Dysbiosis – The condition that results when the natural flora of the gut are thrown out of balance
The gut has not received alot of research in either fibromyalgia or chronic fatigue syndrome but it’s becoming more and more clear that the gut is a player and the only question is how big of a role it plays.
The gut plays a role in ME/CFS/FM; the question is how much of role?
Gastrointestinal symptoms and IBS-like syndromes are common in both disorders. Tegaserod’s ability to relieve IBS symptoms, fibromyalgia symptoms and reduce tender points in fibromyalgia suggested gastrointestinal issues were effecting more than the gut in FM. A Spanish study found that no less than 98% of FM patients had at least one ‘functional gastric disorder’.
Giardia has been confirmed as a cause of chronic fatigue syndrome and enteroviruses were readily found in ME/CFS patients guts. Dr. Mady Hornig focused heavily on the gut and its role in disorders like autism and ME/CFS in her presentation at NSU. Gut inflammation has been proposed to play a major role in the disorder and probiotics increased neurocognitive functioning in one small study.
CAA Gut Webinar Coming Up
We’re going to learn alot more about gut flora and chronic fatigue syndrome in two weeks when the CFIDS Association of America’s releases the result’s of Shukla’s microbiome pilot study on a webinar on` May 2nd. As we get ready for that we’re going to use a series of fascinating review papers that chart how the medical communities view of gut flora and its effects on our health have changed over time. As a bit of an extra added bonus two of the authors, Dr. Alison Bested and Dr. Alan Logan, have long been associated with chronic fatigue syndrome. Dr. Bested has written several books on ME/CFS and she now runs the Chronic Complex Disease Clinic in Vancouver focused on ME/CFS/FM.
Lessons From Medical History
The authors aren’t just reviewers, they’re actually pioneers in the field of gut manipulation and disease. Logan’s seminal 2005 paper suggesting probiotics could be helpful in the treatment of depression interrupted seventy years of silence on the subject. It turns out that manipulating the gut flora to fight neurasthenia (an old name for CFS), depression and other disorders found favor in the medical community over 70 years ago, but was ultimately discarded, largely due to the efforts of one forceful physician. Only in the past ten years has gut flora re-entered the medical community as a serious subject and it’s done so with a vengeance with the number of studies exploding.
The gut flora story is a a fascinating look at how medical ignorance and prejudice can cause a promising field to basically disappear and how persistence caused it to reappear again. The basic question the medical community has been grappling with for over a hundred years is how important the gut flora and gut integrity are not just to abdominal health but to our health as a whole. The answers to that question have changed radically over time. Let’s take a look.
The Paper
Bested et al. Gut Pathogens 2013, 5 :5 http://www.gutpathogens.com/content/5/1/5,
Alison C Bested, Alan C Logan, and Eva M Selhub. Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part I – autointoxication revisited
We’re dealing with two broad issues; the leakage of toxins out of the gut into the bloodstream and the composition of the gut flora itself.
Early theories proposed toxic leakage from the gut could cause fatigue, depression, gut symptoms and other problems characteristic of ‘neurasthenia’
We have to reach way back to the 1860’s to find the first medical practitioners suggesting that leakage out of the colon into the blood stream could cause problems. Calling the colon ‘a receptacle and laboratory of poisons’ Bouchard argued that chemical byproducts of decomposition, if released into the bloodstream, could cause many different types of disorders. Bouchard proposed that inadequate levels of stomach acid, inflammation, influenza and other disorders and ‘nervous excitement’ could degrade the colon allowing toxins to escape into the bloodstream.
By the early 1900’s the colon, with its teeming masses of bacteria was capturing a lot of attention. Although some researchers considered it the birthing place of a wide variety of ailments, they were most interested in guts ability to cause fatigue, pain and mood altering disorders through a process 0f gut leakage called ‘autointoxication’.
They are the cases that present …malaise, total lack of ambition so that every effort in life is a burden, mental depression often bordering upon melancholia, frequent attack s of indefinite abdominal pains due to flatulency, sudden attack s of acute diarrhea alternating with periods of constipation…A battle royal must be fought and when this first great struggle ends in a victory for the Bacillus bulgaricus it must be kept on the field of battle forever at guard .. .’
