Make Visible: Chronic Illness Explored

SCIENCE: What if a small, non-invasive device could help regulate your nervous system, reduce inflammation, improve cognitive function, and support recovery from chronic illness? Dr Elisabetta Burchi, psychiatrist, entrepreneur, and Head of Research at Parasym, is advancing the field of neuromodulation — using gentle electrical stimulation to influence the body’s nervous system through the vagus nerve. Often described as the body’s communication superhighway, the vagus nerve plays a key role in regulating heart rate, inflammation, mood, cognition, and overall resilience. Parasym’s transcutaneous device stimulates the nerve through the tragus of the ear — a non-invasive alternative to implanted technologies, backed by more than 100 studies and clinical trials across conditions including Long Covid, ME/CFS, hypertension, depression, fatigue, anxiety, and cognitive dysfunction. In this episode we explore: What the vagus nerve is and why it matters How vagus nerve stimulation works and the science behind it Non-invasive ear stimulation vs implanted devices Effects on HRV, inflammation, and neuroplasticity What the evidence says about effectiveness, safety, and adherence The potential role of VNS in chronic illness and everyday health Whether you’re living with chronic illness, curious about neuroscience, or interested in longevity and performance, this is one of the most exciting areas in health science right now. Make Visible | @visible.health | podfeedback@makevisible.com

For 23 years, Dr Lucy Foulkes lived with chronic pain, migraines, endometriosis, and unexplained symptoms. She saw neurologists, rheumatologists, urologists, and physiotherapists. Nobody connected the dots. Then a stranger’s Instagram message led her to a diagnosis of hypermobile Ehlers-Danlos Syndrome (hEDS). Dr Foulkes brings a rare dual perspective: an Oxford psychologist who researches diagnosis and mental health language, and a patient who spent two decades undiagnosed. If you live with unexplained chronic pain, fatigue, migraines, MCAS, POTS, endometriosis, or hypermobility — this episode is for you. We cover: - The siloed medical system and why it fails complex chronic illness patients - Dr Foulkes’ 23-year diagnostic journey through hEDS, chronic migraine, and endometriosis - The Beighton Scale, hEDS and Hypermobility Spectrum Disorder (HSD), and the changing diagnostic criteria in 2026 - The mental load of rationing medication, energy, and life itself - Self-diagnosis: danger or necessity? - Why diagnosis can feel like relief, not a sentence - Practical strategies for living well within chronic illness - Identity versus illness About Lucy Foulkes Dr Foulkes is an academic psychologist at the University of Oxford, and author of Coming of Age: How Adolescence Shapes Us (2024) and What Mental Illness Really Is… And What It Isn’t (2021).

80-90% of POTS patients are disabled to some extent — unable to work, go to school, or manage daily life. So why is it still so widely misdiagnosed? Dr Tae Chung, Director of the POTS Program at Johns Hopkins University, breaks down everything you need to know about Postural Orthostatic Tachycardia Syndrome — from diagnosis criteria to the latest treatment research, including his work on Long COVID-related POTS. He covers the full symptom picture — brain fog, dizziness, fatigue, nausea and temperature dysregulation — and explains why personalised care is essential when POTS presents alongside other conditions. Emily Kate and Gez also share practical strategies for patients: how to seek a diagnosis, the NASA lean test, hydration and salt protocols, and how to approach exercise safely.

SCIENCE: Long Covid awareness, understanding and research. Long Covid Awareness Day (15th March 2026) marks six years since the COVID-19 pandemic unleashed its long tail of Long Covid on millions around the world. In this week’s episode Emily Kate Stephens and Gez Medinger review the science and progress that has been made over the past six years in our understanding of this complex chronic condition. Through interviews with some of the most prominent experts in the Long Covid and complex chronic illness field: Dr Avindra Nath, Dr Binita Kane, Joseph Breen PhD, Professor Mark Faghy and Dr Alba Azola, Emily Kate and Gez examine the medical, scientific and political landscapes and ask: What have we learned over the last six years? What are the current leading theories on what drives the condition? What are the approved treatment strategies? What are the latest and most exciting scientific studies that could have impact for those living with the disease? Including personal reflections as Emily Kate and Gez approach their six year anniversary of contracting COVID-19 for the first time, they provide an overview of the condition and research landscape to assess how far we have come and the work still to be done. About the experts Avindra Nath is the Clinical Director of National Institute of Neurological Disorders and Stroke (NINDS) at the NIH in the United States. A neuroimmunologist specialising in the impact of viruses on the brain, he led the Deep Phenotyping of ME/CFS Study which investigated the biological mechanisms of post-infection ME/CFS and chronic fatigue syndrome. Binita Kane is a Consultant Respiratory Physician and founder of The Long Covid Clinic. After working on the front line in the NHS during the COVID-19 pandemic and supporting her daughter through Long Covid, she became a leading advocate, collaborating with organisations including Long Covid Kids, Long Covid Support, and #ThereForME, and advising parliamentary committees. Joseph Breen is Section Chief for Adaptive Immunity specialising in Long Covid and ME/CFS at the National Institute of Allergy and Infectious Diseases (NIAID) at the NIH. He co-chairs RECOVER TLC workshops and contributes to the Trans-NIH ME/CFS Working Group. Mark Faghy is Professor of Clinical Exercise Physiology at Loughborough University, specialising in respiratory physiology, rehabilitation, and Long Covid recovery. He contributes to multiple global initiatives including the World Health Network Long Covid Advisory Group, Long Covid Physio, and Long Covid SOS. Alba Azola is a rehabilitation physician at Johns Hopkins University and leads the ME/CFS and Related Disorders Program. She is also a lead author of the Multidisciplinary collaborative guidance on the assessment and treatment of patients with Long COVID, helping clinicians develop evidence-based care pathways. Make Visible @visible.health

