Long COVID Explained: Diagnostics, Root Causes, and Recovery

Discover why long COVID affects multiple body systems at once—from hormones and the nervous system to gut health, circulation, and energy production—making recovery highly individualized.
Understand how conventional medicine, functional medicine, and traditional Chinese medicine each offer unique strengths in diagnosing and treating long COVID symptoms.
Learn why pacing, nervous system support, gut repair, sleep, and emotional healing are foundational for recovery, especially when progress feels inconsistent or non-linear.

About the Expert

John Nieters, LAc, DAOM, CFMP

Dr John Nieters

Dr John Nieters has been teaching and practicing the combination of Functional Medicine paired with Traditional Chinese Medicine for several decades. He has been practicing Tai Qi, Qi Gong and meditation for 50 years.

He has hosted over 500 call-in talk radio shows on "The Balancing Point." He currently lives in Alameda, CA with his wife, Jenny and son, Johnny. His wife, Jenny, is the acupuncturist for the 49ers football and St Mary's Rugby team.

He has authored the book "The Sweet Spot," on how to read your blood work and plans to have two additional books published this year.

Dr John's patients, staff and listeners call me the "Story-teller".

The Cleveland Clinic had a herbal clinic. We use the same brand of herbs that they have used. They went through almost 500,000 cases, half a million. And they found three times they had some, what they considered a negative effect.

One headache, one case of itching and one of diarrhea. That's in half-a-million. Now you give half million people aspirin and you're going to get deaths.

right? Depending on the dosage, you could get a lot of deaths. And so the herbs are much safer than taking an aspirin if they're given to you by a competent herbalist.

You do not want to go online and pick out an herbal formula because you don't know how it's going to act in your body. It could actually do the opposite of what you want because they are very powerful.

Hi and welcome to The Balancing Point. I'm Dr. John Needers and I am here to make traditional Chinese medicine functional medicine and integrative health simple, practical and fun so you can restore balance, boost vitality and enjoy a healthier life every single day.

Hi, this is Dr. John Needers, your host at The Balancing Point. We're here with some more information. And today I'm going to talk about long COVID, so-called long-COVID, and understanding diagnostics and the treatment options.

So I am going look at this the way I look through many things. many different lenses, many windows, if you will. I want to talk a little bit about conventional medicine, a bit of functional medicine and a traditional Chinese medicine.

And how the integration of those is so powerful. Now I've spoken on that issue many times, including my own life story, how powerful that combination can be.

So today we're going to take a look at Long COVID. What is it? And basically it's ongoing symptoms after COVID or COVID vaccination. Now, in my personal experience as a doctor, they tend to show up a little bit differently.

That may not be true overall, but in the clinic, I see more nerve damage problems from the vaccination and I see more of some of the other problems had COVID.

Now, of course, if people had Covid and were vaccinated multiple times, then it's just a layering on of problems and makes the solution a little bit more difficult to get to.

And the idea with long COVID is that it can last months or longer. It affects multiple body systems. The, some of the more common things are hideous levels of fatigue, like people unable to just walk to their car and then other lesser levels where people that used to be runners can't run anymore.

People that use to work out with weights, can work with weight anymore, so fatigue brain fog where it feels like you're like your. Walking in quicksand through your brain, you just have trouble pulling up words.

You're having trouble with some relatively basic concepts and some severe cases. Breathing issues, lung problems, insomnia. Insomnia is a huge one. And it's interesting.

The more complex the problem is. Often, the most important thing is starting with the basics, right? Everybody wants to fix everything all at once. Well, with long COVID, that's very difficult to do.

It can be fixed, but it's generally not an overnight fix. And we need to make sure that people are sleeping. We need bowel movements regularly, that they're not constipated.

We need to make sure that their gut is healthy, their microbiome. Now, people don't necessarily like to start with those things, but it is important to get those basics, the basics of life handled.

Otherwise, it's very hard to rid of the deeper symptoms. So, we see a lot of reactivations. People who have had Lyme disease historically or co-infections.

suddenly they're back with a vengeance. And some of them, it's pretty easy to trace. There's a big, big uptick in Bartonella cases, and that can cause some very distinct symptoms, particularly brain-related symptoms.

