The Team of Doctors and Biohackers Who Seem to Be Successfully Treating “Long Covid”

While trying to understand the mechanism of Long Covid, which obviously involved serotonin dysfunction balanced by mast cell activation as I wrote about previously - I met a group who seems to have the last pieces of the puzzle and the ultimate scientific validation: they appear to be giving people their lives back using low cost compounds anyone can buy at the pharmacy, the ultimate application and validation of a scientific theory.

Their research, COVID-19: NAD+ deficiency may predispose the aged, obese and type2 diabetics to mortality through its effect on SIRT1 activity, has received an excellent response and seems to be validated in mice, relevant abnormalities found in ferrets and the mechanism echoed by other researchers. Dysfunction of relevant systems are found in COVID19 and correlated with inflammatory markers. Clinical trials are under way to treat the same mechanism using more exotic and commercial compounds than the simple ones used with success in their case.

According to this theory, cofactors coupled to the oxidation/NAD+ cascade are critical to outcomes and this is seen in the observation that low selenium levels correlated to poor outcomes in China. Observations of high blood sugar being a predictor of death in COVID19 patients, regardless of diebetic status validate metabolic changes being a major risk factor of COVID19 according to NAD+ theory. Activation of the same kynurenine pathways predicted in NAD+ theory of COVID19 correlate to blood sugar deregulation.

Unrelated to the core mechanism, a recent publication in the journal Nature, stated: “vitamin B3 (niacin or nicotinamide) is highly effective in preventing lung tissue damage. It might be a wise approach to supply this food supplement to the COVID-19 patients.” A recent bioinformatics analysis also indicated niacin should be studied as a treatment for COVID19. A forward looking pre-print indicates nicotinic acid may act as a one of a kind bioenergetic “pump” of inflammatory molecules out of cells, critical for COVID19. Niacin has been seen to easily cure systematic NAD+ deficiency in clinical research. In 2010, this exact biochemical cascade surrounding NAD+ has been speculated as an HIV cascade in the paper, “The oxidative stress-induced niacin sink (OSINS) model for HIV pathogenesis”. Interestingly, the well respected Open Medicine Foundation collaborated with bioinformatics companies and scientists from leading universities to develop the Metabolic Trap theory of Chronic Fatigue Syndrome/ME which looks to be a leading theory based on the same mechanisms presented here.

An informal survey of over 200 long covid sufferers, showed a high correlation between niacin intake and improvement in a recent video by a patient advocate journalist. This same patient advocate journalist interviewed both myself and Dr. Ade Wentzel regarding biochemical aspects of this theory.


Simply, their theory is that COVID19 causes NAD+ depletion, some people with vitamin deficiencies, existing NAD+ depletion or genetic deficits in energy metabolism have long term NAD+ dysfunction. The body tries to make up for low NAD+ by feeding in tryptophan, which is the precursor for serotonin, causing low serotonin. Mast cells are activated locally to release serotonin instead, leading to histamine release and mast cell activation issues. Neurological effects are due to low serotonin and NAD+, which also effects the microbiome and general homoeostasis. Energy disruptions are specific to high metabolically active tissues such as the heart and brain. This is further complexed with disruption of the gut-immune axis, mobilization of bacteria, secondary infections - both bacterial and reactivation of dormant neurotrophic viruses. Reactivation of dormant Epstein-Bar virus can open the door to bacterial infections and it is known to trigger the creation of complex and unrelated auto-antibodies, leading to downstream issues.

The group treating this mechanism utilizes:
Nicotinic acid aka Niacin (most important and not nicotinamide or other forms) — 100mg
Vitamin C aka Ascorbic Acid — 1500mg
Vitamin D — 3000iu
Zinc — 15mg
Selenium — 50mcg
Quercetin — 500mg

Nicotinic acid is the most important with a good target dose to be 100mg. This will require tapering up as a dose as low as 50mg once a day could cause facial flushing and discomfort in the first few days of use, which may be even more pronounced due to the mast cell activation and other inflammatory mechanisms already seen in long-haulers. Some people with cardiac or mitochondrial myopathy may require a dose as high as 1000mg+/day for extended periods. Care must be taken to not take nicotinic acid if you are suffering from cardiovascular issues or using cardiovascular medication. SSRI’s are also a contraindication as the dramatically increased circulatory serotonin from supporting the NAD+ system can cause serotonin syndrome or other interactions with SSRI’s.