Around this time, Sir Anthony Lane, a well-known British surgeon asserted bacterial overgrowth was a major cause of problems. The symptoms he charted – indigestion, abdominal pain, constipation alternating with diarrhea, malaise, incapacity for prolonged exertion of any type, insomnia and depression – fit closely enough to another puzzling disorder called neurasthenia, for Lane and other to become convinced they were the same and that the root of each was ‘colon toxicity’.
Jankelson nailed the outlines of what would later become called small intestinal bacterial overgrowth (SIBO), with his description of excessive bacterial fermentation, which he called ‘enteros-thenia’. He too believed enteros-thenia and neurasthenia were closely connected and proclaimed enteros-thenia commonly preceded neurathenia.
Cutting for Good Health
Surgeon that he was Lane turned to surgery to remove the bacterial pockets of putrefaction he believed were causing fatigue, mental illness and malaise. Lane was convincing enough that surgery came, for a time, to become a popular treatment option for neurasthenia, despite death rates that would be intolerable today. Believing that small pockets of infection were driving both physical and mental symptoms surgeons began hacking away at neurasthenia patients so readily that one physician reported that colon surgery was being recommended ‘for relatively trivial symptoms’.
For a time surgery to remove illness causing ‘pockets of infection’ was a common treatment for neurasthenia
An obsessive search for life altering pockets of infection came to a head at the office of American physician, Dr. Henry Cotton, who extracted thousands of teeth and did hundreds of colectomies in his effort to cure mental disorders at mental hospital in New Jersey. Cotton asserted he had high cure rates (statistics lost) but neglected to report a staggering 30% mortality rate. One of the first controlled studies in the history of psychology which involved removing the tonsils and an average of 5 teeth per patient in a mental institution eventually put an end to Cotton’s claims.
Physicians preferring a less invasive approach began using lactic acid bacteria to combat ‘autointoxication’ in the 1910’s and lactobacillus products gained in popularity over the next couple of decades. Investigations in gut flora manipulation indicated that fatigue, diet, bacteria, stress and carbohydrate intolerance could all generate bacterial overgrowth problems.
By the 1920’s researchers were taking bacteria from the stools of healthy people and transplanting them via enemas into the colons of neurasthenic and arthritis patients. In New York Satterlee reported that his injections of up to 300 million bacterial units in his ‘colon vaccines’ indicated to him that ‘disturbances of the gastro-intestinal system are more often the cause of nervous symptomatology than the result of a diseased nervous system’ .
The Gut Bloom Wilts
When small studies did not bear out improvement in mood and fatigue symptoms after lactobacillus supplementation and a backlash grew against an ever increasing commercialization of probiotic products (many of which did not have significant amounts of active lactobaccillus in them) and strange colonic practices, the gut flora theory was due for a fall.
In the end one vociferous critic, Dr. Walter Alvarez of the University of California, San Francisco, took down the theory of auto-intoxification with studies suggesting that distention of the colon caused by constipation was causing the fatigue and mood issues present. As many studies were in those days, Alvarez’s studies were full of holes (although recent IBS studies suggest his theory did have merit) but his timing and force of personality lead Alvarez to prevail and the idea that the gut flora playeda significant role in health disappeared.
A bit of a crank, Alvarezent on to suggest such things as attractive women with large breasts were more susceptible to migraines and rued the fact that antiobiotics were keeping alive hundreds of thousands of people who were nothing but a ‘drain on the community’, but such idiosyncracies – more common at that time – didn’t matter; the idea that gut flora could cause disease was laid to rest for over 70 years and as with ulcers gut disturbances because associated with stress, poor coping mechanisms and were often left to the realm of Freudian psychologists.
As late as the 1970’s a leading gastrointestinal textbook explained away carbohydrdate intolerance as being the province of ‘essentially unhappy individuals’, and in 1989 physicians writing in the Journal of Clinical Gastroenterology explained away the idea of gut flora causing disease as the result of conflicts over toilet training.
Not until 2003 with the publication of Logan’s seminal paper suggesting that microbe administration might be helpful in the treatment of fatigue and mood disorders was the topic broached again in medical journals. Times had changed and by 2012 a review in a leading psychological journal now suggested Logan and his predecessors of 100 years earlier were on the right track.
