Decoding Dysautonomia Part 5: Addressing the Root Cause
Are these cellular engines the missing piece in your recovery?
Mitochondrial Mayhem
Despite getting more than enough sleep (sometimes 10 or more hours a night) I still felt a heavy fatigue that never lifted. Attempts to return to exercise, even at a light intensity, left me mostly bed bound for several days. On multiple occasions, a single gym session triggered a level of muscle soreness and mobility restrictions I had never experienced before.
And one year ago, things escalated. A light workout landed me in the hospital with a severe case of rhabdomyolysis—a dangerous condition where damaged muscle tissue breaks down and floods the bloodstream with proteins that can injure the kidneys.
It was clear something deeper was going on.
I’d spent so much time chasing down the symptoms that shouted—tachycardia, chest pain, tremors—that I ignored the one quietly weighing me down all along: fatigue.
But what if they were all connected?
That realization led me to look deeper, and that’s where mitochondria came into the picture.
The Final Chapter: Root-Cause Recovery
I’ve been living with long COVID for nearly two and a half years. And while I’m not sure it ever fully goes away, I can tell you this: it can get significantly better.
Today, I’ve been flare-free for more than seven months. I feel about 90% back to myself, a reality that once felt impossible.
That kind of progress didn’t come from quick fixes. It came from deepening my understanding of this condition—and of myself. Learning what my body needed, what fueled it, what depleted it, and how it communicated through symptoms. Slowly but surely, I’ve started to reclaim parts of my life I thought I’d lost. I believe that every inch of autonomy and recovery is worth fighting for. And that’s what I want to share with you here.
If you’ve been following along, you already know that managing long COVID-related dysautonomia takes a multi-layered, personalized approach.
As Hippocrates once said, “It is far more important to know what sort of person has a disease than to know what sort of disease a person has.”
That philosophy has been the thread tying this entire series together—from foundational habits to symptom management to identifying the underlying drivers of my condition.
This final chapter takes us a layer deeper, into the cellular roots of long COVID and how mitochondrial dysfunction was the missing link in my story.
Here, the focus shifts to more advanced, targeted strategies: tools designed to support and optimize mitochondrial function. No band-aid approaches. No generic protocols. Just a closer look at the underlying processes that may be contributing to ongoing symptoms, and how we might begin to support them.
A Word of Transparency 🔍
Before diving deeper, I want to be clear: I don’t claim to have the cure for long COVID or dysautonomia. What I’m sharing here reflects a combination of personal experience, clinical insight, and my interpretation of emerging research.
The more I connect with others in this community, the more I hear stories that mirror mine with people finding meaningful relief through similar strategies. It’s been eye-opening and validating. Not everything can be measured in a lab, and sometimes the most impactful breakthroughs come from shared experience and collective wisdom. My hope is that by sharing my own journey I can offer something useful to others walking a similar path.
Why Focus on Mitochondria? 🔬
Back in Part 2, we explored several potential drivers of long COVID-related dysautonomia: mitochondrial dysfunction, endothelial damage, RAAS dysregulation, and vagus nerve inflammation.
The fascinating thing about long COVID is that everyone’s experience is different. With over 200 documented symptoms, it’s no surprise that the underlying mechanisms can vary too. That’s why a personalized approach is so important—there’s no universal path to recovery.
For this final article, I’m narrowing the focus to the one that had the biggest impact in my journey: mitochondrial health.
Mitochondrial support became a core part of my recovery—not through anything revolutionary, but through simple, targeted changes. By focusing on nutrition, lifestyle, and key nutrients involved in energy production, I was able to support the health of these microscopic engines in a way that actually made a difference.
So let’s zoom in on this tiny, mighty organelle and explore how mitochondrial dysfunction fits into the long COVID puzzle.
Mitochondrial Dysfunction: An Energy Crisis
Mitochondria are found in every cell in the body except red blood cells. These tiny powerhouses convert nutrients into ATP, your body’s main energy currency. Think of ATP like cellular fuel: it powers movement, memory, metabolism—virtually every process that requires energy.
