Supplements are rarely a permanent solution on their own. In Long Covid and related post-viral conditions, they are better understood as targeted support tools that may help the body during specific phases — for example during inflammation, mast cell reactivity, viral reactivation, nutrient depletion, dysautonomia, or periods of reduced recovery capacity.
Their usefulness depends heavily on timing, dose, tolerance, and the current state of the system. A supplement that is stabilising in one phase may be unnecessary, ineffective, or even destabilising in another. For this reason, I treat supplements as part of a broader framework rather than as isolated solutions. This overview collects nutrients, plant compounds, amino acids, antioxidants, and gut-supportive substances that may be relevant within a Long Covid recovery context. Each entry includes a short description of its potential role, typical dosing considerations, possible risks, and the areas of the model it may relate to.
This is not medical advice. Supplements can interact with medications, affect lab values, trigger side effects, or be inappropriate in certain conditions such as kidney disease, liver disease, pregnancy, bleeding disorders, iron overload, autoimmune disease, or active infections. Any supplement plan should be discussed with a qualified physician or healthcare professional, especially when using higher doses or combining multiple interventions.
Supplements
Cluster 1 — MCAS / Histamine / Immune Reactivity
Quercetin
Typical dose: 1500 mg/day in divided doses; with food or fat unless liposomal.
Symptoms: Food, heat, stress or smell reactions; flushing; hives; itching; histamine brain fog; dizziness or nausea after triggers; POTS with histamine component.
How to test: Plasma histamine; serum tryptase; IL-4 / IL-13 via specialist cytokine panel. Normal tryptase does not rule out MCAS.
Useful for: Mast-cell and histamine support, immune modulation and inflammatory signalling. Relevant when MCAS amplifies POTS or brain fog.
Best context: MCAS / histamine flare; post-viral phase; neuroinflammatory symptoms; POTS with histamine component.
Risks: Absorption depends on form. Non-liposomal forms usually need fat. Caution with anticoagulants or antiplatelet medication.
Protocols: MCAS Protocol; Mast Cell Stabilisation Protocol; Infection Protocol; Neuroinflammation Protocol.
Vitamin C
Typical dose: ca. 2,000 mg/day buffered Vitamin C, split across the day. Individual tolerance matters.
Symptoms: Frequent infections; slow wound healing; fatigue during or after illness; histamine intolerance; poor oxidative stress resilience; tissue fragility.
How to test: Plasma Vitamin C if available. Indirect context: high CRP, elevated histamine, frequent infections.
Useful for: Antioxidant defence, immune function, collagen and tissue repair. In MCAS contexts, may support histamine tolerance and pairs well with quercetin.
Best context: Baseline support; MCAS / histamine flare; infection or cold phase; refueling; gut / barrier recovery.
Risks: GI irritation; loose stools; reflux or nausea; kidney-stone risk in susceptible people; caution with iron overload.
Protocols: MCAS Protocol; Infection Protocol; Refueling Protocol.
Bromelain
Typical dose: 1200–2400 units twice daily, between meals. With food, it acts more digestively than systemically.
Symptoms: Post-viral inflammatory load; vascular congestion; slow tissue recovery; mast-cell reactivity; internal heaviness or pressure.
How to test: D-dimer; CRP; fecal calprotectin for gut inflammation context. No direct bromelain test.
Useful for: Proteolytic enzyme support, mast-cell support as part of QBC, inflammation modulation and possible fibrin / clotting-context relevance.
Best context: MCAS flare; inflammatory load; post-viral recovery; microcirculation support if tolerated.
Risks: Avoid with pineapple allergy. Caution with anticoagulants or blood thinners. Timing matters.
Protocols: MCAS Protocol; Mast Cell Stabilisation Protocol; Post-viral Recovery Protocol; Microcirculation Protocol; GI Protocol.
Perilla
Typical dose: 150 mg twice daily. Product quality matters; generic extracts may not have the same effect.
Symptoms: Histamine symptoms not fully controlled by quercetin; pseudo-allergic reactions; Th2 pattern; POTS with histamine driver; histamine brain fog.
How to test: IL-4 if available; plasma histamine; serum tryptase. Th2 dominance is mainly a clinical pattern.
Useful for: Histamine and Th2-oriented support. Contains luteolin, apigenin and rosmarinic acid.
Best context: MCAS / histamine protocol; Th2-dominant immune pattern; POTS with histamine component; neuroinflammatory histamine symptoms.
Risks: Product quality matters.
Protocols: Mast Cell Stabilisation Protocol; MCAS Protocol.
DAO
Typical dose: 1–2 capsules immediately before histamine-rich meals. Situational use, not baseline.
Symptoms: Meal-specific histamine reactions: headaches, flushing, itching, GI cramps, diarrhoea or congestion after aged, fermented, leftover or high-histamine foods.
How to test: DAO activity; plasma histamine; histamine-to-DAO ratio; symptom-food diary.
Useful for: Breaks down dietary histamine in the gut lumen before absorption. Useful when reactions are clearly food-histamine related.
Best context: Travel; restaurants; social eating; temporary support during gut recovery.
Risks: Does not treat MCAS itself or endogenous histamine release. Some products are pork-derived.
Protocols: Histamine Protocol; MCAS Protocol; Gut Support Protocol.
Vitamin B2 / Riboflavin
Typical dose: 100–200 mg/day when deficient or therapeutically used. Adjust to lab status and tolerance.
Symptoms: Histamine intolerance; migraines; fatigue; exercise intolerance; elevated plasma histamine; poor oxidative stress handling.
How to test: Riboflavin / B2 blood level if available; plasma histamine; ferritin and B3 for ALDH context.
Useful for: Cofactor for ALDH, the enzyme involved in histamine breakdown. Also supports glutathione recycling and mitochondrial energy metabolism via FAD.
Best context: Histamine clearance; fatigue with suspected B-vitamin depletion; migraine with histamine component; alongside iron / ferritin correction.
Risks: Usually very well tolerated. Bright yellow urine is normal.
Protocols: Histamine Clearance Protocol; MCAS Protocol; Detox Protocol; Refueling Protocol.
Vitamin B3 / Niacin
Typical dose: Start low, e.g. 25 mg/day, and increase gradually if tolerated. Dose depends on form, tolerance and goal.
Symptoms: Histamine intolerance; fatigue; poor stress resilience; cognitive fatigue; low cellular energy with suspected B-vitamin depletion.
How to test: B3 / niacin if available; plasma histamine; ferritin and B2 for ALDH / histamine-clearance context; homocysteine for broader B-vitamin status.
Useful for: Supports histamine clearance as part of the ALDH cofactor pattern together with B2 and ferritin. Also contributes to cellular energy metabolism through NAD-related pathways.
Best context: Histamine clearance; MCAS with suspected nutrient depletion; fatigue with B-vitamin demand; mitochondrial support as part of a broader B-vitamin strategy.
Risks: Niacin flush is common and usually harmless. High-dose niacin may affect liver enzymes; monitor if using higher doses.