‘Logan and Katzman first proposed the use of probiotics as adjunct therapy in the management of depression. Since then there has been an accumulation of data from both clinical and preclinical studies supporting the view that probiotics may have a role in the treatment of depression”
Logan’s groundbreaking paper on gut manipulation to treat depression came out in 2005, but his first paper on gut manipulation to treat disease was on none other than chronic fatigue syndrome in 2003 (“Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value”).
Next up we check out how medical sciences understanding of gut flora has changed over the past 10 years and how that might impact the understanding and treatment of (chronic fatigue syndrome) ME/CFS.
Interesting topic Cort. Funny, some of the things thought in the past. Thankfully, there have been advancements with medicine. (Large breasted women and headaches – ugh! LOL!)
One thing of interest is that doctors are starting to recognize that there is a lot of connections to the immune system in the gastro tract. Some of us with MCAS are using GastroCrom. It does several things – not only does it suppress mast cell release but it also works on the immune system. (GastroCrom is normally used for mastocytosis thought to be an autoimmune condition.) Thankfully, doctors are recognizing that there may be more than allergies at play here. I think that, in time, there will be more notice taken of autoimmune components in a lot of the illnesses that we deal with. And the autoimmune component associated with the gut and it’s ecology is a very important place to look.
The pieces of the puzzle continue to come into place. Keep up the good work and interesting articles.
Issie
I have CFS and no gut issues….although i have lady yeast issues. Not sure if that counts. I really believe my CFS is from stress, how i react to stress. Maybe the effects of my rough childhood….
I wondered about this. Gut issues were present but not prominent throughout most of my time with ME/CFS but I’ve found that symptoms don’t always match with problems; ie you can have SIBO (bacterial overgrowth of the small intestine) without alot of symptoms….
One of the key theories of gut dysbiosis is that it fosters a state of low level inflammation..Other things can foster that state as well. I imagine that yeast issues would do that, for instance – so the general theory may be correct but apply to a different part of the body.
Ive suffered from chronic fatigue for many years and I dont suffer from stomach problems that much. I’m still looking for answers to my fatigue at the moment. I have tried everything; MLST’s, CBT, meditation, acupuncture, colonic irrigation….sometimes I think science will never solve my problem. I really hope it can though, soon.
I’ve heard of a condition called leaky gut which is an over abundant amount of yeast in the body. It is caused by too many bread products and sugar.
Indeed, you might want to check out the Gluten Intolerance and Celiac disease series by Niki Gratrix on this website.
ME/CFIDS/CFS is an inflammation of the brain, perhaps caused by a virus. It is an autoimmune disorder in which physical, mental or emotional stress cause neuroimmune exhaustion. The fatigue is not the result of physical exertion and is not relieved by sleep.
“Postexertional neuroimmune exhaustion” means you have experienced unexplained and disabling fatigue after simple activities.
Very good topic, Cort. I believe the gut plays a huge part. My first diagnosis was autointoxification and oxidative stress. I saw my cells with a Bradford microscope and actually saw a colony of yeast float by and some protein from the leaky gut.
I was surprised to learn that 80% of the immune system is there and serotonin there as well.
Dr.Natash Cambell Mcbride has a great video on Mercold’s site. I have stated making my own fermented vegetables after reading all that and how Autism is a gut problem..intersting stuff!.. Rich Vank had the same theory. I miss his guidance, he told me to test for parasites and sure enough I had them in the small intestine. I killed them with herbals. I always tested clean before so have no idea how long I had them but they were eating my lunch accodrding to Rich.
I eat 1/4 cup of the vegetables a day…chopped cabbage, kale, parsley and some carrot. I order culture from orders@culturednutrition.com. I have enough for 6 quarts 6 times. I just stated my second batch. I take probiodics as well and have been for a long time.
I had a time with yeast several years ago and learned that lady yeast issues are an overgrowh from the gut.
Yes, stress is a factor too and maybe starts the whole cascade..Dr. Klimas told me our stress mechanism is broken , then the imune system goes down and downward spiral begins. Think of the stress of war, all the toxins and not being able to detox properly..
