A reader asked me to research this area. I have recalled coming across articles A quick check on PubMed found 298 articles. I suspect many of these articles may also impact sugar cravings.

“In clinical trials, the use of probiotics in glycemic control presented conflicting results, and only few studies have attempted to evaluate factors that justify metabolic changes, such as markers of oxidative stress, inflammation, and incretins” [2015] “Our meta-analysis suggests that probiotic supplementation might improve, at least to some extent, metabolic control in subjects with type 2 diabetes” [2015]

• “a strong association between one dominant bacterial species, Bacteroides dorei, and type 1 diabetes was discovered…This dysbiosis may cause a lack of butyrate production by gut bacteria, which, in turn, leads to the development of a permeable gut followed by autoimmunity.”[2015]
• Eating a yoghurt a day is linked to lower risk of type 2 diabetes [2014].
• “Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp lactis BB-12… improved the glycemic control in T2D subjects, however, the intake of fermented milk seems to be involved with others metabolic changes, such as decrease in inflammatory cytokines (TNF-α and resistin) and increase in the acetic acid” [2015]
  • “The total cholesterol:HDL-C ratio and LDL-C:HDL-C ratio as atherogenic indices significantly decreased in the probiotic group” [2011]
• Showed “the efficacy and safety of probiotics administration in preventing conversion of impaired glucose tolerance to diabetes”
  • Bifidobacterium longum [National Center for Medical Culture Collections (CMCC): P0001], Lactobacillus acidophilus [CMCC: P0002] and Enterococcus faecalis [2015]
• ‘Lactobacillus salivarius UCC118… had no impact on glycemic control” [2015] [2014]
• “VLS#3 probiotics to NOD mice but found that VSL#3 colonized the intestine poorly and did not delay diabetes.” [2015]
• “Intake of Lactobacillus reuteri improves incretin and insulin secretion in glucose-tolerant humans: a proof of concept[2015].“

A summary of studies is given in this 2014 full text article.

Bottom Line

There are few clinical studies with probiotics and diabetes. A mixture of Bifidobacterium longum, Lactobacillus acidophilus  and Enterococcus faecalis has great promise in preventing the transition. Clostridium butyricum may have potential because of low butyrate production being associated with the transition to diabetes [ There have been no studies done yet].

There is work going on with engineered probiotics to treat diabetes, based on Lactobacillus gasseri . [2015] ETA for availability End of 2017.

A reader asked me about this probiotic and I thought that I should dig into it as it is often in probiotic mixtures.

Wikipedia gives a great summary with two items of note:

• “In healthy patients, S. boulardii has been shown to be nonpathogenic and nonsystemic”
• “in immunocompromised individuals, S. boulardii has been associated with fungemia or localized infection, which may be fatal.”

Oh…. we just hit a clear issue of safety for CFS patients (or anyone else with a chronic condition) — it’s safety is unknown. We have the classic over simplification happening here — “Yes, studies show that it is good for you (IF YOU ARE A HEALTHY INDIVIDUAL)”. Studies on CFS/IBS/FM patients are really required.

More quick notes from Wikipedia:

• IBS: improved in one study. No effect in another.
• Decreases E.Coli (which CFS patients are low in) — not good

What else do we know?

• No studies with fibromyalgia
• No studies with chronic fatigue syndrome
• 4 Studies with Irritable Bowel Syndrome (ONLY with diarrhea-dominant version)
  • “The improvement of the symptom score was greater with mesalazine alone or combined with Sb as compared with Sb treatment alone.”[2013]
  • “S.boulardii treatment for 30 days in diarrhea predominant IBS patients did not result in any improvement in this study.” [2011]
  • “S. boulardii improved IBS-Quality Of Life better than placebo but was not superior for individual symptoms in patients with diarrhea-predominant IBS or mixed-type IBS.” [2011] – the improvement in the QOL may be a placebo effect.
  • “S. boulardii with ispaghula husk was superior to placebo with ispaghula husk in improving the cytokine profile, histology, and quality of life of patients with IBS-D. These preliminary results need to be confirmed in a well-powered trial.” [2014]
• Going to the heavy weight dysfunction, Crohn’s Disease, 11 hits
  • Saccharomyces boulardii does not prevent relapse of Crohn‘s disease[2013].
  • “S. boulardii added to baseline therapy improved intestinal permeability in these CD patients, even though complete normalization was not achieved.”[2008]
  • “Clinical relapses as assessed by CDAI values were observed in 37.5% of patients receiving mesalamine alone and in 6.25% of patients in the group treated with mesalamine plus the probiotic agent.”[2000]
  • “The group treated with S.b. showed a significant reduction in the frequency of bowel movements in the tenth week, to 3.3 +/- 1.2 evacuations per day,” [1993]

