SWAlexander
Senior Member
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Back in 2021, I posed a question about whether "spherocytosis" or other red blood cells (RBCs) could be deformed.
https://forums.phoenixrising.me/threads/it-is-a-chain-link-reaction.85479/#post-2365583
However, I was met with a wave of denials from people across forums and social media—even from so-called experts—which discouraged me from bringing up the topic again.
And now, here we are:
Google translation:
The Muscles Lack Oxygen
The key symptom of patients with severe Long Covid and ME/CFS is post-exertional malaise, or PEM for short. Sports medicine specialist Christian Puta is researching the mechanisms behind it.
Interview conducted by MARTIN W. ANGLER
Professor Puta, why are the muscles of some people no longer able to sustain exertion after recovering from an infection?
Because the muscles are no longer getting enough oxygen. On the one hand, there’s increasing evidence of microclots that disrupt blood flow. Even more important, however, might be damaged red blood cells. In healthy individuals, these cells are smooth and shaped like gummy candies. But in patients following a SARS-CoV-2 infection, they are visibly frayed. While the red blood cells still transport oxygen, their deformations prevent them from reaching all areas. Additionally, they hold onto the oxygen more tightly and deliver it to the muscles either not at all or only to a limited extent.
How does this damage occur?
The damage happens indirectly. Every cell has tiny power plants inside it called mitochondria. When a healthy muscle is under strain, it requires about 40 times more blood than when at rest. Depending on the exertion, the mitochondria can produce energy in two ways. If the muscle is used only briefly—like when standing up—the power plants initially function without oxygen. But if the muscle is continuously active—like during a walk—it requires oxygen and, for example, sugar as fuel to generate energy.
So the power plants can’t properly burn their fuel without oxygen. What happens then?
Without oxygen, the mitochondria can produce only about six percent of the energy that would be possible with oxygen. This means the muscles perform less. Moreover, the mitochondria create several waste products without oxygen that are harmful to the muscles. One such waste product is lactic acid, which then has to be broken down.
How does the body break down these substances?
The mitochondria are responsible for that too. And like a waste disposal service, they absolutely need oxygen to do their job. If oxygen is lacking, waste products like lactate and calcium remain in the muscle after intense exertion and damage it over time. We don’t yet fully understand how much the mitochondria themselves suffer from this overload. But what’s certain is that they no longer function properly in this state.
So mitochondria are like hybrid cars, with a small but weak electric motor for short distances and a stronger combustion engine for longer ones. Is it fair to say that in Long Covid patients, the combustion engine is broken?
Exactly. With the weaker electric motor, a hybrid car can’t go far, needs frequent recharging, but works fine for short trips. The mitochondria work similarly. One difference, though, is that our bodies can generate energy from three fuels: carbohydrates, proteins, and fat. However, energy from proteins is problematic because it leads to muscle breakdown. That’s something we noticed early on in severe cases—patients had lost significant muscle mass.
As someone affected, how can I recognize if I’m suffering from PEM?
You can check your ability to generate energy quickly with a simple experiment. Sit on a chair, and for one minute, stand up and sit down as quickly as possible. During this, the power plants in your thigh muscles generate energy rapidly and without oxygen. This can cause muscle burning even in fit people, and some may even feel flu-like for about five minutes. But after 30 minutes, healthy individuals recover. Some Long Covid patients also manage the first attempt fine. But they lack the energy for a second round.
Why?
Because they can’t regenerate. Regeneration requires oxygen to clear out waste products. This doesn’t work properly in Long Covid patients. That’s why their muscles often hurt immediately after the first round and feel heavy and inflamed. A second attempt after 30 minutes is usually out of the question and not advisable. It’s important to only try this test if it doesn’t exceed your limits.
Post-exertional malaise often occurs in flare-ups and is delayed after exertion. How can I know how much I can handle?
That’s indeed challenging. Symptoms like severe flu-like sensations and pain often only appear hours or even days after physical or mental activity. The best approach is to monitor for early warning signs before exertion. One indicator is your resting heart rate. If you regularly measure it and notice that it’s 10 to 15 beats higher than usual at night, you should take it easy the next day and do less. When in doubt with PEM, the rule is: “Stop-Rest-Pace.” That means pausing, resting, and staying active only within your energy limits.
Why is resting heart rate an important indicator?
A high resting heart rate signals that the body is under significant strain, for example, from inflammation. In a PEM episode, this could be triggered by waste products from muscle metabolism. Incidentally, we see similar reactions in healthy muscles after exercise. First, the immune system responds, leading to small inflammations. A healthy body can handle this well. But we suspect additional factors contribute to persistent inflammation in Long Covid patients, such as remnants of the SARS-CoV-2 spike protein.
What insights from sports science could help alleviate PEM episodes?
From elite athletes, we know that magnesium can improve the chemical balance in muscles. Up to 300 milligrams per day is generally safe, even as a supplement. I also recommend zinc and selenium, both of which reduce inflammation. A recent study has shown that creatine can improve muscle strength and recovery time in some ME/CFS patients. However, this should only be used by people with healthy kidney function.
How close is research to finding a cure?
