Diet Shift

The food you eat impacts the gut bacteria. The question naturally arises – what should you eat?  This actually depends on your ancestry – particularly your female ancestry.  Why? Our gut bacteria evolved with us and thus by the food that we eat. Why female line? The female lines is the probable source of the gut bacteria that you were populated with.

For myself, it is northern Europe, above the “wheat line”. The wheat line is the line where traditional (not modern hybrid winter wheats) would not reliably grow north of. This means that rye and barley are a historic stable; rice and wheat are not. Wheat was imported as a luxury grain.

“In the Nordic countries, bread was the main part of a meal until the late 18th century. Four different bread regions can be found in the Nordic area in the late 19th century. In the south, soft rye bread dominated. Further north came crisp bread, usually baked with rye, then thin and crispy barley bread. In the far north, soft barley loaves dominated.” Wikipedia

Identifying what cuisine that your gut bacteria has lived upon for hundreds or thousands of years can be a challenge because there tend to be romanticization and casting of modern diets unto the past. Some visual examples:

For meat consumption,

• 1909 was 10+40+48 = 98 lbs/year
• 2007 , the US was up to 271 lbs/day [source]

For myself, it’s 100% rye bread for breakfast with butter, lots of legumes and salad, one or two eggs and 2-4 oz of meat only. Needless to say, no sugar — however a beer is fine!

Bottom Line: Try to feed your gut bacteria what it has grown to expect through generations! There is likely no magic diet for CFS.

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A reader asked:

“Hi Ken. How would you recommend proceeding if I can’t find a doctor willing to prescribe the Jadin Protocol or anything close to it. Do you think healing is possible with only OTC supplements and herbs? If so, where and how should I start. This is a lot of info to dissect and interpret and my brain fog is at all time crippling levels.”

Back story

I know the problem of finding a doctor willing to prescribe antibiotics very well. During my last relapse, I persuaded my MD to prescribe, but she had to run it by her department head so said absolutely no — it is not the recognized standard of care. Fortunately, where I live, naturopaths have prescribing authority so it was a matter of finding one who was willing to prescribe antibiotics for chronic lyme. I came to a working compromise with one — she was willing to prescribe long term antibiotics that would be used for chronic lyme that fitted Jadin’s protocol. On the flip side, I was willing to do various batteries of tests for chronic lyme – one of them was a “positive” (but it would also be positive for re-activated Epstein-Barr – very common with CFS) which covered her backside for prescribing antibiotics. This odd ball situation is likely rare in most of the world, I was lucky.

The greatest improvement in a short period was actually not from the antibiotics but from herbs I identified by which bacteria they inhibited and which ones they did not:

• Tulsi
• Neem

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Answer to the question

In my opinion, it is possible with OTC (actually, OTI – over the internet, often the items will not be found in local stores but will be found online).

The basic medical chest consists of:

• Antibacterial and antivirals
• Potenators (allows better penetration of the above into tissue) which also tend to be fibrinolytics (breaks down coagulation products)
• Anti-biofilms (biofilms protect bacteria by encasing bacteria with a film and dead cells, making them hard to kill)
• Probiotics

I will enumerate the elements of each in my next post. For the moment, I will actually give what I am doing as a prophyltic (protection) against relapse. I am in remission, not cure. My bacteria could get out of control again so I need to insure that I occasionally do a prevention cycle:

At bed time for 2 weeks:

• 2 capsule of prescript assist
• 2 capsules of Align
• 2 capsules of Culturelle
• 2 Capsules of L.Reuteri with Fish Oil
• 2 capules of a “colon health” probiotic (just bifodobacteria in it)

Side effects noticed: became a light sleeper, waking for a short while every 2 hrs. A lot more dreams than usual.

In the morning for 4 weeks (the “OO” mean that I made my own capsule from bulk spice/herb – typically $20 / 500 gm and often organic!!)

