The intense interest in long COVID should spur many repurposed drug trials.
If there’s one thing we might hope for – and expect – to happen over the next year or two is for a flurry of repurposed drugs to get trialed in long COVID. It just makes sense.
Tens of millions of sick people with long COVID provide a lot of incentive to find something to help them.
Repurposed drugs – drugs that are already approved for use in one disease that turn out to help other, sometimes very (very) distantly related, diseases – can provide quick help, and a repurposed generic drug potentially really hits the sweet spot (Abilify, for instance, is cheap). Drug trials can help but aren’t needed to try these drugs out – all you need is a savvy doctor who keeps her/his finger to the wind and is willing to try new things. Abilify, for instance, spread far and wide in ME/CFS prior to any studies being published.
Finding the hidden gems that repurposed drugs can be has never been easier. Machine learning techniques are able to quickly scan through large amounts of data to find possibilities. Plus, ample research really helps. Ample research funding helps. It would be shocking, for instance, if we didn’t see much better anti-coronavirus drugs, given the more than 200 molecules that could be exploited to battle it.
A Chronic Pain Example
A novel repurposed drug recently showed up – not in long COVID or ME/CFS – but in chronic pain. Chronic pain is a great way to illustrate the promise the repurposed drugs hold, as it’s been spectacularly difficult to find safe and effective chronic pain drugs.
The story starts with a substance called BH4 which participates in the production of several prominent enzymes (including one that breaks down tryptophan). Seeking to find a way to reduce BH4 levels, researchers targeted an enzyme (guanosine triphosphate (GTP) cyclohydrolase 1 (GCH1)) that regulates BH4 production. This enzyme is activated by damage to neurons, interestingly enough, to a potentially key factor in fibromyalgia – the dorsal root ganglia.
The BH4 effort is particularly interesting as it presents a novel, and thus far untested, way to battle chronic pain.
After BH4 became linked to chronic pain via blood, genetic, and mouse studies, a team of London, Harvard, Canadian and Austrian researchers got to work screening 1,000 FDA-approved drugs (just a small portion of all drugs) for ones known to regulate the expression of the GCH1 enzyme mentioned above.
A surprising drug popped out. Fluphenazine hydrochloride is an antipsychotic used to treat schizophrenia! It does this by blocking dopamine (D2) and alpha-1 adrenergic receptors, but the screen suggested it might also reduce the levels of the enzyme that triggers the production of BH4.
A mouse model study found that it “markedly alleviated pain hypersensitivity in mice” using a dose comparable to that being used in humans. Because fluphenazine can produce problems with movement and depression, the authors suggested using a form of fluphenazine that restricts its effects to the periphery of the body – keeping it from entering the brain.
These researchers had the benefits of years of work, and the identification of a possibly crucial factor in neuropathic/inflammatory pain, that allow them to look for drugs that might affect it.
No Strangers to Repurposed Drugs
That kind of factor hasn’t been identified in ME/CFS, fibromyalgia, or long COVID yet, but neither fibromyalgia nor ME/CFS are strangers to repurposed drugs. Cymbalta was used solely as an antidepressant until studies revealed that it relieved pain in FM patients who were not depressed. Low dose Abilify – approved to fight schizophrenia – has thus far had been found to help (probably by relieving neuroinflammation) in ME/CFS. A low-dose naltrexone/Trazodone combination was proposed to help in ME/CFS years ago. The guanfacine/NAC combination and the RECOVER Paxlovid trial are the latest examples of repurposed drugs being assessed in long COVID.
Opportunities Knock?
Peter Manu’s name is enough to strike horror in people who’ve had ME/CFS for a while. Manu, the author of “The Psychopathology of Functional Somatic Syndromes: Neurobiology and Illness Behavior in Chronic Fatigue Syndrome, Fibromyalgia, Gulf War Illness, Irritable Bowel, and Premenstrual Dysphoria“, popped up in long COVID – not to deny its existence – but to propose that three repurposed drugs (methylphenidate (Ritalin), duloxetine (Cymbalta), and brexpiprazole (Rexulti) – another “antipsychotic” (!) be trialed in long COVID. Manu asserted:
“Testing the benefits and adverse effects of methylphenidate, duloxetine, and brexipiprazole, or all other reasonable interventions for patients with “long-haul COVID-19,” should be rapidly pursued.”
