There have been two recent papers on mitochondrial dysfunction and chronic fatigue syndrome.

• Targeting mitochondrial dysfunction in the treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) – a clinical audit, Sarah Myhill, Norman E. Booth , John McLaren-Howard, Int J Clin Exp Med 2013;6(1):1-15
• Chronic fatigue syndrome and mitochondrial dysfunction, Sarah Myhill, Norman E. Booth , John McLaren-Howard, Int J Clin Exp Med (2009) 2, 1-16

As a mathematical modeler, I tend to automatically ask the question – which is simpler (Osler’s Principle) with better evidence

• mitochondrial dysfunction causes microflora dysfunction
• microflora dysfunction causes mitochondrial dysfunction

My conclusion is that microflora dysfunction causes mitochondrial dysfunction.

Looking at the 2013 paper, the treatment (pp.4,5) from Dr. Myhill  is:

• Stone Age Diet – known to alter microflora
• Standard pack of nutritional supplements (substituting what the microflora should have been producing)
• Plus balance of sleep, rest and work.

So, the exact same outcome would be expected from correcting microflora.

For example, B12 is classically low in CFS patients. Gut flora appears to be the source per this PubMed article Vitamin B12 synthesis by human small intestinal bacteria. One species has been identified, Lactobacillus reuteri CRL1098, which ” The cell extract of L. reuteri corrected the coenzyme B12 requirement of Lactobacillus delbrueckii subsp. lactis ATCC 7830 and allowed the growth of Salmonella enterica serovar Typhimurium (metE cbiB) and Escherichia coli (metE) in minimal medium.” Several other articles reported other species of Lactobacillus reuteri producing B12.

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