• 2 “00” capsules of Piracetam
• 2 “00” capsules of Neem
• 2 “00” capsules of Japanese Knotweed Rhizome – Polygonum cuspidatum
• 2 capsules of Alpha Lipotic Acid (ALA)
• 20000 IU of Vitamin D3

At 2 weeks, I change my evening pills for 2 weeks

• 2 “OO” capsules of Olive Leaf
• 2 “OO” capsules of Cumin
• 2 “OO” capsules of Aswanghanda
• 2 “OO” capsules of “Tulsi”
• and also have some Japanese desert, Natto — which is where nattokinease comes from!
  • warning: Natto is an acquired taste…

Side effects: Sleep hard (sleep in), some night sweats

At 4 weeks, I will usually ebb off (so resistant bacteria are not encourage too take over)

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On another cycle, I would switch in turmeric, wormwood, serrapetase, bromelain, EDTA, NAC etc.

When the issue comes to remission, then it is a slow ramp up on them, one at a time until you are likely around 8 “00” capsules and any herxing stopped before going on to the next. More on that tomorrow…

I am by academic training a mathematician and accustomed to working logically after axioms to derive theorems.  That same mind is applied to Chronic Fatigue Syndrome and autoimmune conditions. The axioms or facts, are actual PubMed studies, ideally with real CFS patients. PubMed studies appear to be full of contradictory results for many simple models, yet, I believe that there appears to be a model that appears in full agreement with almost all of the studies.

Note: “Effort Syndrome” appears to be an old name for CFS in some circles,s ee [Why did the entity of effort syndrome disappear] 1997.

This is a statement of what my model is, which will revised(typically tuned) as more facts come:

CFS (and likely IBS and FM) is a case of mild to severe Lactic Acidosis. Lactic acid is typically produced exercising.

• Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome: a case-control study.[2012]
• Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome. [2009] [Full text]
• “CFS simulations exhibited an increased acidosis and lactate accumulation consistent with experimental observations.” [2015]
• Is chronic fatigue syndrome synonymous with effort syndrome? [1990]

The associated change of pH has been attempted with various breathing techniques (I did Hale’s breathing during one onset of CFS, it was popular for a while) with some reduction of symptoms. By altering of pH alone by breathing is unlikely to address the root cause.

• Hyperventilation and chronic fatigue syndrome. [1995]
• The grey area of effort syndrome and hyperventilation: from Thomas Lewis to today. [1993]

The cause of this lactic acidosis appears to be a shift of gut bacteria  [2009] [1998] 2001] (see my earlier posts for more references). Gut bacteria is well known to shift due to stress, viral infections, bacterial infections, and even immunizations. In general, the shift returns to normal in > 99% of the cases, but 0.1 – 5.0% do not within 6 months (depending on infections), with roughly 50% of these returning in the next 6 months (with decreasing odds after that). The low incidence of the gut bacteria being stuck in a dysfunction often falls in the experimental error rate of studies and thus “no evidence”.

Lab results: With a shift of bacteria, the ability for bacteria to extract and process food is altered. In short, increases and decreases of amino acids, vitamins, minerals can all be explained by this — including contradictory results because the shift of bacteria will not be identical for all CFS patients.

Treatment of lactic acidosis

This is where the pain begins, a successful treatment is described in this pubmed article [2013], unfortunately the probiotics described are not available in the US. Additionally, the high dosages of antibiotics are unlikely to be acceptable to MDs for a CFS diagnosis.

• Fasting reduces the food to the bacteria, and can improve symptoms temporarily [2002]

A better understanding of lactic-acidosis can be obtained here [2015].

• “Type A lactic acidosis—due to hypoperfusion and hypoxia—occurs when there is a mismatch between oxygen delivery and consumption, with resultant anaerobic glycolysis.”
  • Ding ding ding!  SPECT scans shows hypoperfusion in CFS patients. Coagulation (Hemex Lab research) causes hypoxia!
  • Hyperbaric oxygen for CFS do show symptom improvement in many [2003] [2013]

A significant (but not 100%) remission rate has been reported using antibiotic regimes (Prof. Garth Nicolson, Cecile Jadin MD, Phillipe Bottero, MD … see here. I did notes up on some of them a few years ago), with those regimes that use multiple antibiotics in rotation having the best success rates. Everyone knows that “antibiotics kills gut bacteria” — more accurately, “antibiotics kills selected gut bacteria strains”. These corollary are also very true:

• “Many herbs and spices kills selected gut bacteria strains”.
• “All probiotics kills selected gut bacteria strains”.
• “Many antivirals kills selected gut bacteria strains”.
  • “Commensal microbes are often required to control viral infection by facilitating host immune defenses”[2014]
  • “these findings reveal the fundamental importance of commensal microbiota in viral infections.”[2011]

The challenge is that you want the right ones to be killed. This typically means killing and then repopulating with suitable replacements who will hopefully become sufficiently established to kill off the bad ones.

