Friday, July 12, 2013

Gut Ecology and ME/CFS


I have been waiting for some time for this Redlabs ME/CFS gut ecology study to be published. This work by Kenny De Meirleir, Marc Fremont and their colleagues is a first significant step in examining the gut bacteria of ME/CFS patients. Work currently being done by Simon Carding will add to the general knowledge of this emerging field.

The blogger at cellfatigue.blogspot.com gives a good overview of previous gut ecology research in ME/CFS.

The Redlabs study made some interesting observations:

"A remarkable similarity between Norwegian and Belgian patients was the strong, specific increase ofLactonifactor (20-fold in Norwegian patients, 45-fold in Belgian patients). Lactonifactor is a Firmicute from theClostridiaceae family. Although this genus is not very well characterized, it is known to be involved in the conversion of lignan phytoestrogens into bioactive enterodiol (ED) and enterolactone (EL) [36] and [37]. In Belgian patients, the increase of Lactonifactor was paralleled by a decrease of the ActinobacteriaAsaccharobacter."

"Another potentially relevant aspect of phytoestrogens and their metabolites is their capacity to regulate vitamin D receptor (VDR) activity, and vitamin D synthesis. Similar to 17β-estradiol, phytoestrogens can induce expression of VDR in gut epithelial cells; they also regulate several cytochrome P450 enzymes which are integral part of vitamin D synthesis pathways [44]. The vitamin D system is critical for maintenance of gut mucosal immunity, and several reports have shown a link between vitamin D, VDR, and inflammatory intestinal diseases [45] and [46]. VDR-mediated signaling can antagonize TNF-α, IL-17, IL-6, IL-1 in macrophages and dendritic cells and prevent development of inflammatory bowel disease. Vitamin D has also been shown to modulate T-cell antigen receptor and induce FoxP3, which is critical for prevention of mucosal inflammation [47] and [48]." 

What this means at the moment is anyone's guess.

I assume that the following test is the same test that was used in this Redlabs study?  This test is available from Redlabs BE and can be ordered here. It is an easy test to do.



Abnormalities on this test can be seen in the low bifidobacteria and the elevated Lactonifactor.

It is my understanding that bifidobacteria is often low in ME/CFS patients. It is also my understanding that secretory IgA is also often low in these patients. (Secretory IgA is not measured in the Redlabs Metagenomics study. However it is measured on the Metametrix test.) Additionally a high level of diversity is seen as a positive item.

The question remains - can these items be altered in some manner?  What can be done about it? Can bifidobacteria be raised? Can lactonifactor be decreased? Can the balance of firmicutes and bacteroidites be improved? The general consensus is that gut ecology can be altered in certain ways over time.

About the means to do this, different people will tell you different things - different ways to approach these problems. Generally the addition of prebiotics and probiotics is seen as potentially helpful. The more tested probiotics include VSL #3, Klaire Ther-bioitc, Theralac, Femdolphilus, Culturelle, Mutaflor, and Florastor. These include strains such Nissle 1917, l. reuteri RC-14, b. infantis 35624, l.plantarum 299v, l. rhamnsus GR-1, BB-12, and so forth and so on. Certainly probiotic foods are seen as beneficial - live culture foods. These were grandma's ideas, going back 4,000 years.

Certainly these ruminations should not be taken as medical advice. Any treatment of the gut ecology should be done under careful supervision of a knowledgeable physician - should you be able to find one.

Ken Lassesen writes an important post on Heath Rising, Cort Johnson's new website. The comments are good, too, as they are on many gut ecology stories. I look forward to more of Ken's observations as his mind bends more towards the scientific than mine - and he has first-hand experience with recovery.

Each day now there are new articles and new studies regarding the connection of the gut biome and disease. Recently, this study was released on HIV and the gut biome. A very informative video can be found here.  The astute reader might recall the name of Dr. Susan Lynch at the University of California, San Francisco, who was mentioned in this previous post  on her research regarding the microbiome of the sinuses.

Additionally a Plos one study of July 3 points to a lack of bacterial diversity in Autism.

I recently went back and read this fascinating overview of the human gut biome published several weeks ago in the NYTimes, written by Michael Pollan. The NY Times is doing its very best to be "out in front" of this unfolding story. Last week there was an FT article that can be found here.

I remember standing in the Ottawa airport in the fall of 2011. I went up to Dr. Dan Peterson, who is very accessible. I asked him about various treatments and my take-away was his statement regarding treatment for ME/CFS - "Be aggressive!" I appreciated his comment and understand it clearly in light of his use of Vistide and other modalities. However, how does a housebound/bedbound patient, often without a doctor, be aggressive? It is not going to be with Vistide or Rituxan or IVIG. However, we must, those of us dealing with severe ME/CFS, make our own way. Working away in an individualized manner on diet and gut ecology is an important avenue for severe ME/CFS patients - provided that they can tolerate this kind of experimentation. It can be done at home, provided that one takes the long view, and is not looking for instant results. Keeping flexible - with an eye on unfolding research - gives us an avenue of hope.

3 comments:

  1. Thank you, Chris.

    I find that I am stuck not knowing where to start. All I've tried recently are Primadophilus (the version of which I use has bifidus) and Threelac, both of which dry things up too much and make a spot in my intestines worse. I take Primadophilus on rare occasions if IBS is too far in the other direction.

    In my case, anything that reduces inflammation, reduces allergy, kills/discourages internal fungus, or improves fungus-related immune characteristics would be ideal.

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  2. You make a case that is followed very strongly in IBD community (me being one of them at Healingwell.com) The Ulcerative colitis section there is very active and what is observed in Autism/CFS is also observed in UC. The difference may be, the intestines of UC patients are inflamed and as a result of that good bacteria can not hold themselves there and it becomes a place to be easily colonized by folks like C. diff.

    In UC community VSL#3 DS is a highly regarded probiotic. The ones you mentioned are good too but money being an issue, have look at Nexabiotic, it is good too. But VSL#3 DS is the best bang for the buck.

    It has been observed, if you are aggressive enough to supplement yourself with good doses of VSL#3 like probiotic with a good amount of fiber like inulin, these guys do manage to hold on and you can try to recolonize your gut with good bacteria.

    Also have a look at Fecal transplantation. May folks have done it at home in extreme cases with successful results. There is an Australian gastroenterologist Dr. Borody is forefront of this. He has few interesting patents on this line of therapy. Have a look at http://www.google.com/patents/US20040028689

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