While working on a different blog post on brain fog, the light went on for a model that may explain newly developed alcohol intolerance in ME/CFS. People tolerated and enjoyed alcohol before ME/CFS so the cause is not DNA for these people, but some change caused by ME/CFS.

A major subset of people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has excessive lactic acid, typically d-lactic acid, especially with cognitive issues (see Systematic review and meta-analysis of cognitive impairment in myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS). [2022])

What would consuming alcohol (known as ethanol) do to such a person? The answer is clear from the literature:

• Lactic acidosis and acute ethanol intoxication [1994]
• SEVERE LACTIC ACIDOSIS SECONDARY TO ACUTE ALCOHOL INTOXICATION [2021] 
• Survival from profound alcohol-related lactic acidosis. [1999]
• Does ethanol explain the acidosis commonly seen in ethanol-intoxicated patients? [2005]
  “patients with ethanol intoxication had lower blood acidosis and higher Lactic Acidosis”
• Delirium and lactic acidosis caused by ethanol and niacin coingestion.[1991]
• Effect of ethanol on lactic acidosis in experimental hemorrhagic shock. [1984]
• Use of fructose in the treatment of acute alcoholic intoxication [1975]
  “Lactic acidosis is a potentially serious side effect of large doses of fructose (sugar). “

So the model is simple:

High Lactic Acid + alcohol => severe lactic acidosis

So the key issue is to reduce lactic acid levels. I have written about this many times over the years, a few examples:

• Reducing Lactic Acid Producing Bacteria – LABO [2019]
• D-lactic Acidosis -Sauerkraut is not good for you if you have CFS! [2015]
  • The Dilemma of D-Lactate Free Probiotics [2020]
  • Note that most Lactobacillus probiotics tend to increase lactic acid and should be avoided.
• Reminder of D-Lactic acidosis and ME/CFS [2019]

Bottom Line

As a FYI, a few people using their microbiome results and my analysis site, Microbiome Prescription, has reported the ability to enjoy a glass of wine when they were intolerant before. There is hope.