Q: “What about  Lactobacillus acidophilus (New Latin ‘acid-loving milk-bacterium’) – almost all of my probiotics contain it!”

A: In general, all lactobacillii produce lactic acids (with exception for a few strains), lactic acidosis is TOO MUCH lactic acid. Do you really want to compound the problem. I remember reading a conference paper where one of the CFS MDs committed heresy to the alternative medicine principles and stated “I have not seen any benefits to any CFS patients from taking [common] probiotics”.

There are probiotics on the market that do not contain any Lactobacilli — those are what you need to seek out. My own preferences (and documented to help) are:

• Align – Bifidobacterium infantis 35624
• Mutaflor (E.Coli Nissle 1917)
• Prescript Assist

Killing with spices and herbs: See this earlier post for a starting point.

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I recently purchased 454 gm (1 lb) of the rhizome of Polygonum cuspidatum, in bulk because it is high in resveratrol (read earlier post here)l and far cheaper than prepared Resveratrol capsules. As powder I get 454 gm for the same price that I would pay 72gm as capsules, 6 x cheaper.

This post is about PubMed Article on this supplement.

• “the paper summarized its pharmacological effects, including antibacterial, antiviral, anti-inflammatory, analgesic, cardiovascular system protection, liver protection, anti tumor, improving immunity pharmacology” [2013]
• “and the mutual transformation between polydatin and resveratrol keeps balance; they both have the ability of antioxidative stress in vivo, and polydatin has a better effect than resveratrol, which hints that polydatin may be a substitute for resveratrol in antioxidant for clinical use.” [2015]
• Polydatin supplementation ameliorates diet-induced development of insulin resistance and hepatic steatosis in rats [2015]
• .In vitro and in vivo studies of the inhibitory effects of emodin isolated from Polygonum cuspidatumon Coxsakievirus B₄.[2013]
  • Note: Coxsakievus are associated with many cases of CFS
• 8-Hydroxycalamenene isolated from the rhizomes of Reynoutria elliptica exerts neuroprotective effects both in vitro and in vivo [2013].
• Polydatin alleviates non-alcoholic fatty liver disease in rats by inhibiting the expression of TNF-α and SREBP-1c [2012].

This is available in bulk on Amazon.

NOTE: Chinese knotwood (Polygonum Multiflorum), and Japanese knotwood(Polygonum Cuspidatum) are DIFFERENT. I in-error assumed they were the same, see comment for comparisons between them.

Suggested Dosing

Chinese knotweed supplements are recommended in doses between 8g and 25g per day, or as a tea, according to the Herbal Resource Guide. The Public Health Report notes that Japanese knotweed is the premier herb for Lyme’s disease. It’s suggested as a full-spectrum herb, meaning in its whole root form, in doses of 500mg to 2000mg three to four times per day for eight to 12 months. There may be benefits within two weeks to two months, according to the Public Health Report.

Side Effects

The Herbal Resource Guide notes that Chinese knotweed supplement can be sold in crude or unprocessed forms, as well as those forms that have undergone processing. The unprocessed forms exhibit more of the laxative qualities than the processed forms, and side effects of the supplement may be abdominal upset or loose stools. The Public Health Report says Japanese knotweed should not be used by pregnant women and may lead to a metallic taste in the mouth. The Oregon State University monograph on the concentrated knotweed supplement, resveratrol, notes that a single dose of up to 5g per day has not been found to cause any side effects. It is also not suggested for use in pregnant or lactating women, or in people with estrogen-sensitive cancers because of lack of evidence to prove safety. The herb may interact with several medications, such as blood thinners and drugs metabolized by the P-450 enzyme system in the liver.

The 2009 article cited below is there, BUT you have to navigate a few layer of restrictions. The file is above.

