Germain, Arnaud, Barupal, Dinesh K, Levine, Susan M et al. · Metabolites · 2020 · DOI
Researchers studied the chemicals in blood samples from 26 ME/CFS patients and 26 healthy controls to understand what might be different in ME/CFS. They found that ME/CFS patients have lower levels of certain fats (especially acyl cholines) and hormones (including some involved in stress response and reproduction) compared to healthy people. These chemical differences might help explain why ME/CFS causes such widespread symptoms affecting many body systems.
This study provides objective biological markers that could help validate ME/CFS as a physiological condition and advance understanding of its multi-system effects. The findings on reduced acyl cholines and steroid hormones offer new targets for investigating disease mechanisms and potentially developing treatments.
This study does not prove that the identified metabolic changes cause ME/CFS symptoms—they may be consequences of the illness or indirect markers. The cross-sectional design cannot establish temporal relationships or determine whether these changes are specific to ME/CFS or correlate with severity. Results are limited to women and require validation in larger, more diverse populations.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Germain, Arnaud, Barupal, Dinesh K, Levine, Susan M, & Hanson, Maureen R (2020). Comprehensive Circulatory Metabolomics in ME/CFS Reveals Disrupted Metabolism of Acyl Lipids and Steroids.. Metabolites. https://doi.org/10.3390/metabo10010034
BibTeX
@article{mecfsatlas-germain-2020-comprehensive-circulatory,
author = {Germain, Arnaud and Barupal, Dinesh K and Levine, Susan M and Hanson, Maureen R},
title = {Comprehensive Circulatory Metabolomics in ME/CFS Reveals Disrupted Metabolism of Acyl Lipids and Steroids.},
journal = {Metabolites},
year = {2020},
doi = {10.3390/metabo10010034},
note = {PubMed: 31947545},
url = {https://www.mecfsatlas.com/evidence/germain-2020-comprehensive-circulatory},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/germain-2020-comprehensive-circulatory
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