Evidence browser

Gut MicrobiomeImmune System

Recognizing the Leaky Gut as a Trans-diagnostic Target for Neuroimmune Disorders Using Clinical Chemistry and Molecular Immunology Assays.

Simeonova, Denitsa, Ivanovska, Mariya, Murdjeva, Mariana et al.·Current topics in medicinal chemistry·2018

This review examines how a condition called 'leaky gut'—where the intestinal barrier becomes too permeable, allowing harmful bacteria to enter the bloodstream—may contribute to ME/CFS and other conditions affecting mood and energy. The authors summarize available blood and stool tests that can help doctors recognize leaky gut in practice. They identify specific markers (like immune responses to bacterial toxins and inflammatory proteins) that could signal intestinal barrier problems.

E0 ConsensusReviewPEM not requiredSystematic-Review

Exercise therapy is a beneficial intervention for chronic fatigue syndrome (PEDro synthesis).

Dannaway, Jasan, New, Cameron C, New, Charles H et al.·British journal of sports medicine·2018

This review examined multiple studies to determine whether exercise therapy helps people with ME/CFS. The researchers looked at existing evidence to see if physical activity programs could improve fatigue and other symptoms. However, it's important to note that findings on exercise for ME/CFS are complex and sometimes controversial in the patient community.

Interventions

Measuring School Functioning in Students With Chronic Fatigue Syndrome: A Systematic Review.

Tollit, Michelle, Politis, Jennifer, Knight, Sarah·The Journal of school health·2018

This review looked at 36 studies examining how ME/CFS affects students' school experiences. Researchers found that most studies only measured school absences, but didn't thoroughly look at other important aspects like grades, motivation, or what support students receive. The review highlights that we need better ways to measure and understand how ME/CFS impacts all areas of school life.

A systematic review of the association between fatigue and genetic polymorphisms.

Wang, Tengteng, Yin, Jie, Miller, Andrew H et al.·Brain, behavior, and immunity·2017

Researchers reviewed 50 studies to understand whether differences in our genes (called genetic polymorphisms) might make some people more likely to experience severe fatigue. They found that certain genetic variations in immune system and brain chemistry genes were linked to fatigue across different diseases, including ME/CFS. This suggests that our genes may play a role in determining how tired we become.

E0 ConsensusReviewPEM not requiredEditorial

Evidence Refuting the Existence of Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA).

Ameratunga, Rohan, Gillis, David, Gold, Michael et al.·The journal of allergy and clinical immunology. In practice·2017

This study examined whether a theory called ASIA (a proposed condition blamed on vaccine adjuvants like aluminum) is supported by scientific evidence. Researchers looked at data from people who received allergen immunotherapy, which contains much more aluminum than vaccines, and found they actually had fewer autoimmune diseases, not more. The study concludes that current evidence does not support the idea that aluminum in vaccines causes autoimmune problems.

E0 ConsensusReviewPEM unclearEditorial

Cognitive behaviour therapy and objective assessments in chronic fatigue syndrome.

McPhee, Graham·Journal of health psychology·2017

This review looked at studies testing whether cognitive behavioral therapy (CBT)—a talking treatment—helps people with ME/CFS. Most studies only asked patients if they felt better, but didn't measure whether they could actually do more physical activities. The review found little evidence that CBT improves what patients can actually do or helps them return to work.

E0 ConsensusReviewPEM unclearEvidence-Map

Exercise and the Athlete With Infectious Mononucleosis.

Shephard, Roy J·Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine·2017

This review examines how infectious mononucleosis (a viral illness caused by Epstein-Barr virus) affects young athletes and whether it can lead to chronic fatigue syndrome. The main finding is that with proper diagnosis and a few weeks of rest followed by gradual return to activity, most athletes recover fully within 2-3 months, and serious complications like splenic rupture are rare.

Post-Exertional Malaise

The European ME/CFS Biomarker Landscape project: an initiative of the European network EUROMENE.

Scheibenbogen, Carmen, Freitag, Helma, Blanco, Julià et al.·Journal of translational medicine·2017

Researchers across Europe are working together to find biological markers (signs in blood or body tests) that could help diagnose ME/CFS and track how treatments work. This study reviewed all the biomarker research happening in Europe and created a database of what scientists are studying. The goal is to develop reliable tests that doctors could use in the future to diagnose ME/CFS and improve clinical trials.

Biomarkers

E0 ConsensusReviewPEM not requiredReview-Narrative

Are Traditional Remedies Useful in Management of Fibromyalgia and Chronic Fatigue Syndrome? A Review Study.

Mahjoub, Fatemeh, Salari, Roshanak, Noras, Mohammad Reza et al.·Journal of evidence-based complementary & alternative medicine·2017

This study looked at how traditional Persian medicine approaches fibromyalgia and ME/CFS, which are conditions that cause widespread pain and extreme tiredness. The researchers compared ancient Persian medical texts, particularly writings by the physician Avicenna, with modern understanding of these diseases. They found that traditional medicine recognized fatigue as a complex condition with different types, each with distinct symptoms.

Pain and Sensitization

Serious adverse events after HPV vaccination: a critical review of randomized trials and post-marketing case series.

Martínez-Lavín, Manuel, Amezcua-Guerra, Luis·Clinical rheumatology·2017

This review examined safety reports from HPV vaccine studies and medical databases. The authors found that some large vaccine trials reported more serious side effects in vaccinated groups than in control groups, though researchers did not conclude these were caused by the vaccine. The study raises questions about how thoroughly vaccine safety is monitored and reported.

E0 ConsensusReviewPEM not requiredSystematic-Review

Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis.