Sleep strategies for Long Covid, insomnia, and chronic illness When you’re living with Long Covid or a complex chronic condition, sleep can feel like the one thing your body needs most — and the hardest thing to access. From insomnia and restless legs to sleep anxiety, constant waking, and unrefreshing rest, sleep disturbances are a common and exhausting part of chronic illness. In this episode of Make Visible, Emily Kate Stephens and Gez Medinger explore how sleep has affected — and been effected by — their Long Covid and chronic illness, and share practical strategies to improve sleep quality and quantity. Emily Kate is joined by sleep and respiratory physician David Joffe, who draws on over 40 years of clinical experience supporting patients with severe sleep disorders, respiratory disease, and Long Covid–related complications. Together, they discuss why Long Covid disrupts sleep architecture, how reduced slow-wave sleep impacts brain detoxification via the glymphatic system, and what the body needs to initiate and maintain restorative rest. This episode covers: Sleep hygiene for Long Covid and chronic illness Daily routines to support circadian rhythm and sleep quality Calming nighttime rituals to reduce sleep anxiety Supplements for sleep and nervous system regulation Pharmacological supports, including melatonin, magnesium, and glycine Emily Kate and Gez then reflect on the interview, sharing their lived experience of these strategies, discussing supplements in more detail, and highlighting why a personalised approach to sleep is essential when the nervous system, metabolism, and brain are highly dysregulated. About David Joffe David Joffe is a senior staff physician at Royal North Shore Hospital in Sydney, with specialist interests in insomnia, restless legs syndrome, non-invasive ventilation (NIV), sleep apnea, and Long Covid–related sleep disorders. He is Vice Chair of the World Health Network’s Long Covid Advisory Group.

Living with chronic or invisible illness after the holidays can be overwhelming. In this episode of Make Visible, Emily Kate Stephens is joined by investigative science journalist and Long Covid advocate Gez Medinger to explore coping with chronic illness, ME/CFS, and Long Covid during and after the holiday season. They discuss EMDR therapy, nervous system regulation, breathwork, and emotional processing, sharing lived experience and practical strategies that support recovery and acceptance. This conversation offers validation and support for those living with ME/CFS, Long Covid, Fibromyalgia, EDS, POTS, Chronic Lyme, and other energy-limiting conditions.

Amy Mooney’s aim is to improve the quality of life for her patients. She is an occupational therapist specialising in the treatment of conditions that cause post-exertional malaise (PEM) and their comorbidities – working with patients with ME/CFS, Long Covid, Ehlers Danlos, fibromyalgia, dysautonomia, POTS, and MCAS. Operating from a place of huge empathy and understanding – she is also a mother of a child with these conditions – Mooney focuses on the individual needs of patients, creating personalised strategies to move patients out of a constant fight for survival, and into a situation in which they can start to improve. She does this through a full assessment of patient’s ADLs (activities of daily living) and their symptom fluctuations. In this week’s episode Mooney provides us with a breakdown of her approach – endeavouring to build a platform of stability and control for patients by prioritising daily functions and focusing on understanding how symptoms respond to different types of stressors, including cognitive, physical, social, emotional, and environmental factors. She explains the concept of dynamic energy management, responding to our body’s differing capacities on different days, and encourages patients to regain control of their illness by building awareness and learning from the setback. With a background in sensory integration therapy, Mooney highlights the significance of addressing all sensory inputs alongside the, perhaps more obvious, other stressors that contribute in this illness. Amy Mooney offers telehealth and clinical services to individual clients in private practice, but is also an educator – advising healthcare professionals globally, including contributing substantially to the Bateman Horne Center’s Clinical Care Guide, authoring multiple articles in “WORK: A journal of prevention, assessment and rehabilitation”, and striving to educate practitioners to a deeper understanding of P.E.M. and the tools to reduce it. Make Visible @visible_health @visible.health

