Shukla, Sanjay K, Cook, Dane, Meyer, Jacob et al. · PloS one · 2015 · DOI
This study examined whether the bacteria living in the gut of ME/CFS patients behave differently after exercise compared to healthy people. Researchers collected stool and blood samples from 10 ME/CFS patients and 10 healthy controls before and after an intense exercise test. They found that after exercise, ME/CFS patients showed unusual changes in their gut bacteria and had more bacterial DNA circulating in their blood 72 hours later—something that didn't happen in healthy people.
Post-exertional malaise is a hallmark and often the most disabling feature of ME/CFS, yet its biological mechanisms remain poorly understood. This study provides preliminary evidence that gut dysbiosis and bacterial translocation may contribute to symptom exacerbation after exercise, potentially opening new avenues for therapeutic intervention targeting the microbiome or intestinal barrier function.
This study does not prove that altered gut bacteria *cause* post-exertional malaise, only that changes occur in association with exercise. The small sample size and lack of correlation between microbiome changes and symptom severity limit causal claims. Additionally, the study cannot determine whether the microbiome changes are a primary driver of symptoms or a secondary consequence of ME/CFS pathophysiology.
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
Shukla, Sanjay K, Cook, Dane, Meyer, Jacob, Vernon, Suzanne D, Le, Thao, Clevidence, Derek, et al. (2015). Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).. PloS one. https://doi.org/10.1371/journal.pone.0145453
BibTeX
@article{mecfsatlas-shukla-2015-changes-gut,
author = {Shukla, Sanjay K and Cook, Dane and Meyer, Jacob and Vernon, Suzanne D and Le, Thao and Clevidence, Derek and Robertson, Charles E and Schrodi, Steven J and Yale, Steven and Frank, Daniel N},
title = {Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).},
journal = {PloS one},
year = {2015},
doi = {10.1371/journal.pone.0145453},
note = {PubMed: 26683192},
url = {https://www.mecfsatlas.com/evidence/shukla-2015-changes-gut},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/shukla-2015-changes-gut
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