Beware! Chronic fatigue syndrome may bring big trouble! Check to see if you are affected →

Have you ever been extremely tired in your life, and even rest and sleep can't eliminate the fatigue? It's not that you are too lazy or too depressed, it may be that you are really sick.

01

Chronic fatigue syndrome has complex causes

There is currently no effective treatment

There is a medical condition called chronic fatigue syndrome (CFS), in which patients experience extreme fatigue that lasts for at least 6 months without any underlying medical illness.

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This fatigue worsens with physical or mental activity but does not improve after rest, and is accompanied by symptoms such as depression, headache, gastrointestinal disorders, and allergies.

The disease is also called myalgic encephalomyelitis (ME) , sometimes abbreviated to ME/CFS, and a more recent term is systemic exertion intolerance disorder (SEID) .

Chronic fatigue syndrome not only affects mood, social interaction, and work efficiency, but is also prone to stroke, autoimmune diseases, etc. Unfortunately, there is no particularly effective treatment for chronic fatigue syndrome, and there is not even any symptomatic medicine. The only way to alleviate the symptoms is through auxiliary means such as conversation and exercise.

In order to develop treatments for chronic fatigue syndrome, the cause must be found. The causes of chronic fatigue syndrome are very complex, and viral infections, immune system disorders, hormonal imbalances, malnutrition, stress trauma, etc. may all be the culprits of chronic fatigue syndrome.

02

New research finds

Chronic fatigue syndrome may be linked to butyrate deficiency

Scientists collected and analyzed blood, feces and other samples from patients, looking for differences between chronic fatigue syndrome patients and healthy people in the complex data, and what is the key to the disease. They found:

① Patients with chronic fatigue syndrome have abnormal states of multiple immune cells[1]. For example, the number of pro-inflammatory cells is higher, which puts the body in a state of chronic inflammation. The number of natural killer cells that are responsible for cleaning up "garbage" in the body decreases, causing necrotic cells to accumulate in the body.

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② Patients with chronic fatigue syndrome also have abnormal metabolism [1]. Each of our cells is like a small factory, processing hundreds of "products". Key nutrients such as amino acids, lipids, sugars, adenosine, etc. are constantly assembled, decomposed, processed, and transformed in cells every minute and every second, just like a complex production line. From raw materials to products, every step is important. This complex process is metabolism.

Different cells show their own specific functions in the metabolic process, such as replication, movement, signal exchange, etc. Scientists have found that 80% of the "production lines" of patients with chronic fatigue syndrome have lower production capacity than healthy people, and the production is not active. Cell energy and metabolites are insufficient, and the function is definitely impaired.

③The intestinal flora of patients with chronic fatigue syndrome is disordered, and the intestinal epithelial cells of these patients are often more fragile, making them prone to intestinal problems such as enteritis.

A recent article published in the journal Cell Host & Microbe found that patients with chronic fatigue syndrome lack key intestinal bacteria that synthesize butyrate: Faecalibacterium prausnitzii and Eubacterium rectale[2]. Moreover, the lack of these intestinal bacteria occurs in the early stages of chronic fatigue syndrome patients, which may serve as an early detection indicator of the disease.

It can be seen that the state of immune cells, human metabolism, and intestinal flora disorders all have an impact on chronic fatigue syndrome. But why do intestinal bacteria, which seem to have nothing to do with fatigue, also get involved? Why is butyrate in the intestine related to fatigue?

Butyrate is a type of short-chain fatty acid and is currently widely recognized as a metabolite that is beneficial to health. Butyrate can promote the regeneration of intestinal epithelial cells, ensure the integrity of the intestinal epithelium, and protect against the invasion of toxins and pathogens.

In addition, butyrate can also reduce inflammation in the intestines and excite macrophages, which are the "patrol police" in the intestines. Excited macrophages can more effectively resist the invasion of bacteria and viruses [3].

Butyrate is also an important source of energy for cells. 70% of the energy for intestinal cells comes from butyrate[4].

Although butyrate is important, it cannot be synthesized by our human body.

Butyrate is a fermentation product of carbohydrates such as cellulose and starch. These carbohydrates are not only difficult to digest, but we do not have the enzymes to decompose them, so we can only rely on intestinal flora to decompose and ferment them. Moreover, not all intestinal flora have the ability to ferment cellulose. Only a few bacteria such as Faecalibacterium prausnitzii, Ruminococcus bromorum, and Eubacterium rectum can do it.

