Why You Have Good Days and Bad Days With Long COVID and Chronic Fatigue Syndrome with Evan H. Hirsch, MD

Why You Have Good Days and Bad Days With Long COVID and Chronic Fatigue Syndrome with Evan H. Hirsch, MD

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So why do you feel worse when you're doing everything right? And why can one day feel manageable while the next day feels like a total crash? Welcome back to the EnergyMD podcast, where we help you resolve your long COVID and chronic fatigue syndrome naturally so that you can get back to living your best life. I'm Evan Hirsch. If you feel like you're doing everything right but still crashing, it does not mean that you did something wrong.

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Your body may be following a pattern no one has helped you to see yet. In this episode, I'm going to walk you through nine reasons symptoms flare with long COVID and chronic fatigue syndrome, including the ones most people miss: hormonal shifts, seasonal infection cycles, and full moon flares. So stay tuned. Once you can see the pattern, the bad days make more sense. And when they make more sense, they become easier to respond to. So the first reason is physical overexertion.

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This is the classical post-exertional malaise pattern. You do something that would seem normal to someone else, like a longer walk, errands, housework, travel, or a social event, and then symptoms rise hours or even days later. The delay is what makes it confusing. You may feel worse on Thursday because of what happened on Tuesday. And oftentimes when you have a good day and you exert more energy, then you have a crash. So it's really this catch-22 where when you have a good day and you really want to get stuff done,

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you're not able to because of the concerns of the crash that might be coming. The second reason is stress from mental, emotional, spiritual, and energetic reasons. So I'm grouping these together because they all affect the nervous system, immune function, inflammation, and energy production. You know, mental energy is still energy. A long Zoom day, a difficult conversation, paperwork, planning, problem solving, or too much screen time can create the same kind of crash as physical activity.

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Emotional stress matters too. So relationship tension, family demands, grief, worry about money, or fear about the future can activate the stress response. When that happens, inflammation can rise, immune function can drop, and chronic infections like Epstein-Barr virus can become more active. Spiritual stress can also affect symptoms. When you feel disconnected from your purpose, isolated, unseen, or like your life has been taken from you, like so many people do in my community, your body feels that.

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And energetic stress matters too. Many people with long COVID and ME/CFS feel drained at the cellular level after stressful environments, EMFs, poor sleep conditions, people who dysregulate them, or being stuck in fight, flight, or freeze or shutdown. Excuse me. If your symptoms rise after mental effort, emotional stress, spiritual depletion, or a draining environment, your body is asking for nervous system recovery. The third reason is dietary triggers.

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Sugar can feed candida and other pathogens. Gluten and dairy can increase inflammation. Alcohol stresses the liver. Restaurant meals can bring in seed oils, pesticides, additives, hidden gluten, hidden dairy, or chemicals your body is not ready to handle. For some people, one off-plan meal can create symptoms within 24 or 48 hours. The fourth reason is poor sleep. Sleep is when your immune system repairs, your brain clears waste, your nervous system resets,

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and your body rebuilds. One rough night can increase inflammation and lower immune resilience. Repeated poor sleep can make infections, pain, brain fog, and anxiety much harder to calm down. The fifth reason is menstrual cycle, menopause, and hormone shifts. This is especially important for women with long COVID and chronic fatigue syndrome. If you are still cycling, symptoms may flare before your period, during your period, or around ovulation. If you're in menopause or perimenopause,

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the pattern may look different. You may not have a monthly period anymore, but hormones can still affect sleep, temperature regulation, inflammation, histamine, blood sugar, mitochondria, mood, and nervous system stability. Hot flashes, night sweats, poor sleep, anxiety, brain fog, and fatigue can all make long COVID and ME/CFS symptoms harder to regulate. So if symptoms worsen around your cycle, during perimenopause, or after menopause,

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hormone shifts can be one of the causes. The sixth reason is toxic exposure. Molds, heavy metals, pesticides, fragrances, cleaning products, smoke, dental materials, and chemicals can worsen symptoms quickly. For example, walking into a water-damaged building can trigger brain fog, fatigue, pain, anxiety, histamine symptoms, or breathing issues. This is especially hard when you're traveling and staying at different hotels, or you go to visit your friend's house for a potluck.

