COVID Long-Haul

In this article, Amy Rothenberg, ND and Michelle Simon, PhD, ND review what is known about Long-haul COVID and why naturopathic medicine is ideal for addressing post-viral complications. To Illustrate, they offer a patient case study as an example of what to expect if you were to see a naturopathic physician. Please note, the following information is for educational purposes only and is not intended to treat or cure any viral infection, syndrome or disease.

According to published reports and patient surveys involving upwards of 50,000 patients, 50% to 80% of those who have had COVID-19 continue to have symptoms three months after the acute ailment,regardless of the severity of the initial infection and well after blood tests show no virus in the system. For others, a wide range of symptoms across physical, cognitive, and emotional landscapes last even longer. Based on the ongoing prevalence of COVID-19 infection,we may well see a multitude of patients suffering from post-COVID-19 symptoms, called Long-Haul COVID-19 of Long COVID, for decades to come.

Post-viral syndromes are not new. We’ve long known acute viral infections can leave some people with lingering symptoms, such as fatigue, weakness, a general unwell feeling, digestive complaints, skin issues, hair loss, cognitive impairment, headaches, sore throat, and more. In addition, organ systems have been involved, including the heart, lung, kidney and the skin. At this time, it is unknown if these symptoms will go away on their own or lead to chronic disease states. For some patients who were hospitalized, there are additional issues such as post-intensive care syndrome (PICS) characterized by ongoing extreme fatigue, physical symptoms due to side effects of treatment, and trauma from hospitalization, similar to post-traumatic stress disorder (PTSD)

Though post-viral syndromes are not new, doctors are not used to seeing so many post-viral patients at one time. . Many Long-Haul COVID-19 patients share characteristics with chronic fatigue syndrome patients, Gulf War Syndrome patients, and others with ailments that reflect overall immune system dysfunction, leading to inflammation and complex, multi-organ complaints.

Many patients are seeking a fresh perspective on addressing their COVID-19 Long Haul challenges. Licensed naturopathic doctors (NDs) are reporting positive results by applying naturopathic medicine philosophy and gentle, effective approaches used to treat similar ailments. From our experiences, NDs are reporting positive results with patients who have been suffering and had very few options for treatments prior to seeking naturopathic therapies.

So What Can you Expect if You See an ND for Long-haul COVID?

First, the dcotor will apply the Therapeutic Order, to assess each patient then individualize treatment recommendations accordingly. No two Long Haul patients are the same. There are no cookbook prescriptions. For many Long Haul Covid patients, the very first step is feeling heard and believed, a key step in beginning the healing process.

There are themes to treatment, but for optimal results, specific lifestyle and natural medicine prescriptions are generated and unique to each person.Naturopathic doctors lean into a wide-reaching philosophy, which guides the practice of naturopathic medicine including the following key principles:

  • Like all doctors: First, do no harm (Primum Non Nocere).
  • Identify and treat or remove the Root Causes of illness (Tolle Causam.)
  • Treat the Whole Person: Consider individual physical, mental, emotional, spiritual, genetic, environmental, and social elements of our patients. Understanding symptoms in the context of the patient’s life is essential.
  • Apply the healing power of nature (Vis Medicatrix Naturae): Encourage both patients’ innate ability to move toward health and apply resources from the natural world that have the ability to support those efforts.
  • Doctor as teacher (Docere): Naturopathic doctors spend time teaching patients and encouraging self-responsibility for health and healthy lifestyle choices. Naturopathic doctors recognize, utilize, and honor the therapeutic potential of the doctor-patient relationship.

Naturopathic approaches for Long Haul Covid aim to rejuvenate immune function, decrease overall inflammation, support a robust and diverse microbiome, reverse autonomic nervous system dysfunction from ongoing stress, and reduce environmental exposures that may affect endocrine dysfunction (much more on this below).

