Dysbiosis – The condition that results when the natural flora of the gut are thrown out of balance
The gut has not received alot of research in either fibromyalgia or chronic fatigue syndrome but it’s becoming more and more clear that the gut is a player and the only question is how big of a role it plays.
Gastrointestinal symptoms and IBS-like syndromes are common in both disorders. Tegaserod’s ability to relieve IBS symptoms, fibromyalgia symptoms and reduce tender points in fibromyalgia suggested gastrointestinal issues were effecting more than the gut in FM. A Spanish study found that no less than 98% of FM patients had at least one ‘functional gastric disorder’.
Giardia has been confirmed as a cause of chronic fatigue syndrome and enteroviruses were readily found in ME/CFS patients guts. Dr. Mady Hornig focused heavily on the gut and its role in disorders like autism and ME/CFS in her presentation at NSU. Gut inflammation has been proposed to play a major role in the disorder and probiotics increased neurocognitive functioning in one small study.
CAA Gut Webinar Coming Up
We’re going to learn alot more about gut flora and chronic fatigue syndrome in two weeks when the CFIDS Association of America’s releases the result’s of Shukla’s microbiome pilot study on a webinar on` May 2nd. As we get ready for that we’re going to use a series of fascinating review papers that chart how the medical communities view of gut flora and its effects on our health have changed over time. As a bit of an extra added bonus two of the authors, Dr. Alison Bested and Dr. Alan Logan, have long been associated with chronic fatigue syndrome. Dr. Bested has written several books on ME/CFS and she now runs the Chronic Complex Disease Clinic in Vancouver focused on ME/CFS/FM.
Lessons From Medical History
The authors aren’t just reviewers, they’re actually pioneers in the field of gut manipulation and disease. Logan’s seminal 2005 paper suggesting probiotics could be helpful in the treatment of depression interrupted seventy years of silence on the subject. It turns out that manipulating the gut flora to fight neurasthenia (an old name for CFS), depression and other disorders found favor in the medical community over 70 years ago, but was ultimately discarded, largely due to the efforts of one forceful physician. Only in the past ten years has gut flora re-entered the medical community as a serious subject and it’s done so with a vengeance with the number of studies exploding.
The gut flora story is a a fascinating look at how medical ignorance and prejudice can cause a promising field to basically disappear and how persistence caused it to reappear again. The basic question the medical community has been grappling with for over a hundred years is how important the gut flora and gut integrity are not just to abdominal health but to our health as a whole. The answers to that question have changed radically over time. Let’s take a look.
Bested et al. Gut Pathogens 2013, 5 :5 http://www.gutpathogens.com/content/5/1/5,
Alison C Bested, Alan C Logan, and Eva M Selhub. Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part I – autointoxication revisited
We’re dealing with two broad issues; the leakage of toxins out of the gut into the bloodstream and the composition of the gut flora itself.
We have to reach way back to the 1860’s to find the first medical practitioners suggesting that leakage out of the colon into the blood stream could cause problems. Calling the colon ‘a receptacle and laboratory of poisons’ Bouchard argued that chemical byproducts of decomposition, if released into the bloodstream, could cause many different types of disorders. Bouchard proposed that inadequate levels of stomach acid, inflammation, influenza and other disorders and ‘nervous excitement’ could degrade the colon allowing toxins to escape into the bloodstream.
By the early 1900’s the colon, with its teeming masses of bacteria was capturing a lot of attention. Although some researchers considered it the birthing place of a wide variety of ailments, they were most interested in guts ability to cause fatigue, pain and mood altering disorders through a process 0f gut leakage called ‘autointoxication’.
They are the cases that present …malaise, total lack of ambition so that every effort in life is a burden, mental depression often bordering upon melancholia, frequent attack s of indefinite abdominal pains due to flatulency, sudden attack s of acute diarrhea alternating with periods of constipation…A battle royal must be fought and when this first great struggle ends in a victory for the Bacillus bulgaricus it must be kept on the field of battle forever at guard .. .’
Around this time, Sir Anthony Lane, a well-known British surgeon asserted bacterial overgrowth was a major cause of problems. The symptoms he charted – indigestion, abdominal pain, constipation alternating with diarrhea, malaise, incapacity for prolonged exertion of any type, insomnia and depression – fit closely enough to another puzzling disorder called neurasthenia, for Lane and other to become convinced they were the same and that the root of each was ‘colon toxicity’.
