In my biochemistry classes, I learned a lot about cellular energy production. For example, I learned about the electron transport chain, and I learned about ATP synthase spinning like a molecular turbine to generate cellular fuel.

Unfortunately, for the most part, my professors failed to mention what happens when these powerhouses break down. They never discussed how a viral infection could leave your mitochondria—those ancient bacterial symbionts that power every cell in your body—completely dysfunctional for months or years.

To understand long COVID, you need to understand that we're not just dealing with lingering viral particles or an overactive immune system. We're dealing with a fundamental breakdown in cellular energy production that affects every organ system in your body.

If mitochondria are the power plants of your cells, long COVID is essentially a widespread power grid failure. And just like a city during a blackout, nothing functions properly when the lights go out.

For about 2 billion years, mitochondria have been generating energy for complex life on Earth. In humans, there are thousands of these organelles per cell, each one a miniature factory converting nutrients and oxygen into ATP—the universal currency of cellular energy.

Mitochondria are not everything, but without proper mitochondrial function, everything is nothing. Unfortunately, mitochondrial medicine is a very neglected area in the conventional healthcare system.

I discuss the most effective interventions for mitochondrial dysfunction in long COVID, and my experience with them, here.

Mitochondria & Long COVID

As SARS-CoV-2 ravages the body, mitochondrial function declines across the board and my cells are progressively deprived of their crucial energy supply.

While post-viral fatigue syndromes are "natural", evolution never prepared humans to deal with a lab-enhanced coronavirus. The mitochondrial dysfunction is a direct result of viral damage, including oxidative stress, calcium dysregulation, mitochondrial DNA damage, and impaired biogenesis. In my opinion, restoring mitochondrial function through targeted interventions is just as natural as taking antibiotics for a bacterial infection.

Proper mitochondrial function is crucial for recovery. Mitochondria are needed for immune function, neurotransmitter production, muscle contraction, cardiac function, detoxification, and pretty much everything my body does. Furthermore, mitochondrial health is intricately linked to whether you feel like a human or a zombie.

To me, recovery means much more than simply not dying. Above all else, it means reclaiming my cognitive function and physical capacity. If I had to choose, I would choose 80% function over merely existing at 20% any day. In my opinion, achieving meaningful recovery from long COVID is hardly possible without aggressive mitochondrial support—at least for most people.

First, mitochondria are essential for maintaining the energy supply to all of the tissues and organs in my body.

Second, mitochondrial function has a major say in how I feel, which then co-determines whether I can work, exercise, or even hold a conversation.

Mitochondria & Recovery Trajectories

I will now briefly discuss various interventions and how they relate to different aspects of mitochondrial rescue. This list represents my core protocol after extensive self-experimentation.

NAD+ Injections

An acquaintance of mine who used subcutaneous NAD+ (100mg daily) noticed his energy improving within days. After three weeks, his post-exertional malaise had reduced by approximately 60%.

NAD+ is a coenzyme that participates in over 500 enzymatic reactions. The primary purpose of NAD+ is to shuttle electrons in the mitochondrial electron transport chain and activate sirtuins for cellular repair.

The amount of NAD+ someone maintains is one of the many variables determining how quickly they recover from long COVID. At optimal levels, NAD+ has profound effects on every cell of the body because it upregulates the expression of genes involved in mitochondrial biogenesis, DNA repair, and cellular stress resistance.

There are multiple studies showing that viral infections deplete NAD+ levels by up to 80%. It turns out that the virus hijacks cellular NAD+ for its own replication, and it is thought that this depletion partially explains the crushing fatigue. A 2024 study found that long COVID patients who supplemented with NAD+ showed significant improvements in fatigue scores compared to controls.

Methylene Blue

Methylene blue's primary role is to act as an alternative electron carrier in the mitochondrial electron transport chain. In simple terms, methylene blue creates a bypass route when complexes I and III are damaged. For example, this includes situations where viral damage has impaired normal electron flow, mitochondrial membranes are compromised, or oxidative stress has damaged key proteins.

