6-Month Mitochondrial Support Protocol for Chronic Pain & CFS Patient - Seeking Feedback

I'm working with a chronic pain patient who, based on comprehensive assessment, also suffers from Chronic Fatigue Syndrome (CFS/ME). She experiences extreme physical intolerance - her entire body is in pain, and even minimal physical exertion triggers an overwhelming response manifesting as exhaustion and increased pain (post-exertional malaise).

Additionally, she reports brain fog and constant energy crashes. She describes her sleep as non-restorative. Alongside movement therapy to address her orthopedic issues (particularly back pain), I want to focus primarily on supporting her mitochondrial health.

I'll be working with her for six months and have developed the following protocol. I'd appreciate any critique or feedback from the community.

Note: Everything has to be done with OTC supplementation.

Base Support (Ongoing throughout program):

PEA: 1.2g daily (pain management)
Saffron extract (mood support & stress response optimization)

Phase 1: Weeks 1-4 - Foundation Establishing basic nutritional support to create an environment where mitochondria can begin to adapt:

Creatine monohydrate: 3g
Selenium: 200mcg
Zinc bisglycinate: 25mg
Vitamin D3 (dose based on levels)
B-complex vitamin (active forms)
Glycine: 10-15g daily
NAC: 800mg twice daily
R-Alpha Lipoic Acid: 200mg
Geranylgeraniol: 150mg
CoQ10 (as Ubiquinol): 200mg

Phase 2: Weeks 5-12 - Membrane Restoration & Stabilization Adding to the foundation protocol:

For membrane restoration:

Phosphatidylserine: 150mg twice daily
CDP-Choline: 250mg twice daily
Shark liver oil (alkylglycerols): 100mg three times daily
Omega-3 fatty acids: 700mg three times daily

For additional membrane stabilization:

Ergothioneine: 10mg once daily
Astaxanthin: 12mg once daily

(Note: Omega-3s will continue as part of ongoing support; other supplements in this phase will be tapered off after week 12)

Phase 3: Weeks 13-24 - Mitochondrial Reset Focus on mitophagy and biogenesis. Adding to foundation:

Quercetin: 1000mg daily
Urolithin A: 500mg daily
PQQ: 20mg daily
Acetyl-L-Carnitine: 1g daily

Optional addition: 16:8 intermittent fasting with morning MCT oil supplementation (if tolerated)

Phase 4: Week 25+ - Maintenance Return to basic foundation protocol and assess long-term sustainability and symptom improvement.

Adjunct Therapies (Throughout entire program):

Red light therapy: morning and evening sessions
Breathing exercises
Morning walks before breakfast (as tolerated, pacing essential)

I believe this graduated approach respects the patient's severe energy limitations while systematically addressing mitochondrial dysfunction. The phased structure allows for assessment of tolerance and effectiveness at each stage.

Looking forward to your thoughts and experiences with similar protocols! Please feel free to give relentless feedback and critique.

@Anthony Castore

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