Also, we're seeing an uptake in retroviruses. Now, a very high percentage of our DNA, the estimates are about 8% or so, are actually retroviruses that our ancestors picked up and they've gotten into our DNA.

And as long as you're healthy, those retro viruses, you know, don't seem to bother you much. But when you get weakened by something like COVID or certain vaccinations, then the retrovirus is really come out and wreak havoc.

POTS, that's postural orthostatic tachycardia syndrome. So you stand up and your heart rate just shoots through the ceiling. Dysautonomia. Pots is a type of dysautomia, but you have other cases where you could do a tilt table test, for example, or we do what's called a raglan's test here in our office on almost every patient.

You go from lying down to standing up and your blood pressure should go up from 5 to 10 points. With severe dysautonomia, you stand up, and you're blood can drop 20 to 25 points, very scary stuff.

So those are very, very common with long COVID. You also see a lot of nerve damage. We're treating several patients right now that developed small fiber nerve damaged within days of getting vaccinated.

Again, I'm not seeing that quite as much with actual COVID, more with the vaccine. And I've got several cases that have been confirmed by their medical doctors that that is what occurred.

Also, we see microclots. Now micro clots are clods that if you do a normal scan, you're not going to find them. So we do lab testing for certain things to see if the body is clotting in general.

And as you'll see later in the presentation, in Chinese medicine, We have a huge advantage in that area because we have A variety of ways of testing For what's called blood stasis, where the blood isn't moving.

and certainly with the clot, that would be the case. And so why it's complex? There isn't a single test. There is no single tests to prove long COVID.

Now, we're looking at antibody tests for the spike protein. And if that's positive, we're going to assume that that is an issue. But even then, that isn't the only problem, because the spike protein, which would be present if you have spike-protein antibodies, could be attacking anything.

It could even be stuck in anything, so even there is no single test. Symptoms can vary widely. Some people have every symptom that I mentioned, some people only have one.

And there can be multiple root causes of that. As I mentioned, it could be cardiovascular. And as you'll see later on, there are many other things that can because by like immune system problems, nervous system, problems cardiovascular problems.

Why it's complex. It can affect the hormones and the feedback loops. In fact, often it affects hormones. Early on in the COVID pandemic, we had a lot of women having significant menstrual changes.

Either they stopped having periods or they started having very heavy periods. We had one patient that was 80 years old started to having period again.

Obviously the first thing you think of is some form of cancer. So of course we referred her out to her gynecologist who examined her and said, no, You're having a period.

So it can throw all of those hormones and feedback loops off. And so most of the hormonal activity in the body is run by feedback, loops, either positive feedback or negative feedback.

During menstruation, the estrogen levels get very low. The body starts putting out a higher level of follicle stimulating hormone, which will stimulate the follicles to produce more estrogen.

When the estrogen gets to a certain point, the feedback tells the pituitary, we don't need any more FSH. And then you shift over to luteinizing hormone which then causes you to ovulate, and then your progesterone goes up.

But those are all feedback loops. And those feedback loop can easily become dysregulated with long COVID. So we've got the adrenal dysfunction of people who just have no energy, hard to get out of bed.

One of the problems is often adrenal disfunction. We're looking at problems there with the HPA axis, the hypothalamic pituitary adrenal axis. Hypothalamus is reading everything.

It's like the master control room, the blinking lights on a submarine or in a nuclear facility. And when it sees that a change needs to happen, maybe you need more thyroid hormone, may be you a need a more luteinizing hormone.

Maybe you needed more estrogen, etc. it sends a closed loop message to the pituitary. The pitutary then sends out what are called trophic hormones. thyroid stimulating hormone being one of those.

So doctors call that a thyroid hormone often, but it's not. It's a pituitary hormone that is stimulating to either make more or less thyroid hormones.

That can get thrown off. And then you have the sex hormone dysfunction, which is very, very common with long COVID. In conventional medicine, the focus is of course on diagnosis and symptom management generally.

People will go to one of the major clinics who specialize in treating long COVID. I support that because they do a tremendous amount of testing, very expensive testing.

