Persistent nausea and poor

[MyPinkElephant]

Hi there,

Do any of you have gastrointestinal involvement with your flares? I am 5 years into my illness, and 6 weeks post Covid & complications. I have been experiencing persistent nausea, poor appetite & stomach discomfort for 3 weeks (following an ulcer flare triggered by Covid). This is a new stage for me - unsure if it's related to "long Covid" or progression of Behcet's. Awaiting blood results and cardiac investigations.

Look forward to any insights. With thanks.

[GloomyEeyore]

I suffer from severe nausea. Have been on prochloperazine for years to help with this. It does ease it but it never seems to go completely. The symptoms you mention however could all be related to long covid nhs.uk/conditions/coronavir... hope that you get some help with them soon. Gastric symptoms are not pleasant at all. Xx 💐

[AusBehcets]

I’m just 2 1/2 weeks out from having COVID-19 diagnosis. Finding I’m left with sinusitis, bit of upset gut, some minor lower gut pains & diarrhoea episode. More food intolerance than usual.

I did gargle with aspirin for my throat during having COVID-19 & still doing this a bit. Though not swallowing b/c get stomach ulcer if I do!

I did eat a certain chocolate bar on Mother’s Day & it made me feel sick. Got some reflux & choking on the reflux from it. Always scary when that happens. Some other brands I tolerate OK.

I’ll probably need antibiotics for the sinus infection but concerned about further upsetting my gut.

My other half who had COVID-19 the Mon before me, is still coughing. I’m fortunate it did not go to my chest in that way.

I still have worse fatigue than I had before catching the virus. I’m sleeping a lot in the daytime. Days have suddenly got colder in Sydney. Want to get my Flu vax but need to be well for that!

[rooser1]

its definitely inflammation. few things you can do to help are:

1. extended fasts. try to aim for 18:6

2. drinking only water and a lot of it.

3. cutting all sugar, including fruit for the time being as sugar is inflammatory.

thats what i do, usually takes only a day or two to resolve.

[Psalm116]

My Behcet's has always caused GI issues (nausea, diarrhea, loss of appetite). In fact, that's how I know I'm about to have a flare-up because it starts with my GI issues.I also had a lot of nausea with covid. Covid also caused a lot of joint pain for me. I had "long-haul" covid which lasted for months.

Take care

[deus777]

here is an extract from a paper , can't find the original link (PASC is long covid)

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IMPACT OF COVID-19 ON THE GUT MICROBIOME PERSISTS FOR MANY MONTHS• Decreased bacterial diversity, increased pro-inflammatory species. Gu et al. Alterations of the Gut Microbiota in Patients with COVID-19 or H1N1 Influenza. Clin Infect Dis. 2020

• Increased fungal richness: C. albicans, C. auris, Aspergillus flavus. Zuo, et al. Alterations in Fecal Fungal Microbiome of Patients With COVID-19 During Time of Hospitalization until

Discharge. Gastroenterology. 2020

• Enterococcus faecalis, potent inducer of gamma-interferon, associated with increased mortality. Ward etal. Intestinal and oral Microbiomes Are Robest Predictors of COVID-19 Severity, the Main predictor of COVID-19-Related Fatality. MedRxIV 2020

• Keystone depleted species: Faecalibacterium prausnitzii, Zuo et al, Alterations in Gut Microbiota of Patients With COVID-19 During Time of Hospitalization, Gastroenterology (2020). Yeoh et al. Gut microbiota composition reflects disease severity and dysfunctional immune responses in patients with COVID-19. Gut 2021.

Gut Microbiome at Disease Onset Predicts Development of PASC

• Gut microbiome of patients with PASC were characterized by lower levels of Faecalibacterium prausnitzii and higher levels of Ruminococcus gnavus, Bacteroides vulgatus.

• Butyrate-producing bacteria, especially Faecalibacterium prausnitzii and Bifidobacterium pseudocatenulatum showed the largest inverse correlations with PASC at 6 months.

Liu et al, Gut microbiota dynamics in a prospective cohort of patients with post-acute COVID-19 syndrome, Gut (2022). DOI: DOI: 10.1136/gutjnl-2021-325989

DOES PERSISTING VIRAL INFECTION CONTRIBUTE TO PASC?

• Stool may contain SARS-CoV-2 for months after respiratory samples become negative

• Persisting viral RNA has been reported in multiple tissues at autopsy or surgery, weeks or months after disease onset

• Some patients experience marked improvement of PASC after vaccination, anti- viral drugs and/or monoclonal antibody therapy. These are individual case reports

• Patients with NeuroPASC have impaired function of T-effector memory lymphocytes, an immune deficit seen with persistent antigenic stimulation

Visvabharathy etal. Neuro-COVID long-haulers exhibit broad dysfunction in T cell memory generation and responses to vaccination. medRxiv [Preprint]. 2021 Oct 29:2021.08.08.21261763.

