A systematic review of enteric dysbiosis in chronic fatigue syndrome/myalgic encephalomyelitis.

BACKGROUND: Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is an illness characterised by profound and pervasive fatigue in addition to a heterogeneous constellation of symptoms. The aetiology of this condition remains unknown; however, it has been previously suggested that enteric dysbiosis is implicated in the pathogenesis of CFS/ME. This review examines the evidence currently available for the presence of abnormal microbial ecology in CFS/ME in comparison to healthy controls, with one exception being probiotic-supplemented CFS/ME patients, and whether the composition of the microbiome plays a role in symptom causation. METHODS: EMBASE, Medline (via EBSCOhost), Pubmed and Scopus were systematically searched from 1994 to March 2018. All studies that investigated the gut microbiome composition of CFS/ME patients were initially included prior to the application of specific exclusion criteria. The association between these findings and patient-centred outcomes (fatigue, quality of life, gastrointestinal symptoms, psychological wellbeing) are also reported. RESULTS: Seven studies that met the inclusion criteria were included in the review. The microbiome composition of CFS/ME patients was compared with healthy controls, with the exception of one study that compared to probiotic-supplemented CFS/ME patients. Differences were reported in each study; however, only three were considered statistically significant, and the findings across all studies were inconsistent. The quality of the studies included in this review scored between poor (< 54%), fair (54-72%) and good (94-100%) using the Downs and Black checklist. CONCLUSIONS: There is currently insufficient evidence for enteric dysbiosis playing a significant role in the pathomechanism of CFS/ME. Recommendations for future research in this field include the use of consistent criteria for the diagnosis of CFS/ME, reduction of confounding variables by controlling factors that influence microbiome composition prior to sample collection and including more severe cases of CFS/ME.

Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review.

BACKGROUND: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is characterised by unexplained fatigue for at least 6 months accompanied by a diverse but consistent set of symptoms. Diet modification and nutritional supplements could be used to improve patient outcomes, such fatigue and quality of life. We reviewed and discussed the evidence for nutritional interventions that may assist in alleviating symptoms of CFS/ME. METHODS: Medline, Cinahl and Scopus were systematically searched from 1994 to May 2016. All studies on nutrition intervention were included where CFS/ME patients modified their diet or supplemented their habitual diet on patient-centred outcomes (fatigue, quality of life, physical activity and/or psychological wellbeing). RESULTS: Seventeen studies were included that meet the inclusion criteria. Of these, 14 different interventions were investigated on study outcomes. Many studies did not show therapeutic benefit on CFS/ME. Improvements in fatigue were observed for nicotinamide adenine dinucleotide hydride (NADH), probiotics, high cocoa polyphenol rich chocolate, and a combination of NADH and coenzyme Q10. CONCLUSIONS: This review identified insufficient evidence for the use of nutritional supplements and elimination or modified diets to relieve CFS/ME symptoms. Studies were limited by the number of studies investigating the interventions, small sample sizes, study duration, variety of instruments used, and studies not reporting dietary intake method. Further research is warranted in homogeneous CFS/ME populations.

Muscle and plasma coenzyme Q10 concentration, aerobic power and exercise economy of healthy men in response to four weeks of supplementation.

AIM: To investigate whether 4 weeks of oral supplementation with coenzyme Q10 (CoQ10) would increase its concentration in skeletal muscle, and affect aerobic power (VO2max) and oxygen consumption during submaximal exercise in healthy, physically active men. METHODS: Six volunteers with an average (+/-SD) age of 29.7+/-7.2 years and VO2max of 39.4+/-8.5 mL.kg-1.min-1, participated in a single-blind trial. The experiment consisted of 4 2-week phases, in the order of placebo run-in, CoQ10 supplementation (150 mg daily), CoQ10 (150 mg) plus vitamin E (1,000 IU daily), and placebo wash-out. A three-stage cycle economy test (4 minutes at each of 50, 100, and 150 watts), followed by a VO2max test (25 watts increment every minute till exhaustion), were performed prior to the supplementation and at the end of each phase. Blood samples were taken pre and post each VO2max test, and biopsy samples were obtained from the vastus lateralis muscle pre and post the 4 weeks of CoQ10 supplementation. RESULTS: The plasma CoQ10 concentration was significantly elevated by the supplementation (P<0.05), however, it did not vary significantly pre and post each exercise test (P>0.05). The muscle CoQ10 concentration, VO2max ventilatory threshold, exercise economy and oxygen deficit showed no significant changes in response to the supplementation. CONCLUSION: It was speculated that the non-significant effects of supplementation in healthy, non CoQ10-deficient men could be due to either that the mitochondrial membrane is normally saturated with CoQ10, or that the selected exercise testing protocol and variables were not sensitive enough to detect the effects.