Dysbiosis, Fibromylagia (and Chronic Fatigue)…and Me

As many of you may know, chronic fatigue syndrome (CFS) is thought to be  closely related to fibromyalgia… and as someone who suffers from the latter, any news on these two illnesses is near and dear to me.

Inspired by the d-lactate findings I wrote about in my last two posts, I did some snooping around, looking for any recent news on CFS.  I found a few interesting tidbits I thought I’d share today.

In January 2018, the journal, Nature, published a scathing feature on the ignominious history of CFS.[i]  I have written a little about this before as my memory is long.  I have never forgotten how, back when I was in college, people suffering from it were accused of having the “yuppy flu.”  For those new to CFS:  the illness, is now thought it affect somewhere between 800,000 and 2.5 million people in the United States alone, according to a 2015 report by the U.S. Institute of Medicine (IOM).  It is characterized by unrelenting fatigue that is not relieved by rest, exercise intolerance, muscle and joint pain, cognitive dysfunction, sleep disturbances and often, irritable bowel syndrome. At its best, it seriously affects quality of life.  At its worst, it’s entirely debilitating, leaving people unable to work, bedridden, potentially unable to walk or speak.  (The number of those afflicted varies widely because there currently is no medially established way to test for CFS.  It’s a clinical diagnosis, and one that is too often missed by physicians as there is so little good medical information on it.)

It was really not until that 2015 IOM report that a major shift occurred in the attitude of the medical community toward the disease.  That report reviewed 9000 studies and concluded that, “…ME/CFS is a serious, chronic, complex and systemic disease.”  Shortly after it was published, the director of the US National Institute for Health (NIH) said that the agency would begin supporting serious work in the field.

One of the biggest areas of CFS study, based in part upon the findings that I talked about in my May 2017 post referenced above, is the relationship of the disease to alterations in the biome.

The Nature paper also describes current research looking at an abnormal inflammatory response to an infection potentially being the culprit:  “Infections generally lead to inflammation when protein receptors on T cells, a kind of immune cell, recognize corresponding proteins carried by bacteria, parasites or viruses. The T cells multiply and catalyse an inflammatory attack that includes the replication of antibody-producing immune cells, called B cells. In the past few years, researchers have revealed hints of an unusual immune response in ME/CFS….What disrupts the inflammatory response, however, remains unknown. One possibility is that, as in some autoimmune disorders, T cells mistakenly become alarmed by one of the body’s own proteins…”

More on this in a moment.

Earlier this year, a paper was published that asks the question, “Does the microbiome and virome contribute to myalgic encephalomyelitis/chronic fatigue syndrome?”[ii]

The definitive answer to this question, is CFS a result of dysbiosis due to phage abnormality, is as yet unknown…but considering the bacterial alterations present, the virome seems like a reasonable place to look for clues.  (Remember: phages are viruses that infect bacteria.  Under different circumstances, they can be good (keeping bacterial populations in check, kind of like natural antibiotics); or bad (creating dysbiosis, such as is currently suspected to be a factor in the development of Parkinson’s disease).  These authors found only 3 papers that examined the intestinal virome in CFS, and while one found “an increase in bacteriophage richness,” the authors point out that the study was “statistically underpowered” due to its small sample size.

These scientists conclude that more research into the association between an altered bacterial microbiome and virome are warranted, as “…microbiome dysbiosis in ME/CFS patients is evident.”

In one of those coincidences I love so much:  I was getting ready to proofread and post this, when I got a notification of an article on CFS, autoimmunity and the microbiome from ProHealth.[iii]  So back to the idea that an infection is the match that ignites the immune pyre…the author describes a paper on the subject published this past February, that points to a pattern that may help explain the etiology of CFS:

“ME/CFS often starts after or during an infection. A logical explanation is that the infection initiates an autoreactive process, which affects several functions, including brain and energy metabolism. According to our model for ME/CFS pathogenesis, patients with a genetic predisposition and dysbiosis experience a gradual development of B cell clones prone to autoreactivity. Under normal circumstances these B cell offsprings would have led to tolerance. Subsequent exogenous microbial exposition (triggering) can lead to comorbidities such as fibromyalgia, thyroid disorder, and orthostatic hypotension.”[iv]

Essentially, these researchers believe that CFS starts with a leaky gut from dysbiosis well before the illness starts.  As the article on ProHealth states, “Blomberg believes that slow leakage from the gut created a population of auto-reactive B-cells that remained mostly inactive or quiescent (in a state of anergy), almost like undercover agents infiltrating a city, waiting for the signal to pounce. At some point a “decisive” immune event flipped them into action, and an autoimmune disease – ME/CFS – was born.”

This pattern – irritable bowel  followed by a major infection followed by a decline into autoimmunity and fibromylgia/CFS is the exact pattern I followed.  I had IBS very early in life, which was not helped by a heap of antibiotics; got mononucleosis in college; developed autoimmune thyroid disease; was eventually diagnosed with fibromylgia.

I’ll continue to keep an eye on developments.

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[i] Maxmen, A. A reboot for chronic fatigue syndrome. Nature. 2018. 553, 14-17. doi: 10.1038/d41586-017-08965-0

[ii] Newberry, F, Hsieh, SY, Wileman, T, Carding, SR. Does the microbiome and virome contribute to myalgic encephalomyelitis/chronic fatigue syndrome?  Clinical Science. 2018. 123:523-543.

[iii] https://www.prohealth.com/library/autoimmune-model-proposes-chronic-fatigue-syndrome-cfs-begins-gut-85441

[iv] Blomberg, J, Gottfries, CG, Elfaitouri, A, Rizwan, M, Rosen, A. infection elicited autoimmunity and myalgic encephalomyelistis/chronic fatigue syndrome: an explanatory model.  Frontiers in Immunology. 2018:9:229.