lassesen 7:23 am on March 17, 2024
Tags: chronic-fatigue ( 2 ), chronic-illness ( 4 ), chronic-pain ( 4 ), health, mental-health

Gender based Microbiome Shifts for ME/CFS

A question was ask – are there significant gender differences with ME/CFS. A partial answer is possible from our citizen science data (Available here). The number of bacteria identify as statistical drops because we are reducing sample sizes. The table below shows the shifts that are seen in common with P < 0.01.

For Symptom of ME/CFS

Source	Tax_name	tax_rank	Male	Female	Male_Chi2	FeMale_Chi2
thryve	Thermodesulfobacteria	phylum	increases	increases	234.0375	138.4544
biomesight	Verrucomicrobiaceae	family	increases	increases	8.333333	7.262051
biomesight	Rhodothermaeota	phylum	increases	increases	179.2	217.3071
biomesight	Akkermansiaceae	family	increases	increases	8.718378	9.965634
biomesight	Erysipelothrix muris	species	increases	increases	9.533889	10.08333
biomesight	Akkermansia	genus	increases	increases	8.718378	9.965634
biomesight	Rhodothermales	order	increases	increases	179.2	217.3071
biomesight	Akkermansia muciniphila	species	increases	increases	8.718378	9.965634
biomesight	Erysipelothrix	genus	increases	increases	9.663289	9.663289
biomesight	Rhodothermia	class	increases	increases	179.2	217.3071
biomesight	Thermodesulfobacteria	phylum	increases	increases	281.1738	299.9112

ME/CFS With IBS

We find differences here.

Source	Tax_name	tax_rank	Taxon	Male	Female	Male_Chi2	FeMale_Chi2
biomesight	Sutterella	genus	40544	decrease	increases	8.333333	11.25018
biomesight	Rhodothermales	order	1853224	increases	increases	139.9274	114.5716
biomesight	Dorea	genus	189330	increases	decrease	18.75	16.17875
biomesight	Rhodothermia	class	1853222	increases	increases	139.9274	114.5716
biomesight	Thermodesulfobacteria	phylum	200940	increases	increases	280.3333	187.9779
biomesight	Sutterellaceae	family	995019	decrease	increases	8.333333	11.25018
biomesight	Alcaligenaceae	family	506	decrease	increases	8.333333	9.120714
biomesight	Rhodothermaeota	phylum	1853220	increases	increases	139.9274	114.5716

ME/CFS Without IBS

We found no differences yet (given the sample size)

Source	Tax_name	tax_rank	Taxon	Male	Female	Male_Chi2	FeMale_Chi2
biomesight	Bacteroides fluxus	species	626930	increases	increases	7.355161	7.910588
biomesight	Thermodesulfobacteria	phylum	200940	increases	increases	124.4571	170.4624

Irritable Bowel Syndrome

Following up from above and noting that there is a gender bias in incidence, we find some differences

thryve	Thermodesulfobacteria	phylum	200940	increases	increases	252.8232	95.10095
biomesight	Rhodothermales	order	1853224	increases	increases	125.1467	110.6182
biomesight	Rhodothermia	class	1853222	increases	increases	125.1467	110.6182
biomesight	Thermodesulfobacteria	phylum	200940	increases	increases	314.4971	174.6182
biomesight	Rhodothermaeota	phylum	1853220	increases	increases	125.1467	110.6182
biomesight	Sharpea azabuensis	species	322505	increases	increases	16.18526	6.80625
biomesight	Sharpea	genus	519427	increases	increases	16.18526	6.80625
thryve	Mycoplasma	genus	2093	increases	decrease	12.81524	20.3229
thryve	Mycoplasmataceae	family	2092	increases	decrease	14.88581	20.3229
thryve	Phocaeicola vulgatus	species	821	increases	decrease	7.893492	17.06273
thryve	Mycoplasmatales	order	2085	increases	decrease	14.88581	26.01485

Depression

Another condition with a gender association

Source	Tax_name	tax_rank	Taxon	Male	Female	Male_Chi2	FeMale_Chi2
thryve	Thermodesulfobacteria	phylum	200940	increases	increases	227.7557	148.4336
thryve	Parabacteroides distasonis	species	823	decrease	increases	9.118356	13.46941
thryve	Eubacterium oxidoreducens	species	1732	decrease	increases	12.99507	6.76
biomesight	Rhodothermales	order	1853224	increases	increases	121.2002	91.125
biomesight	Rhodothermia	class	1853222	increases	increases	121.2002	91.125
biomesight	Thermodesulfobacteria	phylum	200940	increases	increases	223.4402	189.2431
biomesight	Rhodothermaeota	phylum	1853220	increases	increases	121.2002	91.125
thryve	Lactobacillus rogosae	species	706562	decrease	decrease	23.88368	12.12781

