The gut-brain axis has been validated in many studies.
More studies need to be done, but it appears that something has gone awry in the gut flora of people that’s impacting the symptoms found in chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), Gulf War Illness (GWI), and now, it appears, long COVID. That’s not a surprise. Studies and papers exploring the gut-brain axis abound and make it clear that gut issues can impact the central nervous system and can influence symptoms like fatigue, pain, and sleep.
First, this blog looks at what the gut flora studies have found in ME/CFS, FM, GWI, and long COVID. Then it’s onto a cheap and possibly effective gut flora modifier that might help.
Chronic Fatigue Syndrome (ME/CFS)
A 2018 review concluded that the poor/fair quality and the mixed results of gut microbiome ME/CFS studies indicated there was “currently insufficient evidence for enteric dysbiosis playing a significant role in the pathomechanism of CFS/ME.” Indeed, Hanson’s 2018 study did not find significant evidence of dysbiosis in ME/CFS but Lipkin’s 100-person 2017 study, Hanson’s 2016 study, and a 2013 DeMeirleir study did. So did one of the most interesting and possibly consequential microbiome studies in ME/CFS. A small 2015 study found that exercise produced major changes in the gut microbiome, and problems with leaky gut in ME/CFS but not in healthy controls.
“Something Completely Different”: Ian Lipkin Talks at the CDC on ME/CFS – Health Rising
Plus, the 2018 review did not include Lipkin’s 2018 study, which was able to integrate fecal metagenomic data with plasma metabolomic data – thus linking together alterations in the gut with metabolic markers in the blood. Nor did it include the most recent ME/CFS microbiome study – a 105-person Italian study – which found similar results as past microbiome studies: i.e. decreased levels of bacteria from the Firmicutes phylum and increased levels of bacteria from the Bacteroidetes phylum were present.
The authors reported that this shift in gut flora mimics what has been found in autoimmune conditions such as Crohn’s disease, lupus, and diabetes. Interestingly, in the latest study, the alterations in gut flora in both people with ME/CFS and their near relatives were mainly due to increases of the notorious Clostridiales order which contains anaerobic bacteria (oxygen is toxic to them).
Many Clostridiales bacteria are not harmful but the order also includes notably toxic species such as Clostridium difficile and C. botulinum. Intriguingly, the Clostridiales bacteria found decreased in ME/CFS (Lachnospiraceae family) were “good” bacteria that produce butyric acid – an important energy source and gut lining protector. Increasing butyrate production will be a major theme in GWI studies (see below).
Another 2018 review found only two studies that attempted to use probiotics to improve ME/CFS symptoms. Both studies used a single probiotic (Lactobacillus casei strain Shirota, Bifidobacterium infantis 35624) to change the gut composition and both appeared successful in reducing anxiety or inflammatory markers. While the studies were successful, the authors called the evidence that probiotics can influence ME/CFS “limited”.
Fibromyalgia
The gut microbiome hasn’t been studied as well in fibromyalgia, but similar findings have shown up there. A 2004 Pimental study, which unfortunately has not been replicated, found small-bowel bacterial overgrowth in 100% of FM patients, 84% of IBS patients, and only 20% of healthy controls. Pain levels in FM were positively correlated with breath hydrogen levels.
Back in 2008, in a study which one review article did not entirely trust, increased gut permeability was found in both FM and chronic regional pain patients compared to healthy controls. All in all, the results suggest a breakdown in the gut flora in FM has occurred, but a recent Australian review reported that “a paucity of quality research in this area” remains.
Gulf War Illness
Gulf War Illness (GWI) may be on the firmest ground with regard to gut dysbiosis. It’s certainly moved the quickest with regard to testing potential gut treatments. This is presumably because of two overlapping emphases – both of which are missing in ME/CFS and FM. One is the focus from GWI research funders, such as the Department of Defense, on producing treatment options, and the other involves the rapid production of animal models to test potential treatments.
Four years ago, GWI researchers demonstrated that the chemical exposures could cause gut microbiome problems in GWI mice, and that these gut microbiome changes were associated with neuroinflammation as well. Next, GWI researchers demonstrated that butyrate administration improved metabolism, inflammation, fatigue, gastrointestinal problems, etc.
Several studies have found evidence of leaky gut in ME/CFS and GWI.
A 2019 placebo-controlled, double-blinded 120-person-plus GWI study, unfortunately, did not find that an antibiotic often used in IBS, called Rifaxmin, was helpful. Another 2019 study found, though – similar to ME/CFS – increased levels of Firmicutes bacteria in GWI. Using the mouse model, a 2019 study suggested that alterations in the gut virome were contributing to leaky gut in GWI.
Gulf War Illness researchers then tried to reverse gut and other problems by using a nutraceutical, derived from the Chinese herb Sparstolonin B (SsnB), to boost butyrate-producing bacteria levels in their mouse model. By restoring the tight gut linings in the mice, SsnB reduced inflammation in the gut and in the central nervous system.
The Gist
- Numerous studies indicate that the flora or bacteria/viruses in our guts can affect the brain causing fatigue and other problems.
