Year end review of CFS/ME

It’s year end and I thought a review of the last articles in 2018 on PubMed would be a good way to see out the year.

When seemingly disparate biomedical findings on ME/CFS are interpreted through the lens of these microbiome-based paradigms and platforms, a cohesive picture of the ME/CFS disease process emerges. ME/CFS may be driven by pathogen-induced dysfunction, with resulting microbiome dysbiosis varying based on a patient’s unique infectious and environmental history. 

It is subsequently important to consider that the microbiome may contribute to host blood pressure regulation. Pluznick et al. (69) found that gut microbiome-derived Short Chain Fatty Acids such as acetate and propionate travel to the kidneys and blood vessels. There they impacted activity of Olfr78 and Gpr41, two host receptors that control circulation and blood flow.

Several research teams have tied ME/CFS to bacterial gut microbiome dysbiosis. 

Composition of the blood metabolome has also been shown to shift in ME/CFS. One such study reported elevated plasma levels of choline, carnitine, and complex lipid metabolites in ME/CFS patients (84).

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in the Era of the Human Microbiome: Persistent Pathogens Drive Chronic Symptoms by Interfering With Host Metabolism, Gene Expression, and Immunity.

Definition of ME/CFS

This is a constantly moving target.

Chronic fatigue syndrome (CFS), introduced in 1988 and re-specified in 1994, is defined as (unexplained) chronic fatigue accompanied by at least four out of eight listed (ill-defined) symptoms.

The diagnosis of ME requires only two type of symptoms (post-exertional muscle weakness and neurological dysfunction), but a patient has to experience at least eight symptoms to meet the diagnosis according to the ME-ICC. 

Myalgic Encephalomyelitis or What? The International Consensus Criteria.

Microbiome Dysfunction

IMHO, the mind set of researchers tend to be towards finding a singleton pattern (one causing bacteria, one causing virus in the past) and as we see in this review, one pattern of microbiome shifts. My view is that each symptom is likely connected to a pattern of metabolite shifts. Similar shifts can occur with different bacteria shifts.

Differences were reported in each study; however, only three were considered statistically significant, and the findings across all studies were inconsistent. 

A systematic review of enteric dysbiosis in chronic fatigue syndrome/myalgic encephalomyelitis.

Nutritional Treatment

Quick list of current deficiencies accepted for CFS. Some symptoms may be moderated by therapeutic levels of supplements. See this post.

Also, some nutrient deficiencies (vitamin C, vitamin B complex, sodium, magnesium, zinc, folic acid, l-carnitine, l-tryptophan, essential fatty acids, and coenzyme Q10) appear to be important in the severity and exacerbation of CFS symptoms.

Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach.

Blood Volume

This is a continuation of Dr. David Bell’s 1998 work

Adults with ME/CFS had a significantly lower blood volume if they had a clinical suspicion of orthostatic intolerance (OI) compared to those without a clinical suspicion of OI, as well as a significantly lower blood volume compared to the expected value. 

Blood Volume Status in ME/CFS Correlates With the Presence or Absence of Orthostatic Symptoms: Preliminary Results.

Brain Scans

For more information on brain scans, see this post.

In the ME/CFS patients, we observed significant FA decreases in the genu of the corpus callosum and the anterior limb of the right internal capsule (P < 0.05), there were also significant MK decreases in the right frontal area, anterior cingulate gyrus, superior longitudinal fasciculus (SLF), and left parietal area (P < 0.05). Significant NDI decreases were observed in the right posterior cingulate gyrus, SLF, and left frontal area of the ME/CFS patients (P < 0.05). Significant ODI decreases were seen in the bilateral occipital areas, right superior temporal gyrus, the anterior limb of internal capsule, and the posterior cingulate gyrus (P < 0.05), and significant ODI increases were revealed in the bilateral occipital and right temporal areas (P < 0.05).

Brain abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome: Evaluation by diffusional kurtosis imaging and neurite orientation dispersion and density imaging

Regional cerebral blood flow and glucose utilization rates are decreased in patients with ME/CFS as compared with age- and sex-matched healthy subjects. Acetyl-L-carnitine uptake into the releasable pool of glutamate and serotonin transporters densities are decreased in a few specific brain regions, mostly in the anterior cingulate in the patients. Our recent PET study successfully demonstrated that neuroinflammation is present in widespread brain areas in ME/CFS patients, and is associated with the severity of neuropsychological symptoms.