Protocols: Histamine Clearance Protocol; MCAS Protocol; Mitochondrial Support Protocol; Refueling Protocol.
Iron / Ferritin Support
Typical dose: Only with confirmed need. Example: iron bisglycinate 25 mg twice daily when ferritin is low. Target range often approx. 60–100 ng/mL.
Symptoms: Profound fatigue; exercise intolerance; cold hands and feet; restless legs; muscle aches; hair loss; brain fog; histamine intolerance with low ferritin.
How to test: Ferritin, full iron panel, CRP for interpretation. Do not interpret ferritin during active infection without caution.
Useful for: Oxygen transport, energy production, tissue resilience and histamine clearance. Ferritin is part of the ALDH cofactor context together with B2 and B3.
Best context: Confirmed low ferritin; rebuilding phase; exercise intolerance; histamine symptoms with low iron stores.
Risks: Do not supplement without testing. High iron can increase oxidative stress. Use caution with inflammation, haemochromatosis, liver disease or iron overload.
Protocols: Histamine Clearance Protocol; MCAS Protocol; Rebuilding Protocol; Mitochondrial Support Protocol.
Cluster 2 — Inflammation / Polyphenols / Immune Modulation
OPC / Grape Seed Extract
Typical dose: 100–300 mg/day. Often used as part of a broader polyphenol / antioxidant stack.
Symptoms: Cold extremities; poor peripheral circulation; vascular fragility; slow tissue recovery; oxidative stress load; histamine-related flushing.
How to test: No direct OPC test. Indirect: CRP, hs-CRP, oxidative stress markers, vascular symptoms, capillary fragility.
Useful for: Polyphenol antioxidant support for endothelial integrity, microvascular function and inflammatory signalling.
Best context: Microcirculation support; inflammatory baseline; oxidative stress load; vascular recovery; polyphenol strategy.
Risks: May mildly increase bleeding tendency. Caution with anticoagulants or antiplatelet medication.
Protocols: Microcirculation Protocol; Antioxidant Protocol; Polyphenol Protocol.
Resveratrol
Typical dose: Usually taken with food or fat. Trans-resveratrol preferred. Dose depends strongly on product quality and formulation.
Symptoms: Chronic inflammatory load; oxidative stress; post-viral fatigue; neuroinflammatory symptoms; reduced metabolic flexibility.
How to test: No direct routine test. Indirect: CRP, hs-CRP, IL-6 if available, oxidative stress markers, symptom response.
Useful for: Polyphenol support for inflammatory pathway modulation, mitochondrial signalling, vascular health and neuroimmune regulation.
Best context: Chronic inflammation baseline; neuroinflammatory phase; mitochondrial / metabolic support; oxidative stress load.
Risks: Product quality matters. Possible interaction with anticoagulants or antiplatelet drugs. High doses may cause GI symptoms.
Protocols: Anti-inflammatory Protocol; Neuroinflammation Protocol; Mitochondrial Support Protocol.
Curcumin / Turmeric
Typical dose: Often 500–1000 mg/day curcumin extract. Needs enhanced absorption: fat, phospholipid form or piperine-containing product.
Symptoms: Systemic inflammation; joint or muscle pain; gut inflammation; brain fog with inflammatory component; post-viral inflammatory tail.
How to test: CRP, hs-CRP, IL-6 if available, fecal calprotectin for gut inflammation. No direct curcumin test.
Useful for: Plant compound support for inflammatory pathway modulation. Relevant across gut, neuroinflammatory and systemic inflammatory patterns.
Best context: Chronic inflammatory baseline; gut inflammation; neuroinflammatory symptoms; post-viral inflammatory phase.
Risks: Can cause GI irritation, reflux, diarrhoea or constipation. Caution with gallbladder disease, anticoagulants, liver disease and high-bioavailability formulas.
Protocols: Anti-inflammatory Protocol; Neuroinflammation Protocol; Gut Support Protocol.
Omega-3 EPA/DHA
Typical dose: Common target: 1–3 g/day combined EPA+DHA. For vegans: algae-based EPA/DHA. ALA is not an adequate substitute.
Symptoms: Brain fog; inflammatory load; low mood; cardiovascular symptoms; slow recovery; dry skin/eyes; poor neuroimmune resilience.
How to test: Omega-3 index, often targeting above 8%. CRP / hs-CRP as general inflammation markers.
Useful for: Cell membranes, neuroimmune regulation, cardiovascular function and inflammatory balance. Especially relevant in vegan diets.
Best context: Baseline anti-inflammatory support; neuroinflammation; vegan deficiency correction; cardiovascular / microcirculation support; rebuilding.
Risks: Mild anticoagulant effect at higher doses. Quality matters: oxidation, heavy metals and EPA/DHA content. Algae oil needed for vegan protocol.
Protocols: Anti-inflammatory Protocol; Neuroinflammation Protocol; Mitochondrial Support Protocol; Vegan Deficiency Protocol.
Vitamin D3
Typical dose: Guided by 25-OH Vitamin D blood level. Often taken with K2 when using higher doses. Recheck after 8–12 weeks.
Symptoms: Frequent infections; low mood; immune dysregulation; muscle weakness; fatigue; persistent inflammatory baseline.
How to test: 25-OH Vitamin D; calcium if using higher doses; optionally PTH. Recheck regularly when supplementing.
Useful for: Immune regulation, inflammatory balance, bone / muscle function and possibly neuroimmune resilience.
Best context: Confirmed deficiency or low-normal status; immune support; post-viral recovery; winter / low sunlight phase; vegan correction.
Risks: Toxicity possible with excessive long-term dosing: hypercalcaemia, kidney issues, arrhythmia risk. Monitor labs.
Protocols: Baseline Protocol; Immune Support Protocol; Post-viral Recovery Protocol.
Zinc
Typical dose: Common range: 15–30 mg/day. Higher doses should be temporary and monitored. Balance with copper during longer use.
Symptoms: Frequent infections; slow wound healing; loss of taste/smell; immune weakness; poor skin healing; inflammatory load.
How to test: Serum zinc plus copper; optionally zinc:copper ratio.
Useful for: Immune function, epithelial repair, antioxidant systems, taste/smell recovery and metabolic regulation.
Best context: Immune rebuilding; post-viral recovery; deficiency correction; skin / barrier repair; detox cofactor support.
Risks: High zinc can cause nausea and copper deficiency. Avoid long-term high-dose zinc without copper and testing.
Protocols: Immune Protocol; Baseline Protocol; Detox Protocol.
Reishi / Medicinal Mushrooms
Typical dose: Product-dependent. Prefer quality-controlled extracts with specified beta-glucan content and fruiting body source.
Symptoms: Immune weakness; recurring infections; post-viral immune dysregulation; Th2 / allergic tendency; stress-related immune suppression.
How to test: NK cell activity if available; cytokine panel in specialist context; viral titres if relevant.
Useful for: Beta-glucan immune modulation and antiviral immune surveillance. Reishi may also support stress-related immune dysregulation.
Best context: Post-viral immune rebuilding; recurring infections; stress-related immune weakness; immune modulation phase.
