Exercise Intolerance in Preload Failure Treated with Pyridostigmine (2018) Faria Urbina et al (mentions ME/CFS & POTS)

American Journal of Respiratory and Critical Care Medicine 2018;197:A6146


Exercise Intolerance in Preload Failure Treated with Pyridostigmine


M. Faria Urbina 1, R. Oliveira 2, A.L. Oaklander 3, A.B. Waxman 1, D.M. Systrom 1,

https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2018.197.1_MeetingAbstracts.A6146

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Dr Systrom has been given a grant by the Solve ME/CFS Initiative to look at exercise intolerance in ME/CFS

 

FYI, NAtural alternative? Huperzine A. Have not done much research but might try this.

 

I've tried Huperazine A for this reason -- no effect noted. Did it only for awhile and could really have had the wrong dosage, so YMMV.

 

So did I. Three times with different doses. Each time I got a 'buzz' for a couple of days then crashed, stopped taking it and recovered to base line. Never had the courage to keep taking it through the crashes.

 

The results provided in the abstract aren't the ones of interests - it is not peak cardiac output or VO2Peak that we are interested in, because it's possible that patients simply worked harder on the second test and achieved a higher heart rate. We're interested in stroke volume and O2 pulse. The lack of difference in ca-VO2Max leads to some doubt...

The rationale behind Pyridostigmine is the assumption that there is something limiting cholinergic activity of specific nerves which is hypothesised to be the cause of the preload failure.

The strange part to me is well, post-exercise hypotension is associated with increased parasympathetic activity in healthy normotensive people, so increasing cholinergic activity won't necessarily help in this case.

 

I feel like a little increased inflammation belongs in the "it may get worse before it can get better" category, because I feel better long-term from a little immune stimulation... but anything that makes you crash isn't a wait-and-see. You did the right thing.