- Studies suggest that an unhealthy, mix of gut flora in ME/CFS, FM, GWI, and long COVID may be contributing to inflammation, leaky gut, and perhaps even neuroinflammation.
- GWI studies that have used herbs and supplements to increase the levels of butyrate-producing bacteria have eliminated leaky gut and reduced inflammation and perhaps even neuroinflammation.
- A recent Stanford study that compared high-fiber and high-protein diets in healthy people found that while high-fiber diets provided some benefits they did not improve microbiome (gut flora) diversity or reduce inflammation.
- The fact that those people on the high-fiber diets who started out with higher levels of microbiome diversity did reduce inflammation suggested that a certain level of gut microbiome diversity is necessary to achieve the full benefits of high fiber diets.
- The people on the fermented foods diets significantly improved their microbiome diversity and reduced their levels of inflammatory markers.Their microbiome diversity slowly improved over time and reached its peak in the last part of the study. The more fermented foods consumed the higher the microbiome diversity reached.
- Note that while the fermented food group ramped up their intake of fermented foods over 4 weeks, they also experienced initial bloating which resolved over time.
- The fact that the same general gut flora factors that had been found depleted in the GWI and ME/CFS studies. improved in the Stanford study suggested that fermented foods might be helpful in these diseases as well.
Finally, this year GWI researchers found that an herbal supplement called Andrographolide not only restored helpful gut bacteria but also helped to correct the gut virome in mice. Leaky gut disappeared, intestinal inflammation declined and appeared to reduce microglial activation as well.
Note that, despite the emphasis on the gut in GWI research, no GWI studies have attempted to improve the gut microbiome using probiotics. Note also that the studies have focused on increasing the levels of the same kind of butyrate-producing bacteria found to be depleted in ME/CFS (butyrate bacteria), and that doing so has been helpful.
The fact that GWI studies are having success using gut modifiers – in GWI mice, for sure – suggests that successful gut modification in GWI (or, for that matter, ME/CFS, FM, or long COVID) may not necessarily entail using probiotics, antibiotics, fiber supplements or diet.
Long COVID
Few long-COVID studies have been done yet, but an oral microbiome study found similar bacterial species to those found in ME/CFS. A review of 4 long-COVID microbiome studies found a loss of microbiome biodiversity, an increase of inflammatory bacteria, decreased anti-inflammatory bacteria, and leaky gut – all of which have been found in ME/CFS. Two studies are underway to study a gut flora modifier called KB109 in long COVID.
It’s good to see new gut treatment options showing up. Recently, an ancient possibility – possibly the most ancient possibility – one which required no special supplements or drugs was tested in healthy controls. A complex Stanford study, “Gut Microbiota-Targeted Diets Modulate Human Immune Status“, explored the role fermented foods can play in returning the gut flora to health. The results were encouraging indeed.
The Stanford Study
The Stanford study used state-of-the-art immune profiling to determine how two dietary interventions – a plant-based fiber diet and a fermented food diet – affected the gut flora and immune functioning in a 17-week randomized, prospective study.
Anyone wishing to try either diet should note that the study contained a 4-week ramp-up phase where the participants gradually increased their fiber/fermented foods intake (“ramp”), followed by a 6-week maintenance phase where they maintained a high level of either fiber or fermented foods (“maintenance”). During the final 4-week choice period, the participants were able to continue their diets as they wished.
Throughout the study, stool samples were assessed for microbiome composition, function, and metabolic output. The blood samples produced a “systems-level view of the immune system”, and included cytokine levels, cell-specific cytokine response signaling, and cell frequency and immune cell signaling at steady-state. In short, this was a heavy-duty study. It was funded by a variety of sources including several foundations, an NIH grant, and a fellowship.
Results
The goal seems to have been to have the participants increase their fiber/fermented intake in a manner of their choosing. They were provided detailed instructions to encourage the two groups to increase their variety of fiber sources (legumes, seeds, whole grains, nuts, vegetables, and fruits) or fermented foods (fermented dairy products, fermented vegetables, fermented non-alcoholic drinks).
The fiber sources were then grouped into fruits, grains, legumes, nuts/seeds, vegetables, meat, dairy, and others for analysis. One serving of fermented foods was defined as: kombucha, yogurt, kefir, buttermilk, kvass = 6 oz; kimchi, sauerkraut, other fermented veggies = 1/4 cup; vegetable brine drink = 2 oz. Broad categories of fermented foods were grouped into cottage cheese, kefir, kombucha, vegetable brine drinks, vegetables, yogurt, other foods, and other drinks.
People in the high-fiber diet arm increased their fiber consumption from an average of 21.5±8.0 g per day (.75 ounces) at baseline to 45.1±10.7 g (1.6 ounces) per day by the end of the maintenance phase (Figure 1C) – about triple the average American intake of fiber/day.
Participants in the high-fermented food diet arm consumed an average of 0.4+0.6 servings per day of fermented food at baseline, which increased to an average of 6.3+2.9 servings per day at the end of the maintenance phase. A New York Times article noted that “one cup of yogurt for breakfast, a 16-ounce bottle of kombucha tea at lunch, and a cup of kimchi at dinner amounts to six daily servings.” The high-fiber group did not increase their fermented food intake and the fermented food group did not increase their fiber intake.
