Robert Groysman, MD

01/27/2026

You never had anxiety before COVID.

You were calm under pressure. Handled stressful situations like a champ. Worked in high-pressure environments without breaking a sweat.

Now your heart races at 120 bpm sitting down. It hits 150 when you stand up. Your chest pounds. You feel dizzy. You can't catch your breath during activities that used to be automatic.

They tell you it's anxiety. Panic disorder. Health anxiety. "You're worrying yourself into symptoms."

But here's what they're missing: Your sympathetic nervous system is stuck ON.

This isn't psychology. This is physiology.

Your autonomic nervous system has two branches: sympathetic (gas pedal, fight-or-flight) and parasympathetic (brake, rest-and-digest). In healthy people, these balance automatically based on activity.

Long COVID damaged that balance. Your sympathetic system fires constantly. Your parasympathetic system can't engage the brake. The result is a body that thinks it's under threat 24/7, even when you're lying in bed.

This triggers: racing heart, pounding chest, shortness of breath, dizziness, sweating, shaking.

The same symptoms as anxiety. But the cause is opposite.

Anxiety causes autonomic activation. Long COVID causes autonomic DYSFUNCTION that mimics anxiety.

You're not anxious about nothing. Your nervous system is misfiring about everything.

That's not mental. That's dysautonomia.

And it's why telling you to "just relax" doesn't work. You can't relax a broken nervous system back into function.

01/27/2026

"Your heart is fine." That's what the cardiologist said after reviewing your echocardiogram, EKG, and stress test.

But your heart races at 120 sitting down. Standing up sends it to 150. You feel like you're dying during activities that used to be effortless.

Here's the problem: They checked the wrong thing.

Cardiologists check the heart muscle. They look for structural damage, blockages, valve problems. And when those tests come back normal, they conclude nothing is wrong.

But they're not checking the autonomic nervous system that CONTROLS your heart.

Think of it like this: Your heart is a car engine. Your autonomic nervous system is the electrical system that tells the engine when to rev, when to idle, when to slow down.

Imagine taking your car to a mechanic because the engine randomly revs to 6,000 RPM while you're parked. The mechanic checks the engine: cylinders look great, no damage, compression is perfect. "The engine's fine," they say.

But the problem isn't the engine. It's the wiring. The electrical system that controls WHEN the engine revs? Completely haywire.

That's Long COVID.

COVID damaged the electrical system (your autonomic nervous system). The engine (your heart) is structurally perfect. But the wiring that controls when it revs got scrambled.

Your sympathetic nervous system (gas pedal) is stuck ON. Your parasympathetic system (brake) isn't working. So your heart races during rest because the signal to slow down never arrives.

This is dysautonomia. And it's why every cardiac test comes back normal while you feel like you're having a heart attack sitting on your couch.

The heart is fine. The autonomic control system is broken.

01/26/2026

Long COVID patients with completely normal cardiac workups but severe palpitations.

Heart racing. Pounding. Skipping beats. Sometimes 140 bpm just standing up. ER trips where every test shows "no heart damage."

Their cardiologists review the results: structurally normal heart. No blockages. No valve issues. Normal ejection fraction. Clean bill of health.

But these patients can't stand for more than a few minutes without their heart rate spiking. They can feel every single heartbeat. Their chest feels tight even though oxygen saturation is 98%.

Here's what's happening: Your heart muscle is fine. The wiring that controls it isn't.

The autonomic nervous system regulates heart rate based on activity. In Long COVID, dysautonomia breaks that regulation. Your sympathetic nervous system (the gas pedal) gets stuck ON. Your parasympathetic system (the brake) stops working effectively.

The result? A structurally perfect heart that responds to sitting down like you're sprinting upstairs.

This is why cardiac testing comes back normal. Cardiologists check the engine. They're not checking the electrical system that controls when it revs.

Your heart is fine. Your autonomic nervous system isn't.

