Mitochondrial Dysfunction

Mitochondria are the energy-producing structures inside nearly every cell in the body. They convert nutrients into adenosine triphosphate (ATP), the molecule that powers everything from muscle contraction to cognitive function. In Long COVID, growing evidence suggests that mitochondrial function becomes impaired, leading to the profound fatigue and brain fog that patients describe as their most disabling symptoms.

The mechanism appears to involve several disruptions. SARS-CoV-2 may directly damage mitochondrial membranes, interfere with the electron transport chain (the final step of ATP production), or trigger persistent inflammation that diverts mitochondrial resources toward immune defense rather than energy generation. Oxidative stress also plays a role. When mitochondria are stressed, they produce excess reactive oxygen species (ROS), which further damage mitochondrial DNA and membranes in a self-reinforcing cycle. The result is an energy deficit at the cellular level that rest alone cannot resolve.

Interventions that may help support mitochondrial recovery target specific steps in this pathway. Coenzyme Q10 (CoQ10) is a direct participant in the electron transport chain and may help support ATP production. N-acetylcysteine (NAC) supports glutathione, the body’s primary antioxidant defense against mitochondrial oxidative damage. Acetyl-L-carnitine helps transport fatty acids into mitochondria for fuel. Dr. Groysman considers mitochondrial support a foundational layer in Long COVID treatment, because without adequate cellular energy production, other recovery efforts may stall regardless of how well they address inflammation or immune dysregulation.