Nater, Urs M, Youngblood, Laura Solomon, Jones, James F et al. · Psychosomatic medicine · 2008 · DOI
This study measured stress hormone (cortisol) levels and immune markers in saliva and blood from people with ME/CFS, people with significant fatigue who don't meet full CFS criteria, and healthy controls. People with ME/CFS showed an abnormal pattern: lower cortisol in the morning and higher in the evening (the opposite of what's healthy), suggesting their stress-response system may not be working normally.
This study provides evidence that ME/CFS involves measurable dysfunction in the body's stress-response system (HPA axis), which could help explain persistent fatigue and may guide development of targeted treatments. Understanding these biological abnormalities legitimizes ME/CFS as a physiological condition rather than a purely psychological one.
This cross-sectional study cannot establish causation—abnormal cortisol patterns may be a consequence of ME/CFS rather than its cause. The study does not prove that HPA axis dysfunction is the primary mechanism of ME/CFS, only that it is associated with the condition. Results are correlational and do not establish whether correcting cortisol rhythm would improve symptoms.
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 →
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