My usual practice is to answer questions by a post — that way people can comment (and disagree) . Also, others may have the same questions and do not have the energy to write.

• Many probiotics produce natural antibiotics, so some killing of bacteria happens. The key issue is to prevent antibiotic resistance — antibiotic resistance to the natural antibiotics produced by the probiotics. Hence the need to constantly rotate the probiotics.
• Since you have found that certain herbs suppress  recurring infections you should try to identify which herbs do it. If you get a short list then of herbs then you (or me) may be able to identify which family of bacteria is involved and look for additional herbs effective against this family. Again the recurring issue is the bacteria developing resistance to how each herbs kills.  With this list, you should rotate them every 7-14 days so when the bacteria adapts to one, the next one is effective against the adaptation.

• If you do not herx severely, go for a high dosage for a short period. The key logic is to kill off more before resistance develops. Do not take the same probiotic or herb continuously – it just encourages resistance.

• Yes, but time-box how long you take each one.  When you rotate back to it, start with a higher dosage.

• Most studies use water extract, or alcohol extract or some other way of extracting the active ingredients.  The current cost of getting these extracts commercially is high and beyond the budget of most CFS patients. I have (without evidence) opted to suggest taking the raw herb in capsules.  If you do the herb is tea, then you are actually doing a water extract! Perfectly fine.

  • Example extract: Neemaura Naturals Neem Extract Triple Potency (1 To 5) 1 Ounce  $12

  •  “Alcohol, vegetable glycerin, water, dry herb to menstruum ratio 1:5 35% grain alcohol usp 35% vegetable glycerin, 30% water.” – so it is just dried herb in alcohol! Buy a bottle of Vodka and mix yourself!

  • Skin grade:
    • Neem Oil Organic & Wild Crafted Pure Cold Pressed Unrefined Cosmetic Grade 12 oz for Skincare, Hair Care, and Natural Bug… $15.70
    • NOW Foods Neem Oil, 1-Fluid Ounce. $6.59
  • Bulk Powder: 1 lb – $15.00 or $12
• If someone over-reacts to capsules, then I suggest they move to tea instead (or both) you do not need to buy tea bags — you can also go old school Tea Infuser. Make sure that your mesh size works with the bulk neem.
  • Since you do not have the energy to make capsules — consider the tea route.

This last week there were two very interesting studies published:

• Robert K. Naviaux, on identifying metabolome that accurately predict CFS. Official Press Release, Full Text.
• Healthy human gut phageome [2016] finding some virus(bacteriophages) are found in healthy individuals but not sick ones, see NPR Your Gut’s Gone Viral, And That Might Be Good For Your Health (with audio)

Metabolome Study

• Patients were a very specific subset of CFS patients (“met diagnostic criteria for ME/CFS by Institute of Medicine, Canadian, and Fukuda criteria.” – i.e. 3 different criteria )
• “Patients with CFS showed abnormalities in 20 metabolic pathways. Eighty percent of the diagnostic metabolites were decreased”
  • Male abnormalities were:
    • Sphingolipids
      • ceramides,  possibly available as a supplement –
      • sphingomyelin
    • Glycosphingolipids
    • Phospholipids
      • “a very specific molecular species of phospholipid, PC(18:1/22:6), containing the essential omega 3 fatty acid docosahexaenoic acid (DHA, C22:6) and oleic acid (C18:1) was increased.”
    • P5C, Arg, Ornithine, Pro
    • Cholesterol, nongonadal steroids
    • Branch chain amino acids (different in males and Females)
    • Purines
    • Microbiome metabolism
    • Vitamin B2 (riboflavin) – this is a component of d-ribose which is known to help CFS
    • Serine, 1-carbon metabolism
    • SAM, SAH, methionine, glutathione
    • Very long chain fatty acid oxidation
    • Propiogenic amino acids
    • Threonine metabolism
    • Fatty acid oxidation and synthesis
    • Collagen/hydroxyproline metabolism
    • Bile salt metabolism
    • Endocannabinoids (Females only)
    • Vitamin B12 (cobalamin) metabolism (Females only)
    • Amino-sugar, galactose, and nonglucose (Females only)
• “the metabolic features of CFS are consistent with a hypometabolic state.”
  • From 1959: “The most common signs and symptoms of hypometabolism were chronic fatigue, enlarged thyroid gland, gynecologic disorders, dry hair, and nervousness and irritability. The most frequent gynecologic disorders were adnexal congestion, pelvic pain, adnexal tenderness, and menstrual irregularity.”

I am not going to dive into each and every item above. With the above metabolites (chemicals) being low then supplementation should reduce symptoms – remember we are talking about chemicals produced by cells and bacteria. In fact, we know that B12 and B-2 (via d-ribose) does that.

What I find  interesting is Microbiome metabolism. “Aromatic Amino Acid Metabolites from the Microbiome Were Decreased….this pattern is also opposite of what is found during acute inflammation and infection “. Metabolites ” have various functions, including fuel, structure, signaling, stimulatory and inhibitory effects on enzymes, catalytic activity of their own (usually as a cofactor to an enzyme), defense, and interactions with other organisms (e.g. pigments, odorants, and pheromones).”  Metabolites are produced by cells, including bacteria in the microbiome.

Illustration:

• E Coli metabolites  has 2700+ PubMed Articles
• L. Reuteri metabolites has 23 PubMed Articles
• Straphylococcus Aures metabolites has almost 700 PubMed Articles

In short — a change of metabolism can clearly be associated with a shift of bacteria in the microbiome. Different bacteria will produce different metabolites.

Questions and Answers

• Can this be used to give a CFS diagnosis?
  • No. This allows a group of CFS patients and healthy controls to be classified. These tests may fail to tell the difference between diabetes and CFS, or migraines and CFS, IBS and CFS, UC and CFS, Crohn’s Disease and CFS, Hypothyroidism and CFS,  etc. For example, Alzheimer’s Disease had hypometabolism also. [2008]

    Further studies are needed to see if it can tell the differences between different diseases that are associated with hypometabolism.

• Can this be used to exclude CFS?
  • Not with absolute certainty … The test is 90-95% accurate, i.e. 1 in 10 CFS patients will return a false negative.
• What are positive conclusions?
  • CFS should not be viewed as “acute inflammation and infection” and treatment assuming that, may be counter productive
  • Supplementation for items that are low may result in symptom reductions.
• The findings on DHA suggests we should not supplement with it?
  • There are two studies on levels and no studies on trying it as a treatment. Personally, I would not.
    • [2003] “found that the levels of … docosahexanoic acid (DHA) were decreased in patients suffered from CFS. However, the levels of the palmitic acid and oleic acid were increased.”
    • [2005] which look at the general levels
• Does this finding agree with your model?
  • Yes — what is being measured is what is being produced by bacteria and cells. Thus a change of bacteria would result in a change of metabolites.

Bacteriophages Study

see NPR Your Gut’s Gone Viral, And That Might Be Good For Your Health (with audio)

The common (and incorrect) attitude is that all virus are bad.

• “From the combined group of people, Young and his team identified 23 bacteriophages that seemed to be associated with a healthy gut. These viruses were common in more than half the healthy people and were much less common in people with Crohn’s or colitis”
• “Some scientists suspect bacteriophages may determine which bacteria get to dwell in the gut and which ones aren’t allowed to stay, Eisen says. Bacteriophages are potent assassins.”

So one day, we may see capsules of virus being used to treat the microbiome dysfunction seen in CFS, IBS, etc — until that day, the best hope is snogging with healthy young people 🙂 — transfer their healthy bacteria and virus!