Butyrate has a wide range of effects in our body. Although butyrate is produced by intestinal flora in the intestinal cavity, it can easily pass through intestinal epithelial cells and enter the blood circulation throughout the body.

Moreover, most cells recognize butyrate and have butyrate receptors on their surfaces that can bind to butyrate and are affected by it. Therefore, many diseases such as diabetes, obesity, and neurological diseases are related to the butyrate content in our bodies.

03

How to relieve chronic fatigue syndrome?

Some clinical trials are underway

Knowing the functions and processing methods of butyrate, it is not difficult to see how important the intestinal flora that synthesizes butyrate is to our health. So will supplementing this type of bacteria or supplementing butyrate help alleviate the symptoms of chronic fatigue syndrome?

Currently, with the cooperation of scientists and clinicians, a number of clinical trials on changing diet or supplementing prebiotics have been launched, including supplementing patients with chronic fatigue syndrome with fiber-rich foods, fermented foods, coenzyme Q10, and chocolate rich in cocoa polyphenols [5].

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Changes in diet have indeed shown the effect of improving symptoms and are expected to be promoted among patients as an auxiliary treatment.

In addition, clinical data on the supplementation of patients with probiotics or fecal microbiota therapy are also very encouraging. Probiotics or fecal microbiota transplantation can restore the homeostasis of the intestinal flora and lead to significant long-term improvements in energy and physical fitness in more than half of the patients [6-8].

Of course, the use of probiotics to treat chronic fatigue syndrome still requires more data from large-scale clinical trials and needs to be continuously optimized before it can be transformed into a drug.

But after reading this article, I believe everyone has realized the importance of butyrate.

We can eat more fiber-rich foods, such as whole grains, vegetables, fruits, nuts and beans. This is the most effective way to increase butyrate and other short-chain fatty acids. It is also beneficial to improve the composition of intestinal flora and help us live energetically and healthily!

References:

[1]Tomas C, Newton J. Metabolic abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a mini-review. Biochem Soc Trans. 2018;46(3):547-553.

[2]Guo C, Che X, Briese T, et al. Deficient butyrate-producing capacity in the gut microbiome is associated with bacterial network disturbances and fatigue symptoms in ME/CFS. Cell Host Microbe. 2023;31(2):288-304.e8.

[3]J. Schulthess, S. Pandey, M. Capitani, et al., The short chain fatty acid butyrate imprints an antimicrobial program in macrophages. Immunity, 50 (2019), pp. 432-445.e7, 10.1016/j.immuni.2018.12.018

[4]JG LeBlanc, F. Chain, R. Martín, et al., Beneficial effects on host energy metabolism of short-chain fatty acids and vitamins produced by commensal and probiotic bacteria. Microb. Cell Fact., 16 (2017), p. 79.

[5]Campagnolo, N., Johnston, S., Collatz, A., et al., Dietary and Nutrition Interventions for the Therapeutic Treatment of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review. J. Hum. Nutr. Diet. 2017, 30, 247–259.

[6]Sullivan, Å., Nord, CE & Evengård, B. Effect of supplement with lactic-acid producing bacteria on fatigue and physical activity in patients with chronic fatigue syndrome. Nutr J 8, 4 (2009).

[7]Borody, TJ, Nowak, A., Finlayson, S. The GI Microbiome and Its Role in Chronic Fatigue Syndrome: A Summary of Bacteriotherapy. ACNEM J. 2012, 31, 3–8.

[8]Borody, T. Bacteriotherapy for Chronic Fatigue Syndrome: A Long-Term Follow up Study. In Proceedings of the 1995 CFS National Consensus Conference; 1995.

This article is a work supported by Science Popularization China Starry Sky Project

Author: Zhao Bei, popular science creator

Review | Wang Qiang, deputy chief physician, Department of Gastroenterology, Peking Union Medical College Hospital

Produced by: Science Popularization Department of China Association for Science and Technology

Producer｜China Science and Technology Press Co., Ltd., Beijing Zhongke Xinghe Culture Media Co., Ltd.

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