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Probiotics and Chronic Fatigue Syndrome

Chronic fatigue syndrome  

Chronic fatigue syndrome (CFS) is a debilitating clinical condition characterised by unexplained persistent and relapsing fatigue worsened by physical and mental stress.1 CFS is usually accompanied with neuropsychological disturbances such as headaches, myalgia and cognitive difficulties including impaired memory and concentration, and unrefreshing sleep.2 CFS patients also tend to experience mood changes, typically associated with major depressive disorder and anxiety disorder.2 As reported by over 40% of CFS patients, these changes include altered appetite, shortness of breath, dizziness, heart palpitations, and poor sleep quality.3 Thus, CFS impacts the ability to perform daily activities, affecting the quality of life of those suffering from it. Currently, there is no known cure for CFS and there is still a major gap in understanding the pathogenesis of CFS.1  

How does the intestinal microbiome affect chronic fatigue syndrome?  

Despite CFS not being inherently a gastrointestinal disorder, CFS patients often experience gastrointestinal disturbances, including abdominal pain or discomfort and bowel dysregulation.1,3,4 In fact, CFS patients are more likely to report a previous diagnosis of irritable bowel syndrome (IBS), a common intestinal disorder associated with diarrhoea, bloating, and constipation.1,3,4 A high prevalence of CFS patients also meet the Manning diagnostic criteria for IBS and experience IBS symptoms.1–3,5 Although the pathogenesis of CFS remains unclear, these findings suggest that the underlying cause of CFS cannot be limited to an organ, such as the brain, but may be related to an integrating system such as the gut-brain axis.1 Some studies have found that CFS patients have an altered intestinal microbiome with decreased levels of the beneficial Bifidobacteria and increased levels of potentially harmful aerobic bacteria, contributing to the IBS-related symptoms.3,5  

The role of probiotics in chronic fatigue syndrome  

There are probiotic strains that could have a positive benefit in CFS patients. A systematic review (2018) displayed the probiotic strains Lacticaseibacillus paracasei Shirota strain (LcS) and Bifidobacterium infantis 35624, respectively, decreased anxiety levels, improved the intestinal microbiome composition, and reduced inflammatory biomarkers that may be related to CFS.6 While this study does not specifically explore the effect of probiotic supplementation on bowel function, other studies have shown that the LcS strain is able to regulate bowel function, decrease constipation, reduce small intestinal bacterial overgrowth (SIBO), and assists in the passage of gas in patients with IBS.7,8 SIBO is a condition where the proximal part of the small intestine contains >105 bacteria per ml of intestinal juice and is experienced by 77% of CFS patients as reported by researchers from the Cedars-Sinai Medical Center in Los Angeles.5 SIBO results in similar symptoms to IBS including abdominal pain, gas, bloating, and altered bowel functions. Hence, the correction of SIBO is crucial in alleviating the discomfort of CFS. In fact, studies have found that the correction of SIBO, along with intestinal permeability, is correlated with improved symptoms in CFS.10,11 

In summary, the relationship between CFS and the intestinal microbiome yields promising insights into potential interventions. However, due to the complex nature of CFS, continued research and a deeper understanding are essential to support effective probiotic use.  This understanding will serve as the foundation for the development of targeted approaches that specifically address the intestinal microbiome’s role in managing and alleviating CFS symptoms, reducing the burden it places on affected individuals.  

References

  1. Lakhan, S. E., & Kirchgessner, A. (2010). Gut inflammation in chronic fatigue syndrome. Nutrition & Metabolism, 7, 1-10. 
  1. Hotopf, D. M., & Sharpe, D. M. (1998). Chronic Fatigue and Its Syndromes. Oxford University Press. 
  1. Rao, A. V., Bested, A. C., Beaulne, T. M., Katzman, M. A., Iorio, C., Berardi, J. M., & Logan, A. C. (2009). A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathogens, 1(1), 1-6. 
  1. Aaron, L. A., Burke, M. M., & Buchwald, D. (2000). Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Archives of Internal Medicine, 160(2), 221–227. https://doi.org/10.1001/archinte.160.2.221 
  1. Logan, A. C., Venket Rao, A., & Irani, D. (2003). Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value. Medical Hypotheses, 60(6), 915–923. https://doi.org/10.1016/s0306-9877(03)00096-3 
  1. Corbitt, M., Campagnolo, N., Staines, D., & Marshall-Gradisnik, S. (2018). A systematic review of probiotic interventions for gastrointestinal symptoms and irritable bowel syndrome in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Probiotics and Antimicrobial Proteins, 10, 466-477. 
  1. Koebnick, C., Wagner, I., Leitzmann, P., Stern, U., & Zunft, H. J. (2003). Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation. Canadian journal of gastroenterology = Journal Canadien De Gastroenterologie, 17(11), 655–659. https://doi.org/10.1155/2003/654907 
  1. Barrett, J. S., Canale, K. E., Gearry, R. B., Irving, P. M., & Gibson, P. R. (2008). Probiotic effects on intestinal fermentation patterns in patients with irritable bowel syndrome. World Journal of Gastroenterology, 14(32), 5020–5024. https://doi.org/10.3748/wjg.14.5020 
  1. Pimentel, M., Hallegua, D., Chow, E. J., Wallace, D., Bonorris, G., & Lin, H. C. (2000). Eradication of small intestinal bacterial overgrowth decreases symptoms in chronic fatigue syndrome: a double blind, randomized study. Gastroenterology, 4(118), A414. 
  1. Barrett, J. S., Canale, K. E., Gearry, R. B., Irving, P. M., & Gibson, P. R. (2008). Probiotic effects on intestinal fermentation patterns in patients with irritable bowel syndrome. World Journal of Gastroenterology, 14(32), 5020–5024. https://doi.org/10.3748/wjg.14.5020 
  1. Maes, M., & Leunis, J. C. (2008). Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria. Neuro Endocrinology Letters, 29(6), 902–910.