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And all of a sudden halfway through it you realize that you're being exposed to mold. If your symptoms change after a place, a product, food, dental visit, or exposure, pay attention. The seventh reason is a Herxheimer reaction, also called die-off. This can happen when you're actively killing infections or mobilizing toxins. As pathogens die, they can release inflammatory compounds. As toxins move, symptoms can rise if they're moving faster than your body can eliminate them.

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And they get redeposited into a different part of the body. A HERX often peaks in one to three days and improves within three to seven days, depending on how you're addressing it. In our program, we want people to move through our process as gracefully as possible. So our hope is to always mitigate it and decrease your reaction to symptoms within 24 to 48 hours, just by adjusting what you're currently taking.

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The answer is not to force your way through it. The answer is to support drainage, binders, hydration, sleep, pacing, and gentle detox. So this is really important because a lot of people don't realize that when you get a new supplement from your provider, or you've tried a new supplement and you feel worse from it, you're not exactly sure why. If it has any sort of antimicrobial activity, you can just go to AI and ask it that question.

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And then it's very possible that you're having a die-off reaction. You may not even realize it. And when you have a die-off reaction or a Herxheimer reaction, it's very hard on your hormones. It's hard on your adrenals, your thyroid, your sex hormones. It damages your mitochondria and it sets you back, which is why it's so important. We've got a four-step process where step three is to open up those exit pathways so that when you go into step four and you're removing the toxins and the infections,

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you are going to be a lot more successful and you're going to have a lot less die-off. So the eighth reason is seasonal infection cycles. So different infections tend to rise at different times of year. Parasites, Borrelia, Babesia, Bartonella often flare in warmer months. Epstein-Barr virus and herpes family viruses can flare in summer and winter. Candida often worsens with heat, humidity, sugar, alcohol, and holiday stress.

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Mycoplasma and chronic bacteria often worsen in winter. So if you always feel worse in July or every November through February, that may not be random. It may be your immune system showing you which infections are active and when your body is most vulnerable. The ninth reason is full moon infection cycles. So many people with parasites, Borrelia, and Babesia notice a predictable flare around the full moon. This can look like insomnia, vivid dreams, anxiety,

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irritability, digestive symptoms, depression, itching, pain, night sweats, or fatigue. The common window is about five to seven days around the full moon, a few days before, a few days after. One possible reason is that light around the full moon can lower melatonin, and melatonin supports immune regulation. Serotonin may also shift, and some parasites and spirochetes appear to use serotonin-related signaling for reproduction and motility.

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There's also a question about whether the change in barometric pressure during this time is affecting the infections. So if you feel worse around the full moon, you're not imagining it. It may be another pattern your body is showing you. Now, once you see the nine reasons, the next question is why is your body so vulnerable to these flares in the first place? This is where the toxic five come in. This is a term that I like to use. The toxic five are heavy metals, chemicals, molds, infections,

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and nervous system dysfunction or being caught in fight or flight. These are the five root causes I see time and time again in people with long COVID and chronic fatigue. Heavy metals like mercury, lead, and arsenic can interfere with mitochondria, immune regulation, detoxification, and hormone signaling. Chemicals like pesticides, plastic solvents, and flame retardants can disrupt hormones, the liver, mitochondria, and the nervous system.