Symptom: Problems remembering things

This is one of the characteristics of ME/CFS, Long Covid, etc

Source	Tax_name	tax_rank	Taxon	Male	Female	Male_Chi2	FeMale_Chi2
thryve	Thermodesulfobacteria	phylum	200940	increases	increases	316.4446	120.0944
biomesight	Rhodothermales	order	1853224	increases	increases	171.7445	133.3333
biomesight	Rhodothermia	class	1853222	increases	increases	171.7445	133.3333
biomesight	Thermodesulfobacteria	phylum	200940	increases	increases	369.0078	289.0992
biomesight	Odoribacteraceae	family	1853231	increases	increases	12.79311	7.962632
biomesight	Rhodothermaeota	phylum	1853220	increases	increases	171.7445	133.3333
biomesight	Acetivibrio	genus	35829	decrease	increases	9.180865	17.49208
biomesight	Odoribacter	genus	283168	increases	increases	9.334949	12
biomesight	Acetivibrio alkalicellulosi	species	320502	decrease	increases	9.180865	19.95636
biomesight	Hathewaya histolytica	species	1498	decrease	increases	9.180865	7.262051
biomesight	Hathewaya	genus	1769729	decrease	increases	9.180865	7.262051
biomesight	[Clostridium] thermoalcaliphilum	species	29349	increases	increases	7.35	6.880909
thryve	Intestinimonas	genus	1392389	decrease	increases	16	8.552727
thryve	Intestinimonas butyriciproducens	species	1297617	decrease	increases	16.48646	9.992258
ubiome	Bacteroides sp. EBA5-17	species	447029	increases	decrease	9.055577	7.314286

Symptom: Worsening of symptoms with stress.

Another common symptom of ME/CFS

Source	Tax_name	tax_rank	Taxon	Male	Female	Male_Chi2	FeMale_Chi2
thryve	Thermodesulfobacteria	phylum	200940	increases	increases	282.4023	185.22
biomesight	Thermoanaerobacterales Family III. Incertae Sedis	family	543371	decrease	increases	22.00454	8.491649
biomesight	Sharpea	genus	519427	increases	increases	17.55625	12.38345
biomesight	Hathewaya	genus	1769729	decrease	increases	16.98612	11.70814
biomesight	Rhodothermales	order	1853224	increases	increases	142.9353	188.8704
biomesight	Hathewaya histolytica	species	1498	decrease	increases	16.98612	11.70814
biomesight	Sharpea azabuensis	species	322505	increases	increases	17.55625	12.97965
biomesight	Rhodothermia	class	1853222	increases	increases	142.9353	188.8704
biomesight	Thermodesulfobacteria	phylum	200940	increases	increases	352.2616	362.7038
biomesight	Acetivibrio alkalicellulosi	species	320502	decrease	increases	12.65818	8.491649
biomesight	Rhodothermaeota	phylum	1853220	increases	increases	142.9353	188.8704
biomesight	Acetivibrio	genus	35829	decrease	increases	12.65818	8.491649

Other Symptoms with Significant Gender Differences in patterns

Immune Manifestations: Abdominal Pain
Sleep: Unrefreshed sleep
Comorbid: High Anxiety
General: Fatigue
Neurological-Audio: hypersensitivity to noise
DePaul University Fatigue Questionnaire : Unrefreshing Sleep, that is waking up feeling tired
DePaul University Fatigue Questionnaire : Fatigue
Neurocognitive: Brain Fog
Neurocognitive: Problems remembering things
DePaul University Fatigue Questionnaire : Anxiety/tension
General: Myalgia (pain)
Immune Manifestations: Constipation
Post-exertional malaise: Rapid muscular fatigability,
Neuroendocrine Manifestations: Poor gut motility
Comorbid: Restless Leg
Comorbid: Small intestinal bacterial overgrowth (SIBO)
DePaul University Fatigue Questionnaire : Difficulty finding the right word
DePaul University Fatigue Questionnaire : Mood swings
DePaul University Fatigue Questionnaire : Pain in Multiple Joints without Swelling or Redness
Sleep: Problems falling asleep
Sleep: Problems staying asleep

lassesen 7:48 pm on February 20, 2024
Tags: Chronic Fatigue Syndrome ( 4 ), chronic-pain ( 4 ), health, microbiome ( 2 ), wellness

ME/CFS Books and MDs

In the family dealing with ME/CFS we were very fortunate in working with now retired folks, (links to MEPedia pages on them). It was 25 years ago.