[Brain Science on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome]

Interesting Articles

Stomach Acid test with Bicarbonate

On Facebook, the following was asked:

My daughter took a stomach acid test with bicarbonate. She burped after 51 seconds. If you burp after 1 to 2 minutes, it means that you have normal stomach acid. So my question is. Her doctor still wants her to take butyric acid (Butycap). The doctor says it does not matter that my daughter has normal stomach acid. He said Butyric acid is important for intestinal health and is recognized as the main source of energy for the colon epithelium or intestinal barrier or intestinal mucosa, the epithelial cells that make up the thin layer of a mucous membrane covering the intestinal surface. But I am afraid it could be too much stomach acid? Isn’t it that everything should be in balance?

This type of test is common in alternative medicine (and some traditional MDs). A good example is given here. The key factor is that you appear to be testing HCl (hydrochloric acid)

All Acids are Not the Same

A long time ago, I taught some chemistry courses at Vancouver City College in B.C. Canada. Some acids will not react to bicarbonate. Consider
Acetylsalicylic acid (commonly known as Aspirin!!) or even vinegar, it will react but at a different speed — that is the key: speed of reaction. This can be influence by temperature and other factors.

Stomach Acid is hydrochloric acid ONLY

Gastric acidgastric juice or stomach acid, is a digestive fluid formed in the stomach and is composed of hydrochloric acid (HCl), potassium chloride (KCl) and sodium chloride (NaCl).

Butyric Acid Sources

For benefits see: Butyric acid – a well-known molecule revisited [2017]


The species of bacteria involved in the production of butyrate are Clostridium spp,Eubacterium spp., Fusobacterium spp., Butyrivibrio spp., Megasphaera elsdenii, Mitsuokella multiacida, Roseburia intestinalisFaecalibacterium prausnitzii and Eubacterium hallii [18]. Recently, an increased intake of highly processed, low-fibre food products rich in simple sugars has been observed, resulting in low levels of butyrate production in the intestinal lumen. 

Butyric acid in irritable bowel syndrome [2013]


Buying capsules is always one solution, but often an expensive path,

Butter contains significant amounts of butyric acid (a low molecular weight fatty acid) which is volatile and makes a significant contribution to the flavour of the fat. 

Stanley P. Cauvain, in Baking Problems Solved (Second Edition), 2017

Butter contains 290 mg of butyric acid for 10 grams (1/3 of a oz – or 1/48th of a pound of butter). For a fuller food list see this page. 1 lb of butter = 290 * 48 = 13.9 gram. Using France’s cost this amounts to 0.20 Euro per gram of butyric acid

For the supplement path, let us look at this item selling for 40 Euros for 30 sachets containing 787mg each. Total 23.6 grams or 1.69 Euro per gram
of butyric acid .

Bottom Line

Taking butyric acid will not impact stomach acid. As with all supplements, a little research can reduce you supplement coasts by a factor of 10 often (as also seen in my last post).

Polymannuronic acid and Iodine

A reader wrote:

  I have a question I was hoping I could get a lead on.  Under my recommendations I have polymannuronic acid.  I couldn’t find anything on your site about this and didn’t have any luck finding it in a supplement.  Taking brown seaweed seems to have risk of iodine overdose.  Have you heard of any viable options for polymannuronic acid?

Risk of Iodine overdose?

My initial take on this was ??? overdose???. All commercial table salt has iodine added because our diet has been iodine deficient! Read More Here. The Linus Pauling Institute (Oregon State University) had an excellent summary.

Seaweed and Iodine

Mean iodine concentration in bulk seaweed biomass is species specific.

The brown seaweeds have higher iodine concentrations than the red seaweed.

