Natelson, Benjamin H, Intriligator, Roxann, Cherniack, Neil S et al. · Dynamic medicine : DM · 2007 · DOI
This study compared how ME/CFS patients and healthy volunteers responded to standing up for 8 minutes. Researchers measured blood pressure, heart rate, breathing rate, and carbon dioxide levels in the blood. ME/CFS patients were more likely than healthy people to have abnormal responses, particularly low carbon dioxide levels (hypocapnia), which was linked to feeling more ill and short of breath.
This study identifies orthostatic hypocapnia as a potential biological marker that could help distinguish a physiologically measurable subgroup of ME/CFS patients, reducing the clinical heterogeneity that complicates research and treatment. Understanding specific physiological abnormalities in ME/CFS may lead to targeted diagnostic tools and interventions. The association between hypocapnia and symptom severity suggests a mechanism worth investigating further.
This cross-sectional study cannot establish causation—it shows that hypocapnia is associated with ME/CFS and orthostatic symptoms, but does not prove hypocapnia causes the condition. The study does not demonstrate whether hypocapnia is primary, secondary, or merely a marker of other underlying dysfunction. The findings apply specifically to patients with positive orthostatic testing and cannot be generalized to all ME/CFS patients.
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
Natelson, Benjamin H, Intriligator, Roxann, Cherniack, Neil S, Chandler, Helena K, & Stewart, Julian M (2007). Hypocapnia is a biological marker for orthostatic intolerance in some patients with chronic fatigue syndrome.. Dynamic medicine : DM. https://doi.org/10.1186/1476-5918-6-2
BibTeX
@article{mecfsatlas-natelson-2007-hypocapnia-biological,
author = {Natelson, Benjamin H and Intriligator, Roxann and Cherniack, Neil S and Chandler, Helena K and Stewart, Julian M},
title = {Hypocapnia is a biological marker for orthostatic intolerance in some patients with chronic fatigue syndrome.},
journal = {Dynamic medicine : DM},
year = {2007},
doi = {10.1186/1476-5918-6-2},
note = {PubMed: 17263876},
url = {https://www.mecfsatlas.com/evidence/natelson-2007-hypocapnia-biological},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/natelson-2007-hypocapnia-biological
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