Comment by thenerdhead | Hacker News Reader

Comment by thenerdhead | Hacker News Reader

> The cause of PASC is currently debated but likely involves several different components, including: viral dissemination and persistence, immune activation and dysregulation (e.g. clotting, autoantibodies and reactivation of pre-existing latent viruses), cell death and tissue damage, and long-lasting cellular changes (e.g. epigenetic changes, senescence, fibroproliferation, metabolism alterations) (3). However, at present we lack an integrative understanding of how these disease components interact to cause the variable symptomology of PASC. Based on studies on acute COVID-19, PASC and the related myalgic encephalomyelitis (ME; chronic fatigue syndrome), we hypothesize that an inflammatory acid-base disruption underpins PASC and that viral proteins, both acutely and persistently-expressed, cause disease symptomology through disseminated tissue damage and inflammatory acid-base disruptions.

Seems like an explanation for the body compensating for hypoxic-environments by changing its acid-base. But what is fundamentally causing these environments?

Focusing on sleep, diet/hydration, and exercise are your three major ways to combat long covid. The latter (exercise) is heavily controversial in the long covid / ME/CFS communities, but would help moderate your acid-base over the long term if you can push through the pain/fatigue/etc.

The author suggests a few things helped them. Deep breathing, diet changes surrounding acidic foods, and stretching.

My personal experience with two bouts of long covid (14 months and 7 months) has me still believing that microclots and nitric oxide deficiency being the key factors in my recovery. I've recovered twice now and back to pre-covid ability. It took me two years of constant exercise to build back to where I was. A modern Sisyphean task at that.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9212559/

> but would help moderate your acid-base over the long term if you can push through the pain/fatigue/etc.

Pushing through is part of the problem. The crash that comes from pushing is the real problem --all kinds of blood markers go amuck after exertion (especially anything aerobic >10m, like a cardio pulmonary exercise test) and stay amuck for about a week. And the more you try to do during the crash the longer or worse the crash becomes. Pushing regardless of crash status, like in graded exercise therapy, has actually caused ME/CFS/Long Covid baseline symptoms to become worse semi-permanently.

> nitric oxide deficiency

Wasn't there something around Cialis / Viagra being explored for covid recovery? Since those drugs act on that, maybe there's a potential connection?

> Seems like an explanation for the body compensating for hypoxic-environments by changing its acid-base. But what is fundamentally causing these environments?

Damage to the lung tissue!

No idea. I've read stories about people getting CTs showing damage and others showing absolutely none. A very, very strange virus.

Or damage to microvasculature, whether in the lungs or elsewhere

I had weird cardiovascular issues (stuff that feels like microclotting after various type of efforts) and \i'm really curious about how to improve microvasculature (I altered my diet a lot but that's a bit of a blind shot). I thought it was out of reach of people today.

What has helped me is nattokinase, occasional aspirin, and plenty of nitric oxide foods / supplements. Very low risk and are generally found in natural foods. But I take these because I suspect I’ve had long Covid post my two infections.

There is also a triple anticoagulant therapy of clopidogrel, aspiring, and apixaban. Those studies are popular in South Africa.

Thanks, I'm gonna read about this. I didn't try microdosing aspirin, even though it's well known, because i'm too weak on biochemistry to avoid bleeding.

Really, thanks a lot, it's a damn burden when your cardiovascular system is feeble, you're constantly on the edge of a problem and have to monitor every effort (almost requiring a car for groceries because i'm not sure I can walk with a backpack multiple times a week).

ps: I've recently learned about the blood viscosity aspect and also red blood cell renewal through "blood donation", you red blood cells being more elastic, it's supposed to ensure better flow in microvasculature.

Can you place the article? Who is the author in a wider context?

I have to ask because sometimes you don’t know the credentials and there is a lot of fluff articles and information around.

Pretty interesting that you were able to beat long covid, so you think your regimen helped speed up recovery?

The author has a link in the mastodon post. I was simply quoting the article and some of their other threads.

There is a lot of fluff in general, but experience is the best teacher. I'm convinced personally that it helped speed up my recovery, but then again who knows if it is gone for good. That's the vicissitudes of life for ya.

I can confirm that I had ME for 10 years and the treatments which the author discusses helped me too, I had to discover them through experience but it has always been clear that my lactate levels were sky high, I've always felt as I was feeling after an all out rowing competition when I was healthy. The condition is terrible.

> But what is fundamentally causing these environments?

With the caveat that this doesn't contain an answer, cf. cited studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8469745/ ("inflammation, difficulty in gas exchange in the lungs and thrombosis" during early infection causes a self-reinforcing cycle of metabolic acidosis: decrease in blood pH leads to decrease in oxygen saturation, which exacerbates the acidosis) and https://pubmed.ncbi.nlm.nih.gov/32738466/ (increased general COVID-19 vulnerability correlating with increased lactate dehydrogenase levels).

The OP study suggests in the broader context that a person more prone to acidosis is more likely to have a much longer and worse experience with COVID. This isn't necessarily news because acidosis was already well correlated with worse short-term COVID outcomes, but if treating the acidosis can substantially treat the symptoms of PASC/long COVID - which one of the authors attempts to experimentally prove on the smallest meaningful sample size of herself - then identifying and treating the cause of _pre-infection_ acidosis risk factors might reduce the likelihood and potency of long COVID.

COVID's already been shown to have a harmful effect on renal health post-illness: https://journals.lww.com/jasn/fulltext/2021/11000/kidney_out..., https://www.nature.com/articles/s41581-021-00487-3

And a strong correlation to both complications in diabetic patients and as a potential cause of diabetes: https://www.cdc.gov/diabetes/library/reports/reportcard/diab...

And since two of the strongest causes of metabolic acidosis are poor renal health and poorly managed diabetes, it feels like there's a case for at least experimentally trying to treat long COVID with a combination of renal nutrition (low-acid/high-alkaline diet, more alkaline-forming foods, alkaline water, less alcohol, more sodium citrate or bicarbonate) and pre-diabetic treatment (stop smoking, exercise, increase low-starch vegetable intake, treat high blood pressure).

Or tl;dr: eat all brussels sprouts and carrots, go play outside more, and stop eating and drinking so much crap. Preferably before you get COVID, but especially after.

Brussels sprouts are a great way to get nitric oxide.

Unironically my first thought was sildenafil. The little blue pill works by increasing nitric oxide production and was originally designed for vascular heart issues iirc

I’ve heard of that as a wonder drug. It signals for blood flow and dilate blood vessels. There’s other supplements like l-arginine + citrulline that has similar effects but different mechanisms.

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