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Moreover, GI comorbidities such as IBS are frequently observed in CFS/ME, further supporting the hypothesis that gut microbiota imbalances are not merely a consequence of illness but may actively contribute to its pathogenesis ( Ruminococcaceae and increases in Paraprevotella have been associated with greater disease severity ( 3.5.4 Gut microbiota-based therapeutic interventions 3.5.4.1 Probiotics Given these findings, probiotic supplementation, particularly with strains of Lactobacillus and Bifidobacterium , has shown potential to restore microbial balance, enhance SCFA production, and reduce inflammation in CFS/ME patients (Skjevling et al., 2024)