Does The Gut Microbiome Hold The Key To Understanding Chronic Fatigue Syndrome?


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Being tired is a normal part of our day that the average person will inevitably experience, but when intense fatigue and cognitive challenges inhibit our ability to function normally, this can indicate Myalgic Encephalomyelitis (ME), or more commonly known as Chronic Fatigue Syndrome (CFS). Other symptoms of ME/CFS include muscle pain, trouble concentrating, and even gastrointestinal issues. Since the COVID-19 pandemic, it is estimated that between 8 million and 23 million Americans are dealing with ME/CFS, while prior to the pandemic, only an estimated this number was closer to 2.5 million. The exponential increase in the prevalence of ME/CFS can be attributed to the symptoms of long haul (or Long) COVID-19 infections meeting the same diagnostic criteria as ME/CFS. So how do we begin to treat the dramatic increased number of patients with ME/CFS?

“…our gut ecosystem can be disrupted and in some cases, the disruption will not return to normal upon recovery from the viral infection.”

Scientists believe that they may have found a link between an altered gut microbiome and the disease. While there is still more research needed to develop a full understanding of how the disease develops and possible treatments, scientists have found that ME/CFS often follows a viral infection, such as COVID-19, which led to a disruption of the gut microbial ecosystem. A healthy gut microbiome is a rich and diverse ecosystem where trillions of microorganisms live in symbiosis and are able to effectively communicate with each other and with our body. When we have a viral infection accompanied by gastrointestinal symptoms such as nausea or diarrhea, our gut ecosystem can be disrupted and in some cases, the disruption will not return to normal upon recovery from the viral infection. Previous research has indicated that gut microbiome issues are common in patients dealing with ME/CFS, but until recently it had been unclear as to which microbes were associated with the disease.

“…early intervention could be the key to prevent the accumulation of symptoms in the future.”

Lawrence Purpura, an infectious disease specialist at Columbia University Medical Center, has worked with patients facing long COVID-19 symptoms. He has also spent time studying the gut microbiome of these patients. Purpura describes ME/CFS as an “accumulating snowball” and states that early intervention could be the key to prevent the accumulation of symptoms in the future. Fortunately, the science is evolving in the ways we can better diagnose and care for patients who are suffering from ME/CFS. In recent research studies funded by the National Institute of Health (NIH), scientists discovered that there is a reduced abundance of “good” bacteria being found in the gut of patients dealing with ME/CFS. This decreased abundance is associated with a reduced production of short fatty acids, such as butyrate, that are needed for regulating metabolic function and the immune system. Brent Williams, the lead author on the Columbia study, and his colleagues chose to specifically focus on the bacteria in the gut that produced butyrate. Butyrate is a short chain fatty acid that is responsible for many essential functions in the body such as a reduction of inflammatory processes, responding to infections, protecting bodily systems, metabolic health, and more. Butyrate is produced by certain gut microbes by breaking down complex carbohydrates (fiber) from plant-based foods.

Researchers at the Jackson Laboratory obtained a large sample of 149 ME/CFS patients and also found similar findings to those of the Columbia researchers. The results of both research teams indicated that the low levels of butyrate-producing bacteria in the stool could be both a key indicator in the diagnosis of ME/CFS and a risk factor for the disease. The extensive research done by these two teams have led to further understanding of how these disruptions in the gut microbiome may be connected to ME/CFS. It is worth noting that the studies used a large and diverse sample with patients at different stages of their diagnosis of ME/CFS. Their findings also suggested that the gut ecosystems will slowly recover over time since the recently diagnosed patients had more severe microbial alterations, including a reduced diversity in their gut microbiomes, whereas the gut microbiomes of patients with a long-term diagnosis were showing signs of microbiome normalization. While this may seem as simple as the gut microbiome naturally recovering from these long-term issues, patients who had a long-term diagnosis were now faced with metabolic issues and more dysfunctional immune systems. These findings suggest that early intervention is key to preventing long term health issues that could affect the bodily systems.

“Reducing inflammation in the body from diet alone can allow for the overall health of the body to significantly improve and for symptoms of disease to lessen.”

As the research surrounding ME/CFS advances, new ways to treat patients suffering from the disease are being discovered. It is theorized that early disease intervention could be possible by altering the gut microbiome by following a diet high in fiber and in naturally fermented foods, intended to restore diversity and enrich the gut ecosystem. While it could take years for research studies to be published on the effectiveness of diet interventions and ME/CFS symptom alleviation, patients are encouraged to adhere to a largely plant based diet, and increase their consumption of naturally fermented foods, and monitor their symptoms for possible improvement. Naturally fermented foods include sauerkraut, yogurt, kefir, miso, fermented vegetables, and kvass. These foods can help aid in the restoration of a healthy gut microbial ecosystem after a disruptive viral infection. Additionally, following a fiber rich, anti-inflammatory diet can aid in the restoration of metabolic health and immune system function. Since it may be some time until formal treatments are given to patients diagnosed with ME/CFS, those dealing with intense fatigue, cognitive challenges, and gastrointestinal issues could start to alleviate their symptoms by following a diet intended to reduce inflammation in the body and restore the gut microbiome. When following an anti-inflammatory diet, it is essential to increase the consumption of fruits and vegetables, and cut back on foods that are ultra-processed and high in added sugar. Reducing inflammation in the body from diet alone can allow for the overall health of the body to significantly improve and for symptoms of disease to lessen.

While the science behind the connection between the gut microbiome and ME/CFS is still evolving, patients with long Covid and with ME/CFS now have good reason to experiment with dietary changes to restore their gut ecosystem. Such a dietary intervention could potentially result in a reduction in the duration and severity of symptoms.

Amanda Johnson is a recent graduate from the University of Southern California where she received her degree in Psychology. In addition to her university studies, she earned her Integrative Nutrition Health Coach certification from the Institute of Integrative Nutrition (IIN). Amanda works as a Health Coach and strives to educate her clients more about the gut-brain axis.