Natelson, Benjamin H, Lin, Jin-Mann S, Blate, Michelle et al. · Journal of translational medicine · 2022 · DOI
This study tested how the bodies of ME/CFS patients respond when they shift from lying down to leaning upright for 10 minutes. Researchers measured heart rate, blood pressure, breathing, and carbon dioxide levels in the blood. They found that 60% of patients showed abnormal responses, with low blood carbon dioxide levels being the most common problem, followed by an excessively fast heartbeat when standing.
This research identifies a simple, reproducible test that reveals objective physiological abnormalities in ME/CFS patients that would be missed by standard clinical evaluation alone. The finding that hypocapnia is both common and persistent suggests a potential biomarker worthy of further investigation as a therapeutic target.
The study does not establish that orthostatic intolerance causes ME/CFS symptoms or explain the underlying mechanisms producing hypocapnia. It does not determine whether correcting these physiological abnormalities would improve patient symptoms, and the lack of a healthy control group prevents definitive assessment of how these findings compare to non-ME/CFS 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
Natelson, Benjamin H, Lin, Jin-Mann S, Blate, Michelle, Khan, Sarah, Chen, Yang, & Unger, Elizabeth R (2022). Physiological assessment of orthostatic intolerance in chronic fatigue syndrome.. Journal of translational medicine. https://doi.org/10.1186/s12967-022-03289-8
BibTeX
@article{mecfsatlas-natelson-2022-physiological-assessment,
author = {Natelson, Benjamin H and Lin, Jin-Mann S and Blate, Michelle and Khan, Sarah and Chen, Yang and Unger, Elizabeth R},
title = {Physiological assessment of orthostatic intolerance in chronic fatigue syndrome.},
journal = {Journal of translational medicine},
year = {2022},
doi = {10.1186/s12967-022-03289-8},
note = {PubMed: 35172863},
url = {https://www.mecfsatlas.com/evidence/natelson-2022-physiological-assessment},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/natelson-2022-physiological-assessment
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