However, in those with long COVID, that energy-making process can become impaired. Mitochondria may not work as efficiently, leaving your cells under powered. Researchers believe this dysfunction may be driven by a mix of viral injury, chronic inflammation, and oxidative stress—all of which place significant strain on mitochondrial health.
Interestingly, these mitochondrial issues aren’t unique to long COVID. They’ve also been observed in ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), a condition characterized by symptoms like profound fatigue and post-exertional malaise. The overlap between these two conditions has sparked growing interest in shared biological pathways, especially those related to how the body generates and utilizes energy.
Your muscles, for example, are among the most energy-demanding tissues. Skeletal muscle cells can house hundreds to thousands of mitochondria to meet physical demands. When mitochondria are not functioning optimally and ATP is in short supply, your muscles may lack what they need to perform basic functions, let alone vigorous exercise. This helps explain why even light activity can leave you wiped out or recovering for days—a familiar cycle for many living with long COVID.
The heart is also heavily reliant on mitochondrial energy. Heart muscle cells contain an estimated 5,000 to 8,000 mitochondria per cell to keep the heart pumping 24/7. The heart's high energy demands mean that impaired mitochondrial function can lead to energy deficits, potentially resulting in frequently reported long COVID symptoms such as arrhythmias, palpitations, and chest pain. In fact, mitochondrial dysfunction has been proposed as a key player in the cardiovascular complications observed in post-viral syndromes.
Mitochondria power your brain too, which happens to be the most metabolically active organ in the body. Though it makes up just 2% of your body weight, the brain uses around 20% of your resting energy. While we often think of “brain fog” as mental fatigue, what’s happening under the hood is far more complex and energy-dependent. Every thought, memory, and movement relies on nerve cells (neurons) firing signals through a process called action potential propagation. This signaling requires a steady supply of ATP. In short, ATP is the fuel for the brain's entire communication network. When mitochondrial dysfunction compromises ATP production (as seen in some long COVID cases) symptoms like brain fog, executive dysfunction, memory problems, and other cognitive difficulties can emerge.
These are just a few examples demonstrating how mitochondrial dysfunction can impact various systems. When you step back and consider how much mitochondria do, and how essential they are for basic functions, it makes a compelling argument for why dysfunction at the cellular level can result in such widespread and debilitating symptoms. This may explain some of the hallmark symptoms like chronic fatigue, post-exertional malaise, exercise intolerance, brain fog, palpitations, and poor temperature regulation.
The Goal: Rebuilding Mitochondrial Capacity
So now we know what happens when mitochondria are dysfunctional, but how do we support these microscopic organelles?
When we talk about “supporting mitochondria,” we’re really talking about a few key goals: improving how they function, protecting them from stress or damage, and in some cases, encouraging the body to create new ones.
These processes fall under what scientists call mitochondrial dynamics—the way mitochondria grow, repair, multiply, and interact with one another. For example, mitochondrial fusion helps healthy mitochondria share resources and recover from stress, while fission allows damaged parts to be removed and replaced. If these dynamics aren’t working well (like in long COVID) cells can struggle to meet basic energy demands.
Furthermore, through a process called mitochondrial biogenesis, the body creates new mitochondria in response to certain internal signals (for the science nerds, this is modulated by PGC-1α and AMPK). Some approaches like intermittent fasting, exercise, cold exposure or other forms of mild metabolic stress have been shown in research to help activate these signals.
But for those of us with long COVID, these strategies must be approached carefully and individually. What supports recovery for one person might set someone else back. For example, exercise can promote mitochondrial growth, but overexertion can also trigger flare-ups or worsen symptoms like fatigue—especially in those prone to post-exertional malaise.
Alongside biogenesis, it’s also important to care for the mitochondria you already have. That means making sure you’re getting the nutrients required for energy production, supporting your antioxidant defenses, and prioritizing restorative sleep. These foundational strategies create the internal environment to encourage healing.
