Article from Townsend Letter
Eliminating Persistent Post-COVID Symptoms and CFS/Fibromyalgia
by Jacob Teitelbaum, MD

COVID-19 deaths have been the main media focus for over a year now. But with time, something else has become clear: We’re focusing largely on the death statistics. Now, with the first wave of the battle done and the casualties counted, we are realizing that it is time to focus on the people who didn’t die—but who also don’t completely recover.

Many infections trigger chronic fatigue syndrome and fibromyalgia (CFS/FMS). For example, 40% of 369 SARS survivors studied in China reported a “chronic fatigue problem,” while 27% met the US Centers for Disease Control (CDC) definition for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).1 Numerous infections have also been shown to cause postinfectious CFS and fibromyalgia, including Epstein-Barr Virus (EBV), where post-mono CFS occurs in 23% of college students, 2 Lyme, and over a dozen others.3-10

We are now seeing a similar situation post-COVID 19. For example, in one study three-fourths of a group of patients who received care for coronavirus at Bristol’s Southmead Hospital were still suffering ongoing symptoms three months later.11 In another study of 128 participants, more than half reported persistent fatigue (52.3%; 45/128) at 10 weeks (median) after initial COVID-19 symptoms. There was no association between COVID-19 severity (need for inpatient admission, supplemental oxygen or critical care) and fatigue following COVID-19.12

Dr. Fauci has noted that post viral CFS/ME is what these persistent post-COVID symptoms represents,13and I concur with him on this.

One silver lining? Because of COVID 19, CFS/FMS is finally being taken seriously, with the NIH CFS/ fibromyalgia budget increasing from $28 million in 2019 to $1.15 billion over the next four years for post-COVID CFS.14

Although estimates vary dramatically, my estimate is that about 10% of symptomatic cases will end up having persistent disabling fatigue and other symptoms. This is similar to the estimates made by doctors Komaroff and Bateman.16 The bottom line:

The Good News

Fortunately, people with persistent symptoms of post-recovery do not transmit the virus, so they do not need to worry about being contagious.18

Both the post-viral CFS and effects on the heart, brain, and lung are very treatable, using a CAM mix of natural and prescription therapies. In this article, I will teach you what is needed to help people effectively recover.

How I Got Interested in Post-Viral CFS/FMS

The same way so many holistic practitioners do. Having the illness, or a family member who had the condition, and having been failed by the standard healthcare system.

In 1975, I came down with a nasty viral illness that I call the “Drop Dead Flu.” It knocked me out of medical school and left me homeless for good part of the year. But it was as if the Universe put a “Holistic Homeless Medical School” sign on my park bench. Naturopaths, herbalists, energy healers, nutritionists, and a wide array of other healers found their way to my park bench. Sometimes they even had a pizza with them, and I ate. But this was the venue in which I learned the bits and pieces of what I needed to recover from my own post-viral CFS and fibromyalgia. I was able to return to medical school, get honors in medicine, and I have spent the last 45 years researching, writing, treating, and teaching about effective treatments for these conditions. This includes four new treatment studies that I have been principal investigator on in the last 18 months.

The Treatment Protocol – Step One

Begin with the basics: shutting down excessive inflammation and free radical reactions. This is a critical first step in the healing process. Because so many systems go off-line in post-viral chronic fatigue syndrome, and post-COVID presents with even additional organs that need assistance, I find it essential to use supplements that not only are high-quality and research-based, but which maximize absorption and effectiveness with the smallest number of pills. For this purpose, I find products by EuroMedica®(available at Emerson Ecologics® and Fullscript®) to be superb. I would note that I take no money from this company. Payments I receive for being on their scientific advisory board go to charity. So let’s begin.

Balance the inflammation and free radical excess with a mix of Curaphen® and Clinical Glutathione™. These are my two favorites. The former is a mix of curcumin and turmeric essential oil, which increases absorption of the curcumin about 693%. To put this in perspective, turmeric is only about 2% curcumin. So it takes 50 pills of turmeric to get the active amount of one capsule of curcumin. Then the absorption of curcumin is increased almost seven-fold by adding in the turmeric essential oil. Translation? One Curaphen replaces handfuls of turmeric pills.

