Gut Bacteria Hold Key to Diagnosing, Treating Chronic Fatigue

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Chronic fatigue syndrome, a baffling disorder that affects an estimated 1 million Americans, has been strongly linked to imbalances in gut bacteria in a new study from Columbia University’s Mailman School of Public Health.

The researchers found abnormal levels of specific gut bacteria are found in people with the condition β€” formally known as myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), according to the study published in the journal Microbiome.

The findings offer new hope for an effective new way to diagnose and treat ME/CFS, a complex, sometimes-debilitating disorder that can interfere with activities of daily living.

Symptoms include extreme fatigue after exertion, muscle and joint pain, cognitive dysfunction, sleep disturbances, and orthostatic intolerance (light-headedness, dizziness, or fainting when standing upright).

Up to 90 percent of ME/CFS patients also have irritable bowel syndrome IBS, past research has shown. But the Columbia University study is among the first to disentangle microbiome imbalances in individuals with ME/CFS and IBS.

β€œIndividuals with ME/CFS have a distinct mix of gut bacteria and related metabolic disturbances that may influence the severity of their disease,” says co-lead investigator Dr. Dorottya Nagy-Szakal.

The findings suggest sufferers may be able to ease their symptoms by incorporating certain probiotics β€” healthy bacteria β€” in their diets, to balance their gut bacteria.

To reach their conclusions, the researchers tracked 50 ME/CFS patients and 50 others without the condition. They tested subjects’ fecal samples for bacterial species, and blood samples for immune molecules.

The study’s key findings show that:

  • Levels of distinct intestinal bacterial species β€”Faecalibacterium, Roseburia, Dorea, Coprococcus, Clostridium, Ruminococcus, Coprobacillus β€” are strongly associated with ME/CFS.
  • The abundance of these species appears to be predictive of a ME/CFS diagnosis.
  • An abundance of Alistipes and low levels of Faecalibacterium are the top biomarkers of ME/CFS with IBS. Increased Bacteroides abundance and decreased Bacteroides vulgatus are the top biomarkers of ME/CFS without IBS.

The researchers also noted the severity of patients’ symptoms β€” such as pain and fatigue β€” correlated with the abundance of distinct bacterial types.

β€œOur analysis suggests that we may be able to subtype patients with ME/CFS by analyzing their fecal microbiome,” says co-lead investigator Dr. Brent L. Williams, Ph.D. β€œSubtyping may provide clues to understanding differences in manifestations of disease.”

The study also points toward a possible mechanism behind the development of ME/CFS.

β€œME/CFS may involve a breakdown in the bidirectional communication between the brain and the gut mediated by bacteria, their metabolites, and the molecules they influence,” explains senior author Dr. W. Ian Lipkin.

β€œBy identifying the specific bacteria involved, we are one step closer to more accurate diagnosis and targeted therapies.”

So far, researchers have not identified the cause of ME/CFS. Nor are there any standard diagnostic lab tests or federally-approved treatments for the condition. For reasons that are unclear, women are two to four more times likely than men to have ME/CFS.

Because MD/CFS is so variable, treatment focuses on individual symptom control. Conventional approaches include prescription medications to treat anxiety, depression, and insomnia; graded exercise, physical therapy, and psychological counseling including cognitive-behavioral therapy (CBT).

Adjunctive therapies to help manage pain and fatigue include:

  • Acupuncture.
  • Biofeedback.
  • Deep breathing exercises.
  • Hypnosis.
  • Massage.
  • Meditation.
  • Muscle relaxation techniques.
  • Yoga or tai chi.
  • Preliminary but inconclusive research suggests that some natural remedies may be helpful for ME/CFS, according to the Mayo Clinic. These include:
  • Magnesium injected into the muscles of people with low red blood cell magnesium.
  • A combination supplement containing fish oil and evening primrose oil.
  • Melatonin.
  • Nicotinamide.
  • Adenine dinucleotide hydrate (NADH).
  • Coenzyme Q10.
  • Propionyl-L-carnitine.
  • D-ribose.

Although the new Columbia University study suggests that probiotic supplements may be helpful for ME/CFS, more research is needed, experts say.

A 2009 study of 39 ME/CFS patients, however, showed that the Lactobacillus casei strain Shirota (LcS) was associated with significantly reduced anxiety symptoms compared to placebo.

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