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Table 1 Metabolic Changes That May Affect Fatigue in ME/CFS Patients

From: Oxaloacetate Treatment For Mental And Physical Fatigue In Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long-COVID fatigue patients: a non-randomized controlled clinical trial

Metabolic change Effect on ME/CFS patient Normalization by oxaloacetate
Warburg Effect Increased lactate production Reduction in lactate production via inhibition of lactate dehydrogenase in the cytosol
Decrease in NAD + /NADH ratio Increase ROS production Reset of NAD + /NADH ratio and quenching of ROS by antioxidant Oxaloacetate
Increased NF-kB movement to nucleus Activation of chronic inflammation Reset of inflammation pathway to normal by Lowering NF-kB translocation to nucleus
Mitochondrial damage Reduced ability to process glucose Increased number of mitochondria to produce energy via PGC1-alpha increase
Reduced AMPK activation Reduced cellular glucose uptake Increase in glucose uptake via AMPK activation and more glucose fuel available for the patient
Increased neurological ROS production Damage from free radicals Oxaloacetate is a highly effective antioxidant