Chronic Fatigue Syndrome (ME/CFS)

What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome, also called myalgic encephalomyelitis (ME/CFS), can be a devastating and complex condition that affects approximately 0.9% of the global population. Unfortunately, many medical professionals are skeptical about the validity of the condition leading to delayed diagnosis, misdiagnosis, or ineffective treatment prescriptions (like antidepressants).

ME/CFS can affect multiple organs and is characterized by at least six months of moderate-to-severe symptoms affecting three core areas:

1. Impaired functioning in work, social, or personal activities, accompanied by persistent fatigue.
2. Post-exertional malaise (PEM), where symptoms worsen after physical or mental exertion.
3. Unrefreshing sleep.

Other common symptoms can include:

• Cognitive impairment (“brain fog”)
• Autonomic dysregulation (POTS, temperature dysregulation, etc.)
• Small, soft lymph nodes in the neck, behind the ears, armpits, or groin

These varied symptoms are a result of dysregulation across the neuro-immune system, hormonal regulation, and even cardiovascular and gastrointestinal systems. You can learn more about ME/CFS in our detailed article.

What Causes ME/CFS?

ME/CFS can have different triggers, including:

• Infections: Viral and bacterial infections such as Epstein-Barr virus (EBV) and COVID-19.
• Physical & Psychological Stressors: Trauma, surgery, or PTSD.
• Environmental Toxins: Neuroimmune and oxidative stress interactions.
• Genetic Predisposition: Polymorphisms in HPA-axis genes may increase susceptibility.
• Mitochondrial Dysfunction: Impaired ATP production affects cellular energy metabolism.

Stellate Ganglion Block for ME/CFS

Stellate ganglion block (SGB) offers new hope for those suffering from ME/CFS by targeting a root cause: nervous system imbalance. By calming overactive “fight-or-flight” nerves, SGB can help restore balance to the body’s stress response—often linked to chronic fatigue, brain fog, and unrefreshing sleep. Patients report feeling more energized, clear-headed, and rested, making SGB a promising option for those who haven’t found relief through conventional treatments.

SGB has specifically shown promise in treating:

• Long COVID-related ME/CFS
• PTSD-associated ME/CFS

You can learn more about the Stellate Ganglion Block for ME/CFS here.

Comprehensive Lab Testing for ME/CFS: A Functional and Evidence-Based Workup

Most ME/CFS patients arrive have been told for years their bloodwork is "normal." The problem isn't that their labs are normal, it's that the wrong labs were ordered. A standard primary care panel doesn't detect the mitochondrial dysfunction, immune dysregulation, microbiome imbalance, hormonal shifts, or chronic viral reactivation that drive chronic fatigue syndrome.

A comprehensive ME/CFS workup with our doctors draws on functional and evidence-based medicine to map what's actually happening in your body:

• Advanced bloodwork: beyond the basic panel: inflammatory markers (hs-CRP, IL-6, TNF-α), comprehensive thyroid) (TSH, Free T3, Free T4, reverse T3, antibodies), complete iron panel, micronutrients (vitamin D, B12 and folate), magnesium, and metabolic precursors that reveal mitochondrial stress.
• Microbiome and GI testing: advanced stool analysis to assess microbial diversity, dysbiosis, intestinal permeability, and gut inflammation. The gut-brain axis is increasingly recognized as a driver of fatigue, brain fog, and immune dysfunction in ME/CFS.
• Hormone panels: full thyroid, cortisol patterns, estrogen, progesterone, testosterone, DHEA - interpreted in the context of HPA-axis dysfunction and the hormonal dysregulation common in ME/CFS. When clinically indicated, we offer integrated bioidentical hormone replacement therapy.
• Genomic testing: genetic variants in COMT, MTHFR, mitochondrial function genes, and HPA-axis genes (50+ in total) that influence how your body processes nutrients, neurotransmitters, and stress.
• Mitochondrial and metabolic markers: assessed through inflammatory, metabolic, and energy-related biomarkers to identify the mitochondrial dysfunction central to ME/CFS.
• Viral and infectious workup when indicated: including EBV, HHV-6, and post-viral inflammatory markers for patients with suspected long COVID or post-viral fatigue.

This is what we mean by functional and evidence-based medicine: every test we order has a clinical purpose, every result is interpreted in the context of your full picture, and every treatment recommendation is built around what your data actually shows — not against a population average.

Our ME/CFS workup is integrated with interventions that offer fast-acting possibilities, including the stellate ganglion block and IV NAD+ therapy.