The good news is many strategies that support mitochondrial health are simple, accessible, and can be put into practice without needing expensive testing. That said, functional lab testing can offer deeper insight to guide targeted interventions and provide an explanation that some of us with long COVID or other chronic conditions are searching for.
In my case, it helped confirm what I was already feeling and gave me a clearer direction. So before we dive into specific strategies, let’s take a closer look at how I used lab testing to uncover signs of mitochondrial dysfunction and how it shaped my next steps.
Lab Testing: What’s Beneath the Surface 🧪
Over the course of my long COVID dysautonomia journey, I’ve had a variety of labs run—some ordered by my doctors (like routine bloodwork, diagnostics, and emergency labs), and others I sought out myself, including functional tests to explore nutrient status and mitochondrial function.
Each of these played a role in shaping my recovery, but to keep this article focused and digestible, we’ll be honing in on mitochondrial testing specifically. This is the area that offered insight into the underlying drivers of my symptoms and ultimately helped me create a more targeted support plan.
Organic Acids Testing (OAT): A Window Into Cellular Function 💥
When symptoms persist despite doing all the right things—nourishing diet, reconditioning, adequate sleep, nervous system support, managing flare-ups—it may be time to zoom in a little closer. That’s where functional labs can be helpful.
One tool that gave me clarity during my journey was an organic acids test. This type of test analyzes compounds in your urine—metabolic byproducts that your body naturally produces as it breaks down nutrients and generates energy. These markers offer a unique view into how your systems are functioning on a cellular level, especially your mitochondria.
Think of it like a snapshot of your metabolism in action:
⚡ Is your body producing energy efficiently?
💥 Are antioxidant systems keeping up with oxidative stress?
🌪️ Are nutrient pathways (like B vitamins and amino acids) running smoothly?
OAT panels can flag subtle imbalances that aren’t always visible in routine labs—like impaired mitochondrial energy production, low levels of key nutrients, or elevated oxidative stress. There are several functional labs that can test for markers of mitochondrial function including the NutrEval, Metabolomix+ and Mescreen (to name a few). Tests like these can help identify unique metabolic patterns, uncovering novel biomarkers that not only reveal where support is needed most, but also help guide more personalized nutrition and lifestyle strategies.
For me, this was a turning point. My results showed clear signs of nutrient deficiencies and mitochondrial dysfunction, finally giving a name to the chronic fatigue and exercise intolerance I was experiencing. I no longer felt like I was guessing. I had something to work with. That clarity shaped the targeted strategies I used in the months that followed.
While helpful, these tests aren’t diagnostic. They offer patterns that may point us in the right direction, but interpretation requires context. Whether or not you pursue testing, supporting your mitochondria doesn’t have to be complicated. Small, consistent shifts in how you eat, move, and care for your body can make a real difference.
Medical Disclaimer
This article is for informational purposes only and is not intended as medical advice. Dysautonomia and long COVID are complex conditions that require individualized care. Always consult your healthcare provider before making changes to your treatment or lifestyle.
Nourish to Neutralize 🥗
When it comes to mitochondrial health, food is far more than fuel—it’s information. What you eat can send signals that either support or strain your mitochondria. This section focuses on a few key strategies I used to address deficiencies, reduce oxidative stress, support mitochondrial structure, and enhance energy metabolism without getting lost in the biochemistry.
Antioxidants: Defend and Repair 🫐
Every time your mitochondria make energy (ATP), they generate a natural byproduct: reactive oxygen species (ROS)—a type of free radical. In small amounts, ROS aren’t harmful; in fact, they’re a normal part of cellular metabolism. But when production exceeds your body’s ability to neutralize them (a state known as oxidative stress), they can damage proteins, mitochondrial DNA, and even the delicate membranes that help your mitochondria function.
And because mitochondria are both a major source and a target of ROS, this creates a vicious cycle: impaired mitochondria generate more ROS, which further harms mitochondrial structure and function.
