What to Do First When You Suspect Post-Viral Illness
If you've been feeling off — fatigued all the time, foggy, in pain, unable to sleep, heart racing for no clear reason — and no one has been able to tell you why, this episode is your starting point.
In this conversation, Haylie Pomroy sits down with Dr. Nancy Klimas, Director of the Institute for Neuro-Immune Medicine at Nova Southeastern University and Director of Environmental Medicine Research at the Miami VA, to map out a clear, clinically grounded roadmap for anyone navigating post-viral illness — whether that's long COVID, ME/CFS, post-viral chronic fatigue, or a diagnosis they're still trying to name.
What Dr. Klimas lays out isn't theory. It's the distilled wisdom of someone who has spent over 30 years in the trenches with some of the most complex, most dismissed patients in medicine — and who still believes, deeply and without cynicism, that these are curable illnesses.
Why Dr. Klimas Does This Work
Dr. Klimas describes herself as a feminist at heart — and it's where her passion for this field begins. She was outraged by the way the medical establishment was treating women presenting with a very real disease: dismissing them, disbelieving them, handing them antidepressants instead of answers.
Her mother had fibromyalgia. Many of her patients are her friends. She knows firsthand, beyond the clinical, how much this illness takes from people's lives.
"If you think something's really wrong, don't let somebody else tell you it's not," she says. "Just get after it and try to figure it out."
Step One: Become a Good Historian of Your Health
Before anything else — before appointments, before labs, before treatment — Dr. Klimas wants you to go back.
When did you last feel right?
That question matters more than most people realize. Illness doesn't always announce itself. For many people with post-viral conditions, it crept in slowly, quietly, over months — until one day it was undeniable. Going back and finding the line, identifying the moment or season when things shifted, can provide crucial clues about what triggered it.
Dr. Klimas shares her own story as an example. During the pandemic, working from home, she was unknowingly being exposed to a significant amount of mold. It wasn't obvious. Her friends started noticing before she did. When she finally got the workup, the answer was right there in her environment — hiding in plain sight. The starting question was the same one she asks every patient: when did this start, and what changed around that time?
"You don't have to have the answer," she says. "But ask the question."
This is especially important in the context of long COVID, where the triggering infection may have been asymptomatic. You don't have to have been hospitalized — or even to have known you were sick — for long COVID to follow. Anyone who developed an ME/CFS-like illness in the last four years is, in many cases, dealing with a COVID trigger.
Step Two: Make Your Lists
Once you've tried to locate the beginning of your illness, Dr. Klimas wants you to do two things: make a list of what makes you worse, and make a list of what makes you better.
What makes you worse is often more revealing than people expect. The most common answer she hears: having a decent day, feeling a little hopeful, and then doing too much — trying to catch up on everything that didn't get done the week before. The result is an exertion-induced relapse, a crash that can last days. Understanding this cycle — and learning to prevent it — is foundational to managing this illness.
Other triggers vary person to person: certain foods, fasting, environmental exposures, stress. Some people can even predict their day by checking their pulse when they wake up. A resting heart rate of 120 before getting out of bed tells the body something very different than a resting rate of 60. That's the sympathetic nervous system speaking, and learning to listen to it is a skill worth building.
What makes you better is equally important. What has helped? What treatments, however partial, have moved the needle? What habits, foods, or routines leave you feeling more like yourself? This list becomes your foundation — the things to double down on while the rest gets sorted.
"Get really intimate with yourself," Haylie says. "Listen to your body. Know yourself, and don't let anybody else talk you out of it."
Step Three: Educate, Then Advocate
If you've recently been diagnosed — or are trying to get a diagnosis — Dr. Klimas has a clear directive: educate yourself.
Not obsessively. Not in a way that takes over your life or fills you with anxiety. But enough that you know what to ask. Enough that you can walk into an appointment and guide the conversation. Because the hard truth is that you cannot assume your providers are well informed about ME/CFS or long COVID. You may need to bring the information to them.
A few resources she recommends:
- The NIH and CDC both have primer-level web pages on ME/CFS and long COVID
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HealthRising.org (Cort Johnson) offers deep, well-researched resources on the science, what helps, and what hurts
- The ME/CFS Clinician Coalition website provides guidelines and treatment frameworks you can share with your own doctor
And here's something worth reframing: advocacy doesn't have to mean confrontation. Haylie puts it simply — "You invite your practitioner on the journey with you. They are on the journey. They aren't the journey." Asking your doctor to learn something new, to refer you somewhere, to take your symptoms seriously — that is part of their job. That is what they signed up for.
The Three Foundational Areas to Work On
Once you've started building your health history and educating yourself, Dr. Klimas wants you to pick three areas to focus on over the next 90 days. Not everything at once — that's too overwhelming, too exhausting for a body that is already overwhelmed and exhausted. Just three.
1. Sleep
Sleep is first. Always.
Not because it's simple — it's not — but because a primary sleep disorder can look exactly like ME/CFS or long COVID. The fatigue, the body pain, the cognitive fog, the inability to function: the symptoms are the same. This is why every new patient at INIM gets a sleep consult. If there's untreated sleep apnea or another sleep disorder driving the illness, you need to know that before anything else.
But beyond ruling out primary sleep disorders, there's a deeper problem: the sympathetic nervous systems of people with these conditions are so dysregulated that they drive daytime signals in the brain at nighttime. Sleep becomes the opposite of restorative. Instead of rest, repair, and memory consolidation, the body is stuck in adrenaline-driven activation — unable to recover, unable to clear toxins, unable to do the nighttime work that health depends on.
Some practical starting points Dr. Klimas shares:
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Sleep on your side to reduce upper airway resistance
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Avoid long daytime naps — power naps are fine, but three- and four-hour naps will destroy your night
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Get morning sunlight within the first 10-15 minutes of waking — even five minutes outside resets the circadian rhythm and supports vitamin D production
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Work on vagal tone — breathing practices before sleep can help shift the nervous system from sympathetic to parasympathetic
When you bring sleep to your doctor, Dr. Klimas suggests making it its own appointment. Don't try to cover it alongside five other things. "Sleep needs deep thinking and working through," she says. "Give it the time it deserves."
2. The Autonomic Nervous System
The second area is the autonomic nervous system — the system that regulates blood pressure, heart rate, vascular tone, gut motility, and dozens of other functions that happen without conscious thought.
In ME/CFS and long COVID, this system is significantly dysregulated. The sympathetic-parasympathetic imbalance shows up in ways that can look like completely separate conditions: POTS, gastroparesis, slow gut motility, racing heart, dizziness, temperature dysregulation. When you trace those symptoms back to their root, they often land in the same place: an autonomic nervous system that has lost its balance.
Working on this doesn't require a specialist immediately. There are noninvasive, accessible starting points — checking your blood pressure regularly, understanding what POTS is, looking into compression garments, learning about pacing. Wednesday, Haylie suggests, could be your autonomic day.
3. Bioenergetics — Mitochondria, Nutrition, and Antioxidant Status
The third area is bioenergetics: how your cells make energy, what they need to do it, and what's getting in the way.