IV Ketamine for Chronic Fatigue Syndrome (ME/CFS)

IV ketamine is emerging as a powerful option for ME/CFS relief by working at the intersection of pain, fatigue, and nervous system dysfunction. As a rapid-acting NMDA receptor modulator, ketamine helps calm overactive nerve signaling and supports neuroplasticity and energy regulation, two areas potentially disrupted in ME/CFS. Many patients report improvements in energy, mental clarity, and pain levels after treatment—offering a new path forward for those who feel stuck and exhausted despite trying everything else. Ketamine infusion therapy is specifically helpful for:

• Depression: Ketamine can significantly relieve symptoms in ME/CFS patients with coexisting depression
• Chronic Pain: Reducing the pain-component of ME/CFS can address the incredible overlap of pain and autonomic dysfunction
• Post-Surgical Fatigue: IV ketamine has been shown to reduce postoperative fatigue syndrome
• Direct Anti-Fatigue Effects: Independent of its antidepressant properties, ketamine may reduce fatigue in ME/CFS

You can learn more about IV Ketamine for ME/CFS here.

NAD+ Therapy for Mitochondrial Support in ME/CFS

NAD+ is a key regulator of energy metabolism in the body. NAD+ therapy may support ME/CFS recovery by targeting impaired mitochondrial energy production, which is often poisoned in ME/CFS. By restoring cellular NAD+ levels, these infusions help enhance ATP generation, reduce neuroinflammation, improve mitochondrial resilience, and reduce oxidative stress—all of which may contribute to improved energy, sleep efficiency, mental clarity, and cognitive function in people with ME/CFS. Patients heavily burdened with cognitive impairment, energy depletion, and exercise intolerance may be candidates for:

• IV Nicotinamide Riboside (NR) to restore cellular metabolism and ATP production
• NAD+ therapy, particularly in those with brain fog, neuroinflammation, impaired sleep, and cardiovascular dysfunction

‍Genetic & Personalized Medicine Approaches to Reduce ME/CFS

Genetic testing offers a powerful tool to help personalize care for individuals with ME/CFS by uncovering underlying vulnerabilities in key biological pathways. Variants in the following genes may contribute to ME/CFS symptoms:

• Mitochondrial health and energy metabolism genes, including B12 metabolism
• Inflammatory and oxidative stress pathways, especially those affecting circadian rhythm
• Thyroid and gut permeability markers‍

Abnormalities in these pathways can shed light on why certain patients experience profound fatigue, cognitive dysfunction, and sleep disturbances. This allows for targeted interventions—such as mitochondrial support, methylation cofactors, specific anti-inflammatory therapies, or gut-healing protocols. Identifying these genetic susceptibilities allows for more precise and efficient treatment strategies tailored to the individual biology of each ME/CFS patient.

Antioxidant Support in ME/CFS

Antioxidant supplementation can play a critical role in managing ME/CFS by targeting one of its key underlying mechanisms: oxidative stress and mitochondrial dysfunction. This is particularly observed in patients with long COVID. Several vital nutrients are reduced in some patients with ME/CFS:

• Specific B-vitamins: some patients with ME/CFS have reduced B-vitamin availability. Adequate B-vitamin status is critical for neurotransmitter synthesis and serotonin/dopamine regulation
  • Your B-vitamin dose depends on your health history and genes
• Vitamin C: patients supplementing with vitamin C perceive improvements in their health
• Magnesium: red blood cell concentrations of magnesium are reduced in some patients with ME/CFS, and supplementation may help relieve symptoms
  • Magnesium doses need to be personalized to your health conditions
• Glutathione: a powerful anti-oxidant whose function may be impaired in some patients with ME/CFS

IV infusions bypass the gastrointestinal tract to provide 100% bioavailability for faster and more reliable blood levels. This is particularly valuable for patients with malabsorption issues, chronic stress, or fluctuating hormone levels that may impair nutrient uptake. Together, these antioxidants may help reduce inflammation, improve cellular resilience, and support clearer thinking and improved energy in individuals with ME/CFS.

Holistic ME/CFS Treatment: What to Expect

Dr. Kaveh’s holistic approach to relieving ME/CFS includes 3 steps:

1. Preparation: Consultation with Dr. Kaveh to learn about your specific ME/CFS symptoms to develop a personalized treatment plan
2. Treatment: Most patients undergo SGB and NAD+ treatment as a foundation for the management of ME/CFS
3. Maintenance: Positive effects may be sustained through a combination of IV interventions followed by oral supplements and lifestyle interventions, informed by genetic and hormonal testing

Contact Clarus Health with any questions about how SGB, IV Ketamine, NAD+ and antioxidant therapies can help relieve symptoms of ME/CFS.