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Two years ago, Health Rising posted about Fred Friedberg’s small hydrogen water clinical trial for ME/CFS. Hydrogen water appears to potentially present a relatively cheap, easy, and safe way to possibly help with a number of issues in ME/CFS: reduce inflammation, enhance metabolic functioning, reduce lactate levels after exercise, improve mitochondrial functioning and even reduce pain. A recent review paper suggested it may also be able to help improve micro-circulation – a topic of obvious interest in ME/CFS and long COVID.

Hydrogen Rich Water – Could it Help With ME/CFS and/or Fibromyalgia? The Friedberg Pilot Study Begins

Since then a number of things have happened. The coronavirus pandemic triggered more interest in the use of hydrogen gas as a therapy, a review paper, “Molecular Hydrogen as a Medical Gas for the Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Possible Efficacy Based on a Literature Review“, coming out of Japan specifically proposed that hydrogen gas be trialed in ME/CFS, and Fred Friedberg has launched a new hydrogen water ME/CFS clinical trial.

Hygrogen rich water

Hydrogen water has gotten more interest in ME/CFS and COVID-19 lately.

The ME/CFS hydrogen gas review pointed out that hydrogen gas has been shown to reduce fatigue during exercise in several animal studies, that blood glucose, lactate, and oxidative stress were reduced, that glutathione was increased and pro-inflammatory cytokine levels were reduced.

Perhaps the most interesting studies from an ME/CFS perspective were done in healthy subjects many hours after exertion. One study found improvements in antioxidant capacity after exercise. Given the consistent reductions in antioxidant levels and increased oxidative stress found in ME/CFS, and the hit to the antioxidant system produced by exercise, any improvement in antioxidant status in ME/CFS could be helpful.

Bindu Paul and Marian Lemle have proposed that impaired antioxidant functioning may play a key role in ME/CFS. They believe a new generation of more effective antioxidants could be quite helpful. Interestingly, they’re focused on a different form of hydrogen – hydrogen sulfide.

Could a Free Radical Explosion Be Causing ME/CFS and Long COVID?

 

Another possibility is an increase in mitochondrial functioning. Hydrogen-rich water (5.9 ppm) intake for two weeks in healthy subjects significantly increased their peak energy levels (peak oxygen intake). Since it’s the ability to produce energy aerobically that appears to have been hit hardest in ME/CFS, anything that could improve that even in small amounts could be helpful. One hydrogen water study, though, found it improved aerobic energy production only in trained athletes.

Another possibility is improved autonomic nervous system functioning. A double-blinded, placebo-controlled Japanese study presented to the Japanese Fatigue Society found that hydrogen-rich water (600 mL/d) for 4 weeks reduced sympathetic nervous activity and anxiety, and improved mood. Watanabe, the senior author of that study, has been studying fatigue as well as ME/CFS for many years.

The Mitochondria in ME/CFS – Could Hydrogen Gas or Hydrogen-Rich Water Help?

Free radical scavenging

One paper asserted that hydrogen’s unique ability to get into the mitochondria made it the perfect free radical scavenger for ME/CFS.

The 20 citations involving the mitochondria in ME/CFS that the authors of the hydrogen ME/CFS paper refer to attest to the breadth of possible mitochondrial abnormalities that have been found. Still, since we don’t know exactly what’s going on with them, it’s not clear which treatments might help.

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The authors, though, believe that hydrogen gas/water might be the ticket to fight the “decreased proton leakage, ATP production, and mitochondrial membrane potential and increased mitochondrial mass” as well as the increased inflammatory cytokines found in ME/CFS. They believe that hydrogen’s unique ability to scavenge the hydroxyl radical (OH) produced by the mitochondria during energy production could make it an essential factor. They assert that hydrogen (h2) is the only scavenger able to make it into the mitochondria and bind up this free radical.

