Tiredness that rest does not fix, widespread pain, sleep that does not restore. For people affected by chronic fatigue syndrome or fibromyalgia, diagnosis is often slow and explanations scarce. Research is increasingly looking at energy production.
What researchers observe
A review published in August 2026 in Nutrients brings together the available data. In these patients, several teams have noted converging signs: less efficient energy production in cells, an excess of free radicals, a dysregulated immune system, and a drop in NAD, the molecule that allows mitochondria to transfer electrons. None of these signs explains everything on its own, and the strength of the evidence varies. But together they draw a coherent picture: an energy machine running badly and feeding inflammation.
Micronutrients, a serious and cautious lead
Mitochondria need cofactors to work: B vitamins, magnesium, coenzyme Q10, among others. For each one, the authors examine what is known of its biological role and what clinical trials say. Their conclusion is honest: the mechanism is plausible, but controlled trials specific to these conditions remain few and small. They announce a randomised, placebo-controlled trial, planned for 2027, in fibromyalgia patients with marked fatigue.
What this changes for patients
First, recognition: the fatigue of these conditions has measurable biological foundations; it is neither laziness nor imagination. Then a method: the researchers argue for a personalised approach, based on blood markers and a metabolic profile, rather than supplements taken at random. Finally, caution: nothing replaces medical follow-up, and the results of the coming trials will tell what really works.
Key points
- Chronic fatigue and fibromyalgia come with measurable signs of mitochondrial dysfunction.
- The micronutrients that keep mitochondria running are a plausible lead, not yet a proof.
- A controlled trial is announced for 2027; until then, personalisation and medical follow-up come first.
Sources
- Abanades S, Fernández I, Capdevila N, Cardona F. Micronutrition as a therapeutic strategy for mitochondrial dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia: a narrative review. Nutrients, 2026. https://doi.org/10.3390/nu18162702
- Vine J et al. Baseline measurements of cellular respiration affect the response to thiamine treatment in post-arrest patients. Resuscitation, 2026. https://doi.org/10.1016/j.resuscitation.2026.111029
