News and views in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): The role of co-morbidity and novel treatments, by F Comhaire, JP Deslypere in Medical Hypotheses Vol 134, January 2020, 109444 [doi.org/10.1016/j.mehy.2019.109444]
Though affecting many thousands of patients, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) should be considered an orphan disease, since the cause remains elusive and no treatment is available that can provide complete cure.
There is reasonable insight into the pathogenesis of signs and symptoms, and treatments specifically directed to immunological, inflammatory and metabolic processes offer relief to an increasing number of patients. Particular attention is given to the importance of co-morbidity requiring appropriate therapy.
Promising results are obtained by treatment with Metformin, or possibly Momordica charantia extract, which will correct insulin resistance, with Meldonium improving the transportation of glucose into the mitochondria, with sodium dichloroacetate activating pyruvate dehydrogenase, and with nutraceutical support reducing oxidative and inflammatory impairment.
Extract from materials & methods:
Sixty four (64) consecutive patients participated in a prospective pragmatic open-label trial. They had been diagnosed to suffer from ME/CFS by certified expert university centres, and consulted at the private clinic of one of the authors (FC). All patients underwent a thorough and systematic evaluation at intake. This included history taking and completion of the fatigue severity score (FSS) , propaedeutic physical examination, echography, blood analysis including immunological and endocrinological tests with postprandial C-peptide measurement  and essays for the detection of infections, NeuroSPECT fusion imaging of cerebral blood supply  and quantitative electro-encephalography (sLORETA) .
Patients were offered the option to start a treatment trial with a nutraceutical composed of sodium dichloroacetate, Vitamin B1, Alpha lipoic acid, and Ubiquinone Q10 as described earlier . Six weeks after the intake consultation, patients came back to discuss the results of the examinations, to report on their experience with the nutraceutical, and to complete the FSS once again.