N-acetyl cysteine or NAC is a most interesting compound. Most often thought of as an antioxidant it appears to be able to enhance mitochondrial production as well. Perhaps the most powerful antioxidant available and certainly the most widely studied, NAC is able to rejuvenate the levels of glutathione – the most powerful antioxidant in the body. It appears to do its work mostly in the mitochondria where recent research indicates it also triggers the production of hydrogen sulfide which, in turn, produces antioxidant effects and perhaps enhances ATP production as well.

A 2019 hypothesis paper proposed that supplements like coenzyme Q10, melatonin, curcumin, molecular hydrogen, and N-acetylcysteine could be helpful in ME/CFS patients with inflammation, increased oxidative and nitrosative stress, leaky gut, and mitochondrial dysfunction.

Shungu, interestingly, does not believe ME/CFS is a mitochondrial disorder. The mitochondria are affected in ME/CFS but at its heart, Shungu believes ME/CFS is an oxidative stress-induced micro-circulatory disease. High levels of oxidative stress are causing the blood vessels to shut down, making it impossible for the oxygen the mitochondria need to get through. Shungu’s hypothesis, which was produced some time ago, is circling around the same blood flow issues that other hypotheses are.

oxidative stress hypothesis

Although very few studies have shown elevated cytokine levels in FMS, the data available suggest that a high chemokine level may play a causative role in this disease

A review of the FMS literature and related studies suggest that IL-1, IL-6 and IL-8 are deregulated in the syndrome. Therefore, therapies directed against these cytokines and others may be of potential importance in the management of FMS