The following X thread was convincing:
have had moderate to severe long covid for 4 years. I started B12/B1 injections a week ago along with cofactors D3/K2 and methylfolate. Today I drove an hr, met a lifelong friend for two hours, and drove home. Then I did a couple hours of work. Win.
This represents a clear indication of nitrosative stress in the context of mitochondrial dysfunction.
It is already well known that mitochondria in Long-COVID and ME/CFS disintegrate and become fragmented (see Haemolaser can help here).
Injections naturally act 20 times stronger than oral intake, but in principle, all of this can also be absorbed orally. My approximate dosages would be:
- 1000 µg Hydroxo-Cobalamin (best as oral spray)
- 100 mg Vitamin B1 Thiamine
- 1 mg Methyl-Folate
We would of course test this bioenergetically and also perform laboratory checks beforehand (see below).
Patient Information: Potential Nitrosative Stress / Elevated Nitric Oxide Stress (Nitrosative Stress)
In some cases of Long-COVID, ME/CFS or other chronic fatigue states, elevated nitrosative stress (nitrosative stress) can play a role.
This arises from excessive production of nitric oxide (NO) and its toxic by-products (mainly peroxynitrite). This leads to inflammatory cascades, mitochondrial damage, and impairments in energy production.
Typical Symptoms in Nitrosative Stress / NO Overload
- Pounding or pulsating headaches (often migraine-like, frequently described as delayed headache)
- Severe fatigue and lack of energy despite rest
- Brain fog, concentration and thinking disorders
- Muscle weakness or sensation of “concrete muscles”
- Sleep disturbances and nocturnal adrenaline surges
- Orthostatic intolerance (e.g. POTS symptoms: tachycardia on standing, dizziness)
- Hypersensitivity to exertion (PEM-like)
- Occasionally dry mouth, sweating or unclear neurological complaints
This symptom pattern often occurs after viral infections and can worsen in flares.
Important Notes
Nitrosative stress is not a standalone diagnosis (ICD), but a pathophysiological mechanism that can be involved in various conditions (Long-COVID, fibromyalgia, MCS, post-viral syndromes).
It is associated in the literature with elevated nitrate/nitrite levels in the headache-free interval in migraine patients (Gruber, 2010, Cephalalgia, https://pubmed.ncbi.nlm.nih.gov/19673897/).
NO donors (e.g. nitroglycerin) trigger immediate or delayed migraine-like headaches in healthy individuals and especially in migraine patients (Olesen, 2010, Pharmacology & Therapeutics, https://www.sciencedirect.com/science/article/pii/S1878747923002581).
What to do?
In case of suspected nitrosative stress (e.g. pounding headaches + extreme fatigue after exertion), a targeted laboratory diagnostic workup should be performed (e.g. nitrotyrosine, peroxynitrite markers, indirectly citrulline/arginine metabolism). –> Laboratory Ganzimmun or Biovis
Integrative medical approaches aim at reducing NO overproduction and scavenging peroxynitrite (e.g. antioxidants such as high-dose vitamin C, B vitamins, Coenzyme Q10, NAC, alpha-lipoic acid – always individualized and dosed!). Scavenging and neutralizing peroxynitrite through Vitamin B12 – we have better results with Hydroxo-B12 than with Methyl-B12.
In acute pounding headaches, always exclude other causes (blood pressure, CCSVI, venous stasis, mitochondrial dysfunction).
If you recognize this symptom pattern in yourself, we are happy to discuss it in detail during the consultation.
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