Potential role of microbiome in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), 2020, Lupo

http://tesionline.unicatt.it/handle/10280/72840

 

Some more information in English
http://tesionline.unicatt.it/bitstream/10280/72840/2/01_frontespizio_tesiphd_Lupo.pdf

 

Unfortunately it seems the full text of the thesis is under embago

Would have been nice to see the data in tables and figures.

 

the dates are 2018-2019 on the above document, so it is not very recent. But their conclusion that ME may be autoimmune comes from this sentence:

"these results add new information and support the autoimmune hypothesis for CFS/ME condition in that in this study the intestinal microbial profile recorded in CFS/ME patients is consistent with that reported for autoimmune conditions, such as Chron’s disease (Manichanh et al., 2006), ulcerative colitis (Maukonen et al., 2015) and Systemic Lupus Erythematous (Hevia et al., 2014)."

There is discussion of leaky gut too, but I'm not sure how leaky gut is autoimmune.

 

published in Nature
"
Abstract


Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a severe multisystemic disease characterized by immunological abnormalities and dysfunction of energy metabolism. Recent evidences suggest strong correlations between dysbiosis and pathological condition. The present research explored the composition of the intestinal and oral microbiota in CFS/ME patients as compared to healthy controls.

The fecal metabolomic profile of a subgroup of CFS/ME patients was also compared with the one of healthy controls. The fecal and salivary bacterial composition in CFS/ME patients was investigated by Illumina sequencing of 16S rRNA gene amplicons. The metabolomic analysis was performed by an UHPLC-MS. The fecal microbiota of CFS/ME patients showed a reduction of Lachnospiraceae, particularly Anaerostipes, and an increased abundance of genera Bacteroides and Phascolarctobacterium compared to the non-CFS/ME groups.

The oral microbiota of CFS/ME patients showed an increase of Rothia dentocariosa. The fecal metabolomic profile of CFS/ME patients revealed high levels of glutamic acid and argininosuccinic acid, together with a decrease of alpha-tocopherol. Our results reveal microbial signatures of dysbiosis in the intestinal microbiota of CFS/ME patients. Further studies are needed to better understand if the microbial composition changes are cause or consequence of the onset of CFS/ME and if they are related to any of the several secondary symptoms."
https://www.nature.com/articles/s41598-021-86425-6

 

It's actually Scientific Reports (a Nature Publishing Group journal), which is a journal that often publishes work rejected by the top-tier journals, such as Nature. But, it's still a high-profile journal.

 

What a waste of time...some people with CFS had different poo than some other people...this tells us very little I’m afraid. Especially at the genus level. The fact that they are talking about leaky gut is a red flag for me...trash upon trash.

classic end here caveating the whole thing ....not even interesting when we don’t even know what a healthy gut looks like and this is almost certainly decades away before we even have a proper reference.

 

All this can show is that some people with ME can have a different microbiome at any one point. With a disease that people have for years this sort of research can say nothing about conditions when things first went wrong.

A better approach would be to look at what happens if the gut microbiota are changed.

 

Most likely consequence not cause. Improvements following FMT should be permanent if it was the cause, but people who have trialed FMT and improved typically report they need to repeat the procedure to maintain benefits. I also can see how having autonomic dysfunction, restricted diets, limited activity and lots of other factors could have a big impact on the microbiome in ME/CFS patients.

 

I believe the evidence base for this is weak? ...could you post something that shows the evidence that so called leaky gut is responsible for symptoms in many autoimmune conditions? I see quite a bit of nonsense in this area quite regularly and I’m keen to see whether there is anything more tangible than I’ve seen so far (theory with not a lot of compelling evidence).

 

Yes that’s pretty much what I see...an interesting anomaly that can’t quite be linked to anything in terms of causation or symptoms. I’ve also seen some studies that look at the rise of non coeliac self-reported intolerance claims (sharp rise over the last 10 years or so) and try to link it to gluten sensitivity and then leaky gut but so far these are only a few weak self reported surveys that don’t even show that the diet changes are down to gluten as opposed to anything else (e.g. lower starch/just altering gut biome by change in diet).