Results
High-Fiber Group
High-fiber foods had some positive benefits but did not increase microbial diversity or decrease inflammation. A more diverse microbiome may be necessary to achieve the full benefits of high-fiber diets.
The high-fiber diet group reported an increase in stool softness over time.
Fiber-rich foods provide a good “fermentable” carbon source for the microbiome, but despite the high levels of dietary fiber reached in the high fiber group, microbiome diversity did not increase. Nor did inflammatory markers decrease.
Intriguingly, though, the people on the high-fiber diet who did see a drop in inflammatory markers had a higher microbiome diversity to start off with. That suggested that the people on the high-fiber diet who did not see a drop in inflammatory markers may simply have lacked the bacterial species which fed on the fiber. High levels of undigested carbohydrates in their stools suggested this was so.
That suggests that high-fiber diets may not as beneficial for people who already have a less diverse microbiome, and that finding ways (such as fermentable foods) to increase gut microbiome diversity may be helpful. The gas and bloating that some people experience when adding fiber to their diets may be due to a lack of gut flora diversity.
Fiber enrichment did, however, increase stool microbial protein density, carbohydrate-degrading capacity, and altered short-chain fatty acids.
The High Fermented Foods Group
The fermented food cohort reported bloating during the ramp-up phase which disappeared over time.
Fermented foods like Kimchi increased microbiome diversity and reduced inflammation.
In contrast to the high fiber group, microbiome diversity increased over time in the fermented foods group and reached its greatest peak during the last “choice” phase of the study. More was better in this case; the more fermented foods a person ate, the higher their microbial diversity. (Note again that the fermented portion of the diet was slowly increased and some bloating was found at first.)
The bacterial species that increased over time were all in the same Firmicutes phylum which has been found depleted in ME/CFS. Four of the species were found in the Lachnospiraceae family which has also been found depleted in ME/CFS. Interestingly, the new species did not directly come from the fermented foods. Instead, the fermented foods appeared to open the gut flora for the introduction of new bacterial species.
The fermented foods also resulted in a broad dampening of inflammation markers. Nineteen of the 93 cytokines, chemokines, and other inflammatory serum proteins (including some biggies: IL-6, IL-10, and IL-12b) that were assessed during the study decreased significantly. Markers of immune activation also declined.
GWI interventions have largely focused on increasing butyrate levels. The increased butyrate levels found group-wide (but mostly in the high-fiber group) in the study were associated with decreased B-cell frequency – an interesting finding given the role B-cells play in autoimmunity.
The authors called the possibility that a high-fiber/high fermented food diet could synergistically improve both microbiome and immune system functioning “exciting”.
Conclusion
More studies are needed, but gut microbiome studies suggest microbiome diversity is reduced in ME/CFS, with bacteria from the Firmicutes phylum reduced and bacteria from the Bacteroidetes phylum increased. A similar pattern is found in autoimmune diseases as well as Gulf War Illness, where researchers have found that enhancing butyrate bacteria using gut treatments (the Chinese herb Sparstolonin B (SsnB), lacto-N-fucopentaose-III (LNFPIII), Andrographolide) has tightened gut linings and reduced gut inflammation and neuroinflammation. Thus far, the long-COVID gut studies suggest a similar process is occurring there.
A heavy-duty, 16-week Stanford study that compared high fiber and high fermented food diets found that while high fiber diets had some benefits, they did not increase microbiome diversity or impact immune factors. The fact that the participants who had higher baseline levels of microbiome diversity did reduce their inflammatory markers suggested that a diverse gut flora was crucial to achieving the full benefits of a high fiber diet. The bloating and distress some experience on high fiber diets may be due to a lack of gut flora diversity.
On the other hand, the participants on the high fermented food diet did see a significant increase in gut microbiome diversity and did see reductions in inflammatory markers. The more fermented foods the participants incorporated into their diet the greater the increase in gut microbiome diversity that occurred. Interestingly, the same gut flora found to be depleted in ME/CFS and GWI was enhanced by the fermented food diet.
Note that some bloating may be expected as fermented foods are incorporated into one’s diet but this study found that the bloating did disappear over time. People with mast cell activation syndrome (MCAS) may experience problems with fermented foods. That will be covered in the next blog.
- Next up – a review of “The Gut Health Protocol: A Natural Approach to Healing SIBO, Intestinal Candida, GERD, Gastritis and other Gut Health Issues“
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Interesting! I also have MCAS so I struggle with eating fermented foods that are high in histamine. Does anyone know how to navigate this?
Good question – I don’t know but I heard Dr. Afrin at the IACFS/ME conference say that dietary changes helped some people with MCAS and not others. So maybe some people can tolerate them????
Oh interesting! I wonder what makes the difference.
The study showing fermented foods encouraged microbiome diversity did not say where the new species would come from. Probiotics or the less savory option of others’ fecal matter along the way?