Meanwhile, while the curcumin is balancing the cyclooxygenase inflammation system (e.g. – joints), the Curaphen also contains boswellia (a.k.a. frankincense), which balances the lipoxygenase (LOX) pathway of inflammation, which is so important in the gut and lungs. Curaphen also has phenylalanine to increase endorphin levels for pain and nattokinase to help break down the debris from the excess clotting and inflammation.  As you can see, this single compound is outstanding for healing. It is also the first thing I go to in helping most people who have chronic pain, and it has been a pain relief miracle. Bottom line? Start with one-to-two caps, three times of Curaphen daily.

I also consider Clinical Glutathione one tablet twice daily. This contains the glutathione in a reduced and highly absorbable form. So this simple mix can go a long way to shutting down any persistent inflammation.

The third arm of balancing both the immune system and clotting systems are the omega-3s. Most fish oils have a relatively small percent of omega-3’s, and the remainder are largely useless oils that goes rancid and causes “fish oil burps.” Through a process called “vectorization”, the omega-3s in EurOmega-3® are extracted using enzymes and water, rather than intensive heat or chemicals.  The result is that the omega-3s are bound to phospholipids instead of triglycerides, and the tablet also provides peptides not found in other supplemental sources. This stability and structure means that one tablet twice daily can replace seven large fish oil pills.

I give the above three supplements to rebalance the immune system for 6-12 weeks.

Step Two

Restore energy production and mitochondrial and hypothalamic function with the SHINE Protocol.

Basically, post-viral chronic fatigue syndrome and fibromyalgia represent an energy crisis with resultant mitochondrial and hypothalamic dysfunction. The hypothalamus is like a “circuit breaker,” which controls the following:

Gravity causes blood to drop to our legs when we stand up. The autonomic system is what sends it back to our muscles, and the brain and other organs. When this does not work properly, the person develops postural orthostatic tachycardia syndrome or neurally mediated hypotension (POTS/NMH). These can be easily screened for with a two-minute quiz or a 10-minute pulse test. It is often remarkably simple to treat as well, starting with medium pressure (20-30 mm) compression stockings, increasing salt intake and adrenal support, and then progressing to numerous available other treatments as needed. Orthostatic intolerance has been found to be common in CFS/FMS and long hauler syndrome.19-20

To address this mitochondrial/hypothalamic dysfunction, several of my published studies, including a randomized double-blind placebo-controlled prospective study, showed that the SHINE Protocol resulted in an average 90% increase in quality-of-life (p<.0001 vs placebo) in people with CFS/fibromyalgia, including post-viral.21-22 The SHINE Protocol optimizes Sleep,

Hormones/Hypotension, Immunity, Nutritional support, and Exercise as able (mild to avoid postexertional malaise).

How to apply the SHINE Protocol is discussed in depth in earlier articles and in the newest 4th edition of my best-selling book From Fatigued to Fantastic (Penguin/Avery June 15, 2021). It is geared for both practitioners and the public and will make you an expert in these conditions.

An easy way to get started is with free treatment tools that I am happy to send you. Simply email me at and ask for the free treatment tools (SHINE Protocol overview, intake and treatment protocol check lists, orthostatic intolerance information sheet and quick screens, etc.). Do let me know if you are a health practitioner, so I know what to email you. These will help get you up to speed much more quickly.

Step Three – (or an easy way to begin)

Because of this severe need, my research team and I recently completed a series of four studies on new supplements we were finding to be highly effective at improving energy and function.

The first two studies were done using a unique oral European serum bi- and tri-peptide formula. Many of you are familiar with the blossoming use of these peptides intravenously, but so many find it unaffordable. My colleague, Gaetano Morello, ND, stumbled over an oral preparation that had been used in African hospitals to treat severe malnutrition for over a decade. In addition to being exceedingly safe and effective in helping people recover from their severe malnutrition, numerous other conditions seemed to resolve. Gaetano found that 60% of people in his fibromyalgia and complex illness clinic had dramatic benefits. I asked him if he had a few bottles I could try with the people I treat, and I got the same results. Which are simply stunning! We decided to do an initial study that confirmed what we found clinically. Then COVID with its persistent post-viral debilitation hit, so we did a second study looking specifically at persistent post-viral debilitation. Here’s what we found:

Recovery Factors – A Remarkable Tool for Speeding Recovery. This unique mix of European oral bi- and tri- peptides has been life-changing for people. Whether they are nonfunctional, or high-level athletes. Benefits are most often seen within one bottle (a month) and often within days. They are available to the public from A practitioner affiliate program is also available. I encourage people to follow the dosing instructions on the website. [added in January 2022 by author  “This is available worldwide except for the US. The company hopes to make it available in the US in the next 3 to 6 months.”]

