A reader wrote:

“Sorry to bug you again but I learn *so* much from your posts! If it interests you, I wonder if you might do an analysis of equilibrant. I did a search and didn’t find mention of it on your site. When I started taking it, I very quickly went from about 100 to 1000 steps a day. I find that if I don’t keep taking it, I am prone to certain types of crashing or viral flares. It’s keep something under control. Dr. John Chia would say it’s an enterovirus. I’d love to know what you think.”

When I get a request like this, it interests me to see if some component has been off my radar and should be.

The contents are

The items above are IMHO non-significant. Vitamin D levels are insignificant, etc. with the possible exception of selenium. Wikipedia mentions “. It is also found in three deiodinase enzymes, which convert one thyroid hormone to another…Selenium deficiency is rare in healthy, well-nourished individuals. It can occur in patients with severely compromised intestinal function…The effect of selenium deficiency on health remains uncertain”

“Selenium (Se) is an important micronutrient for many organisms, which is required for the biosynthesis of selenocysteine, selenouridine and Se-containing cofactor.” [2016]

“Epidemiological studies have suggested an inverse association between selenium levels and inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis that can potentially progress to colon cancer.” [2015]

” The results of RFLP showed that the faecal microbial flora in the selenium-enriched probiotics group changed the most (numerically) as compared to the Probiotic or sodium selenite group” [2015]

” Importantly, the nanoparticles showed strong growth inhibition toward S. aureus at a concentration as low as 1 ppm. . Interestingly, growth of E. coli was unaffected at all concentrations tested.” [2016]

“Bacterial cells usually possess low tolerance to selenite stress and also low ability to reduce high concentrations of toxic selenite. Here, high tolerance to selenite and selenium bioaccumulation capability were developed in mutated clones of probiotic and starter bacteria including Enterococcus faecium, Bifidobacterium animalis ssp. lactis, Lactobacillus casei and Lactococcus lactis ssp. lactis by food-level strain development process and clone selection. All mutant clones possessed increased glutathione concentration and glutathione reductase activity.” [2015]

For more on Selenium and the microbiome see this post.

Protective effects of Selenium-enriched probiotics on carbon tetrachloride-induced liver fibrosis in rats[2015].

• Astragalus [Note: CFS induced may a poor match] – note there are hundreds of species
  • A Chinese herbal decoction, Danggui Buxue Tang, improves chronic fatigue syndrome induced by food restriction and forced swimming in rats[2011].
  • Myelophil, an extract mix of Astragali Radix and Salviae Radix, ameliorates chronic fatigue: a randomised, double-blind, controlled pilot study[2009].
  • Astragalus membranaceus flavonoids (AMF) ameliorate chronic fatigue syndrome induced by food intake restriction plus forced swimming[2009].
  • Synergy of Astragalus polysaccharides and probiotics (Lactobacillus and Bacillus cereus) on immunity and intestinal microbiota in chicks[2009].
  • Effects of mushroom and herb polysaccharides, as alternatives for an antibiotic, on the cecal microbial ecosystem in broiler chickens.[2004]
• Sophora flavescens
  • In vitro anti-reovirus activity of kuraridin isolated from Sophora flavescens against viral replication and hemagglutination. [2015]
  • Anti-rotavirus effects by combination therapy of stevioside and Sophora flavescens extract. [2014]
  • “Planktonic S. mutans showed susceptibility to all of the extracts and S. mutans biofilm exhibited the highest level of sensitivity for the extracts of S. flavescens.” [2013]
  • Antimicrobial effect of sophoraflavanone G isolated from Sophora flavescens against mutans streptococci[2013].
  • ” Most prenylated flavonoids (7-13) [of Sophora flavescens]  displayed potent inhibitory activity against gram-positive and gram-negative bacteria except E. coli, with minimum inhibitory concentrations values ranging from 4.40 to 27.7 μM, and weak or no activity against fungal strains tested.” [2011]
• Shittake Mushroom
  • “Numbers of predominant cecal bacteria, in particular, E. coli, bifidobacteria, and lactobacilli, were significantly increased with increases in the Lentinus edodes extract dose.”[2004]
  • “This study showed that the relatively low concentration (0.1% to 0.5%) of polysaccharides from Lentinula edodes stipe… can enhance the survival rate of Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium longum subsp. longum during cold storage.” [2013]
  • ” Lentinus edodes is the most studied species and seems to have a broad antimicrobial action against both gram-positive and gram-negative bacteria.” [2012]
    • The anticaries effect of a food extract (shiitake) in a short-term clinical study[2012].
  • Biodegradation of an organoselenium compound to elemental selenium by Lentinula edodes(shiitake) mushroom [2012].

Bottom Line

The herbs have antibiotic characteristics with the sweet spot of not impacting E.Coli (which is typically low with CFS) but other species.  They also impact staphylococcus aureus (and other staphylococcus). My usual response for such herbs is rotation — perhaps take this mixture for the initial rotation and then switch to these herbs on an individual basis.

