While these studies are not dealing with CFS patients — they are interesting because some of the conclusions / observations may be relevant.

Feed a cold (viral infection), starve a fever (bacterial infection)

This was reported in a NewScientist news story on 2002. “Dutch scientists have found that eating a meal boosts the type of immune response that destroys the viruses responsible for colds, while fasting stimulates the response that tackles the bacterial infections responsible for most fevers.” This was also reported in Opposing Effects of Fasting Metabolism on Tissue Tolerance in Bacterial and Viral Inflammation [Cell Sept 2016] – so both human and mice studies found the same thing.

Impact for CFS:

• If you have a flare — then one time:
  • fast for 12 hours
  • take food (or capsules) high in glutamine amino acid (i.e. milk, meat, nuts)

If fasting make you better, faster than food then a bacterial infection is likely a significant factor.

If food makes you better, faster than fasting, then a vial infection is likely a significant factor. – for example a viral re-activation.

Bacteria lurking in blood could be culprit in countless diseases

This NewScientist Sept 14, 2016 article reported “A molecule made only by bacteria has been found to change blood proteins in a way that is common to a score of “non-infectious” conditions, from heart attacks to Alzheimer’s disease….. They need iron ions to grow, and iron is bound up by proteins that keep free ions at vanishingly low levels in our blood.”

What is very surprising is the impact “Just one molecule of lipopolysaccharides (LPS). mixed with 100 million fibrinogen molecules was enough to trigger these changes (Journal of the Royal Society Interface, doi.org/bqh5).” Fibrinogen can lead to thick blood.

In terms of treatment, “There could potentially be a link to cancer, too. Inflammation is seen in cancer and the anti-inflammatory drug aspirin is known to lower cancer rates. The pill is also reported to bind free iron, which together may suggest bacteria have a hidden role in this disease too.”

Aspirin

Aspirin has been a bit of a mystery drugs — I recall reading several years ago, a Scientific American article on Aspirin stating that they do not understand how aspirin works. “Although many of ASA’s pharmacological actions are related to its ability to inhibit prostaglandin and thromboxane biosynthesis, some of its beneficial therapeutic effects are not completely understood.” [1995]

During my second remission, I took the maximum daily dosage of aspirin for 10 days to see if hypercoagulation was indeed part of CFS. I made a dramatic improvement. My MD was now willing to explore hypercoagulation. In hindsight, aspirin may have been doing multiple things that resulted in the improvement.

• The influence of non-steroidal anti-inflammatory drugs on the gut microbiome [2016].
  • “The bacterial composition of the gut varied with the type of NSAID ingested.”
  • “Four OTUs (Prevotella species, Bacteroides species, family Ruminococcaceae, and Barnesiella species) discriminated aspirin users from those using no medication”
• Non-steroidal anti-inflammatory drugs may modulate the protease activity of Candida albicans [2010].
  • “In other hand, aspirin seems to reduce the secretion of aspartyl-proteases -related pathogenic behavior of candidal biofilms.”
• Aspirin-associated iron loss: an anticancer mechanism even in the short term?[2013]
• Antiviral activity of aspirin against RNA viruses of the respiratory tract – an in vitro study [2016]
  • “These data demonstrate a specific antiviral activity of aspirin against influenza A virus and HRV. The mode of action against rhinoviruses is still unknown and requires further investigation, as does the possibility of aspirin being effective in vivo to treat the common cold.”
• Aspirin inhibits hepatitis C virus entry by downregulating claudin-1. [2016]
• Aspirin attenuates cytomegalovirus infectivity and gene expression mediated by cyclooxygenase-2 in coronary artery smooth muscle cells. [1998]
• Aspirin inhibits a murine viral infection[1975].
  • “it is possible that aspirin has previously unrecognized therapeutic effects in various clinical situations, such as in viral infections (when used as an antipyretic agent) and in atherosclerosis (when used as an antiplatelet agent).

Health Rising had a recent post “IV Saline Solution For Chronic Fatigue Syndrome (ME/CFS)” with links to  The Nitty Gritty on IV Saline and POTS / Speed and frequency – Does it Matter? and Dr. David Bell “Intravenous Fluid as a Treatment for ME/CFS”.