The possibility of using Cymbalta in long COVID probably won’t excite many, but Ritalin is an intriguing possibility given a successful, small trial of Vyvanse in ME/CFS, and the effective use of stimulants in ADHD – which is commonly found in ME/CFS and FM. These drugs deserve more rigorous studies to find out who they help and who they don’t and the best way to use them. (Dr. Bateman has said they work better in people with a more fibromyalgia-like presentation.) They may get it with long COVID.
Then there’s Rexulti. This drug – also used off-label in PTSD and agitation reportedly “improves daytime alertness, sleep efficiency, sleep-dependent depressive symptoms,16 energy level, cognitive ability, and general functioning” – all things we would want in ME/CFS/FM and long COVID. Rexulti, it should be noted, is the successor to Abilify and is now available as a generic.
We may have to get used to throwing out labels. The adage “never judge a book by its cover”, or its newer version, “All that is gold does not glitter“, has never rung more true than with repurposed drugs. Who knows what might be hiding under whatever label?
Given the RECOVER Initiative’s stated priority in quickly finding treatments for long COVID, we should expect a big press to find repurposed drugs. Long COVID presents the promise of not just uncovering repurposed drugs but doing something with them that ME/CFS and fibromyalgia have rarely been able to do – spur the production of the large, well-controlled trials that ultimately make helpful drugs known to doctors and available to patients.
- The Open Medicine Foundation certainly recognizes the potential that repurposed drugs provide. A blog on their new effort to identify them is coming up.
BIG (Little) End of the Year – and Beyond! (:)) Donation Drive Update
Who knows what’s lurking out there in repurposed drug land? If and when something pops up, HR will tell you about it.
Thanks to the over 460 donors who have supported us thus far as Health Rising – as it does – ignores the end of the year (in its “end of the year” donation drive) and plows resolutely on :).
Health Rising is going to watch the repurposed drug field like a hawk because they potentially provide the quickest way to serious help for these diseases. If that sounds like a good idea to you, please support us if you can. Every bit makes a difference.
I understand why ketamine wouldn’t work for some; but I also understand how some people could make it work. I’m thankfully in the latter group, taking 3-hour large-dose infusions. Very much “re-purposed,” and the drug itself is cheap. Yet, Cymbalta was a total nightmare.
I am curious how you get access to ketamine?
I would be a little nervous trying Fluphenazine, if one had RLS.
My three hour ketamine infusion turned into several more hours and became the worst psychological and physical experience of my life. Too bad since it cost over $2000. It was what my hippie friends in the 60’s would call a bad trip and I would have had an even worse time if my wife hadn’t been there to help me assess reality. Fortunately, I’m a very well-integrated 74 y.o. I had waited a year for the session and had finally found a treatment clinic that would administer it after a formal psychological assessment since I couldn’t find an M.D. to provide a referral. An amusing experience since I’m a retired clinical psychologist. Fibromyalgia folks have similar symptoms of the syndrome but all react differently to meds. I had no response to a year on LDN or any other meds over the decades. All meds are toxic but we hope the benefits outweigh the risks. I’m not as excited about repurposed meds with dreadful side effects.
Cymbalta was terrible. Made me craaave alcohol and made me wild, careless. I went off it as I learned more about complaints and class action suits for these vary reasons.
Does anyone know what dosage of Rexulti helps CFS?
I want to know, too, so I can discuss it with my doctor. She’s pretty open to trying things. Are there any links I can forward to her, e.g. references to using Abilify for ME/CFS? I have been dealing with this DD for 40 years, and the thing most responsible for making my life unmanageable at the moment is “Circadian Rhythm Sleep Disorder, non24, free-running type”; it sounds like Rexulti might be able to help with.
https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-02721-9?fbclid=IwAR3IxybvgF_47lftlObPMdE__m0CwqPh7w65BYMsQQl3ZuxP8Jg0RTH4U24
https://institutodemelatonina.com/
Many ME/CFS patients are deficient in BH4, tetrahydrobiopterin, and can benefit from what used to be a cheap supplement, but is now a specialty drug, Kuvan (which is now generic). It’s a drug for PKU, phenylketonuria, repurposed for patients with more common genetic defects in making or recycling BH4. BH4 is a cofactor for several important reactions, including neurotransmitter production and reducing cell and mitochondrial membrane damaging peroxynitrites.
Testing to determine what one’s own situation is is important.
