News and views in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): The role of co-morbidity and novel treatments (2019) Comhaire et al.

Abstract
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.
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@Jaybee00 oh thanks for letting me know haha. Didnt hear his name before. Was just browsing through some studies and found it an interesting read. Because my main symptom right now is frontal brain pain and brain fog to the grade that i forget my own name :/ thats why the Meldonium treatment seemed interesting to me with the brain scans. Also didnt find anyone here in the forum who ever tried it before.
 
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I don't quite understand the rationale of using these drugs.

Meldonium inhibits fatty acid oxidation (through inhibiting carnitine acetyltransferase, Carnitine Transporter 2 and γ‐butyrobetaine hydroxylase).
There is some evidence that fatty acid oxidation is already (compared to controls) relatively inhibited in ME & CFS patients.
https://pubs.rsc.org/en/content/articlelanding/2017/mb/c6mb00600k/
https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2796.2010.02341.x (suggests that there is already higher peroxisomal utilization of fatty acids, suggesting lower carnitine palmitoyltransferase-I activity)

The therapeutic rationale is to encourage glycolysis but that doesn't seem to be a problem in patients (Fluge & Mela, Hanson etc).

See also (mechanisms of action) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188923/ (Misuse of the metabolic modulator meldonium in sports)
 
We have previous threads on Comhaire's research using his mix of sodium dichloroacetate and some nutritional supplements in a mixture he was trying to patent.

If you read the discussion on those threads, you will see that forum members were unimpressed by his overblown claims of efficicacy based on small short term open label trials with subjective outcome measures.

He tried to do some fancy predictive mathematical models for which patients would respond but seemed not to understand that you have to make the model on one set of data and test if it works on a different set.

https://www.s4me.info/threads/a-nov...ment-of-me-cfs-frank-comhaire-sept-2017.1036/

https://www.s4me.info/threads/treat...th-sodium-dichloroacetate-comhaire-2018.2885/
 
Mhh ok sounds pretty dubious after looking into your links. Did some ppl from the forum really try dichloracetat or Meldonium ?
 
Though affecting many thousands of patients
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I, um, yeah, well, there are definitely more than 5 grains of sand in a handful and a blue whale is definitely at least more than 20kg.

Not much to interpret. Open label with self-reported outcomes. The fatigue questionnaire doesn't look particularly relevant. Doesn't look bad so much as not particularly useful.
 
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