Byron Hyde MD, Canada
David Bell MD. US – Created the Bell disability scale for ME/CFS
David Berg — I hosted several online chats with him. He is now retired

Also we had significant interaction with

Cecile Jadin MD, South Africa – by email. Still practicing
Garth Nicolson Ph.D. US – I was on a TV News Program with him

Many support groups provide lists of local MDs that are sympathetic to ME/CFS patients. Typically, they will attempt to do symptom relief, not remediate the underlying cause or do not test outside of their local standards of practice (i.e. testing for associated viral infection, Lyme or rickettsia infections) – independent of insurance coverage or the patient being will to pay.

For example:

For Washington State, Best Chronic Fatigue Syndrome Doctors in Seattle, WA. The heathgrade site covers most US states.
- Note: the grades tend to indicate friendliness, not effectiveness of treatment.
Chronic fatigue – Internal medicine specialists – Edinburgh

The family was extremely fortunate to be covered by the old Microsoft Medical insurance that covered everything that the MD wanted with no deductibles; and we had a MD that was willing to learn and explore.

My recommendations for books are:

Understanding Myalgic Encephalomyelitis, Byron Hyde MD
The Clinical and Scientific Basis of Myalgic Encephalomyelitis – Edited by Byron Hyde, M.D.
Free Download eBook (PDF) This is a collection of a massive number of early research papers — most still relevant.
Other publications worth a review: https://www.nightingale.ca/publications

Other books can be found here:

Goodreads: Me Cfs Books, I would exclude books not written by a MD or published before 2020.

Note that the better books are often difficult or impossible to understand due to brain fog (and sometime lack of sufficient education is specific areas)

Determine a Model and if possible, see if there is evidence that the model works

I went with two models for ME/CFS: A hypercoagulation condition (David Berg) and an “occult rickettsia like infection” (Cecile Jadin); today we could call it “post Infection Fatigue Syndrome”. Both were testable (by lab or by reaction to low risk drugs, i.e. an antibiotic often prescribed for Acne) and actionable.

Today, my thinking is that the simplest model is a persistent microbiome dysfunction. This is very testable with direct retail tests; and actionable (using Microbiome Prescription). Often the antibiotics suggestions from Microbiome Prescription mirrors the Jadin approach. The treatment plan works for her models and my microbiome model!

Going with a hypothesis that is not both testable and actionable is not recommended. Take action today incase it works! Leave speculations to researchers trying to get grant money for their special interests.

For examples using my model: see Analysis Posts on Long COVID and ME/CFS

Symptoms and Bacteria appears to be strongly related

It is typical that Microbiome Prediction correctly predicts 80-100% of a person’s dominant symptoms from their microbiome. This implies that the bacteria shifts are causing the symptoms; thus correcting the bacteria shifts may reduce or eliminate symptoms.

A follow up ME/CFS Analysis

This is a follow up on the prior post below. The reader’s comments are “I am feeling much better but still very fatigued and lately been quite achey. The recommendations have changed significantly except for whole grain barley.”

24 Years of ME/CFS with Mouth Microbiome

For more analysis see: Analysis Posts on Long COVID and ME/CFS

Comparison of Microbiome Samples

Let us first do the simple numbers. A lot of values are the same (typical) but many of them show improvement. 🙂 indicate significant reduction is out of range values See Technical Note: Lab Quality Versus Bacteria Reported We would expect a 15% drop from lower lab quality, the drops shown are well below that).