I
I also found taking BH4 very helpful for my functionality; unfortunately, as mentioned the FDA removed it as a supplement from the market. I have not tried Kuvan, not because of price, because it is not equivalent to BH4. Kuvan, even without the toxic fillers, is more likely to cause me problems than to help me. Here is what the FDA says about Kuvan:
https://www.fda.gov/media/103159/download
I’m currently at 0.50mg. But I’m not sure what the recommended dose would be. I’m sensitive to medicine doses so I always ask to start out as low as possible.
At 0.50mg it seems like I can better handle life with less crashing. My crashes are shorter in length. My doctor is trying me at1.0mg but it is really hurting my sleep – I’m now awake between 2-3:00am each morning. I want to go back down to 0.50mg.
For Rexulti.
Ivermectin is a great example of a successful repurposed drug. Unfortunately its use has been discouraged here in the US despite having worldwide respect and appreciation.
Although I have no idea if IVM could help with CFS, I have heard it likely has the ability to break down clots. For that reason, as well as Covid prevention, I’ve been using it for a couple of years now. Lucky me, I have Factor V in the era of Covid…
And then I caught it last August. I suffered profound EBV type fatigue, stayed in bed mainly for two days and then quickly recovered.
IVM can, and does, help. Combine IVM and LDN, and it can be life changing for some. I’ve had success with IVM and just started the LDN, so I’ll know for sure in about 8 weeks if it helps. Unfortunately, I have to pay cash for a doctor and for the IVM because our corrupt, corporate medical system won’t allow physicians to prescribe IVM and other off-label medications and pharmacies won’t fill legitimate prescriptions from licensed physicians. But I am finding it is probably worth the out-of-pocket money.
Yes, I can vouch for both LDN and IVM as being helpful.
It’s too bad IVM isn’t covered by insurance but what good is money if you’re not around anymore, I figure.
Wishing you the best.
Overseas access to Ivermectin – need to pay with Bitcoin
https://theantiaging.store/
LDN takes a full year to feel its full effect. I didn’t see any improvement in my pain levels until 6 months. I’m now at 9 months and the chronic back pain I had for 25 years is almost gone. My compounding pharmacist said “just wait until you’re on it for a full year, you should be pain free!”
I took IVM and ARTEMISIA and AB when I had Covid last November. I had very few symptoms, just very tired and no appetite for 2 weeks. I am not vaccinated (too afraid of vaccines).
I started LDN in early December at 0.5mg every other day. Right now I’m taking 1mg every other day. I take it slowly to avoid side effects. I started taking iodine at the same time because I have a thyroid problem. . For the moment, I support well, I feel less tired, more zen and less afraid of everything. I sleep much longer (10 hours per night). But I don’t know if my best sleep is due to Covid or LND…
I, too, avoided the so-called “vaccine” because I knew having a history of DVT it would be incredibly dangerous. A rushed, experimental shot? No thanks. The repeated claim 100% safe and effective? An obvious lie. The reality is becoming more painfully obvious as each day passes.
Good for you for starting slow with LDN. Your improved sleep likely is just one of the many benefits of using it.
As MANY people with ME/CFS are highly sensitive to almost anything they’ve tried, I would urge caution for both repurposed drugs and testing of same on groups of highly vulnerable people.
How miserable are the researchers going to make how many sensitive people in the scattershot approach to trying everything? They don’t like people dropping out of studies – but people experiencing side effects don’t have much of a choice.
Trying the drugs on people WITHOUT ME/CFS also accomplishes little beyond that normal people aren’t having problems with medications they don’t normally have problems with.
First do no harm?
Too many of the things I’ve had to try recently due to surgeons disallowing the drugs for pain that were safe for me as proven over many years, Celebrex and ldn, put me through horrible reactions that it has taken almost three months to get over. Celebrex is an NSAID and ldn can interfere with anesthesia and pain sensitivity, but their alternatives were a horror show.
It would be better if there were a less risky way to try these ideas out – there are an awful lot of potential drugs someone is going to want to ‘try’. Every failure costs a person with ME days of their life, and can cause a huge amount of pain.
I don’t think I’ve seen any concern for what problems the TESTING can cause.
As far as I know, LDN will not interfere with anesthesia, but may also enhance the effect of opioids. However, few people will know this purpose.