This is the intersection of mitochondrial function, nutrition, supplementation, and antioxidant status. It's a big, messy area — and it often requires specialized lab testing to untangle properly. At INIM, this means measuring dozens of micronutrients, vitamins, antioxidants, and pathway markers to understand exactly where the system is breaking down and why.
But even before that kind of deep workup, there are basic questions worth asking: What are you eating? What are you not eating? What supplements are you taking, and are they actually helping? Is it time to do a reset?
"You can't just take it apart into single little bits," Dr. Klimas explains. "Because you're going to end up on a cocktail approach of interventions, taking care of these very interactive elements to try to get a new balance." Sleep, the autonomic nervous system, and bioenergetics are deeply interconnected — and ultimately, so is the immune system underneath all of it.
The Immune System: What's Actually Broken
Dr. Klimas closes with the piece that ties everything together — the immune system.
She's a clinical immunologist by training, but she's been talking about sleep and autonomics and mitochondria because these things are not silos. They interact. They drive each other. And they all circle back to an immune system under chronic siege.
Two specific things are broken in these patients. First, the antiviral surveillance system — the part of the immune system that's supposed to keep latent viruses dormant — is failing. Old viruses that should stay quiet are reactivating: Epstein-Barr, CMV, HHV-6, Coxsackie. Each one adds more immune noise, more inflammation, more burden on a system that's already exhausted.
Second, the immune system itself is driving neuroinflammation — inflammation in the brain. This is why bioenergetics and antioxidants matter so much: they're not just treating energy depletion. They're treating inflammation. "You have to see the big picture," she says. "You can't just address one piece."
The Message That Matters Most
Dr. Klimas closes with the message she carries to every stage, every conference, every microphone she's given:
"These are curable illnesses — not just treatable illnesses. And we are very, very close."
She's been doing this for over 30 years and hasn't gotten cynical. Not about the patients. Not about the science. She says she freaks out when she hears about people who have reached their last thread without hearing this from a frontline investigator: don't give up. The research is moving faster than most patients have been told. We are already helping people a great deal — and the goal is a cure, not just management.
"This is not the time to give up on this field or on yourself."
Your Starting Roadmap
If you take nothing else from this episode, take this:
If your life feels different — if something doesn't feel right — that is a big deal and it deserves attention. Start here:
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Become a historian. When did you last feel well? What changed?
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Make your lists. What makes you worse? What makes you better?
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Educate yourself so you can advocate — not combatively, but lovingly and effectively
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Focus on three things over the next 90 days: sleep, autonomic function, and bioenergetics
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Use your doctor's time wisely — one complex issue per focused appointment
And don't be afraid to ask for help. If you're too unwell to do this alone, hand this roadmap to someone who loves you and ask them to help you work through it. You don't have to figure this out by yourself.
About Dr. Nancy Klimas
Dr. Nancy Klimas is a clinical immunologist and one of the world's leading experts in ME/CFS, long COVID, Gulf War illness, and other complex chronic immune-mediated conditions. She serves as Director of the Institute for Neuro-Immune Medicine at Nova Southeastern University and Director of Environmental Medicine Research at the Miami VA Medical Center GRECC.
Connect with Dr. Klimas:
About Haylie Pomroy
Haylie Pomroy is the Founder and CEO of The Haylie Pomroy Group, assistant director of the Integrative Medicine program at the Institute for Neuro-Immune Medicine, and a New York Times bestselling author of The Fast Metabolism Diet. With over 25 years of experience in nutrition, biochemistry, and patient advocacy, she combines clinical expertise with her own autoimmune journey to help others reclaim their health.
Learn more and connect with Haylie:
Tune in to Fast Metabolism Matters — available wherever you listen to podcasts.
TRANSCRIPT
Haylie Pomroy: Welcome to the Fast Metabolism podcast.
Today I'm going to gather some pearls of wisdom for those of you who are suspecting or dealing with post-viral infection, post-viral chronic fatigue, ME/CFS, or maybe long COVID. And in order to do that, I am joined by Dr. Nancy Klimas. She's the director of the Institute for Neuro-Immune Medicine at NSU, as well as the director of Environmental Medicine at the Miami VA. Dr. Klimas, thank you so much. I am so excited to gather all of these pearls of wisdom from you today.
Dr. Nancy Klimas: I'm very excited to be here.
Haylie Pomroy: I wish that everybody could spend three hours in the clinic with you as their patient. But I recognize that's not a reality for most people — even though we do have people who fly in internationally. What I'm hoping to do today is take a distillation of your vast experience in this space and share some of it with all of our listeners. I want to start by asking you for the condensed version of how you became Dr. Nancy Klimas in this space.
Dr. Nancy Klimas: There are a lot of reasons behind why I do what I do, but perhaps the main reason is that I am a feminist in my heart and soul. I was so extraordinarily offended by the way the medical establishment was treating women with a very real disease — women presenting to doctors who were not believing them.
I also have other things. My mom had fibromyalgia, and I could see how much she suffered from that. It really blighted her life. And many, many of my patients are my friends. So I know, not just from the doctor's office but from being able to share their lives in other ways, how much this illness has affected them.
Haylie Pomroy: That's actually been a large motivation of my own — even in the nutrition and weight loss space. There's a lot of guilt and shame there too. And I think it's all about respect — your own perceptions of what's wrong. If you think something's really wrong, don't let somebody else tell you it's not. Just get after it and try to figure it out.
Dr. Nancy Klimas: Exactly. And that's really the bottom line — it's about respect.
Haylie Pomroy: I want to talk about individuals who maybe haven't had a post-viral or post-episodic toxic injury diagnosis yet — individuals who just feel like they're losing traction, can't move forward in their health, and are having fatigue, lack of sleep, pain, headaches. I'm looking for three things they can take action on. If a person is listening to this and thinking, wait a minute, maybe that's going on with me — what are some things they can do?
Dr. Nancy Klimas: So it's the same kind of individual, though with a lot of differences from person to person. If someone's feeling like their life is different — that they feel fatigued all the time, ill, just not right, having trouble concentrating, a lot of body pain, episodes where their heart is racing and they're dizzy — that is very serious stuff and it's not to be ignored. It's not something that a good night's sleep will fix.
There are a number of different things that can be impacting people who have this illness. The first thing is to ask yourself: when did it start and what got this going? You may not be able to figure it out — it may have come on slowly — but often it came on post-virally.
I'll give my own example. I don't have ME/CFS, thank goodness. But during the pandemic I was working from home, my mom was sick, and it turned out I was being exposed to a tremendous amount of mold. Being stubborn, I let it go on and on until my friends were saying, all you do is cough. I finally got the workup, and lo and behold, something really profound was going on — my house was trying to kill me. I had to go back and ask: when did this start? It started when I began staying home all the time. So become a good historian of your health.
Haylie Pomroy: I love that you shared that, because so many times people feel like they can't figure things out because they don't have the knowledge base. And if someone like you sometimes has to step back and ask those questions, it makes me feel a lot better about how long it took me to get some answers with my autoimmune disorder.
