# Molecular hydrogen as a treatment for ME/CFS: a mini-review of clinical evidence and mechanistic rationale

## TL;DR

Molecular hydrogen, given as hydrogen-rich water, may help reduce fatigue and improve function in people with chronic fatigue syndrome, though more research is needed.

## Contribution

This paper reviews the potential of molecular hydrogen as a novel treatment for ME/CFS based on its antioxidant and anti-inflammatory properties.

## Key findings

- Hydrogen-rich water shows preliminary benefits in reducing fatigue and improving physical function in ME/CFS patients.
- Molecular hydrogen aligns with biological abnormalities in ME/CFS, such as oxidative stress and inflammation.
- Early trials suggest hydrogen-rich water is feasible and has mild side effects.

## Abstract

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystem illness characterized by profound fatigue, post-exertional malaise, cognitive impairment, and autonomic dysfunction, yet it currently lacks FDA-approved treatments. Molecular hydrogen (H2), administered primarily as hydrogen-rich water (HRW), has emerged as a potential therapeutic candidate due to its selective antioxidant effects, anti-inflammatory activity, and support of mitochondrial and cellular homeostasis. These mechanisms align with several biological abnormalities implicated in ME/CFS, including oxidative stress, chronic inflammation, and impaired energy metabolism. This narrative mini-review summarizes mechanistic evidence relevant to ME/CFS and evaluates three developmental clinical studies of HRW in this population. Although early trials are small and methodologically limited, moderate-dose HRW consumed over extended durations has demonstrated feasibility and preliminary benefits in reducing fatigue and improving physical function, with generally mild side effects. Overlapping findings in Long COVID further suggest potential applicability across related post-viral fatigue conditions. Key limitations include small sample sizes, reliance on self-report outcomes, and the absence of objective biomarkers. Future research should prioritize larger, rigorously controlled trials incorporating remote biometric and biochemical assessments to clarify mechanisms of action and identify responsive subgroups. Overall, molecular hydrogen represents a promising, low-burden adjunctive therapy warranting further investigation in ME/CFS.