A reader had to give a presentation and had a flare. An IV solution enabled the reader to proceed with an excellent presentation. “I was able to get a saline IV which helped a tremendous amount. I also took some aspirin. I still had aphasia on stage but it made it 10x more dramatic and well received. The talk was a smashing success.”

My read of saline solution impact was because it reduced coagulation, decreased blood viscosity (allow it to flow faster), in addition to increasing blood volume. Hypercoagulation (thick blood) is a very common problem with CFS, as well as low blood volume.

• “The hypertonic saline solution therapy could significantly improve blood viscosity and reduced viscosity”[1997]
• ““Even as late as World War II and the Vietnam Way, it was thought that adding isotonic fluids to replace blood lost on the battlefield would be good because it lowered blood viscosity, making it easier for the heart to pump.”[UCSD]
• “At 10% blood volume replacement with hypertonic saline, reaction and coagulation times were significantly increased… We conclude that 7.5% hypertonic saline solution has anticoagulant effects if it replaces 7.5% or more of blood volume.”
  • Human blood volume is 4.7 liters, so 0.35 liters or 1 1/2 cup would have an impact

• “Most institutions recommend the use of heparin to prevent occlusion [in catheters], however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective.” [2015]
• “Normal saline influences coagulation and endothelial function after traumatic brain injury and hemorrhagic shock in pigs.[2014]”Normal Saline resuscitation was associated with an early activation of coagulation, natural anticoagulation, and endothelial systems,”

Today I got an email from someone who is frustrated trying to control their weight. “Turns out I’ve been eating 1400-1600 a day for the last 4 months+ without any weight change.” and they are active and around 5’10”. This post does not apply solely to CFS patients, but to many people suffering with excessive weight that will not disappear.

Our understanding of weight has changed a lot in the last few years. Medscape has a nice but very technical article on it “Obesity and the Human Microbiome” which was published originally in Curr Opin Gastroenterol. 2010;26(1):5-11.

The summary says it all: “Summary Large-scale alterations of the gut microbiota and its microbiome (gene content) are associated with obesity and are responsive to weight loss. Gut microbes can impact host metabolism via signaling pathways in the gut, with effects on inflammation, insulin resistance, and deposition of energy in fat stores. Restoration of the gut microbiota to a healthy state may ameliorate the conditions associated with obesity and help maintain a healthy weight.”

Let us try to understand this a little better, food that you eat is processed by bacteria in your gut. Some bacteria are very efficient in extracting energy from the food and other are not. Further more, some bacteria send chemical signals to tell the body to store food. At one time, when food was very seasonal, these bacteria would thrive on “fall food” to build up energy stores for the winter when food may not be bountiful. Traditional seasonal variations in food would result in changes of bacteria (volume of different types) that were adapted to the best survival strategy for the human (who is the host!). With food no longer being seasonal, the bacterial shifts become disrupted .

From the above article there are some possible actions:

• “Thus, the frequency with which food enters the bowel and its transit time may be important factors to control for, or at least note, when comparing studies in humans.” – longer time between meals, or even fasting a day may help
• “those who became overweight by age 7 had had lower levels of Bifidobacteria and higher levels of Staphylococcus aureus as infants compared with those that kept a healthy weight.” — this implies adding herbs against S. Aureus [See this list] and Bifidobacteria probiotics may help.
• “An earlier report indicated that gut microbiota can regulate enteroendocrine cells and influence the release of gut hormones.^[47]”
• “Interestingly, the administration of probiotic microbes[one pill per day of Puritan’s Pride] after the [Roux-en-Y gastric bypass surgery] procedure has been shown to accelerate weight loss,^“

There are a large number(1600+) of newer studies:

