Gut Inflammation in Chronic Fatigue Syndrome

Shaheen E Lakhan; Annette Kirchgessner

Disclosures

Nutr Metab. 2010;7(1) 

In This Article

Therapeutic Restoration of Mucosal Barrier Function

Since altered intestinal microbiota and gut barrier dysfunction barrier are found in CFS,[18] they offer potential targets for intervention that would include modulation of the gut microbiota to correct an imbalance, as well as tightening of interepithelial junctions. Enhancement of barrier function by probiotic bacteria has been observed in both in vitro models and in vivo animal models.[51]

Probiotics are live microorganisms with a vast array of therapeutic potential for GI disease. They have a beneficial effect on the intestinal mucosa via several proposed mechanisms that include inhibition of the mucosal adhesion of pathogens, improvement of the barrier function of the epithelium, and alteration of the immune activity of the host. They may also regulate intraluminal fermentation and stabilize the gut microbiota.[39] In addition, probiotics have recently emerged as promising adjunctive therapy in treating IBS, with B. infantis becoming the frontrunner for treatment (for review see [52]).

Probiotic bacteria are Lactobacilli spp., certain types of Streptococcus, and Bifidobacteria spp., but also other non-pathogenic bacilli such as E. coli-Nisle 1917 and yeasts such as Saccharamyces boulardii. They secrete short chain fatty acids, an action that results in decreased luminal pH and production of bactericidal proteins. Butyric acid, a byproduct of bacterial fermentation of fiber, has been shown to nourish colonic enterocytes, enhancing mucosal integrity.[53] In addition, probiotics may improve bowel dysmotility.[53]

Researchers have demonstrated the utility of probiotics for mood regulation in CFS patients.[54] Administration of Lactobacillus casei strain Shirota (LcS; 24 billion cfu/day) to adult patients meeting the formal diagnostic criteria for CFS, was found at eight weeks to cause a significant rise in both Lactobacillus and Bifidobacteria in those taking the LcS and there was also a significant decrease in anxiety symptoms.[54] The elevation of Bifidobacteria levels should be considered a positive finding, particularly when considering that Bifidobacteria levels may be low in CFS.[18]

Bifidobacteria appear to play an important role in maintaining the gut barrier. An increase in Bifidobacteria in ob/ob mice was associated with a significant improvement of gut permeability measured in vivo; this improvement was linked to an increase in tight junction mRNA expression and protein distribution.[47] In addition, the rise in Bifidobacteria was correlated with a decrease in plasma LPS concentrations; therefore, a significant reduction in markers of oxidative and inflammatory stress.[47]

Bifidobacterium infantis can boost serotonin levels in areas of the brain associated with anxiety and depression. Improvements in anxiety scores among those CFS patients consuming LcS bacteria are especially noteworthy.[54] The idea that implanting the gut with Lactobacillus strains may improve quality of life and mental health is not a new one. Dr. George Porter Phillips first reported in 1910 that although Lactobacillus tablets and powder were ineffective, a gelatin-whey formula with live lactic acid-producing bacteria improved depressive symptoms in adults with melancholia.[55] Overall, probiotics will likely have an emerging therapeutic role in treating CFS.

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