Dr. Nancy Klimas: And also — my sister, the architect, diagnosed my thyroid. This is not the first time I've been willing to ignore a problem.
Haylie Pomroy: I love that — have good people around you. I also want to acknowledge something: a lot of times women are told, well, you're just a mom now, or you've had kids, or it's menopause, or it's stress. All of these things are treated as symptoms of an inability to manage stress, when in reality something very real is going on.
Dr. Nancy Klimas: Yeah, the blame game. If I had less stress I would be a healthy person. I just laugh at that one, because I challenge you to find someone who is truly stress free.
Haylie Pomroy: And when the hurricanes hit, even the most zen person is stressed. So if a person is out there — I want to validate that this is a big deal and it needs attention.
Dr. Nancy Klimas: Get a sense of what triggered it, because that will give you some clues. One of the hardest things since the pandemic is long COVID, because it turns out it can follow an asymptomatic infection — you don't even have to know you had COVID. Initially we were only looking at people who got hospitalized. But it turned out that wasn't necessary. You just had to have had COVID. So anyone who came up with an ME/CFS-like illness in the last four years, we're largely assuming had a COVID trigger.
Haylie Pomroy: And the majority of the population has been exposed — though we also know that most of the population has been exposed to things like EBV too.
Dr. Nancy Klimas: Absolutely. And that's a whole other path we can go down. But let's go back to the beginning: when did you first notice you were sick, and is there something you can line up with the beginning of your illness? You may not be able to — and that's okay.
The next thing is: what makes you worse? That's something you can assess right now. The most common thing that makes people worse is having a halfway decent day and then going out and seizing the world — trying to do everything they didn't get done the week before. Understanding the cycle of exertion-induced relapse is really important, and so is getting a sense of how to prevent it.
There are other triggers too: for some people it's certain foods, fasting, or other little signals that help them predict what's coming. And then the flip side of that is: what makes you better?
Haylie Pomroy: So make a list of what makes you worse and what makes you better. I like creating that list. Sometimes it's not the big massive thing — sometimes it's identifying the little irritants and removing them. Double down on what makes you feel better.
Dr. Nancy Klimas: That's true in life, and it's also true in medicine. Because you've been through a bunch of doctors and they've been trying different things — some of it didn't work, some of it helped. So what's on that list?
One of the things people say makes them better is that they wake up knowing what kind of day they're going to have. If they wake up and their pulse is 120, they know it's going to be a dreadful day. If their pulse is 60, it might be a good day. Their body has already told them something — that their sympathetic drive is off kilter. And you can learn to read those signals.
Haylie Pomroy: I'm going to call that getting really intimate with yourself. Listen to your body. Know yourself, and don't let anybody else talk you out of it. Once you know yourself, don't let anyone who spent an hour with you tell you they know your body better than you do.
Dr. Nancy Klimas: Make a good day/bad day list. What do you know is going to make a bad day? Be self-aware enough to figure that out, and then work on improving it.
Haylie Pomroy: What about someone who has recently been diagnosed?
Dr. Nancy Klimas: People with a recent diagnosis are struggling with a big, complicated diagnosis — and it's not easy to find the information you need to understand it yourself. The NIH and CDC have some nice web pages at a primer level. Cort Johnson at HealthRising.org has a beautiful, in-depth resource on what this illness is, what the latest science says, and what helps versus what hurts. The ME/CFS doctors have something called the ME/CFS Clinician Coalition website, which also gives you information to bring back to your doctor — with guidelines, treatment clues, and more.
Haylie Pomroy: Educate yourself about it.
Dr. Nancy Klimas: Exactly. You won't be your best advocate if you don't know what to ask. So immerse yourself — don't obsess, don't let it ruin your life, be able to put it down. But do try to learn, because you can't assume your providers are well informed. You may have to help guide them toward information, or at least find out who the local clinicians are who know something about this.
Haylie Pomroy: And sometimes when we talk about educating and then advocating, people feel like advocacy has to have combativeness or confrontation. But medical advocacy can be the most loving thing you do — because you invite your practitioner on the journey with you. They are on the journey. They aren't the journey. It's you who has this going on.
Dr. Nancy Klimas: Physicians are advocates — they fight for you with your insurance company every day. They've been advocating from the day they stepped into their first practice. So advocating with you on your behalf to find your way is part of the job. And it's not an unreasonable ask to have your doctor learn new things and help guide you toward the best possible health you can have.
Haylie Pomroy: When we talk about pearls of wisdom, can you give me some things you see consistently — some commonality in this space? And just to be clear, something being common doesn't mean it's normal. You've always shared with me that if we can get people sleeping, that helps the trajectory. What are three things that for the next 90 days a person could invest time, energy, and effort into working on?
Dr. Nancy Klimas: Start with sleep. Sleep matters, and I'm not minimizing it. And let's also say that a primary sleep disorder can look just like this — so it has to be ruled out. If you have untreated sleep apnea or another sleep disorder, you're going to have profound fatigue, body pain, and cognitive issues. The symptoms are exactly the same. So everybody who comes in initially gets a sleep consult.
Cindy Bateman told me a great story about a man who lost everything — his business, nearly his family — only to discover he had sleep apnea, and the severity of his illness was being driven by a complete lack of restorative sleep. It happens. It does not necessarily mean you have ME/CFS or long COVID. But you can have ME/CFS or long COVID and also have sleep disturbances.
When you are profoundly fatigued, your muscles are profoundly fatigued. All night long you're subconsciously working to keep your airway open. Upper airway resistance is a little different than classic sleep apnea, but your oxygen levels can still drop. There are ways to check on that. And simple things help — sleeping on your side, for example, reduces airway closure.
Another thing that happens a lot is that patients are so tired during the day that they take long naps, and then they're not tired at bedtime. So try to get the cycle back to a day-night cycle. I'm a total believer in the power nap — but not three or four hour naps.
Another important thing: in the morning when you wake up, you reset your circadian rhythm — but not without sunlight. Just walking outside for five or ten minutes when you wake up and letting your body know the sun has risen matters tremendously. In South Florida, the best time to get sunlight is in the morning because it's too hot in the afternoon. It gets my circadian rhythm kicked off correctly and gets my vitamin D going. That's a good way to start the day.
Now the deeper problem: our patients have a terrible time with sleep because their sympathetic nervous systems are so dysregulated that they're driving daytime signals in the brain at night while sleeping. At nighttime you're supposed to be in parasympathetic mode — rest, relax, restore. Your heart rate should be low, breathing steady. You're digesting, consolidating memory, repairing tissue, clearing toxins. But if you're on sympathetic drive during the night, none of that is happening. Your deep stages of sleep are disrupted, your memory is affected because you never got REM sleep, and you're not recovering your tissues overnight. The vagus nerve piece is really important here. There are whole podcasts on the vagus nerve, but the idea is trying to retrain your body to have more parasympathetic tone — some of it is just simple breathing practices as you fall asleep.
