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A careful skeptic would say: the in-clinic procedure has solid evidence, the at-home extension is biologically plausible and consistent with the procedure, but the dataset is younger than the recommendation implies

Nevertheless, future research should focus on examining temporal relationships between HPA axis function and immune-inflammatory or nitrosative stress pathways through biomarkers like TNF-, IL-10, TGF-, inducible NO synthase, NO production, protein nitrosylation, and bacterial translocation in ME/CFS patients to better understand their roles [79]

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Reductions in protein consumption [46], even within what are considered safe levels, can alter plasma glutathione synthesis