A reader forwarder to me their results from DOCTOR’S DATA STOOL TEST, and this is my comment  on things to consider (and, of course, consult with your knowledgeable medical professional before taking any action). Tests change every few years and I like to see the latest report. They have been active on herbs and probiotic for a year, with just minor improvement.

As expected:

E.Coli is better than is typically seen, I suspect Mutaflor or Symbioflor-2 supplementation. Symbioflor-2 is my first choice for two reasons:

• Studies found that it does take up residency
• Can be ordered for shipment to the US via Amazon.de (i.e. availability)

Mutaflor would be a secondary choice (much harder to order from the US)

The NG for Enterococcus spp, suggests that a enterococcus probiotic should be used (the more species, the better).

The E.Coli-Enterococcus Marriage

A reader on my enterococcus probiotics post commented:

“E.coli and enterococcus appear to have a symbiotic relationship too! This makes sense.”

So, as is my habit, I decided to determine if this is true, false, or unknown.

The chart below showed that they appear to support each other [2008] and thus may be, and should be, taken together for best effect.

• “E. coli was correlated with enterococci in southern Lake Michigan beaches[2003]
• “This study demonstrated that there was a synergistic effect on virulence when an association of enterococci and E. coli”[2008]

Don’t forget me! Biofilm breakers

You may wish to take the above with herbs and supplements that isted in my biofilm breaker post and the post on biofilm breaker probiotics. Why is this important? It expose the residue infections to the two probiotics so they can be dislodged.

 Bacteria in Imbalance

These are bacteria with larger than normal volumes. They have no explicit issue linked to them, however they could help to support bad bacteria, or needed to sustain them.

For example, gamma hemolytic strep is associated with “pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS).” [2015], which hints at it being involved with neurological symptoms of CFS.

• “Serotonin Activates Bacterial Quorum Sensing and Enhances the Virulence of Pseudomonas aeruginosa in the Host.[2016]”
• “Volatile Compounds Emitted by Pseudomonas aeruginosa Stimulate Growth of the Fungal Pathogen Aspergillus fumigatus [2016].“

The rest of his lab reports were marked normal on the report. You may wish to look at another readers report from 2014 here which contains further suggestions.

• A mushroom extract that may help, see this post.
• Tulsi may also help, see this post
• Zingerone (related to ginger but not in raw ginger) “The results of the present study revealed the anti-quorum sensing activity of zingerone targeting ligand-receptor interaction, hence proposing zingerone as a suitable anti-virulent drug candidate against P. aeruginosa infections” [2015]
• P. Aeruginosa is associated with IBS, this post, as well as higher histamine levels, in this post.

Bottom Line

First try E.Coli+ enterococcus probiotics + biofilm breakers, then rotate to Tulsi and Zingerone (only product that I could locate is this one on Amazon).

Some CFS patients are very low in Enterococcus, my next post will look at the lab results on a CFS patient that shared his results with me.

“Species from the genus Enterococcus have been used as probiotic for humans or animals, although this genus is not considered “generally recognized as safe” .[2001]..

• “Furthermore, E. faecium has experimentally been shown to have a high colonization potential, especially if administered in connection with treatment with antimicrobial agents [15].”

“Enterococcus strains have been used as supplement for the food and feed such as poultry and swine to replace the use of sub-lethal antibiotics in the feeds. Many studies have been conducted to evaluate the effect of probiotic strains of this genus (mainly E. faecium)….Some strains are resistant to many antibiotics and possess virulence factors such as adhesins and haemolysin, often located on pathogenicity islands or plasmids.” [2013]

“Pulse-field gel electrophoresis showed that the sixteen isolates (from commercial Korean Probiotics) tested in this study are originated from three strains.” [2008]

Single Family (Only Enterococcus)

Bioflorin – Enterococcus faecium SF 68

Reviewed in early post.