The role of selenium with probiotics suggests that it should be taken with probiotics. Since selenium is not likely to develop resistance (but excessive selenium is toxic), taking some with probiotics (whenever you take probiotics) is suggested. There are significant results for some digestive disorders at  100 microg/day.

A reader sent this to me:

“This is another supplement [Active hexose correlated compound (AHCC) – a fermented mushroom extract] that helped me a lot and stopped working

• http://www.ncbi.nlm.nih.gov/pubmed/18752476 
• http://www.ncbi.nlm.nih.gov/pubmed/10946621“

Since I am working off a model, it gives a framework to evaluate such things and possibly identify the mechanisms involved. Fermentation often produce bacteria that produces antibiotics [In fact, I just heard a report that 25% of the bacteria in men’s beard produce antibiotics!!!].

Reading PubMed, the mechanism of AHCC effects is not clear, but what we do find in terms of results include:

• “the oral treatment with AHCC protected mice from lethal infection with Pseudomonas aeruginosa and intraperitoneal one also protected mice from infection with methicillin-resistant Staphylococcus aureus (MRSA).”[2000]
• “Supplementation with AHCC appears to modulate immunity and increase survival in response to acute infection and warrants further investigation.” [2008]
• ” Our previous studies demonstrated that heat-shock protein 27 (HSP27) was involved in …. and it was down-regulated by AHCC-treatment.”[2015]
• “adenosine was identified as one of the NO suppressive components in AHCC” [2014]
  • “Herein we describe the synthesis and evaluation of a series of adenosine analogs for in vitro antibacterial activity against Staphylococcus aureus … compound c6 has much stronger antibacterial potency against Pseudomonas aeruginosa than ciprofloxacin” [2015]
• “Our data provide a preclinical experimental basis for the synergistic effect of AHCC and B. longum BB536 on inflammatory bowel disease.” [2013]
• “The study of colonic microflora indicated that rats treated with AHCC had higher aerobic and lactic acid bacteria counts as well as higher bifidobacteria counts,” [2007]

The heat shock protein rang a bell, and checking Wikipedia we find “Production of high levels of heat shock proteins can also be triggered by exposure to different kinds of environmental stress conditions, such as infection, inflammation, exercise, exposure of the cell to toxins” Heat shock proteins are associated with CFS [2012] ” Basal hsp27 was significantly higher among CFS patients compared to controls, and decreased immediately post-exercise, remaining below basal levels even at 7 days” [2002] and even Cort Johnson has a post on them. The gotcha is that it appears to be seen in only 30-40% of CFS patients (which suggests that it maybe microbiome dysfunction centric).

Bottom Line

It is a prebiotic that does influence bacteria growth. It appears to have antibiotic characteristics against a significant species for CFS. It also impacts heat shock proteins and appears to reduce chemicals produced by stress.

The reader’s report of it stop working is reasonable, because bacteria such as staphylococcus aureus would originally be reduced significantly and then the resistant strains would re-populate. A strong reason to do rotation with only 1-2 weeks on anything that had antibiotic characteristics.

If you take it, it should be taken with B.longum and other bifidobacteria probiotics.

In 2012, I started working on notes on CFS as part of searching for the best path forward. I attached the book as a PDF to this page, for people to use for reference.

I also attached mechanical translations into

• English
• German
• French
• Spanish

You will find about 90 pages and 1000 references to PubMed.

Och Svenske!

Enjoy!

I am a numbers man. Many studies say something like “CFS have high A-B-C” which is correct if you look at the average of a group. Unfortunately, it may just be 30% of the patients that are high and 70% that are normal. I have attempted to track down abnormality by the percentage of patients with various conditions.

• Magnesium deficiency 45% – 50% of CFS patients have low levels [2000]
• CoQ 10 low in 45% of CFS patients have low levels [2009]
• high levels of cytokines in 60% only, 40% of CFS patients do not have high levels of the typical 9 cytokines [1994].
• Cortisol is low in 33% [2001]
• Heart is smaller [2011] (61% [2008])
• Iron – 69% of CFS patients are insufficient or deficient [2001] [2011].
• Magnetic resonance imaging (MRI) studies are hit-and-miss for showing abnormalities [1997] [2000] [2010].  Approximately 27% [1993] – 32%[1997] has abnormal scans.
• Positron emission tomography (PET) scan has 50% with abnormal scans [2003]
• Single-photon emission computerized tomography (SPECT) scans has 80% – 81% with abnormal scans [1992] [1994]
• Shortness of breath (32%)
• Dyspnea on effort (28%),
• Rapid heartbeat or tachycardia (18% – 38%),
• Chest pain (43%)
• Neurally-mediated syncope (21%)
• Fainting (43%),
• Orthostatic dizziness (40% – 45%)
• Coldness of feet (42%), were all frequent complaints.
• Hypo-tension (28%) was occasionally noted.
• Electrocardiograms with right axis deviation (21%) and
• Severe sinus arrhythmia (34%)
• Small heart shadow (cardiothoracic ratio <or=42%) patients (60%)
• Low heart stroke volume (36%)

Infections found with Percentages

There are many other infections found that are over-represented with CFS compared to controls.