Bottom Line

There is no clean evidence of any significant improvement with CFS or any related condition, there is also a risk of potentially fatal reaction.  Immunocompromised patients and CFS individuals are frequently cited together in studies, additionally, often items used by CFS individuals suppression inflammation and thus part of the immune system. We need more studies (which are expected to show no or marginal results) before this should be included – IMHO.

Do not explicitly take this probiotic. 

For items like candida, it is effective but should be used only when needed.

• “Prophylactic S. boulardii supplementation is as effective as nystatin in reducing fungal colonization and invasive fungal infection, more effective in reducing the incidence of clinical sepsis and number of sepsis attacks” [2013]
• “Capric acid secreted by S. boulardii inhibits C. albicans filamentous growth, adhesion and biofilm formation. [2010]”

UPDATE:

See this uBiome post it encourages bacteria that inhibit bifidobacteria.

Recently on Health Rising, Carol Wolf(her blog) wrote “Did Probiotics Cure My Chronic Fatigue Syndrome?”  I say awesome!  I do have some concerns about the article because it will cause people to try some probiotics and likely fail to put the person into remission. I am concerned because it potentially will result in bad mouthing of the microbiome approach by those that it failed to help.

Such an approach has been tried by many (including physicians) in the past with no or a low rate of success on the general CFS population.  By try — I mean tossing any off the health food store probiotics at the patient.

No warning of Herx risk

Various readers, and my own experience, has had significant herx/die off from some probiotics. Which one varies from person to person and likely reflects that the bacteria in the dysfunctional microbiome are different. The differences causes the difference in symptoms seen from one CFS patient to the next.

If you take a mixture and have a severe (sufficient to discontinue) herx, then knowing how to proceed becomes fuzzy. With a single species (or in the case of Prescript Assist) a specialized mixture not available elsewhere, the next step is clearer.

Cost – especially for those on Social Security / Disability

She cited 4 probiotics — the ones that she is on, not her history of what she took in the past. She correctly kept changing probiotics according to her article — the problem is that she did not give a full history. Taking just one capsule/day of these 4  is $82.50/month. There is an implication from her words that she may be taking a higher dose of each, “I am taking FOUR different high-quality probiotics plus some prebiotics a day with meals.” (it was unclear if it was at each meal).

Some of the probiotics bottles cited suggest a higher dosage than 1 capsule/day.

Since this post, she has clarified her cost in this post. “I pay between $70 and $100 a month on probiotics.”

Is she cured or just successfully containing?

This is a nasty question to ask.  She indicates that she is still taking probiotics, at least  215 Billion CFU/day. The antibiotics produced from these will likely suppress the evil bacteria. Has her microbiome returned to a stable persistent state? We do not know until she goes off the probiotics at those dosages for at least 3-6 months. Fetal transplants are often reported successful for 3+ months and then a relapse happen.

“I recently quit taking them as religiously and I went into a horrible, horrible depression – remember I’m anti-depressant free at this point. I loaded up on probiotics again and the depression lifted in about three days.”

Probiotic Mixtures Suggested

I took these 4 mixes and examined them below. One of them especially interested me (more below) because of some hard to obtain strains (in bold below).