• Causality of small and large intestinal microbiota in weight regulation and insulin resistance[2016]
  • “Ingestion of probiotic yogurt containing Lactobacillus acidophilus and Bifidobacterium lactis for 6 weeks …. Treatment with another strain (Lactobacillus plantarum) enhanced the intestinal barrier ….In summary, probiotics are a promising agent for the diabetes management, but further evaluation is required.”
  • “Recipients of a lean-type microbiota showed an improvement in insulin sensitivity and higher abundance of butyrate-producing species six weeks after transplantation ” — which implies Miyarisan (clostridium-butyricum) may help [It reduced weight in mice studies]
• The changing microbial landscape of Western society: Diet, dwellings and discordance[2016].
  • “Technological advances that have led to changes in agriculture and engineering have altered our eating and living behaviors in ways never before possible in human history. These changes also have altered the bacterial communities within the human body in ways that are seemingly linked with the rise of many intestinal and systemic metabolic and inflammatory diseases. Insights into the mechanisms of this reciprocal exchange between the environment and the human gut microbiome may offer potential to attenuate the chronic health conditions that derail quality of life.”
• Estrogen and Microbiota Crosstalk: Should We Pay Attention?[2016]
  • “Recent advances have suggested that steroid hormones such as estrogens, and gut microbiota might synergize to influence obesity, diabetes, and cancer.”
• Gut Microbiota: Modulation of Host Physiology in Obesity.[2016]
  • “The ability of the microbiota to regulate host fat deposition, metabolism, and immune function makes it an attractive target for achieving sustained weight loss.”
• Effect of probiotics on body weight and body-mass index: a systematic review and meta-analysis [2015]of randomized, controlled trials.
  • “Probiotic consumption significantly reduced body weight by 0.59 kg (95% CI, 0.30-0.87) and BMI by 0.49 kg/m(2) (95% CI, 0.24-0.74). A greater reduction in BMI was found with multiple species of probiotics. Subgroup analysis of trials with intervention duration ≥8 weeks found a more significant reduction in BMI. Limiting analysis to trials with a baseline BMI ≥25 kg/m(2) showed a greater reduction in BMI.”

Bottom Line

With our current available literature, an action plan could be:

• Cooking with herbs effective against S.Aureus [list]
• Bifidobacteria probiotics
• Lactobacilus Planatrum probiotics
• Miyarisan (clostridium-butyricum)
• Buy and eat local seasonal food and stop eating imported out-of-season food.

85+% of CFS patients being hypercoagulated (thick blood) was discovered by Dave Berg before he retired. He described it as a variation of antiphospholipid syndrome [PubMed 1999] or [Full Text]  No one has continued his work, very unfortunately. I responded to a reader comment that I suspect coagulation and the microbiome would be studied in the next 5-10 years. To my surprise, he provided a link to a study that is actually examining this.

I should point out that most coagulation disorders are viewed to be inherited. Actually, they run in families and often have DNA associated with them. The key word is associated. This does not mean that if you have the DNA, you will have it — just that the odds are greatly increased. Only recently have we found out that DNA and the microbiome have a cross dependency. Both the microbiome and DNA are inherited. Many inherited conditions may depend on both the right inherited microbiome and the right DNA to occur.

in 2013, a clinical trial was started at Yale University -“The purpose of this study is to explore if certain commensals within the gut microbiota (the collection of all microbes that live inside the gut) correlate with autoantibodies in the autoimmune clotting disorder called antiphospholipid syndrome. The study hypothesis is that particular commensals induce the autoantibodies (immune molecules that bind to self structures) and thus correlate with the level of immune cells and antibodies that are self-reactive. Participants are patients with antiphospholipid syndrome and individuals who have tested positive on a prior blood test for anti-beta2-glycoprotein I antibodies or those that have tested negative for antiphospholipid antibodies in their blood, but had a clotting event or a health problem that puts them at risk to form blood clots.” The investigator was Martin Kriegel [Source]

• Self or non-self? The multifaceted role of the microbiota in immune-mediated diseases [2015].
• Does vitamin D affect risk of developing autoimmune disease?: a systematic review[2011]. “Cross-sectional data point to a potential role of vitamin D in autoimmune disease prevention, but prospective interventional evidence in humans is still lacking.”
  • Vitamin D deficiency changes the intestinal microbiome reducing B vitamin production in the gut. The resulting lack of pantothenic acid adversely affects the immune system, producing a “pro-inflammatory” state associated with atherosclerosis and autoimmunity [2016].
• The role of the gut microbiota in the pathogenesis of antiphospholipid syndrome[2015].  Full Text
  “One potential piece in the “APS puzzle” could be the contribution of commensal bacteria to the development and maintenance of autoreactive CD4⁺ T cells and autoantibodies. This hypothesis is supported by early data from our laboratory using (NZW×BXSB)F₁ mice, a spontaneous APS animal model.”
  “A long-standing hypothesis in the development of autoimmunity is that of molecular mimicry, which refers to the generation of cross-reactive T and B cells that recognize antigens from microbial pathogens but cross-react to autoantigens [69, 70]. ” i.e. bacteria producing chemicals that matches the signals that the body produces resulting in inappropriate responses (i.e. auto-immune).
• “We propose that commensal bacteria can act as a source of persistent cross-reactive antigen in APS and other chronic autoimmune syndromes. In a similar vein, transient aPLs could be caused by cross-reactive pathogens in human subjects, whereas chronic autoimmunity in APS might be mediated by cross-reactive gut commensals”

