Year end review of CFS/ME

It’s year end and I thought a review of the last articles in 2018 on PubMed would be a good way to see out the year.

When seemingly disparate biomedical findings on ME/CFS are interpreted through the lens of these microbiome-based paradigms and platforms, a cohesive picture of the ME/CFS disease process emerges. ME/CFS may be driven by pathogen-induced dysfunction, with resulting microbiome dysbiosis varying based on a patient’s unique infectious and environmental history. 

It is subsequently important to consider that the microbiome may contribute to host blood pressure regulation. Pluznick et al. (69) found that gut microbiome-derived Short Chain Fatty Acids such as acetate and propionate travel to the kidneys and blood vessels. There they impacted activity of Olfr78 and Gpr41, two host receptors that control circulation and blood flow.

Several research teams have tied ME/CFS to bacterial gut microbiome dysbiosis. 

Composition of the blood metabolome has also been shown to shift in ME/CFS. One such study reported elevated plasma levels of choline, carnitine, and complex lipid metabolites in ME/CFS patients (84).

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in the Era of the Human Microbiome: Persistent Pathogens Drive Chronic Symptoms by Interfering With Host Metabolism, Gene Expression, and Immunity.

Definition of ME/CFS

This is a constantly moving target.

Chronic fatigue syndrome (CFS), introduced in 1988 and re-specified in 1994, is defined as (unexplained) chronic fatigue accompanied by at least four out of eight listed (ill-defined) symptoms.

The diagnosis of ME requires only two type of symptoms (post-exertional muscle weakness and neurological dysfunction), but a patient has to experience at least eight symptoms to meet the diagnosis according to the ME-ICC. 

Myalgic Encephalomyelitis or What? The International Consensus Criteria.

Microbiome Dysfunction

IMHO, the mind set of researchers tend to be towards finding a singleton pattern (one causing bacteria, one causing virus in the past) and as we see in this review, one pattern of microbiome shifts. My view is that each symptom is likely connected to a pattern of metabolite shifts. Similar shifts can occur with different bacteria shifts.

Differences were reported in each study; however, only three were considered statistically significant, and the findings across all studies were inconsistent. 

A systematic review of enteric dysbiosis in chronic fatigue syndrome/myalgic encephalomyelitis.

Nutritional Treatment

Quick list of current deficiencies accepted for CFS. Some symptoms may be moderated by therapeutic levels of supplements. See this post.

Also, some nutrient deficiencies (vitamin C, vitamin B complex, sodium, magnesium, zinc, folic acid, l-carnitine, l-tryptophan, essential fatty acids, and coenzyme Q10) appear to be important in the severity and exacerbation of CFS symptoms.

Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach.

Blood Volume

This is a continuation of Dr. David Bell’s 1998 work

Adults with ME/CFS had a significantly lower blood volume if they had a clinical suspicion of orthostatic intolerance (OI) compared to those without a clinical suspicion of OI, as well as a significantly lower blood volume compared to the expected value. 

Blood Volume Status in ME/CFS Correlates With the Presence or Absence of Orthostatic Symptoms: Preliminary Results.

Brain Scans

For more information on brain scans, see this post.

In the ME/CFS patients, we observed significant FA decreases in the genu of the corpus callosum and the anterior limb of the right internal capsule (P < 0.05), there were also significant MK decreases in the right frontal area, anterior cingulate gyrus, superior longitudinal fasciculus (SLF), and left parietal area (P < 0.05). Significant NDI decreases were observed in the right posterior cingulate gyrus, SLF, and left frontal area of the ME/CFS patients (P < 0.05). Significant ODI decreases were seen in the bilateral occipital areas, right superior temporal gyrus, the anterior limb of internal capsule, and the posterior cingulate gyrus (P < 0.05), and significant ODI increases were revealed in the bilateral occipital and right temporal areas (P < 0.05).

Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging

Regional cerebral blood flow and glucose utilization rates are decreased in patients with ME/CFS as compared with age- and sex-matched healthy subjects. Acetyl-L-carnitine uptake into the releasable pool of glutamate and serotonin transporters densities are decreased in a few specific brain regions, mostly in the anterior cingulate in the patients. Our recent PET study successfully demonstrated that neuroinflammation is present in widespread brain areas in ME/CFS patients, and is associated with the severity of neuropsychological symptoms.

[Brain Science on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]

Interesting Articles