• Raw Probiotics for Women 85 Billion CFU, $30 90 capsules or $0.004/ B CFU
  • Lactobacillus plantarum,
  • Lactobacillus reuteri,
  • Lactobacillus rhamnosus,
  • Bifidobacterium bifidum,
  • Bifidobacterium lactis,
  • Bifidobacterium longum,
  • Lactobacillus acidophilus,
  • Lactobacillus bulgaricus,
  • Lactobacillus casei,
  • Lactobacillus gasseri,
  • Lactobacillus helveticus,
  • Lactobacillus kefiranofaciens,
  • Lactobacillus kefirgranum,
  • Lactococcus lactis,
  • Lactococcus cremoris,
  • Streptococcus thermophilus,
  • Lactobacillus kefir,
  • Lactobacillus parakefir,
  • Lactobacillus brevis,
  • Lactococcus lactis biovar diacetylactis,
  • Leuconostoc lactis,
  • Leuconostoc mesenteroides,
  • Leuconostoc cremoris,
  • Leuconostoc dextranicum,
  • Kluyveromyces marxianus,
  • Brettanomyces anomalus,
  • Debaryomyces hansenii,
  • Saccharomyces unisporus,
  • Saccharomyces turicensis,
  • Saccharomyces cerevisiae,
  • Saccharomyces exiguus,
  • Torulaspora delbrueckii
• Complete Probiotic by Mercola  70 BCFU $35 60 capsules $ 0.008 /B CFU
  • Lactobacillus acidophilus DDS-1
  • Bifidobacterium lactis
  • Lactobacillus plantarum
  • Lactobacillus casei
  • Lactobacillus rhamnous
  • Lactobacillus brevis
  • Bifidobacterium longum
  • Lactobacillus salivarius
  • Steptococcus thermophilus
  • Lactobacillus bfidum
• Perfect Probiotics 30 BCFU  $40 30 capsules   $0.044 / BCFU
  • Lactobacillus acidophilus,
  • Bifidobacterium lactis,
  • Lactobacillus plantarum,
  • Lactobacillus rhamnosus,
  • Lactobacillus casei,
  • Lactobacillus salivarius,
  • Lactobacillus bulgaricus,
  • Bifidobacterium breve,
  • Lactobacillus paracasei,
  • Lactococcus lactis,
  • Streptococcus thermophilus,
  • Lactobacillus brevis,
  • Bifidobacterium bifidum,
  • Bifidobacterium longum,
  • Bifidobacterium infantis
• Multidophilus 24, Super 30 bil Solaray 30 BCFU $30 60 capsules $ 0.016 BCFU
  • Lactobacillus plantarum,
  • Lactobacillus rhamnosus,
  • Bifidobacterium lactis,
  • Lactobacillus acidophilus,
  • Lactobacillus lactis,
  • Bifidobacterium infantis,
  • Bifidobacterium breve,
  • Bifidobacterium bifidum,
  • Bifidobacterium longum,
  • Lactobacillus bulgaricus,
  • Lactobacillus casei,
  • Lactobacillus delbrueckii,
  • Lactobacillus brevis,
  • Enterococcus faecium,
  • Lactococcus lactis,
  • Lactococcus cremoris,
  • Lactobacillus paracasei,
  • Lactobacillus salivarius,
  • Lactobacillus gasseri,
  • Lactobacillus helveticus,
  • Lactobacillus fermentum,
  • Lactobacillus kefir,
  • Pediococcus acidilacti
  • Streptococcus thermophilus.

Bottom Line

Her success indicates that the model that I am using may be correct. Symptoms are results of shifts in the microbiome. The Raw Probiotics for Women cited above is very worth trying based on unusual species and excellent cost per BFCU. I would hesitate to suggest it be tried by someone starting an attempt to shift — the number of species is so high that the odds of a herx is likely high. Someone starting should start with single species (where practical) to minimize the risk of a herx.

UPDATED: July 2017. See CFS Diets also.

Also see this update

In the US, the degree of social safety net for people with CFS/ME/FM/IBS is horrible. In a few countries it is “livable” without excessive stress (which would hinder recovery).

This post is for a very long term friend, DanB, and many others who have suffered for years with no or little cash after essentials.

I am going to build up a list of supplements and their average monthly cost for suggested dose — the items are order by monthly cost. Some, like piracetam may be hard to obtain in some countries. I included most items from this “Basics” post and the best  herbs from my earlier post (usually as tea bags), and old post from 2012 is worth reviewing too. Others like chocolate may have risks for some individuals. Prices are usually from Amazon.com

Most medical resources tend to be oblivious to cost and IMHO often misdirects patients money towards high cost / low return items.

