Supplements and Drugs That Reduce or Prevent PEM (Post-Exertional Malaise)

Learner1

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What form do you take, how much do you take and do you take it with or without food?
I'm using Seeking Health Liposomal Glutathione, Thorne R-Glutathione and NOW or BodyTech BCAAs from Vitamin Shoppe. For the BCAAs, it can take up to 6g to make the PEM go away.
 

Mary

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I'm using Seeking Health Liposomal Glutathione, Thorne R-Glutathione and NOW or BodyTech BCAAs from Vitamin Shoppe. For the BCAAs, it can take up to 6g to make the PEM go away.
Thanks - I do take 5000 mg. BCAAs every day, I've been taking them for close to 3 years. They have cut my PEM recovery time in half but do not prevent it unfortunately.

Do you take the Thorne glutathione with or without food?
 
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I'm using Seeking Health Liposomal Glutathione, Thorne R-Glutathione and NOW or BodyTech BCAAs from Vitamin Shoppe. For the BCAAs, it can take up to 6g to make the PEM go away.
Has the oral Glutathione been helpful with PEM? I consider trying to get the intra-nasal version but the cost is enormous cause they would have to compound it -_-.
 
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In case this helps someone, this not only kept me reasonably functional through a bad cold virus (healthies were calling it flu, so who knows) it prevented any backlash in the aftermath.

I started taking hydrocortisone at the first signs and did a short taper:

Days 1 to 4:
0900 10mg
1430 5mg
2030 5mg

Day 5:
0900 10mg
1430 5mg
2000 2.5mg

Day 6:
0900 10mg
1500 5mg

Day 7:
0900 10mg

Day 8:
0900 5mg

Additionally I was taking daily:
Ascorbic acid 5-6g x 4 (to bowel tolerance - to get the squits then back off slightly just enough that the dose is high but the squits stop)
selenium 50-100mcg chewed every few hours
zinc 2.5mg chewed every few hours
ginger and licorice tea
hypertonic saline nebuliser

Once anything settles in my sinuses there is hell to pay for months, so I also went hard at it with guaifenesin 400mg 3-4 x daily to thin mucus, plus xylometazoline (decongestant) nasal spray (to make way for the emptying of said liquefied mucus) a few times a day for a few days (it's a miracle worker but do not use for more than a week as rebound congestion will occur).

If there is a more appropriate thread to post this in then please redirect me. I just hope this can be of use to someone this winter
 

Hip

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I started taking hydrocortisone at the first signs and did a short taper:
It may not be wise to take corticosteroids during viral infection, as steroids reduce the Th1 antiviral response (although they increase the antibacterial Th2 response).
 
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It may not be wise to take corticosteroids during viral infection, as steroids reduce the Th1 antiviral response (although they increase the antibacterial Th2 response).
Would that not only apply to supra-physiological doses? I get symptoms of hypoadrenalism when fighting a virus (blood sugar dropping, hypo symptoms, adrenaline release etc) and it's really those symptoms that 'floor' me. So I decided to put it to the test by just bolstering physiological levels.
 

Hip

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Would that not only apply to supra-physiological doses?
Yes that's right, you'd probably be fine with normal physiological doses of steroids (eg, hydrocortisone 15 mg daily). But if you you use supra-physiological doses like hydrocortisone 80 mg (equivalent to prednisone 20 mg or prednisolone 20 mg) during an acute viral infection, that might cause issues. (I forgot to look at the doses you actually used).

Dr Chia found that giving supra-physiological doses of corticosteroids during the acute stage of enterovirus infection is actually a recipe for creating ME/CFS. See this post. My guess is that the immune weakening that corticosteroids produce with respect to the antiviral response lets enterovirus get the upper hand during its acute infection phase (the acute phase is the first week or two of infection), which then paves the way for the chronic enterovirus tissue infections which some researchers think cause ME/CFS.

Taking a short course of supra-physiological doses of corticosteroids during the chronic stage of enterovirus infection when ME/CFS has already appeared is less of an issue, though there are reports of ME/CFS becoming worse after patients have taken supra-physiological doses for a few months.
 