01/26/2026

Your heart races at 120 bpm sitting down. Standing up to get water sends it to 150. You feel like you're dying.

You went to the ER. EKG came back normal. Blood work looked fine. They sent you home with "anxiety."

You followed up with a cardiologist. Echocardiogram showed no damage. Stress test was fine. "Your heart is structurally sound."

But sitting still feels like running a marathon. Your chest pounds. You can feel every heartbeat in your throat.

They keep telling you nothing is wrong. But your body is screaming that something is very wrong.

You're not imagining this. You're not anxious about nothing.

Your heart IS fine. Your autonomic nervous system controlling it? That's what broke.

01/26/2026

If you have long COVID and feel like you crash out of nowhere, you're not imagining it. It's one of the most common patterns people describe. Why does this happen? Learn about the 4 major systems that malfunction and what PEM is.

01/26/2026

You never had food sensitivities before COVID.

You were the foodie. The adventurous eater. The "I'll try anything" friend. Sushi. Thai food. Aged cheese. Wine with dinner. Leftovers for lunch. No hesitation. No tracking. No reactions.

Now you have a shrinking list of "safe" foods. Chicken. Rice. Zucchini. Cucumber. Blueberries. That's it. Everything else triggers symptoms.

You try adding back tomatoes. Flushing and heart palpitations within thirty minutes. You try wine. Brain fog and fatigue for two days. You try leftovers. GI distress and crashes that wipe out your week.

Friends stop inviting you to restaurants. Family thinks you're being difficult. Doctors say your allergy tests are negative so it must be stress.

They say you're being dramatic.

But here's the truth: Your mast cells are attacking your meals.

MCAS. Mast Cell Activation Syndrome. It's one of the six mechanisms that drive Long COVID. After COVID, your mast cells became hyperreactive. They release histamine in response to foods that used to be safe. High-histamine foods. Foods that trigger histamine release. Even foods with no histamine content if your system is already overloaded.

You're not imagining the flushing. You're not imagining the crashes. You're not being dramatic. You're dealing with immune dysregulation that makes eating an inflammatory event.

This mechanism is real. It's understood. And when properly identified, it's manageable.

01/26/2026

"It's all in your head." No. It's histamine.

Food reactions dismissed as psychosomatic are actually mast cell activation syndrome. The flushing is real. The brain fog is real. The crashes are real. They're not imagined. They're measurable inflammatory responses.

Standard allergy testing measures IgE antibodies. MCAS doesn't always involve IgE. Your mast cells release histamine without triggering classic allergic pathways. So you test negative while reacting to half your diet.

The confusion makes sense. You don't have hives. You don't have anaphylaxis. Your throat doesn't close. So it's labeled anxiety about food or orthorexia or health anxiety.

But your body knows the difference between anxiety and inflammation.

Think of your mast cells as an overly sensitive car alarm. Before COVID, they ignored passing cats, wind, leaves. They saved their response for actual break-ins. Now they go off when a leaf falls. Same mast cells. Broken calibration.

That's not anxiety. That's immune dysregulation.

High-histamine foods load the system. Aged cheese. Wine. Fermented foods. Leftovers. Tomatoes. Avocados. Spinach. Your mast cells see these as threat and react. Histamine floods your system. You crash.

Not dramatic. Not imagined. Not psychological. This is mast cell activation syndrome. It's one of the six core mechanisms driving Long COVID symptoms. And it's treatable when properly identified.

01/25/2026

Long COVID patients who loved trying new restaurants now afraid of most meals.

They react to foods they've eaten for decades. Tomatoes that never bothered them. Avocados they ate daily. Wine they enjoyed weekly. Cheese that was a staple.

The reactions follow a pattern. Flushing. Heart palpitations. GI distress. Fatigue that hits like a wall. Sometimes within minutes. Sometimes hours later.

Standard allergy testing comes back negative. IgE panels are normal. There's no anaphylaxis. No hives. Nothing that fits the classic allergy picture.

