A case report demonstrating sequential neurorepair, lipid repletion, microbiome stabilization, and mitochondrial support in post-infectious CFS/ME recovery.

Dr. Vy Simeles, ND, Restorative Health Clinic

Abstract

This case report details the recovery of a 22-year-old woman with post-infectious CFS/ME using a structured, layered naturopathic protocol targeting neuroinflammation, mitochondrial dysfunction, and microbial burden. Strategic lipid repletion with DHA and plasmalogens, combined with microbiome modulation and targeted antimicrobial therapy, resulted in significant restoration of cognitive clarity, functional capacity, and overall resilience.

Introduction

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a debilitating condition characterized by post-exertional malaise, cognitive dysfunction, sleep disturbance, and autonomic instability.1 The pathophysiology of CFS/ME remains complex and multifactorial, often involving chronic infections, mitochondrial dysfunction, immune dysregulation, and neuroinflammation.2 While naturopathic interventions have long targeted the gut-immune-brain axis, recent advancements underscore the critical role of lipid substrates (such as DHA and plasmalogens) in restoring cognitive and cellular function.3,4

This case follows a 22-year-old woman whose academic and physical trajectory was disrupted by a multisystem crash during her final year of college. As high school valedictorian and avid backpacker, the onset of illness—which included cognitive decline, post-exertional crashes, and neuromuscular instability—was severe enough to necessitate mobility aids, including the use of a cane. The layered naturopathic approach in this case emphasized mitochondrial recovery, neurorepair, microbiome stabilization, and cautious pathogen management—demonstrating a meaningful reversal of symptoms over a 6-month treatment arc.

Case Presentation

Patient Information

The patient is a 22-year-old female with a history of ADHD, mood dysregulation, CFS/ME, and recurrent sinus and gastrointestinal infections. She presented after months of severe fatigue, cognitive dysfunction, and systemic collapse following multiple untreated or unsuccessfully treated infections during her final college term.

Presenting Concern

She presented in early 2025 for evaluation of persistent fatigue, post-exertional malaise, brain fog, gastrointestinal symptoms, and sleep disturbance. The patient reported being largely housebound, relying on a cane for basic mobility due to exertion-related instability and myalgias. She described daily “crash” episodes characterized by inability to concentrate, orthostatic symptoms, severe brain fog, and profound fatigue requiring prolonged bed rest. Functional capacity was rated at 1–2/10 on crash days and 4/10 on her best days.

Clinical History and Context

Symptoms began during her final college term in 2024 when she went multiple times to urgent care for presumed sinus infections and treated with various antibiotics and corticosteroids. After graduation, attempts at travel and physical activity—including short hikes—were unsustainable. Her GI health collapsed, necessitating liquid nutrition. She was ultimately diagnosed with CFS/ME.

Clinical Findings

Symptoms included:

• Energy averaging 4/10, dropping to 1–2/10 during crashes
• Severe brain fog, word-finding difficulty, and reading comprehension deficits
• Temperature dysregulation, restless leg syndrome, myalgias, insomnia
• Poor appetite, vomiting, and reliance on liquid calories
• Mild lymphadenopathy, daily headaches during crashes
• Neurocognitive signs included difficulty concentrating, memory loss, tinnitus, and emotional dysregulation. 
• Reliance on a cane for walking assistance due to muscle weakness and fatigue 

Diagnostic Assessment

A comprehensive functional lab panel revealed borderline low copper, low iron saturation, low vitamin D (27 ng/mL), elevated homocysteine, and MTHFR mutation. Lyme serologies were equivocal with IgM band 39 positive. EBV reactivation markers were positive without active infection (negative early antigen antibodies). Mycoplasma pneumoniae antibodies were elevated. Physical instability, light/noise sensitivity, and reliance on a cane were attributed to neuromuscular dysfunction and mitochondrial depletion.

Clinical Assessment

The working diagnosis included CFS/ME with post-viral neuroinflammation and mitochondrial dysfunction, compounded by unresolved chronic sinusitis and suspected microbial burden. Differential diagnoses included early neurodegenerative syndromes, MCAS, and post-infectious encephalopathy.

