Table 7.

Oxaloacetate metabolic changes that may improve fatigue in ME/CFS patients.

Metabolic change	Effect on ME/CFS patient	Normalization by oxaloacetate
Warburg effect	Increased lactate production	Reduction in lactate production via inhibition of lactate dehydrogenase in the cytosol
Decrease in NAD+/NADH ratio	Increase in ROS Production	Reset of NAD+/NADH ratio and quenching of ROS by antioxidant oxaloacetate
Increased NF-kB movement to the nucleus	Activation of chronic inflammation	Reset of the inflammation pathway to normal by lowering NF-kB translocation to the nucleus
Mitochondrial damage	Reduced ability to process glucose	Increased number of mitochondria to produce energy via PGC1-alpha increase
Reduced AMPK activation	Reduced cellular glucose uptake	Increase in glucose uptake via AMPK activation and more glucose fuel available for the patient
Increased neurological ROS production	Damage from free radicals	Oxaloacetate is a highly effective antioxidant.