Hydrogen Water Treatment for Chronic Fatigue Syndrome

SPECIFIC AIMS

The aim of this pilot randomized control trial (RCT) is to explore the possible beneficial effect of a novel therapy, molecular hydrogen (H2) for the symptoms and related functional limitations in patients with chronic fatigue syndrome.

BACKGROUND AND SIGNIFICANCE Oxidative stress and impaired energy metabolism have been implicated in the pathophysiology of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a debilitating illness without clearly identified etiology or effective medical treatments. As such, treatments that reduce oxidative stress and yield improvements in energy production may show potential to ameliorate the symptoms and functional limitations of this illness. Numerous publications on the biological and medical benefits of H2 have shown that H2 reduces oxidative stress not only by direct reactions with strong oxidants, but also indirectly by regulating various gene expressions. In addition to its potential therapeutic properties for ME/CFS, H2 water is portable, easily administered and safe to ingest.

PRELIMINARY STUDIES

The proposed study is a pilot study in ME/CFS for which there are no directly applicable preliminary studies utilizing the proposed H2 therapy.

RESEARCH DESIGN AND METHODS

Eligible subjects will be recruited by advertising. Assessments will be conducted by telephone, via home-based monitoring, and online diaries. The PI has 16 years' experience recruiting ME/CFS patients for his NIH funded studies. Given the absence of effective interventions for this illness and the absence of in-person visits in the proposed study, the possibility of being helped by the benign treatment of H2 is likely to attract many patients with ME/CFS.

Study Sample

Subjects who meet the inclusion/exclusion criteria below and provide consent will be recruited and randomized sequentially 1:1 to receive either H2 or placebo. The investigators will seek to enroll a total of 25 patients meeting enrollment criteria and randomized to H2 vs placebo arms. The investigators project a study duration of 8-10 months.

Screening

Inclusion criteria: These are: patients aged 18-65 of both sexes considered physically capable and willing to perform the study tasks, including wearing a heart monitor and an actigraph (at baseline and post-treatment weeks). Subjects must also meet our validated phone-screen eligibility for ME/ CFS criteria. A physician note confirming a CFS diagnosis will be requested.

Medical exclusions, determined by validated phone screen interview, will consist of cases of fatigue clearly attributable to self-report medical conditions such as untreated hypothyroidism, unstable diabetes mellitus, organ failure, chronic infections, and chronic inflammatory diseases, or AIDS. Exclusionary psychiatric disorders include any psychosis, or alcohol/ substance abuse within two years prior to illness onset and any time afterward, and current or past depression with melancholic or psychotic features within 5 years prior to onset of ME/CFS or anytime afterward. Pregnancy, as determined by reliable home test kit sent to subjects, is also an exclusion. Two other exclusionary criteria will be used: a) patients on heart medication or patients not dose-stabilized for at least 3 months on antidepressant drugs; b) patients at significant risk of suicide or in need of urgent psychiatric treatment. As much as possible, appropriate medical and psychiatric referrals to facilities local to subjects will be provided.

Procedures/Outcome measures

This will be a double blinded, placebo-controlled trial. Subjects will be sequentially randomized in a 1:1 ratio to receive H2, or corresponding placebo, additional to all standard-of-care treatments. All study-related participant activities, including questionnaires, activity and heart monitoring, and online diaries will be completed by participants in their homes. No face-to-face visits to Stony Brook are involved. H2 water is Generally Recognized As Safe (GRAS) and is increasingly available on the general consumer market. Self-report questionnaire assessments for ME/CFS symptoms, fatigue, autonomic symptoms, physical function, anxiety, and depression will be done in the week before and the week after the 30 day trial. In addition, an online web diary to record ME/CFS symptoms and home-based objective assessments of heart rate variability (a measure of parasympathetic function) and accelerometry (a physical activity assessment) will be scheduled before, during, and/or after the intervention period.

STATISTICS The study will define improvement by a 50% reduction in ME/CFS symptoms. Repeated measures analysis of variance (ANOVA) will compare pre- and post-treatment measurements of effectiveness and general health markers.