Treatment for ME/CFS and Long COVID (PASC): What Helps
I recently had the lovely experience (sarcasm) that many of us know so well: being dismissed by a healthcare provider. I sought 2 different general practitioners and described my ME/CFS diagnosis, only to be quickly sent away and told there was nothing that could be done.
Unfortunate but not unusual, am I right?
The saddest part about this is that there are, in fact, things that can be done! Despite the condition still having no definitive biomarker and no approved medication, there are a whole host of treatments that are established and known to improve or stabilize the symptoms of ME/CFS.
Finding ways to manage symptoms of ME/CFS can be a challenge. While there is no one-size-fits-all solution, many benefit from lifestyle changes, dietary adjustments, and certain medications and supplements (Grach et al., 2023).
Long COVID shares many clinical and biological features with ME/CFS, including fatigue, post-exertional symptom exacerbation, and cognitive dysfunction (Davis et al., 2021). So these tips also apply.
Many people search for answers to questions like “How long does chronic fatigue syndrome last?” or “Can it be cured?” While there is currently no cure, a variety of treatments—from pacing and diet to supplements and medications—can make a meaningful difference in symptom control. This article reviews what’s known to help, based on research and lived experience.
How to Manage ME/CFS and Long COVID Day-to-Day
Managing your daily energy levels is one of the most important steps in living with chronic fatigue syndrome. By making small changes in your routine, you can avoid the "boom-and-bust" cycle, where you feel better and do too much, only to crash later.
The first step is to avoid triggering activities as much as possible. For the most severe, this could be avoiding noise or other stimuli. Using noise-canceling headphones and an eye mask can help reduce these inputs that provoke the nervous system response. Avoiding stress, exercise, and strenuous mental activities is also crucial (Grach et al., 2023).
Pacing in ME/CFS and Long COVID (PASC)
Pacing is key. This means balancing activity with rest and knowing when to stop before you feel too tired. Listening to your body and spreading out tasks throughout the day can help you avoid feeling completely wiped out. Enlisting the help of others is crucial in this process. It is also extremely helpful to keep a daily symptom diary or to use an activity tracker to document activity and energy levels.
Pacing is completely individual. Only you, and you alone, will know your energy window and the boundaries you must keep to stay within it. For those newly diagnosed, this may take a great deal of trial and error. It’s important to be patient and forgiving with yourself as you determine what is best for you.
Start by tracking your energy levels and figuring out when you're most likely to feel tired or have a crash (symptom worsening). By planning your day around these patterns, you can avoid doing too much at once. Knowing these patterns can also help you know when to ask others to step in and help out. Gentle activities like walking, stretching, or yoga can be helpful if they don’t worsen your symptoms. Performing graded increases in activity or exercise is not recommended.
Get step-by-step nutrition guidance in one of my online courses.
Diet and Nutrition for ME/CFS and Long COVID
The diet also plays a role in managing chronic fatigue syndrome. The best diet for the condition is one that is anti-inflammatory (Grach et al., 2023). Individuals must also avoid foods that trigger symptoms. Sweets, gluten, high-FODMAP foods, and high-histamine foods are frequent culprits.
Staying hydrated is also crucial. Dehydration can make fatigue and brain fog worse.
If you want a more detailed breakdown, see my guide to diet and nutrition strategies for long COVID (PASC), where I cover anti-inflammatory diets, food triggers, and metabolic considerations in more depth.
Supplements for ME/CFS and Long COVID
Certain supplements may help support energy production and improve symptoms in chronic fatigue syndrome (ME/CFS).
A multivitamin can help address underlying nutrient gaps, particularly in those with restricted diets or malabsorption. But it should not be viewed as a primary treatment strategy. Research has shown deficiencies in B vitamins and certain minerals in those with ME/CFS. Vitamins and minerals are essential for energy production (the breakdown of our food into cellular energy) and the proper function of immune cells and mitochondria. Supplementing with omega-3 fats (EPA and DHA) may also be helpful to reduce inflammatory symptoms of the condition (Castro-Marrero et al., 2018).
Coenzyme Q10 (CoQ10): Known for supporting energy production at the cellular level, CoQ10 may help reduce fatigue in some people with ME/CFS. Some studies have used CoQ10 with NADH and shown improvements in subjective fatigue (Castro-Marrero et al., 2018).
This is just a starting point. For a more complete and realistic discussion of supplements—including what tends to work, what doesn’t, and why—I’ve covered this in more detail in my guide to supplements for long COVID (PASC).
Immune and Antiviral Approaches in ME/CFS and Long COVID
Some people with chronic fatigue syndrome may have underlying infections that contribute to their symptoms. Treatments that target these infections, such as antiviral therapies, could help reduce fatigue in certain cases. Some are prescribed antiviral drugs like acyclovir, valacyclovir, or rintatolimod. These medications have limited effects but may benefit some individuals (Richman et al., 2019).
