As a person who’s been gifted with being in remission from chronic fatigue syndrome (for the third time), I adhere to a model of what I believe causes typical ME/CFS in hope of staying in remission. The model is stable and consistent with the latest (and older) research studies. It follows William Osler’s principle basing diagnosis and treatment on a strict observation of symptoms (not forgone conclusions and KISS (Keep It Simple Stupid).
“Listen to your patient, he is telling you the diagnosis” – William Osler
Recently, I added another narrative to the model: that the symptoms in ME/CFS are caused by the over production/under clearance of lactic acid. Lactic acid is produced when you exercise and makes you tire as it accumulates.
The Key Study
“Patients with chronic fatigue syndrome (CFS) are affected by symptoms of cognitive dysfunction and neurological impairment, the cause of which has yet to be elucidated. However, these symptoms are strikingly similar to those of patients presented with D-lactic acidosis... this might explain not only neurocognitive dysfunction in CFS patients but also mitochondrial dysfunction, these findings may have important clinical implications.”
“Faecal microbial flora of CFS patients and control subjects. The mean viable count of the total aerobic microbial flora for the CFS group (1.93×108 cfu/g) was significantly higher than the control group (1.09×108 cfu/g) (p<0.001). There was a significant predominance of Gram positive aerobic organisms in the faecal microbial flora of CFS patients. …This study confirms the previous observation (22), and those reported by other investigators (23) that there was a marked alteration of faecal microbial flora in a sub-group of CFS patients….. In this study the mean total count for Enterococcus and Streptococcus spp. for the CFS group was 52% of the total aerobic intestinal flora, which is significantly higher than the 12% seen in the control subjects (p<0.01). ”
“In this study the NMR-based metabolic profiles of the three intestinal micro-organisms, E. faecalis., S. sanguinis. and E. coli showed that the Gram positive bacteria (Enterococcus and Streptococcus spp.) produce more lactic acid than the Gram negative E. coli. Not surprisingly, these Gram positive bacteria were shown to lower the ambient pH of their environment in vitro as compared to that of E. coli. This suggests that when Enterococcus and Streptococcus spp. colonization in the intestinal tract is increased, the heightened intestinal permeability caused by increased lactic acid production may facilitate higher absorption of D-lactic acid into the bloodstream, henceforth perpetuating the symptoms of D-lactic acidosis. Increased intestinal permeability is also associated with endotoxin release from Gram negative enterobacteria, leading to inflammation, immune activation and oxidative stress, which are cardinal features in a large subset of CFS patients “
My model’s core element has been that CFS/FM/IBS are caused by microbiome dysfunction. This has been reported multiple times in the literature by Butt  and Schloeffel , and preliminary results from the Lipkin/Hornig microbiome study suggest major alterations in gut flora occur. Anecdotal reports indicated that fecal transplants can result in immediate remission in a significant set of ME/CFS patients. (Unfortunately, many did not stay in remission beyond six months).
A major decrease of E.Coli in CFS patients is well established. If there are less E.Coli, then other bacteria which produce more lactic acid per unit of bacteria can take it’s place.
This lactic acid/chronic fatigue concept is not new, and has been reported in the literature before:
- Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome: a case-control study.
- “CFS simulations exhibited an increased acidosis and lactate accumulation consistent with experimental observations.” 
- Is chronic fatigue syndrome synonymous with effort syndrome? 
However the lactic acid findings may have been viewed as a consequence and not a cause. The opposite may be more accurate.
Using the term “lactic acidosis”, I checked for recommended treatments on the large research citation database, PubMed as well as EMedicine, and the popular website, WebMD. The news – that there is no known effective treatment for lactic acidosis – was not unexpected. (I did find a study that regular probiotics can cause it. Ouch! This is consistent with some conference reports, though, where a some ME/CFS MD’s have stated “I have seen no improvement from patients taking probiotics”).
A successful treatment is described in this PubMed article ; unfortunately the probiotics described are not available in the US and the high dosages of antibiotics suggested are unlikely to be acceptable to MD’s working with ME/CFS patients.