I agree Coeliac and possibly Crohns are going to be different due to observed damage to gut lining/difficulty absorbing nutrients.

But coeliac cases are not on the rise it’s this pesky sensitivity without inflammation that seems to be causing the rise in the popularity of leaky gut, despite there being no direct evidence.

A few human studies which so far are just self reported questionnaires following a non supervised diet change doesn’t seem to say anything. Doesn’t stop people muddling causation/correlation though. It would be good to have a few studies that actually had some objective measures.

 

Yes but zonulin as a biomarker has been hotly disputed with other studies calling the validity of it into question.
https://gut.bmj.com/content/early/2...nt_medium=cpc&int_campaign=usage-042019#ref-4

This is about the non specificity of the assays as the main point I think (feels sort of valid). I’m not sure what assay the above study used?

Yes agreed it is clearly not as simple as being portrayed. I think flavanoids also has quite a bit of guff around it...last I heard, the amounts you would need to be “protective” (not that there is any clear evidence for the actual amount or it being directly beneficial) is beyond our natural diet concentration anyway or just plain impractical to apply and would cause imbalance in the diet that would probably lead to malnutrition. Most of the work on this stuff is quite early days from what I’ve read?

I agree though that there may be something in eating an imbalanced amount of wheat-based products (perhaps together with a lack of fibre from fruit and veg) initially that may just push things out of whack. Phytic acid is something often touted as bad but I’m thinking very few of us eat wheat or wheat flour raw without it being baked or processed first so that also feels like a blind alley. Fodmaps are also a bit strange. I think a lot of the noise has spun out of the use of high fructose corn syrup in the states (and then subsequently branched into oligosaccharides etc). The science is shaky here too, and appears to be more misinformation using correlation studies and a bit of pseudoscience around normal organic molecules naturally found in a wide variety of foods we should be eating for a balanced diet.

However there are enough reports of people feeling better on a gluten free diet or after doing a low fodmap diet to suggest there is something going on. I think this may then take us back to gut flora where the change of diet restores or partially restores an imbalance. Also there is secretion regulation as another possible contender? People with pernicious anaemia often have problems with IBS symptoms which is put down to low stomach acid causing imbalance in the flora in the upper small intestine. A key “stress” response is to halt digestion temporarily (particularly stomach acid secretion) to divert energy away from digestion. Perhaps this off and on response makes for a disrupted gut flora? That might explain why ibs pops up in a variety of different chronic conditions? All speculation though...we need much better studies on diet over time together with objective as well as subjective studies.

yes it is ironic that many gluten free foods just replace wheat with corn flour which would be pretty pointless if gut flora and too much readily available starch were the main problem?

 

yes that’s my main problem with the whole thing, the way it’s misused/misrepresented ...I think the original intention was 8 weeks abstinence followed by slow reintroduction (can’t remember exactly)...I.e just long enough time to reset gut flora ?

A big problem with gums and thickeners (e.g. carrageenan and the galactomannans such as guar and locust bean) is their slimy texture in the mouth. The main challenge really is trying to replace starch as well as gluten and how it cooks. I spent around 5 years as part of a bio polymer research team back in the early 90’s ...there was nothing really available at that time that could mimic the way starch/gluten worked together in baked products. I think we came to the conclusion then that we would need “more research” into protein polysaccharide interactions. Fundamentally starch is unique in how it hydrates and cooks out. There are different types in terms of amylose amylopectin ratios but regardless of this, it’s pretty challenging to replace in recipes.

what should be possible is leveraging the film forming and gelling properties of some of the gums and stabilisers to improve satiety and speed of nutrient absorption. I think there should be a lot of mileage to further the b-glucan work and how other polysaccharides/polysaccharide molecular weight fractions may affect the coating effect in the gut and how this may affect speed of absorption. The ‘slimy mouth’ challenge is still there though, but I guess that is subjective and the quantities needed are not fully understood yet? But I digress completely away from the thread subject.

 

So you don’t eat baked products with starch in them?