Progress report - Just so people understand, my body mass index score is right at the bottom of the BMI green zone, the lowest it could be without going into the undesirably low values. In fact when I took dandelion tea as a diuretic (to reduce nocturia) my morning weight was below the green zone due to the dehydration. So I feel a bit close to the edge, as it were and have stopped doing that but I am not fat. I look a bit thin and bony to be honest but I am still alive and able to move around. Not as strong as I was though.
I am continuing a ketogenic diet with the emphasis on a good lipid diet, to reduce glucose and even protein stimulated insulin production and hopefully reduce acanthosis nigricans caused by a build up of insulin, as the insulin is probably not being used due to apparent insulin resistance, the most likely cause of which is suppression of GLUT4 translocation to the cell surface etc by a surfeit of Angiotensin II due to the depletion / impairment of ACE2 activity by covid. To recap, in my case it is recurring covid, the cycle seems to have been about four days at its worst, so frequent it is almost continuous. I am hopeful my immune system is taking it more seriously now and I am trying to support it nutritionally but my tests showed a low white blood cell count and low folate, which are symptoms my mother has and she has a diagnosis of non Hodgkins lymphoma, which is not aggressive but still means she is immunocompromised and has to be careful, like me.
So I am doing the best I can under the circumstances. I am not sure if the peripheral neuropathy is improving and I am trying to ensure it does not get any worse as it is very slow to heal. I am using a very expensive 850nm infrared deep heat therapy boot daily to try to help. (EDIT update, this is causing contact dermatitis because the inner face is made out of leather, would you believe it and when my calves are heated and sweating and they touch this they are contaminated with something leaching from the leather and they have developed a rash. May be able to use it with a transparent polythene bag or something like that but not a very user friendly design IMHO.)
Numbness in my calves indicates when I am getting it wrong but it can be improved in the short term if I reduce protein and most importantly cut carbohydrate intake to the minimum possible. My toes seem to be permanently affected but do fluctuate significantly and seem worse soon after eating. Unfortunately they do not improve as obviously in relation to carb restriction. There seems to be a longer term problem there, possibly nerve damage hence the infrared therapy but it is not very severe when it fluctuates towards a better state suggesting the damage is not that bad and the nerves are themselves being obstructed in their function by other factors but not dead.
I am ascribing two causes to my tingling toes. One is the aforementioned vasoconstriction which I hypothesise is exacerbated by carb even though my HbA1c - IFCC standardised: 31 mmol/mol is considered optimal, equivalent to about 5.08%. I surmise that the affects of Angiotensin II build up and lack of its cleavage by ACE2 to produce Angiotensin(1-7) which is a vasodilation signal molecule means my RAS system is biased to vasoconstriction and so even a tiny influence in that direction by normal glucose levels in the blood can make it worse. So I think I am getting carb induced vasoconstriction despite normal glucose and no hyperglycemia evident. This is probably exacerbated by the second problem which is the AngiotensinII induced insulin resistance which causes the build up of insulin >as though< I had hyperglycemia, when I don't and I suspect this prevents adequate nutrition entering the cells comprising the fine nerve endings, disabling them significantly.
So it is like a covid induced faux-diabetes 2.
I tried berberine to activate AMPK transporter but it gave me mouth ulcers as it is an alkaloid, the same reason I cannot eat any nightshade vegetables due to their alkaloid content so I had to stop. AMPK activation inhibits anabolic processes, which is interesting as this has been a feature of my ME since recurring virus and ME began in 1986 as exercise produces no muscle growth, just damage, since then.
This paper not only elucidates the way AngiotensinII blocks GLUT4 translocation but also suggests beetroot (nitrate) may be a double edged sword after all, which I will have to consider.
Angiotensin II (Ang II) plays a major role in the pathogenesis of insulin resistance and diabetes by inhibiting insulin's metabolic and potentiating its trophic effects. Whereas the precise mechanisms involved remain ill-defined, they appear to be ...
pmc.ncbi.nlm.nih.gov
We found Ang II to block insulin-dependent GLUT4 translocation in L6 myotubes in an NO- and O2 .−-dependent fashion suggesting the involvement of peroxynitrite. This hypothesis was confirmed by the ability of Ang II to induce tyrosine nitration of the MAP kinases ERK1/2 and of protein kinase B/Akt (Akt). Tyrosine nitration of ERK1/2 was required for their phosphorylation on Thr and Tyr and their subsequent activation, whereas it completely inhibited Akt phosphorylation on Ser473 and Thr308 as well as its activity. The inhibitory effect of nitration on Akt activity was confirmed by the ability of SIN-1 to completely block GSK3α phosphorylation in vitro. Inhibition of nitric oxide synthase and NAD(P)Hoxidase and scavenging of free radicals with myricetin restored insulin-stimulated Akt phosphorylation and GLUT4 translocation in the presence of Ang II. Similar restoration was obtained by inhibiting the ERK activating kinase MEK, indicating that these kinases regulate Akt activation.