Criteria	Current Sample	Old Sample
Eubiosis Index	62.8% 🙂	59%
Lab Read Quality	4.3	8.4
Outside Range from JasonH	8	8
Outside Range from Medivere	20	20
Outside Range from Metagenomics	10	10
Outside Range from MyBioma	8	8
Outside Range from Nirvana/CosmosId	18	18
Outside Range from XenoGene	42	42
Outside Lab Range (+/- 1.96SD)	9 🙂	16
Outside Box-Plot-Whiskers	38 🙂	98
Outside Kaltoft-Moldrup	56 🙂	139
Bacteria Reported By Lab	494	752
Bacteria Over 90%ile	20 🙂	82
Bacteria Under 10%ile	66 🙂	232
Shannon Diversity Index	1.465	1.701
Simpson Diversity Index	0.035	0.028
Chao1 Index	7474	17093
Shannon Diversity Percentile	28.5	61.4
Simpson Diversity Percentile	30.2	21.5
Chao1 Percentile	28.9	87.7
Lab: BiomeSight
Pathogens	18 🙂	39
Condition Est. Over 90%ile	4	4
Kegg Compounds Low	969 :-)	1242
Kegg Compounds High	5 🙂	23
Kegg Enzymes Low	272	284
Kegg Enzymes High	17 🙂	75
P or P Chi2	.9999245	.999999999

Health Analysis Comparisons

I have not created an automatic compare yet (on to do list). Many values were similar, some interesting ones with improvements are below. Jason Hawrelak Criteria got worse, but I have deep reservations on using his criteria on Biomesight tests (he based them on a very different test method).

	Current	Prior
General Health Predictors: Flagged Bacteria	8 🙂	10
Anti inflammatory Bacteria Score	14.4%ile 🙂	13.3 %ile
Lactate (controls many bad bacteria)	33.1 %ile 🙂	20 %ile
L-Lactic Acid (controls many bad bacteria)	47.1 %ile :-)	25.2 %ile
NADH (Typically low with ME/CFS)	26.5 %ile :-)	13.7 %ile
Hydrogen peroxide (controls many bad bacteria)	17.3 %ile 🙂	5.8 %ile
D-Lactic Acid (Associated with brain fog)	6.5 %ile 🙂	7.9 %ile
Potential Medical Conditions Detected	2 🙂	7
Bacteria deemed Unhealthy	7 🙂	22
Jason Hawrelak Criteria	56.4 %ile	75.8 %ile

Going Forward

A review of the Health Analysis was done above, with the two items: Mood Disorders and COVID-19 (a proxy for ME/CFS IMHO). A secondary review of all the items on [Changing Microbiome]/[US National Library of Medicine Studies] for high items not flagged. Nothing added.

Doing what is becoming a regular pattern: “Just give me suggestions” and then using given symptoms under Special Studies using these items:

Note: items like age and gender are omitted as well as any other symptoms that we do not have sufficient data.

First the filtered PDF suggestions. The list is much longer than usual:

And the to avoid list is more typical.

Let us go over to viewing the consensus for the latest microbiome sample to get some suggestions.

The highest suggested value/priority was 485 (so 240 for cutoff), lowest value was -574 ( so-287 for cutoff)

Foods
1. whole-grain barley
2. lauric acid(fatty acid in coconut oil,in palm kernel oil,)
3. Vegemite (with apologies — it’s an acquired taste)
Diet Style
- Only gluten-free was in positive range
- Avoids: animal-based diet, high beef diet, ketogenic diet
Herb or Spice
Prebiotics and similar
- Nothing in take
- Avoid: inulin (prebiotic),xylan (prebiotic),Psyllium (Plantago Ovata Husk) etc
Probiotics
1. lactobacillus kefiri (NOT KEFIR) — only available in Italy
2. lactobacillus casei (probiotics)
3. bifidobacterium breve (probiotic)
4. bifidobacterium longum bb536 (probiotics)
5. AVOIDS: lactobacillus plantarum (probiotics), lactobacillus rhamnosus (probiotics), bacillus licheniformis,(probiotics)
Sugar and similar- Effectively LOW SUGAR DIET
1. sucralose
2. chitosan,(sugar)
3. Avoid: stevia, saccharin, galactose (milk sugar), sugar, polydextrose
Vitamins, Minerals and similar
- The typical ME/CFS ones: Vitamin B1, B3, B6, B7, B9, B12 and Vitamin C
Amino Acid and similar
1. melatonin supplement (it helps with sleep but also can improve the microbiome)
2. Taxifolin
3. Avoid most of the other ones
Antibiotics (limited to those used for ME/CFS)
1. metronidazole (antibiotic)s[CFS]
  - “Metronidazole/Flagyl is reported to have 75% of CFS patients improving according to some surveys.”
2. amoxicillin (antibiotic)s[CFS]
3. dapsone (antibiotic)[CFS]
4. lymecycline (antibiotic)[CFS]
5. azithromycin,(antibiotic)s[CFS]

So in summary, shift a diet to low sugar, gluten free with moderation in meat (no guidance on chicken or fish). If your MD is willing, I would suggest reviewing Cecile Jadin approach with antibiotics and rotate with those suggested above. IMHO Continuous on a single antibiotic is more likely to complicate the microbiome.

