immune system outright. We typically start patients at a low dose and titrate slowly upward as tolerated.
Targeted Anti-Inflammatory Nutraceuticals: Including omega-3 fatty acids and liposomal curcumin. Used to reduce the cytokine-driven inflammation that perpetuates symptoms.
4. Addressing Microclots & Circulatory Dysfunction
Circulatory dysfunction is caused by injury to the vascular endothelial cells, and its protective covering called the endothelial glycocalyx.
Nattokinase & Lumbrokinase: Two enzymes that work to breakdown microclots. They may also address persistent spike protein.
Rhamnan Sulfate: An extract from the seaweed called Monostrum Nitidum. It has a promising effect on repairing the damaged endothelial glycocalyx to improve function of the vascular lining.
5. Restoring Mitochondrial Energy Production
Post-exertional malaise, the hallmark crash after physical or mental exertion, reflects real, measurable dysfunction in how your cells generate energy. We support mitochondrial repair with targeted nutrients including phospholipids, CoQ10, PQQ and creatine, matched to your individual needs.
6. Supporting the Autonomic Nervous System
For patients with dysautonomia (lightheadedness on standing, racing heart, exercise intolerance, temperature dysregulation), we combine foundational measures such as fluid and electrolyte loading, compression garments, and graded recumbent reconditioning with more targeted options as needed. Here are some novel therapies we may use:
Transdermal Nicotine: An emerging and still investigational option for dysautonomia-dominant Long COVID. Nicotine works to dislodge persistent COVID spike protein from acetylcholine receptors. This may improve autonomic nervous system function.
5 Hydroxy Tryptophan (5 HTP): COVID disrupts the conversion of 5 HTP into serotonin in the intestines. Taking 5 HTP may increase serotonin production leading to improvement in autonomic function.
7. Hormonal & Thyroid Support
We routinely find peripheral thyroid resistance (a pattern of elevated reverse T3 that standard TSH testing misses entirely) in Long COVID patients with persistent fatigue. Where appropriate, we also address perimenopausal and menopausal hormone changes that compound post-viral fatigue and brain fog.
8. Treating Underlying Infections & Reactivated Viruses When Present
COVID-19 infection can reactivate dormant viruses such as Epstein-Barr virus, and in patients with a prior history of tick-borne illness, it can also unmask previously controlled chronic Bartonella, Babesia, and Borrelia. When our evaluation identifies these contributors, we treat them directly with targeted antimicrobial and antiviral strategies rather than leaving them unaddressed in the background.
We also consider antiviral supports for persistent COVID infectious reservoirs or recommend nattokinase for persistent COVID spike protein.
9. Mast Cell Activation Syndrome
If you are suddenly sensitive to many foods, chemicals or allergens in your environment, COVID may have triggered your mast cells (allergy cells) to stay activated. At the center of our approach for this is LDN, mentioned above, which stabilized mast cells. But we also work with other herbs and prescriptions to fix this problem.
10. Limbic System Brain Retraining
For some with Long COVID, the limbic system of the brain gets stuck in an on position. This part of the brain oversees sleep, reproduction, the autonomic nervous system, and more. When it is stuck on, it leads to fatigue, body pain, cognitive impairment, and more. We use brain retraining programs, like the Gupta Program, to address this issue.
A Note on Graded Exercise for Long COVID
Based on the same evidence that reshaped post-viral illness care after the 2021 UK NICE Guidelines, we do not use graded exercise therapy in Long COVID. Pushing through fatigue in a patient with post-exertional malaise worsens the underlying physiology and can set recovery back significantly. Movement is reintroduced carefully, and only once your underlying biology supports it.
A Partnership in Your Recovery from Long COVID
Long COVID recovery is rarely linear, and, unfortunately, rarely fast. But in our experience, patients who receive a thorough evaluation and a personalized, root-cause treatment plan — rather than a shrug and a referral to “wait it out” — can and do get meaningfully better.
We will partner with you through that process: testing what needs to be tested, treating what we find, and adjusting the plan as your body responds and as the science continues to evolve.
Your Path Forward
You do not have to navigate Long COVID alone.