Nicotinamide, Nicotinic Riboside and Nicotinic Acid Mononucleotide and Nicotinamide Adenine Dinucleotide and NAD+ injections are all promoted as better NAD cycle supplements but these more expensive forms either enter the NAD+ cycle at the incorrect point for this mechanism, or have their own negative effects on the coupled PARP-1 system. Nicotinamde is well tolerated without flushing but has complex effects on the PARP-1 system and anecdotally does not seem as effective. Slow release no-flush niacin is actually inositol hexaniacinate and only breaks down to nicotinic acid after the first pass liver metabolism, liver burden should be avoided.

This same low cost treatment stack has been used by Mast Cell Activation Syndrome expert, Dr. Tina Peters, who recommends it for “long covid” and adds histamine blockers like famatodine. These H1/H2 blockers are good for turning off the fire alarms of mast cell activation but does not shut off the fire and seem to lose efficacy over the course of a few weeks in long covid.

Selenium and Zinc could potentially be sourced from a few Brazil nuts a day and Vitamin D from sun exposure.

*Talk to your doctor before any changes in supplementation or lifestyle, this is research analysis and not medical advice.

This theory can explain some of the strangest observations in COVID19:

— Why male balding as well as Vitamin D deficiency is so highly correlated with fatality. (Lack of NAD+ synthesis cofactors)

— Why the frontal cortex appears to have electrical slowing with no organic damage or viral invasion. (Energy cycle issues in metabolically active tissue)

— Why runners and other athletes seem to have “long covid” issues disproportionately. (NAD+ depletion)

— Why “long covid” and acute damage seems to evolve and present in all organ systems, specifically the nervous system and secondary infections are so common. (Energy cycle disruption, mast cell activation, disruption of gut-immune axis)

— Why children very seldom have adverse events but can present with rashes and other skin issues. (naturally high NAD+ pools)

— Why locations like Sweden, Africa, Indian villages etc have drastically lower death rates than expected without intensive distancing measures (They supplement bread with nicotinic acid unlike many Western Countries)

Why complex neurotoxicity is clearly seen without viral presence in the brain (neurotoxic metabolites from activation of alternative NAD+ pathways)

Video Interview:

Interview Discussing NAD+ Theory of COVID19 — The Biology of Long Covid | Why the NAD+ Deficiency Theory Could Be The Answer

Interview with Dr. Ade Wentzel:

Nikita Alexandrov: What is your background, involvement in COVID19 efforts and how did the group come together that is working on this NAD+ theory/treatment related to COVID19?

Dr. Ade Wentzel: Its really quite an interesting story pretty much like this whole experience. The city in which I stay was really under-prepared as we went into lockdown. As a specialist anaesthesiologist, I was really worried that we would not have enough gas points in out city to do what was needed. I had been in isolation and had time to watch a lot of footage of hospitals around the world struggling with lack of oxygen points.

Coming from a cardiac anaesthesia background and having managed an ICU for many years with a colleague of mine, it was evident that CPAP and high flow nasal canula was where we should be aiming for which presented a huge problem from a gas point of view and gas blending point of view. I also wanted the patients to be able to self prone themselves, something we had frequently needed to do in the ICU.

I started with my local friend, and scuba instructor. They are really disciplined solution finders. After 5 referrals down the line, I met up with Duncan Pattenden, from Orca Industries, who committed himself immediately and wholeheartedly.

Duncan’s go to man was Robert Miller, a never say never hacker supreme of all spheres. In 5 days the team designed a PPE and CPAP dive mask conversion with the help of Seac Italy. Help on the projects poured in- everyone got a job.

While doing the mask, building an assist ventilation device with VW and designing a 3000 bed factory hospital conversion, Rober Miller dropped the bomb….” I can explain why people are dying….LOW NAD+”

I loved biochem, and after 5 minutes I was a convert. I knew that this was the answer. As a clinician I had many clinical questions that needed answering. The most important was , “why are we doing this?”

Robert and I set out with the agreed decision that if we saved 1 person, that it would be worth any effort we put in. We set forth like 2 madmen possessed 18 hours a day for 5 months.