Iodine content in bulk biomass of wild-harvested and cultivated edible seaweeds [2018]

 Currently, the European Food Safety Authority (EFSA) allows 600 µg day−1 upper tolerable iodine intake (EFSA NDA Panel, 2014) which permits the consumption of larger quantities of seaweed, among other iodine sources. Despite high levels of iodine present in some seaweeds, ingestion of large amounts will not necessary imply a risk for excessive intake of iodine. Also, post-harvest processing such as drying and boiling in freshwater reduces iodine content in seaweeds within a couple of minutes (Lüning and Mortensen, 2015Nitschke and Stengel, 2016). In addition, only 49–82% of seaweed iodine appeared to be accessible for absorption by humans after gastrointestinal digestion (Domínguez-González, et al., 2017). Therefore, concerns over iodine toxicity from eating seaweed appears to be unfounded. 

Polymannuronic Acid Sources

There appear to be some research sources for this chemical (i.e. Carbosynth)

Alginate is a collective term for a family of polysaccharides produced by brown algae and bacteria. Species of Pseudomonas and Azotobacter are the only prokaryotic sources for this algal like-polymer. Polymannuronic acid (PM) together with polyguluronic acid (PG) constitute the structure of alginate. 

Polymannuronic acid, a microbial polymer of great medicinal application. [2012]

Look for Alginate Supplements

The cheapest way is just buy it as a food grade thickening agent. $20.00 for 450mg/ 16 oz.

Sodium alginate is a gum, extracted from the cell walls of brown algae. – Wikipedia

PS from a reader:

In regard to the overdose I should have been more specific.  In a google search for brown seaweed and thyroid there are several articles on thyroid problems for people who have pre-existing thyroid dysfunction.  Also one case study of a person with no thyroid condition.  Since the majority of people with CFS and related conditions also have thyroid issues, including myself, it seems to me a relevant concern.

“While high iodine intake from seaweed consumption is believed to have numerous health benefits, it has been reported to negatively affect individuals with underlying thyroid disorders [13141516].”

Chromolyn Sodium – a minor Christmas miracle for histamine issues?

A reader that I know personally have been struggling with odd challenges, especially sickness triggered by eating (within a minute). A good day was often 600 calories. The usual ‘useless’ round of both conventional and alternative physicians. The reader speech has been impacted, struggling to get a sentence out sslllooowwwwllllyyyy.

Atypical mast cell issues interacting with other medical issues appears to be the cause. Abnormal histamine release from eating was a target (deal with one symptom at a time).

The reader took inspiration from my researching PubMed, especially the older, not in fashion, treatmentsThe reader discovered Chromolyn Sodium. A classic asthma medication


Almost all of the literature dealt with Asthma — it was an old treatment for Asthma.

On a very few sites, it is mentioned as Cromoglicic acid, a mast cell stabilizer. The reader does not have asthma.

The reader was able to persuade a traditional medical physician to prescribe a one month supply as solution ampoules . (The aerosol/nasal form appears to be available over the counter and on Amazon. One spray appears to be equivalent to one ampoules). Because it was a very atypical prescription in today’s market, the pharmacist insisted on speaking with the physician. After a few days, the prescription arrived: 120 ampoules to be taken 1 every 6 hours.


After just one day, speech has greatly improved, symptoms have reduced. The reader did admit that this could be just a placebo effect — but given how much they struggled with speech just yesterday, I doubt it.

More information

Going over to DrugBank, a nice resource. We can see it’s structure (
C23H16O11 ) and read a precise description. It was first marketed for Asthma in 1981.

A chromone complex that acts by inhibiting the release of chemical mediators from sensitized mast cells. It is used in the prophylactic treatment of both allergic and exercise-induced asthma, but does not affect an established asthmatic attack.

Cromoglicate inhibits degranulation of mast cells, subsequently preventing the release of histamine and slow-reacting substance of anaphylaxis (SRS-A), mediators of type I allergic reactions. Cromoglicate also may reduce the release of inflammatory leukotrienes. Cromoglicate may act by inhibiting calcium influx.


From Facebook feedback, some of the sprays have stabilizers which could cause adverse reactions. Checking with the reader cited above — the content had just two ingredients: sterilized water and Chromolyn Sodium.

Additional Items to Review

Using the sweet Canadian DrugBank, we have a list of alternative things to research (all Mast-cell stabilizers):

Bottom Line

Just sharing a little good news in this Christmas Season.