Looking forward to the next installment.
I’m glad to hear about fermented vegetables – I’m just starting in on them…I found that a really fresh batch of sauerkraut helps…
If one has yeast issues anywhere in the body, it most often emanates from the gut, regardless of the lack of “gut issues”. Ref: Dr. Martin Gallagher and many others.
Here we are, returning to the Candida of 20 years ago! So 300 people in Incline Village suddenly came down with leaky bowel- great- what was the underlying cause? Why don’t we see ME/CFS in any other animal species?
It feels like we are straying off into the aftermath of the disease rather than looking for the cause. We may understand the physiology and immunology, endocinology of the digestive system better, but do we really think it’s the cause of our disease?
With regards to your question as to why we don’t see ME in any other animal species. Apparently we do according to the specialist I see. According to him a similar disease is found in race horses reason being because they push themselves so much. I’m no expert but I thought I’d just post this as I definitely think it is food for thought along with other contributing factors. Other animals are not constantly exposed to high levels of stress could be a possible reason.
Good question. I always thought the gut was secondary and it very well may be. For it to be primary it would have, at least in my case, to not be causing alot of symptoms at the time I got ME/CFS….which I acknowledge is a bit of a stretch -but I’m holding out hope. (Pressing down on the lower gut, though, has been really painful for me since day one.)
On the other hand, in the recovery stories project I’ve come across several people who’s focus on gut issues allowed them to recover and the fact that its referred to as the second brain with all its nervous system and immune connections makes me think it may be a bigger player than we think.
I just found out that exercise has been shown to induce small gut aberrations even in healthy people – isn’t that something? The CAA’s study – due on on the 2nd – is looking at just that…
So I’m actually in agreement and the issue is so complex and the subject is getting so interesting that I’m hoping there’s more to it than the symptom presentation suggests. 🙂
Thanks, Cort, for presenting research with historical and hysterical basis. I don’t mean funny by hysteria, but the ever present female pyche explanation. And I do not disagree on some of these theories. Gut dysfunction is a major player in my ever waging war going on in my body and illness. I am still trying to understand gut wall issues, permeability and inflammation. I think research funds associated with these illnesses should be highly intended for gastroenterological studies. I cannot say with certainty, which came first as far as onset vs. gut problems; but do know I found great help with a product called Fibermucil, which stopped the cycle of constipation and diarrhea. No pain if lots of water taken alongside, 6-8 oz.s and within a few days a normal pattern of gut functions reappears. Pro-Caps.com also carries Cholesteracare, which helps ‘sweep out’ the cholesteral on gut walls. All amazing to study, and appreciate these early doctors for recognizing the importance of health in the gut. Even though some of what they wrote seems antiquated, so many truths advanced in medical understanding.
Thanks for the tip on treatment possibility. I just read an abstract which indicated that
stress’ in the form of cold, results in more gut permeability in women than men. I’m getting kind of astonished how women live longer than men since you seemed be on the short side of the stick in so many areas biologically.
I wouldn’t say that women are “on the short side of the stick”–we do give life, you know.
The immune system is designed to rid the host body of things that are alien to it. It must distinguish between what is-self and is-not-self. This results in a major challenge to women in that a fetus both is, and is not, the host. Therefore, a woman’s immune system is both more complicated and more vulnerable than a man’s.
I have severe CFIDS, however my gut is perfectly healthy. How you could write about the gut without once mentioning the immune system is beyond me.
http://behindthelockeddoors.wordpress.com/2013/11/16/beyond-fatigue/
For the first several yrs I was sick, I had very few gut issues; however, trying probiotics sent my GI system into hell & it has become progressively worse. I am now at the pt where there are NO foods that I can eat w/o either vomiting or having hrs of diarrhea…..and as my gut issues have worsened, so have many of my other symptoms. I don’t know if that is coincidence or not, & I also highly suspect that in my case, the vagus nerve is playing a huge role in many of the symptoms that I have that are often associated with ME/CFS, but not a necessary part of the diagnosis.