The study23 included 100 people (about half post-viral), who had at least a 50% decreased function. Sixty percent improved:
1.   79% average increase in energy (p<.001)
2.   84.2% average increase in overall well-being (p<.001)
3.   45.7% average improvement in sleep (p<.001)
4.         52.2% average improvement in mental clarity (p<.001)
5.         22% average decrease in pain (p=.001)
6.         54.4% average composite improvement in the above five domains (p<.001)
7.         35.3% average decrease in anxiety (p<.001)
8.         57.1% average improvement in digestive symptoms (p<.001)
9.         FIQR decreased from 61.9 to 39.3. (36.5%) (p<.001)

This is what I recommend for anybody whose symptoms and debilitation requires “Intensive Care” nutritional support, and for athletes who want to increase performance. In a subset with total IgG or IgG subset deficiencies, these protective antibodies increased an average of 14%.24Feel free to email me at if you’d like me to send you the study reports.

Another remarkable herbal development has also recently come available: Ginseng – the Asian Miracle Recovers. For over a millennium, ginseng has been the most popular herb in China and much of Asia. Unfortunately, the overharvesting of wild ginseng led to its becoming insanely expensive. The newer farmed ginsengs often just didn’t work as well, so its popularity started to wane.

Old wild ginseng produces over 50 different ginsenosides, as a protective response to the insect attacks and difficult weather. But these are usually not found in most farmed ginseng. But now, a unique new hydroponic farming technique that reproduces the plant’s challenges faced in the wild has allowed grown ginseng to have the same active component profile as the old wild plants. Creating new health possibilities, including in this situation.

The key active ginsenosides are found in red ginseng, which is made from the whole root and then steamed. But these then need to be converted to what are called “rare (or noble) ginsenosides” to be able to be absorbed and active. Unfortunately, the levels of these in current farmed ginseng is very low. So, they can be helpful, but nowhere near as much as the old popular wild ginseng.

But I was astounded at the effectiveness of this new form of HRG80™ red ginseng (available as Red Ginseng Energy –from EuroMedica and sold at Emerson Ecologics and Fullscript). I tried one of the capsules myself and I could feel the effectiveness within minutes. In fact, even though I feel great, I take it myself on days that my schedule is very busy. It keeps my energy and mental clarity very solid, with no waning. I recommend that you get a bottle yourself and try it! The people I treat routinely found the same effect, so I recently completed a third study, looking at its use in individuals dealing with chronic fatigue, fibromyalgia, or persistent post-viral exhaustion.

Sixty percent of the CFS and fibromyalgia population in our study improved with the HRG80 red ginseng. Here’s what the findings showed. In our recent study25 of 188 people, about 40% had onset of symptoms post-viral infection. About 60% improved showing an average (p <.0001 for each outcome measure):

The HRG80 red ginseng (Red Ginseng Energy from EuroMedica – Emerson Ecologics and Fullscript) is the form I recommend. One or two capsules in the morning. May repeat a second dose at lunch.

I am completing a fourth study looking at a mix of six nutrients/herbs which has also been very helpful. But that data is still being analyzed, so I will save that discussion for a future article.

When emailing me at for the free treatment tools, I can also send you the study reports for the above.

Two other medical treatments out of the Stanford CFS clinic are also showing a lot of promise. The first would be low doses of the anti-schizophrenia medication Abilify, using just 1/8 to 2 milligrams a day instead of the 15-30 mg dosing used for psychosis. More details can be found in their study26 and feel free to email me and request an article I wrote on ultra-low dose Abilify as well.

For stubborn cases, including cases where people developed debilitation from the vaccine itself, we are starting to see benefits from a three-drug combination (Ivermectin, a statin and an AIDS medication) being researched at Stanford. This is too new to be discussed here, as the data is very early. But it is promising, and by the time this article is published, I should have more data to share.

The bottom line? A comprehensive treatment approach helps most people with persistent post-COVID symptoms improve dramatically, and they can often recover full health.