And so I love that. However, I find that a lot of times their treatments just are the same. Four different people that have four different problems, but the treatment is essentially the same.

But I do love the testing and I also want to rule out something that's very severe. A cancer, a brain tumor, et cetera, and conventional medicine is very, very good at those procedures.

And it is evidence-based mostly. There are certainly quite a few exceptions, But mostly it's evidence based. Again, it's going to rule out serious conditions.

And so I love that and I loved patients to start there even. The diagnostics, they'll run blood tests. They'll do heart testing. There'll be lung testing, autonomic testing which is, as I mentioned, the tilt table type test to verify whether there's POTS or dysautonomia and they will do imaging, right?

They can check out the lungs and the heart or the brain, et cetera, which all very, very helpful. The treatment is pacing, is the term that's used now, but it's really energy management.

I had one patient. had been told by a major facility that she had chronic fatigue, ME-CFS, and that, she, had to take two years off. She could only get up to eat and to go to the bathroom.

Well, this was a very, very powerful woman who had, been an exercise teacher, et cetera. And so we would do deals, right? She loved the Warriors, going to, the San Francisco Warriors game.

And so we would set up a week ahead of time, a pacing system for her. Okay. You can do your life. The last two days before the game, have someone else walk your kids to school, go to the.

Game the next day, plan nothing, do nothing. Stay in bed, eat, goto the bathroom, like the clinic said. And she was able to completely. Get over her chronic fatigue.

It took a while, but she was able to get over it completely. Medications, you know, if they find a virus, they'll give an antiviral. If they. Find a bacterial problem, I'll given antibacterial for anxiety, depression, et cetera.

So they will give medications and then sometimes they do rehab. They may do lung rehabilitation. And if it's affecting the brain, They made do cognitive interventions.

The very powerful stuff. Functional medicine's a little different. The focus is on root causes and eliminating the root cause rather than doing primarily symptom management.

They'll do some different testing. As I mentioned, there is now a test for spike antibodies, which can be very helpful. And there are people who've figured out tiers.

So if you're under a certain level, you are probably asymptomatic. If you were in the next tier, your going to have some symptoms. and if your in top tier you probably can't get out of bed.

That's really valuable. Also with functional medicine, I mentioned thyroid. Well, typically the HMOs in the San Francisco Bay Area, I get a lot of their tests and they typically do two tests, thyroid stimulating hormone and T4.

T-4, so when the thyroid is stimulated, it makes several different hormones and the most abundant is T 4. But that doesn't have much bioactivity. When you need bio activity, one of the iodine molecules is broken off by a deiodinase and becomes T3.

And that's the energy bunny. These HMOs don't test for T3, and that is an extremely significant oversight. A very high percentage of females, some estimates are 50 to 55%, do not do a good job of converting T4 to T 3. So if you're just checking TSH and T 4, you could really be missing the boat.

With functional medicine, we check T SH for sure. Free T3, the amount that's unbound, free T4, maybe T 3, T 4, but also reverse T three. And that is a very important test for people that are under stress.

If you have long COVID, you are in stress, so reverse is an attempt by the body to shut down your energy functions. So what it does is it binds in the same receptor sites as T but it doesn't have much activity.

So it really, really shuts down your ability to use your thyroid hormone. And then we would test for thyroid antibodies, thyroid peroxidase, antithyroglobulin antibodies and maybe some other things.

But that's A big difference between functional medicine and more what I'm going to call conventional medicine is how deeply the testing goes in that direction.

Now with conventional medicines, they go very deep in other directions. It's a whole body system, right? Much like Chinese medicine, functional medicines is a body.

It's treating everything. Your microbiome can contribute to anything actually, but particularly to long COVID. All of your hormones can. And it's an extremely personalized approach.

When I have new acupuncturists come study with me or when I'm teaching a class, they want protocols. What's your protocol? Like if you go to a conventional medical doctor in an HMO, They'll have protocols if.

If you have symptom A, you get drug B, right? And there are protocols, I don't do protocols because no two people are alike. I know that seems obvious, but it's true.

Right. You get a headache. Well, there are many, many different types of headaches and in functional medicine and Chinese medicine, they all deserve different kinds of treatments.