The Gist

  • Two years ago Fred Friedberg began a small trial of hydrogen-rich water in ME/CFS. Now he’s back with a larger trial – this time combined with heart rhythm biofeedback. 
  • With its possible ability to reduce inflammation, enhance metabolic functioning, reduce lactate levels after exercise, improve antioxidant levels, mitochondrial functioning, the microcirculation, and reduce sympathetic nervous system activity, and even possibly pain, hydrogen-rich water provides a potentially safe and relatively cheap aid for people with ME/CFS and similar disorders. 
  • Few human trials have been done, though, and its effectiveness is unclear. A recent review targeting ME/CFS hypothesized, though, that hydrogen-rich water might be able to improve mitochondrial functioning by sopping up free radicals that may be interfering with mitochondrial functioning in ME/CFS. 
  • The vast majority of interest and research into hydrogen-rich water has come out of Japan and China.  With four out of five clinical trials in the U.S. coming out of Stony Brook – the University that Fred Friedberg PhD hails from – Stony Brook is clearly the epicenter of hydrogen water research in the U.S.
  • Friedberg’s 39-person hydrogen-rich water/heart rhythm biofeedback 8-week trial consists of 3 arms: a hydrogen-rich water arm that requires taking tablets, a heart rhythm biofeedback arm that uses an app on a smartphone, and a combined hydrogen-rich water and heart rhythm biofeedback arm. 
  • The trial is open to people with chronic fatigue, chronic fatigue syndrome, and similar disorders, who are from 18-65, and have a BMI <30. The study is done online. Contact Fred Friedberg at fred.friedberg@stonybrookmedicine.edu or (631) 638-1931 if you’re interested in participating. 

Slowly Growing Interest in the West

It’s remarkable how much more interest in the use of hydrogen water as a therapeutic option exists in Japan and China than in the U.S. A 2021 review by Chinese researchers listed the many possible neuroprotective effects hydrogen water may have. Stony Brook researchers apparently agreed with that idea as a 2018 Neurology/Neurosurgery Grand Rounds presentation focused on it in “Hydrogen Water: Is There Evidence for Therapeutic Potential in Neurology?. Stony Brook – where Dr. Friedberg hails from – is something of an anomaly, though. With four out of the 5 hydrogen-rich water clinical trials in the U.S. taking place at Stony Brook University, it’s clearly the center of hydrogen-rich water research in the U.S.

Fred Friedberg’s New Hydrogen Water ME/CFS Trial

I don’t think anyone thinks hydrogen water is going to be the answer to ME/CFS, but it could help. Perhaps hydrogen water, plus some mitochondrial enhancers, might work well together (?). It may very well be that “the answer” to ME/CFS and FM and long COVID will consist of a variety of treatments that work together to boost a patient back to health.

Dr. Freidberg’s new hydrogen water trial is a bit bigger and more comprehensive than his 2020 one. The 10-week, 39-person trial which began at the end of May and is slated to end up next year, will have three treatment arms: a hydrogen water arm, a heart rhythm biofeedback arm, and hydrogen water – plus heart rhythm biofeedback – arm.

The hydrogen water arm simply consists of taking hydrogen pills mixed in water 3x a day for eight weeks.

The heart rhythm biofeedback arm is administered via an app downloaded to your smartphone. A wireless sensor attached to the ear monitors your heart rate, which is displayed on the phone screen app. Biofeedback is used to achieve optimal levels of heart rate variability – an important index of overall health.

Studies indicate that HRV is usually low in ME/CFS – suggesting that the sympathetic nervous system or fight/flight system has been turned on. Low HRV could be impacting sleep, energy production, immune regulation, the ability to relax and recover, etc. in ME/CFS. The heart rhythm biofeedback portion of the study also lasts for eight weeks.

Various self-report questionnaires (short-form SF-36; Depression, Anxiety and Stress Scale; Brief Resilience Scale) will assess effectiveness. If the trial is successful, Dr. Friedberg plans to apply for a larger NIH-funded trial.

Eligibility – 18-65 and a diagnosis of chronic fatigue, chronic fatigue syndrome (ME/CFS), or something similar. BMI must be less than <30.

The study is done entirely online. There is no need to visit the facility at Stony Brook in New York. If you’re interested in participating contact Fred Friedberg, PhD at fred.friedberg@stonybrookmedicine.edu or (631) 638-1931

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