Here’s where antioxidants come in. Like the name suggests—anti (against) + oxidant (referring to oxidative stress)—these compounds help neutralize excess ROS, breaking the cycle of cellular damage and protecting mitochondrial structure, especially the delicate inner membrane where ATP is produced.
Fortunately, the foods that support antioxidant defenses aren’t rare or complicated. They’re often the same ones that make your meals more colorful and flavorful.
Some of the most antioxidant-rich foods include:
🫐 Deeply colored fruits and vegetables like berries, cruciferous veggies, leafy greens
🧄 Herbs and spices like turmeric, garlic, ginger, rosemary, cinnamon
🫒 Polyphenol-rich foods like extra virgin olive oil, cacao, green tea
You don’t need to chase exotic superfoods. Just build your meals around diverse, colorful plant foods. That’s one of the simplest, most effective ways to support your mitochondria.
But nutrients don’t just defend, they also build. Let’s shift gears and talk about the kind of fuel your mitochondria thrive on, especially when it comes to structure and energy production.
Fat Metabolism & Mitochondrial Health 🧈
Gram for gram, fat is the most energy-dense fuel we have—packing over twice the energy of carbs or protein. And when your mitochondria are struggling to keep up, that kind of high-yield fuel can make a meaningful difference.
🧱 Build the Foundation
Let’s start with structure. Your mitochondria have both an inner and outer membrane, made largely of phospholipids (a type of fat). These fatty structures are critical for cellular signaling, communication, and efficient energy production. If the membranes are damaged or weak, everything from ATP output to antioxidant defense can suffer.
🔥 Fuel the System
Now let’s talk about fuel. Carbohydrates are converted to usable energy through a pathway called glycolysis, which produces ATP more quickly, but in smaller amounts. This makes carbs a preferred energy source during high-demand situations when your body needs rapid fuel, like intense exercise. Proteins can also be used for energy under certain conditions, though they play a more supportive role in energy production.
On the other hand, mitochondria convert fat into usable energy through a process called beta-oxidation, which generates significantly more ATP per molecule than carbohydrates. It’s a clean-burning, long-lasting energy source. That is…when it’s working well.
In long COVID, mitochondrial dysfunction may impair beta-oxidation, limiting your ability to access this efficient energy source. When this pathway is disrupted, energy reserves can run low and symptoms like fatigue, brain fog, and exercise intolerance may follow.
One way to support this pathway is through the fats you include in your diet.
Not all fats are created equal. While unsaturated fats can enhance mitochondrial performance, excessive intake of certain saturated fats (particularly from ultra-processed foods) has been linked to increased oxidative stress and impaired mitochondrial function. In contrast, polyunsaturated omega-3s may support mitochondrial fusion. If you recall from before, this is a protective process that helps mitochondria share resources, repair damage, and cope with stress.
Additionally, omega-3s have been shown to promote mitochondrial biogenesis by activating the PGC-1α pathway—a key regulator that helps your cells produce new, healthy mitochondria. These are just a few reasons why omega-3s are such a valuable part of a mitochondria-supportive diet.
Here are a few of the fat sources I prioritized:
🐟 Omega-3 rich options like wild-caught salmon, walnuts, pumpkin and flaxseed
🥑 Monounsaturated fats like extra virgin olive oil, avocado, and almonds
🍳 Phospholipid rich foods like egg yolks and sunflower seeds
Like we mentioned earlier, mitochondria are responsible for converting the nutrients from fats and carbohydrates into ATP. Let’s now explore the impact of carbohydrates on mitochondrial function.
Balanced Blood Sugar and Metabolic Strain ⚖️
Your mitochondria don’t operate in a vacuum. The way your body processes carbohydrates, and how steady your blood sugar stays throughout the day, can have a direct impact on mitochondrial performance.
Wide glucose fluctuations and chronically elevated insulin don’t just affect how you feel, they place additional strain on mitochondrial energy metabolism and can amplify oxidative stress. That’s why blood sugar regulation became a foundational part of my strategy.