Risks: Quality varies strongly. Caution with anticoagulants, immune-suppressive medication, autoimmune instability or mushroom sensitivity.
Protocols: Viral Reactivation Protocol; Immune Support Protocol; MCAS Protocol.
Astragalus
Typical dose: Often 1000–3000 mg/day in divided doses, product-dependent. Better as phase-specific support than acute standalone treatment.
Symptoms: Recurring viral infections; suspected viral reactivation; post-viral fatigue; Th2 / allergic immune pattern; stress-related immune weakness.
How to test: EBV early antigen; EBV/HSV IgM if relevant; cytokine panel if available; NK cell activity in specialist setting.
Useful for: Immune-modulating herb for antiviral resilience and stress-related immune depletion. Relevant where viral persistence, MCAS tendency and chronic stress overlap.
Best context: Post-viral phase; viral reactivation support; MCAS with immune imbalance; chronic stress with immune suppression.
Risks: Avoid in pregnancy unless medically supervised. Caution with immunosuppressants, autoimmune disease, transplant medication or active immune overactivation.
Protocols: Viral Reactivation Protocol; MCAS Protocol; Stress Regulation Protocol.
Cluster 3 — Detox / Oxidative Stress / Glutathione
NAC / N-Acetylcysteine
Typical dose: Often 600–1800 mg/day, divided. Start low if sensitive or if viral / toxin load is suspected.
Symptoms: Oxidative stress; chemical sensitivity; thick mucus; slow detoxification; post-viral fatigue; inflammatory flares.
How to test: RBC glutathione; oxidative stress markers if available; CRP / hs-CRP; GST variants if relevant.
Useful for: Precursor to glutathione. Supports antioxidant defence, mucus clearance, liver detoxification and inflammatory load reduction.
Best context: Toxin load; post-viral phase; respiratory symptoms; oxidative stress; MCAS with oxidative component.
Risks: Can cause die-off / mobilisation reactions in sensitive people. Start low. May aggravate symptoms if mould / toxin load is high and drainage is poor.
Protocols: Detox Protocol; Viral Reactivation Protocol; Antioxidant Protocol; MCAS Protocol.
Liposomal Glutathione
Typical dose: Product-dependent. Start low; liposomal form preferred. Often taken away from food.
Symptoms: Chemical sensitivity; oxidative stress; inflammatory flares; poor detox capacity; neuroinflammatory fatigue; post-viral load.
How to test: RBC glutathione; liver enzymes; oxidative stress markers; TGF-β if clinically relevant.
Useful for: Direct antioxidant and detoxification support. Helps neutralise oxidative stress and supports liver handling of inflammatory or toxic load.
Best context: Toxin / oxidative stress load; mould or chemical exposure context; post-viral recovery; inflammation resistant to other measures.
Risks: Mobilisation reactions possible, especially with mould or high toxin burden. Standard non-liposomal capsules may be poorly absorbed.
Protocols: Detox Protocol; Antioxidant Protocol; Post-viral Recovery Protocol; MCAS Protocol.
Selenium
Typical dose: Often 100–200 µg/day if needed. Do not exceed 400 µg/day total intake.
Symptoms: Poor detox capacity; thyroid sluggishness; immune weakness; fatigue with thyroid or antioxidant component.
How to test: Serum selenium; thyroid panel; RBC glutathione as indirect cofactor context.
Useful for: Cofactor for glutathione peroxidase and thyroid hormone conversion. Supports antioxidant enzymes and immune resilience.
Best context: Glutathione optimisation; thyroid support; detox and oxidative stress support; immune deficiency pattern.
Risks: Selenium toxicity is possible. Brazil nut content varies strongly. Avoid stacking multiple selenium sources blindly.
Protocols: Detox Protocol; Thyroid Support Protocol; Glutathione Protocol.
MSM / Methylsulfonylmethane
Typical dose: Often 1–3 g/day. Start low if sensitive. Can be used intermittently depending on tolerance.
Symptoms: Joint or connective tissue pain; poor tissue repair; histamine reactivity with sulphur pathway component; gut barrier symptoms.
How to test: No direct MSM test. Indirect: homocysteine, cysteine, taurine, RBC glutathione, symptom response.
Useful for: Bioavailable sulphur for glutathione, methylation and connective tissue. May support inflammatory and histamine-clearance pathways.
Best context: Detox / sulphur metabolism; connective tissue support; histamine clearance support; gut barrier support.
Risks: Usually well tolerated. Caution if sulphur or sulphite sensitivity is suspected.
Protocols: Detox Protocol; MCAS Protocol; Gut Support Protocol; Recovery Protocol.
L-Methionine
Typical dose: Often 500–1000 mg/day. Best used with adequate B12, B6 and folate status.
Symptoms: Poor methylation; histamine intolerance; low mood with methylation component; poor detoxification; fatigue with amino acid deficiency context.
How to test: Plasma amino acids; homocysteine; B12, B6, folate; methylation context if relevant.
Useful for: Essential amino acid feeding methylation and sulphur pathways. Relevant for histamine inactivation, glutathione production and liver detox support.
Best context: Vegan / restricted diet correction; histamine clearance; methylation support; liver detox; neurotransmitter support.
Risks: Can raise homocysteine if B12, B6 or folate are insufficient. Do not use high doses blindly.
Protocols: Methylation Protocol; MCAS Protocol; Detox Protocol; Vegan Deficiency Protocol.
Liposomal Phosphatidylcholine
Typical dose: Often 600 mg once or twice daily, product-dependent. Take with meals if better tolerated.
Symptoms: Brain fog; poor vagal tone; digestive sluggishness; bile flow issues; cognitive fatigue; histamine with liver / detox component.
How to test: Plasma choline if available; liver enzymes; genetic context such as PEMT variants if relevant.
Useful for: Supports cell membranes, bile flow, liver detoxification and acetylcholine-related vagal signalling. Useful at the interface of detox and neuroinflammation.
Best context: Brain fog; vagal / dysautonomia pattern; liver and bile support; histamine with detox component.
Risks: High doses may cause fishy odour in susceptible people. Tolerance varies; start moderate.
Protocols: Neuroinflammation Protocol; Vagus Rehabilitation Protocol; Liver Support Protocol; Detox Protocol.
CoQ10
Typical dose: Often 100–300 mg/day with food or fat. Higher doses may be used therapeutically depending on context.
Symptoms: Muscle fatigue; exercise intolerance; cardiac energy symptoms; slow recovery; fatigue with statin context.
How to test: CoQ10 plasma level if available; lactate / pyruvate in specialist mitochondrial context; statin history.
Useful for: Electron transport chain support and mitochondrial ATP production. Particularly relevant for energy deficit and statin-associated depletion.
Best context: Mitochondrial support; ME/CFS energy deficit; cardiac energy support; statin use.
Risks: Fat-soluble, so absorption depends on food / fat. May mildly lower blood pressure. Can be expensive.
Protocols: Mitochondrial Support Protocol; ME/CFS Protocol; Cardiac Support Protocol.