While building the masks, index person 1, the dive instructor, phoned me up and informed me that he had received a message via one of his clients related to Prof Guy Richards, that he had an urgent need to trial the PPE masks we were working on. Prof Guy Richards after hearing us out on our initial NAD+ hypothesis joined the team and we wrote the initial paper published in Medical Hypothesis. Even after we wrote the paper we continued to be fascinated by the cleverness of this virus and dived deep to to find a solution. We wanted to change the mortality risk rather than chase the virus like everyone else. We were not bound by anything, and we had freedom to hunt the solution everywhere.

Nikita Alexandrov: Can you share your research and other relevant papers?

Dr. Ade Wentzel: The paper, COVID-19: NAD+ deficiency may predispose the aged, obese and type2 diabetics to mortality through its effect on SIRT1 activity, had a very positive response, the research and science was strong, however it was still a hypothesis. We were looking at prophylaxis and treatment of Covid 19 and really trying to avoid and threat of the hyperinflammatory response in those that had a pre-existing low NAD+ which we had identified as the same well known risk group that Docherty et al had singled out in an observational study of hospital admissions in the UK.

Soon thereafter a paper by Brenner et al identified abnormality of the NAD+ metabolome with increased PARP activity in ferrets which supported our theories and most recently a study treating covid mice with NAD. We had no allegiance to any company, so total freedom to seek a comprehensive solution- we weren’t trying to push any agendas or sell any big pharma products.

Our observation of long-haulers after working with many of them, and having experienced the long-haul road personally, allowed us to gather strong evidence for our observations.

Nikita Alexandrov: You have a strong theory on the COVID19 mechanism, there are thousands of theories, most of them come from testing a companies drugs/current projects against coronavirus in cells and making assumptions without looking at the human body as a living system — you worked differently, you developed a theory and then validated it by showing it can give people their lives back, can you talk a bit more about your theory and its mechanism?:

Dr. Ade Wentzel: Let me take you through it. Those at most risk from Covid-19 all share a common underlying factor, low NAD+. NAD+ is a fundamental housekeeping molecule that catalyses electron transfer in metabolic reduction-oxidation reactions, functioning as an electron shuttle in the production of adenosine triphosphate (ATP) and is crucial for energy production.

One of the important things NAD+ does is enable sirtuin activation . Sirtuins are a family of seven NAD+ dependent signalling proteins that are intrinsically involved in metabolic regulation and cellular homeostasis.

When it comes to Covid-19 sirtuins perform 2 crucial functions 1) Sirtuins are a powerful weapon that the body uses to combat both DNA and RNA viruses. Covid-19 is a RNA based virus 2) Sirtuins are also a crucial component of the body’s mechanism to control inflammation and prevent cytokine storms.

During the activation of sirtuins NAD+ is consumed and zinc is bound to the activating sirtuin. Sirtuins need to activate sufficiently in response to a Covid-19 infection. If either NAD+ or zinc is in short supply activation will be impacted.

NAD+ naturally declines as we age, but this decline is unnaturally accelerated in those who are obese, have hyperinsulinaemia or high levels of oxidative stress. All the groups most vulnerable to Covid-19 would be expected to have low levels of NAD+. What we know- Covid-19 high risk factors-age 65+, Obesity, type2 diabetes, hypertension, and other conditions resulting from high levels of oxidative stress. The common factor to all the above conditions is low NAD+.

Fortunately we can all boost our NAD+ levels.This does not only apply to prevention before contracting Covid-19, but also applies to those suffering long haul symptoms many experience post recovery.

In addition to low NAD+ levels increasing your risk from Covid-19, we now know that the virus has another nasty action. Covid-19 depletes NAD+ through its activation of PARP. This NAD+ depletion causes a serious condition called pellagra and in addition low NAD+ is such a serious problem that your body hijacks tryptophan to make NAD+ at the expense of serotonin. It is no surprise that long haul symptoms take on a new light when compared to symptoms of Pellagra (NAD+/ niacin deficiency) and low serotonin (tryptophan depletion).