Wang, Taiwu, Xu, Cong, Pan, Keli et al.·BMC complementary and alternative medicine·2017

This study reviewed 31 previous research trials examining whether acupuncture and moxibustion (traditional Chinese treatments involving needles and heat) help treat ME/CFS. The researchers found that combining multiple acupuncture and moxibustion techniques appeared more effective than using just one technique, and both were more effective than sham acupuncture (fake treatment). However, the overall quality of the research studies reviewed was weak, so stronger evidence is needed before drawing firm conclusions.

Interventions

Pediatric chronic fatigue syndrome: current perspectives.

Crawley, Esther·Pediatric health, medicine and therapeutics·2017

This review examines ME/CFS in children, showing it is a common condition that significantly affects children and their families. The good news is that most children improve when they receive specialized treatment from doctors who understand this illness. The review summarizes what we know about how many children get ME/CFS, what factors may be involved, and what treatments have evidence supporting them.

Interventions

Chronic fatigue syndrome and the immune system: Where are we now?

Mensah, Fane Kojo Fosu, Bansal, Amolak Singh, Ford, Brian et al.·Neurophysiologie clinique = Clinical neurophysiology·2017

ME/CFS is a complex illness that causes exhaustion, headaches, and thinking problems, and gets worse with activity. Researchers have suspected for years that the immune system plays a role in ME/CFS, but studies have produced confusing and sometimes contradictory results. This review examines what we currently know about immune system changes in ME/CFS and discusses promising new research directions, including the possibility that certain immune-targeting treatments might help patients improve.

Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and D-lactic acidosis: a systematic review.

Wallis, Amy, Ball, Michelle, McKechnie, Sandra et al.·Journal of translational medicine·2017

This study compared symptoms reported in cases of D-lactic acidosis (a rare condition where a specific type of acid builds up in the body) with symptoms of ME/CFS. Researchers found that many neurological symptoms—like brain fog, movement problems, and nerve-related issues—appeared in both conditions. Both groups also had gut bacteria imbalances and stomach problems. The authors suggest that ME/CFS might involve similar gut-related processes as D-lactic acidosis, but stress that we need more research to understand if this connection is real.

Energy Metabolism

Practical management of chronic fatigue syndrome or myalgic encephalomyelitis in childhood.

Brigden, Amberly, Loades, Maria, Abbott, Anna et al.·Archives of disease in childhood·2017

This article provides practical guidance on how doctors should diagnose and treat ME/CFS in children and teenagers. ME/CFS is a serious condition that affects at least 1 in 100 secondary school students in the UK, causing severe fatigue and limiting daily activities. Although effective treatments exist, many young people with ME/CFS don't get diagnosed or receive help they need.

Diagnostics

Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome.

Castro-Marrero, Jesus, Sáez-Francàs, Naia, Santillo, Dafna et al.·British journal of pharmacology·2017

This review looked at all available research on treatments for ME/CFS to see what actually helps patients. The researchers found that while some treatments like behavioral therapy, pacing strategies, and nutritional supplements show promise, the evidence is still limited because most studies were small and used different methods. The authors conclude that personalized pacing and treating nutritional deficiencies are reasonable approaches, but much larger and better-designed studies are urgently needed to know what really works.

E0 ConsensusReviewPEM not requiredSystematic-Review

Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review.

Campagnolo, N, Johnston, S, Collatz, A et al.·Journal of human nutrition and dietetics : the official journal of the British Dietetic Association·2017

Researchers reviewed 17 studies looking at whether diet changes and supplements could help ME/CFS symptoms like fatigue and quality of life. While a few interventions—including NADH, probiotics, and high-cocoa chocolate—showed promise for reducing fatigue, most studies did not find clear benefits. Overall, there isn't enough strong evidence yet to recommend specific diets or supplements as reliable treatments for ME/CFS.

What treatments work for anxiety in children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)? Systematic review.

Stoll, Sarah Victoria Ellen, Crawley, Esther, Richards, Victoria et al.·BMJ open·2017

Many children with ME/CFS experience anxiety alongside their fatigue symptoms. This review looked at nine studies to find out which treatments help reduce anxiety in children with ME/CFS. While a few treatments showed some promise—particularly therapy approaches like cognitive behavioural therapy and one immune treatment—the evidence is limited and no treatment was specifically designed to target anxiety in this group.

E0 ConsensusReviewPEM not requiredSystematic-Review

Exercise therapy for chronic fatigue syndrome.

Larun, Lillebeth, Brurberg, Kjetil G, Odgaard-Jensen, Jan et al.·The Cochrane database of systematic reviews·2017

This review looked at eight research studies testing whether exercise therapy helps people with ME/CFS feel less fatigued and improve their daily functioning. Overall, patients who did exercise therapy felt less tired and reported better sleep and physical function compared to those who received standard care or relaxation therapy. Exercise therapy appeared to work about as well as cognitive-behavioral therapy (talking therapy), though more research is needed to figure out the best type, intensity, and duration of exercise for each patient.

Sleep

Gut Microbiota, Bacterial Translocation, and Interactions with Diet: Pathophysiological Links between Major Depressive Disorder and Non-Communicable Medical Comorbidities.

Slyepchenko, Anastasiya, Maes, Michael, Jacka, Felice N et al.·Psychotherapy and psychosomatics·2017

This review examines how changes in gut bacteria and a 'leaky gut' (where bacteria can cross the intestinal barrier) may contribute to depression and related conditions like ME/CFS. The authors found evidence that diet, gut bacteria composition, and immune system activation are interconnected, and that these connections may explain why depression often occurs alongside conditions like irritable bowel syndrome, ME/CFS, obesity, and diabetes.