While the ketogenic diet has shown benefits for mitochondrial health, it’s not appropriate for everyone. I took a more flexible approach. I reduced my intake of refined and high-glycemic carbs and focused instead on complex, fiber-rich sources like non-starchy vegetables, legumes, and whole grains paired with healthy fats and lean proteins. With small changes, I noticed fewer energy crashes and less post-meal symptom flares. (For a deeper dive into blood sugar strategies check out Part 3 of this series!)
This may be helpful because diets high in refined carbohydrates can contribute to insulin resistance, drive inflammation and oxidative stress, and interfere with mitochondrial biogenesis. Over time, this kind of metabolic stress can even suppress beta-oxidation, the fat-burning pathway we want to preserve.
If your body is a campfire, carbohydrates are like kindling—they catch quickly but burn out fast. Fats are more like a dense log: they take longer to ignite, but provide slow, steady heat once they do. When your mitochondria are struggling to keep the fire going, you need that long-burning fuel source.
All together—antioxidant rich foods, nutrient-dense fats, and balanced blood sugar—can reduce stress on your mitochondria and help them do what they’re built to do: generate energy efficiently.
We have talked about the main superheroes in mitochondrial function, so let’s shift our focus to the side kicks involved in energy production.
Targeted Supplementation & Nutrient Support
Food and lifestyle will always form the foundation, but in some cases targeted supplementation can give your mitochondria the extra support they need to function more efficiently.
Let’s start with the under-appreciated heroes of energy production: micronutrients.
Micronutrient Cofactors: The Energy Sidekicks
Mitochondria don’t just run on fuel—they also rely on a team of micronutrients that act as cofactors in the energy making pathway. These nutrients help drive the Krebs cycle, support antioxidant defense, and keep the electron transport chain (ETC) humming along.
I will spare you the details of the Krebs cycle and ETC, but just know they are key steps involved in the energy production pathway known as cellular respiration. Without diving into the full biochemistry, just think of these micronutrients as the nuts and bolts that hold the energy-making machinery together.
Deficiencies in these micronutrients can impair how efficiently your mitochondria produce ATP—and unfortunately, in long COVID and other chronic illnesses, these deficiencies are common. Sometimes it’s due to inflammation, other times it’s related to absorption issues or increased demand. Or it could be as simple as not eating enough of the foods that contain these nutrients.
I identified my micronutrient deficiencies using the Metabolomix+ panel, a functional lab that looks at organic acids, micronutrient status, and other key metabolic markers all in one. It revealed several deficiencies and patterns of mitochondrial dysfunction that helped guide both my nutrition and supplement plan.
Of course, you don’t have to test to benefit from supporting these pathways. Eating a diverse, colorful, nutrient-dense diet is one of the best ways to give your mitochondria the cofactors they need to work optimally. But if deficiencies are identified, supplementation may be helpful—especially when food alone isn’t meeting your needs.
What I Used in My Own Protocol 💊
The following nutraceuticals became part of my protocol—not all at once, but gradually, based on my lab results, symptoms, and research. I started with food first, then added this targeted support when it felt appropriate, especially during periods of higher stress or recovery.
CoQ10 (Ubiquinone or Ubiquinol)
This antioxidant is a key player in the electron transport chain (ETC), where ATP is produced. It helps shuttle electrons within the ETC in the mitochondria and supports overall cellular energy production. I added it to my routine shortly after my case of rhabdomyolysis to give my mitochondria extra support.
📌 If you’re on statins: these medications can deplete CoQ10 levels—something to ask your doctor about if you’re experiencing fatigue.
NAC (N-Acetylcysteine)
A precursor to glutathione, your body’s master antioxidant. NAC helps buffer oxidative stress and supports the detoxification pathways that can become overwhelmed during chronic illness. It’s especially useful when inflammation or oxidative stress markers are elevated. I started supplementing this early in my journey, but became more consistent with it after I had rhabdo.