While writing the paper, we had researched pellagra, a nicotinic acid deficiency (niacin, B3), rarely seen today. A deficiency that causes low NAD+ resulting in numerous symptoms in metabolically active tissues. Incidentally the last major pellagra outbreak occurred in the south-east USA. When comparing symptoms of pellagra to long haul Covid-19, the symptoms are virtually interchangeable.

Dermatitis, diarrhoea, fatigue, apathy, raised temperature loss of smell, loss of taste, loss of hair, skin lesions, mouth ulcers, agression , insomnia, weakness, mental confusion, ataxia, paralysis of extremities, peripheral neuritis, oedema, nutritional deficiency cardiomyopathy, multi-organ failure, dementia and death.

We know that Covid-19 causes low NAD+ and that this low NAD+ results in Covid-19 Induced Secondary Pellagra (CISP), and that pellagra and long-haul symptoms are the same. These long haul NAD+ symptoms also respond to treatment with nicotinic acid (niacin) with great success.

Nikita Alexandrov: The NAD+ theory makes a lot of sense but at the end of the day science is about predicting and treating and your theory seems to have allowed for a working treatment of “long covid”. What have you observed in terms of “long covid” treatment, can you give some anecdotal examples in terms of how patients presented and how their recovery was dealt with?

Dr. Ade Wentzel: Managing long haul covid patient is really a huge challenge. Firstly you have to deal with the severe distress that the patient finds themselves in. In many cases patients are disappointed by the medical profession. This thrown on top of a low serotonin level makes the patient feel like they are about to die, with nobody to turn to and often angry, ratty and desperately seeking answers for a set of symptoms that are often intermittent, changing and bizarre in presentation. While this is all happening, they may be fatigued, have poor effort tolerance, fast heart rates, lack of smell and taste and hair that is falling out, often to be told its just anxiety. It is not only frightening from a patient perspective, but also as a care giver.

To manage it needs a huge amount of empathy and understanding of the underlying pathological process.

Explanation of symptoms comes as a relief, but with anxiety that there may be hurdles too great to overcome.

There needs to be unbundling of the Covid Induced Secondary Pellagra symptoms related to NAD+ deficiency and the serotonin depletion symptoms caused by a low tryptophan. Remember that this needs to take place with a patient that is often experiencing “brain fog”. The challenge is for both patient and clinician to both remain calm and push through this process.

Supplementation is a combination of Nicotinic acid and zinc for increased SIRT1 activity. Both zinc and sirt1 have antiviral properties. SIRT1 then manages endothelial repair, cellular autophagy and the downregulation of tumour necrosis factor alpha through its inhibitory action on tumour necrosis factor alpha converting enzyme (TACE). In so doing it also controls IL1 and IL6.

Quercetin increases NAD+levels by acting on regulatory enzymes. Addition of VitC, vit D3 and Selenium compliment by decreasing oxidative stress.

We advise people to supplement with nicotinic acid during the pandemic as it is cheap, safe and easy to do.This will reduce the risk of having a low NAD+ when contracting covid. The activation of SIRT1(zinc and NAD+ dependent) and the use of zinc both have direct antiviral properties and hence reduce viral replication and hopefully infection.

Unfortunately NAD+ is difficult to measure and hence tryptophan is measured as an indicator. This also is not freely available in many countries.

It is interesting to note that areas that were affected by endemic pellagra in the early 1900’s are also some of the areas hardest hit by Covid-19 namely South-east USA and Italy and areas that we thought would be worst hit for example Africa have gotten off relatively lightly.

Africa being a case of interest to us. In South Africa the bread, maize and and flour are heavily fortified with niacin(B3), zinc, Thiamine(Vit B1), riboflavin(VitB2), Pyridoxine (Vit B6), folic acid and iron.