The anesthesiologist knew of ldn. The papers I’ve read point out that being used to ldn can make your pain receptors respond differently (less) to the drugs that keep you from feeling pain during surgery – and that the anesthesiologist needs to know this sensitivity of yours to keep you safe. Otherwise they don’t understand why you need higher levels of painkillers during surgery. ldn does NOT enhance opioids – how could it? It targets the same receptors, and the two should not be taken together because they interfere with each other. And even if you get off ldn before surgery, you are not the same as someone who has never taken it.
This is a LAY person’s understanding, based on what I just went through with surgery at Stanford. Don’t quote me – go look for the proper explanations – but never hide ldn use from your anesthesiologist, and follow their instructions about getting off ldn before surgery, and don’t go back on ldn until you are OFF opioids. That’s asking for trouble. Please get your information from reliable sources, and follow their instructions.
A trial for a month or longer of very low dose LDN was awful for me. I suffered with disabling dizziness within an hour of taking it and this never changed.
It gave me zero benefits and made me unable to do basic stuff I can usually do.
Definitely not a harmless drug to try in my experience.
Pam
Abilify is the single worst drug I’ve ever taken . One dose almost killed me. I had never felt suicidal before, but this had me crying my eyes out and wanting to kill myself. It was terrifying and I am glad someone was with me. It was given to me for agitated depression due to my FMS and neuroborreliosis.
I would be willing to do nearly anything to regain my previous Self. This ten years with everything that I have underwent has been the ultimate pain. I have and will continue to try any substance that I think might have clinical efficacy but only after my intensive over the horizon research. Medical research is so outdated and extremely inefficient it boggles my mind. We waste more dollars doing nonsensical research.
Cort, I have been hearing through long COVID grapevines that the only clinical treatment trials that RECOVER is doing are on versions of GET and CBT. There are emails and petitions going around to be sent to the NIH about wasting federal research dollars on disproven treatments rather than on repurposing drugs. But I see here you’ve mentioned that Paxlovid for long haulers will be part of a RECOVER study. Can you separate fact from fiction here? These days, I have to carefully reserve and place my outrage where it truly belongs (one could argue I should have spent my first 45 years doing that 😉).
The Paxlovid trial is definitely on. It’s the only clinical trial listed on the RECOVER website.
https://clinicaltrials.gov/ct2/show/NCT05595369
I hadn’t heard about the other stuff. I would hope RECOVER wouldn’t put there resources there!
Hi Cort, have not looked into this further, but Jaime Seltzer tweeted about it on 22 December https://twitter.com/exceedhergrasp1/status/1606059212395597824?cxt=HHwWgMCqsYWW78ksAAAA . I saw her post on @MECFSNews, a channel whose reporting on ME/CFS related scientific developments I can recommend.
When I had covid I was Put on paxlovid and I felt so much better on it, despite having covid. I had much more energy & my muscles felt better too. I’m sure antivirals must help those with a background of EBV
Rexulti prompted a thought. This NIH grant funded research article describes the therapeutic benefit of the “prazole family of drugs, wouldn’t one of these “prazoles” mentioned be more logical to try than Rexulti? I’d much rather trial a proton pump inhibitor (such as pantoprazole) than an antipsychotic.
Also reminds me of how Pepcid helps many with CFS, brain fog, MCAS and other issues such as recovering from Covid. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470332/
Any idea when there might be more results on cortene, Cort?
Probably this forum should stay seriously on topic. But in celebration of 10 yrs Health Rising I can’t resist the joke: “There is a drug named after you, Cort??” 🙂
Thank you again and again Cort for all the phenomenal work you do.
May 2023 bring us better health with good treatment.
Best wishes to you all
Thanks, Claudine from France! 🙂
About repurposing drugs, what I found very interesting is reading about the proposed mechanism of Low Dose Naltrexone (LDN): As far as I remember, by blocking opiate receptors only temporarily, it effectively causes a rebound effect that results in production of more endorphines in the body, while in high doses when used for therapy of drug addiction it blocks receptors completely, thereby blocking the endorphine rush caused by narcotics.
I feel it made me understand for the first time why a drug might act very differently in different dosages.
Maybe this applies to other drugs too, possibly involving rebound effects or different prevailing metabolisation pathways in the low dose range. But then, I suppose there is maybe also an initial phase where the system just needs to adjust to the new substance before a balance is achieved (there is often a phase of e.g. 2-3 weeks of initial side effects with psychopharmaka).