Re the reaction I had to probiotics, I have heard of quite a few others with similar reactions. One of the theories we came up with re that is that since H2S is a byproduct of probiotics being broken down, & it’s a neurotoxin that our bodies don’t seem able to get rid of, it could be the cause of our bad responses to probiotics. Another thing that i recently heard is that some researchers are starting to believe that in small amounts our bodies actually use e coli for good, & probiotics could be getting rid of it. Apparently, many people with ME/CFS also have very low levels of e coli. (I do know that at this pt, I have basically no probiotics OR e coli in my GI tract.)
Cort,
You are doing a fabulous job with your new website. The information you are presenting with each blog is so informative,fascinating and extremely encouraging. I can’t believe how much is now going on in the ME/CFS and FM research world. I have not been feeling well lately so have not been able to engage in discussions but just wanted to let you know that I am reading each blog and am captivated by everything you are presenting on this site- as well as printing everything to show friends and family. Thank you so much and keep up the excellent work. Hope you are well- don’t over do it at the expense of your health.
Claire ( Gamboa)
Thanks Claire, it really is amazing how much is going (given how little relative to other disorders is going on)…. There’s lots of interesting avenues of research that are being followed or proposed and certainly thought about.
I hope you feel better. I remember my trip to your beautiful city, Ottawa, with fondness 🙂
A number of years ago read I about Dr Chia’s discovery of and testing of gut viruses. Talked my gastroenerologist into taking a separate biopsy during an endoscopy. Sent biopsy to Dr Chia testing lab and received back very graphic positive tests of widespread entrovirus or entrovirus. I have little dout that there is a relationship between CFS and the Gut
I too have found that the introduction of pro biopics changes the status quo for the worst?
Cort I Really appreciate your dedication to the cause!
Hi Cort, thanks once again for a very informative article and one which is close to my heart.
I was diagnosed with Crohn’s Disease back in 1987 after years of stomach/bowel problems which were never defined. In those days not much was known about the disease and not much has changed since ! I think I suffered from the symptoms of CFS from an early age but wasn’t diagnosed until 2006. I’ve always believed there is a link between the CFS and the Crohn’s, the possibility of their being leakage from the gut into bloodstream makes perfect sense to me. Let’s hope that in time they will find a reason for and a solution to both problems.
I think the connection to CFS and Crohn’s may be elevated tumor necrosis factor (TNF). Tumor necrosis factor is what the drug Humira was designed to target. Here is a quote from their website: “Many patients with Crohn’s disease produce too much of a protein called tumor necrosis factor (TNF) in their body. This excess attacks the intestines and other parts of the gastrointestinal (GI) tract, and can cause them to become inflamed. This can result in the pain, diarrhea, and other symptoms of Crohn’s disease. Humira® belongs to a class of biologics known as TNF blockers. TNF blockers have a specific target in the body and work by binding the excess TNF to help block the inflammation that can lead to Crohn’s symptoms” (Abbott Laboratories, 2010).
Here is a study on CFS and tumor necrosis factor.
Dysregulated expression of tumor necrosis
factor in chronic fatigue syndrome:
interrelations with cellular sources and patterns
of soluble immune mediator expression.
Patarca, R., N.G. Kilmas, S. Lugtendorf, M. Antoni, M.A. Fletcher. 1994. Clin Infect
Dis. 18(Suppl.1):S147-53.
“Among a group of 70 individuals who met the criteria established
by the Centers for Disease Control and Prevention (Atlanta) for chronic fatigue
syndrome (CFS), 12%-28% had serum levels exceeding 95% of control values
for tumor necrosis factor (TNF) alpha, TNF-beta…”
There is a direct connection to elevated TNF and the gut. I can explain if you would like me to.
You can control TNF without using potentially harmful medications though.
Here is some information on the spice turmeric and its ability to naturally block TNF.
“The active component of turmeric turns out to be the best blocker yet of a natural chemical called TNF, or tumor necrosis factor, which contributes to cancers and arthritis and is resistant to chemotherapy drugs,” stated Bharat B. Aggarwal, professor of cancer medicine in the Department of Experimental Therapeutics at the University of Texas M.D. Anderson Cancer Center, who has studied the spice for a decade. “You don’t even need tens of thousands of dollars of TNF blockers,” Aggarwal stated. “Turmeric does exactly the same thing.”
http://www.naturehaditfirst.com/our-blog/medicine-cabinet-reduce-inflammation-naturally/
Wow ! Thanks for that, very interesting and not heard about that theory at all. I will look into it a bit more and certainly give it a go. I’m all for natural therapy so thank you.