So it a whole body system and it is a personalized approach. to you. So the diagnostics, inflammation markers, your conventional doctor may do that also, but usually the functional doctors do right at the beginning.

Your hormones, again more detailed testing, so example if they were going to test for testosterone, they don't just test total testosterone. They do free testosterone which tells you how much is in unbound and you're able to use.

And there's some other testosterone tests that can also be done with that. gut health, microbiome, intestinal integrity. Very, very rare for a conventional medical system to test any of those on a significant level.

I mean, there are stool tests now that measure hundreds and hundreds of markers to tell the health of your microbiomes, to how it's out of balance, if it is out-of-balance, are there yeast problems, etc.

And also several different tests that will tell if you have leaky gut, which is a real thing, the gut actually leaks. And there are some good reasons why that happens and some bad things that it does.

For one, if have leaking gut you also have a leaking brain. It's just the way it is. Again, I'll do a session on that and explain why it's so, but it so.

Then they'll nutrients and additional testing. You know, what are your vitamin levels? What are your mineral levels? Those fundamental, fundamental things.

Magnesium alone has hundreds of different functions in the body. If your B12 is off, you're not going to have energy. if your iron is too low, your not gonna have any energy, so you want to go deeply into those.

treatment, it might be an anti-inflammatory diet, some targeted supplements. Often supplements can get to the root a little faster than some other things.

You're going to want to do the gut repair. If you don't, heal the If you don't balance the microbiome and if you recreate gut integrity, nothing else will ultimately work.

And then nervous system support. So these are some of the ways that functional medicine would treat. Now in traditional Chinese medicine. It focuses on balance and energy, what's often called Qi.

Now, there are many different kinds of Qi, I'm not going to get into a discussion of that right now, but it's really, really misunderstood in many ways.

And it can be measured. We have many devices to measure Qi in the body or Qi flow in a body. In fact, you can go to a hardware store and get an electrical testing unit that measures ohms or resistance, and you can map out the acupuncture channels, right?

They're the areas of lowest resistance to energetic flow. Literally, you could get a $10 device and map it out. Now, ours cost a lot more than $ 10 and they're a little more accurate, but we will map the energy systems in your body so that we know exactly what needs to be treated.

and we do what's called a pattern-based diagnosis. We're not looking at one symptom. Now, we will gather all your symptoms, and then we'll do more testing.

But it's a patterns- based diagnosis, which is much broader than a symptom- base diagnosis and the pulse is a critical element of traditional Chinese medical diagnosis Essentially, there are three positions on each arm and three depths.

Now it's, you know, they're lots of overlap and 27 different pulse types. So you can imagine you've got nine pulses on or locations on the left hand, nine on, the right hand 27, different possibilities.

And you could imagine what that matrix is like for one thing. Someone sits down and I feel their pulses. I can tell what they have pots. It will, it'll stand out like crazy.

They don't have to say a word. The tongue is an underused, in my opinion, diagnostic tool. it's the sublingual veins, the veins underneath your tongue.

And after you watch this presentation, go look in the mirror, lift your. Tongue up and see what the two veins look like. Ideally, you can't see them. If you CAN, it means that there's some blood stasis.

The blood is not moving well, which means it's more prone to clotting and high blood pressure and many other cardiovascular problems. And if they're big purple earthworm looking veins, go see your local acupuncturist or herbalist.

Cause that's a life threatening condition. So my mom used to say that the eyes were the windows to the soul, Johnny. And for me, the sublingual veins are the window into the cardiovascular system.

and so symptom patterns, Chinese medicine is based on pattern diagnosis. Basically there are five major branches. in TCM treatment. I got my doctorate at Five Branches University.

So first, what most people know of is acupuncture, which would include electroacupuncture and moxibustion which is a heat application. But that's usually the acupunture, electro acu puncture.

You're going to insert very, very fine needles into acuplcture points. Usually you don't even feel them and that is going help rebalance the energy. For an injury, you put the acupuncture needles in and it draws what they call the soup.

It will bring at least 15 different chemicals or products to the site of the injury to really boost up the healing process. So there are many different ways that acupunture works.