No, it didn’t but not from probiotics or fecal matter as they weren’t part of the trial. Maybe the fermented foods encouraged the growth of some bacteria that they didn’t pick up before? Or it allowed the growth of some bacteria from foods (?) which were not part of the experiment? It’s an interesting question.
I was going to post the same question, re histamine intolerance. It seems unlikely that none of the subjects had this, given how common it is with us. I usually give up my fermented food attempts quickly because the brain fog etc is so bad, but would persist if I thought it would improve. Is there some way of asking the experimenters?
I believe the book I’m reading and will be reviewing “The Gut Health Protocol” deals with this question.
That’s the first thing I thought of too! If it’s a DAO issue only maybe it would be worth taking a higher amount of DAO once in awhile to add a little fermented food to our diet? Someone needs to address this!
Try meeting with a holistic dietician. Almost seems like glyphosate toxicity.
Perhaps the difference is the baseline mix of bacteria already present ????
Again, a good reason to look at the GAPS eating methodology which uses fermented foods extensively. Plus is aimed at eventually getting to a balanced diet not purely elimination forever plan.
Thanks Janet for the tip.
Good article. I have had plenty of gut issues, on and off, and it sounds like many CFS sufferers do. I guess the question is whether it is cause or effect, or a bit of both?
Thank you, I’ve never heard of GAPS eating. I’m looking into it now
Very good. It is time for the gut flora to be taken seriously.
I’m sorry, it was hard for me to read because of brain fog. They write about improving microbiome diversity and reducing the levels of inflammatory markers, but did the participants with ME / CFS, GW and FM feel better after the studies?
How was the fatigue score before and after the studies? And what about other symptoms?
These were all healthy controls and there was not attempt that I could see to assess things like fatigue or other symptoms. They just went straight for the biology.
Am i now so brainfogged, so healthy people can be healthy with a bad microbiome, gutpermeability, etc??? what is then the difference between deseases as ME/cfs, FM, long covid, GWI? I do not understand it. but as i said, bad brain…
I am curious about what any of these researchers found about oxalates and lack of oxalate degrading bacteria in the microbiome. Most antibiotics That we have been prescribed kill off the oxalate degrading bacteria, leaving us vulnerable to oxalate toxic buildup, which binds to minerals, and deposits sharp oxalate crystals In tissues, joints, and organs, which can create fibromyalgia pain. This also leads to osteoporosis, as well as causing significant oxidative stress, and depleting antioxidants, minerals, and vitamin B6. Anecdotally, this seems to be an incredibly common issue in ME/CFS patients, and I am surprised that the researchers have not been looking into this. Or have they?
Additionally, the microbiome consists of over 30 trillion organisms of over 1,000 types. It is incredibly individual, which is why one size fits all approaches can be a problem. Is there any research on individualizing gut improvement, to bring a variety of imbalanced microbiomes into a more normal state? I have been using the Viome Gut Intelligence test, which uses sophisticated algorithms based on microbiome research to identify the constituents of the microbiome, what they are doing, as well as providing advice on superfoods, foods to avoid, and gut supplements to individualize improvement and manipulate the microbiome.
I also had asked some of the microbiome researchers at the NIH conference 2 years ago whether they were planning on doing any tests of FMT, fecal transplants, and they response unfortunately was a resounding no. It would be nice to see some research on this, because I have seen many patients whose microbiomes are in very sad shape after the drugs they have taken have damaged it.
I’ve often wondered if antibiotics can’t be delivered intravenously for every patient , by some new technology, useable at home, so we can perhaps avoid the nuclear explosion and in the gut that they cause
For my part, I haven’t heard anything about oxalate research. I agree regarding one-shot solutions to gut issues. I don’t see how that’s possible given the complexity of the gut flora and that issue is one reason why I wonder if fermented foods with their complex microbiome might be more helpful.
Has the Viome Gut Intelligence test been helpful?
Has anyone tried andrographides? Did they work and how long before a difference was noted? Any particular side effects?
My gut is a mess. I once got done to 83 pounds due to leaky gut. I might give it a trial after I read more about it.
i can not remember from who, maybe it was even on your blog, or a conference but i saw a whole time ago a whole (was it youtube) video about microbiota and the individuallity of this and what to eat. it was really about individual eating/”diets”
One thing that companies like Viome and others are doing is a “dimensionality reduction” that determines how all the various species combine to produce/degrade various bacterial functional products. Viome calls this “pathway analysis”.
I don’t fully understand it yet (and likely never will!), but it seems this /may/ help to find common patterns without having to get hyper-individualized at the species level (which Viome calls the taxonomy analysis).
For instance, these pathways include the production of butyrate, which the other studies Cort mentions have shown is decreased in ME/CFS. Another is lactate which I believe has generally been found to be elevated. Another gut pathway I’m getting interested by is H2S production, since the recent redox study Cort mentioned in another post has shown elevated H2S in ME/CFS.