We believe that within about six years, we’ll have a solid understanding of the detailed mechanisms behind PEM. By then, medications could be targeted at specific points in the body where processes go awry after a viral infection. These could include drugs that promote circulation or strengthen mitochondria directly. Clinical trials are already testing existing medications off-label and developing new ones. However, it will take some time before any are approved. Until then, the best advice is to hang in there!
https://forums.phoenixrising.me/threads/it-is-a-chain-link-reaction.85479/#post-2365583
However, I was met with a wave of denials from people across forums and social media—even from so-called experts—which discouraged me from bringing up the topic again.
And now, here we are:
Google translation:
The Muscles Lack Oxygen
The key symptom of patients with severe Long Covid and ME/CFS is post-exertional malaise, or PEM for short. Sports medicine specialist Christian Puta is researching the mechanisms behind it.
Interview conducted by MARTIN W. ANGLER
Professor Puta, why are the muscles of some people no longer able to sustain exertion after recovering from an infection?
Because the muscles are no longer getting enough oxygen. On the one hand, there’s increasing evidence of microclots that disrupt blood flow. Even more important, however, might be damaged red blood cells. In healthy individuals, these cells are smooth and shaped like gummy candies. But in patients following a SARS-CoV-2 infection, they are visibly frayed. While the red blood cells still transport oxygen, their deformations prevent them from reaching all areas. Additionally, they hold onto the oxygen more tightly and deliver it to the muscles either not at all or only to a limited extent.
How does this damage occur?
The damage happens indirectly. Every cell has tiny power plants inside it called mitochondria. When a healthy muscle is under strain, it requires about 40 times more blood than when at rest. Depending on the exertion, the mitochondria can produce energy in two ways. If the muscle is used only briefly—like when standing up—the power plants initially function without oxygen. But if the muscle is continuously active—like during a walk—it requires oxygen and, for example, sugar as fuel to generate energy.
So the power plants can’t properly burn their fuel without oxygen. What happens then?
Without oxygen, the mitochondria can produce only about six percent of the energy that would be possible with oxygen. This means the muscles perform less. Moreover, the mitochondria create several waste products without oxygen that are harmful to the muscles. One such waste product is lactic acid, which then has to be broken down.
How does the body break down these substances?
The mitochondria are responsible for that too. And like a waste disposal service, they absolutely need oxygen to do their job. If oxygen is lacking, waste products like lactate and calcium remain in the muscle after intense exertion and damage it over time. We don’t yet fully understand how much the mitochondria themselves suffer from this overload. But what’s certain is that they no longer function properly in this state.
So mitochondria are like hybrid cars, with a small but weak electric motor for short distances and a stronger combustion engine for longer ones. Is it fair to say that in Long Covid patients, the combustion engine is broken?
Exactly. With the weaker electric motor, a hybrid car can’t go far, needs frequent recharging, but works fine for short trips. The mitochondria work similarly. One difference, though, is that our bodies can generate energy from three fuels: carbohydrates, proteins, and fat. However, energy from proteins is problematic because it leads to muscle breakdown. That’s something we noticed early on in severe cases—patients had lost significant muscle mass.
As someone affected, how can I recognize if I’m suffering from PEM?
You can check your ability to generate energy quickly with a simple experiment. Sit on a chair, and for one minute, stand up and sit down as quickly as possible. During this, the power plants in your thigh muscles generate energy rapidly and without oxygen. This can cause muscle burning even in fit people, and some may even feel flu-like for about five minutes. But after 30 minutes, healthy individuals recover. Some Long Covid patients also manage the first attempt fine. But they lack the energy for a second round.
Why?
Because they can’t regenerate. Regeneration requires oxygen to clear out waste products. This doesn’t work properly in Long Covid patients. That’s why their muscles often hurt immediately after the first round and feel heavy and inflamed. A second attempt after 30 minutes is usually out of the question and not advisable. It’s important to only try this test if it doesn’t exceed your limits.
Post-exertional malaise often occurs in flare-ups and is delayed after exertion. How can I know how much I can handle?
That’s indeed challenging. Symptoms like severe flu-like sensations and pain often only appear hours or even days after physical or mental activity. The best approach is to monitor for early warning signs before exertion. One indicator is your resting heart rate. If you regularly measure it and notice that it’s 10 to 15 beats higher than usual at night, you should take it easy the next day and do less. When in doubt with PEM, the rule is: “Stop-Rest-Pace.” That means pausing, resting, and staying active only within your energy limits.
Why is resting heart rate an important indicator?
A high resting heart rate signals that the body is under significant strain, for example, from inflammation. In a PEM episode, this could be triggered by waste products from muscle metabolism. Incidentally, we see similar reactions in healthy muscles after exercise. First, the immune system responds, leading to small inflammations. A healthy body can handle this well. But we suspect additional factors contribute to persistent inflammation in Long Covid patients, such as remnants of the SARS-CoV-2 spike protein.
What insights from sports science could help alleviate PEM episodes?
From elite athletes, we know that magnesium can improve the chemical balance in muscles. Up to 300 milligrams per day is generally safe, even as a supplement. I also recommend zinc and selenium, both of which reduce inflammation. A recent study has shown that creatine can improve muscle strength and recovery time in some ME/CFS patients. However, this should only be used by people with healthy kidney function.
How close is research to finding a cure?
We believe that within about six years, we’ll have a solid understanding of the detailed mechanisms behind PEM. By then, medications could be targeted at specific points in the body where processes go awry after a viral infection. These could include drugs that promote circulation or strengthen mitochondria directly. Clinical trials are already testing existing medications off-label and developing new ones. However, it will take some time before any are approved. Until then, the best advice is to hang in there!
