Use of 1-MNA to Improve Exercise Tolerance and Fatigue in Patients After COVID-19, 2021, Chuzdik, preprint

https://www.medrxiv.org/content/10.1101/2021.07.14.21259081v1

Background Coronavirus disease 2019 (COVID-19) is a serious respiratory disease that results from infection with a newly discovered coronavirus (SARS-COV-2). Unfortunately, COVID-19 is not only a short-term infection but that patients (pts) recovering from SARS-CoV2 infection complain of persisting symptoms including: fatigue, diffuse myalgia and weakness, which may lead to chronic fatigue syndrome. There is currently no evidence that nutritional supplements and/or physical exercise can assist in the recovery of pts with chronic fatigue syndrome. 1-Methylnicotinamide (1-MNA) is an endogenic substance that is produced in the liver when nicotinic acid is metabolized. 1-MNA demonstrates anti-inflammatory and anti-thrombotic properties. Therefore, we investigated whether 1-MNA supplements could improve exercise tolerance and decrease fatigue among patients recovering from SARS-CoV-2.

Methods The study population was composed of pts after COVID-19, expressing subjective feelings of limited tolerance to exercise. The selected pts were randomized into two groups: GrM0 – without supplementation; GrM1 – with 1-MNA supplementation. At the beginning of the study (Phase 0), in both groups, a 6-minute walk test (6MWT) was carried out and fatigue assessment with Fatigue Severity Scale (FSS) was performed. After 1 month (Phase 1), a follow up FSS and 6MWT once more were performed in both groups.

Results A significant improvement in the mean distance covered in the 6MWT was noted among the pts in GrM1, compared to those in GrM0. We also noted that in GrM1 the 6MWT distance was significantly higher after 1 month of supplementation with 1-MNA, compared to the beginning of the study (515.18 m in Phase 0 vs 557.8m in Phase 1; p = 0.000034). In GrM1, significantly more pts improved their distance in the 6MWT (23 out of 25 pts, equal to 92%), by a mean of 47 meters, compared to GrM0 (15 of 25 pts, equal to 60%) (p = 0.0061). After one month, significantly more patients in the group without 1-MNA had severe fatigue (FSS ≥ 4) compared to the group with supplementation (GrM1 = 5 pts (20%) vs GrM0 = 14pts (56%); p = 0.008).

Conclusions 1-MNA supplementation significantly improved physical performance in a 6-minute walk test and reduced the percentage of patients with severe fatigue after COVID-19. The comprehensive action of 1-MNA, including anti-inflammatory and anticoagulant effects, as well as activation of the SIRT1 enzyme, may be beneficial for the recovery of patients with persistent symptoms of fatigue and low tolerance to exercise after COVID-19.

 

Over such a short time period, when the patient is knowingly focusing on their ability to increase their tolerance of physical exertion, we have no idea if improvement of a six minute walk test represents a genuine overall improvement or a focusing of activity to allow more investment in the test activity.

The only way around this is to measure all the patient’s activity 24/7 during the research period.

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Yes, 6MWD are highly susceptible to biases of the order found in the trial (7.5% difference) because they are sub-maximal and easily susceptible to the participant simply choosing to walk faster or slower.

 

Another early study. Subsequent studies should show more rigor, but its hard to get funding without at least a simple study like this. I suspect it will go nowhere, as usual, but have interest because I am interested in Niacin metabolism in ME and diabetes, and how it raises HDL. There is probably a lot we still don't know, both encouraging and discouraging.

Its worth noting though that in healthy people there are also limited early studies showing boosting NAD boosts exercise capacity. This is an area worth keeping an eye on, though far too early to be making recommendations.

 

It might be statistically significant, but the increase in meters does not seem to be imo. Having this as the only outcome makes results too susceptible to bias as people will overperform