Postscript – and Reminder

I am not a licensed medical professional and there are strict laws where I live about “appearing to practice medicine”. I am safe when it is “academic models” and I keep to the language of science, especially statistics. I am not safe when the explanations have possible overtones of advising a patient instead of presenting data to be evaluated by a medical professional before implementing.

I cannot tell people what they should take or not take. I can inform people items that have better odds of improving their microbiome as a results on numeric calculations. I am a trained experienced statistician with appropriate degrees and professional memberships. All suggestions should be reviewed by your medical professional before starting.

The answers above describe my logic and thinking and is not intended to give advice to this person or any one. Always review with your knowledgeable medical professional.

lassesen 6:08 pm on January 31, 2024
Tags: food, gut-health ( 3 ), health, mushrooms, nutrition ( 2 )

Beta-Glucan and ME/CFS: The Microbiome Fixer

A reader that does microbiome analysis of her ME/CFS daughter ‘s microbiome using Microbiome Prescription expert system sent me this note with some literature.

Your wonderful system recommended beta-glucans [also written β-Glucan] for my daughter, and when I looked further, I found this. I’m trying her on them for a month-, after testing her for reactions for three days- the first week has been hopeful. Will keep you posted if you wish.
Reader

β-Glucan is a nonstarch polysaccharide having documented health benefits and industrial applications. It can be extracted from various sources, including cereals, bacteria, molds, and fungi. The chemical nature of extracted β-glucan from these sources differs slightly. This variation in chemistry defines its industrial uses and health benefits.
Biopolymers for Food Design, 2018

Literature

There is not much literature available for ME/CFS.

“The findings showed that the beta-glucan supplementation significantly improved cognitive fatigue (assessed with FIS-40 scores) after the 36-week treatment compared to the baseline (p = 0.0338). Taken together, this study presents the novel finding that yeast-derived beta-glucan may alleviate cognitive fatigue symptoms in ME/CFS.” [2023]
β-Glucan Improves Conditions of Chronic Fatigue in Mice by Stimulation of Immunity [2020] Reduces TNF-α (which is connected to mast cell issues)
Effects of β-(1,3–1,6)-d-glucan on irritable bowel syndrome-related colonic hypersensitivity [2012]
“β-Glucan did not affect the pain response in general but specifically affects the visceral pain response.”
Serum concentrations of 2′,5′-oligoadenylate synthetase, neopterin, and beta-glucan in patients with chronic fatigue syndrome and in patients with major depression. [1994]
“ the dosage of supplementation ranged from 2.5 to 1000 mg daily [of beta-glucan] for up to 6.5 months … The primary physiological outcome of the majority of the interventions was immunomodulation, which resulted in (a) strengthened immune defense that reduces the incidence and symptoms of cold, flu and other respiratory infections and (b) improvement of allergic symptoms.” [2021]
β-glucan attenuates cognitive impairment via the gut-brain axis in diet-induced obese mice [2020]

Some literature for Autism

Many Sources of Beta Glucan

Often the expert system on Microbiome Prescription comes up with Barley as a strong recommendation for ME/CFS people. Barley is an excellent source. Personally, I have oats or barley porridge a couple of times every week. The impact of the β-Glucan in the Barley may be the mechanism — we just do not have as many studies as we do for Barley.

“The primary sources of food β-glucan for humans are cereals (especially oats and barley), fungi, algae, and yeast ” [2023] A table from this article is below

“β-glucans bind to specific receptors on immune cells and initiate immune responses…. In vitro study found that the fermentation of barley and oat β-glucan by human fecal samples show variations in SCFAs production and the bacterial populations of Clostridium histolyticum and the ratio of Bacteroides–Prevotella species. Absorption of these SCFAs by the gut epithelial cells helps in regulating cell differentiation, proliferation, apoptosis, and gene expression (210). Butyrate increases the protein expression of tight junctions such as ZO-1 and claudin-1, resulting in enhanced intestinal barrier function.”
“β-glucan is an essential food ingredient in controlling metabolic dysregulations linked to metabolic syndrome. β-glucans have a very minimal probability of having any unfavorable side effects and are reasonably inexpensive.” [2023]

Bottom Line

Real simple: Barley or Oats porridge for breakfast each day! Since there are some chemical differences between the β-glucans in these two grains– rotate between these (and different brands) at least monthly.