Haylie Pomroy: There's a lot of different things you can work with your team to address — things like low-dose therapies, melatonin, and other interventions. But addressing inadequate sleep is a really big deal.
Dr. Nancy Klimas: If you're going to take that to a doctor, I often talk about using your doctor's time wisely. Make an appointment for just the sleep issue, and then make another appointment for something else. It takes time to unravel the sleep thing. If you have five things you want to cover with your doctor, make five appointments if you have to. But if something needs deep thinking and working through — sleep is one of them.
Haylie Pomroy: What comes next? If the person has been diagnosed with long COVID, viral reactivation, post-viral illness — what's the next area to focus on after sleep?
Dr. Nancy Klimas: It depends on the individual and what's bothering them most. But the big ones — sleep is a huge deal. And then easily, the autonomic nervous system is another big one. That sympathetic-parasympathetic balance affects so many things: slow gut motility, gastroparesis, and all these other symptoms people come in with. When you look at the underlying diagnostic picture, so much of it traces back to that sympathetic-parasympathetic imbalance.
A big one after that is bioenergetics — how are your mitochondria? What is your energy? What is your antioxidant status? What do you eat? What don't you eat? What supplements are you taking? Are they making you feel better or not? Do you need to do a reset and start over? There are very sophisticated ways to measure nutrient balance. We do a lot of that in our clinic — laboratory tests that measure dozens of things to understand the status of critical vitamins, antioxidants, bioenergetics pathways, and the genetics of how those pathways are working. It's a big, messy appointment — but a terribly important one to try to untangle.
Haylie Pomroy: I envision it in my brain — like Monday, Wednesday, Friday. Monday I'm going to learn about sleep and sleep hygiene. Wednesday I'm going to focus on the autonomic nervous system — learn about POTS, check my blood pressure, look into compression stockings and other noninvasive, nurturing things that can make a real difference. Friday I'm going to focus on my nutrition and supplement protocol, get that organized and defined. Because sometimes those little bite-sized learnings are the most manageable way into something this complex.
Dr. Nancy Klimas: That's a good way to manage your doctor too. Our visits are unusual because we give two hours and you can cover real ground. But the average doctor spends 20 minutes with you. One thing worth mentioning — Medicare recently changed its billing to allow longer visits for high-complexity cases. That has changed how much time you can spend with your doctor if they check the right boxes. But regardless, come in organized. Use your time wisely.
When you're in these early stages, spend enough time on the big complicated things so that you come away knowing what the plan is and why. Later on, once you know your regimen — what you're doing for your sleep, your autonomic system, your immune system, the viral piece — you can come in for a follow-up and tick through efficiently. But it's okay to need multiple visits in the beginning to get everything organized.
Haylie Pomroy: I just want to distill it down. If your life is different, if you're feeling different, if it doesn't feel right — that's a big deal. Become a good historian of your health. When was the last time you felt good? When did things change? What did you notice first? Make a list of what makes you worse, and what makes you better — double down on that. Advocate for yourself. And then start focusing on these three foundational areas: sleep, autonomic function, and nutrition and bioenergetics. If those three things were under control, you'd be in a very different place.
Dr. Nancy Klimas: And you'd give me 30-minute appointments. That'd be great.
Haylie Pomroy: You guys can do that. All of you out there. You can start to take these concepts and get organized with the process. You're in it for the long haul — and the more versed and organized you are, the better. It's really hard when you feel unwell or are having cognitive issues, but don't hesitate to ask for help. If you have this kind of instruction manual, you can hand it to a friend or loved one and say, hey, I need you to help me become a good historian. Can I just dictate this to you? Get help and support.
Dr. Klimas, any other pearls of wisdom you want to leave people with? I just wanted to give people a starting place.
Dr. Nancy Klimas: The immune system — since I am an immunologist.
Haylie Pomroy: Please.
Dr. Nancy Klimas: So here I am talking about sleep and bioenergetics and autonomics — and I'm a clinical immunologist. That's my original training and certification. But these things are not silos. They're very connected ways of thinking, and you have to fix them together.
Back in the immune system space: the part of the system that's not working the best is the antiviral part — specifically the part that keeps old viruses from reactivating, the part that's supposed to be watching and snapping up those little viruses if they try to pop out again. That system is pretty broken. So we spend a lot of time trying to repair the immune system.
And the other thing that's wrong is that the immune system is driving a lot of inflammation — particularly inflammation in the brain. If you have oxidative stress, you're going to have inflammation in your brain. So when I say I'm dealing with bioenergetics and antioxidants, those aren't simply about treating energy in the brain — they're treating inflammation in the brain. You have to see the big picture. You can't take it apart into single little bits, because you're going to end up on a cocktail approach of interventions, taking care of these very interactive elements to try to get a new balance and get back to health.
Haylie Pomroy: Any time someone sticks a microphone in front of my face, I say I hope some good things came out of the pandemic. One thing I've seen is that we're now being forced to look at complex treatment because of the complexity of long COVID — which so closely mirrors the complexity of ME/CFS. The doctors who were addressing ME/CFS were acutely aware of this way ahead of time. And I think it's going to change the trajectory of medicine. There is no magic pill because this isn't a broken bone or high cholesterol. I think if we're going to treat these patients — and there are a lot of them — we're going to have to think with a more diverse cocktail of options.
Dr. Nancy Klimas: I absolutely believe that. My family accuses me of being a rose-colored-glasses person — I've always been that way and I still am. I can't believe I've been doing this for so many years and haven't gotten cynical. Not cynical about the patients, not even about the illness.
These are curable illnesses — curable, not just treatable — and we are very, very close. One of the reasons why we did this Hope and Help podcast is because I freak out when I hear about people who have reached their last thread, and I haven't been able to inject into them the optimism they need to hear from a frontline investigator and frontline clinician. We are so close. This is not the time to give up on this field or on yourself. We are already helping people a great deal. And we believe these are curable illnesses. I just wanted to leave that great big pearl on the table: we're going to keep at it until we get there.
Haylie Pomroy: I love that. Dr. Klimas, thank you so much. And to everyone out there — if you know somebody who is struggling, make sure you let them know there is hope. I feel very fortunate to get to witness what we see in the clinic every day, during our Friday clinicals where everybody comes together and hundreds of hours of education pour over cases. There is a significant amount of hope. This podcast is here to provide help. And I just can't thank you enough for being on. Sometimes in the complexity of all of this, it helps to have a guideline for where to start and how to get moving in the right direction toward getting well.
Dr. Nancy Klimas: Thanks, I appreciate that.
Haylie Pomroy: Absolutely. We'll talk again very soon. And next time we really do need to do a whole session on viruses and immunology.
Dr. Nancy Klimas: We need to do a whole session on viruses and immunology — it would be great. And I can share a colleague who has a long view on this and is wonderful on the herpes family viruses and enteroviruses. He's been exploring them for a long time.
Haylie Pomroy: Let's put him on our list.
Dr. Nancy Klimas: I'm sure he would be happy to do it. He and his wife are just extraordinary.