• “Enterococcus faecium SF 68 (sensitive to penicillin, tetracycline, virginiamicin and tylosin, but resistant to streptomycin)” [1994]
• “An antagonistic activity of Enterococcus faecium SF 68 towards Plesiomonas shigelloides, Aeromonas sp., enteropathogenic Escherichia coli and Yersinia enterocolitica has been studied and demonstrated.’ [1990]
• “Fingerprints identical to the ingested probiotic strains were recovered from fecal samples of 4/7 volunteers after one week of Mutaflor, from 4/6 after taking Bioflorin” [2007]

Symbioflor-1

From the makers of Symbioflor-2, contains a strain of Enterococcus faecalis. [Package Insert]. It is unlikely to take up residence, so should be viewed as a catalyst-probiotic (one that may help others during the short time that it is there).

• Significant decrease of titres of circulating IgG after oral intake of a preparation of Enterococcus faecalis in a group of ten healthy volunteers [1993].
• ” The objective of the present study was to employ such in vitro methodology to characterise different strains of Enterococcus faecalis. The characteristics of a commercial product marketed as a probiotic, Symbioflor-1 (Symbiopharm), were compared with the characteristics of both pathogenic and commensal strains. Tolerance towards low pH and viability after exposure to human gastric and duodenal juices were assayed. Symbioflor-1 was the most susceptible strain to these treatments when compared with the other E. faecalis strains.” [2012]
• [The effect of a bacterial immunostimulant (human Enterococcus faecalis bacteria) on the occurrence of relapse in patients with chronic recurrent bronchitis][2001]. It does help that condition.

Multistrains

Multi-Strain-PROBIOTIC-InnovixLabs-Broad-Spectrum

Contains Enterococcus faecium SD-5843 – no studies

130 Tablets New Biofermin S Tablet By Biofermin

Japanese Product.

Three-Lac

Enterococcus faecalis

Integrative Therapeutics – Enterogenic Concentrate

Enterococcus faecium

Also in Cat and Dog Probiotics

I will not touch the question of using Vet probiotics by humans.

Bottom Line

• Bioflorin is the first choice because it has a good chance of persisting (likely depends on what it has to deal with… a boxing match).
• Symbioflor-1 is the second choice — simple because it has been studied and results published
• For all of the rest, there is no clear winner, but I am bias for Bioferimin (from my experience with other Japanese produced probiotics). According to their site, 1/3 of the probiotic is enterococcus[source]. It is also the easiest to obtain in the US because it is sold on Amazon (and appear to ship from Japan). It also appear to be multiple tablets for a “adult dosage”, so it is possible to slowly introduce it easily
• Taking with herbs or even selected antibiotics appear to increase it success (i.e. knock out the opposition, and it will move in)

A reader asked about retroviruses – these are virus that which  reproduces its RNA the opposite way of normal viruses (i.e. Retro). Antiretroviral drugs are medications for the treatment of this type on infection. Retroviruses are best known in connection with HIV infections.

The XMRV Hype

Due to lab errors, a lot of money and time was spent trying to show that XMRV (RV for retrovirus) was associated with CFS/ME. The titles of many recent studies say it all:

• No association found between the detection of either xenotropic murine leukemia virus-related virus or polytropic murine leukemia virus and chronic fatigue syndrome in a blinded, multi-site, prospective study by the establishment and use of the SolveCFS BioBank.[2014]
• No evidence of XMRV provirus sequences in patients with myalgic encephalomyelitis/chronic fatigue syndrome and individuals with unspecified encephalopathy. [2014]
• Lack of evidence for retroviral infections formerly related to chronic fatigue in Spanish fibromyalgia patients.[2014]
• Absence of xenotropic murine leukemia virus-related virus in Italian patients affected by chronic fatigue syndrome, fibromyalgia, or rheumatoid arthritis. [2012]
• Absence of xenotropic murine leukaemia virus-related virus sequences in healthy blood donors andchronic fatigue syndrome patients in Catalonia, Spain]. [2013]
• Researchers find no link between XMRV and chronic fatigue syndrome. [2012]
• Xenotropic and polytropic murine leukemia virus-related sequences are not detected in the majority of patients with chronic fatigue syndrome. [2012]
• Lack of evidence for a role of xenotropic murine leukemia virus-related virus in the pathogenesis of prostate cancer and/or chronic fatigue syndrome. [2012]
• A multicenter blinded analysis indicates no association between chronic fatigue syndrome/myalgic encephalomyelitis and either xenotropic murine leukemia virus-related virus or polytropic murine leukemia virus. [2012]
• Human endogenous retrovirus-K18 superantigen expression and human herpesvirus-6 and human herpesvirus-7 viral loads in chronic fatigue patients. [2013]