The antibiotics proposed bear a strong similarity to the protocols advocated by Cecile Jadin, MD and Phillipe Bottero, MD; both of which report over 70% remission rates. The treatment they used for lactic-acidosis was:
“The patient received kanamycin (Kanamycin Capsules, Meiji Seika Pharma, Tokyo, Japan) 1000 mg/d. … metronidazole (Flagyl, Shionogi & Co, Ltd, Osaka, Japan) 500 mg/d and kanamycin 2000 mg/d were administered for 5 days under fasting conditions. Polymyxin B (Polymyxin B Sulfate, Pfizer Japan Inc, Tokyo, Japan) 500 3 103 U/ d and vancomycin (Vancomycin Hydrochloride Powder, Lilly, Kobe, Japan) 1000 mg/d were administered over the subsequent 5 days. After the use of antibiotics, a purgative (Niflec, Ajinomoto Pharmaceuticals Co, Ltd, Tokyo, Japan) was used…..Overgrowth suppression was approached by starting synbiotics, specifically B breve Yakult (prepared by Yakult Co, Ltd, Tokyo, Japan) 3.0 g/d and L casei Shirota (Biolactis Powder, Yakult Co, Ltd, Tokyo, Japan) 3.0 g/d as probiotics, and galactooligosaccharide 8.4 g/d as a prebiotic.” 
A better understanding of lactic-acidosis can be obtained here .
- “Type A lactic acidosis—due to hypoperfusion and hypoxia—occurs when there is a mismatch between oxygen delivery and consumption, with resultant anaerobic glycolysis.”
- Ding ding ding! SPECT scans shows hypoperfusion in CFS patients. Coagulation (common with CFS ) causes hypoxia!
- Hyperbaric oxygen for CFS do show symptom improvement in many  
What to do?
After I posted the above information on my blog, a reader asked
“Hi Ken. How would you recommend proceeding if I can’t find a doctor willing to prescribe the Jadin Protocol or anything close to it. Do you think healing is possible with only OTC supplements and herbs? If so, where and how should I start. This is a lot of info to dissect and interpret and my brain fog is at all time crippling levels.”
My answer was “very probable” and the reason is simple: herbs, spices and probiotics have anti-viral, anti-fungal and antibiotics characteristics. In a few cases, they have found to be more effective against some species of bacteria than the strongest prescription antibiotics . The problem is identifying the best candidates to take. For example, you do not want to kill off E.Coli (which would make room for more lactic acid producing bacteria). Instead, you want to reduce the lactic acid producing bacteria.
In response to this comment, I did a series of posts looking at how to correct the gut bacteria dysfunction. Things I tried after finding research supporting them on PubMed and which appeared to work for me, or for others I know that have tried are included below. The different possible treatments are linked to blog posts for those who are interested.
|Diet and Food||A permanent change of eating habits|
|Spices and Herbs||Typically 2 weeks at high dosages and then rotate to other one|
|Cognitive Enhancements||Reducing cognitive impairments|
|Biofilm Breakers and Potenators||Getting the antibiotic herbs to the bacteria|
|Probiotics||Probiotics found effective for IBS in clinical trials, non/low lactic acid producing probiotics|
|An Example Regime|
Why is There Not a “Canned” Recipe?
The reason is simple, each person’s complement of gut bacteria is unique, more unique actually than their DNA (and more complex too!). When the gut flora goes bad, the mixture of bacteria strains found differs from person to person.
It’s possible that the heterogeneity in gut flora may contribute to the complex symptom picture found in ME/CFS. The lack of consistency in symptoms across ME/CFS drives drive researchers and MD’s mad! The microbiome model (gut bacteria), suggests this symptom heterogeneity is to be expected, however. It suggests we are not dealing with a single bacteria, but a shift of the entire population involving thousands, perhaps millions of strains.
A Ted Talks Gut Flora Overview
Using the herbs suggested above I would expect one person to improve cognitively from Tulsi with no Herx while another might herx from a half cup of Tulsi tea. Tulsi kills off many species of bacteria. Some will produce toxins that will result in a herx, others will die quietly.
Treating the gut flora is an art which requires systematically trying good candidate herbs and probiotics for a reasonable length of time and seeing if they cause change. If they cause a change, then they should be tried again — later – we want to keep rotating the antibiotic herbs and spices to prevent resistance from building up.
Check out more of Ken’s gut blogs here