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Yes that's right, you'd probably be fine with normal physiological doses of steroids (eg, hydrocortisone 15 mg daily). But if you you use supra-physiological doses like hydrocortisone 80 mg (equivalent to prednisone 20 mg or prednisolone 20 mg) during an acute viral infection, that might cause issues. (I forgot to look at the doses you actually used).

Dr Chia found that giving supra-physiological doses of corticosteroids during the acute stage of enterovirus infection is actually a recipe for creating ME/CFS. See this post. My guess is that the immune weakening that corticosteroids produce with respect to the antiviral response lets enterovirus get the upper hand during its acute infection phase (the acute phase is the first week or two of infection), which then paves the way for the chronic enterovirus tissue infections which some researchers think cause ME/CFS.

Taking a short course of supra-physiological doses of corticosteroids during the chronic stage of enterovirus infection when ME/CFS has already appeared is less of an issue, though there are reports of ME/CFS becoming worse after patients have taken supra-physiological doses for a few months.
Oh dear... So does that mean that taking the occasional 20mg of pred as a PEM-preventative during high-risk (winter) months might still be playing roulette?!
 

Hip

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Oh dear... So does that mean that taking the occasional 20mg of pred as a PEM-preventative during high-risk (winter) months might still be playing roulette?!
I think these reports of ME/CFS worsening are when supra-physiological doses of corticosteroids are used daily for months. In general I doubt you would get negative effects if you just take an occasional one-off single high dose of a corticosteroid an hour before physical exertion to prevent PEM.
 
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I think these reports of ME/CFS worsening are when supra-physiological doses of corticosteroids are used daily for months. In general I doubt you would get negative effects if you just take an occasional one-off single high dose of a corticosteroid an hour before physical exertion to prevent PEM.
Well I've ordered some pred, fingers crossed it gets through customs OK. I don't even know if this is in an issue in the UK but I've go some harsh words ready for anyone who tries to stand in my way. The NHS provides **** all help !
 
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I think these reports of ME/CFS worsening are when supra-physiological doses of corticosteroids are used daily for months. In general I doubt you would get negative effects if you just take an occasional one-off single high dose of a corticosteroid an hour before physical exertion to prevent PEM.
I would think Cold therapy would be worst for PEM. I used to take cold shower during my PEM phase but thinking through it I thought that was terrible idea. Cold shower equates to increase in body temperature and forcing body into an active chaotic state (similar to exercise?). Just thoughts.
 
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I been taking CoQ 10 for weeks. The first week I took around 250mgx2, morning & afternoon and second week I took around 750mgx2, morning & afternoon. It's been helpful with energy also affecting my sleep. I did a bit of digging and i found that CoQ 10 reduce deep sleep and increase REM sleep. Make sense cause my dreams have been more vivid and been wanting to sleep usually more (probably lack of deep sleep). That's a bit of side effect of CoQ 10 I believe deep sleep is much more important for us with CFS ME.

I'm going to experiment a bit to see if i only take CoQ 10 in the morning and if it'll affect my deep sleep. My goal is take an amount that doesn't effect my deep sleep (if that's even possible). I don't have my fitness tracker yet so I don't have a good "estimate" of my sleep but I have an idea how my body feels (probably not the best data). In general I have more energy in the morning and less in the afternoon, vivid dreams, want to sleep longer, a bit more energy to get through the day, helps a bit with PEM.

Just my thoughts.

Article regarding CoQ 10 sleep cycle: https://medium.com/@sdwaka/dream-in...overs-4-ways-to-alter-your-sleep-4ba1999f819b
 
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Hi,
sorry, but sodium bicarbonate in the stomach reacts with hydrochloric acid to NaCl, H2O and CO2. The only thing you get from it is at most violent belching and nothing else. Baking soda in water is an old home remedy for stomach hyperacidity, but not for muscle hyperacidity.

The thing with the lactate is part of the cell metabolism and if you wanted to buffer something, then you would have to inject the acid antagonist
at least into the cell in such a way that it buffers the formed lactate selectively away and nothing else. The idea with some orally administered baking soda "optimize" cellular metabolic process is naive - to put it mildly.

Unfortunately, sodium bicarbonate can not help against lactate in the muscles.
 