One thing that piqued my interest in H2S is that it can be driven by Enterococcus species, which are the ones one of the early “quality” studies (Sheedy 2009) found to be significantly elevated in ME/CFS, according to this chart from an Australian outfit called Microba which does pathway analysis at least conceptually similar to Viome: https://insight.microba.com/wp-content/uploads/2021/05/HCP-Usual-Suspects-Guide-%E2%80%93-MAR2021.pdf
From what I understand, these functional pathway analyses can pick up significant production/degradation even from species it doesn’t positively identify, although I don’t entirely understand how. Enterococcus doesn’t appear among my topmost species on my whole genome sequencing results (using the Microba platform) but qPCR results I’ve gotten simultaneously to whole-genome sequencing show Enterococcus has become highly elevated as my symptoms have progressed.
Firstly, i do not have CFS..my daughter does. But we are both celiac.
I too did the Viome testing. NO oxalate degrading bacteria at all. No Lacto species either. A very odd mix.
I do try and use various probiotics etc. And the gut is up and down a bit. Usually not too bad but i use fermented foods, probiotics, eat lots of raw and cooked veg etc, no dairy, small amounts of good meat. and use digestive enzymes as i have no gall bladder to store bile for fat emulsification.
I cannot gain weight. Eat like a horse. 1.75m and 51kg. (The envy of most of my friends!!!)
I read that pickles in the grocery store aren’t fermented. Where do people buy all of these fermented food items from?
We’ll get into this in the follow-up blog. Pickles found in the refrigerated section usually are fermented. Pickles and other items that are marinated in vinegar and found in the canned sections are not.
The cheapest way to do this is to ferment foods yourself.
Good to know! I’m in Chicago and found a local out of work chef selling his fermented items through instagram, who knew https://www.instagram.com/vargobrotherferments/. Maybe there are more local fermenters doing this in other cities
Most health food stores sell a variety of fermented foods. Walmart carries kombucha.
I believe that if you possibly have SIBO that Kombucha may not be ideal. And be careful with all fermented foods.
I note too that kombucha is now being sold in plastic bottles and tins….
That stuff is sooooo acidic (in a good way) i will only ever buy it in glass….heaven knows what it leaches out of plastic containers!!!
Anyone have any more knowledge on this matter?????
Fermented food is very tricky. As per several years and several doctors advice, I’m off all fermented food that I can ID except for occasional yogurt. contributes to chronic yeast infections and digestive problems (viz ulcers and acid reflux).
Yes, I just can see how fermented foods will work with mcas.
Its standard naturopath treatment but seems to harm people with cfs
Not necessarily. I’ve been adding fermented food to my diet without issue (except for some bloating.) It may depend on whether you have MCAS and whether your type of MCAS reacts with fermented foods.
If MCAS is driven at least in part by bad gut bacteria and leaky gut – as is believed (https://drtoddmaderis.com/mast-cell-activation-syndrome) then if fermented foods can help return the gut flora to normal it theoretically should be able to help MCAS.
I believe unfortunately I’m at a less functioning level Cort…it’s just too much for me.
I’m with Oliver. I have MCAS as well as CFS, and caused a major flare by trying to add some apple cider vinegar and Kombucha into my diet. At the time I knew I had leaky gut, but didn’t know about MCAS … and the breakdown caused by adding the fermented foods is part of how I found out.
I’ve done the Viome analysis. Turns out that in my combo, the recommendations that improve one thing, make something else worse, and v.v. — Just as I’ve found some of the other suggestions for improving CFS are no-nos for MCAS.
Kombucha is a fermented food. Apple cider VINEGAR is fermented but its acidic nature means it kills bacteria – not enhance them. It’s not one of the fermented foods used in the study and would not help your gut.
Culturelle works for me, plus Mg carbonate (see Cort’s blog on Magnesium) to settle stomach. Works plus has positive side effects. Pepsid, BTW, has been shown to cause hair loss. see the FDA study from not that long ago.
My allergy doc told me to avoid all fermented food, ESP vinegar and anything with vinegar in it (eg mayo) and wine. I feel better after doing so.
Actually, properly fermented foods do not contain vinegar. Vinegar is used to mimic the sour taste of fermented foods in bottled or canned sauerkraut, etc. These foods do not contain the beneficial bacteria found in the truly fermented foods found in the refrigerator section of health food and some grocery stores.
Should one ferment one’s food oneself to be sure its done properly?
Interesting point re vinegar, though it is a fermented food itself, I believe.
I use OG gelcaps (size0) and “Pure” Mg carbonate powder from Amazon. Stuff them myself.
Just a heads up Andrographsis paniculata has a medsafe warning here in NZ as it has the potential to cause an allergic reaction. Use with caution for those with MCAS.
Thanks for posting this. I was debating trying it but I react to many meds as it is.
Andrographis….I cannot give enough positive accolades for it: IT HAS GIVEN ME MY LIFE BACK. Prior to Andrographis, I would get sick again as soon as I was well. A friend had suggested it when I was getting sick (AGAIN!!) & it stopped the progression of it immediately. At that time she had to order it from her chiropractor, but now Andrographis (chuan xin luan) is everywhere. Since then I have learned that in Nordic countries it’s a standard supplement for colds, but they combine it with Eluethero (Siberian Ginseng) which I also do. How strange to me to not have been sick in five years. freaky
Fermented anything makes me feel absolutely DRUNK with brain fog.