Recommendations may include the following:

  1. Education about optimal nutrition, an anti-inflammatory, appropriate-for-you diet, and correcting nutritional deficiencies, especially Zinc and Vitamin D. Investigating and removing food allergens or sensitivities which can cause inflammation and irritation throughout the physical and emotional areas.
  2. Working to support a robust and diverse microbiome, by eating fermented and cultured foods and drinks, and in some cases, taking supplemental probiotics, since a healthy microbiome is central to optimal immune function, hormone balance, mood, cognition and more.
  3. Offering evidence-informed nutritional supplements or botanical medicines, each with its specific or synergistic biochemical impact as indicated for your general and your specific symptoms.
  4. Ensuring adequate hydration, perhaps half your body weight in ounces if possible, which helps to coordinate body temperature, keeps joints lubricated, prevents various kinds of infections, brings nutrients into cells, and is essential in  keeping major organ systems functioning well. Being well-hydrated also helps with sleep quality, cognitive function, and overall mood.
  5. Encouraging adequate and restful sleep, key to physical healing, and emotional and cognitive health.
  6. Suggesting appropriate exercise, as tolerable, and in consultation with physical therapists, cardiologists and pulmonologists, since some post-COVID patients have respiratory weakness, cardiac symptoms or musculoskeletal limitations.
  7. Obtaining referral for physical, respiratory or cardiac therapy as needed.
  8. Assessing and addressing psycho-emotional health, with referral for talk therapy and with naturopathic measures for the treatment of anxiety and depression.  The integration of body-mind methods is important as our understanding grows about the relationship between mood, immunity, the hormone system, and the central and peripheral nervous system. Using methods like mindfulness meditation, breathing exercises, positive imagery, and gratitude practices, all help normalize the activated stress response. Body-mind approaches, social engagement, adequate sleep and exercise, all raise the threshold for feeling stress and give you tools to help let go of some of the ongoing stress, part of the Long Haul Covid challenge for many people.
  9. Employing naturopathic medicine to address brain fog and cognitive decline.
  10. Adding whole- person medicines like acupuncture and homeopathy to stimulate the innate healing capacity.
  11. Addressing any structural issues, as indicated, through physical manipulation, massage, cranio-sacral work, etc., or referral to other providers who can provide such services. When the physical body is well aligned, other approaches will work better and circulation and perfusion is improved.
  12. Getting pharmaceutical intervention, as appropriate when other options have been exhausted. While prescription medications are not generally the first tool employed by naturopathic doctors, as state laws allow, NDs are able to prescribe many prescription medications; for others, appropriate referral is made.

Case Study of a Long Haul COVID Patient

The following is an example case study of patient treated by a naturopathic physician for Long-haul COVID. This is an illustration of what to expect if you see an ND. This is not a treatment plan or should be used to replace advice from your physician. If you wish so see an ND for Long-haul COVID, INM recommends you use our Find an ND database, here.

Here is a Long Haul COVID patient story and treatment plan that was created for her:

Prior to COVID-19, this 45-year- old woman was an otherwise healthy, robust person, who took her health seriously, ate a healthy diet, regularly exercised, and took a women’s multivitamin, vitamin D, and iron, as needed, due to anemia from heavy menstrual flow. She never drank and did not smoke. She had a life partner, a home she adored as well as a high stress job. She had the time, determination and resources to work on her health and came in ready to be a partner in her health care. She was looking for information, guidance and support. Her main complaints were shortness of breath, a strong sensation of a lump in her throat alongside a sore throat, a new-to-her sense of growing anxiety and most disturbingly, debilitating fatigue which kept her in bed most of the day, most of the week, being unable to work or do much of anything at all.

After the initial intake appointment, after a complete review of symptoms and physical exam, the following plan was created and shared in this note to the patient:

1.     Work on creating a robust and diverse microbiome. Take a probiotic, include cultured foods in your diet each day and be sure you have high fiber prebiotic foods included in your diet.

2.     Add bone broth to your diet. The collagen helps create healthy mucous membrane, and is essential for healthy blood vessels, and important for adequate perfusion ( blood flow) . Bone broths play a role in immune health. Lastly, their glycine (amino acid) content is high and helpful for quality sleep. To improve your vasculature, use berry juice concentrates, high in bioflavonoids, known to help improve circulation and reduce inflammation. Include berries each day, up to 1-2 cups for snacks or with meals.

