tylik

I've been meaning to write this for sometime now, but I keep being busy, or getting lost in the weeds when I sit down to do it. The main reason I've been wanting to write this up is that so many people are dealing with fatigue symptoms post-covid. Of course, some of my hesitancy is that while I've done a lot of reading on the cluster of issues that I've run into, I haven't AFAIK had covid, and my symptoms are largely from having parvovirus in my first year of grad school and then having fluoroquinolone toxicity issues after less godawful antiobiotics failed to address my pneumonia in my first year in NC. (All of this is somewhat complicated by the migraines, which developed after I had a titanium plate put into my neck, and what I'm now fairly certain are mast cell issues, which also got serious after the spine surgery.)

So: My problems don't stem from covid. Also, even if they did (or you have post viral issues from something else) bodies are different, and what works for me might not work for you. I would generally recommend taking one thing at a time, and keeping notes - give it two weeks before you make any other changes. (But I also understand that sometimes you get desperate and want to throw everything at the wall and see what sticks.) OTOH, it looks like mitochondrial issues might be one of the mechanisms for long covid, and there's likely to be some overlap.

I am not an MD. I am a mad scientist. Keep that in mind.

These are the things I will mention down below, so they're easier to keep track of:

CoQ10
NADH
Niacin
PQQ
Alpha Lipoic Acid

Co-Q10 The most common things recommended in the literature for post-viral fatigue in general are Co-Q10 (the human form of ubiquinone) and NADH. I actually ran across Co-Q10 originally as something that could help my migraines, but darn, my body responded to as if I'd been thirst for a long while, and finally found water to drink. I suddenly had energy. The migraines receded (I'd had one migraine that lasted six weeks...) But after the first flush of progress, I realized it was just not doing enough. So I read up a bunch of Co-Q10, and eventually on mitochondrial damage and causes of ubiquinone insufficiency... and figured out that I could safely take a bunch of it. So I just slowly increased my dosage over time, until taking more didn't make me feel any better. For most people, I'd say, take 300mg/day. And for most people, that's likely to be plenty (it's likely to be useful for anyone over 40, really). But if it really is the right thing, but it doesn't fully address the symptoms, you can try titrating it up.

A note: There are other forms of ubiquinone you can buy. Ubiquinol is supposed to be better absorbed. On a purely chemical level, I have my doubts, because you put it through your stomach first, but maybe? Mito-q is supposed to be more bio available for mitochondria in particular (it's also proprietary, and expensive, though not that bad with the dosage differences). In both cases, you take smaller doses. So far I haven't noticed a real difference, and ended up going back to CoQ10. OTOH, with all the changes I've made, it's likely I should really rework my CoQ10 dose... just, well, what I'm doing works, and who has that kind of time? One of these days.

NADH

I only started taking NADH recently. It might be helping? It's not clear. However - if I were doing it all again, it would be the second thing I tried. Strong clinical support.

Niacin

I've mostly noticed that Niacin helps with the migraines. I decided to try it because it hits a similar pathway as the Co-Q10, and hey. But it also helps with NAD+ metabolism, and maybe that's why I haven't noticed much change with the NADH? I take 500mg/day, though it's possible I could get away with half of that. For heavens sake, look for a non flushing formula, because Niacin flushing isn't a joke! (...there I was, teaching a Chen class, and bright red from head to toe. And it's a weird, prickling feeling with the heat.)

PQQ

So, I was taking all of the above since sometime in the early/mid teens. Then, in the post-fluoroquinolone toxicity thing, I was completely dead. (To be fair, I was also getting over pneumonia, and going to Scotland when I did was probably pushing it...) I kept hitting the literature, trying to see if there were any suggestions. Eventually I found this paper, which I adore: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632915/ From it, I got the idea to take PQQ, which is supposed to synthesize healthy new mitochondria in the wake of mitochondrial damage. (Which can be caused by fluoroquinolones, but it looks like there is a fair bit of mitochondrial fuckage with covid - I haven't gone as far into the literature as I'd like here.) So, I added PQQ, and also made sure I was really on top of my minerals, as recommended. I figured I'd try it for a couple of weeks, and see if there was any difference.

...within an hour I had more energy than I did in months. It was amazing. I'd say start at 20mg, and increase or decrease as needed. (Some people have trouble sleeping when on it.) When I talk about the long slow climb back from fluoroquinolone toxicity, PQQ was a huge part of why. It seemed especially good for mental acuity... or maybe I was just desperate to be able to think again. Oh, and the neurohacker crowd is big into it, which I found distasteful. Still, A++ would recommend.

Alpha Lipoic Acid

CJ Cherryh mentioned this one on her FB. This isn't for post viral fatigue per se - it seems to help a lot with various kinds of neuropathic pain. Since my migraines are triggered by nerve irritation, it seemed worth trying. I mention it here because neuropathic pain can leave you with similar symptoms as post viral fatigue (just, with more pain). And I've gotten the impression that there's a lot of weird shit going on with long covid, and there might be more overlap. Anyhow, when I started taking it, my migraines generally got a lot better, and I generally felt better. I didn't notice it immediately, but after I had been taking it for a month, the difference was apparent.

...I kind of feel like next I should write a companion piece on "all the stuff I take for my migraines" though some of that is Rx. It's also entirely likely I will come back and add things I forgot, or update this as I get more information.

And if you have something that's worked really well for addressing post viral fatigue, please comment here!