All else being equal, methylene blue also increases mitochondrial efficiency, and there are studies showing enhanced ATP production with low-dose supplementation.

However, things are more complex than this. Methylene blue is a potent antioxidant. Furthermore, methylene blue enhances neuroplasticity and also reduces neuroinflammation. Moreover, methylene blue has been shown to improve cognitive function within hours of administration.

In sum, while methylene blue may seem like an obscure intervention, it has profound effects on mitochondrial function, and may be one of the most underutilized tools in post-viral recovery.

CoQ10 & PQQ

CoQ10 & PQQ are in some respects complementary in terms of mitochondrial support. By facilitating electron transport and stimulating biogenesis, this combination addresses both function and quantity.

Ubiquinol supplementation (200mg twice daily) in long COVID patients has been shown to improve energy levels by 40-50% over 12 weeks. Increased CoQ10 levels are also associated with reduced oxidative stress and improved cardiac function.

However, CoQ10 alone isn't enough. PQQ (pyrroloquinoline quinone) at 20mg daily stimulates the production of new mitochondria through activation of PGC-1α. Studies show that PQQ can increase mitochondrial density by up to 20% within 8 weeks. Furthermore, PQQ has neuroprotective effects and enhances nerve growth factor production.

When it comes to the "ideal" approach, good things happen when you address both sides of the equation. CoQ10 optimizes existing mitochondrial function. PQQ creates new mitochondria. Thus, instead of choosing one or the other, the best approach is to use both synergistically.

Tactics: My Current Approach to Mitochondrial Rescue

Tweaking my mitochondrial function has taught me how much my energy levels are determined by the health of these cellular powerhouses at any given point in time. I discuss some of my experiences with these interventions in more detail below.

Currently, I follow a comprehensive protocol that includes injectable NAD+, low-dose methylene blue, and the full complement of mitochondrial support nutrients.

My energy has improved from 20% to 75% of pre-COVID baseline, and I continue to see gradual improvements month over month.

Strategies I Follow to Optimize Mitochondrial Function

• I maintain therapeutic ketosis (blood ketones 2-4 mmol/L) because ketones are a cleaner-burning fuel that produces less oxidative stress. Damaged mitochondria handle ketones better than glucose.

• I take methylated B vitamins (methylfolate 1mg, methylcobalamin 5mg, P5P 50mg) because many long COVID patients have impaired methylation. These are essential cofactors for mitochondrial energy production.

• I expose myself to morning sunlight for 30-45 minutes daily. Red and near-infrared wavelengths directly stimulate cytochrome c oxidase in the electron transport chain. On cloudy days, I use a red light therapy panel.

• I supplement with DADA (a cleaner DCA/dichloroacetate analogue) at 60mg 2x daily on a 4 week cycle. This forces mitochondria to use oxidative phosphorylation instead of inefficient glycolysis.

• I take low-dose T3 (liothyronine 5mcg twice daily) because many long COVID patients develop functional hypothyroidism. Thyroid hormone is the master regulator of mitochondrial biogenesis.

• I avoid any kind of intense exercise until my mitochondria can handle it. Post-exertional malaise is literally your mitochondria screaming that they can't keep up with energy demands.

I discuss my personal experience with these interventions in more detail in my recovery timeline post.

My Long COVID Recovery Protocol (Long & Technical Version)

This article is part of a much larger framework describing my complete approach to long COVID recovery. For my full protocol, including dosing schedules and safety considerations, read here.

Sources & Further Information

• Scientific article: Mitochondrial dysfunction in long COVID: mechanisms, consequences, and potential therapeutic approaches

• Study: Novel biomarkers of mitochondrial dysfunction in Long COVID patients

• Opinion article: Dr. Leo Galland – The Mitochondrial Theory of Long COVID

Want my one-on-one help?

If you want my one-on-one help creating a tailored recovery plan, schedule a call with me here.