3.     Take the combination supplement made of minerals and herbal extracts designed to encourage vascular smooth muscle relaxation, endothelial function andcirculation. It contains magnesium, hawthorn (Crataegus oxyacantha), olive (Olea europea l.) extract, grape seed extract (Vitis vinifera) extract (seed) and  pomegranate (Punica granatum) extract, lycopene and cranberry (Vaccinium macrocarpon).

4.     Take a fish oil supplement as a general anti-inflammatory and immune system modulator.

5.     Aim for 10-15 minutes a day, at least once, of sitting quietly either in a meditative/prayerful state or use an app like Headspace or CALM for a 10-15 minute session.

6.     If you are able to get out for a short walk, even 10-15 minutes, that would be great. Please take up the few yoga postures and breathing postures practiced in the clinic

7. If you enjoy a bath, add 1-2 cups of Epsom salt in your bath 2-3x a week.

8.     Consider dry body brushing to help enhance circulation. Vegetable fiber brush, used on dry skin, small circles starting at the periphery and moving toward your heart.

9.     Please take the homeopathic remedy discussed, which was chosen specifically for how his patient experiences symptoms. This should help in an overall way with the worry and anxiety and hypervigilance. It may also help with the sensation of tightness and inflammation in the throat and with your capacity for taking a deep breath. Homeopathic remedies are prescribed based on your presenting symptoms contextualized in the rest of your overall health as well as more temperamental tendencies. This is the most individualized of all our approaches.I look forward to seeing you at the 3 week mark after you are up and running with this plan. Thank you for the opportunity to try and help,” the doctor concluded.

Long-Haul COVID Case Study Outcome

Patient reported that within a week of starting the plan, she was breathing more easily and could walk further without shortness of breath. Patient shares that she no longer feels tightness or a lump in her throat, and does not have a sore throat. She says her energy is improving, she can get some work and housework done, and  has begun to see friends. We did not change anything at that point and encouraged the patient to continue the plan as above.

At the three-month mark, the patient continued to improve, is back to work half-time, is able to run again, has no further palpitations, no throat symptoms, feels like she’s getting back to herself and to her life. We reviewed her plan together, decreased the frequency of some of her supplements and set up a 2 month follow up visit. Main recommendations at this time are:  not to over-do, stay committed to regular, adequate sleep, and stay with her whole-foods, anti-inflammatory diet along with the supplements.

In conclusion, we encourage you to share this article with anyone you know who has been diagnosed with COVID-19. It’s likely they have some form of lingering and frustrating side effects of the viral infection. As you or someone you know works to put together the best possible health care team to address Long-haul COVID, consider adding a licensed naturopathic doctor to the list of providers. Whole person, gentle, and effective treatments may well be a central part of finding a way back to health. You can find an ND here.

For more on how naturopathic medicine can address difficult-to-treat health conditions, please see these additional articles:

How do Naturopathic Doctors Treat Hypothyroidism?

How do Naturopathic Doctors Use Precision Medicine?

Personal Story of Chronic Fatigue and Fibromyalgia from Razi Berry

Under What Circumstances Should I Choose to See a Naturopathic Doctor?

How Toxins Cause Disease, from Joe Pizzorno, ND

What is an Anti-Inflammatory Diet?


This article is provided by the Institute for Natural Medicine, a non-profit 501(c)(3) organization, partnered with the American Association of Naturopathic Physicians. INM’s mission is to transform healthcare in America by increasing both public awareness of naturopathic medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing health care systems and to empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following  initiatives:

  • Education – Reveal the unique benefits and outcomes of naturopathic medicine
  • Access – Connect patients to licensed naturopathic doctors
  • Research – Expand quality research of this complex and comprehensive system of medicine

Michelle Simon, PhD, ND is the President and CEO of the Institute for Natural Medicine.

Amy Rothenberg ND, DHANP is a contributor to INM and practicing licensed naturopathic doctor in Northampton, Massachusetts.