Jankelson nailed the outlines of what would later become called small intestinal bacterial overgrowth (SIBO), with his description of excessive bacterial fermentation, which he called ‘enteros-thenia’. He too believed enteros-thenia and neurasthenia were closely connected and proclaimed enteros-thenia commonly preceded neurathenia.
Cutting for Good Health
Surgeon that he was Lane turned to surgery to remove the bacterial pockets of putrefaction he believed were causing fatigue, mental illness and malaise. Lane was convincing enough that surgery came, for a time, to become a popular treatment option for neurasthenia, despite death rates that would be intolerable today. Believing that small pockets of infection were driving both physical and mental symptoms surgeons began hacking away at neurasthenia patients so readily that one physician reported that colon surgery was being recommended ‘for relatively trivial symptoms’.
An obsessive search for life altering pockets of infection came to a head at the office of American physician, Dr. Henry Cotton, who extracted thousands of teeth and did hundreds of colectomies in his effort to cure mental disorders at mental hospital in New Jersey. Cotton asserted he had high cure rates (statistics lost) but neglected to report a staggering 30% mortality rate. One of the first controlled studies in the history of psychology which involved removing the tonsils and an average of 5 teeth per patient in a mental institution eventually put an end to Cotton’s claims.
Physicians preferring a less invasive approach began using lactic acid bacteria to combat ‘autointoxication’ in the 1910’s and lactobacillus products gained in popularity over the next couple of decades. Investigations in gut flora manipulation indicated that fatigue, diet, bacteria, stress and carbohydrate intolerance could all generate bacterial overgrowth problems.
By the 1920’s researchers were taking bacteria from the stools of healthy people and transplanting them via enemas into the colons of neurasthenic and arthritis patients. In New York Satterlee reported that his injections of up to 300 million bacterial units in his ‘colon vaccines’ indicated to him that ‘disturbances of the gastro-intestinal system are more often the cause of nervous symptomatology than the result of a diseased nervous system’ .
The Gut Bloom Wilts
When small studies did not bear out improvement in mood and fatigue symptoms after lactobacillus supplementation and a backlash grew against an ever increasing commercialization of probiotic products (many of which did not have significant amounts of active lactobaccillus in them) and strange colonic practices, the gut flora theory was due for a fall.
In the end one vociferous critic, Dr. Walter Alvarez of the University of California, San Francisco, took down the theory of auto-intoxification with studies suggesting that distention of the colon caused by constipation was causing the fatigue and mood issues present. As many studies were in those days, Alvarez’s studies were full of holes (although recent IBS studies suggest his theory did have merit) but his timing and force of personality lead Alvarez to prevail and the idea that the gut flora playeda significant role in health disappeared.
A bit of a crank, Alvarezent on to suggest such things as attractive women with large breasts were more susceptible to migraines and rued the fact that antiobiotics were keeping alive hundreds of thousands of people who were nothing but a ‘drain on the community’, but such idiosyncracies – more common at that time – didn’t matter; the idea that gut flora could cause disease was laid to rest for over 70 years and as with ulcers gut disturbances because associated with stress, poor coping mechanisms and were often left to the realm of Freudian psychologists.
As late as the 1970’s a leading gastrointestinal textbook explained away carbohydrdate intolerance as being the province of ‘essentially unhappy individuals’, and in 1989 physicians writing in the Journal of Clinical Gastroenterology explained away the idea of gut flora causing disease as the result of conflicts over toilet training.
Not until 2003 with the publication of Logan’s seminal paper suggesting that microbe administration might be helpful in the treatment of fatigue and mood disorders was the topic broached again in medical journals. Times had changed and by 2012 a review in a leading psychological journal now suggested Logan and his predecessors of 100 years earlier were on the right track.
‘Logan and Katzman first proposed the use of probiotics as adjunct therapy in the management of depression. Since then there has been an accumulation of data from both clinical and preclinical studies supporting the view that probiotics may have a role in the treatment of depression”
Logan’s groundbreaking paper on gut manipulation to treat depression came out in 2005, but his first paper on gut manipulation to treat disease was on none other than chronic fatigue syndrome in 2003 (“Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value”).
Next up we check out how medical sciences understanding of gut flora has changed over the past 10 years and how that might impact the understanding and treatment of (chronic fatigue syndrome) ME/CFS.