Review The potential therapeutic approaches targeting gut health in ME/CFS: a narrative review, 2025, Hsu et al

Full title: The potential therapeutic approaches targeting gut health in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): a narrative review

Chou-Yi Hsu, Irfan Ahmad, Rana Warid Maya, Mayada Ahmed Abass, Jitendra Gupta, Abhayveer Singh, Kamal Kant Joshi, J. Premkumar, Samir Sahoo & Mohsen Khosravi

Abstract

Background
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex disorder characterized by persistent fatigue and cognitive impairments, with emerging evidence highlighting the role of gut health in its pathophysiology. The main objective of this review was to synthesize qualitative and quantitative data from research examining the gut microbiota composition, inflammatory markers, and therapeutic outcomes of interventions targeting the microbiome in the context of ME/CFS.

Methods
The data collection involved a detailed search of peer-reviewed English literature from January 1995 to January 2025, focusing on studies related to the microbiome and ME/CFS. This comprehensive search utilized databases such as PubMed, Scopus, and Web of Science, with keywords including “ME/CFS,” “Gut-Brain Axis,” “Gut Health,” “Intestinal Dysbiosis,” “Microbiome Dysbiosis,” “Pathophysiology,” and “Therapeutic Approaches.” Where possible, insights from clinical trials and observational studies were included to enrich the findings. A narrative synthesis method was also employed to effectively organize and present these findings.

Results
The study found notable changes in the gut microbiota diversity and composition in ME/CFS patients, contributing to systemic inflammation and worsening cognitive and physical impairments. As a result, various microbiome interventions like probiotics, prebiotics, specific diets, supplements, fecal microbiota transplantation, pharmacological interventions, improved sleep, and moderate exercise training are potential therapeutic strategies that merit further exploration.

Conclusions
Interventions focusing on the gut-brain axis may help reduce neuropsychiatric symptoms in ME/CFS by utilizing the benefits of the microbiome. Therefore, identifying beneficial microbiome elements and incorporating their assessments into clinical practice can enhance patient care through personalized treatments. Due to the complexity of ME/CFS, which involves genetic, environmental, and microbial factors, a multidisciplinary approach is also necessary. Since current research lacks comprehensive insights into how gut health might aid ME/CFS treatment, standardized diagnostics and longitudinal studies could foster innovative therapies, potentially improving quality of life and symptom management for those affected.

Open access: https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-025-06527-x

 

From their conclusion:

Yet this is what they write in the abstract:

Which isn’t supported by the evidence.

 

that clause
“contributing to systemic inflammation” is just so… wrong.
As you wrote, contributing is an unwarranted assumption here.
Inflammation has not been generally found to be part of ME. And since it hasn’t been found, there is nothing systemic about it.

 

It sounds like they're expecting the end result will be prescribing one or more strains that will effectively treat the patient. My guess is that it's too dependent on the individual, and the result will be that <strain A> will help 7% of patients, make 9% of patients worse (.3% dramatically worse, long-term), and have no significant effect on the rest (except for the cost and hassle of the process).

I've had, I think 5 now, accidental very effective treatments that seemed to be via altering my microbiome. Very dramatic effects, but I think it would be unlikely that a project to study microbiome effects would result in a visit to a doctor's office and getting a prescription for a capsule that would have done what I accidentally did.

I support studying the microbiome and its effects. Knowledge is important. I'm just not convinced that it will provide actual patient benefits anytime soon.