Quick Reference: Evidence-Based Treatment Summary
Table Quick Reference: Evidence-Based Treatment Summary provides a rapid-access summary for clinicians and patients, organized by evidence strength and implementation tier.
| Intervention | Typical Dose | Evidence Level | Primary Indication | Cost/Month | Tier |
|---|---|---|---|---|---|
| TIER 1: Strong Evidence, Immediate Implementation | |||||
| Pacing (energy envelope) | Individualized | HIGH (2-day CPET, consensus) | PEM prevention; core intervention | Free | 1 |
| Fluid/salt loading (POTS) | 2.5–3L, 6–10g Na/day | HIGH (orthostatic physiology) | Orthostatic intolerance, blood volume | $5 | 1 |
| Compression stockings | 20–30 mmHg waist-high | HIGH (POTS, space medicine) | Orthostatic intolerance | \(30–60 one-time | 1 | | ORS (sports recovery) | 500mL 2–3\)\times$/day | MODERATE (sports medicine) |
| Vitamin D | 4000–5000 IU/day | MODERATE (ICU, geriatrics) | Immune function, muscle | $5 | 1 |
| Magnesium glycinate | 300–400mg/day | MODERATE (ICU, sports) | ATP synthesis, cramps | $10 | 1 |
| B-complex (thiamine) | B1 100–300mg; B-complex | MODERATE (ICU critical care) | Aerobic metabolism, neurological | $10 | 1 |
| TIER 2: Moderate Evidence, Consider Trial | |||||
| CoQ10 + Acetyl-L-carnitine | 200mg CoQ10; 500–1000mg ALC | MODERATE (mitochondrial support) | ATP production, fat oxidation | $40–60 | 2 |
| Iron optimization | Target ferritin 100–200 | MODERATE (altitude medicine) | Oxygen transport, dopamine synthesis | \(10–15 | 2 | | NAC | 600mg 2\)\times$/day | MODERATE (ICU, oxidative stress) |
| Vitamin C | 1000–2000mg/day divided | MODERATE (ICU sepsis protocols) | Antioxidant, immune support | \(10 | 2 | | Zinc + selenium | 15–30mg Zn; 200\)$g Se | MODERATE (ICU) |
| LDN | 3.0–4.5mg/day | MODERATE (n=218 observational) | Fatigue, brain fog, PEM | $20–40 | 2 |
| TIER 3: Emerging/Speculative, Needs Validation | |||||
| Pyruvate (prophylactic) | 1–2g pre-exertion | SPECULATIVE (mechanistic rationale) | PEM prevention | $15–25 | 3 |
| NAD+ precursors (NR/NMN) | NR 300–1000mg; NMN 250–500mg/day | SPECULATIVE (lactate clearance hypothesis) | Post-exertional recovery | $40–60 | 3 |
| Methylene blue | 1–5mg/day | SPECULATIVE (patient reports) | Brain fog, mitochondrial enhancement | \(10–20 | 3 | | Acetazolamide | 125–250mg 2\)\times\(/day | SPECULATIVE (altitude medicine) | Oxygenation, cognitive function | Rx required | 3 | | D-ribose | 5g 2–3\)\times$/day | SPECULATIVE (sports medicine) |
| CONTRAINDICATED: Evidence of Harm | |||||
| Graded Exercise Therapy (GET) | N/A | HIGH (patient harm, PACE discredited) | HARMFUL; causes deterioration | N/A | — |
| Rituximab (B-cell depletion) | N/A | HIGH (Phase III RCT negative) | No benefit; placebo superior | N/A | — |
Usage Notes for Table Quick Reference: Evidence-Based Treatment Summary.
- Tier 1: Implement immediately based on strong physiological rationale or consensus; low cost, high safety
- Tier 2: Consider trial for 3 months; monitor response; moderate evidence from observational studies or related conditions
- Tier 3: Experimental; discuss risks/benefits; await formal trials; mechanistically plausible but unvalidated
- Start with Tier 1, add Tier 2 interventions sequentially if no benefit after 3 months
- Monitor responses with symptom diary, objective measures (heart rate, activity tolerance)
- Medical supervision required for prescription medications, high-dose supplementation, or if multiple comorbidities present