E0 ConsensusWeak / uncertainPEM unclearSystematic-ReviewPeer-reviewedMachine draft
Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis.
Joustra, Monica L, Minovic, Isidor, Janssens, Karin A M et al. · PloS one · 2017 · DOI
Quick Summary
This review looked at whether people with ME/CFS and fibromyalgia have low levels of vitamins and minerals, and whether taking supplements helps. Researchers found very little evidence that vitamin or mineral deficiencies cause these illnesses or that supplements improve symptoms. While some studies showed lower vitamin E levels in patients, this finding disappeared when looking only at higher-quality research.
Why It Matters
This comprehensive review addresses a common clinical practice—35-68% of ME/CFS and fibromyalgia patients use supplements—by systematically evaluating whether evidence supports this approach. The findings help patients and clinicians make informed decisions about supplement use and guide future research priorities.
Observed Findings
- Circulating vitamin E concentrations were lower in CFS/FMS patients compared to healthy controls in the overall meta-analysis (SMD: -1.57, p = .042)
- This vitamin E difference disappeared when analyses were restricted to high-quality studies only
- No vitamins or minerals were consistently or repeatedly linked to symptom severity or quality of life across studies
- RCTs testing vitamin and mineral supplementation did not produce clinical improvements in patients
- Substantial heterogeneity and poor methodological quality were documented in most included studies
Inferred Conclusions
- Current evidence does not support the hypothesis that vitamin and mineral deficiencies play a significant role in ME/CFS and fibromyalgia pathophysiology
- Supplementation with vitamins and minerals is not effective in improving clinical outcomes in these patient populations based on available RCT data
- Higher-quality, well-designed studies are needed before recommending micronutrient supplementation for these conditions
Remaining Questions
- Are there specific micronutrient deficiencies in intracellular compartments that circulating blood tests fail to detect?
- Could particular subgroups of patients (defined by genetics, disease severity, or other factors) benefit from targeted supplementation?
What This Study Does Not Prove
This study does not prove that micronutrient supplementation is ineffective in individual patients, only that current published evidence does not support it broadly. It also does not rule out the possibility that specific subgroups might benefit, or that intracellular micronutrient status (rather than circulating levels) could be relevant. The poor quality of many included studies means we cannot definitively exclude micronutrient involvement based on this evidence alone.
Tags
Symptom:PainFatigue
Biomarker:Blood Biomarker
Method Flag:Weak Case DefinitionSmall SampleMixed Cohort
Metadata
- DOI
- 10.1371/journal.pone.0176631
- PMID
- 28453534
- Review status
- Machine draft
- Evidence level
- Established evidence from major reviews, guidelines, or evidence maps
- Last updated
- 8 April 2026
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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