Berberine
Typical dose: Often 250–500 mg/day to start. Higher metabolic doses are usually divided and need caution.
Symptoms: Blood sugar instability; post-meal crashes; gut dysbiosis; inflammatory metabolic pattern; insulin resistance tendency.
How to test: Fasting glucose, fasting insulin, HbA1c, HOMA-IR; microbiome testing if gut dysbiosis is central.
Useful for: AMPK and metabolic signalling support. May help blood sugar regulation, gut microbial balance and inflammatory metabolic patterns.
Best context: Metabolic dysfunction; blood sugar instability; gut dysbiosis; inflammation with metabolic driver.
Risks: GI discomfort possible. Interacts with glucose-lowering drugs, metformin, cyclosporine and anticoagulants. Avoid in pregnancy.
Protocols: Metabolic Support Protocol; Gut Protocol; Anti-inflammatory Protocol.
Cluster 4 — Mitochondrial / Nervous System / Rebuilding
Creatine Monohydrate
Typical dose: 3–5 g/day as powder. No loading phase needed. Consistency matters more than timing.
Symptoms: Physical fatigue; muscle weakness; cognitive fatigue; brain fog; slow recovery; difficulty rebuilding after crash or illness.
How to test: No direct test usually needed. Creatine can raise serum creatinine without indicating kidney damage. Check kidney markers if clinically relevant.
Useful for: Buffers cellular energy via phosphocreatine and supports short-term ATP availability. Relevant for both muscle and brain energy.
Best context: ME/CFS / PEM recovery; post-crash rebuilding; return-to-activity; cognitive and physical fatigue.
Risks: Avoid in active kidney disease unless medically supervised. Tell doctors if creatinine rises while supplementing.
Protocols: Mitochondrial Support Protocol; ME/CFS Protocol; Rebuilding Protocol.
NAD+ / NMN / NR
Typical dose: Product-dependent. NMN or NR often 250–500 mg/day. Start low and assess stimulation, sleep and tolerance.
Symptoms: Low cellular energy; post-viral fatigue; cognitive fatigue; poor recovery; reduced metabolic flexibility; stress-related depletion.
How to test: NAD+ testing is specialist-only. Indirect: fatigue pattern, mitochondrial markers if available, inflammation markers, response to trial.
Useful for: Supports NAD+ availability, mitochondrial energy metabolism, cellular repair signalling and sirtuin-related pathways. Distinct from B3/Niacin, although biochemically connected.
Best context: Mitochondrial support; post-viral energy depletion; ME/CFS rebuilding phase; cognitive fatigue; recovery after prolonged stress load.
Risks: Can feel stimulating or worsen sleep in sensitive people. Use caution in active crash states, cancer context, pregnancy or complex immune disease unless supervised.
Protocols: Mitochondrial Support Protocol; ME/CFS Protocol; Rebuilding Protocol; NAD+ Protocol.
B-Vitamin Complex
Typical dose: Product-dependent. Prefer active or methylated forms if MTHFR or methylation issues are suspected.
Symptoms: Fatigue; histamine intolerance; low mood; anxiety; nerve symptoms; poor stress resilience; cognitive impairment.
How to test: B12, MMA, folate, homocysteine, B2/B3 if available, B6/P5P if needed.
Useful for: Energy metabolism, methylation, neurotransmitter production, histamine clearance and nervous-system function. Chronic stress and vegan diets increase relevance.
Best context: Energy depletion; methylation support; vegan correction; histamine clearance; nervous-system rebuilding.
Risks: Some people react poorly to methylated forms. Niacin may cause flushing. High-dose B6 can cause neuropathy if overused.
Protocols: Methylation Protocol; Histamine Clearance Protocol; Mitochondrial Support Protocol; Vegan Deficiency Protocol.
B12 / Methylcobalamin
Typical dose: Often 1000–2000 µg/day as methylcobalamin or hydroxocobalamin; sublingual or spray may improve absorption.
Symptoms: Fatigue; brain fog; nerve pain; tingling; numbness; low mood; poor memory; elevated homocysteine.
How to test: Serum B12 plus methylmalonic acid; homocysteine; folate. Serum B12 alone may miss functional deficiency.
Useful for: Myelin, methylation, red blood cell formation, neurological function and energy metabolism. Non-negotiable in vegan diets.
Best context: Vegan correction; neurological symptoms; methylation support; fatigue with B12 risk; histamine clearance support.
Risks: Very safe generally. Functional deficiency can exist despite normal serum B12. Kidney disease or complex cases need monitoring.
Protocols: Vegan Deficiency Protocol; Methylation Protocol; Neuroinflammation Protocol; Histamine Clearance Protocol.
B6 / P5P
Typical dose: 25–50 mg/day as P5P. Avoid long-term high-dose pyridoxine.
Symptoms: Low mood; anxiety; poor stress resilience; histamine intolerance; nerve pain; PMS-like mood instability; poor dream recall.
How to test: Plasma P5P; homocysteine; broader B-vitamin panel if needed.
Useful for: Cofactor for neurotransmitters, amino acid metabolism, haem synthesis, methylation support and histamine metabolism.
Best context: Neurotransmitter support; histamine clearance; nerve symptoms; stress depletion; vegan deficiency correction.
Risks: High-dose B6, especially pyridoxine, can cause neuropathy. Stay conservative unless monitored.
Protocols: Methylation Protocol; Histamine Clearance Protocol; Neurotransmitter Support Protocol; Vegan Deficiency Protocol.
Folate / Methylfolate
Typical dose: Dose depends on status and form. Methylfolate preferred when methylation / MTHFR issues are suspected. Avoid stacking high doses.
Symptoms: Fatigue; low mood; poor methylation; elevated homocysteine; histamine intolerance; cognitive impairment; poor stress resilience.
How to test: Serum folate; red blood cell folate; homocysteine; B12 and MMA; MTHFR context if relevant.
Useful for: Methylation, DNA repair, neurotransmitter synthesis, red blood cell formation and histamine clearance. Works closely with B12 and B6.
Best context: Methylation support; elevated homocysteine; vegan / restricted diet correction; histamine clearance; neurocognitive fatigue.
Risks: Do not supplement folate without checking B12 status, as folate can mask B12 deficiency. Some people need very low starting doses.
Protocols: Methylation Protocol; Histamine Clearance Protocol; Vegan Deficiency Protocol; Neuroinflammation Protocol.
Magnesium Glycinate / Threonate
Typical dose: Dose depends on elemental magnesium. Start low and titrate. Glycinate for sleep / muscle; threonate for cognitive focus.
Symptoms: Palpitations; poor sleep; muscle cramps; restless legs; anxiety; headaches; constipation; sympathetic overdrive.
How to test: Serum magnesium is limited; red blood cell magnesium is more informative if available. Check kidney function with higher doses.
Useful for: Cardiac rhythm, muscle and nerve function, sleep quality, NMDA regulation and stress resilience.
Best context: POTS; sleep disturbance; palpitations; muscle cramps; stress depletion; neuroinflammatory pain.
