Nikolova, Ralitsa, Donchev, Deyan, Vaseva, Katya et al. · International journal of molecular sciences · 2025 · DOI
This review examines the connection between gut bacteria and ME/CFS, a condition characterized by exhaustion that worsens after activity. The authors explain how an imbalance in gut bacteria may damage the intestinal barrier, allowing bacterial particles to enter the bloodstream and trigger inflammation throughout the body. They also discuss how changes in gut bacteria might affect the brain, contributing to the brain fog and cognitive problems many ME/CFS patients experience.
Understanding the gut microbiome's role in ME/CFS is important because it may explain multiple symptoms patients experience and could lead to new diagnostic approaches and treatments. This review brings together evidence suggesting that targeting gut dysbiosis through dietary or probiotic interventions might help reduce inflammation and improve symptoms in ME/CFS patients.
This systematic review does not establish that dysbiosis is the primary cause of ME/CFS or prove that microbiome changes directly cause the disease in all patients. The studies reviewed show associations and propose mechanisms, but do not definitively prove causation, and individual patient responses to microbiome interventions may vary significantly.
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
Nikolova, Ralitsa, Donchev, Deyan, Vaseva, Katya, & Ivanov, Ivan N (2025). Gut Microbiome and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Insights into Disease Mechanisms.. International journal of molecular sciences. https://doi.org/10.3390/ijms27010425
BibTeX
@article{mecfsatlas-nikolova-2025-gut-microbiome,
author = {Nikolova, Ralitsa and Donchev, Deyan and Vaseva, Katya and Ivanov, Ivan N},
title = {Gut Microbiome and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Insights into Disease Mechanisms.},
journal = {International journal of molecular sciences},
year = {2025},
doi = {10.3390/ijms27010425},
note = {PubMed: 41516296},
url = {https://www.mecfsatlas.com/evidence/nikolova-2025-gut-microbiome},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/nikolova-2025-gut-microbiome
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