Hoel, Fredrik, Hoel, August, Pettersen, Ina Kn et al. · JCI insight · 2021 · DOI
This study examined the chemicals in the blood of 83 ME/CFS patients compared to 35 healthy people to understand how their bodies use energy differently. Researchers found that ME/CFS patients had common metabolic changes suggesting their bodies are working harder to produce energy and are using fats and proteins differently as fuel. Interestingly, patients also fell into different subgroups with distinct metabolic patterns, suggesting ME/CFS may involve different energy problems in different people.
This study provides concrete biological evidence that ME/CFS involves real, measurable changes in how the body metabolizes energy—moving beyond the historical dismissal of the disease as psychological. Identifying distinct metabolic subtypes could eventually enable personalized treatment approaches and explains why different patients may respond differently to interventions. Understanding energy metabolism dysfunction as a potential driver of symptoms opens new avenues for targeted supportive therapies.
This study does not prove that metabolic changes cause ME/CFS symptoms or that correcting these metabolic abnormalities will cure the disease—it shows correlation, not causation. The cross-sectional design cannot establish whether metabolic changes precede symptom onset or result from prolonged illness. The findings also do not indicate whether the identified metabolic phenotypes represent distinct disease mechanisms or vary along a continuum.
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
Hoel, Fredrik, Hoel, August, Pettersen, Ina Kn, Rekeland, Ingrid G, Risa, Kristin, Alme, Kine, et al. (2021). A map of metabolic phenotypes in patients with myalgic encephalomyelitis/chronic fatigue syndrome.. JCI insight. https://doi.org/10.1172/jci.insight.149217
BibTeX
@article{mecfsatlas-hoel-2021-map-metabolic,
author = {Hoel, Fredrik and Hoel, August and Pettersen, Ina Kn and Rekeland, Ingrid G and Risa, Kristin and Alme, Kine and Sørland, Kari and Fosså, Alexander and Lien, Katarina and Herder, Ingrid and Thürmer, Hanne L and Gotaas, Merete E and Schäfer, Christoph and Berge, Rolf K and Sommerfelt, Kristian and Marti, Hans-Peter and Dahl, Olav and Mella, Olav and Fluge, Øystein and Tronstad, Karl J},
title = {A map of metabolic phenotypes in patients with myalgic encephalomyelitis/chronic fatigue syndrome.},
journal = {JCI insight},
year = {2021},
doi = {10.1172/jci.insight.149217},
note = {PubMed: 34423789},
url = {https://www.mecfsatlas.com/evidence/hoel-2021-map-metabolic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/hoel-2021-map-metabolic
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