Elsevier

Medical Hypotheses

Volume 60, Issue 6, June 2003, Pages 915-923
Medical Hypotheses

Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value

https://doi.org/10.1016/S0306-9877(03)00096-3Get rights and content

Abstract

Chronic fatigue syndrome (CFS) is complex illness with unknown aetiology. Recent research shows that patients with CFS have marked alterations in microbial flora, including lowered levels of bifidobacteria and small intestinal bacterial overgrowth (SIBO). Research also indicates that CFS patients are under increased oxidative stress, have a type 2 helper cell dominate cytokine profile, frequently report allergies, have altered essential fatty acid (EFA) status and may have malabsorption of certain micronutrients. Lactic acid bacteria (LAB) have the potential to influence the immune system in CFS patients by supporting T helper cell 1 driven cellular immunity and may decrease allergies. In addition LAB are strong antioxidants, may improve EFA status, can enhance absorption of micronutrients by protecting the intestinal epithelial barrier, and have been used to treat SIBO. It is our contention that LAB may have a therapeutic role in the treatment of CFS.

Introduction

Chronic fatigue syndrome (CFS) is a medically unexplained illness, characterized by persistent and relapsing fatigue. In addition to cognitive dysfunction, headaches, joint pains, central nervous system disturbances, and a variety of other symptoms, many CFS patients complain of gastrointestinal disturbances [1], [2]. Patients with CFS are more likely to report a previous diagnosis of Irritable bowel syndrome (IBS), meet diagnostic criteria for IBS and experience IBS-related symptoms (3). In a one-year retrospective evaluation, over 70% of patients with chronic fatigue met the Manning criteria for IBS (4).

While the etiology of CFS remains unknown, several causative factors have been suggested, including viral infection, altered immune function and pre-illness stressors (5). Recent research indicates that there are marked alterations in the intestinal microflora of CFS patients [6], [7]. Although the gastrointestinal (GI) microflora is itself far from being completely understood, it is clear that it plays an important role in the health of the human body. The goal of this report is to integrate various branches of research in order to support our hypothesis, that lactic acid bacteria may be of therapeutic value in the treatment of CFS.

Section snippets

Normal intestinal flora

The bacteria that make up the GI microflora are part of a complex and delicately balanced ecosystem. It is estimated that the human intestine contains close to 500 bacterial species, belonging to about 200 genera (8). The variety and location of bacteria in the intestines is dependent on a number of factors, including stomach acid secretion and small bowel motility. The proximal small bowel of healthy individuals normally contains relatively small numbers of microorganisms in the range of 102–10

Role of normal microflora

Normal GI microflora is considered beneficial in the human body for a number of reasons. Bacteria that are normally found in high numbers, such as bifidobacteria and lactobacilli (lactic acid bacteria) are involved in vitamin synthesis, stimulation of the immune response, prevention of pathogenic and opportunistic bacterial colonization, protection of the intestinal barrier defense system, production of short chain fatty acids for enterocyte energy, and metabolism of carcinogenic substances [8]

Factors affecting normal flora

Although the intestinal microflora is quite stable over time, a number of factors can disturb the normal balance. The GI microflora can be altered by immune mechanisms of the host, redox state, adrenal function, intestinal pH, peristalsis, diet, aging, drugs, exogenous organisms, climate and emotional stress [10], [11]. It is clear that many of these factors are capable of causing more than a transient alteration in the flora of patients with CFS.

Intestinal flora and CFS

Henry Butt and colleagues (6) from the Department of Biological and Chemical Sciences, University of Newcastle, Australia have been examining the microbial flora of CFS patients for a number of years. In 1998 they presented the first research showing an altered fecal microbial flora in CFS patients (n=27) vs. controls. The mean distribution of Escherichia coli as a percentage of the total aerobic flora of the control subjects was 92.3% compared to 49% in CFS patients. The mean percentage

Stress and intestinal microflora

There is some research in both humans and animals showing that emotional stressors can negatively affect microflora. States of stress associated with anger and fear have been shown to be related to increases in bacteroides, specifically the thetaiotaomicron and uniformis group (71). Normally compromising 2–4% of the flora, these bacteroides increase to 20–30% of the flora under conditions of anger or fear (72).

Lizko et al. [73], [74] examined the effect of nervous-emotional stress on intestinal

Stress, cytokines and CFS

Research suggests that stress plays a significant role in the onset and exacerbations of CFS symptoms. Both physical and psychological stressors appear to contribute to the illness, leading some investigators to refer to CFS as a disorder of stress (89). The majority of CFS patients believe that stress, or a combination of stress and an infection resulted in the condition [90], [91], [92], [93]. There is some research to support this notion, as those who reported to a doctor’s office with a

CFS and essential fatty acids

The suggestion has been made that essential fatty acid (EFA) deficiency, both viral and immune induced and/or through abnormalities of metabolism, is playing a role in the pathogenesis of CFS [117], [118]. There is research to support this, as CFS patients have been found to have lower levels of plasma EFA levels. These levels normalized and clinical improvements resulted during a three-month intervention trial with an EFA preparation (119). The administration of an omega-3 fatty EFA

A role for lactic acid bacteria?

Emerging research suggests that the intestinal microflora in CFS is markedly different than that of healthy controls, findings that are not entirely surprising given the research cited on the influence of stressors on microbial flora. We postulate that stress-induced alterations in microbial flora, specifically diminished lactobacilli, bifidobacteria and anaerobes in general, will amplify the domination of Th2 cytokines. Further, it is our contention that the administration of specific strains

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