“A relatively uniform post-infective fatigue syndrome persists in a significant minority of patients for six months or more after clinical infection with several different viral and non-viral micro-organisms. Post-infective fatigue syndrome is a valid illness model for investigating one pathophysiological pathway to chronic fatigue syndrome.” [2006]

• Q fever confirmed – 17%  [2006]
• Ross River virus – 24%  [2006]
• EBV (20%[2003] -23% [1991] – 27% [2006] – 57% [2004]) Epstein-Bar Virus (EBV)
• Mycoplasma (50%[2003] – 52%[2003] – 69% [2004] [1998])
• HHV6 (31% [2003]) Human Herpes Virus 6 (HHV6)

Bottom Line

The model that is the simplest to explain the same type symptoms across many infection is a stable dysfunctional microbiome. The precise symptoms are dependent on the specific bacteria involved. These bacteria are more varied and unique than DNA. High or low values are likely caused by specific groups of bacterias.

A reader asked me to look at the Lightning Process. This is an area that can be emotional for many CFSers .. so I have tended to avoid it. The question was asked, and thus I should attempt to answer it.

“Some people have done Lightning Process or Dynamic Neural Retraining and claim that they are completely or substantially healed, either 3 days later or after several months of continuing the practice.”

My usual response to such is “show me the evidence on PubMed” – I have been reading CFS forums for many years and seen similar claims. I believe that the placebo effect is real — and when the condition is known to flare with stress, a substantial change of attitude (thus reducing stress) actually has the possibility of working for some. But as always on this blog — evidence!!!!

• Dynamic Neural Retraining – no hits on pubmed
• Lightning Process  – at least 4 articles

Other Commentators on this process

• BMJ should retract flawed research paper on chronic fatigue syndrome by DAVID TULLER , Dec 13, 2019
• Trial By Error: The SMILE Trial’s Undisclosed Outcome-Swapping, Dec 13, 2017
• Scepticism about the Lightning Process , ME-UK

Lightning Process

“The Lightning Process is a 3-day training programme that has recently become available, but no outcome studies have yet been published. It is a non-medical training programme that combines concepts from Neuro-Linguistic Programming, Life Coaching and Osteopathy” [2013].

• “among 123 newspaper articles. The most frequent statements were positive statements towards alternative treatment Lightning Process (26.2%), negative statements towards evidence-based treatments (22.1%), and positive statements towards other alternative treatment interventions (22.1%).” [2011]
• “Three of the 5 patients had been diagnosed with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and all of them have related their unfavorable outcomes to the treatment method called Lightning Process (LP), a 3-day training program designed by British osteopath Phil Parker...One patient expressed that “to follow the advice from the LP instructor eventually became a direct risk to my health….The 3 “worst” cases reported with regard to LP are consistent, and there is reason to suspect a causal relationship.” [2012]
• Experiences of young people who have undergone the Lightning Process to treat chronic fatigue syndrome/myalgic encephalomyelitis–a qualitative study [2013]. ” Less helpful aspects were the intensity and short duration of the treatment with little follow-up, the secrecy surrounding it, and feelings of being blamed if the treatment did not work.” There were no before and after lab tests done. The evaluation was subjective after the 3 day course (no followup from 1 month or 6 months later)
  
• “Conducting randomized controlled trials (RCTs) to investigate an alternative treatment such as LP is feasible and acceptable for children with CFS or ME. Feasibility studies that incorporate qualitative methodology enable changes to be made to trial protocols to improve acceptability to participants.” [2013]
• “This study will tell us whether adding the LP to SMC is effective and cost-effective compared to SMC alone. This study will also provide detailed information on the implementation of the LP and SMC.” [2013] The info on this clinical trail is here. The trial site has been taken down. “We have now shown that it is possible to run the study and are planning to convert the study to a randomised trial. Report. We anticipate that this will start in September and will run for a further 8 months.”[2014] – no further study appear to have started.

Bottom Line

There have been no objective results. In a study group of over 150 teenagers, there was not a single report of remission. The study compared the results of Lightening Process to Conventional Specialist Treatment – which is a naive approach. I recall reading studies that the outcome of conventional treatment on a sample of patients was worst than having no treatment (a true placebo test).

The 100% reporting adverse results in an earlier study is also significant. ” and feelings of being blamed if the treatment did not work” raises a great red flag over the reliability of any subjective or interview results. Guilt for non-results will cause people to lie (actually deceive themselves would be a better expression)

For any tests to have objective credit-ability, I believe a SPECT scan before and after the training is needed. SPECT scans show abnormalities in over 75% of CFS patients and thus would be a good, simple, single reference point.  If after the study, the before and after spect scan are given to independent radiologist (with which is which being hidden), the results would likely passing scientific object muster.

There is no evidence on PubMed  that Lightening Process can result in remission. The information from the existing studies strongly suggests that to be creditable, any future study MUST have objective lab results and not just interviews and subjective reports.