RTHM

10/23/2026

Mast cell activation syndrome (MCAS) can affect multiple systems in the body, contributing to symptoms like flushing, hives, GI issues, brain fog, headaches, fatigue, shortness of breath, and autonomic symptoms.
MCAS is also increasingly discussed in Long COVID, where research suggests SARS-CoV-2 infection may contribute to persistent mast cell dysregulation and inflammatory signaling.

Swipe through to learn more about MCAS treatments, how each treatment may work, what symptoms it may help, and what the current research shows.

You can also try the free RTHM HIPAA-compliant platform to organize your health information, track records and labs, access treatments, and explore evidence-informed resources to support conversations with your care team.

Create an account today and get started: www.rthm.com

10/22/2026

Recent topline results from a Phase 2 clinical trial suggest that bezisterim, an investigational drug, may help improve fatigue, post-exertional malaise (PEM), and cognitive impairment in people with Long COVID who have greater baseline burden of these symptoms.

BioVie had a press release with topline results from its ADDRESS-LC trial, a randomized, double-blind, placebo-controlled study involving 203 participants with Long COVID. Researchers evaluated bezisterim, an oral medication believed to reduce inflammation and improve insulin sensitivity, against placebo.

While the study did not find statistically significant improvements across the overall study population, 21 of 22 clinical endpoints numerically favored bezisterim. More promising results emerged in pre-specified subgroups of participants with higher baseline symptom severity.

Participants with more severe fatigue showed statistically significant improvements across five clinical measures, including three fatigue-specific endpoints. Those with high baseline PEM experienced improvements in PEM, fatigue, and objective cognitive function, while participants with substantial objective cognitive impairment showed statistically significant improvements across four objective cognitive measures.

Bezisterim was also generally well tolerated, with a safety profile similar to placebo. Adverse events were reported in 41.6% of participants receiving bezisterim compared with 55.9% receiving placebo.
These findings are encouraging, however, the subgroup results remain exploratory and require confirmation in larger trials. BioVie has announced plans to advance bezisterim into a Phase 3 trial to further evaluate its effectiveness and identify which patients may benefit most.

Read the full announcement: BioVie Phase 2 ADDRESS-LC Trial, September 15, 2026. (https://na2.hubs.ly/H08yLQS0)

You can find a clickable link in our Linktree.

10/20/2026

Managing post-exertional malaise (PEM) goes beyond pacing alone.

In this clip, Dr. David Putrino, Dr. Lucinda Bateman, and Dr. Jennifer Curtin share emerging approaches to reducing physical and cognitive PEM, including treatments targeting metabolic dysfunction and options such as low-dose rapamycin, metformin, oxaloacetate, CoQ10, dextromethorphan, low-dose naltrexone (LDN), NAD+, high-dose B1, and IV saline.

While some patients report improvements, responses vary, and research is still evolving. Identifying which treatments may help specific patients remains an important part of developing more personalized PEM management strategies.

Have you found any medications or supplements that help manage your PEM? Share in the comments.

Watch the full How to Manage and Treat Post-Exertional Malaise (PEM) webinar featuring Dr. Putrino, Dr. Bateman, Dr. Curtin, and moderator Charlie McCone.

Comment PEM and we’ll send you the link to the full webinar recording on YouTube.

Always consult with your healthcare provider before starting any new supplement, over-the-counter medication, or treatment. Individual risks, potential interactions, and appropriate dosing should be discussed with and monitored by your clinician.

10/16/2026

Have you tried supplements or OTC medication to help manage PEM? Share in the comments.

Post-exertional malaise (PEM) isn’t simply feeling tired after activity. For people with ME/CFS and Long COVID, physical, cognitive, emotional, or sensory exertion can trigger a significant worsening of symptoms that may not appear until hours or even days later.

Some supplements and over-the-counter options may be used as part of an individualized PEM-support plan created between you and your clinician: for ongoing baseline support, before exertion, or to help reduce crash severity or duration. What helps, when to use it, and whether it is tolerated can vary widely from person to person. These options are not a substitute for pacing and other strategies to avoid exceeding your energy limits.

Swipe through to learn more about supplements and other over-the-counter medication options being explored for PEM.

Finding the right approach can take time, and treatments should be individualized based on your symptoms, health history, medications, and tolerability. Explore RTHM’s PEM supplement suggestions, or create a free account on our HIPAA-compliant platform for treatment suggestions personalized to your health history.

Link in bio to get started.

10/13/2026

Patient-Led Research Collaborative (PLRC) and RTHM Clinic recently released the Long COVID Treatment Guide to support more informed conversations between patients and their clinicians.
The guide covers over 30 different treatments. Today, we’re highlighting hyperbaric oxygen therapy (HBOT), which may be especially relevant for people with Long COVID experiencing cognitive impairment, fatigue, sleep issues, neuropsychiatric symptoms, or pain.

In a randomized, double-blind, placebo-controlled trial of 73 people with Long COVID, 40 HBOT sessions led to significant improvements in attention, sleep quality, pain, and energy levels that persisted even one year after treatment. Echocardiogram assessment in the same group also showed a meaningful reduction in global longitudinal cardiac strain.