Hip

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Unfortunately, sodium bicarbonate can not help against lactate in the muscles.
Oral sodium bicarbonate is used to treat metabolic acidosis, so that suggests that it does have a systemic effect in raising low body pH. Oral sodium bicarbonate has also been shown to improve athletic performance.

It may well be that the bicarbonate is neutralized in the stomach by hydrochloric acid, but that process would still require the donation of protons (acids are proton donors), which I think would mean that these protons must taken from elsewhere in the body, thereby raising body pH. I can't say that I understand this fully, but that's the sort of thing I presume might happen.



The thing with the lactate is part of the cell metabolism and if you wanted to buffer something, then you would have to inject the acid antagonist at least into the cell in such a way that it buffers the formed lactate selectively away and nothing else.
Lactic acid is indeed produced inside the cells from anaerobic glycolysis (and one study found that exertion in an ME/CFS patient produced greater elevations in lactic acid than normal); however, this lactic acid is then expelled from the cells into the blood, where it is processed by the liver (Cori cycle).

Myhill, Booth and McLaren-Howard theorize that this lactic acid build-up in the blood compounds the issue of PEM, because to clear lactic acid by converting it back to glucose, it requires considerably more energy than was originally gained from the conversion of glucose to lactic acid in anaerobic glycolysis. See this post. (Though they theorize that the main cause of PEM is the breakdown of ATP molecules, which need to be replenished before you can recover from the PEM episode).
 
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Oral sodium bicarbonate is used to treat metabolic acidosis, so that suggests that it does have a systemic effect in raising low body pH. Oral sodium bicarbonate has also been shown to improve athletic performance.

It may well be that the bicarbonate is neutralized in the stomach by hydrochloric acid, but that process would still require the donation of protons (acids are proton donors), which I think would mean that these protons must taken from elsewhere in the body, thereby raising body pH. I can't say that I understand this fully, but that's the sort of thing...
No thats incorrect, sorry.
only ENTERIC sodium bicarbonates can enter the small intestine and act against acidosis from there. normal sodium bicarnonate can not do that. And in acidosis, either enteric sodium bicarbonate is used or intravenously.
 
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Please can you provide references to support your assertion that oral sodium bicarbonate does not address acidosis (so that the discussion is a scientific one).
"Further, sodium bicarbonate supplementation fails to raise plasma pH or increases it only slightly in some patients affected with malignancy-associated lactic acidosis, while control of the underlying malignancy brings plasma pH to normal [1522]."

"No benefit from sodium bicarbonate therapy has been found in the management of lactic acidosis regarding clinical outcomes or mortality [35]"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227445/

In addition, a clinical acidosis is treated with sodium bicarbonate INTRAVENOUSLY or enteric sodium bicarbonate. As a source, you can consult any hospital. I do not know if you have it in GB, but here in Germany there is "Bicanorm". that might work out because its enteric SodiumBC.
 

Hip

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"Further, sodium bicarbonate supplementation fails to raise plasma pH or increases it only slightly in some patients affected with malignancy-associated lactic acidosis, while control of the underlying malignancy brings plasma pH to normal [1522]."
Thanks for providing that study, it certainly does suggest oral bicarbonate does not have much effect in patients with acidosis due to illness.

But what about the numerous studies on oral sodium bicarbonate supplementation improving exercise performance? This article says "over 30 different studies have been published on sodium bicarbonate loading prior to exercise. "

Here are some sodium bicarbonate exercise performance studies:
Sodium bicarbonate intake improves high-intensity intermittent exercise performance in trained young men
High-dose sodium bicarbonate intake (0.4 g · kg−1 body weight) improved high-intensity intermittent exercise performance in trained young men, with concomitant increased blood alkalosis.
Though that is a large amount of sodium bicarbonate: for an 80 kg person, it would correspond to 32 grams of sodium bicarbonate (about 2 heaped teaspoons), and may cause gastrointestinal irritation. When I tried sodium bicarbonate for alkalization purposes, I was using doses around 4 to 8 grams daily on an empty stomach.

Effects of Sodium Bicarbonate on High-Intensity Endurance Performance in Cyclists: A Double-Blind, Randomized Cross-Over Trial
BICA [sodium bicarbonate] ingestion resulted in an increased pH, bicarbonate concentration and BLa [blood lactate] before, throughout and after both exercise testing modes.
 
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