If you've been feeling off — fatigued all the time, foggy, in pain, unable to sleep, heart racing for no clear reason — and no one has been able to tell you why, this episode is your starting point.
In this conversation, Haylie Pomroy sits down with Dr. Nancy Klimas, Director of the Institute for Neuro-Immune Medicine at Nova Southeastern University and Director of Environmental Medicine Research at the Miami VA, to map out a clear, clinically grounded roadmap for anyone navigating post-viral illness — whether that's long COVID, ME/CFS, post-viral chronic fatigue, or a diagnosis they're still trying to name.
What Dr. Klimas lays out isn't theory. It's the distilled wisdom of someone who has spent over 30 years in the trenches with some of the most complex, most dismissed patients in medicine — and who still believes, deeply and without cynicism, that these are curable illnesses.
Why Dr. Klimas Does This Work
Dr. Klimas describes herself as a feminist at heart — and it's where her passion for this field begins. She was outraged by the way the medical establishment was treating women presenting with a very real disease: dismissing them, disbelieving them, handing them antidepressants instead of answers.
Her mother had fibromyalgia. Many of her patients are her friends. She knows firsthand, beyond the clinical, how much this illness takes from people's lives.
"If you think something's really wrong, don't let somebody else tell you it's not," she says. "Just get after it and try to figure it out."
Step One: Become a Good Historian of Your Health
Before anything else — before appointments, before labs, before treatment — Dr. Klimas wants you to go back.
When did you last feel right?
That question matters more than most people realize. Illness doesn't always announce itself. For many people with post-viral conditions, it crept in slowly, quietly, over months — until one day it was undeniable. Going back and finding the line, identifying the moment or season when things shifted, can provide crucial clues about what triggered it.
Dr. Klimas shares her own story as an example. During the pandemic, working from home, she was unknowingly being exposed to a significant amount of mold. It wasn't obvious. Her friends started noticing before she did. When she finally got the workup, the answer was right there in her environment — hiding in plain sight. The starting question was the same one she asks every patient: when did this start, and what changed around that time?
"You don't have to have the answer," she says. "But ask the question."
This is especially important in the context of long COVID, where the triggering infection may have been asymptomatic. You don't have to have been hospitalized — or even to have known you were sick — for long COVID to follow. Anyone who developed an ME/CFS-like illness in the last four years is, in many cases, dealing with a COVID trigger.
Step Two: Make Your Lists
Once you've tried to locate the beginning of your illness, Dr. Klimas wants you to do two things: make a list of what makes you worse, and make a list of what makes you better.
What makes you worse is often more revealing than people expect. The most common answer she hears: having a decent day, feeling a little hopeful, and then doing too much — trying to catch up on everything that didn't get done the week before. The result is an exertion-induced relapse, a crash that can last days. Understanding this cycle — and learning to prevent it — is foundational to managing this illness.
Other triggers vary person to person: certain foods, fasting, environmental exposures, stress. Some people can even predict their day by checking their pulse when they wake up. A resting heart rate of 120 before getting out of bed tells the body something very different than a resting rate of 60. That's the sympathetic nervous system speaking, and learning to listen to it is a skill worth building.
What makes you better is equally important. What has helped? What treatments, however partial, have moved the needle? What habits, foods, or routines leave you feeling more like yourself? This list becomes your foundation — the things to double down on while the rest gets sorted.
"Get really intimate with yourself," Haylie says. "Listen to your body. Know yourself, and don't let anybody else talk you out of it."
Step Three: Educate, Then Advocate
If you've recently been diagnosed — or are trying to get a diagnosis — Dr. Klimas has a clear directive: educate yourself.
Not obsessively. Not in a way that takes over your life or fills you with anxiety. But enough that you know what to ask. Enough that you can walk into an appointment and guide the conversation. Because the hard truth is that you cannot assume your providers are well informed about ME/CFS or long COVID. You may need to bring the information to them.
A few resources she recommends:
- The NIH and CDC both have primer-level web pages on ME/CFS and long COVID
- HealthRising.org (Cort Johnson) offers deep, well-researched resources on the science, what helps, and what hurts
- The ME/CFS Clinician Coalition website provides guidelines and treatment frameworks you can share with your own doctor
And here's something worth reframing: advocacy doesn't have to mean confrontation. Haylie puts it simply — "You invite your practitioner on the journey with you. They are on the journey. They aren't the journey." Asking your doctor to learn something new, to refer you somewhere, to take your symptoms seriously — that is part of their job. That is what they signed up for.
The Three Foundational Areas to Work On
Once you've started building your health history and educating yourself, Dr. Klimas wants you to pick three areas to focus on over the next 90 days. Not everything at once — that's too overwhelming, too exhausting for a body that is already overwhelmed and exhausted. Just three.
1. Sleep
Sleep is first. Always.
Not because it's simple — it's not — but because a primary sleep disorder can look exactly like ME/CFS or long COVID. The fatigue, the body pain, the cognitive fog, the inability to function: the symptoms are the same. This is why every new patient at INIM gets a sleep consult. If there's untreated sleep apnea or another sleep disorder driving the illness, you need to know that before anything else.
But beyond ruling out primary sleep disorders, there's a deeper problem: the sympathetic nervous systems of people with these conditions are so dysregulated that they drive daytime signals in the brain at nighttime. Sleep becomes the opposite of restorative. Instead of rest, repair, and memory consolidation, the body is stuck in adrenaline-driven activation — unable to recover, unable to clear toxins, unable to do the nighttime work that health depends on.
Some practical starting points Dr. Klimas shares:
- Sleep on your side to reduce upper airway resistance
- Avoid long daytime naps — power naps are fine, but three- and four-hour naps will destroy your night
- Get morning sunlight within the first 10-15 minutes of waking — even five minutes outside resets the circadian rhythm and supports vitamin D production
- Work on vagal tone — breathing practices before sleep can help shift the nervous system from sympathetic to parasympathetic
When you bring sleep to your doctor, Dr. Klimas suggests making it its own appointment. Don't try to cover it alongside five other things. "Sleep needs deep thinking and working through," she says. "Give it the time it deserves."
2. The Autonomic Nervous System
The second area is the autonomic nervous system — the system that regulates blood pressure, heart rate, vascular tone, gut motility, and dozens of other functions that happen without conscious thought.
In ME/CFS and long COVID, this system is significantly dysregulated. The sympathetic-parasympathetic imbalance shows up in ways that can look like completely separate conditions: POTS, gastroparesis, slow gut motility, racing heart, dizziness, temperature dysregulation. When you trace those symptoms back to their root, they often land in the same place: an autonomic nervous system that has lost its balance.
Working on this doesn't require a specialist immediately. There are noninvasive, accessible starting points — checking your blood pressure regularly, understanding what POTS is, looking into compression garments, learning about pacing. Wednesday, Haylie suggests, could be your autonomic day.
3. Bioenergetics — Mitochondria, Nutrition, and Antioxidant Status
The third area is bioenergetics: how your cells make energy, what they need to do it, and what's getting in the way.