B-Vitamin Complex
These are critical cofactors for converting food into energy—especially in the Krebs cycle and ETC. Interestingly, several of these vitamins can become depleted during periods of high stress or illness. My lab testing revealed several B-vitamin deficiencies, so I incorporated a B-complex to help fill those gaps and better support energy metabolism during recovery.
Magnesium Glycinate
Magnesium is involved in over 300 enzymatic reactions and supports both ATP production and nervous system regulation. My lab testing indicated a moderate need for magnesium support, leading me to supplement this mineral. I found magnesium to be most helpful in the evenings—it became part of my wind-down routine and noticeably improved my sleep quality. I use a powder that I add to my tea at night but it can be taken in many different forms.
Other Nutraceuticals
What I discussed above is by no means an exhaustive list, but simply what I have personally tried. In my research I have come across many other promising nutraceuticals including alpha lipoic acid, creatine, PQQ, BCAAs and more. These may be worth exploring with a provider depending on your unique needs and goals.
What supplements have been supportive in your journey? Comment Below!
⚠️ A Gentle Reminder
Supplements can be powerful tools, but they’re not without nuance. What works for one person may not work for another, and more isn’t always better. I highly recommend working with a knowledgeable provider to personalize your approach.
Wrapping It All Together
Healing isn’t linear. And as I sit here writing these final words I am reminded of this testament.
For two years I’ve had a poster hanging above my desk which features a drawing of a woman hiking a jagged mountain trail, with valleys as deep as the peaks are high. Just before she reaches the summit, she’s curled up at her lowest point. The words above her read:
“Progress is not linear.”
This image became a kind of compass for me—a reminder that setbacks don’t erase progress, and that feeling stuck doesn't mean I’m not moving forward. In fact, my biggest setback came right before everything began to shift.
Whether you’ve followed along since Part 1 or are just joining now, thank you for being here. I created Decoding Dysautonomia to build a framework for supporting the chaos of long COVID related dysautonomia—to offer science backed strategies, meaningful insights from personal experience, and share a deeper understanding of this complex condition.
In case you’re just joining:
✅Part 1: Understanding Dysautonomia – unpacked the basics of what dysautonomia is and how it shows up.
✅Part 2: The Long COVID Connection – explored the rising epidemic of dysautonomia linked to long COVID.
✅Part 3: The Foundation for Wellness – covered core strategies for nutrition, gut health, sleep, movement, and nervous system regulation that sets the stage for healing.
✅Part 4: Active Episode Support & Symptom Management – offered tools for flare-ups, symptom management, and how to create your own flare-up first-aid kit.
✅Part 5: Addressing the Root Cause – we’ve gone beneath the surface to explore how mitochondrial support can be a next level strategy when the foundation isn’t enough.
If you’re in a valley in your own journey right now, remember this: from where you stand, the road ahead may feel steep. But rest is not retreat, it is part of the path forward. The climb isn’t just about reaching the summit—it’s about rebuilding strength between every step.
If this has resonated with you, I hope you’ll stick around. I’ll continue sharing more about dysautonomia, chronic illness, long COVID, and the ways we can navigate this unknown terrain together—guided by science, grounded in experience, and open to the process of healing.
Buy Me a Coffee ☕ (Decaf, of course)
My goal is to keep my work free and accessible to the chronic illness community. Living with long COVID and dysautonomia can be financially draining, and for many of us who are partially or fully disabled, accessing support and care can feel out of reach.
If you’ve found this series helpful and you have the means to contribute, I’ve set up a Buy Me a Coffee page—a virtual tip jar where you can make a small donation if you'd like.
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Whether you’re able to contribute or not, I’m so grateful you’re here. Thank you for being part of this community. 💛
Beautifully and cogently laid out, as usual. Thank you!
Thank you so much for the time and effort to share your journey with this. It has been incredibly limiting for me. I am literally scared of being outside when it is over 75 degrees. And spend a lot of time sitting when I used to be very active but between the heat and humidity and bright sun, also a trigger I spend lots of glycine on my computer or watching TV.