The last study had a bit wider scope on other virus associated with CFS/ME “We fail to demonstrate a difference in HERV-K18 envtranscripts, HHV-6 viral copy number, and HHV-7 viral copy number between CFS patients and healthy controls. Our data do not support the hypothesis of reactivation of HHV-6 or HHV-7 in CFS.” which is echoed in some studies:

• No serological evidence for a role of HHV-6 infection in chronic fatigue syndrome. [2012]
• Serological and virological investigation of the role of the herpesviruses EBV, CMV and HHV-6 in post-infective fatigue syndrome. [2010] ” These data do not support the hypothesis of ongoing or reactivated EBV, HHV-6, or CMV infection in the pathogenesis of CFS.”

And there are other older studies who speculate “HHV-6 and HHV-7 may be involved in the pathogenesis of CFS and reactivation of both viruses may provoke changes in the phenotype of circulating lymphocytes.”[2006] and “These findings suggest that the amount of HHV-6 and HHV-7 reactivation can be an objective biomarker for fatigue.” [2007] “Parvovirus B19 may be involved in the pathogenesis of CFS, at least for a subset of patients.” [2009]

Anti-viral Drugs — works by side effects???

On the flip side, an antiviral drugs such as Valacyclovir have positive results on a subset of ME/CFS patients . “We concluded that the 16 CFS patients (included in both phases of this study) with EBV-persistent infection (EBV single-virus subset) are improved after 6 months of continuous pharmacokinetic dosing with valacyclovir.” [2002] [2007] Patients with multiple viruses did not benefit – even when one was EBV.

My  model of CFS is that it is a microbiome dysfunction, a major shift of bacteria types and volumes in the person. I was unable to find any studies on how antivirals shifts (or do not shift) the microbiome by the use of antiviral drugs. Drugs intended for one purpose often are later to have other consequences — for example, a drug  intended for the treatment of various cardiovascular disorders… is commonly known as Viagra.

Bottom Line

IMHO, retrovirus and virus are red-herrings in CFS/ME. They have been heavily studied “and found wanting” as explanations and models for treatment. Virus may become reactivated as a side effect of the bacteria shift is a small subset of CFS/ME patients, but it is not a global answer.

While these studies are not dealing with CFS patients — they are interesting because some of the conclusions / observations may be relevant.

Feed a cold (viral infection), starve a fever (bacterial infection)

This was reported in a NewScientist news story on 2002. “Dutch scientists have found that eating a meal boosts the type of immune response that destroys the viruses responsible for colds, while fasting stimulates the response that tackles the bacterial infections responsible for most fevers.” This was also reported in Opposing Effects of Fasting Metabolism on Tissue Tolerance in Bacterial and Viral Inflammation [Cell Sept 2016] – so both human and mice studies found the same thing.

Impact for CFS:

• If you have a flare — then one time:
  • fast for 12 hours
  • take food (or capsules) high in glutamine amino acid (i.e. milk, meat, nuts)

If fasting make you better, faster than food then a bacterial infection is likely a significant factor.

If food makes you better, faster than fasting, then a vial infection is likely a significant factor. – for example a viral re-activation.

Bacteria lurking in blood could be culprit in countless diseases

This NewScientist Sept 14, 2016 article reported “A molecule made only by bacteria has been found to change blood proteins in a way that is common to a score of “non-infectious” conditions, from heart attacks to Alzheimer’s disease….. They need iron ions to grow, and iron is bound up by proteins that keep free ions at vanishingly low levels in our blood.”

What is very surprising is the impact “Just one molecule of lipopolysaccharides (LPS). mixed with 100 million fibrinogen molecules was enough to trigger these changes (Journal of the Royal Society Interface, doi.org/bqh5).” Fibrinogen can lead to thick blood.