Risks: Loose stools at higher doses. Avoid high-dose magnesium in kidney disease. Oxide / citrate more often cause GI issues.
Protocols: POTS Protocol; Sleep Protocol; Electrolyte Protocol; Neuroinflammation Protocol.
Potassium
Typical dose: Prefer dietary potassium. Supplemental potassium should be conservative and medically cautious, especially with kidney or heart medication context.
Symptoms: Muscle weakness; cramps; palpitations; dizziness; constipation; POTS worsening after high sodium without potassium balance.
How to test: Serum potassium; kidney function; renin / aldosterone if POTS or volume dysregulation is suspected.
Useful for: Membrane potential, cardiac rhythm, nerve conduction, muscle function and sodium balance.
Best context: POTS; electrolyte balancing; stress-driven mineral loss; muscle weakness; blood-pressure instability.
Risks: Hyperkalaemia can be dangerous. Avoid supplementation in kidney disease or with potassium-sparing medication unless supervised.
Protocols: POTS Protocol; Electrolyte Protocol; Stress Regulation Protocol; Crash Stabilisation Protocol.
Electrolytes / Na-K + Trace Minerals
Typical dose: Individual dosing. Sodium, potassium, magnesium and trace minerals should be balanced. Acute POTS phases may need more sodium under guidance.
Symptoms: Orthostatic dizziness; racing heart on standing; brain fog relieved by salt; low blood pressure; thirst despite drinking; poor heat tolerance.
How to test: Serum electrolytes; kidney function; blood pressure / heart-rate response; renin / aldosterone if indicated.
Useful for: Blood volume, vascular tone, orthostatic stability, hydration and stress-related mineral replacement.
Best context: POTS core support; acute flare; heat / travel; crash stabilisation; pre / post exertion.
Risks: Excess sodium can worsen hypertension or fluid issues. Potassium requires caution in kidney disease. Balance matters.
Protocols: POTS Protocol; Electrolyte Protocol; Crash Stabilisation Protocol.
Protein / Amino Acid Support
Typical dose: Often 1.2–1.6 g/kg/day in recovery phases. Practical: 20 g complete protein at breakfast and evening, adjusted to tolerance.
Symptoms: Poor rebuilding; muscle loss; slow wound healing; fatigue; low mood; immune weakness; poor recovery; hair / nail fragility.
How to test: Plasma amino acids; albumin / prealbumin; ferritin, B12 and zinc as co-markers.
Useful for: Substrates for immune cells, enzymes, neurotransmitters, tissue repair, glutathione and muscle rebuilding.
Best context: Functional undernourishment; post-crash rebuilding; vegan diet; gut healing; return-to-activity; immune and neurotransmitter support.
Risks: Protein source matters. Soy, dairy or histamine-rich proteins may trigger some people. Excess intake without B-vitamin support may strain homocysteine handling.
Protocols: Rebuilding Protocol; Vegan Deficiency Protocol; ME/CFS Protocol; Gut Support Protocol.
Cluster 5 — Gut / SCFA / Sleep / Adaptogens
Lysine
Typical dose: Acute viral / reactivation phase often 1–3 g/day in divided doses; maintenance usually lower. Avoid high-arginine overload if herpesvirus reactivation is suspected.
Symptoms: Recurring cold sores; shingles tendency; flu-like post-viral fatigue; nerve pain; neuropathy; fatigue after herpes-family flares.
How to test: EBV early antigen; EBV / HSV IgM if relevant; high EBV / HSV IgG context; plasma amino acids.
Useful for: Supports antiviral resilience against herpes-family viruses by competing with arginine. Also relevant as an essential amino acid in vegan or restricted diets.
Best context: EBV / HSV / VZV reactivation context; post-viral neuroinflammation; nerve pain; vegan deficiency correction.
Risks: Usually well tolerated. Do not rely on lysine alone in severe viral reactivation; medical antivirals may be needed.
Protocols: Viral Reactivation Protocol; Herpes / EBV Protocol; Neuroinflammation Protocol.
Butyrate
Typical dose: Product-dependent. Enteric-coated or pH-protected forms preferred so it reaches the colon.
Symptoms: Post-infectious gut symptoms; loose stools; urgency; gut-brain fog; leaky-gut-type inflammation; post-antibiotic disruption.
How to test: Fecal calprotectin; zonulin; secretory IgA; microbiome analysis for butyrate-producing bacteria.
Useful for: Main energy source for colon cells. Supports gut barrier repair, gut inflammation reduction and gut-brain axis stability.
Best context: Post-infectious gut recovery; gut barrier support; post-antibiotic recovery; gut-driven neuroinflammation.
Risks: Smell is unpleasant but harmless. Product form matters; unprotected forms may be less effective.
Protocols: Gut Recovery Protocol; Post-infection Protocol; Neuroinflammation Protocol.
Probiotics / OmniBiotic 10
Typical dose: As directed, especially during / after antibiotics or post-infectious gut recovery. Strain selection matters in MCAS.
Symptoms: Antibiotic-associated diarrhoea; dysbiosis; bloating; altered bowel habits; histamine-related gut symptoms; immune dysregulation with gut origin.
How to test: Comprehensive stool analysis; microbiome test; fecal calprotectin; secretory IgA. Consider SIBO assessment if symptoms fit.
Useful for: Supports microbiome rebuilding, gut barrier function and immune modulation via the gut. MCAS-compatible strains matter because some strains can produce histamine.
Best context: Antibiotic phase; post-infectious recovery; gut rebuilding; MCAS-compatible microbiome support.
Risks: Can worsen SIBO or histamine symptoms if wrong strains are used. Not a substitute for dietary diversity.
Protocols: Gut Recovery Protocol; Antibiotic Protocol; MCAS Protocol.
Melatonin
Typical dose: Start low, often 0.5–1 mg at bedtime; increase only if needed / tolerated. Many OTC doses are unnecessarily high.
Symptoms: Non-restorative sleep; difficulty falling asleep; night-time sympathetic activation; brain fog from poor sleep; immune dysregulation.
How to test: Sleep diary / wearable data; salivary cortisol rhythm if stress-sleep overlap is relevant; DLMO testing in specialist settings.
Useful for: Sleep timing support plus neuroimmune and antioxidant effects. Relevant where poor sleep worsens PEM, brain fog or inflammatory load.
Best context: Sleep initiation problems; neuroinflammatory phase; ME/CFS with non-restorative sleep; stress-driven night activation.
Risks: Morning hangover if dose is too high. Possible interactions with anticoagulants, anticonvulsants, blood pressure medication and sedatives.
Protocols: Sleep Protocol; Neuroinflammation Protocol; Stress Regulation Protocol.
Ashwagandha
Typical dose: Product-dependent. Usually best in stable phases, often evening. Not for acute crashes or unstable flare phases.
Symptoms: Stress-driven fatigue; poor sleep quality; cortisol dysregulation; anxiety with physiological activation; sympathetic overdrive.
How to test: 4-point salivary cortisol; DHEA-S; HRV trend; symptom response.