This is the intersection of mitochondrial function, nutrition, supplementation, and antioxidant status. It's a big, messy area — and it often requires specialized lab testing to untangle properly. At INIM, this means measuring dozens of micronutrients, vitamins, antioxidants, and pathway markers to understand exactly where the system is breaking down and why.
But even before that kind of deep workup, there are basic questions worth asking: What are you eating? What are you not eating? What supplements are you taking, and are they actually helping? Is it time to do a reset?
"You can't just take it apart into single little bits," Dr. Klimas explains. "Because you're going to end up on a cocktail approach of interventions, taking care of these very interactive elements to try to get a new balance." Sleep, the autonomic nervous system, and bioenergetics are deeply interconnected — and ultimately, so is the immune system underneath all of it.
The Immune System: What's Actually Broken
Dr. Klimas closes with the piece that ties everything together — the immune system.
She's a clinical immunologist by training, but she's been talking about sleep and autonomics and mitochondria because these things are not silos. They interact. They drive each other. And they all circle back to an immune system under chronic siege.
Two specific things are broken in these patients. First, the antiviral surveillance system — the part of the immune system that's supposed to keep latent viruses dormant — is failing. Old viruses that should stay quiet are reactivating: Epstein-Barr, CMV, HHV-6, Coxsackie. Each one adds more immune noise, more inflammation, more burden on a system that's already exhausted.
Second, the immune system itself is driving neuroinflammation — inflammation in the brain. This is why bioenergetics and antioxidants matter so much: they're not just treating energy depletion. They're treating inflammation. "You have to see the big picture," she says. "You can't just address one piece."
The Message That Matters Most
Dr. Klimas closes with the message she carries to every stage, every conference, every microphone she's given:
"These are curable illnesses — not just treatable illnesses. And we are very, very close."
She's been doing this for over 30 years and hasn't gotten cynical. Not about the patients. Not about the science. She says she freaks out when she hears about people who have reached their last thread without hearing this from a frontline investigator: don't give up. The research is moving faster than most patients have been told. We are already helping people a great deal — and the goal is a cure, not just management.
"This is not the time to give up on this field or on yourself."
Your Starting Roadmap
If you take nothing else from this episode, take this:
If your life feels different — if something doesn't feel right — that is a big deal and it deserves attention. Start here:
- Become a historian. When did you last feel well? What changed?
- Make your lists. What makes you worse? What makes you better?
- Educate yourself so you can advocate — not combatively, but lovingly and effectively
- Focus on three things over the next 90 days: sleep, autonomic function, and bioenergetics
- Use your doctor's time wisely — one complex issue per focused appointment
And don't be afraid to ask for help. If you're too unwell to do this alone, hand this roadmap to someone who loves you and ask them to help you work through it. You don't have to figure this out by yourself.
About Dr. Nancy Klimas
Dr. Nancy Klimas is a clinical immunologist and one of the world's leading experts in ME/CFS, long COVID, Gulf War illness, and other complex chronic immune-mediated conditions. She serves as Director of the Institute for Neuro-Immune Medicine at Nova Southeastern University and Director of Environmental Medicine Research at the Miami VA Medical Center GRECC.
Connect with Dr. Klimas:
About Haylie Pomroy
Haylie Pomroy is the Founder and CEO of The Haylie Pomroy Group, assistant director of the Integrative Medicine program at the Institute for Neuro-Immune Medicine, and a New York Times bestselling author of The Fast Metabolism Diet. With over 25 years of experience in nutrition, biochemistry, and patient advocacy, she combines clinical expertise with her own autoimmune journey to help others reclaim their health.
Learn more and connect with Haylie:
Tune in to Fast Metabolism Matters — available wherever you listen to podcasts.
TRANSCRIPT
Haylie Pomroy: Welcome to the Fast Metabolism podcast.
Today I'm going to gather some pearls of wisdom for those of you who are suspecting or dealing with post-viral infection, post-viral chronic fatigue, ME/CFS, or maybe long COVID. And in order to do that, I am joined by Dr. Nancy Klimas. She's the director of the Institute for Neuro-Immune Medicine at NSU, as well as the director of Environmental Medicine at the Miami VA. Dr. Klimas, thank you so much. I am so excited to gather all of these pearls of wisdom from you today.
Dr. Nancy Klimas: I'm very excited to be here.
Haylie Pomroy: I wish that everybody could spend three hours in the clinic with you as their patient. But I recognize that's not a reality for most people — even though we do have people who fly in internationally. What I'm hoping to do today is take a distillation of your vast experience in this space and share some of it with all of our listeners. I want to start by asking you for the condensed version of how you became Dr. Nancy Klimas in this space.
Dr. Nancy Klimas: There are a lot of reasons behind why I do what I do, but perhaps the main reason is that I am a feminist in my heart and soul. I was so extraordinarily offended by the way the medical establishment was treating women with a very real disease — women presenting to doctors who were not believing them.
I also have other things. My mom had fibromyalgia, and I could see how much she suffered from that. It really blighted her life. And many, many of my patients are my friends. So I know, not just from the doctor's office but from being able to share their lives in other ways, how much this illness has affected them.
Haylie Pomroy: That's actually been a large motivation of my own — even in the nutrition and weight loss space. There's a lot of guilt and shame there too. And I think it's all about respect — your own perceptions of what's wrong. If you think something's really wrong, don't let somebody else tell you it's not. Just get after it and try to figure it out.
Dr. Nancy Klimas: Exactly. And that's really the bottom line — it's about respect.
Haylie Pomroy: I want to talk about individuals who maybe haven't had a post-viral or post-episodic toxic injury diagnosis yet — individuals who just feel like they're losing traction, can't move forward in their health, and are having fatigue, lack of sleep, pain, headaches. I'm looking for three things they can take action on. If a person is listening to this and thinking, wait a minute, maybe that's going on with me — what are some things they can do?
Dr. Nancy Klimas: So it's the same kind of individual, though with a lot of differences from person to person. If someone's feeling like their life is different — that they feel fatigued all the time, ill, just not right, having trouble concentrating, a lot of body pain, episodes where their heart is racing and they're dizzy — that is very serious stuff and it's not to be ignored. It's not something that a good night's sleep will fix.
There are a number of different things that can be impacting people who have this illness. The first thing is to ask yourself: when did it start and what got this going? You may not be able to figure it out — it may have come on slowly — but often it came on post-virally.
I'll give my own example. I don't have ME/CFS, thank goodness. But during the pandemic I was working from home, my mom was sick, and it turned out I was being exposed to a tremendous amount of mold. Being stubborn, I let it go on and on until my friends were saying, all you do is cough. I finally got the workup, and lo and behold, something really profound was going on — my house was trying to kill me. I had to go back and ask: when did this start? It started when I began staying home all the time. So become a good historian of your health.
Haylie Pomroy: I love that you shared that, because so many times people feel like they can't figure things out because they don't have the knowledge base. And if someone like you sometimes has to step back and ask those questions, it makes me feel a lot better about how long it took me to get some answers with my autoimmune disorder.
