Recent findings involve research with the endoplasmic reticulum that appears to go off the rails when over-stressed breaking the mitochondria within a cell robbing it of ATP production and increasing lactate (related to metabolic acidosis) in the body:

My current reasoning is somehow to recover you've got to pace yourself just enough to encourage new mitochondria to form, but not so much that you experience PEM/crashing. The ME/CFS people have been discussing pacing for years. So:

Fail With

staying in bed for weeks doing as little as possible (a very slow success?-- mitochondria aren't encouraged to form)
trying to train it away with exercise/exertion (a quick fail-- the stressed ER will break mitochondria and flood body with lactate and set you back with a slew of acidosis-caused symptoms that will take time for the body to resolve. e.g. kidneys excreting the acid, COVID diabetes from gluconeogensis of lactate into glucose in order to raise the body's pH away from acidosis)

Possibly Succeed With

small exertions (signal need for more mitochondiria) before PEM followed by "intense" resting, cold exposure (ice baths or cold showers) and kidney-friendly diets (see: https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition ) to help the body process the acidity of lactate out to reduce ER stress.

This was a purposefully supplement-free/drug-free plan.

[–] [email protected] 6 points 1 year ago

I am prescribed high dose creatine and CoQ10 to support ATP production in mitochondria by my physician who studies ME/CFS. It's not perfect, but it's a hell of a lot better than I was before. And it's a very safe regimen to recommend.