In a change to our usual format, this week Emily Kate Stephens sits down with fellow journalist, podcaster and chronic illness sufferer, Gez Medinger to explore their personal anecdotes and discuss the strategies that have made a difference in the trajectory of their health. Between them, over the last five years of their illnesses, they have interviewed hundreds of experts to unravel the science and medical advancements in Long Covid and other energy-limiting conditions. In this episode they discuss, reflect on and explore the ways in which they have applied all that they have learned to shape the course of their respective progress. In this, very personal, discussion they veer away from some of the hard science, despite their remarkable shared knowledge, and reveal how many of the softer, more holistic approaches to healing have made the biggest differences, not only in their journeys towards recovery, but in their outlooks on life. From fasting to finding acceptance, from psilocybin to breathwork, their discussions reveal that it does not seem to be drugs or medical intervention that has made the difference, rather nervous system regulation, simple grounding healthy habits, a slower pace and compassion that have really proved key tools. Perhaps this is because medicine really does not yet have the answers, but this conversation gives hope that, despite this, there are techniques and practices that can contribute to an improvement in quality of life for those suffering from these illnesses. Gez Medinger is a science journalist and former filmmaker, author of The Long Covid Handbook and host of his own YouTube channel - Gez Medinger. Emily Kate Stephens is a broadcast journalist who now focuses on health and medical journalism, and hosts Make Visible every two weeks. She is a qualified breathwork practitioner specialising in Nervous System Regulation and Buteyko. Both have had Long Covid since 13th March 2020. Make Visible @visible_health @visible.health

Analysis of wearable data gathered from the Visible app found that symptoms in Long Covid and ME/CFS fluctuated considerably in-line with the menstrual cycle, in a new study from Imperial College (currently in pre-print). In this week’s episode Abigail Goodship, a biomedical scientist at Imperial College, responsible for scrutinizing the data from almost 4000 women, talks us through the findings of the study, which corroborates something which women have been anecdotally reporting for years, and gives us insights into how we might be able to manipulate hormones and work with our cycles to live a more balanced illness. The points at which the immune and endocrine systems interact are complex and multi-layered with the hypothalamus, pituitary glands and ovaries all playing different roles in the functioning of our cycles. Emily Kate Stephens and Abigail take it back to basics, discussing the hormones involved and the way in which they shape the menstrual cycle, before diving into what the research teaches us about symptom variability which tends to worsen in the pre-menstrual phase and improve around ovulation. Understanding the hormones at play at these points, and the impact they have on our immune systems, inflammation levels and pain perception will be key to using this information to develop helpful strategies and potential treatments. We discuss the potential implications of pregnancy, vaccination, contraception, menopause and HRT in Long Covid and ME/CFS, along with the role of hormones in autoimmune conditions, as areas that are ripe for more substantial research in this much under-researched area of menstrual health. Abigail Goodship is a first year PhD student in the Department of Metabolism, Digestion and Reproduction at Imperial College London. Under the supervision of Dr Viki Male and Dr Bryn Owen, Abigail is researching the fascinating intersection of immunology and reproductive endocrinology, with a focus on how the immune system influences the menstrual cycle. Her work combines laboratory techniques like cytokine assays and hormone profiling with big data analysis, aiming to better understand menstrual changes after vaccination and the impact of chronic immune dysregulation on reproductive health. Drawing on expertise across both biological and computational sciences, Abigail is dedicated to bridging disciplines to advance women’s health, with a focus on translating research into meaningful, real-world impact. Her work is funded by the Medical Research Council (grant number MR/W00710X/1). Further references from this conversation: Menstruation as an inflammatory event The effect of ovarian hormones on rheumatoid arthritis Oestrogen and Progesterone in rheumatoid conditions Oestrogen in COVID-19 HRT in actute COVID-19 Impact of COVID vaccines on fertility Menstrual cycle and COVID vaccination & retrospective analysis ---- Make Visible @visible_health @visible.health