Dr. Nancy Klimas: And also — my sister, the architect, diagnosed my thyroid. This is not the first time I've been willing to ignore a problem.
Haylie Pomroy: I love that — have good people around you. I also want to acknowledge something: a lot of times women are told, well, you're just a mom now, or you've had kids, or it's menopause, or it's stress. All of these things are treated as symptoms of an inability to manage stress, when in reality something very real is going on.
Dr. Nancy Klimas: Yeah, the blame game. If I had less stress I would be a healthy person. I just laugh at that one, because I challenge you to find someone who is truly stress free.
Haylie Pomroy: And when the hurricanes hit, even the most zen person is stressed. So if a person is out there — I want to validate that this is a big deal and it needs attention.
Dr. Nancy Klimas: Get a sense of what triggered it, because that will give you some clues. One of the hardest things since the pandemic is long COVID, because it turns out it can follow an asymptomatic infection — you don't even have to know you had COVID. Initially we were only looking at people who got hospitalized. But it turned out that wasn't necessary. You just had to have had COVID. So anyone who came up with an ME/CFS-like illness in the last four years, we're largely assuming had a COVID trigger.
Haylie Pomroy: And the majority of the population has been exposed — though we also know that most of the population has been exposed to things like EBV too.
Dr. Nancy Klimas: Absolutely. And that's a whole other path we can go down. But let's go back to the beginning: when did you first notice you were sick, and is there something you can line up with the beginning of your illness? You may not be able to — and that's okay.
The next thing is: what makes you worse? That's something you can assess right now. The most common thing that makes people worse is having a halfway decent day and then going out and seizing the world — trying to do everything they didn't get done the week before. Understanding the cycle of exertion-induced relapse is really important, and so is getting a sense of how to prevent it.
There are other triggers too: for some people it's certain foods, fasting, or other little signals that help them predict what's coming. And then the flip side of that is: what makes you better?
Haylie Pomroy: So make a list of what makes you worse and what makes you better. I like creating that list. Sometimes it's not the big massive thing — sometimes it's identifying the little irritants and removing them. Double down on what makes you feel better.
Dr. Nancy Klimas: That's true in life, and it's also true in medicine. Because you've been through a bunch of doctors and they've been trying different things — some of it didn't work, some of it helped. So what's on that list?
One of the things people say makes them better is that they wake up knowing what kind of day they're going to have. If they wake up and their pulse is 120, they know it's going to be a dreadful day. If their pulse is 60, it might be a good day. Their body has already told them something — that their sympathetic drive is off kilter. And you can learn to read those signals.
Haylie Pomroy: I'm going to call that getting really intimate with yourself. Listen to your body. Know yourself, and don't let anybody else talk you out of it. Once you know yourself, don't let anyone who spent an hour with you tell you they know your body better than you do.
Dr. Nancy Klimas: Make a good day/bad day list. What do you know is going to make a bad day? Be self-aware enough to figure that out, and then work on improving it.
Haylie Pomroy: What about someone who has recently been diagnosed?
Dr. Nancy Klimas: People with a recent diagnosis are struggling with a big, complicated diagnosis — and it's not easy to find the information you need to understand it yourself. The NIH and CDC have some nice web pages at a primer level. Cort Johnson at HealthRising.org has a beautiful, in-depth resource on what this illness is, what the latest science says, and what helps versus what hurts. The ME/CFS doctors have something called the ME/CFS Clinician Coalition website, which also gives you information to bring back to your doctor — with guidelines, treatment clues, and more.
Haylie Pomroy: Educate yourself about it.
Dr. Nancy Klimas: Exactly. You won't be your best advocate if you don't know what to ask. So immerse yourself — don't obsess, don't let it ruin your life, be able to put it down. But do try to learn, because you can't assume your providers are well informed. You may have to help guide them toward information, or at least find out who the local clinicians are who know something about this.
Haylie Pomroy: And sometimes when we talk about educating and then advocating, people feel like advocacy has to have combativeness or confrontation. But medical advocacy can be the most loving thing you do — because you invite your practitioner on the journey with you. They are on the journey. They aren't the journey. It's you who has this going on.
Dr. Nancy Klimas: Physicians are advocates — they fight for you with your insurance company every day. They've been advocating from the day they stepped into their first practice. So advocating with you on your behalf to find your way is part of the job. And it's not an unreasonable ask to have your doctor learn new things and help guide you toward the best possible health you can have.
Haylie Pomroy: When we talk about pearls of wisdom, can you give me some things you see consistently — some commonality in this space? And just to be clear, something being common doesn't mean it's normal. You've always shared with me that if we can get people sleeping, that helps the trajectory. What are three things that for the next 90 days a person could invest time, energy, and effort into working on?
Dr. Nancy Klimas: Start with sleep. Sleep matters, and I'm not minimizing it. And let's also say that a primary sleep disorder can look just like this — so it has to be ruled out. If you have untreated sleep apnea or another sleep disorder, you're going to have profound fatigue, body pain, and cognitive issues. The symptoms are exactly the same. So everybody who comes in initially gets a sleep consult.
Cindy Bateman told me a great story about a man who lost everything — his business, nearly his family — only to discover he had sleep apnea, and the severity of his illness was being driven by a complete lack of restorative sleep. It happens. It does not necessarily mean you have ME/CFS or long COVID. But you can have ME/CFS or long COVID and also have sleep disturbances.
When you are profoundly fatigued, your muscles are profoundly fatigued. All night long you're subconsciously working to keep your airway open. Upper airway resistance is a little different than classic sleep apnea, but your oxygen levels can still drop. There are ways to check on that. And simple things help — sleeping on your side, for example, reduces airway closure.
Another thing that happens a lot is that patients are so tired during the day that they take long naps, and then they're not tired at bedtime. So try to get the cycle back to a day-night cycle. I'm a total believer in the power nap — but not three or four hour naps.
Another important thing: in the morning when you wake up, you reset your circadian rhythm — but not without sunlight. Just walking outside for five or ten minutes when you wake up and letting your body know the sun has risen matters tremendously. In South Florida, the best time to get sunlight is in the morning because it's too hot in the afternoon. It gets my circadian rhythm kicked off correctly and gets my vitamin D going. That's a good way to start the day.
Now the deeper problem: our patients have a terrible time with sleep because their sympathetic nervous systems are so dysregulated that they're driving daytime signals in the brain at night while sleeping. At nighttime you're supposed to be in parasympathetic mode — rest, relax, restore. Your heart rate should be low, breathing steady. You're digesting, consolidating memory, repairing tissue, clearing toxins. But if you're on sympathetic drive during the night, none of that is happening. Your deep stages of sleep are disrupted, your memory is affected because you never got REM sleep, and you're not recovering your tissues overnight. The vagus nerve piece is really important here. There are whole podcasts on the vagus nerve, but the idea is trying to retrain your body to have more parasympathetic tone — some of it is just simple breathing practices as you fall asleep.