Then herbs, there are 10,000 formulas, base formulas. And those can be combined in an infinite number of ways. These are very researched. The same people that do the medical research in China are doing the herbal research.

It's amazing and incredibly safe. the Cleveland Clinic had a herbal clinic. We use the same brand of herbs that they have used. They went through almost 500,000 cases, five, half a million.

And they found three times they had some, what they considered a negative effect. One headache, one case of itching and one of diarrhea. That's in half-a-million.

Now you give half million people aspirin and you're going to get deaths. Right. Depending on the dosage, you could get a lot of deaths. And so the herbs are much safer than taking an aspirin.

If they're given to you by a competent herbalist, You do not want to go online and pick out an herbal formula because you don't know how it's going to act in your body.

It could actually do the opposite of what you want because they are very powerful. Third is the Tai Chi, Qi Gong, which are meditation and movement oriented, stretching, martial arts, etc.

to move the energy in your body yourself rather than having the acupuncturists do it. Then food therapy, and it's very different than Western food, therapy.

It's seasonally based, our bodies developed, to be in rhythm with the seasons and the Chinese medicine we do, we really work with that. And it's very specific to specific cases.

I will give out handouts often of a huge list of foods that you can eat and a hugely list, a list foods to avoid if possible. and it is really based very personally on you.

not a condition. You know, I could get 10 people to come in with multiple sclerosis and they could all get a different diet plan. They could each get different herbal plan and each could different acupuncture treatment.

Then there's the kind of hands-on work called Tweenaw, which is Chinese massage, and then cupping, where you're putting cups on the body to pull the blood to the surface and the energy to surface.

And then gua sha, which is a kind of a scraping technique to do a similar issue to cuping. So the importance of balance. Now in Western medicine, they call it homeostasis, keeping things in balance, so a quote from Sun Tzu Mao.

I'll tell you a dozen reasons why Sun Tsum Mao is so important, but one, you know, David Brownstein is the thyroid guy, right? He's the specialist. Well, Soon-Samal was doing treatments that are as good as David's or better in 600 A. D.

and certainly better than what you get from most conventional medical systems. He was doin' this in six hundred A D. And he said, the way of nurturing life is rooted in yin and yang.

If yin and yang are in harmony, life is secure. If they lose their proper balance, disaster and illness arise. So think Einstein, E equals MC squared, where E equal energy, M equals mass, C equals the speed of the light squared.

Energy and mass are interchangeable and not absolutes. but they're relative. Think the theory of relativity, right? And so that's much like yin and yang, all right.

The ying is, mass is relatively yen, the body, et cetera. While energy is a relatively yang. But they are always, always interacting and you want to keep them in balance.

So. Integrative approach conventional for safety you're looking for really serious stuff and ruling it out functional going to root causes and TCM going To balance and so when you put those all together you have just miraculous healing possibilities so Key concept, pacing is critical, avoid overexertion, and recovery is not linear, right?

People will start up and they get really excited and then they'll level off for a while. And then there'll go up, then the level of for awhile. Maybe they overdo it and actually go down for while, so.

The recovery is not linear. Our body will heal at the rate that it needs to. I'm going to say here, the most important thing is that you also need to treat the emotional trauma.

We have several different ways of doing that in the clinic. but you need to treat the emotional trauma. There are some good online systems available that we have seen our patients have really good success with.

So don't leave that piece out of it. Complex condition, no single solution and it requires patience. Listen to your body, gradual progress and get professional guidance.

Be happy, be healthy, and thank you for tuning in. Without you, I wouldn't do this. And I love doing this, so thank Most approaches just manage symptoms.

Here we get to the root. So real healing, real clarity and balance can begin. Visit alamedaacupuncture.com. That's alamedaacupuncture dot com to learn more, explore our supplements or book a call.

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Alameda Acupuncture

Ancient medicine for our modern world

Long COVID Explained: Diagnostics, Root Causes, and Recovery

About the Expert

Recent Posts

Interested in knowing if we are the right fit for you and your condition?

Alameda Acupuncture

Ancient medicine for our modern world

Long COVID Explained: Diagnostics, Root Causes, and Recovery

About the Expert

Recent Posts

Tags

Interested in knowing if we are the right fit for you and your condition?