Thank you for taking the time to reply and to provide more detail on your views on the disease. I think context is definitely key in terms of claims associated with any nutritional supplement. I personally take many of these and have got some improvements in symptoms from things like B vitamins and mitochondrial support supplements. However I would say that the use of these are mainly around symptom relief to improve quality of life while I'm sick. These treatments haven't moved me forward in terms of improving my capability, they have just eased things like brain fog, and reduced the duration of PEM episodes slightly. I am pretty certain that my energy envelope hasn't increased since I've been measuring heart rate activity and steps before and during taking the supplements. It's really important to stress that this is for symptom relief/ quality of life rather than to give people more energy and feeling less fatigued which could be misleading to many desperate sufferers who are looking for a "cure"particularly with the confusion around the name ( as you mention in your paper). That is why I hope with future studies you might include the wider aspects of the disease and perhaps use activity and cognitive measurements. It would also be good to see if people's energy envelope did increase or whether it remains unchanged with measures such as constant heart rate monitoring to give an objective measure of activity before and after supplementation. This would also show up PEM episodes so the frequency of these vs activity could then be also captured? I also found that initial supplementation took a while to settle down (6-8 weeks) and in the case of B12 this took a long time (6 months). Longer term studies would be helpful to see what is going on in terms of continuous supplemental therapy. It's also worth noting that pacing activity in a lot of cases will control a lot of symptoms without supplementation so this would need to be a control. I hope you find these critiques useful and hope you will post some more of your findings.