Addressing the Individual Key Organs – Heart, Lungs, and Brain

People are understandably frightened. They have shortness of breath and presume their lungs are damaged beyond repair. They have palpitations with the shortness of breath and are convinced they have heart failure. Meanwhile, given the “brain fog” common with post-viral CFS/fibromyalgia, many are convinced they have permanent brain damage as well.

What I’m finding is that, by and large, they don’t. It is important that people be assessed, and then be given accurate information. This usually turns out to calm them considerably—especially as they improve with treatment.

One of the most important tools you can recommend for people with these symptoms is a simple $20 pulse oximeter available on Amazon. Quality varies, and I have found the ZacVrate brand to be helpful and reliable for home use.

Let people know to simply check the oxygen saturation using the pulse oximeter when they are short of breath. If it is over 95%, especially if oxygen saturation increases with walking, it is not likely to be coming from severe heart or lung damage. Most often it is coming from anxiety. In addition, breathlessness is a common non-heart/lung symptom of fibromyalgia. Interestingly, an old study by the Korean acupuncturist Neoh Aum Chu found that stimulating three acupuncture points on the back of the skull could make the breathlessness in fibromyalgia go away. So can the pulse oximeter and its reassurance.

But many do have significant post-COVID organ involvement. When this is present and significant, here’s how to help it.

Cardiac Involvement 

In a cohort of 100 German patients recently recovered from infection, cardiovascular magnetic resonance (CMR) revealed cardiac involvement in 78% and ongoing myocardial inflammation in 60%. Cardiac involvement occurred irrespective of infection severity.27

But again, this does not mean that the cardiac involvement is causing their symptoms. If their oxygen saturation goes over 95% and increases with exercise while the breathlessness is worsening, it is unlikely that the shortness of breath is cardiac. Palpitations are also routine in fibromyalgia despite healthy cardiac function, and usually are PVC’s or a pounding heart from excess adrenaline tone. Both of which are usually benign (although they should be evaluated) and resolve with treatment.

But for those who do have a decreased ejection fraction or symptoms of heart failure (from most causes), here is a simple recipe that can leave them feeling dramatically better in six weeks. It increases cardiac muscle efficiency:

If evidence of decreased cardiac function or the need to increase efficiency persists despite these, see other recommendations under “Heart” in the Cures A-Z Phone App

Persistent Lung Damage Improves Gradually After COVID-19

Fortunately, lung damage with ARDS, including post-SARS, tends to improve and often resolves after two years.28 So often, all that is needed is reassurance and the pulse oximeter so they can see improvement over time. Several treatments may help to speed this lung healing along. I usually simply begin with the Curaphen (2 caps three times a day) plus Clinical Glutathione (1 cap twice a day) discussed above. In more severe cases, I consider colchicine (6 mg twice a day) and other anti-fibrotic agents.29

Post-Viral Brain Involvement

Given what we are seeing from numerous other forms of post-viral CFS/fibromyalgia, the brain fog does not likely represent long-term brain injury. Rather it represents the decreased blood flow in the brain from the orthostatic intolerance discussed above, microglial activation, persistent free radical irritation, and alterations in temporal blood flow (contributing to the difficulty with word finding and substitution). But people with the condition are understandably afraid that they have suffered permanent brain damage. You can reassure them that with a high probability their cognitive function will recover with the protocol.

We routinely find that the brain fog resolves with the SHINE Protocol, using the Recovery Factors and HRG80 Red Ginseng, addressing the immune and free radical activation, and settling down the microglial activation with low-dose naltrexone (3–4.5 mg at bedtime) or other nonprescription alternatives.

A Few Other Persistent Problems

Although there are countless other problems and symptoms which may persist, most are treatable. Loss of taste and smell seems to be the hardest to eliminate currently. But a few considerations follow.

COVID-19 may reduce fertility in men.30Increasing both male and female fertility can be done naturally and very effectively. Although beyond the scope of this article, simply email me ( for the free “Infertility Information Sheet.”

Although there does tend to be persistent loss of some taste and smell, over time, these do usually improve quite a bit. An analysis showed that at five months, average smell ratings were 8.98 before infection, 2.85 during the acute phase, and 7.41 after five months.31 I add 50 mg of zinc a day for three months. In men, I add 25,000 units of the retinol form of vitamin A. (CAUTION: doses of vitamin A over 8000 units a day can cause birth defects in pregnant women!)