Useful for: Adaptogenic HPA-axis support. May help when chronic stress physiology, poor sleep and sympathetic overactivation maintain symptoms.
Best context: Stable chronic stress phase; sleep support; ANS rebalancing; adrenal / HPA support.
Risks: Can be destabilising in acute inflammatory crashes. Caution with hyperthyroidism, autoimmune instability, liver issues, sedatives and pregnancy. Nightshade-family relevance for strict protocols.
Protocols: Stress Regulation Protocol; ANS Rebalancing Protocol; Sleep Protocol.
Inulin
Typical dose: Start very low, e.g. 1/4–1/2 tsp/day, then increase slowly if tolerated.
Symptoms: Low microbiome diversity; constipation tendency; low SCFA production; poor gut resilience; gut-driven inflammation.
How to test: Microbiome analysis; stool pattern; bloating response; SCFA markers if available.
Useful for: Prebiotic fiber that feeds beneficial bacteria and can increase short-chain fatty acid production, including butyrate.
Best context: Microbiome rebuilding; constipation tendency; low-fiber diet; gradual gut diversity expansion.
Risks: Can cause gas, bloating, pain or worsening symptoms in SIBO / IBS. Start very low.
Protocols: Gut Support Protocol; Microbiome Protocol; SCFA Protocol.
Resistant Starch
Typical dose: Start small, e.g. 1/2 tsp potato starch or small portions of cooled rice / potato; increase slowly.
Symptoms: Gut instability; low butyrate production; blood sugar swings; poor satiety; post-antibiotic gut weakness.
How to test: Microbiome analysis; stool pattern; glucose response if relevant; SCFA markers if available.
Useful for: Feeds butyrate-producing bacteria and may support gut barrier, metabolic stability and microbiome diversity.
Best context: Gut rebuilding; SCFA support; metabolic support; post-antibiotic or post-infectious recovery.
Risks: Can worsen bloating, SIBO or fermentation symptoms. Introduce slowly and rotate sources.
Protocols: Gut Support Protocol; SCFA Protocol; Metabolic Support Protocol.
Propionate / Propionic Acid
Typical dose: Product-dependent. Start low and assess tolerance. Often used as part of SCFA / gut-repair logic.
Symptoms: Gut-brain symptoms; post-infectious gut instability; low SCFA context; poor metabolic signalling; gut-related fatigue.
How to test: SCFA stool testing if available; microbiome analysis; symptom response.
Useful for: Short-chain fatty acid involved in gut-immune signalling, metabolic regulation and gut-brain communication. May complement butyrate in gut recovery.
Best context: Gut recovery; SCFA support; post-infectious rebuilding; metabolic / gut-brain support.
Risks: Tolerance varies. Can be stimulating or GI-irritating in sensitive people; start low.
Protocols: Gut Recovery Protocol; SCFA Protocol; Neuroinflammation Protocol.
Collagen / Gut Lining Support
Typical dose: Animal-derived collagen peptides are commonly used at 5–10 g/day. In a vegan framework, focus on collagen synthesis support: complete protein, glycine / proline-rich amino acids, Vitamin C, zinc, copper, silica and sulphur support.
Symptoms: Gut lining fragility; leaky-gut-type symptoms; slow tissue repair; connective tissue weakness; poor wound healing; barrier instability after infection or inflammation.
How to test: No direct collagen test. Indirect: zonulin; fecal calprotectin; albumin / prealbumin; amino acid status; zinc / copper / Vitamin C status.
Useful for: Supports the structural repair logic behind gut barrier and connective tissue recovery. In vegan protocols, the aim is supporting endogenous collagen synthesis.
Best context: Gut barrier recovery; post-infectious gut repair; tissue rebuilding; recovery after inflammation; connective tissue support.
Risks: Standard collagen is animal-derived and not vegan. Some collagen products may be histamine-relevant or poorly tolerated. Avoid framing it as essential.
Protocols: Gut Support Protocol; Barrier Repair Protocol; Rebuilding Protocol; Refueling Protocol.
Cluster 6 — On-Demand / Situation-Specific Supplements
DGL / Deglycyrrhizinated Licorice
Typical dose: 100–400 mg/day, situation-specific. At 400 mg, avoid continuous use beyond two weeks without checking potassium.
Symptoms: Low blood pressure on standing; dizziness; salt cravings; poor fluid retention; heat- or exertion-worsened POTS symptoms.
How to test: Serum potassium; blood pressure lying/standing; renin/aldosterone if indicated; morning cortisol if adrenal pattern is relevant.
Useful for: May support sodium and water retention and blood-volume stability in low-pressure POTS patterns. Best understood as short-term support, not a baseline supplement.
Best context: POTS flare with low blood pressure; poor fluid retention; heat/travel; short-term bridge alongside electrolytes.
Risks: Not for hypertension. Monitor potassium with higher or repeated use. Avoid regular licorice root unless medically supervised.
Protocols: POTS Protocol; Adrenal Support Protocol; Electrolyte Protocol.
SAMe / S-Adenosylmethionine
Typical dose: Often 200–400 mg twice daily. Use only when methylation or elevated histamine pattern supports it; start low.
Symptoms: Persistent histamine symptoms despite diet/H1/H2 support; elevated plasma histamine; low mood with methylation pattern; elevated homocysteine context.
How to test: Plasma histamine; homocysteine; B12, B6, folate; MTHFR context if relevant; SAMe/SAH ratio in specialist labs.
Useful for: Universal methyl donor. May support histamine inactivation through HNMT methylation and support mood/liver pathways where methylation is under-resourced.
Best context: Confirmed elevated histamine; methylation support; histamine symptoms not fully controlled by standard protocol.
Risks: Avoid in bipolar disorder or mania risk. Do not use blindly when histamine is normal. Correct B12/B6/folate status first.
Protocols: MCAS Protocol; Histamine Clearance Protocol; Methylation Protocol.
DAO / Diamine Oxidase
Typical dose: 1–2 capsules immediately before histamine-rich meals. Situational use only; timing before eating matters.
Symptoms: Meal-triggered headaches; flushing; itching; hives; bloating; cramps; diarrhoea; congestion after leftovers, fermented foods, wine, vinegar or aged foods.
How to test: DAO enzyme activity; plasma histamine; histamine-to-DAO ratio; detailed food-symptom diary.
Useful for: Breaks down dietary histamine in the gut lumen before absorption. Useful for travel/social eating, but does not treat endogenous mast-cell activation.
Best context: Clear dietary histamine reactions; restaurants/travel; gut recovery phase with impaired DAO production.
Risks: Not a treatment for MCAS itself. Some products are pork-derived. Product potency varies; check declared activity units if possible.
Protocols: MCAS Protocol; Histamine Protocol; Gut Support Protocol.
Electrolytes — Acute / On-Demand
Typical dose: Situation-specific. Salt tablets, oral rehydration solution, or warm electrolyte drink during active flare, heat exposure, crash onset or high demand.
Symptoms: Sudden dizziness; pre-syncope; rapid heart-rate rise; heavy legs; blurred vision; nausea with orthostatic pattern; heat-induced collapse.
