Positives

• One patient noted that taking a TMG/betaine anhydrous powder helped reduce the intensity of post-exertional malaise crashes. They noted that even after months, the effects were “genuinely helpful” and not just placebo Reddit.
  
  

Negatives

• Patients on betaine 6 g/day for 6 weeks commonly see LDL cholesterol and triglycerides rise, with the lipid increase potentially undoing the homocysteine-lowering cardiovascular benefit. PubMed.
• Examine.com notes that trimethylglycine commonly causes diarrhea, bloating, cramps, dyspepsia, nausea, or vomiting, particularly at the higher doses needed to meaningfully lower homocysteine. Examine.com.
• Patients on betaine commonly see total cholesterol rise modestly, raising concern for Long COVID patients with cardiovascular risk factors or post-viral lipid disturbances. PubMed.

Hurdles & Side Effects

• WebMD notes betaine anhydrous is likely safe up to 6 g/day, but cardiovascular safety hinges on monitoring blood lipids - meaning patients need a fasting lipid panel before and during use, which adds clinic visits and cost. WebMD.