Another symptoms of ME/CFS of which there are many and if we took medications for every symptom we would go broke and the pharmaceutical industry would benefit greatly. All these topics are just confusing the issue and the people who genuinely have ME/CFS are being sidetracked by a multitude of topics. CFS and Long COVID are in most cases caused by reactivated Epstein Bar Virus which in most cases are not being picked up by normal viral serology tests. If you follow the latest research into CFS and Long COVID the evidence is already there for reactivated Epstein Bar Virus as the cause. Unfortunately there are for the reason of financial gain either Insurance companies and pharmaceutical companies along with high up medical people who try to muddy the waters with all these differing topics and make it sound like an unsolvable illness when all it needs is treatment for viral infections. Also note the NICE recommendations which was to be released last month which was with medical research and patients input was to reverse the 2007 guidelines which supported CBT – GET as the new research found it to be flawed and actually harmful. The reason for delay came from high medical people put pressure on NICE not to proceed. Who are these people and for what reason are they trying to keep these illnesses mysterious. There never has been anything to be gained from the financial world by curing people from there diseases only by treating symptoms which is ongoing financial rewards. Do not be fooled by all the confusing miss information they are putting out.
hi Cort, i tryd to open : A complex Stanford study, “Gut Microbiota-Targeted Diets Modulate Human Immune Status“, but you need to pay for it.
do you know more, for excample on how many people it was, .p value, etc?
my head is not clear, but was it on 2 groups (the high fibere and the fermented food) healthy individuals or was it a part long covid haulers and healthy controls?
how many of each? do you know that?
not that i do not want to pay for it, but if it is for excample on 10 healthy persons only, i can use my mney better 🙂
thanks!!!
ps i would say i try it but i have much problems with my stomach, so picles and everything i do not tolerate and lactose intolerant. the only thing i could try is for example waterkefir.
I watched this very interesting talk given by Karl Morten last week. It was put on by Omega and did last two hours, as Karl Morten chatted on in response to questions at the end. He talks about the gut and the microbiome and research they’re undertaking. He had some very interesting things to say about mitochondria too. I thought it was packed with information and Karl Morten appears to be very well connected in the ME/CFS research community. I can’t describe it more, because a fair amount went over my head but if you’re able to, I would recommend watching it.
Karl Morten : Talk on M.E. Research 18th september 2021 : OMEGA
https://www.youtube.com/watch?v=bSc6QZyvQN8
Thanks!
Yet another well-written and fascinating roundup. Kudos!
Gut abnormalities have been central to my own ME/CFS journey and so I’ve been reading many of these studies and tracking my biome over the past couple of years. I’m somewhat dubious about how useful relatively coarse measures (at the phylum level) like Firmicutes:Bacteroidetes ratio could possibly be.
But I’m glad you’ve pointed me to some of the better studies looking at this ratio. I managed to have whole genome sequencing both in 2019 when I was early-stage and again this year as my condition has progressed. Indeed, my F:B ratio has markedly declined, with the decrease in Lachnospiraceae noted by the recent Italian study.
So I’m becoming a bit more convinced. I’m very glad you pointed out the 2015 study tracking gut and plasma biome changes after exercise. I hadn’t seen that one before and it does seem potentially quite important. It also uses the F:B ratio, showing differences between patients and controls both at rest and in how the ratio evolves after exercise. Although the way I read it, they seem to say that ME/CFS subjects have differently leaky guts, rather than more leaky guts (bacterial translocation after exercise appears to be normal).
To UGHHH
Please buy the GAPS book by Dr. Natasha Campbell-McBride, MD. This is a explanation of a careful process which is explained in detail and often initially takes two years. This should be a low and slow approach including recognizing when to back up and then try again later. Just going out and starting on the amount of fermented foods in this study is a recipe for failure. Also, the processing is really important….like need for 24 hours to make yogurt which reduces allergic reactions. You will not find commercial yogurt which meets her criteria.
Additionally, fermented food is only part of a comprehensive program. The cookbook “Internal Bliss” is helpful.
Thanks Janet. I bought a kefir culture from a woman in Arizona, I think it was about five years. The kefir it produced – light, fizzy and alive – was nothing like store-bought kefir. I was astonished at the difference and, if I can find her again, will get some more.
Thanks for the tips Janet, I’ll look into the GAPS book by Dr. Natasha Campbell-McBride, MD!
Lipopolysaccharides [LPS] are involved in these gut issues. And systemic inflammation. And cardiovascular issues. and more.
If I recall, one of the researchers has mentioned LPS playing a bigger role than thought in ME/CFS somewhere in this site.
And the Australian team has a paper on ME/CFS with IBS and without it – that there is a correlation with pain (maxillofacial) and digestive issues.
Here are two ME/CFS + LPS studies:
pubmed.ncbi.nlm.nih.gov/25433843/
https://pubmed.ncbi.nlm.nih.gov/17007934/
If andographolide is helping the LPS-related issues
– may it be because its effect on [reducing] LPS circulation into the body?