How to test: Acute response within 15–30 minutes is informative. Baseline: serum electrolytes, kidney function, blood pressure/heart-rate response, renin/aldosterone if indicated.
Useful for: Rapid blood-volume support. Sodium helps pull water into the vascular compartment; potassium and magnesium help balance cardiac, muscular and vascular effects.
Best context: Active POTS flare; crash warning signs; heat/travel; pre-exertion preparation; post-exertion recovery.
Risks: Avoid excess sodium in hypertension or fluid-retention issues. Potassium requires caution in kidney disease or relevant medication context.
Protocols: POTS Protocol; Crash Stabilisation Protocol; Acute Stabilisation Protocol; Electrolyte Protocol.
Medication
Low Dose Naltrexone / LDN
Typical dose: Start low, often 0.5–1.5 mg at night; increase gradually every 1–2 weeks. Common target: 4.5 mg, but optimal dose may be lower. Prescription and compounding required.
Symptoms: Brain fog; neurological fatigue; sensory sensitivity; post-exertional worsening; flu-like feeling; pain amplification; fibromyalgia-like symptoms.
How to test: No direct LDN test. Indirect: CRP, IL-6, TNF-alpha if available. Clinical response after 8–12 weeks is often most informative.
Useful for: May modulate neuroinflammation and glial / microglial activation. Used in ME/CFS, Long Covid, fibromyalgia and chronic pain contexts, though response is individual.
Best context: Neuroinflammation; ME/CFS with PEM; chronic pain amplification; Long Covid with persistent neurological symptoms.
Risks: Do not combine with opioid medication. May cause vivid dreams or sleep disturbance. Titrate slowly. Not effective in everyone.
Protocols: Neuroinflammation Protocol; ME/CFS Protocol; Glial Regulation Protocol.
Ivabradine / Corlanor / Procoralan
Typical dose: Often 2.5–5 mg twice daily, adjusted by cardiology or specialist supervision. Do not self-titrate.
Symptoms: Standing tachycardia; palpitations; heart-rate spikes with minimal exertion; near-fainting; POTS-driven exercise intolerance.
How to test: Tilt-table test; active stand / poor man’s tilt test; wearable heart-rate data; rule out anaemia, dehydration, thyroid dysfunction and adrenal issues.
Useful for: Selectively lowers sinus-node heart rate without the same blood-pressure-lowering effect as many beta blockers. This can make it useful in POTS patterns where blood pressure is already low or borderline.
Best context: Confirmed or strongly suspected POTS; persistent tachycardia despite fluids, electrolytes, compression and pacing; beta-blocker intolerance or hypotension tendency.
Risks: Prescription only. Not for bradycardia, sick sinus syndrome or certain arrhythmias. Can cause visual light flashes / phosphenes. Monitor resting HR.
Protocols: POTS Protocol; Cardiac Rate Management Protocol; Dysautonomia Protocol.
Famotidine / H2 Blocker
Typical dose: Often 20–40 mg twice daily. Commonly combined with an H1 blocker for broader histamine receptor coverage. Adjust dose in kidney impairment.
Symptoms: Histamine-related reflux, gastritis, nausea, bloating or stomach pain; flushing; tachycardia; dizziness; systemic histamine symptoms not fully controlled by H1 blockers.
How to test: Plasma histamine; serum tryptase; 24h urine N-methylhistamine if available. Pause before testing only with medical guidance.
Useful for: Blocks H2 histamine receptors, especially relevant in gastric and cardiovascular histamine effects. H1 + H2 blockade is commonly used in mast-cell strategies to cover different histamine receptor patterns.
Best context: MCAS protocol; gastric histamine symptoms; POTS with mast-cell driver; post-Covid histamine pattern; initial H1/H2 trial.
Risks: Reduce dose in kidney impairment. Can affect histamine testing. Long-term use may affect mineral absorption in some cases. Not the same as PPIs.
Protocols: MCAS Protocol; Histamine Protocol; POTS Protocol; Gut Support Protocol.
H1 Blockers / Antihistamines
Typical dose: Agent-dependent. Examples: cetirizine 10 mg, loratadine 10 mg, fexofenadine 120–180 mg. Sedating options such as hydroxyzine or ketotifen require medical guidance.
Symptoms: Flushing; hives; itching; congestion; watery eyes; histamine headache; inner agitation; insomnia with histamine component; POTS symptoms from histamine-mediated vasodilation.
How to test: Plasma histamine; serum tryptase; 24h urine N-methylhistamine if available. Pause before testing only with medical guidance.
Useful for: Blocks H1 histamine signalling in skin, respiratory tract, gut, cardiovascular system and brain. H1 antihistamines are commonly used as first-line symptom control in mast-cell disease.
Best context: Acute histamine reactions; suspected MCAS; POTS with histamine component; sleep support when histamine drives night activation; alongside botanical mast-cell support.
Risks: Sedating agents can impair cognition and cause next-day drowsiness. Check kidney/liver dosing. Antihistamines may need to be stopped before testing under medical guidance.
Protocols: MCAS Protocol; Histamine Protocol; POTS Protocol; Acute Stabilisation Protocol.
Interventions
4-7-8 Breathing / Vagus Training
Typical use: 1–2 short sessions daily. Start with 1–2 rounds only; increase gently.
Symptoms: Sympathetic overdrive; palpitations; poor sleep initiation; anxiety-like activation; post-exertional autonomic instability.
How to assess: HRV trend; resting HR; symptom diary; sleep onset.
Useful for: Gentle vagal training and downregulation. Supports parasympathetic access without strong physical load.
Best context: Daily baseline regulation; pre-sleep; POTS/dysautonomia support; crash prevention.
Risks: Breath-holding may trigger symptoms in severe dysautonomia. Start very gently.
Protocols: Vagus Rehabilitation Protocol; Stress Regulation Protocol; POTS Protocol.
Compression Garments
Typical use: Compression tights or stockings during upright activity; abdominal compression if needed.
Symptoms: Dizziness; leg pooling; tachycardia on standing; heavy legs; pre-syncope.
How to assess: Active stand test with/without compression; HR response; visible pooling.
Useful for: Mechanical venous return support. Reduces compensatory tachycardia without medication.
Best context: POTS; travel; heat exposure; upright activity; pre-exertion support.
Risks: Must fit properly. Too tight can worsen discomfort or circulation. Not standalone.
Protocols: POTS Protocol; Dysautonomia Protocol.
Pacing / Energy Envelope Management
Typical use: Use HR monitor; stay below individual threshold; rest blocks are part of treatment.
Symptoms: PEM; repeated crashes; unpredictable capacity; post-exertional worsening.
How to assess: HR monitor; HRV; crash diary; CPET in specialist setting.
Useful for: Prevents overexertion-triggered baseline worsening. Core ME/CFS intervention.
Best context: Active ME/CFS/PEM; unstable Long Covid; return-to-activity planning.
Risks: Do not confuse with push-through exercise. Traditional GET can worsen PEM.
Protocols: ME/CFS Protocol; Crash Prevention Protocol; Return-to-Activity Protocol.
