I started off last month with an admission that I’m an exercise freak, so I’ll continue this month with another admission about my workout habits. About a week after I finished that last article I came down with one of those seasonal flu viruses and since then I haven’t been able to do a thing. At first, I figured it was just a little bit of the blahs that go along with these viruses, but it got much worse. I couldn’t do anything without really disabling muscle pain, fatigue, dizziness, and a total lack of energy. I used to swim a mile or more, but after that bout with the flu I could barely lift my arms to make it through a few laps. When I didn’t work out in the ocean or the pool, I would run 6 or 7 miles at a time; after that flu I had to stop after just a couple of minutes and rest. It quickly became a real thing for me—not just my imagination.
Once these post-flu symptoms settle in on you for more than just a few days, you’ll earn a diagnosis of something called “post-viral fatigue syndrome (PVFS),” and it’s actually pretty common. Studies show that somewhere between 20% and 40% of viral infections lead to some or all of these symptoms. A persisting illness similar to this has also been reported following a number of different bacterial and protozoal infections. A good review of the topic was published last year that states, “Post-viral fatigue syndrome encompasses a wide range of complex disorders of unknown causes characterized by disabling post-exertional fatigue, myalgia (muscle pain), joint pain, cognitive impairments, unrefreshing sleep, autonomic dysfunction, and neuropsychiatric symptoms.” The autonomic nervous system is well named; it controls all the things that happen in our body automatically like breathing, digestion, and more importantly, control of blood pressure and heart rate when we exercise and change body position like standing up from sitting or lying down. When it’s not functioning properly, patients get dizzy when they stand up, known as “orthostatic hypotension." The World Health Organization estimates that about 65 million people worldwide are affected each year with the post-viral blahs and the number is expected to rise to about 150 million patients in the next few years. At least I’m not alone.
There’s nothing new about this syndrome—it’s been in the medical literature for over 100 years. Before the COVID outbreak, the most common cause of PVFS was in the 1920s brought on by the Spanish Flu epidemic. A lot more attention has been turned to this constellation of post-viral symptoms since COVID when it was given a special designation, “long COVID,” which we’ve talked about in these pages before. The incidence of long COVID after infection is about the same as PVFS but seems to have more cognitive side effects, “brain fog," associated with the condition, and can be even more debilitating. A little less than half of people with COVID also meet the criteria for post-viral fatigue syndrome, so the World Health Organization decided to give a formal name and add a bunch more syllables—just to make it totally impossible to pronounce. I like my little name for it but it’s now known as “myalgic encephalomyelitis chronic fatigue syndrome (ME/CFS). The acronym has been adopted by the United States Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the National Academy of Medicine. It describes symptoms as being a combination of muscle pain and fatigue, and a diagnosis of “PVFS” requires that the symptoms be present for months and have moderate, substantial, or severe intensity at least half of the time. So buckle up—you might be feeling the blahs for a while.
It stands to reason when you just don’t have any strength and vitality that energy metabolism is a part of the blahs. The way all mammals store energy from our diet is in a chemical called ATP (adenosine triphosphate). We make it in our own little intracellular power plants—the mitochondria—in a pretty complicated set of reactions that burn up glucose and store that energy in those ATP molecules to use later. One possible explanation was proposed recently that post-acute viral infection syndromes “result from the activation of a protective biologic response designed to prioritize available energy stored in our ATP and shunt it to the eradication of infection and the healing of injury. This is achieved, in part, by generating symptoms that discourage energy-consuming behavior and as a result, more ATP is available for the immune response.” This kind of metabolic reprogramming response is another one of those biochemical pathways developed in our caveman days that has been evolutionarily preserved throughout the animal kingdom in our genetics, but it can haunt us today. A genetic basis was confirmed by recent studies of both gene structure and gene expression comparing people with ME/CFS with healthy control subjects that have shown links in ME/CFS to specific genetic traits.
Most of the treatments for PVFS are symptomatic like Tylenol or Motrin for muscle pain, sleep medication, limiting exercise, and getting lots of rest. Another over-the-counter option is to use a scopolamine patch like for motion sickness to relieve the dizziness and autonomic symptoms. Recent data also suggest using antidepressants to treat some post-viral symptoms. There’s another option based on the theory like the one above about energy metabolism that came out last year. It’s a really interesting approach to management of those low energy and fatigue symptoms and treats this from the angle of getting more energy stores. The theory is to enhance ATP and energy production since there’s lack of energy at the center of these symptoms. There’s nothing more critical for all cellular functions than an adequate and constant supply of energy, and when it’s not there for us, we really feel it. The series of chemical reactions that generate and store energy in ATP are dependent on some “helper enzymes” called “co-enzymes.” One of those is called co-enzyme Q10, which was shown back in the mid-1950s to be a key component of the energy transport system and “plays a central role in cellular bioenergy generation and regulation with its synthesis of mitochondrial ATP.”
Based on all of this, it’s been suggested recently that CoQ10 supplements might boost energy production when we get run-down and reduce or even eliminate those feelings of fatigue and low energy. Randomized controlled clinical trials have reported significant symptomatic benefits with CoQ10 treatment of these disorders by 25-40%. The suggested daily supplemental dose is 300-400mg/day for a few months and it's a over-the-counter with no known side effects. I’m only an uncontrolled study of one so completely statistically useless, but I got some at the corner drugstore and can report that within 2-3 days I did feel much better and started having better workouts and felt less fatigued. It still took about 5 or 6 weeks for me to completely get over the post-flu symptoms; reports in the literature say that it usually lasts about one or two months but in some unfortunate patients it can persist for several years.
The bottom line from all of this is that post-viral blahs can be really debilitating, so don’t push yourself when it sets in. Give yourself a break, don’t overdo it with your exercise routine, get lots of sleep, take some Motrin for the muscle aches, and try CoQ10 supplements; it can make things better. But mostly just wait it out, stay out of your airplane if you get dizzy and tired easily, and as always, FLY SAFE!