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Mold and mycotoxins from water-damaged buildings can drive inflammation, brain fog, histamine issues, immune dysfunction, and neurologic symptoms. Infections, including Epstein-Barr virus, HHV-6, Lyme-related infections, parasites, candida, mycoplasma, chronic bacteria, and spike protein-related immune disruption. Nervous system dysfunction keeps the body stuck in fight, freeze, or shutdown, which makes it harder to detoxify, repair, sleep, digest,

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and regulate the immune system. Most providers, even many functional medicine providers, unfortunately, are still relying too heavily on lab results. But testing isn't perfect. Urine tests show what you're excreting, not your total body burden. Serology tests show your immune system's response, but a dysfunctional immune system can give misleading results. Standard blood work often misses chronic toxic burden and stealth infections.

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This is why the longer I do this work, the less I rely on testing alone and the more I focus on taking action across all five root causes. When you address 99% of all of the known causes for a particular condition, like long COVID or chronic fatigue syndrome, you are just hedging your bets and you are just going to be a lot more successful. You're going to save a ton of time and energy and money by just addressing the toxic five. So the nine reasons explain why symptoms can flare.

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The toxic five explain why the body is vulnerable to the flare. So what to do with this? Start with a simple checklist. When symptoms rise, ask: did I overexert physically? Was there mental, emotional, spiritual, or energetic stress? Did I eat something that triggered me? Did I sleep poorly? Am I near my period, ovulation, perimenopause, or a hormone shift? Was I exposed to mold, chemicals, fragrances, smoke, dental materials, or pesticides?

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Am I actively treating infections or toxins and possibly herxing? Is this one of my seasonal infection windows? Am I within five to seven days of the full moon? Then track it. You don't need a complicated spreadsheet. Just write down the date, your top symptoms, sleep quality, food changes, stress level, menstrual cycle timing if relevant, and moon phase. After two to three months, patterns often become clear. And once a pattern is clear, you can prepare. For known flare windows, you may need to lighten your schedule.

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Protect your sleep, reduce sugar, use blackout curtains, increase hydration, support binders, support drainage, and be more consistent with antimicrobial herbs. You know, the goal is not to fear the calendar. The goal is to work with your body instead of being surprised by the same flare again and again. If you take one thing from this episode, let it be this. A bad day does not mean you're back at the beginning. It may mean your body is responding to exertion, stress, hormones, toxins, treatment, infections, the season, or the moon.

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Your body is just giving you information. When you learn how to read it, you can respond with more confidence and less fear. And it's really important also to remember that it's not your fault that you, you know, you have to keep doing the nervous system retraining work and the mindset work. You have to have gratitude for where you're at, even though it's uncomfortable. You have to have a vision for where you want to go. You have to ask yourself empowering questions. You know, what is my body trying to tell me?

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You know, how can I love my body more? That is a lot more supportive for you than: why is this happening again to me? This absolutely sucks. And yes, you can say that. And yes, it does absolutely suck. And you can also have compassion for yourself and realize that you are going to get there. If you move through a process and address the toxic five. So if you want my help understanding the toxic five and how they're keeping you stuck and how to address them systematically, you can go to fixyourfatigue.com.

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This is where I walk you through the method we use to help people recover from long COVID and chronic fatigue syndrome naturally. This is my latest masterclass. It's at fixyourfatigue.com. And I would love to hear from you in the comments, you know, do your symptoms flare more with your cycle, the full moon, a certain season, stress, food, or treatment. If someone, you know, keeps wondering why they feel worse when they're doing everything right, share this with them. It may help them see a pattern they have never been taught to look for. Thanks for being here.

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Have an amazing day and I'll see you in the next episode.

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I hope you learned something on today's podcast. If you did, please share it with your friends and family and leave us a five-star review on iTunes. It's really helpful for getting this information out to more people who desperately need it. Sharing all the experts I know and love and the powerful tips I have is one of my absolute favorite things to do. Thanks for being part of my community. Just a reminder, this podcast is for educational purposes only.

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And is not a substitute for professional care by a doctor or other qualified medical professional. It is provided with the understanding that it does not constitute medical or other professional advice or services. Thanks for listening and have an amazing day.