Gottschalk, Carl Gunnar, Whelan, Ryan, Peterson, Daniel et al. · International journal of molecular sciences · 2023 · DOI
This study looked at a molecule called BH4 in the blood of ME/CFS patients, particularly those who experience dizziness when standing up. The researchers found that ME/CFS patients have higher levels of BH4 than healthy people, and this may be connected to oxidative stress (harmful chemical reactions in the body). This finding could help explain why some ME/CFS patients struggle with dizziness and blood flow problems.
Orthostatic intolerance affects a substantial subset of ME/CFS patients and current treatments are limited. Identifying BH4 dysregulation as a potential biomarker and mechanism opens new avenues for understanding cardiovascular and neurological complications in ME/CFS, potentially leading to targeted therapeutic interventions.
This study does not prove that elevated BH4 causes orthostatic intolerance or ME/CFS symptoms—it only shows an association. The findings are preliminary from a small pilot study and have not been replicated in larger populations. The study does not establish that targeting BH4 metabolism would be an effective treatment.
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
Gottschalk, Carl Gunnar, Whelan, Ryan, Peterson, Daniel, & Roy, Avik (2023). Detection of Elevated Level of Tetrahydrobiopterin in Serum Samples of ME/CFS Patients with Orthostatic Intolerance: A Pilot Study.. International journal of molecular sciences. https://doi.org/10.3390/ijms24108713
BibTeX
@article{mecfsatlas-gottschalk-2023-detection-elevated,
author = {Gottschalk, Carl Gunnar and Whelan, Ryan and Peterson, Daniel and Roy, Avik},
title = {Detection of Elevated Level of Tetrahydrobiopterin in Serum Samples of ME/CFS Patients with Orthostatic Intolerance: A Pilot Study.},
journal = {International journal of molecular sciences},
year = {2023},
doi = {10.3390/ijms24108713},
note = {PubMed: 37240059},
url = {https://www.mecfsatlas.com/evidence/gottschalk-2023-detection-elevated},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/gottschalk-2023-detection-elevated
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