Using the generic suggestions for me/cfs we see both barley and B-glucan are positive (but oats are slightly negative). The more detailed citizen science suggestions are still be worked on, but I expect similar.

Reviewing Clinical Trials, my impression is 1 gram/day of β-glucans which translates to 20 grams of Barley or 40 grams of Oats per day.

“30g uncooked oats or barley will make a fairly small bowl of porridge whilst 70-80g will provide a particularly large serving for one person. Traditional porridge recipes tend to use oatmeal with approximately 200ml of water per 50g oats, and a pinch of salt.”
University of Aberdeen

Some people will advocate just eat mushroom. While correct that it contains beta-glucans, we need to be careful not to slip into homeopathic dosages!

Among those, mushrooms feature a particularly high level, so it’s no exaggeration when we say “for beta glucans, look to mushrooms!” The amounts of beta glucans found per 100 g of raw mushroom include 2.3 g (maitake), 2.0 g (bunapi), 1.9 g (eryngii), 1.8 g (bunashimeji) and 1.5 g (shimofuri hiratake) (Hokuto data).
https://www.hokto-kinoko.co.jp/lang/en/kouka/jiten/jiten06/

When we go to typical US mushrooms (i.e. Button), we drop to .75 g/100 grams [FDA]. So we are talking about 5-6 oz of mushrooms per day. That 3/4 of the typical mushroom package per day per person.

Celiac and Gluten Sensitive Issue

Most beta glucan supplements are produced from Saccharomyces cerevisiae (thus gluten free). For example the item below is about US$17.00 and gives 100 days at 1 gram per day.

I should note that there are different forms of beta glucan, for example above it is the 1,3/1,6 forms. Another product has 1,3/1,4 and is derived from Oats (you will have to write the company to see if it is gluten free or low gluten).

The cost per gram is much lower as bulk powders than with pre-filled “premium” capsules – the same volume of beta glucan can be as high as $250 (12x more) with some products.

lassesen 7:40 am on December 15, 2023
Tags: bacteria ( 2 ), gut-health ( 3 ), health, microbiome ( 2 ), Probiotics ( 2 )

Tool for getting suggestions for your specific ME/CFS Symptoms

After I posted List of Bacteria significant for ME/CFS from the shared samples uploaded to Microbiome Prescription, several readers asked “How do I use this”. This took me a few days to come up with, code and implement an answer.

I wanted this to go beyond just ME/CFS because there is a huge variety of symptoms and co-morbidity seen with ME/CFS. After testing and tuning the algorithm, I am pleased with the current results.

The process is show below.

The Steps

First get a suitable microbiome test done (See this list of supported tests)
Transfer or upload your results to Microbiome Prescription
An email will be sent to you to login
Login in.
Enter your symptoms

Return to “My Profile”
A new button will appear

Clicking it will move to the page below. YOU MAY FIND THAT IT TAKES UP TO A MINUTE (We are doing a massive number of computation)

This will show a tree of the bacteria involved. The Species are under the genus they below to. In the example below we see the ENTIRE phylum that Bifidobacterium is in are low (none found) of 9 species whose presence would likely reduce your symptoms.

Elsewhere you may see highs with certain bacteria species desired to higher. Often the symptom key is at the species level.

At the bottom you will see a button to get suggestions

The next page shows the symptoms being targeted to and choices of what you want to consider.

Make any changes desired and click show suggestions

REMEMBER these are suggestions for ONE person using their Symptoms and their microbiome profile. It is intended for them only. Your own suggestions may be very different with many items exchanged between ADD and REMOVE.

Technical Methodology Details are described here Technical Note: Prevalence, Average and Not Reported.

Post-Script

This approach sidestep the proforma process often drilled into researchers (you must have a healthy control group and a verified, criteria matching target population). I kept to rigorous statistical analysis while ignoring these constraints which are philosophical in nature. We used the available data and set our significance level to P < 0.005; instead of the typical research level of P < 0.05. In other words, we are 10 times more certain about our results.

CFS Remission

Striving for true remission of CFS, chronic Lyme, FM, IBS etc

Tag Archives: health