A separate 10-patient study reported statistically significant improvements in fatigue and cognitive function after 10 HBOT sessions over 12 days. However, an interim safety analysis from an ongoing Karolinska Institute trial found that nearly half of participants experienced cough or chest discomfort during treatment, though it remains unclear whether those symptoms were related to HBOT or underlying Long COVID.

In the Harvard/Stanford/OMF TREATME study, 38% of people with Long COVID who tried HBOT reported moderate to much better symptom improvement, though the Long COVID sample was small at 13 participants. Among people with ME/CFS, 25% reported moderate to much better improvement.
HBOT should be discussed with a qualified clinician to determine whether it is appropriate for an individual case. The guide also notes that medical-grade HBOT can be expensive and time and energy consuming, and that claustrophobia can make treatment challenging.

If you want a direct link to download the guide, comment below, and we’ll send you a DM.

10/09/2026

COVID-19 continues to circulate across the United States with wastewater activity levels and trends varying meaningfully by location. Some states in the South, West, and Northeast report high or very high activity. CDC estimates released October 9 show that infections may be growing in some states, while trends are stable or declining in others.

The best time to make a COVID plan is before you need one.

Clinical research has found that starting metformin early during a COVID-19 infection was associated with a 41% lower risk of developing Long COVID.

RTHM offers medication assessments to help determine whether metformin may be appropriate for you to take if you get COVID-19, with access to the same dosing studied in the clinical trial. You can get the medication to have on hand before you need it or if you already have COVID-19.

Learn more through the link in bio, or comment and we’ll DM you the RTHM COVID-19 Preparedness Kit.

10/06/2026

This week, we’re highlighting five recent publications on Long COVID, ranging from potential underlying biological mechanisms–including gut microbiome signatures, inflammatory-endothelial biomarkers, blood-brain barrier disruption and copper-zinc imbalance– to teachers’ occupational risk of developing Long COVID.

RTHM’s Research Corner helps patients stay up to date on emerging Long COVID research, with studies curated to your health conditions, symptoms, and topics of interest.

Not living with Long COVID? You can still personalize your weekly research email by selecting the conditions, symptoms, and topics most relevant to you.

Sign up for weekly curated research emails here: https://www.rthm.com/research-corner/tags

10/02/2026

10/02/2026

Have you tried low-dose naltrexone (LDN), pyridostigmine, or ivabradine for your PEM symptoms? Share your experience in the comments.

Post-exertional malaise (PEM) is more than feeling tired after activity. It’s a worsening of symptoms that can follow physical, cognitive, emotional, or even sensory exertion—and the crash may not hit until hours or even days later.

For people with ME/CFS and Long COVID, PEM can make it incredibly difficult to predict what the body will tolerate from one day to the next. Something as routine as showering, socializing, running errands, doing household tasks, or being in a stimulating environment can sometimes trigger a crash.

While there is currently no FDA-approved treatment for PEM, certain off-label medications may help address symptoms or underlying factors that contribute to crashes. Low-dose naltrexone (LDN), pyridostigmine, and ivabradine are three options supported by emerging research and used in clinical care for some patients.

Finding the right approach can take time, and treatment should be individualized based on your symptoms, health history, and other conditions. Swipe through to learn more about these three medications and the research behind them.

You can explore potential treatments like LDN, pyridostigmine, and ivabradine through RTHM, or create a free account on our HIPAA-compliant platform for treatment suggestions personalized to your health history.

Click here to get started: https://www.rthm.com/medications

09/29/2026

A new study published in Nature Communications found that the skeletal muscle changes seen in Long COVID and pre-pandemic ME/CFS differ from those caused by prolonged physical inactivity.

Researchers compared 25 people with Long COVID, 26 people with pre-pandemic ME/CFS, 30 healthy controls who had fully recovered from SARS-CoV-2, and 24 healthy participants who underwent 60 days of strict bed rest.

While prolonged bed rest caused expected signs of deconditioning, including muscle atrophy, people with Long COVID and ME/CFS showed a different pattern. Researchers found changes in muscle fiber composition, capillarization, oxygen delivery and utilization, and mitochondrial function that were not reproduced by bed rest alone.

In ME/CFS, participants had reduced capillary-to-fiber ratios and changes involving type I muscle fibers. Long COVID and ME/CFS participants also showed evidence of altered oxidative phosphorylation and exercise responses suggestive of impaired oxygen extraction or reduced stroke volume.

The findings suggest that reduced exercise capacity in Long COVID and ME/CFS cannot be explained by inactivity or deconditioning alone. Instead, underlying mitochondrial, vascular, and skeletal muscle abnormalities may contribute to exercise intolerance and post-exertional malaise. Importantly, the findings also support the need for rehabilitation approaches that recognize the underlying disease physiology rather than treating patients as simply deconditioned.

Read the full study: DOI 10.1038/s41467-026-75725-y

You can find a clickable link in our linktree: https://linktr.ee/rthm_health