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Understanding Dizziness, Vertigo, and Long COVID

Dizziness and vertigo have become common long-term symptoms in individuals recovering from COVID-19 and Long COVID. These symptoms can significantly impact quality of life, mobility, and cognitive function, often leading to chronic fatigue, anxiety, and difficulty performing daily tasks.

A functional medicine approach focuses on identifying the root causes of dizziness and vertigo in Long COVID, optimizing neurological function, vascular health, and mitochondrial energy production to restore balance and improve well-being.

What Causes Dizziness and Vertigo in Long COVID?

Long COVID is associated with persistent inflammation, nervous system dysregulation, and impaired circulation, which can lead to dizziness and vertigo. Common underlying mechanisms include:

1. Autonomic Nervous System Dysfunction (Dysautonomia & POTS)

• Postural Orthostatic Tachycardia Syndrome (POTS) – Blood pressure and heart rate dysregulation cause dizziness when standing.
• Vagal Nerve Dysfunction – Disrupts balance, digestion, and nervous system regulation.
• Chronic Sympathetic Overdrive – Keeps the body in a fight-or-flight state, exacerbating dizziness.

2. Vestibular System Dysfunction

• Inner Ear Inflammation (Labyrinthitis, Vestibular Neuritis) – Viral-induced inflammation affects balance.
• Benign Paroxysmal Positional Vertigo (BPPV) – Calcium deposits disrupt the inner ear’s balance signals.
• Meniere’s Disease Exacerbation – Fluid retention and inflammation in the inner ear impact stability.

3. Microvascular & Circulatory Issues

• Reduced Oxygenation to the Brain – Poor blood flow causes lightheadedness and cognitive impairment.
• Endothelial Dysfunction & Clotting Issues – Microclots can impair circulation and neurological function.
• Histamine Intolerance & Mast Cell Activation Syndrome (MCAS) – Triggers inflammation that affects blood vessels and nervous system function.

4. Mitochondrial Dysfunction & Energy Depletion

• Post-Viral Fatigue & Oxidative Stress – Low energy production leads to dizziness and muscle weakness.
• Neuroinflammation – Increases brain fog, balance issues, and lightheadedness.
• Hypoxia-Induced Dysfunction – Cellular damage from oxygen deprivation affects the brain and nervous system.

5. Nutrient Deficiencies & Electrolyte Imbalances

• Vitamin B12 & Magnesium Deficiency – Impairs nerve function and energy production.
• Sodium & Potassium Imbalance – Worsens blood pressure instability.
• Dehydration & Poor Electrolyte Regulation – Common in Long COVID due to increased water loss.

Functional Medicine Testing for Long COVID Dizziness & Vertigo

A comprehensive functional medicine assessment includes testing for vascular health, nervous system function, inflammation, and nutrient status:

1. Autonomic Function Testing – Evaluates dysautonomia and POTS severity.
2. Vestibular Testing (VNG, ENG, Rotary Chair) – Assesses inner ear and balance dysfunction.
3. D-Dimer & Microclot Testing – Identifies clotting abnormalities contributing to dizziness.
4. Comprehensive Blood Panel – Assesses B12, magnesium, iron, sodium, and potassium levels.
5. Organic Acids Test (OAT) – Evaluates mitochondrial function and oxidative stress.
6. Inflammatory & Immune Markers (CRP, Cytokines, Histamine Levels) – Detects chronic inflammation.
7. Comprehensive Stool Analysis & Gut Testing – Identifies gut dysbiosis, which impacts the nervous system.

Functional Medicine Approach to Treating Dizziness & Vertigo in Long COVID

A functional medicine strategy targets the root causes of dizziness and vertigo by supporting neurological function, circulation, mitochondrial health, and inflammation control.

1. Restoring Nervous System Balance & Reducing Dysautonomia

• Vagal Nerve Stimulation – Deep breathing, gargling, and cold exposure improve autonomic balance.
• Electrolyte Support (Sodium, Potassium, Magnesium) – Supports blood pressure and nerve function.
• Compression Garments & Gradual Postural Adjustments – Help manage POTS symptoms.
• Adaptogenic Herbs (Rhodiola, Ashwagandha, Holy Basil) – Regulate the stress response and autonomic function.

2. Supporting Vestibular Health & Balance Recovery

• Vestibular Rehabilitation Therapy (VRT) – Retrains the inner ear to improve balance.
• Gingko Biloba & Bacopa Monnieri – Enhance circulation to the brain and inner ear.
• Low-Histamine & Anti-Inflammatory Diet – Reduces histamine intolerance, which can worsen dizziness.
• Hydrotherapy & Cold Immersion – Improves nervous system resilience and circulation.

3. Improving Circulation & Oxygenation to the Brain

• Nitric Oxide Boosters (Beets, Citrulline, Arginine) – Enhance blood flow and vascular function.
• Omega-3 Fatty Acids (EPA/DHA) – Reduce inflammation and support endothelial health.
• Coenzyme Q10 (CoQ10) & PQQ – Support mitochondrial energy and cardiovascular function.
• Mild Cardiovascular Exercise (Rebounding, Walking, Swimming) – Stimulates circulation without overwhelming the nervous system.

4. Restoring Mitochondrial Function & Energy Production

• L-Carnitine & Alpha-Lipoic Acid (ALA) – Improve mitochondrial efficiency.
• Magnesium Malate & Creatine – Enhance ATP (cellular energy) production.
• Intermittent Fasting & Ketogenic Diet (if tolerated) – Supports mitochondrial repair.
• Infrared Sauna & Red Light Therapy – Boosts cellular recovery and reduces oxidative stress.

5. Addressing Gut Health & Reducing Neuroinflammation

• Probiotics & Prebiotics (Lactobacillus, Bifidobacterium) – Support gut-brain communication.
• L-Glutamine & Collagen – Repair leaky gut and reduce systemic inflammation.
• Curcumin & Resveratrol – Anti-inflammatory compounds that protect brain health.
• Elimination Diet (Gluten-Free, Dairy-Free, Low-Histamine) – Reduces inflammation linked to dizziness.

Long-Term Management & Prevention of Long COVID Dizziness

• Monitor Electrolyte & Hydration Levels – Essential for nervous system function.
• Regular Functional Testing – Ensure continued recovery and track inflammation markers.
• Neurological & Vestibular Therapy – Ongoing balance training reduces recurrence.
• Reduce Environmental Toxins & EMF Exposure – Supports nervous system stability.
• Mindfulness & Meditation Practices – Helps regulate autonomic nervous system function.

When to Seek Functional Medicine Support for Long COVID Dizziness & Vertigo

If you experience chronic dizziness, balance issues, or unexplained vertigo after COVID-19, working with a functional medicine practitioner can help identify underlying dysfunctions, restore nervous system balance, and optimize recovery.

Conclusion

Dizziness and vertigo in Long COVID result from nervous system dysregulation, inflammation, poor circulation, and mitochondrial dysfunction. A functional medicine approach integrates neurological rehabilitation, anti-inflammatory nutrition, targeted supplementation, and lifestyle optimization to restore balance and improve long-term health.