The Principal Investigator, Martin Kriegel MD PhD: has a talk on Youtube

My reader wrote: “He’s giving an interesting 12 minute talk to Lupus patients (who are known to develop antiphospholipid syndrome). In one as yet unpublished mouse study, wiping out all the gut bacteria (with vancomycin or ampicillin) greatly improved mortality from clotting – ostensibly by reducing the autoantibodies which are suspected to induce APS.

In an early mouse feeding study, a starch diet also reduced mortality. which is surprising to me since I would have thought that an all fat diet would have starved or at least quieted the bad bacteria.”

Other YouTube worth watching by him:

As a foot note, we know that microbiome diversity reduces with age. This reduction may also be a significant factor for strokes.

• Microbiota Dysbiosis Controls the Neuroinflammatory Response after Stroke[2016].
• Stroke: Gut microbiota influence stroke recovery in mice [2016].
• Depletion of Cultivatable Gut Microbiota by Broad-Spectrum Antibiotic Pretreatment Worsens Outcome After Murine Stroke [2016].

Iron Absorption

“Iron therapy induces inflammation, which could decrease iron absorption. Increased exposure of iron in the gut could also alter microbiome file.” [2016]

“The statistical analysis revealed that the meal constituents which were found to influence iron absorption positively were ascorbic acid and β-carotene in breakfast and only β-carotene in dinner.” [2016]

• Vitamin C capsules are unlikely to help
• Vitamin C from a citric fruit in the morning is desired.
• β-carotene should also be taken.

Bonnie and Clyde: Vitamin C and iron are partners in crime in iron deficiency anaemia and its potential role in the elderly[2016].

“In this setting, provision of iron-containing micronutrient powder MNPs to weaning infants adversely affects the gut microbiome, increasing pathogen abundance and causing intestinal inflammation.”[2015]

“Mothers of infants in the MNP + Fe group reported more infant days spent with cough (P = 0.003) and dyspnoea [shortness of breath] (P = 0.0002); “[2015]

“The present study suggests that in African children with a low enteropathogen burden, Fe status and dietary Fe supplementation did not significantly affect the dominant bacterial groups in the gut, faecal SCFA concentration or gut inflammation.” [2014]

“The relative abundance of the genus Roseburia (phylum Firmicutes), a butyrate producer, increased in the Fe + Vitamin E group (Δ1.3%, P < 0.01). Also at the genus level, the genus Escherichia decreased by 1.2% on average among all participants (effect of time P = 0.01).” [2016]

• So Iron Supplements reduces E.Coli, which is very low in CFS

“. Provision of iron fortificants to school-age children and iron-containing MNPs to weaning infants decreases the number of beneficial ‘barrier’ commensal gut bacteria (e.g., bifidobacteria), increases the enterobacteria to bifidobacteria ratio and abundances of opportunistic pathogens (e.g., pathogenic Escherichia coli), and induces gut inflammation. Thus, although iron-containing MNPs are highly effective in reducing IDA, they may increase gastrointestinal morbidity in infants, and safer formulations are needed.” [2016]

“Consumption of rice fortified with micronutrients can increase hookworm prevalence, especially in environments with high infection pressure.” [2016]

Bottom Line

Without a proper control study done with CFS/IBS patients, I have reservations about doing any iron supplements. Eat a diet rich in natural iron instead (List). Have an orange and a slice of cantaloupe with breakfast always. See this list of beta-carotene food for supper.