New research has shown that the once unidentifiable chronic fatigue syndrome (CFS) may now be a real and diagnosable condition stemming from gut inflammation and bacterial imbalance (dysbiosis). In a landmark study[i] researchers were able to identify biological markers in both gut bacteria and blood to diagnose CFS with 83% accuracy from a pool of people with long standing CFS and healthy control subjects.

Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is a debilitating condition of unknown cause in which sufferers feel extreme fatigue, muscle and/or joint pain, swollen glands, headaches, gastrointestinal (GI) symptoms, unrefreshing sleep and post-exertional tiredness without relief. It is currently diagnosed by the process of exclusion in which all other known fatigue causes are ruled out[ii] and there is no widely accepted therapy. Recent research has shown trends towards two key physiological points of difference between those with CFS and those without:

- Differences in gut bacteria (microbiota)

- Immune system dysfunction and chronic inflammation (oxidative stress)

In the study researchers profiled gut microbial diversity by sequencing genes from stool samples in 48 patients with CFS and 39 healthy controls. They also examined a set of inflammatory markers in blood from the same patients as a gauge of internal oxidative and inflammatory stress.

Their analysis of the microbiome and biomarkers in the gastrointestinal tract of CFS patients showed it to be a rich pro-inflammatory environment. This inflammation and oxidation are thought to cause damage to the intestinal lining, allowing bacteria to leak into the blood (microbial translocation) and trigger a continual low-level immune response. These processes could account for some of the immune dysfunction and related symptoms including swollen glands, mild fevers, tiredness, GI issues, fatigue, and weakened immunity.

Genetic mapping of the gut biome demonstrated people with CFS had bacterial imbalances (dysbiosis) and reduced levels of healthy gut bacteria

Chronic gut inflammation (shown above) is a key contributing factor in the progression of chronic fatigue syndrome (CFS). It allows for bacteria to leak into the blood (microbial translocation) and results in debilitating, fatiguing symptoms.

The group were also able to show that CFS patients had noticeably less diverse and unstable communities of gut bacteria (biomes) compared to healthy people. The paper’s senior author Dr Maureen Hanson commented:

“Our work demonstrates that the gut bacterial microbiome in chronic fatigue syndrome patients isn’t normal, perhaps leading to gastrointestinal or inflammatory symptoms in victims of the disease”

From their results the researchers were able to successfully diagnose patients with an 83% success rate based entirely on their gut bacteria and inflammatory markers. They also suggested that therapeutic interventions should be aimed at reducing local inflammation and restoring gastrointestinal tract immunity.

So what does this study prove:

  • Surely we can now put the crazy notion to sleep that CFS is psychological in origin as there are now significant identified physiological differences between people with CFS and those without. “It’s not all in your head, it's in your gut”
  • We now have a new and more robust diagnosis tool that can be used to identify people with CFS and allow for earlier intervention
  • Oxidative stress and inflammation are the culprits behind this and other debilitating “non-specific” health condition (see more here)
  • Our gut health is integral to our overall health and well-being. Gut dysbiosis can now be linked to CFS amongst many other conditions
  • Treatment should focus on reducing oxidative stress while balancing healthy gut bacteria

Questions remain as to whether it is the chicken or egg that comes first. Do inflammation and immune dysfunction lead to gut dysbiosis or does gut dysbiosis lead to inflammation and immune dysfunction? Only future research can answer this question, either way, when it comes to CFS both are diagnostic tools and issues requiring treatment.

It is not known if increased gut inflammation leads to decreased healthy gut bacteria or if decreased healthy gut bacteria leads to increased gut inflammation.

A combination of probiotics, fermented foods or drinks and specific targeted, enzymatic anti-inflammatories (like GPx – read more) could be one solution to better long-term health.

My personal experience with overcoming CFS (How I bet chronic fatigue syndrome), demonstrated that both were integral to better health and the solution required treating both. Our body has its own super intestinal antioxidant enzyme designed with the specific role of reducing intestinal inflammation known as GPX2 (Glutathione Peroxidase). What is also notable is that GPX levels are generally reduced in people with long-term chronic inflammatory conditions like CFS. Supplementation of such enzymes can act to reduce local inflammation and improve total body health and well-being. While dietary adjustments combined with probiotics and fermented cultures (Kombucha, Kraut, etc) may help alleviate dysbiosis and improve symptoms. This approach not only worked for me but also others I know who have previously struggled with CFS.

Factual opinion piece written by Dr Corin Storkey, Founder and Director Seleno Health

[i] Giloteaux et al. Microbiome (2016) 4:30.

[ii] Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121(12):953–9.

[iii] (a) Sullivan A, Nord CE, Evengard B. Effect of supplement with lactic-acid producing bacteria on fatigue and physical activity in patients with chronic fatigue syndrome. Nutr J. 2009;8:4. (b) Rao AV, Bested AC, Beaulne TM, Katzman MA, Iorio C, Berardi JM, et al. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog. 2009;1(1):6. (c) Sheedy JR, Wettenhall RE, Scanlon D, Gooley PR, Lewis DP, McGregor N, et al. Increased d-lactic acid intestinal bacteria in patients with chronic fatigue syndrome. In Vivo. 2009;23(4):621–8. (d) Fremont M, Coomans D, Massart S, De Meirleir K. High-throughput 16S rRNA gene sequencing reveals alterations of intestinal microbiota in myalgic encephalomyelitis/chronic fatigue syndrome patients. Anaerobe. 2013;22:50–6.

[iv] (a) Komaroff AL, Buchwald DS. Chronic fatigue syndrome: an update. Annu Rev Med. 1998;49:1–13.
16. Hornig M, Gottschalk G, Peterson DL, Knox KK, Schultz AF, Eddy ML, et al. (b) Cytokine network analysis of cerebrospinal fluid in myalgic encephalomyelitis/chronic fatigue syndrome. Mol Psychiatry. 2016;21(2):261– 9. (c) Hornig M, Montoya JG, Klimas NG, Levine S, Felsenstein D, Bateman L, et al. Distinct plasma immune signatures in ME/CFS are present early in the course of illness. Sci Adv. 2015;1(1).

[v] (a) Wingler K and Brigelius-Flohe R. Gastrointestinal glutathione peroxidase. Biofactors 10: 245–249, 1999. (b) Esworthy RS, Yang L, Frankel PH, Chu FF, Aranda R, Martin MG, Doroshow JH, and Binder SW. J Nutr 135: 740–745, 2005.

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