Exercise alteration of the CFS Microbiome

An article was just published “Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) [Dec 18, 2015]” that had interesting results. While the sample size (10 control, 10 patients) was far less than ideal, the results were not surprising when applying the model that I use.

CFS Changes compared to Controls

We need to note that blood is generally deemed to be sterile (no bacteria), however bacteria is able to enter the blood and can survive for a limited period of time. The volume found depends on the translocation into the blood and thus things like stomach permeability can increase or decrease the amount.

Family Blood Sample Stool Sample
Actinobacteria Similar Decrease by 50%
Bacteroidetes Decreased Increased
Firmicutes Increased Decreased
Proteobacteria Increased Increased by over 50%

The study then saw how these families changed 72 after doing an exercise challenge. Exercise changes the chemicals circulating in the body, for example lactic acid is increased. These chemicals impact the growth and inhabitation rates of different bacteria.

Some of these changes may include the degree that bacteria can move from the digestive system to the blood system. This can result in a decrease in stools and an increase in the blood (or the reverse) because of the changes induced by exercise chemicals of the barriers.

Screen Shot 2015-12-19 at 7.25.04 AM

They also examined changes in the blood microbiome, as shown below.

Screen Shot 2015-12-19 at 7.30.49 AM

As many CFSers have experienced, they will do absolutely fine during the exercise challenge and then start to crash on the day after (I went thru precisely that during my 2nd CFS episode). What we see is that exercise induces a major change in the microbiome and after 72 hours, the prior state has not been restored. I wished that the sampling had continued longer so we could see what the return to normal time was for both controls and CFS.

They also did a measurement just 15 minutes after the start of the exercise challenge, with CFS levels of certain bacteria increasing quickly in the blood.

Screen Shot 2015-12-19 at 7.38.12 AM

Impact of Study on Multiple Chemical Sensitivity

The last figure above may provide a clean clue as to the mechanism. If the chemical induces a similar change as an exercise challenge in the microbiome, we have a very rapid increase of some bacteria which then start a cascade of microbiome changes — and thus the symptoms.

Selected Quotes

“The evidence of altered intestinal microbiota and bacterial translocation into the bloodstream following exercise challenge in patients with ME/CFS is consistent with previous findings and provides novel evidence of systemic bacterial signal and exercise induced bacterial translocation—one potential explanation for the worsening of symptoms seen in patients when they attempt to become more physically active.”

“Although no “typical” enterotype has been defined to date, reports of dysbiosis in patients with ME/CFS in Norway and Belgium are consistent with the changes in relative abundance of Firmicutes and Bacteroidetes observed here.”

“Evidence for altered intestinal permeability in patients with ME/CFS has been mounting and preliminary studies suggest that treatments designed to modulate the gut microbiota or enhance intestinal barrier function may be able to improve ME/CFS symptoms”

“While the careful selection process allowed for high quality case and control populations, the study sample size was small and as such, many observations failed to rise to the level of statistical significance. Additionally, the small sample size precluded us from directly examining the associations between symptoms and changes to the gut and plasma microbiome.”

“We are still a long way from fully understanding how the intestinal microbiota impacts etiology and symptomology in ME/CFS, but the evidence presented here and elsewhere suggests that changes in gut microbiome are associated with this disease.”

Bottom Line

The above does not explicitly lead to any new type of treatment for CFS. It does demonstrate that unusual rapid changes in gut/blood bacteria does occur with CFS in a very different manner than with healthy individuals.

This study is consistent with my model. It does raises questions on which probiotics impact permeability and thus the amount of translocation.  Whether the translocation is a significant factor, the alternative factor to consider is just the chemicals being produced by bacteria in the gut crossing into the blood, remains unclear/unresolved.