My last post cites a 2009 article that found:

“Faecal microbial flora of CFS patients and control subjects. The mean viable count of the total aerobic microbial flora for the CFS group (1.93×108 cfu/g) was significantly higher than the control group (1.09×108 cfu/g) (p<0.001). There was a significant predominance of Gram positive aerobic organisms in the faecal microbial flora of CFS patients. …This study confirms the previous observation (22), and those reported by other investigators (23) that there was a marked alteration of faecal microbial flora in a sub-group of CFS patients….. In this study the mean total count for Enterococcus and Streptococcus spp. for the CFS group was 52% of the total aerobic intestinal flora, which is significantly higher than the 12% seen in the control subjects (p<0.01). ” largely old hat to readers of this blog, a microbiome dysfunction.

But the study went on to some new interesting stuff, a possible mechanism:

“In this study the NMR-based metabolic profiles of the three intestinal micro-organisms, E. faecalis., S. sanguinis. and E. coli showed that the Gram positive bacteria (Enterococcus and Streptococcus spp.) produce more lactic acid than the Gram negative E. coli. Not surprisingly, these Gram positive bacteria were shown to lower the ambient pH of their environment in vitro as compared to that of E. coli. This suggests that when Enterococcus and Streptococcus spp. colonization in the intestinal tract is increased, the heightened intestinal permeability caused by increased lactic acid production may facilitate higher absorption of D-lactic acid into the bloodstream, henceforth perpetuating the symptoms of D-lactic acidosis. Increased intestinal permeability is also associated with endotoxin release from Gram negative enterobacteria, leading to inflammation, immune activation and oxidative stress, which are cardinal features in a large subset of CFS patients “

This ties in well with observations, for example, some people getting relief by various breathing techniques intended to alter pH of the stomach and intestines.

So, putting on the blinkers and focusing solely on the overgrowth of Enterococcus and Streptococcus, how can someone impact this without getting antibiotics (in some countries, prescribing antibiotics for a condition that is not recognized as needing them, can cost a MD their license)?

• “Among the plants chloroform and isoamyl alcohol extracts of Cumin ( Cuminum cyminum), Clove (Syzygium aromaticum) and Turmeric (Curcuma long Linn) had significant effect against … Streptococcus pyogenes” [2013]
• “Cortex phellodendri showed antimicrobial activity against Streptococcus mutans, while Radix et rhizoma rhei was effective against Streptococcus mitis and Streptococcus sanguis. Fructus armeniaca mume had inhibitory effects againstStreptococcus mitis, Streptococcus sanguis, Streptococcus mutans and Porphyromonas gingivalis in vitro.” [2010] – most of these are Chinese/Japanese medicinal herbs
• “eight herbal extracts could inhibit the growth of Streptococcus sanguinis. Jasmine, jiaogulan, and lemongrass were the most potent,” [2008]
• ” (common Fig) F. carica and  (Olive leaf) Olea europaea leaves inhibited growth of… Streptococcus pyogenes” [2011]
• “onion could inhibit E. coli, …   Streptococcus faecalis [1985] – not recommended because of impact on E.coli
• ” Lemongrass, oregano and bay inhibited all organisms” [1999]
• “especially those of Origanum glandulosum and  (Mediterranean thyme) Thymbra capitata with interesting minimum inhibitory concentration, biofilm inhibitory concentration, and biofilm eradication concentration values” [2014]

Early post on treating Enterococcus cites: Azadirachta indica, Ocimum tenuiflorum, Monolaurin. Streptococcus is associated with excessive histamine, see earlier post.  MedScape Article reveal no effective accepted treatment. A fuller article is (here JASN).

Brain Fog etc caused by lactic-acid

Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and D-lactic acidosis: a systematic review [2017]

cites:

• “Higher levels of d-lactate producing bacteria (such as Streptococcus and Enterococcus) have been identified in stool samples from patients with ME/CFS “
• Shared with acidosis and ME/CFS “B1. Encephalopathy/Mental confusion/disorientation/dazed/Concentration difficulties/Slow processing and responding to questions/slow speech
  
  B2. Headaches/Muscle pain
  
  B3. Drowsiness/sleepiness/somnolence
  
  B4a. Blurred vision
  
  B4b. Weakness/hypotonic (lowered muscle tone)/flaccidity/impaired gait (staggering/wide/ataxic/unsteady/instability)/ataxia (movement and co-ordination difficulties)/impaired balance”

Antibiotic Approach

The prime bacteria to reduce are Enterococcus and Streptococcus. After the antibiotic, you want to have E.Coli back fill the spaces created by the above being killed.

