Case-report summary: Hydrogen inhalation for ME/CFS — a 4-case report

Myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) is defined by unexplained, debilitating fatigue lasting more than six months, accompanied by neurological and psychiatric symptoms — low-grade fever, headache, cognitive impairment, post-exertional malaise and depression. There is no established curative therapy.

Symptomatic overlap with long COVID has driven renewed interest in disease-modifying interventions. Hydrogen has been studied in both contexts, making case-report evidence in ME/CFS directly informative for the post-viral fatigue population that has expanded sharply since 2020.

H₂ is a small, neutral diatomic gas that diffuses rapidly across cell membranes, the blood–brain barrier and into mitochondria. Unlike non-selective antioxidants, hydrogen reacts preferentially with the most cytotoxic reactive oxygen species — the hydroxyl radical (·OH) and peroxynitrite (ONOO⁻) — without disturbing physiologically important ROS signalling.

Recent neuroimaging, blood biomarker and energy-metabolism studies indicate that ME/CFS patients carry measurable mitochondrial and immune abnormalities. A redox-active gas that reaches mitochondria and damps neuroinflammation is therefore a mechanistically plausible candidate.

Symptoms began in April 2012 with extreme fatigue, headache and cognitive fog. After years of unsuccessful workups he was diagnosed at the National Center for Neurology and Psychiatry (NCNP) in 2019. From June to November 2021 he inhaled 6–7% H₂ at 2 L/min for 3–5 hours daily.

Canadian Consensus Criteria severity score (21 symptoms, 0–63 scale): 29 at baseline, 23 after four weeks, 16 after 20 weeks. Most marked improvements were in post-exertional fatigue, headache, muscle pain and cognitive function. A temporary worsening followed each COVID-19 vaccination but reversed within 1–2 weeks of continued hydrogen therapy.

By week 16 the patient was well enough to resume rehabilitation training and part-time work, alternating activity days with rest days.

Case 2: 43-year-old woman, ME/CFS diagnosed 2017. Previously unable to maintain upright posture; multiple therapies had failed. Improvement observed at 3-week and 8–9-week interval interviews on the same hydrogen protocol.

Case 3: 18-year-old woman, bedbound most of the day. From August to October 2021 she began daily H₂ inhalation and gradually regained activity tolerance.

Case 4: 18-year-old male with comorbid ME/CFS and fibromyalgia presenting with fatigue, headache, muscle weakness and systemic pain. Showed similar response on the same protocol.

Clinical studies of rituximab, NADH, coenzyme Q10 and acetyl-L-carnitine for ME/CFS have produced either negative or marginal results. In this series, hydrogen produced visible, sustained reductions in symptom-severity scores without adverse events — consistent with H₂'s well-documented safety margin.

These are self-assessed case reports in a small series, not a randomised controlled trial. They cannot establish efficacy, but they justify formal RCTs and offer a low-risk option for patients with treatment-refractory symptoms. The authors note overlap with long-COVID fatigue and call for controlled trials in both populations.