I once tried quetiapine to see if it would aid with noise shielding (in the lowest available dosage of 25mg/tablet, which is not low dose). (I know that neuroleptics are sometimes also employed by people with autism for noise shielding.)
In the first 2 weeks on quetiapine I noticed some positive (slightly euphoric) effects, but then it tipped into the opposite. I now wonder if it could have been a dosage effect and might warrant another low dose try (or just “positive” initial side effects).
I have fibromyalgia and in Feb. 2022 I was in Mexico and picked up some diet pills – Acxion. I started them when I got home at the end of March, I did slowly lose some weight but what surprised me was that I felt better – less pain, more energy and most important for me was I was free of muscle cramps that have at times crippled me. I felt so good that I was able to get and maintain a part time job after not working for 9 years. The main ingredient is phentermine and unfortunately I cannot get this in Canada. My doctor said it just isn’t used anymore so cannot access it. He gave me some pills that he said are in the same “family” and are used for ADHD and they were ok but did not help me quite as much as the phentermine. I am currently back in Mexico and have been taking them for 15 days and they are staring to work again for me. The only side effect I have had is some sleep problems for the first 2 weeks but then I seem to adapt and actually sleep at a more normal pattern – tired at the same time each night and waking at the same time every morning without feeling foggy or tired. I do still wake up 3 or 4 times but I am able to get back to sleep immediately. My doctor advised me to keep an eye on my blood pressure but said to go ahead with them since they make me feel so much better. I have also been able to start exercising!
I am very interested in the treatment trials of C.Scheibenbogen for ME/CFS and LongCovid. She got 10 million € from the German state for these trials for the next 2 years, and she’ll use it for repurposed drugs, IA and HBOT.
One of the first trials will be Vericiguat. if the IA study is successful then B Cell depletion like Obinutuzumab. Abilify, JaK inhibitors, PDE inhibitors and Atorvastadin are also on her list. And more. Hope she gets more money in the future so she can trial everything.
That is great news! Do you by any chance have any links to that?
Np6 has better information, but this at least is the project website (NKSG = National Clinical Study Group Post-Covid & ME/CFS) https://cfc.charite.de/klinische_studien/nksg/ (use browser translate). Charité university medicine is Scheibenbogen’s workplace.
Yes, but some of it is in german, hope you can translate the important parts.
Here is a link to the study platform:
https://cfc.charite.de/klinische_studien/nksg/
There will be more information about the clinical studies soon.
She gave a few talks in September/October in german, and the study platform was part of these talks.
Here is a screenshot of her list of possible trials:
https://ibb.co/TBknczm
Here is a screenshot of the timetable:
https://ibb.co/2NxjLKh
I just remembered that she also gave a talk to Solve ME/CFS(in english). minute 26 onwards:
https://youtu.be/RdGrA4mlR74
I think this is one of the trials(that’s where i got the Obinutuzumab from):
https://clinicaltrials.gov/ct2/show/NCT05629988
And one bit of information that is pretty new: Scheibenbogen found that muscle sodium in ME/CFS patients is increased, just as she predicted in her previous papers. She wrote on Twitter that she wants to trial drugs that reduce muscle sodium.
https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-022-03616-z
And this detailed Scheibenbogen interview about autoimmunity in ME/CFS https://phoenixrising.me/myalgic-encephalomyelitis-chronic-fatigue-syndrome/autoimmunity-me-cfs/ ties in with some of the trial information, in particular immunoadsorption. It also gives interesting insights into her past research process, including how modern bioinformatic technologies allowed for better analysis of previous data. And it mentions that Bhupesh Prusty will be one of their cooperation partners!
The two major German ME/CFS and LongCovid patient organisations are part of the NKSG steering committee, see information on how the project came to happen: https://longcoviddeutschland.org/nksg/.
I have long thought that Carmen is our best shot at properly understanding and solving this illness.
Great to hear she has some decent funding behind her.
