Gut Bacteria Hold Key to Diagnosing, Treating Chronic Fatigue

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 — 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.

“Individuals 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 — healthy bacteria — 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 —Faecalibacterium, Roseburia, Dorea, Coprococcus, Clostridium, Ruminococcus, Coprobacillus — 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 — such as pain and fatigue — correlated with the abundance of distinct bacterial types.

“Our 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. “Subtyping may provide clues to understanding differences in manifestations of disease.”

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

“ME/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.

“By 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.