IBS/CFS Insight from Bergen’s Giardia Infection

I have been following the 2004 Giardia infection population studies because it is a good size population with a laboratory-confirmed root cause of CFS and IBS for the patients in the population. The 10 year report has just be published on PubMed Prevalence of Irritable Bowel Syndrome and Chronic Fatigue 10 Years after Giardia Infection [2018]

“In 2004, the drinking water source in Bergen, Svartediket, was infected by the Giardia lamblia parasite. At least 2,500 people suffered from diarrhoea and abdominal pains as a result. Many have struggled with abdominal complaints and fatigue since then, results from the follow-up studies show.” [2015]

My model is that some event result in a shift of the microbiome which did not return to the prior state within 6 months (diagnostic definition for CFS).  In this case, we have a specific known event (instead of “some event”) and can see something about the life cycles of CFS/IBS given the large number of patients with the same initial event at the same time. This is a unique population significant for understanding CFS and IBS behaviors.

The numbers below come from different authors who sometimes did different samples and criteria. 😦

For CFS (remember CFS diagnosis require 6+ months. Fukuda et al’s 1994 criteria was used)

  • in 1-3 years: 60%
  • After three years: 46.1%
  • After five years: 41.5%
  • After six years: 30.8%
  • After ten years: 26%

For IBS (Rome II criteria):

  • After one year: 43%
  • After three years: 46.1%
  • After three years: 46.1%
  • After five years: 59.6%
  • After six years: 39.4%
  • After ten years: 40%

Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study. [2012]

Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course [2013]

Irritable bowel syndrome and chronic fatigue 6 years after giardia infection: a controlled prospective cohort study. [2014]

  • “Lactulose-induced hydrogen breath excretion was not significantly different in patients and controls.” [2006]
  • “Exposure to Giardia infection was associated with perceived food intolerance 3 years after giardiasisIBS status did not alter the association between exposure status and perceived food intolerance. Perceived intolerance to high FODMAP foods and low FODMAP foods were both statistically significantly associated with exposure to Giardia infection.” [2015]
  • “A total of 58 (60%) out of 96 patients with long-lasting post-infectious fatigue after laboratory confirmed giardiasis were diagnosed with CFS.” [2012]

Bottom Line

“CFS has been reported to affect 10% following Epstein Barr virus (EBV) infection [4,5], and fatigue, depression and hair loss is a common syndrome following Dengue fever [6,7]. In controlled studies chronic fatigue has been reported after Lyme borreliosis [8], Parvovirus B19 infection [9], Q fever [10] and Ross River virus infection [4].”  [2013]

Doing some math, for natural recovery

  • At 1-3 years: ~ 9% recovered from CFS per year
  • At 3-6 years: ~ 13% recover from CFS per year
  • At 6-10 years: ~ 4.2% recover from CFS per year

In short, the longer the dysfunction continues, the more stable it becomes — thus the harder to undo.

IMPORTANT — Natural recovery is cited above

That is doing nothing, or a variety of ad hoc things.

See https://cfsremission.com/2016/03/12/ibs-probiotics/ for probiotics that have had demonstrated effect for IBS in studies.