Therapeutic Intervention

Visit 1 (Baseline):

• Supportive interventions included probiotics (Saccharomyces boulardii and spore-based probiotic), glutathione (500 mg daily), red ginseng, and digestive enzymes.
• Herbal sleep support (500 mg L-theanine, 400 mg magnolia and 100 mg curcumin extracts) and light therapy were initiated for sleep regulation.
• Apple cider vinegar and hydration with electrolytes supported digestion and detoxification.
• Psychiatric care was coordinated to maintain lamotrigine.

Visit 2:

• Patient noted improved digestion, more restorative sleep, and partial reduction in brain fog.
• Energy improved to 6/10.
• Labs showed elevated EBV titers, MTHFR mutation, low copper, and low vitamin D.
• Added methylated B12/folate, vitamin D (5000 IU daily), and copper glycinate.
• Initiated targeted antimicrobial therapy with digestive health blend that focuses especially on yeast overgrowth in the gut (containing monolaurin, caprylic acid, berberine, serrapeptidase, GSE, Pau D’arco, and oregano, thyme and clove oils).
• Started glutathione, curcumin, and binders to support detoxification and inflammation during protocol.

Visit 3:

• Brain fog improved further; patient reported glimpses of cognitive clarity and re-engagement with reading.
• Sinus symptoms worsened, triggering short-term fatigue and mild die-off reaction.
• Sleep remained stable; neuromuscular twitching improved.
• Introduced high-dose DHA (omega-3) loading protocol (9g in divided doses per day for 1 month and decreasing to 6g per day for 1 month, and then 3g per day thereafter) to target neuroinflammation.
• Gradual transition from candida-targeted herbal blend to Cryptolepis-based synergistic herbal blend (which focuses on intracellular bacterial infections and immune support). 

Visit 4:

• Functional capacity peaked; patient resumed full-time work but noted overexertion symptoms.
• Energy stabilized at 7/10; sleep, digestion, and mood all showed sustained improvement.
• Chronic sinusitis flared; compounded topical nasal spray (mupirocin/EDTA/itraconazole) prescribed.
• Transitioned from fish oil to an omega-9 plasmalogen supplement targeting brain lipid architecture.3,5,6

Final Visit:

• Patient initiated mild interval jogging with only transient post-exertional symptoms.
• Myalgia decreased in severity and frequency.
• Neurologic stability restored: no dizziness, neuralgia, or psychiatric destabilization.
• GI health normalized with whole-food diet.
• Final interventions included synergistic mitochondrial support blend (containing ALCAR, ALA, CoQ10, PQQ, phospholipids and B-complex), quercetin, and an isoquercetin-quail egg blend for histamine-related exertional hives.

Follow-up and Outcomes

The patient moved from cane-reliant fatigue with debilitating brain fog and gut dysbiosis to full-time work, resumed exercise, and symptom remission across neurocognitive, immune, and GI domains. Functional improvement tracked with strategic introduction of mitochondrial and neurorepair supports. Notably, the most consistent gains in cognition and mood stability occurred following high-dose DHA and plasmalogen therapy, supported by literature linking these lipids to neuronal resilience.3,5,6

Safety and Tolerability

Mild Herxheimer symptoms occurred after antimicrobial initiation, managed effectively with glutathione and binders. No adverse psychiatric reactions occurred with supplementation. Patient tolerated all therapies and remained highly engaged in shared decision-making.

Timeline

• May 2024: Illness onset, severe sinusitis, GI collapse
• June–Nov 2024: Travel attempts, functional decline, returns home
• Dec 2024: Initial visit; interventions started
• Jan–Feb 2025: Digestion, sleep, cognition improve
• Mar–May 2025: Sinus infection treated topically; energy and cognition stabilize
• June 2025: Resumes work and exercise, neuroinflammation resolves

Discussion

This case illustrates a layered naturopathic strategy for managing neuroimmune dysfunction in CFS/ME. Key therapeutic highlights included:

1. Neurorepair via DHA and Plasmalogens: High-dose omega-3 therapy with DHA improved cognition and mood stability. Subsequent introduction of omega-9 plasmalogen-rich supplement targeted membrane integrity and myelin repair. Emerging research supports plasmalogen deficits in neurodegeneration and links phospholipid restoration to cognitive resilience.7–10
2. Targeted Mitochondrial Support: Glutathione, methylated B vitamins, and mitochondrial support nutrients supported oxidative balance and energy production. Addressing low copper and high homocysteine likely enhanced methylation and detox capacity.
3. Non-Systemic Antimicrobials: To reduce microbiome disruption, botanical antimicrobials and compounded nasal therapies were favored over systemic antibiotics. The localized spray and sinus probiotic led to complete resolution of recurrent infections.
4. Microbiome Modulation: Probiotic cycling, dietary changes, and minimal antibiotic use preserved gut integrity, key for immune and neuroendocrine stability.
5. Neuroimmune Patterning: Her presentation of fatigue, myalgia, and temperature dysregulation alongside mild viral titers and low MSH paralleled neuroimmune and autonomic instability, responding well to immune modulating strategies.

Limitations: Diagnostic clarity around tickborne infections and mast cell activation was limited by resource constraints and patient preference. Outcomes were tracked via clinical observation and patient report.

From cane-dependent fatigue to restored executive function and physical activity, this patient’s recovery exemplifies how layered naturopathic interventions—applied sequentially and with attention to physiologic thresholds—can meaningfully reverse neuroimmune collapse.

Conclusion

In this case of post-infectious CFS/ME, naturopathic treatment targeting neuroinflammation and mitochondrial dysfunction—particularly with DHA, plasmalogens, and non-systemic antimicrobials—resulted in remission of disabling symptoms and return to function. Lipid-based brain repair and cautious pathogen targeting should be considered central in complex chronic fatigue syndromes.

 

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Dr. Vy Simeles, ND, LAc is a Naturopathic Physician and Licensed Acupuncturist specializing in complex chronic illness, with a focus on environmental medicine, tickborne infections, autoimmune disease, and post-viral syndromes. She earned her Doctorate in Naturopathic Medicine and Master’s in Acupuncture from the National University of Natural Medicine in Portland, Oregon.

Her clinical expertise includes mold toxicity, heavy metal exposure, Lyme disease and co-infections, mast cell activation syndrome (MCAS), and dysautonomia (POTS).

Her approach combines evidence-based naturopathic medicine with acupuncture, nutritional therapy, and somatic practices, tailored to each patient’s unique circumstances. She is known for her deep listening, advocacy, and step-by-step guidance that helps patients reclaim vitality and a sense of self.

IG: @dr.vysimeles @restorativehealthclinic

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References

1. Institute of Medicine. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. National Academies Press; 2015.
2. Komaroff AL, Bateman L. Will COVID-19 Lead to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome? Front Med (Lausanne). 2021;7:606824. doi:10.3389/fmed.2020.606824
3. Goodenowe DB, Haroon J, Kling MA, et al. Targeted Plasmalogen Supplementation: Effects on Blood Plasmalogens, Oxidative Stress Biomarkers, Cognition, and Mobility in Cognitively Impaired Persons. Front Cell Dev Biol. 2022;10:864842. doi:10.3389/fcell.2022.864842
4. Goodenowe DB, Senanayake V. Brain ethanolamine phospholipids, neuropathology and cognition: A comparative post-mortem analysis of structurally specific plasmalogen and phosphatidyl species. Front Cell Dev Biol. 2022;10:866156. doi:10.3389/fcell.2022.866156
5. Wei BZ, Li L, Dong CW, et al. The Relationship of Omega-3 Fatty Acids with Dementia and Cognitive Decline: Evidence from Prospective Cohort Studies. Am J Clin Nutr. 2023;117(6):1096-1109. doi:10.1016/j.ajcnut.2023.04.001
6. Hachem M, Nacir H. Emerging Role of Phospholipids and Lysophospholipids for Improving Brain DHA. Int J Mol Sci. 2022;23(7):3969. doi:10.3390/ijms23073969
7. Hossain MS, Mawatari S, Fujino T. Biological Functions of Plasmalogens. Adv Exp Med Biol. 2020;1299:171-193. doi:10.1007/978-3-030-60204-8_13