Remember:

• There are no studies comparing their effectiveness against each other — so I assume “equally effective” on a restricted budget
• I have picked tea bags for many herbs — the cost goes down a lot if you buy bulk and use a tea-ball or strainer. If you can stomach (not too bad a herx) after one box of a tea, go the bulk organic route.
• Many items should be rotated. These items could also cause a herx in some.
• Specialize probiotics are a lot more expensive. My wife told her MD that she spends more on probiotics a month than food (and she shops organic!) — it’s true!
• A smaller dose if fine. Better a little than none. If something seem to work well, consider increasing the dose

Alternatives to consider

• Benfotiamine 300mg/day – Doctor’s Best – $5.74
• Methylocbalamin (B12) – 1000mcg/day  – Pure encapsulations = $7.25
  • See link, many have additives that may hurt the gut bacteria

As always, the list should be discussed with your medical professional. On this site, I have attempted to provide links to PubMed studies supporting each of the  items above.

A good medical professional should be able to provide PubMed links to any items that they feel are contraindicated. We want to move to evidence based science for treating CFS and not speculative theories.

Recently I have come across several articles citing psychoactive bacteria (where the bacteria was from a probiotic).  I thought it would be fun to do a review of such.   Psychobiotics: a novel class of psychotropic[2013]. “…including Bifidobacterium infantis ….Evidence is emerging of benefits in alleviating symptoms of depression and in chronic fatigue syndrome.”

Also see my earlier post on depression and diet

• “We previously have demonstrated that administration of Lactobacillus rhamnosus (JB-1) to healthy male BALB/c mice, promotes consistent changes in GABA-A and -B receptor sub-types in specific brain regions, accompanied by reductions in anxiety and depression-related behaviors.”[2016] [2014] [2014]
  • “Within minutes of application, JB-1 increased the constitutive single- and multiunit firing rate of the mesenteric nerve bundle, but Lactobacillus salivarius (a negative control) or media alone were ineffective.” [2013]
• “These results suggest that chronic ingestion of Lactobacillus plantarum strain PS128 could ameliorate anxiety- and depression-like behaviors and modulate neurochemicals related to affective disorders.Thus PS128 shows psychotropic properties and has great potential for improving stress-related symptoms.” [2015]
  • “PS128 is safe and could induce changes in emotional behaviors…These findings suggest that daily intake of the L. plantarum strain PS128 could improve anxiety-like behaviors and may be helpful in ameliorating neuropsychiatric disorders.”[2016]
• “One study showed improved mood in healthy volunteers following 3-week consumption of a probiotic-containing milk drink that contained Lactobacillus casei Shirota” [2007]
  • “administration of the probiotic, L. casei Shirota, decreased anxiety in patients with chronic fatigue syndrome.”[2009]
• “L. helveticus and B. longum, for 30 days demonstrated significantly less psychological distress,” [2011]

The negatives

• “higher anxiety scores in IBS patients and healthy controls were associated with lower fecal microbial diversity supporting a link between microbiota and psychological state” [2014]
• “Gut microbiota alterations have also been reported in a substantial number of children with autism, particularly citing a 10-fold increase in Clostridium numbers as well as greater diversity” [2011]
• “Alistipes, a genus in the phylum of Bacteroidetes was overrepresented in depressed patients.”[2012]
  • “Alistipes is also overrepresented in chronic fatigue syndrome [2013 Kenny De Meirleir]and in irritable bowel syndrome (IBS) [2011]“
  • “it has been shown that Alistipes levels and other gut microbiota can be modified through dietary intervention”[2014] i.e. less meat.
    • soluble dietary fiber (soluble resistant maltodextrin) may decrease [2015] – likely any significant (MAJOR) increase in fiber will help.
  • Bacillus subtilis may increase Alistipes [2015]
  • “the three β-lactam antibiotics(Ceftriaxone Sodium, Cefoperazone/Sulbactam and meropenem), showed consistency in inhibiting Papillibacter, Prevotella and Alistipes while inducing massive growth of Clostridium.”[2015]

Bottom Line

Above we found that there is evidence that one common probiotic (Bacillus Subtilis) may actually make depression worst! Reducing meat and increase fiber in a major shift may also improve depression. All of the Lactobacillus cited above are acceptable for CFS (but L. helveticus is questionable).