Thank you Cort! I would want to add that even testing available drugs is a very cumbersome endeavor which can last years. Indeed, realistically, many promising therapies for ME/CFS will never be studied because drug trials have become prohibitively expensive, bureaucratic and time-consuming (at least in most parts of the world). This is why we should not forget about a third option (besides de novo drug development – like BC-007 – and drug trials on existing drugs). And this is: gathering (and disseminating) therapeutic experience. There are hundreds of thousands of patients, some of them with good-willing doctors, a few are MDs or other prescribers themselves, others are pharmacists or even work in the pharmaceutical industry. Here a lot of experimentation is going on, probably more than we think… As a matter of fact, if a drug trial is announced today (like the ones at the Charite Berlin) you can expect that dozens of patients will replicate the protocol ASAP and come up with some informed assessment… And, crucially, these preliminary guesses will be in within months and not within years. Of course, this does not make RCTs superfluous and should not replace systematic drug studies, and yes, there are disadvantages and risks (which I do not want to deny!). Yet, these self hacks may be very valuable to guide researchers in their selection of drugs to be studied. What if a researcher wants to do a 1 million drug trial on a candidate drug already on the market and you´d have access to a sizable stack of patient experiences ? You´d probably look at these experiences with a keen eye, wouldn´t you? Because, if a few dozens of patients – especially severly affected patients – will report no benefit (or just a tiny or questionable benefit) you could probably save yourself a lot of time and money and move on to a more promising candidate… So we should really celebrate all efforts to collect patient experiences with therapies – there is a lot to learn from these.
Hello,
Which form of Fluphenazin for special body periphery was used? You did not mention it.
Thanks, Frank
Our daughter has found relief of muscle pain and fatigue with repeated rounds of Tamiflu. (Also improvement in visual probems.) There are other anecdotal reports of this, but I don’t think anyone is looking at this in a formal way. Tamiflu was originally made from Star Anise but when the world supply was decimated, they found a way to synthesize it from E-coli.
https://cfsremission.com/2017/03/17/temporal-remission-from-tamiflu/
https://forums.phoenixrising.me/threads/any-improvement-on-tamiflu-oseltamivir.59018/
Hi, A company called Montai Health was recently “unveiled” by Flagship Pioneering. Its premise is similar to that of Cort’s article, to repurpose things to improve peoples’ health. Here’s a web link about it.
https://www.prnewswire.com/news-releases/flagship-pioneering-unveils-montai-health-to-treat-and-preempt-chronic-disease-afflicting-two-billion-people-worldwide-301700893.html
Flagship Pioneering’s biggest success so far is probably Moderna Therapeutics and its vaccine for COVID-19.
Thank you and best wishes for the new year to Cort and everyone.
I by accident found that 100%
Cocoa helps cfs. It’s anti inflammatory as well gives me energy I make a cake with 1 cup of cocoa it has stimulant effect have notice it really works for fatigue pain and inflammation. Just throwing it out there if anyone wants to try it it’s cheap it works for me.
Shelie, can you share your recipe?
A low-effort way of consuming cocoa (povided you tolerate milk) is dry-mixing unsweetened cocoa powder with milk powder for
coffee (coffee creamer) in a cup, optionally add spices to taste (e.g.: a small pinch of sugar, salt, paprika or chili powder, pepper and indian spice mixture (garam masala)), fill up with hot water, stir and optionally add some fresh milk or cream.
I can confirm a stimulating effect of cocoa. Cocoa powder contains caffeine. If I drink it in the evening I will be awake at night.
My view is to observe carefully whether stimulants keep you awake in the evening, and also pay extra attention to pacing when using them. I have become quite sensitive to stimulants like coffee: They make me feel much more functional but not in a sustainable way – in my case I feel what they do is not provide real additional energy, but enable more pushing/adrenaline in a way that’s not sustainable and promotes overexertion – they just seem to “make the candle burn to its end faster” or mobilise energy in a way that eats on the substance of the body and actually drains energy levels further over time – so a couple of weeks on 1-2 cups of coffee a day in order to try and get some things done before Christmas coupled with sleep disturbance have now left me crashed again.
They can definitely help with getting things done, but I suppose that for me, resting and enduring small progress would probably be the more sustainable way to recovering energy.
As everyone isn’t the same, I suppose you need to try it out and maybe take stimulants before midday in order to preserve sleep.
https://www.allrecipes.com/recipe/17981/one-bowl-chocolate-cake-iii/
https://www.allrecipes.com/recipe/17981/one-bowl-chocolate-cake-iii/
Thank you Shelie, I will give it a try. At least, it will be tasty.
Steve,
When you say you found no benefit from LDN, did you have before and after tests on both amount of and function of Natural Killer Cells? Dr. Klimas’s group has found that their patients definitely improve on LDN but this is because they are tested for this. They report that LDN gives a better response than Inosine for NK Cells.