SBO probiotics – lot of skimpy formulations

Today, I decided to see if there were any worthy new-comers to Soil Based Organism (SBO) probiotics. The reason I tend to favor a good formulation of these is that historically, before our modern hyper-hygienic world, kids would pick a shaft of straw from the fields and suck on it — transferring bacteria from there. Or take an apple from a tree and just ripe out any dirt and eat it. Today, it will likely be washed several times before it is ever consumed. There is a growing body of evidence that this change of hygience has caused growing immune issues.

“The Amish and Hutterites are U.S. agricultural populations whose lifestyles are remarkably similar in many respects but whose farming practices, in particular, are distinct; the former follow traditional farming practices whereas the latter use industrialized farming practices….Despite the similar genetic ancestries and lifestyles of Amish and Hutterite children, the prevalence of asthma and allergic sensitization was 4 and 6 times as low in the Amish” – i.e. industrialized farming practices resulted in six times (600%) the rate of asthma and allergies. See Innate Immunity and Asthma Risk in Amish and Hutterite Farm Children(2016). This is also echoed in their farm products!!! Amish and Hutterite Environmental Farm Products Have Opposite Effects on Experimental Models of Asthma [2016]. Given a choice of buying groceries from a Hutterite farm or a Amish farm, buy the Amish (non industrialized) groceries!!!!

SBO Probiotic Supplement, 90 Capsules

  • Lots of Lactobacillus — which I do not classify as SBO
  • Bacillus subilitis, Bacillus clausii, Bacillus coagulans

Ancient Nutrition SBO Probiotic Supplement Dr. Axe Formula

Total disappointment as above — appears to be very similar product (may just be a custom label from same manufacturer)Lots of Lactobacillus — which I do not classify as SBO

Prescription Strength Three Strain Soil Based Probiotic – Primal Earth Probiotic from The Myers Way Protocol

Same ones as above! Bacillus subilitis, Bacillus clausii, Bacillus coagulans

Totnes’ NEW Stomach-Surviving Super Strong Soil Based Probiotics

Lactobacillus (not SBO) and Bacillus subilitis only

Enviromedica Terraflora Synbiotic SBO Supplement 

At last something a little different:

  • Bacillus pumilus
  • Bacillus megaterium
  • Bacillus subilitis,
  • Bacillus clausii,
  • Bacillus coagulans 

Just Thrive: Probiotic & Antioxidant Supplement 

  • Bacillus  Indicus 
  • Bacillus subilitis,
  • Bacillus clausii,
  • Bacillus coagulans 

Royal Flora Soil Based Organisms

just states “soil based organisms” without identification

Bottom Line – Nothing new

None of the above seem to be a rich SBO probiotic.

All of these are bacillus probiotics mixtures for SBO species, very different from my two traditional favorites: Equilibrium and Prescript Assist (which appears to be under a cloud, has had recalls, and involved with legal disputes).

I would advise readers to read my earlier post from 2016 on Bacillus Probiotics. Many of these are histamine producers which can cause adverse effects for some people. If you buy, buy for best price per BCFU.

Legal Notice Received

Suggested reading after reading below.

Dear Mr. Caton:

I have been retained to represent Mr. George Ackerson to address his concerns regarding the reputational damage caused by the following links on blogs and the below Facebook page you control:

I understand that you have a long history with Mr. Ackerson, and that your friendship and professional relationship ended badly. That being said, the extent to which you are posting attacks about him online goes beyond speech protected by the First Amendment to be unprotected defamation.

Further, this defamation amounts to tortious interference with Mr. Ackerson’s and Safer Medical’s business relations, as well as intentional and negligent infliction of emotional distress. The amount of damage being inflicted is quite severe and is recoverable in a legal action against you.

On Mr. Ackerson’s behalf, I hereby request that you remove any and all reference to Mr. George Ackerson from your blogs and Facebook page, including the specifically listed links above and to refrain from posting additional information about him.

Please feel free to contact me should you wish to discuss this matter. We look forward to your prompt response.


Jennifer A. Kreder
Attorney at Law 
27110 Jones Loop Rd
Unit 128
Punta Gorda, Florida 33982
(941) 241-7686

New Chart Style for Conditions to Bacteria Taxonomy

I have created a new set of charts showing the connection of bacteria to various conditions.  These charts allow drill down by taxonomy rank (phylum, order, class, genus, etc).

NOTE: As you move down the rank, some items may not be available to graph



By Class


By Order


by Family


By genus


Often at this level — there may be no studies.