Comhaire, Frank · Medical hypotheses · 2018 · DOI
Researchers gave 22 ME/CFS patients a supplement containing sodium dichloroacetate to see if it might help their symptoms. About half of the patients (10 out of 22) felt significantly better and their fatigue scores dropped to roughly half of what they were before. The other half of the patients didn't improve, and doctors found that many of them had other underlying health conditions. This small study suggests that for some ME/CFS patients, a problem with how their cells produce energy might be treatable with this supplement.
This study addresses a persistent challenge in ME/CFS treatment by proposing a mechanistic hypothesis—mitochondrial dysfunction—and testing a targeted intervention. For patients with refractory ME/CFS, even preliminary evidence of a potential treatment warrants further investigation. The finding that approximately half the cohort responded well suggests heterogeneity in ME/CFS pathophysiology and the possibility that future diagnostic criteria could better identify responders to targeted therapies.
This study does not establish that sodium dichloroacetate is an effective ME/CFS treatment, as it lacks a control group, blinding, and placebo comparison—all essential for determining true treatment efficacy. The open-label design creates substantial risk for placebo effects and observer bias. The small sample size and failure to respond in half the cohort mean these findings cannot be generalized to the broader ME/CFS population, and the study cannot definitively prove mitochondrial hypo-metabolism causes ME/CFS.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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