Daniel — 58, Pennsylvania, USA
Daniel became sick at the end of January with difficulty breathing (feeling like he was not taking in enough oxygen), congestion , mild cough, stomach issues/diarrhea, loss of taste and smell, temperature regulation, night sweats, nightmares, vivid dreams, dizziness, foggy thinking, headaches, body aches, soreness, and fatigue. Around the 5th day, he was unable to function and does not recall the next 4 days. Daniel developed long haulers syndrome with recurring symptoms that lasted for 8 months. In October, he started a regime of: Niacin B3, Vitamin D, Vitamin C, Quercetin, Zinc, and Selenium. Vitamin C, Quercetin and Selenium are obtained from his diet. Care was taken not to consume too much Selenium. He eats 1 Brazil nut a day. The Vitamin D is obtained from 15 minutes a day in the sun and a D3 supplement of 1000iu/day. A 30mg zinc/day supplement. The niacin is the trickiest and most important part. He took the wrong type of B3 for 60 days. It wasn’t until he was guided to the correct type of B3 (nicotinic acid) that he was cured. He started taking the correct Niacin with a dosage of 50–75mg with each meal. Within days, his symptoms diminished and disappeared. The symptoms have not returned for a month+.

Raina — 45, Oregon, USA
Raina became sick March 28th starting with intense leg cramps and then sore throat, mouth sores, diarrhoea, chest pressure, shortness of breath, night sweats and other symptoms. She was admitted to the ER April 8th for cardiac pains and had ongoing cardiac pains, was tested using a holter monitor. Her motor skills were compromised and couldn’t walk properly with crippling pain in her legs, and at all times had debilitating fatigue and headache. In mid September Raina started having body tremors, particularly during sleep. Raina starting taking nicotinic acid 500mg and initially had a flushing reaction and tried other less effective forms of vitamin B3. Restarting at 25mg a day of nicotonic acid and working to 1000mg a day, Raina had most symptoms dissipate in a week, including dramatically increased energy, less pains and tremors reducing to a level where she could sleep as well as sores healing up quickly. Raina is improving a very close to where she was before she became ill.

Danielle — 48, Cape Town, South Africa.
Danielle first stated feeling ill in mid March 2020 when she woke up with flu like symptoms such as a sore head and throat and struggled to get out of bed. Since then her health has been up and down like a rollercoaster experiencing a variety of the Covid symptoms at varying times. It came in waves where she would had no appetite for food, lost taste, had night chills, insomnia, nausea, diarrhea, headaches, limb pains, tight chest, conjunctivitis in my left eye and hallucinations. Her brain felt foggy and she had trouble focusing and planning. She felt emotionally drained and thought she was going crazy. She started taking the supplement stack and immediately and for the first time in months quickly started to feel like she had a chance of beating this virus and being healthy again.

-END Interview

Gez Medinger, a journalist suffering from “long covid” has made a series of videos regarding this mechanism, which has received a lot of support and interest:

Video: First Effective Treatment for Long Covid | Stunning Data from Huge New Study

Video: The Biology of Long Covid | Part 2: The Answers — with Dr Ade Wentzel

Video: The Biology of Long Covid | Why the NAD+ Deficiency Theory Could Be The Answer

Selected Comments:

Today I cried. After watching the last video, I have started taking Niacin and slowly increasing it. I was already taking some of the other supplements suggested. I also have cut out green tea as I was drinking a lot of it (trying to counter inflammation) and started taking a normal dose of antihistamine. Now 9 months into this journey, at last something has changed. I feel different. Today I walked far, far further than I have done since March (I could only manage a few hundred yards before) and the leg pains and muscle aches haven’t come on. This is truly amazing. After months of being dismissed by my GP and now on a waiting list for a LongCovid clinic, I am so grateful for the research you’ve done and shared. You really are onto something here and I can’t thank you enough!

I can attest to the profound benefits of this protocol with some additional features. I was asked by some on this program to convey what worked for me. It is Dec 22, and I am a covid long hauler now symptom free after 11 months of varying issues. I am almost 70 and experienced 2 waves of covid. Initial suspected case January 2020 with mild symptoms of 2 weeks duration, latency, and a second full bloom of symptoms rampant by mid March this year. Second episode more intense with full panoply of typical symptoms.4 weeks of moderate bedridden state and a cycle of wierd symptoms in clusters. No hospitsalization fortunately. Heart area and lung stress fatigue, general malaise, and random rashes coming on and off until mid summer slowly resolving and new more prominent symptom clusters of brain fog and headaches as new issues. On and off symptoms until Ocober when I found this web site.