Probiotic approach

“… Recently, considerable progress has been made in the isolation of these strictly anaerobic butyric acid-producing bacteria from the human gut. It has been shown … that lactic acid, produced in vitro by lactic acid bacteria, is used by some strictly anaerobic butyrate-producing bacteria of clostridial cluster XIVa for the production of high concentrations of butyric acid (Louis & Flint, 2009). This mechanism is called cross-feeding …” [Source]

This implies that miyarisan (clostridium-butyricum) should be of benefit.

E.coli probiotics (symbioflor-2, mutaflor) will displace the high producers and produce a lot less (around 2%) of what the high producers do.

“Lactomin[300 mg Lactobacillus acidophilus, 300 mg Bifidobacterium longum] was discontinued, and she was treated with sodium bicarbonate and oral antibiotics. The probiotics the patient had taken were likely the cause of D-lactic acidosis ” [2010]

Supplement Approach – Thiamine (Vitamin B1) and NAC

100 mg every 12 hours is reported to reverse this for other conditions.

• “Thiamine replenishment at intravenous doses of 100 mg every 12 h resolved lactic acidosis and improved the clinical condition in 3 patients.” [1997]

B1 (at sufficient high dosages) have had major improvement of symptoms. See these posts also:

• B1 variation
• B1 Thiamine

“We concluded that the patient had metabolic acidosis induced by accumulation of 5-oxoproline. We modified her antibiotic treatment, administered acetylcysteine (NAC), and her acidosis resolved.” [2016]

Classification

Cohen and Woods devised the following system in 1976 and it is still widely used:^[1]

• Type A: lactic acidosis occurs with clinical evidence of tissue hypoperfusion or hypoxia is likely what is seen in CFS. The hypoperfusion is well reported as a signature of CFS.

Testing for D-lactic Acidosis

This is a specialized test that is usually not done [Mayo Clinic] “Routine lactic acid determinations in blood will not reveal abnormalities because most lactic acid assays measure only L-lactate. Accordingly, D-lactate analysis must be specifically requested (eg, DLAC / D-Lactate, Plasma). “

Word on Likely Dosage

The last article cited an article treating it. I noticed that often there was very high dosages.  My gut feeling (no evidence to back it up) is that for any of the above, we may well be talking 8 – 16 “00” capsules per day of each one, with a possible change of the herb/spice every 7 days. Remember we are talking about reducing from 52% to 12%, not a walk in the park.

As always, consult with your knowledgable medical professional before starting or changing supplements.

Probiotics to avoid

L. delbrueckii bulgaricus (ATC 11842) has a 26:7 ration of D-Lactic acid to L-Lactic Acid [Source]

Root cause: Low Veillonella?

See this post: on what this bacteria does with lactic acid.

Bottom Line

“Management includes correction of metabolic acidosis by intravenous bicarbonate, restriction of carbohydrates or fasting, and antibiotics to eliminate intestinal bacteria that produce D-lactic acid.” [2017]

“Main treatments are: 1) changing the abnormal intestinal flora with the administration of oral antibiotics, 2) attempt to diminish the quantity of substrate for intestinal fermentation by using the low-carbohydrate diet or enteral formulas containing fructose or starch instead of glucose as the main source of carbohydrate, 3) correction of the underlying abnormality by reanastomosing the intestine in case of intestinal bypass, 4) nonspecific therapy of acidosis with high doses of bicarbonate, 5) correction of the acidosis and simultaneous clearance of D-lactate with hemodialysis3, 4). Antibiotics control symptoms and prevent recurrence of the syndrome in most patients, but in some patients acidosis recurs despite the antibiotic use. Antibiotics that have been tried include neomycin, vancomycin, ampicillin, kanamycin, and metronidazole. The optimum duration of antibiotic therapy is uncertain because the symptoms may recur in a few days after discontinuation of antibiotics in some patients, while others may remain without symptoms for several years in the absence of oral antibiotics4).” [2006]

B1, NAC and sodium bicarbonate taken together are a likely good starting point. Of the antibiotics listed above, I would opt for metronidazole because of the positive results reported in surveys of CFS patients, Probiotics would be any E.Coli probiotic. Any (or multiple) of the above herbs.