Posttraumatic stress disorder (PTSD) may occur in up to a third of patients who recover from severe COVID-19 infection,32 as can other severe emotional traumas. Although beyond the scope of this article, the new fourth edition of From Fatigued to Fantastic discusses how to heal emotional trauma, including PTSD, at length.

Hyperthyroidism is sometimes present with elevated free T4’s and decreased thyroid scan uptake in 15% post-COVID.33


CFS and fibromyalgia, especially following COVID, can be very frightening to the people affected and challenging for the practitioners treating them. The good news? Although complex conditions, they can be effectively treated and often eliminated.

Some Common Post-COVID Symptoms

Symptoms are not limited to cough, fever, and shortness of breath: 
Other widely reported symptoms span neurological, gastrointestinal, cardiovascular, and other systems, and include the following15:


  3.  Shelokov A, et al. Epidemic neuromyasthenia: an outbreak of poliomyelitislike illness in student nurses.N Engl J Med. 1957;257: 345-355.
  4.  Poskanzer DC, et al. Epidemic neuromyasthenia: an outbreak in Punta Gorda, Florida.N Engl J Med. 1957;257: 356-364.
  5. Acheson ED. The clinical syndrome variously called benign myalgic encephalomyelitis, Iceland disease and epidemic neuromyasthenia.Am J Med. 1959; 4: 569-595.
  6. Moldofsky H, Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study.BMC Neurol. 2011;11:37.
  7. Sejvar JJ, et al. Neurocognitive and functional outcomes in persons recovering from West Nile virus illness.J Neuropsychol.2008; 2: 477-99.
  8. Seet RC, Quek,AM, Lim EC. Post-infectious fatigue syndrome in dengue infection.J Clin Virol.2007; 38: 1-6.
  9. Epstein L, et al. Post-Ebola signs and symptoms in U.S. survivors.N Engl J Med. 2015;373: 2483-4.
  10. Hickie I, et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study.BMJ. 2006;333: 575-8.
  12. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection.
  19. Long COVID Brings Welcome Attention to POTS.
  20.  Tachycardia Syndrome May Be a Distinct Marker for Long COVID.
  21. Teitelbaum JE and Bird B, Effective Treatment of Severe Chronic Fatigue: A Report of a Series of 64 Patients.Journal of Musculoskeletal Pain. 1995;3 (4): 91–110.
  22. Teitelbaum JE, et al. Effective Treatment of CFS and FMS: A Randomized, Double-Blind Placebo Controlled Study.Journal of Chronic Fatigue Syndrome. 2001;8(2):3-28.
  23. Teitelbaum J, Morello G, Goudie S. Nutritional Intervention in Post viral Chronic Fatigue Syndrome and Fibromyalgia (CFS/FMS). A Unique Porcine Serum Polypeptide Nutritional Supplement. Submitted for publication.
  24. Teitelbaum J, Morello G, Goudie S.Nutritional Intervention in Chronic Fatigue Syndrome and Fibromyalgia (CFS/FMS) A Unique Porcine Serum Polypeptide Nutritional Supplement.The Open Pain Journal, December 31, 2020, Volume 13:52.
  25. Teitelbaum J, Goudie S. HRG80™ Red Ginseng – An Effective Intervention for Energy, Using CFS, Fibromyalgia, and Post Viral Fatigue as a Model. Study submitted for publication
  28. 28. Persistent Lung Damage Improves Gradually After COVID-19
  29. Chaudhary S, et al. Antifibrotics in COVID-19 Lung Disease: Let Us Stay Focused. Front. Med., 09 September 2020
  31. Loss of Smell Lingers Post COVID.  Https://
  32. PTSD Prevalent in Survivors of Severe COVID-19
  33. COVID-19 Can Cause Atypical Thyroid Inflammation

Author bio:

Jacob Teitelbaum, MD, is one of the most frequently quoted integrative, pain and fibromyalgia medical authorities in the world. He is the author of 10 books, including the best-selling From Fatigued to Fantastic! (Penguin/Avery 2021) . He is the lead author of seven studies on effective treatment for fibromyalgia and chronic fatigue syndrome, and several textbook chapters. Dr. Teitelbaum appears often as a guest on news and talk shows nationwide, including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and FoxNewsHealth. Learn more at

Consult your doctor before using any of the treatments mentioned in this article.

Reprinted with permission from the November 2021 Townsend Letter and Jacob Teitelbaum, MD.

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