Manual Lymphatic Drainage
Typical use: Qualified therapist; gentle sessions; frequency based on tolerance.
Symptoms: Tissue heaviness; puffiness; slow recovery; congestion; cold extremities.
How to assess: Symptom response; swelling/heaviness; therapist assessment.
Useful for: Supports lymphatic clearance and tissue-level recovery.
Best context: Post-viral residue; post-crash support; microcirculation pattern.
Risks: Avoid during active infection, acute inflammation, DVT, or active cancer unless medically cleared.
Protocols: Microcirculation Protocol; Lymphatic Support Protocol.
Blue Light Filter Glasses
Typical use: Evening use, especially after 21:00; amber lenses preferred.
Symptoms: Sleep-onset difficulty; night activation; non-restorative sleep; next-day dysautonomia.
How to assess: Sleep diary; wearable sleep data; HRV.
Useful for: Protects circadian rhythm and endogenous melatonin timing.
Best context: Sleep protocol; screen use at night; stress/HPA dysregulation.
Risks: Low risk. Consistency matters.
Protocols: Sleep Protocol; Circadian Rhythm Protocol.
Mindfulness / MBSR
Typical use: 10 minutes daily or structured 8-week MBSR programme.
Symptoms: Sympathetic overdrive; rumination; poor stress recovery; emotional dysregulation; sensory sensitivity.
How to assess: HRV; Perceived Stress Scale; sleep; symptom diary.
Useful for: Stress physiology regulation and ANS downshifting.
Best context: Chronic stress load; medical trauma; neuroinflammatory phase; sleep disturbance.
Risks: Trauma history may require guided or trauma-informed approach.
Protocols: Stress Regulation Protocol; ANS Rebalancing Protocol.
Ear Acupuncture / taVNS / TENS
Typical use: Ear acupuncture by practitioner or careful taVNS/TENS use; start low.
Symptoms: Poor vagal tone; palpitations; anxiety-like activation; neuroinflammatory symptoms; POTS instability.
How to assess: HRV; resting HR; symptom response; IL-6 if available.
Useful for: Direct vagal stimulation route when breathwork is insufficient.
Best context: Vagus rehab; POTS; neuroinflammation; sympathetic overdrive.
Risks: Caution with pacemakers or cardiac devices. Device quality and placement matter.
Protocols: Vagus Rehabilitation Protocol; Neuroinflammation Protocol.
EFT / EMDR
Typical use: Trauma-trained therapist; EFT may be self-applied after instruction.
Symptoms: Medical trauma; chronic threat response; health anxiety; stress physiology that maintains symptoms.
How to assess: PCL-5; GAD-7; PHQ-9; HRV; symptom-emotion tracking.
Useful for: Trauma processing and reduction of chronic HPA/sympathetic activation.
Best context: Medical PTSD; emotional load; stress-driven symptom loops.
Risks: EMDR can temporarily intensify distress. Use trained support.
Protocols: Trauma Protocol; Stress Regulation Protocol.
Intermittent / Therapeutic Fasting
Typical use: Gentle TRE/12–14h first; 16:8 only if stable. Extended fasting only with medical supervision.
Symptoms: Metabolic dysfunction; inflammatory baseline; gut dysbiosis; insulin resistance; post-viral inflammatory tail.
How to assess: Glucose/insulin; HbA1c; HOMA-IR; CRP; symptom response; weight trend.
Useful for: Autophagy, metabolic flexibility, gut rest and inflammation modulation.
Best context: Rebuilding phase; metabolic reset; stable baseline; not acute crash.
Risks: Often not suitable in active ME/CFS/PEM, undernourishment, low weight, POTS flare or adrenal instability. Maintain electrolytes. MCAS may flare.
Protocols: Metabolic Support Protocol; Autophagy Protocol.
Sauna / Infrared Sauna
Typical use: Start low: 5–10 minutes, low temperature; infrared usually better tolerated. Electrolytes before/after.
Symptoms: Poor circulation; muscle tension; inflammatory load; cold extremities; toxin-load pattern.
How to assess: HRV; heat tolerance; BP/HR response; recovery time after session.
Useful for: Heat hormesis, sweating, blood flow, mitochondrial and vascular conditioning.
Best context: Stable rebuilding phase; detox/microcirculation support; heat acclimation after baseline stability.
Risks: High caution with POTS, low blood pressure, MCAS/histamine flares, dehydration, acute crash or unstable ME/CFS. Stop with dizziness or palpitations.
Protocols: Detox Protocol; Microcirculation Protocol; ANS Retraining Protocol.
Cold Exposure / Cryotherapy
Typical use: Start with brief cold finish in shower. Cryotherapy only supervised. No cold immersion alone.
Symptoms: Inflammatory load; mood/activation issues; poor vascular tone; post-exertional muscle pain.
How to assess: HRV; symptom response; cold tolerance; recovery time.
Useful for: Hormetic anti-inflammatory and vascular training tool. Can support mood and metabolic adaptation.
Best context: Stable phase only; inflammation pattern with sufficient nervous-system resilience.
Risks: Not for nervous/adrenalised systems, panic tendency, active POTS flare, severe dysautonomia, acute crash or cardiovascular instability. Initial sympathetic surge can destabilise.
Protocols: ANS Retraining Protocol; Anti-inflammatory Protocol.
HBOT / Hyperbaric Oxygen Therapy
Typical use: Medically supervised protocol; often repeated sessions. Mild HBOT is lower-intensity but weaker evidence.
Symptoms: Persistent brain fog; cognitive impairment; poor oxygen delivery; neuropathy; slow recovery; post-Covid microvascular pattern.
How to assess: Cognitive testing; symptom scales; oxygen saturation; specialist imaging if available.
Useful for: Oxygen-delivery and rebuilding intervention. Supports tissue oxygenation, neurocognitive recovery and microvascular repair logic.
Best context: Rebuilding phase; persistent neurological symptoms; microcirculation/oxygen-delivery pattern after basics are stable.
Risks: Not first-line acute stabilisation. Medical clearance needed. Avoid during active respiratory infection; caution with ear/sinus issues, pneumothorax risk and certain medications.
Protocols: Neuroinflammation Protocol; Microcirculation Protocol; Cognitive Recovery Protocol.
Light Therapy / Photobiomodulation
Typical use: Morning bright light for circadian rhythm; red/NIR light 3–5x/week depending on device and tolerance.
Symptoms: Circadian disruption; morning lethargy; low mood; brain fog; poor sleep; tissue healing issues.
How to assess: Sleep diary; HRV; mood scale; cortisol rhythm if relevant.
Useful for: Circadian anchoring and mitochondrial support via light signalling.
Best context: Sleep/circadian protocol; neuroinflammatory brain fog; mitochondrial rebuilding; low morning activation.
Risks: Bright light only in morning. Avoid in bipolar disorder without psychiatric oversight. Eye protection and device quality matter.
Protocols: Circadian Rhythm Protocol; Neuroinflammation Protocol; Mitochondrial Support Protocol.