Glass, Katherine A, Germain, Arnaud, Huang, Yuhsin V et al. · International journal of molecular sciences · 2023 · DOI
Researchers tested urine samples from ME/CFS patients and healthy people before and after intense exercise. They found that healthy people's urine chemistry changed noticeably after exercise (showing normal recovery), but ME/CFS patients' urine chemistry barely changed. This suggests that ME/CFS patients' bodies may not be adapting properly to physical stress the way healthy bodies do.
Post-exertional malaise (PEM) is a defining feature of ME/CFS that distinguishes it from other fatigue conditions, yet its biological basis remains unclear. This study provides objective metabolic evidence that ME/CFS patients' bodies fail to mount normal biochemical recovery responses to exercise, potentially explaining why exertion worsens symptoms. These findings could guide development of biomarkers and targeted treatments.
This pilot study does not prove that metabolomic changes cause PEM or that these findings apply to all ME/CFS patients—only a small female cohort was tested. The study identifies associations rather than causal mechanisms, and it cannot determine whether the blunted response reflects a primary defect or a consequence of ME/CFS pathology. Findings require validation in larger, more diverse populations with longer follow-up periods.
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
Glass, Katherine A, Germain, Arnaud, Huang, Yuhsin V, & Hanson, Maureen R (2023). Urine Metabolomics Exposes Anomalous Recovery after Maximal Exertion in Female ME/CFS Patients.. International journal of molecular sciences. https://doi.org/10.3390/ijms24043685
BibTeX
@article{mecfsatlas-glass-2023-urine-metabolomics,
author = {Glass, Katherine A and Germain, Arnaud and Huang, Yuhsin V and Hanson, Maureen R},
title = {Urine Metabolomics Exposes Anomalous Recovery after Maximal Exertion in Female ME/CFS Patients.},
journal = {International journal of molecular sciences},
year = {2023},
doi = {10.3390/ijms24043685},
note = {PubMed: 36835097},
url = {https://www.mecfsatlas.com/evidence/glass-2023-urine-metabolomics},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/glass-2023-urine-metabolomics
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