6 days of the stack and feeling 90% there! Just waiting a while until I feel confident enough for a workout. Lifesaver Gez, merry christmas

A month ago I was in the hospital unable to walk, and a week ago I was so sick I was in bed for 20 hrs a day. Started the supplement stack a week ago and today I am at 95 percent, huge recovery (250 mg Niacin, only amount I could find). Prayed like a scene from stained glass. 33 yrs old; Covid in early October.

I hereby nominate you for the 2020 “Long Covid Ray of Hope” Award, which really should be a thing, and you truly should win it. Thank you for sharing cutting-edge, scientifically tested tips for how long covid sufferers can find our way back to good health. Thanks to your excellent videos and the information you’ve provided, I’m finally starting to feel like my old self

Great data! And agreed. I’m doing the works since 14 December and I feel so much better. Have been on my knees with covid / long covid since May. Thank you — you, Dr Peers and the NAD+ guys are bloomin’ heroes!!

This works! I’m back to normal in every way. Gone is the muscle pain, leg pain, and symptoms that come and go.
A long hauler COVID-19 survivor, removing histamine triggering foods and beverages from my diet. It took anaphylaxis, an extremely severe allergic reaction, where the immune system releases histamine, basophils, mast cells, and other substances. The excessive reaction of the immune system to an allergen causes tightening of airways and difficulty breathing.

You’re amazing. Thank you for the work you’re doing. I started “the stack” a couple weeks ago, and things are improving (though it hasn’t “cured” me.) It definitely feels like symptoms are reduced in frequency and severity.

Well done, yet again, Gez.
I completed your survey as one of the supplements group and had seen some good improvements. I added Niacin 4 days ago and it has already made a significant difference to my energy levels.
Thanks for all of your efforts and I hope you’re also improving!

Thank you so, so much. After your last video, I went out and bought all the Vitamins, including Niacin. I started slowly and on day three started glowing like a glow-worm in the dark. I was also very itchy. I have started taking an anti-histamine with the Niacin and this seems to help.

I am one of those that it has helped. I had a step change massive improvement to health after 10 months of long-covid. I actually took nicotinomide (and did the rest of the regime) have now switched to the one you recommended here. Doesn’t matter, it worked!!!! I have been healthy for 10 days now. I can’t explain how amazing this is

Thanks a lot Gez! Niacin has been a life saver. It didn’t help with heart rate issues yet but definitely made a difference with fatigue. For the first time in 9 months I felt alive. Fatigue was one of the worse symptoms. I couldn’t even do more than single chore without feeling like dying. Now I don’t have Pem relapses post chores as I did earlier. Will add exercise to my regime and see if I get Pem.

I am on day 33 on Niacin B3 with flush and have had a vast increase of energy and the fatigue has vanished although one thing I did do during this time was a 48hr water only fast and can honestly say I felt like superman on the second day which for me is unshakeable evidence that LONG COVID is indeed a histamine issue. No food no issues.

I have started taking the supplements listed, plus Brazil nuts and cut out foods they said to. I’m vegan and also now gluten free. I also try not to eat too much salt. These things have made a HUGE difference for me! Leave it to the UK!! The U.S. loves it’s “drugs” which I do not believe in. “Body heal thyself.”

While NAD+ deficiency appears to be the causative mechanism, a disruption at such a low level of the bodies energy system will cause many other knock-on effects such as: pre-disposition to metabolic disease, disruption of the microbiome, disruption of the gut-brain axis, mobilization of bacteria, secondary infections including bacterial as well as reactivation of the dormant neurotrophic viruses most of the population carries such as Epstein-bar and herpesviruses.

While secondary bacterial infections were the main cause of death in the Spanish flu, and Dr. Anthony Fauci wrote a review of the importance in viral pandemics — secondary infections of all types seem to be ignored during this pandemic and should be detected and treated as a priority. This seems to be a symptom of not treating the body as a living system inside of the current medical and pharmaceutical industry.

Supporting the immune system with low cost natural products may be the single most impactful thing that can be done during a global pandemic and the work of this team indicates that bringing the body into balance and supporting the immune system may be more effective than attempting to fight a virus head-on.

Biochemical mechanism of suspected COVID19 mechanism and druggable targets, modified from the Oxidative Stress-induced Niacin Sink OSINS model of Taylor et al.

Nikita K. Alexandrov, Bchem, MBA

Elegant solutions for complex problems.

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