Annesse,
Interesting info about tumeric. My son has anklosing spondylitis so I passed the info onto him.
The link between CFS and Crohn’s is that they both are diseases of the immune system.
Another great article Cort, thanks for bringing all the latest findings together – Sherlock Holmes II. Loss of gut integrity one way or another is fundamental I’m certain.
Here’s the abstract of a recent study I alluded to before. “Sex Differences in the Gut Microbiome Drive Hormone-Dependent Regulation of Autoimmunity” ( http://www.sciencemag.org/content/339/6123/1084 ) In an interview, Dr. Danska pointed out, “Bacteria are “relatively cheap to grow” – certainly, growing a vat of E. coli is cheaper than producing monoclonal antibodies.”
When I was somewhat well and still able to work I was a laboratory technologist in a microbiology laboratory of a large teaching hospital, from 1990 to 2005, until I became a Pathologist Assistant in another lab. My fellow technologists and I used to have MANY discussions/disagreements with the Medical Microbiologists and Infectious Disease Doctors, who were in charge, of how and what to report in stool specimens. Basically we were instructed to ONLY look for pathogens- Shigella, Salmoenella etc- and report their presence or absence. So often we would have specimens that would grow pure yeast, or pure Pseudomonas auruginosa or some other bacterium or, on the flip side, no growth at all, and we felt that was important and should be reported. The doctors had it drilled into their heads in medical school, however, that stool flora was of no importance as long as none of the usual pathogens were present.
I might add that that I also used to have “discussions” with these same doctors about things like Fibromyalgia and CFS which ironically I didn’t know I would end up having. I used to defend others with these illnesses while the docs ridiculed them and said some very insulting things about people that we knew that were afflicted.
I’m sure they are now beginning to see the light now with regards to the gut flora.
It is interesting to note that a large percentage of people with CFS, FM, GWI, “chronic Lyme” suffer from GI disturbances. Is it a cause or effect of illness? What is the role of the gut in ongoing illness? These are important questions.
I want to mention the case of Ken Lassesen who claims remission after use of certain probiotics and pulsed antibiotics. Look for his blog.
Lastly, maybe off topic but who knows: the Poliovirus originates from the gut. As some may know, before it was called CFS or even ME, the outbreaks at hospitals were described as cases of “atypical polio”. Can an immune-suppressing event cause viruses in the gut to proliferate? Most patients have some acute illness or event precipitating chronic illness (EBV, Lyme, vaccine etc.). If CFS is caused by a yet unknown pathogen which is not rare, could these triggers cause serious illness in those who are susceptible to it whether through genetics or whatever, much like 95% of people with polio only experienced it as a mild flu, and the other 5% faced disability or even death?
My mom had polio and now post polio syndrome, Is it possible to pass any of the disease on to her children? Could it have stayed in her system, changed and now we have fibro/ME? We have crohns and colitis, psoriasis, eczema, rosasea and early cancers, could any of this be related.
My daughter has Me/fibro, my cousin, neice. You wonder what the link is. Am looking into fermented foods, kefir, etc. plus diversification of my foods. I am fat yet don’t eat much of course exercise is almost nil.
I laughed when the article stated pretty woman with big boobs get migraines, we as a family have this (both the breasts and being pretty, ha,ha). We do get migraines, not so funny
Stomach issues for all of us:(
Lets hope the research does not take as long as they say it will.
Cruzgirl
There are 3 children in my family 2 of us have fibromyalgia. And both of my siblings have children with autism. Both of my children show signs of fibromyalgia. But I have also read articles where there are apparent outbreaks of cfm, and fm in certain regions. Does anyone have any thoughts on this. Neither one of my parents have been diagnosed with any of these issues, but they are old school, if you hurt you don’t say anything, you just work until you drop.
Polio is not heritable, nor does it morph in the way you suggested. The other illnesses you mention mostly are diseases of the immune system. Eighty percent of the immune system is located in the gut, and the two issues are becoming confused. Try some research on the immune system.