What is the threshold over which PEM is induced in chronic illness? This is a hugely important question for sufferers, and one for which Rob Wüst is trying to find an answer. Assistant Professor in Musculoskeletal Health and Physiology at the Vrije Universiteit Amsterdam, Dr. Rob Wüst is able to see the physiological impact of Long Covid and ME/CFS in skeletal muscle abnormalities. In his latest study (currently in preprint) he finds that “Skeletal muscle properties in long COVID and ME/CFS differ from those induced by bed rest”, and the abnormalities that he observes in the muscles of this cohort of patients correlate with the Post-Exertional Malaise (PEM), autonomic dysfunction and wearable data that he gathered in another recent study. In this week’s episode Wüst explains to Emily Kate Stephens how he observed exercise-induced worsening of symptoms in almost half of Long Covid patients when they exceeded their ‘ventilatory threshold’ but the much of the time this is from everyday activities such as hanging the laundry or carrying the groceries. But they discus He discusses the physiological clues emerging from exercise testing and muscle biopsies in patients when viewed alongside wearable data and expounds on the circulating theories on this, including mitochondrial dysfunction, local hypoxia, and ion channel abnormalities. And he explores the parallels and distinctions between Long Covid and ME/CFS and why interdisciplinary collaboration is vital to unlock these complex, multi-systemic diseases. The Impact of Bedrest Study 2024 Skeletal muscle adaptations and PEM in LC 2024 Should we be careful with exercise in PEM in LC? 2025 Make Visible @visible_health @visible.health

A new clinical trial is underway to test a monoclonal antibody as a treatment for Long Covid. In this week’s episode Emily Kate Stephens sits down with Dr Nancy Klimas at Nova Southeastern University (NSU), Florida, to discuss the trial alongside the groundbreaking research and integrative care, that is taking place at the Institute for Neuro-Immune Medicine, looking at Long Covid, ME/CFS and other complex conditions. The trial, a collaboration between Nova Southeastern University and the Schmidt Initiative for Long Covid, will use an AstraZeneca drug, which is already approved for COVID-19 prevention in those with compromised immunity, on 100 patients in a double-blind, randomised controlled trail. And Dr Klimas, a globally recognized expert in immunology and chronic illness, believes that this has the potential to be a curative treatment for the disease in around 40% of patients. Alongside this new study, we discuss the role of computational modelling and the progress that AI is having in uncovering hidden patterns in chronic disease; the way in which gender differences shape inflammatory responses and treatment strategies; and the critical importance of restorative sleep, nutrition, and anti-inflammatory approaches in improving the lives of patients. We discuss some of the other studies in which the INIM are involved – the Reboot Study, Microbiome research, probiotics, and the COVIDUP study, along with the power of international collaboration, the challenges of funding and the amazing contribution of patients. Dr. Nancy Klimas is Director of the Institute for Neuro-Immune Medicine at NSU, and a leading voice in translational research focused on chronic illness, ME/CFS, Gulf War Syndrome, and Long Covid. With decades of experience in immunology and clinical science, Dr. Klimas is a champion for an integrative, personalized approach to patient care. Make Visible @visible_health @visible.health

Dr. Theoharis Theoharides ‘The Mast Cell Master’ has been at the forefront of mast cell research for over 30 years. A renowned expert in allergy, neuroinflammation, and mast cell biology, his work centers on understanding the regulation of these critical immune cells. His extensive studies explore their fundamental role in the body, the mechanisms behind their activation and inhibition, and their involvement in a wide range of conditions—from asthma and eczema to neuroinflammatory disorders and complex chronic illnesses. In this week’s episode, we delve into the role of mast cells in complex chronic disease. Dr. Theoharides explains how mast cells are distributed throughout the body, the various stressors that can activate them, and how their activation may contribute to overlapping symptoms seen in conditions such as migraines and irritable bowel syndrome. The comparisons draw into question whether a degree of mast cell activation is co-morbid in many of these conditions, or indeed whether some of these conditions are a symptom of mast cell activation. He underscores the urgent need for better diagnostic tools, greater awareness within the medical community, and a broader, more integrative treatment strategy. This includes lifestyle interventions and the use of natural flavonoids, which have been proven to inhibit mast cell activity. Dr. Theoharides also discusses the ongoing challenges in securing research funding and the potential for integrative approaches to address complex conditions – thinking outside the box to treat patients individually, listening to their needs and treating accordingly – which is what he believes they are able to do with his team at NSU Dr. Theoharides is Executive Director, Center of Excellence for Neuroinflammation Research (CENIR) & Professor, Institute for Neuro-Immune Medicine at Nova Southeastern University. Prior to this he spent four decades at Tufts University where he was Director of Molecular Immunopharmacology & Drug Discovery. Make Visible @visible_health @visible.health