This week I have been pinged by several people with ME/CFS who have seen drops in Saturated Oxygen Level (SO₂) during the day. One model of many symptoms of ME/CFS (brain fog, easy fatigue) is that of diminished oxygen deliver and reduced products clearance (like CO₂ and Lactic Acid). This reduction of oxygen can be due to many causes: Coagulation, Inflammation, Hemoglobin (iron) disruptions, etc.

Long COVID: This also applies here, “Tiny, Menacing Microclots May Explain Long COVID’s Symptoms“

People who follow me knows, know that I prefer to work from facts, models and objective measurements. Saturated Oxygen Level (SO₂) gives us an objective measurement. Personally, my wife and I use a smart watch that records my (SO₂) and other factors every 10 minutes. The data has been helpful to us to triage some events — it is not a Star Trek Tricorder, but better than speculation. Images at end of the data.

Importance of Half Life

What is called half-life is actually critical for dosage size and timings. MDs prescribing drugs specify one tablet a day, two tablets every 12 hours, a tablet every 8 hours; are based on half-life typically.

What is half-life? It is simply the time it takes to reduce the level in the body to half of the prior amount.

This is not always simple, it takes time to get the supplement or drug into the body as the following quote indicates:

“In healthy volunteers who have taken oral doxycycline, the maximum doxycycline plasma concentrations (C_max) of 1.5 to 7.0 μg/ml are usually reached within 3 h, and the drug has a half-life of 14 to 24 h” [2005]

Step One — Find Half Lifes!

This is actually pretty easy, usually typing in the supplement and “half-life” will return answers from the web. For the above people, I assembled a list of possible testing supplements from prior posts on coagulation to see if we can determine the possible mechanism for the SO₂ drop they saw. The purpose is to identify a probable cause which should then be discussed with your medical professionals.

See this post for the literature on these. We want to then find the half-life and the maximum safe dosage. Many of the maximum deemed safe (i.e. used in studies dosages) are listed here.

Supplement	Half Life	Max Dosage
Alpha Lipoic Acid	30 minutes [Full article: Alpha lipoic acid intoxication, treatment and outcome (tandfonline.com)	2400 mg/day (see Src)
Aspirin	3 hours at lower doses (300 to 600 mg), 5 to 6 hours (after 1 g), 10 hours with higher doses [source]	4000 mg/day [Aspirin Dosage – Drugsdb.com]
Grape Seed Extract / Resveratrol	2-5 hours [source]	2000   mg/day
Nattokinase	4-6 hours [source]	14,000   fibrinolytic units/day
Lumbrokinase	8.6 hours [source]	1470   mg/day
Serrapeptase	Could not find	30   mg/day
Boswellia Gum	6 hours	4800 mg/day [src]
Bromelain	6-9 hours	2000 mg/day
Piracetam	5 hours	24000   mg/day
Turmeric	6-7 hours	3000 mg/day
Licorice	3.5 hours	32   g/day
Ginseng	n/a	2000 mg/day
Coenzyme Q10	33 hours	1200   mg/d

As above, there can be time to get it into the body as the following states for CoQ 10.

The T(max) is around 6 h, with an elimination half-life of about 33 h. The reference intervals for plasma CoQ10 range from 0.40 to 1.91 micromol/l in healthy adults. With CoQ10 supplements there is reasonable correlation between increase in plasma CoQ10 and ingested dose up to a certain point. Animal data show that CoQ10 in large doses is taken up by all tissues including heart and brain mitochondria. 

Coenzyme Q10: absorption, tissue uptake, metabolism and pharmacokinetics – PubMed (nih.gov)

This is a useful exercise to do for ALL OF YOUR SUPPLEMENTS. This will answer the question, should you do one mega dose a day or 4 small dosages thru the day or even 6 or 8 small dosages per day – to get the best results. You want to maintain a reasonable level in your body for the whole day.

One possible strategy

There are many possible approaches, my preference here would to start with the longest half life and work down. This leads to the following suggestions (to be discussed with your medical professional)

• CoQ10: 300mg day 1, 600 mg day 2, 900 mg day 3, then 1200 mg/day for at least 2 weeks.
  • 4 capsules per day for some products
• Bromelain: : Given the half life, I would start with 1 capsule every 12 hours (typically 500mg), doubling the dosage on the second day and then keep repeating for the rest of the week
• Lumbrokinase: Given the half life, I would start with 1 capsule every 12 hours, doubling the dosage for the next 4 days keep repeating for the rest of the week
• etc

You want to identify the substance that hints at the source, then get your MD involved. Do not try all of them at once. Introduce one item a week and see what the response is. Personally, I did the Aspirin route which had me running up and down the walls after 7 days — that response persuaded the MD to order the Hemex Lab Coagulation Panels which identified issues. That lead to appropriate treatment.

For the short half-life items, You want to take a SO₂ measurement no longer than the half-life. For Alpha Lipoic Acid, the typical capsule is around 300 mg, so I would go for one capsule every hour for 4 hours and monitor the levels for at least 6 hours. This will keep the concentration at a reasonable level. Going above the maximum dosages has significant risk. This is an example for ALA, Alpha lipoic acid intoxicatıon: An adult [2018]. As always, have your plan reviewed by your medical professional before starting.

Remember: Record in Excel or other product your base line — the daily or weekly pattern before you start. Keep up the recording of SO₂ as you walk thru the substances. For me, having a smart watch that does it makes it so so easy with awesome data to show my MD.

Addendum: DAO – diamine oxidase

This is a troublesome one — with two answers!

• Toward Oral Supplementation of Diamine Oxidase for the … cites 18 hours
• Evaluation of porcine diamine oxidase for the conversion of histamine in food-relevant amounts [2020] cites 19 minutes

If DAO is being taken to reduce histamine in the body – we use 18 hours. If it is being taken to quiet down the histamine release in the gut from eating something, it is 19 minutes. So, taking DAO immediately before or during a meal may have the best benefit.

The Unique Possibility of Symptom Treatment Resolving the Cause

My model of coagulation issues is simple: some group of bacteria are dumping chemical signals into the body that triggers one or another form of coagulation. Why would they be doing that? Survival! These bacteria prefers a low oxygen environment so they are taxa-forming your body for their needs. Increasing the oxygen level in the body will typically inhibit these bacteria – but may not be enough to suppress them. The use of other substances (in the personal experience that I cited above, following Cecile Jadin’s “Occult Rickettsia” protocol of rotating antibiotics) may be needed to suppress these troublesome bacteria, to “rid me of this meddlesome taxa”. Note: The virus or bacteria that trigger the illness is unlikely to be the meddlesome ones, rather, other bacteria that saw opportunity in its disruptions of the body and exploited it. I believe these bacteria are seen in stool microbiome samples.