A Program for Reversing PASC-associated Dysbiosis: Increase Butyrate and F. prausnitzii

• A high fiber, polyphenol-rich diet increases growth of F. prausnitzii

• Adherence to a Mediterranean diet elevates fecal levels of F prausnitzii. Gutiérrez-Díaz et al. J Agric Food

Chem. 2017 Jan 25;65(3):586-595.

• Prebiotic oligosaccharides (FOS, GOS) increase F. prausnitzii, hippocampal BDNF in rats. Maqsood , Stone The Gut-Brain Axis, BDNF, NMDA and CNS Disorders op cit.

• Resveratrol inhibits Enterococcus faecalis, alters gut/lung microbiome to limit superantigen-induced respiratory inflammation. Chan MM. Antimicrobial effect of resveratrol on dermatophytes and bacterial pathogens of the skin. Biochem Pharmacol. 2002. Hu et al. The Bidirectional Interactions between Resveratrol and Gut Microbiota: An Insight into Oxidative Stress and Inflammatory Bowel Disease Therapy. Biomed Res Int. 2019 . Alghetaa et al. Resveratrol-mediated attenuation of superantigen-driven acute respiratory distress syndrome is mediated by microbiota in the lungs and gut. Pharmacol Res. 2021

REVERSING GUT BACTERIAL DYSBIOSIS IN PASC

• RCTs:BifidobacteriumlongumBB536andBacilluscoagulansGBI30increaseF.prausnitzii,subdue inflammation. Odamaki et al. Influence of Bifidobacterium longum BB536 intake on faecal microbiota in individuals with Japanese cedar pollinosis during the pollen season. J Med

Microbiol. 2007. Lau et al. . Bifidobacterium longum BB536 alleviated upper respiratory illnesses and modulated gut microbiota profiles in Malaysian pre-school children. Benef Microbes. 2018. Nyangale et al. Bacillus coagulans GBI-30, 6086 Modulates Faecalibacterium prausnitzii in Older Men and Women. J Nutr. 2015. Nyangale et al. . Effect of prebiotics on the fecal microbiota of elderly volunteers after dietary supplementation of Bacillus coagulans GBI-30, 6086. Anaerobe. 2014

• Prebiotic oligosaccharides (FOS, GOS) increase F. prausnitzii, hippocampal BDNF in rats. Maqsood , Stone The Gut-Brain Axis, BDNF, NMDA and CNS Disorders op cit.

• Bacillus subtilis B-7092 (Tundrex/Vetom/Subalin) secretes a-IFN, which is virucidal for SARS-CoV- 2. Kumari et al. Type I interferon susceptibility distinguishes SARS-CoV-2 from SARS-CoV. bioRxiv 2020

• Resveratrol inhibits Enterococcus faecalis, alters gut/lung microbiome to limit superantigen- induced respiratory inflammation. Chan MM. Antimicrobial effect of resveratrol on dermatophytes and bacterial pathogens of the skin. Biochem Pharmacol. 2002.

Hu et al. The Bidirectional Interactions between Resveratrol and Gut Microbiota: An Insight into Oxidative Stress and Inflammatory Bowel Disease Therapy. Biomed Res Int. 2019 . Alghetaa et al. Resveratrol-mediated attenuation of superantigen-driven acute respiratory distress syndrome is mediated by microbiota in the lungs and gut. Pharmacol Res. 2021

The Gut Microbiome and Cytotoxic T-Lymphocytes (CTLs)

• CTLs play important roles in recovery from viral infection

• CTLs are critical for vaccine-induced protection against Covid-19

• Lactobacillus consumption through yogurt, fermented foods, or as a supplement increases number and activity of CTLs. Meyer et al Ann Nutr Metab. 2006;50(3):282-

9. Ashraf & Shah Crit Rev Food Sci Nutr. 2014;54(7):938-56.

• Lactobacillus plantarum reduced infection after major abdominal surgery by 70%

• Rayes Z Gastroenterol. 2002 Oct;40(10):869-76.

• Lactobacillus plantarum improved gut barrier function, decreased growth of gut pathogens and improved clinical outcomes of patients with pancreatitis

• Qin et al Eur J Clin Nutr. 2008 Jul;62(7):923-30..

Enhancement of T-effector memory cells (TEMs), a type of CTL

• Important for prolonged immune memory following viral infection and immunization

• TEMs thrive on fatty acid oxidation, availability of butyrate and presence of Lactobacilli

• Diet: high fiber, adequate fat, low sugar, fermented food daily (yogurt, sauerkraut, kimchi)

• L-carnitine 500-1000 mg bid

• Black raspberry concentrate 1 tablespoon daily

• Lactobacillus plantarum

Dietary Factors Impact Bacteriophage Activity

• Polyphenols, especially bioflavonoids, disable or kill bacteriophages, inducingis structural damage to the capsid, inhibiting bacteriophage activity and infectivity.

• Oregano oil suppresses multiple types of prophages, preventing their cellular entry and impact on bacteria

• Thenaturalsweeterstevia,promotesmultiplespeciesphageresponses, increasing their impact on bacteria.