In terms of treatment, “There could potentially be a link to cancer, too. Inflammation is seen in cancer and the anti-inflammatory drug aspirin is known to lower cancer rates. The pill is also reported to bind free iron, which together may suggest bacteria have a hidden role in this disease too.”

Aspirin

Aspirin has been a bit of a mystery drugs — I recall reading several years ago, a Scientific American article on Aspirin stating that they do not understand how aspirin works. “Although many of ASA’s pharmacological actions are related to its ability to inhibit prostaglandin and thromboxane biosynthesis, some of its beneficial therapeutic effects are not completely understood.” [1995]

During my second remission, I took the maximum daily dosage of aspirin for 10 days to see if hypercoagulation was indeed part of CFS. I made a dramatic improvement. My MD was now willing to explore hypercoagulation. In hindsight, aspirin may have been doing multiple things that resulted in the improvement.

• The influence of non-steroidal anti-inflammatory drugs on the gut microbiome [2016].
  • “The bacterial composition of the gut varied with the type of NSAID ingested.”
  • “Four OTUs (Prevotella species, Bacteroides species, family Ruminococcaceae, and Barnesiella species) discriminated aspirin users from those using no medication”
• Non-steroidal anti-inflammatory drugs may modulate the protease activity of Candida albicans [2010].
  • “In other hand, aspirin seems to reduce the secretion of aspartyl-proteases -related pathogenic behavior of candidal biofilms.”
• Aspirin-associated iron loss: an anticancer mechanism even in the short term?[2013]
• Antiviral activity of aspirin against RNA viruses of the respiratory tract – an in vitro study [2016]
  • “These data demonstrate a specific antiviral activity of aspirin against influenza A virus and HRV. The mode of action against rhinoviruses is still unknown and requires further investigation, as does the possibility of aspirin being effective in vivo to treat the common cold.”
• Aspirin inhibits hepatitis C virus entry by downregulating claudin-1. [2016]
• Aspirin attenuates cytomegalovirus infectivity and gene expression mediated by cyclooxygenase-2 in coronary artery smooth muscle cells. [1998]
• Aspirin inhibits a murine viral infection[1975].
  • “it is possible that aspirin has previously unrecognized therapeutic effects in various clinical situations, such as in viral infections (when used as an antipyretic agent) and in atherosclerosis (when used as an antiplatelet agent).

Health Rising had a recent post “IV Saline Solution For Chronic Fatigue Syndrome (ME/CFS)” with links to  The Nitty Gritty on IV Saline and POTS / Speed and frequency – Does it Matter? and Dr. David Bell “Intravenous Fluid as a Treatment for ME/CFS”.

A reader had to give a presentation and had a flare. An IV solution enabled the reader to proceed with an excellent presentation. “I was able to get a saline IV which helped a tremendous amount. I also took some aspirin. I still had aphasia on stage but it made it 10x more dramatic and well received. The talk was a smashing success.”

My read of saline solution impact was because it reduced coagulation, decreased blood viscosity (allow it to flow faster), in addition to increasing blood volume. Hypercoagulation (thick blood) is a very common problem with CFS, as well as low blood volume.

• “The hypertonic saline solution therapy could significantly improve blood viscosity and reduced viscosity”[1997]
• ““Even as late as World War II and the Vietnam Way, it was thought that adding isotonic fluids to replace blood lost on the battlefield would be good because it lowered blood viscosity, making it easier for the heart to pump.”[UCSD]
• “At 10% blood volume replacement with hypertonic saline, reaction and coagulation times were significantly increased… We conclude that 7.5% hypertonic saline solution has anticoagulant effects if it replaces 7.5% or more of blood volume.”
  • Human blood volume is 4.7 liters, so 0.35 liters or 1 1/2 cup would have an impact

• “Most institutions recommend the use of heparin to prevent occlusion [in catheters], however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective.” [2015]
• “Normal saline influences coagulation and endothelial function after traumatic brain injury and hemorrhagic shock in pigs.[2014]”Normal Saline resuscitation was associated with an early activation of coagulation, natural anticoagulation, and endothelial systems,”