Because it's not allergies developing. It's mast cells misfiring.

Mast cells are part of your immune system. They're supposed to release histamine when you encounter actual threats. After COVID, they lost their ability to distinguish between threat and non-threat. Now they react to everything. High-histamine foods. Foods that trigger histamine release. Even foods they used to ignore.

Your taste didn't change. Your mast cells' reactivity did.

The former foodies in our practice aren't being dramatic. They're dealing with immune dysregulation that makes eating an inflammatory trigger. That's not psychological. That's biological.

01/25/2026

01/25/2026

Everything you eat triggers symptoms.

It used to be you could eat anything. Pizza, wine, leftovers. No problem. Now 80% of foods cause reactions. Bloating within an hour. Flushing across your face and chest. Brain fog that makes you forget what you were saying. Crashes that last for days.

You start tracking. Dairy. Out. Gluten. Out. Histamine-rich foods. Out. Leftovers. Out. Fermented foods. Out. Your safe food list shrinks to eight items (or less).

Friends think you're being difficult. Family thinks you're too picky. Doctors say your allergy tests are negative. You start wondering if you're imagining it.

You're not.

What you're experiencing is mast cell activation. Your mast cells became hyperreactive after COVID. They see food as threat. They release histamine. You crash.

This isn't allergies developing. This isn't being dramatic. This is your immune system's inflammatory response gone haywire.

The pattern is real. The reactions are measurable. The mechanism is understood.

01/25/2026

You never avoided people before COVID.

You were the connector. The planner. The "yes" person who organized gatherings, initiated plans, held friend groups together. The one who recharged by being social, not drained by it.

Now you rehearse excuses days in advance. Dread invitations. Hide from "Let's hang out!" texts. Watch others on social media living the life you used to have.

They think you changed. Became antisocial. Developed anxiety. Got depressed. Stopped caring about friendships.

But here's the truth: You didn't choose isolation. Your energy capacity chose for you.

Making plans means committing energy you might not have. Every social interaction is a gamble. Will this cost me two days or four? Can I afford to lose a weekend to a dinner out? Is seeing friends worth the crash that follows?

The identity loss cuts deep. "The fun one" became "the flaky one." The social coordinator who everyone counted on became the person who can't commit to anything.

Social media shows you everyone else's gatherings. Vacations. Spontaneous nights out. All the things your body won't let you do anymore. It's watching yourself disappear from your own social world.

You're not antisocial. You're energy bankrupt. There's a difference between choosing isolation and having it forced on you by a body that makes socializing a luxury you can't afford.

01/25/2026

They tell you you're just anxious about socializing now.

You were the extrovert before COVID. The connector. The person who energized from being around people. Now a 30-minute phone call leaves you bedbound for two days.

"You developed social anxiety." That's the standard explanation.

But here's what nobody tells you: Conversation isn't just social activity. It's cognitive load. It's energy expenditure. It's ATP demand that your mitochondria can no longer meet.

Processing speech. Formulating responses. Maintaining eye contact. Emotional regulation. Every moment of social interaction requires cellular energy production.

Imagine running a marathon, but instead of running, you're just listening. That's the energy cost of social interaction with Long COVID. Your brain treats conversation like physical exertion.

For a mitochondrial system already in deficit, social engagement becomes unsustainable exertion. The 48-hour "social hangover" isn't psychological. It's post-exertional malaise triggered by cognitive activity.

This creates a compounding problem. Isolation worsens dysautonomia. It destabilizes circadian rhythm. It amplifies depression. But forced socializing beyond capacity triggers crashes that take days to recover from.

Strategic isolation isn't giving up. It's energy management. Choosing fewer interactions protects capacity for recovery. That's not antisocial behavior. That's adaptive survival when your body's energy production system is damaged.

You're not avoiding people because you're anxious. You're conserving energy because socializing costs you 72 hours of function.