Review Microbial involvement in myalgic encephalomyelitis/chronic fatigue syndrome pathophysiology, 2024, Borrego-Ruiz et al

Microbial involvement in myalgic encephalomyelitis/chronic fatigue syndrome pathophysiology

Alejandro Borrego-Ruiz, Juan J. Borrego

Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and disabling disease related to persistent fatigue, exercise intolerance, post-exertional malaise, cognitive dysfunction, and musculoskeletal/joint pain. Gastrointestinal comorbidities, including irritable bowel syndrome, have been reported in affected individuals, indicating a potential role of gut microbiota in disease progression.

In this paper, bacterial and metabolomic dysbiosis in subjects with ME/CFS are reviewed, and phenotypic, microbial, and metabolic biomarkers specific to individual cohorts are also identified. Furthermore, microbiome fluctuations or metabolic endotoxemia are proposed as possible disorder biomarkers.

Based on the fact that gut microbiota dysbiosis reverts to a state of eubiosis in long-term patients with this condition, it may be hypothesized that disease progression begins with the loss of beneficial gut microorganisms, particularly short-chain fatty acid producers, leading to more widespread gastrointestinal phenotypes that are subsequently reflected in plasma metabolite levels. These alterations, specific of each individual, thereby result in metabolic and phenotypic shifts and in ME/CFS.

Link | PDF (Microbes & Immunity) [Open Access]

 

A paper with a lot of inferences but no solid supporting evidence. It implies that taking probiotics should treat ME, but lots of us have taken probiotics and found no benefit. Dietary change can be effective at avoiding worsening of symptoms, but isn't reliably effective at reducing it below some baseline. I think of gut effects as factors that can worsen ME beyond a baseline, but PWME would likely still have ME even if their digestive system was working perfectly.

My summary of the paper is "Lots of stuff happens in the gut, and that affects ME severity, but we are lacking in details."

 

Do we have any evidence for that? Some pwME have specific intolerances but it is unknown if that is part of ME.

and it may be correlated with severity, who knows about cause and effect.

 

I developed plenty of intolerances since my ME started, and they change with time. I go through periods where meat makes my ME symptoms worse, other times it's fermentable fibre. I tolerated coffee and chocolate for decades, but I abruptly became intolerant, even of the small amount in decaf. A few months ago I became intolerant of something in seed germ, so no wheat, rice, etc. The symptoms aren't new, just the same ME ones amplified. So yes, dietary change (avoidance) prevents worsening of symptoms. It doesn't, AFAIK, change symptoms elevated by non-food factors, if you thought that's what I was claiming.