Haylie Pomroy: There's a lot of different things you can work with your team to address — things like low-dose therapies, melatonin, and other interventions. But addressing inadequate sleep is a really big deal.
Dr. Nancy Klimas: If you're going to take that to a doctor, I often talk about using your doctor's time wisely. Make an appointment for just the sleep issue, and then make another appointment for something else. It takes time to unravel the sleep thing. If you have five things you want to cover with your doctor, make five appointments if you have to. But if something needs deep thinking and working through — sleep is one of them.
Haylie Pomroy: What comes next? If the person has been diagnosed with long COVID, viral reactivation, post-viral illness — what's the next area to focus on after sleep?
Dr. Nancy Klimas: It depends on the individual and what's bothering them most. But the big ones — sleep is a huge deal. And then easily, the autonomic nervous system is another big one. That sympathetic-parasympathetic balance affects so many things: slow gut motility, gastroparesis, and all these other symptoms people come in with. When you look at the underlying diagnostic picture, so much of it traces back to that sympathetic-parasympathetic imbalance.
A big one after that is bioenergetics — how are your mitochondria? What is your energy? What is your antioxidant status? What do you eat? What don't you eat? What supplements are you taking? Are they making you feel better or not? Do you need to do a reset and start over? There are very sophisticated ways to measure nutrient balance. We do a lot of that in our clinic — laboratory tests that measure dozens of things to understand the status of critical vitamins, antioxidants, bioenergetics pathways, and the genetics of how those pathways are working. It's a big, messy appointment — but a terribly important one to try to untangle.
Haylie Pomroy: I envision it in my brain — like Monday, Wednesday, Friday. Monday I'm going to learn about sleep and sleep hygiene. Wednesday I'm going to focus on the autonomic nervous system — learn about POTS, check my blood pressure, look into compression stockings and other noninvasive, nurturing things that can make a real difference. Friday I'm going to focus on my nutrition and supplement protocol, get that organized and defined. Because sometimes those little bite-sized learnings are the most manageable way into something this complex.
Dr. Nancy Klimas: That's a good way to manage your doctor too. Our visits are unusual because we give two hours and you can cover real ground. But the average doctor spends 20 minutes with you. One thing worth mentioning — Medicare recently changed its billing to allow longer visits for high-complexity cases. That has changed how much time you can spend with your doctor if they check the right boxes. But regardless, come in organized. Use your time wisely.
When you're in these early stages, spend enough time on the big complicated things so that you come away knowing what the plan is and why. Later on, once you know your regimen — what you're doing for your sleep, your autonomic system, your immune system, the viral piece — you can come in for a follow-up and tick through efficiently. But it's okay to need multiple visits in the beginning to get everything organized.
Haylie Pomroy: I just want to distill it down. If your life is different, if you're feeling different, if it doesn't feel right — that's a big deal. Become a good historian of your health. When was the last time you felt good? When did things change? What did you notice first? Make a list of what makes you worse, and what makes you better — double down on that. Advocate for yourself. And then start focusing on these three foundational areas: sleep, autonomic function, and nutrition and bioenergetics. If those three things were under control, you'd be in a very different place.
Dr. Nancy Klimas: And you'd give me 30-minute appointments. That'd be great.
Haylie Pomroy: You guys can do that. All of you out there. You can start to take these concepts and get organized with the process. You're in it for the long haul — and the more versed and organized you are, the better. It's really hard when you feel unwell or are having cognitive issues, but don't hesitate to ask for help. If you have this kind of instruction manual, you can hand it to a friend or loved one and say, hey, I need you to help me become a good historian. Can I just dictate this to you? Get help and support.
Dr. Klimas, any other pearls of wisdom you want to leave people with? I just wanted to give people a starting place.
Dr. Nancy Klimas: The immune system — since I am an immunologist.
Haylie Pomroy: Please.
Dr. Nancy Klimas: So here I am talking about sleep and bioenergetics and autonomics — and I'm a clinical immunologist. That's my original training and certification. But these things are not silos. They're very connected ways of thinking, and you have to fix them together.
Back in the immune system space: the part of the system that's not working the best is the antiviral part — specifically the part that keeps old viruses from reactivating, the part that's supposed to be watching and snapping up those little viruses if they try to pop out again. That system is pretty broken. So we spend a lot of time trying to repair the immune system.
And the other thing that's wrong is that the immune system is driving a lot of inflammation — particularly inflammation in the brain. If you have oxidative stress, you're going to have inflammation in your brain. So when I say I'm dealing with bioenergetics and antioxidants, those aren't simply about treating energy in the brain — they're treating inflammation in the brain. You have to see the big picture. You can't take it apart into single little bits, because you're going to end up on a cocktail approach of interventions, taking care of these very interactive elements to try to get a new balance and get back to health.
Haylie Pomroy: Any time someone sticks a microphone in front of my face, I say I hope some good things came out of the pandemic. One thing I've seen is that we're now being forced to look at complex treatment because of the complexity of long COVID — which so closely mirrors the complexity of ME/CFS. The doctors who were addressing ME/CFS were acutely aware of this way ahead of time. And I think it's going to change the trajectory of medicine. There is no magic pill because this isn't a broken bone or high cholesterol. I think if we're going to treat these patients — and there are a lot of them — we're going to have to think with a more diverse cocktail of options.
Dr. Nancy Klimas: I absolutely believe that. My family accuses me of being a rose-colored-glasses person — I've always been that way and I still am. I can't believe I've been doing this for so many years and haven't gotten cynical. Not cynical about the patients, not even about the illness.
These are curable illnesses — curable, not just treatable — and we are very, very close. One of the reasons why we did this Hope and Help podcast is because I freak out when I hear about people who have reached their last thread, and I haven't been able to inject into them the optimism they need to hear from a frontline investigator and frontline clinician. We are so close. This is not the time to give up on this field or on yourself. We are already helping people a great deal. And we believe these are curable illnesses. I just wanted to leave that great big pearl on the table: we're going to keep at it until we get there.
Haylie Pomroy: I love that. Dr. Klimas, thank you so much. And to everyone out there — if you know somebody who is struggling, make sure you let them know there is hope. I feel very fortunate to get to witness what we see in the clinic every day, during our Friday clinicals where everybody comes together and hundreds of hours of education pour over cases. There is a significant amount of hope. This podcast is here to provide help. And I just can't thank you enough for being on. Sometimes in the complexity of all of this, it helps to have a guideline for where to start and how to get moving in the right direction toward getting well.
Dr. Nancy Klimas: Thanks, I appreciate that.
Haylie Pomroy: Absolutely. We'll talk again very soon. And next time we really do need to do a whole session on viruses and immunology.
Dr. Nancy Klimas: We need to do a whole session on viruses and immunology — it would be great. And I can share a colleague who has a long view on this and is wonderful on the herpes family viruses and enteroviruses. He's been exploring them for a long time.
Haylie Pomroy: Let's put him on our list.
Dr. Nancy Klimas: I'm sure he would be happy to do it. He and his wife are just extraordinary.