I looked it up briefly, there are a few studies exploring this.
Here is one:
“In mouse peritoneal macrophages, andrographolide reduces the production stimulated by lipopolysaccharide (LPS) of two important cytokines that participate in the amplification and activation of the inflammatory process, the cytokines tumoral necrosis factor TNFα and granulocyte macrophage colony-stimulating factor (GM-CSF). The inhibition of the release of these cytokines by andrographolide was compared to the synthetic glucocorticoid dexamethasone, showing andrographolide to have a similar effect as dexamethasone, but with a lower potency [24, 52].
Also, the effect of andrographolide on the cellular chemotaxis, a response that allows the movement of inflammatory cells to the injured tissue, show that it reduces the chemotactic migration of macrophage induced by C5a, which may contribute to its anti-inflammatory activity [53].
In local or systemic inflammatory disorders there is an enhanced formation of nitric oxide (NO) following the expression of inducible nitric oxide synthase (iNOS). The inhibition of NO formation may have therapeutic benefit in patients with inflammatory diseases as Rheumatoid Arthritis [54].
Thus, andrographolide reduces the LPS-induced iNOS and COX-2 expression in RAW264.7 macrophages [55, 56].
Additionally, andrographolide may have an effect on inflammation-mediated neurodegeneration, since it reduces the production of reactive oxygen species (ROS), TNFα, NO and prostaglandin E2 in microglia, the counterpart of macrophages in the brain [25]. Andrographolide reduces the in vitro activation of human and murine T-cells, T-cells proliferation, interleukin-2 (IL-2) and IFNγ production [57-60].”
“Andrographolide a New Potential Drug for the Long Term Treatment of Rheumatoid Arthritis Disease”
pdfs.semanticscholar.org/694b/0abd9b544a9d77b593257a4fc5a887883fd4.pdf
Take this with a grain of salt, as I have not read enough.
One needs to read studies carefully, and read a number of them to get bigger picture.
I think the importance of a substance is how it interacts with the whole system.
The above is a good example – it does something with LPS, reduces nitric oxide and the prostaglandins, therefore can reduce inflammation and help the blood/cardiovascular issues, etc.
The substance can help get a leg up on things at first.
Perhaps looking at why LPS absorption is high and trying to reduce it would help even more
Here a few more papers on LPS in ME/CFS
(and one on long/Covid-19)
https://ammes.org/tag/lipopolysaccharides/
LPS is not particular to ME/CFS.
Shared by many diseased states.
One more!
{ LPS/endotoxin is a big topic! }
LPS induces release of IL-1 beta, IL-6, IL-8, TNF-alpha
I think we are familiar with these substances
as they are measured high in ME/CFS
One thing to keep in mind is that some of these fermented foods can have lactic acid.
I don’t know how that jives – since the studies on ME/CFS show both high and low lactic acid.
[Hanson and Armstrong have said they found it low. I think this may be while at rest. We would need to ask for clarification on this, I think]
I don’t know how high the lactic acid would be per serving, how high is high for someone that has high lactic acid, etc.
Hi,
just a note about side-effects. I’ve acquired and unfortunately sustained- several long running infections since I’ve had ME now for 20 years. One of the most annoying is a toenail fungal infection now since 2008. I’ve been through everything to clear it and found that fermented foods exacerbate it. During my first few years in the acute phase was treated by an open minded doc who later transitioned into full time holistic practitioner who sadly passed away about 4/5 years ago. She often stressed things like leaky gut which I remember her mumbling about since it sounded awful. Anyway- I also think it’s important to veer and stay eating as best as one can which can be dicey on a unemployed budget for sure. I’ve been trying as best as I can to keep up and learn but get visually. overwhelmed in a second so please spell out acronyms for people like me now and then. This is really hard to do alone and I feel quite alone.
Hi Bethe, I’m so sorry you feel so alone. It’s incredibly isolating and exhausting trying to manage to somehow get by with little money, on your own, with the chronic illness ME. Sending some good wishes your way… 💕
hi Bethe
Likely you’ve tried this already for toenail fungus, but had quick results for thickened yellow toenails by rubbing vicks vapor rub into toenails.
i dont know the pros and cons of it, but i did it for a week occasionally then forgot about it, only to notice next toetrimming that nail were clear.
maybe ask a nurse? ( i saw it online after a friend tried it for his toenails)
I tried Vick’s too. And then apple cider vinegar – not at the same time. I now put Daktarin on parts of my foot and over that nail too, due to athletes foot – which worsens if I eat sugary things – which is obviously not a good idea. But I have to eat choc, otherwise I lose too much weight and can’t eat dark choc, as it poisons me. My nail is definitely improving.
I’ve also been plagued with fungal infections (3 chronic) since developing severe ME. I’ve never seen this mentioned in info about ME, but it’s not surprising if our immune systems are below par. Its both expensive (I have to apply a supposed one off treatment daily to my hands just to stop it getting unbearable and spreading further) and and another energy drain. One started as a result of trying elasticated leggings to help POTS. A complete failure but I’ve been left with this adverse effect which I’ve never seen mentioned.