Alternatively, there are natural agents with antiviral properties. Monolaurin, for example, is a natural antiviral that has been studied for its ability to fight infections without harming healthy cells. High-dose, bioavailable antioxidants may also support immune defense. This includes sulforaphane, curcumin, and resveratrol.
Low-dose naltrexone is also a possible treatment option. This medication is believed to block inflammation in the nervous system (neuroinflammation), which can help alleviate symptoms of ME/CFS (Grach et al., 2023).
I’ve discussed antiviral strategies like monolaurin, along with their limitations, in more detail in my article on antiviral support in postviral illness.
Managing Coexisting Conditions: POTS, MCAS, and Sleep
Most ME/CFS patients have 1 or more coexisting conditions. Common examples include mast cell activation syndrome (MCAS), irritable bowel syndrome, orthostatic intolerance (POTS), or disrupted sleep. There are various medications and treatments for these conditions. Proper management of coexisting conditions can go a long way in stabilizing and improving the symptoms of ME/CFS (Grach et al., 2023).
Read more about treatment recommendations for POTS in another post.
Table 1: from Grach SL, Seltzer J, Chon TY, Ganesh R. Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Mayo Clin Proc. 2023;98(10):1544-1551.
Why Treatment Looks Different for Everyone
The next time a doctor tells you there are no treatments for ME/CFS, please correct them. Better yet, direct them to some continuing education on proper diagnosis and management of the condition.
Finding the right treatment for chronic fatigue syndrome can take time and patience. However, some medications or supplements can be trialed. Pacing and dietary changes can and do make a difference.
By focusing on small, sustainable changes, many people with ME/CFS find ways to manage their symptoms and regain some control over their daily lives.
References
FAQ: ME/CFS and Long COVID Treatment
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There is no single treatment that works for everyone.
However, there are multiple strategies that can help manage symptoms and improve quality of life. These include pacing, diet, targeted supplements, and in some cases medications. The goal is usually stabilization and gradual improvement rather than a cure.
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Fatigue is one of the most complex symptoms to treat.
Approaches that may help include pacing, improving sleep, addressing nutrient deficiencies, and supporting energy metabolism. Some people also benefit from targeted supplements, though results are often modest.
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At this time, there is no definitive cure.
Many people improve over time, especially with supportive strategies. For others, symptoms can persist and require long-term management. The focus is often on reducing symptom severity and improving daily function.
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Pacing is one of the most consistently helpful strategies.
Learning to stay within your energy limits and avoid crashes can significantly reduce symptom severity over time. Without pacing, even the best treatments are often less effective.
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They can—but they are not the foundation of treatment.
Some supplements may support specific biological processes, such as energy production or immune regulation. However, they should be used selectively and with realistic expectations.
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These conditions are highly variable.
Different people may have different underlying drivers, including immune changes, gut dysfunction, or metabolic issues. A treatment that targets one pathway may not be relevant for another.
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Improvement is usually gradual.
Some changes may occur over weeks, but meaningful progress often takes months. Sudden or dramatic improvements are less common than slow, incremental gains.
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If possible, yes.
Providers familiar with ME/CFS or long COVID are more likely to understand pacing, symptom patterns, and appropriate treatment options. However, access can be limited, and many people end up managing much of their care themselves.
If you’re trying to navigate treatment options and aren’t sure where to start, I also offer consultations to help build a more targeted and realistic approach based on your specific symptoms and tolerance.
1. Grach SL, Seltzer J, Chon TY, Ganesh R. Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Mayo Clin Proc. 2023;98(10):1544-1551. doi:10.1016/j.mayocp.2023.07.032
2. Castro-Marrero J, Zaragozá MC, Domingo JC, Martinez-Martinez A, Alegre J, von Schacky C. Low omega-3 index and polyunsaturated fatty acid status in patients with chronic fatigue syndrome/myalgic encephalomyelitis. Prostaglandins Leukot Essent Fatty Acids. 2018;139:20-24. doi:10.1016/j.plefa.2018.11.006
3. Castro-Marrero J, Sáez-Francàs N, Segundo MJ, et al. Effect of coenzyme Q10 plus nicotinamide adenine dinucleotide supplementation on maximum heart rate after exercise testing in chronic fatigue syndrome - A randomized, controlled, double-blind trial. Clin Nutr. 2016;35(4):826-834. doi:10.1016/j.clnu.2015.07.010
4. Richman S, Morris MC, Broderick G, Craddock TJA, Klimas NG, Fletcher MA. Pharmaceutical Interventions in Chronic Fatigue Syndrome: A Literature-based Commentary. Clin Ther. 2019;41(5):798-805. doi:10.1016/j.clinthera.2019.02.011
5. Davis, H. E., Assaf, G. S., McCorkell, L., et al. (2021). Characterizing long COVID in an international cohort. EClinicalMedicine, 38, 101019.
