1
Natural wake — no alarm if possible. The cortisol awakening response in ME/CFS is blunted. Forcing sudden wake degrades adrenal reserve. Lie still 5 minutes before standing — orthostatic instability is common.
2
Mitochondrial support stack with breakfast. CoQ10 (ubiquinol) 200-400mg, Acetyl-L-Carnitine 500mg, Alpha-lipoic acid 300mg, Riboflavin B2 100mg. Supports every step of the electron transport chain.
3
Morning sunlight 10-15 minutes. Stimulates cytochrome c oxidase in mitochondria through near-infrared wavelengths — directly increasing ATP production. Measurable in ATP output within 20 minutes.
4
Protein-first breakfast. Amino acids required for mitochondrial enzyme production. Blood sugar crashes are catastrophic for energy stability in ME/CFS. Eggs, salmon, protein with vegetables and olive oil.
5
Pacing — energy envelope principle. Never spend more than 70% of perceived energy capacity in a day. Post-exertional malaise is caused by exceeding the cellular energy envelope. Protect the envelope before all else.
6
NMN or NR 250-500mg on empty stomach. NAD+ precursors directly increase NAD+ — the primary fuel molecule for mitochondrial ATP production. Fastest way to replenish the mitochondrial fuel tank.
Avoid in the morning
Caffeine as primary energy source — borrows from depleted adrenal reserves. High-carbohydrate breakfast — blood sugar crash wipes out morning energy. Any activity pushing beyond 70% capacity. Statins — deplete CoQ10 by up to 40%.