I wonder if reducing sugar in the diet would result in better gut flora? Sugar feeds yeast and that throws off the gut microbiome.
Yes, I think many people would agree with you there. Dr Robert Lustig loathes sugar, especially fructose. If you look at the work of most of the functional medicine practitioners, like Dr Mark Hyman, Dr Datis Kharrazian, Dr Dale Bredesen etc., they’ll all say the same thing. However there are disputes around cutting out all carbs completely because the beneficial gut microbiome needs food too. I believe it’s the simple carbs that they believe can be detrimental to our health.
It should. Many studies show that the processed food, carbohydrate-rich Western diets wreak havoc on our gut flora. Just about every diet recommendation for ME/CFS involves reducing sugar to low amounts.
Maureen, the answer to your question is unequivocally “YES!” Years ago, my gut was in terrible shape because of oral antibiotics that I took for years to treat acne. Specifically, I developed severe intestinal candidiasis (yeast overgrowth in the gut). I was strongly craving sugar – or to be more exact, the yeast overgrowth made me crave sugar. I would eat boxes of cookies and quarts of ice cream to satisfy my cravings. It was only when I forced myself to stop eating sugary foods that my gut health improved, as did my mood and energy levels — DRAMATICALLY.
All the naturopathic (including Ayurvedic) doctors I’ve consulted over the 25 plus years I’ve had CFS have said sugar is bad for gut flora. I find when I forget to control my sugar, I develop bad gas as well as worse fatigue, mental fog etc. Taking probiotics has has helped me restore better balance.
Several comments , i have been applying Dr Sarah Myhill’s Groundhog Protocols Basic, Chronic and Acute from her book with Craig Robinson,”The Infection Game, Life is an arms race.
Chapter 10, Iodine – a great all-rounder, there are two formulations of iodine used here, Lugol’s iodine 12 or 15% ( you can make your own ‘Povodine-iodine eye drops 5%’ by adding 2 drops of 12% Lugol’s iodine to 5ml of water.)
Sarah mentions iodine ointment numerous times: you make this yourself by adding 10ml of 12 or 15% Lugol’s iodine to 100ml of organic virgin coconut oil, we can buy this in the UK from Aldi or Lidl for less than £1.70 for 300ml (267g)
I use these extensively. For fungal infections, atheletes foot, nail bed infections etc use neat lugol’s , it evaporates, keep applying. ‘Iodine ointment’ for all skin breaches,cold sores, shingles, chicken pox , I use it on my throat , along the jawline, down the sides of my neck , back of neck, in ears, up nose, neck /skull axis, groin, armpits, anywhere there are skin breaches, spots, warts, virus infections, lymph nodes close to the skin surface where infections may be hiding out eg. EBV. Any breakouts such as Herx at polio or other vax sites and past bites, wounds etc. For Respiratory Virus Infxn, use a salt pipe with 2 drops iodine drizzled in. Plus lots more.
Ch 32 EBV & other herpes viruses, Treatment Chinese Skullcap(Scutellaria baicalensis)Look out for Herx Rxn ( microbe die-off porducts,) [LPS is a die-off product from bacteria, an endotoxin which forms a link between the layers of the cell membrane, released when the cells die or are disrupted.]
Other herbs for herpes & EBV:- oxymarine, neem, artemesia.
Ch 33, Lyme Disease, (Borellia) Herbs, Japanese knotweed,(resveratrol, not grapestuff) Cats Claw, and Andrographis, [, may cause hives, start low, build up to 600mg capsules x2 3x daily] NB This is Andrographis paniculata,
Androgaphalide AG as mentioned in this blog as used and is to be trialled by Nancy Klimas et al, is an extract, so may not contain as many ‘irritating complexes’ to cause allergic rxns.
Ch 34 Bartonella & Babesia, Herbs:- Astragalus, rhodiola, Japanese knotweed, Chinese skullcap.
Other helpful neutraceuticals , see Mitochondrial Enhancers Parts I to IV HR Blog:- B Vit Complex, Extra Bs:- Niacin, Methyl B12, Thiamine, Magnesium levels must be built up first to support action of Bvits & Vit D with K2, . NAC N Acetyl L cysteine, N Acetyl L Carnitine, ALA:- Alpha Lipoic Acid, MSM for pain , Vitamin C as an antioxidant, pain relief and antiviral.Plus many more.
Probiotics, Prebiotics, GABA, Gin Sen Chinese Herbal Sleep Aids
Cort, I’ve looked closer at the Hanson 2018 study that was noted here not to show evidence of dysbiosis. It appears that study used 18S sequencing and was focused on eukaryotes, rather than bacteria (prokaryotes). That’s an interesting different direction, but I don’t think it can be compared to the other studies all showing some degree of dysbiosis in the bacterial microbiome.
THanks Vijay for noting that. You are our resident expert in the microbiome 🙂
Hi Cort, from what I’ve read, bacterial species are passed btw pple via the poop route, and that beneficial species are passed on in the same way as disease causing bacteria.ie from less than perfect handwashing etc