ME/CFS & Chronic Infection of the Gut - Notes on Dr. Kenny De Meirleir's Presentation in Perth

November 17, 2007

ME/CFS & Chronic Infection of the Gut – Notes on Dr. Kenny De Meirleir’s Presentation in Perth

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by Blake Graham, BSc, AACNEM*ImmuneSupport.com11-11-2007 In a recent presentation at the University of Western Australia, Dr. Kenny De Meirleir, MD, PhD, explored evidence suggesting that the gut of 80% to 90% of ME/CFS patients may be compromised by bacterial and/or viral pathogen infections, discussed how these may contribute to immune activation, and outlined a range of therapies that may support significant improvements in various ME/CFS symptoms. Dr. De Meirleir is Professor of Physiology, Pathophysiology, Internal Medicine and Sports Medicine at Vrije Universiteit, Brussels, and Clinical Professor, University of Nevada Medical School, USA.

Following is a summary of Dr. De Meirleir’s presentation by Clinical Nutritionist Blake Graham, director of the Nutritional Healing clinic in Perth. It is reproduced with permission from Blake’s November 8 posting on the Co-Cure Listserv.

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Dr. Kenny De Meirleir's Lecture on ME/CFS - November 3, 2007

Dr. Kenny De Meirleir, MD, PhD, spoke in Perth, Western Australia on November 3, 2007 at a seminar sponsored by the ME/CFS Society (WA). Kenny has seen over 12,000 CFS patients and first became interested in CFS in 1989. His research team has performed over 4,000 in vitro experiments and published many peer reviewed articles on CFS. I attended both his talks to the general public and to health professionals, plus got the opportunity to ask a large number of questions after the professionals talk. The following is based on written notes and from memory, not directly quoting Kenny.

Gastrointestinal Problems More than 80% to 90% of patients have gastrointestinal symptoms. Gastrointestinal abnormalities range from one end of the gastrointestinal tract to the other.

n Saliva pH is low (below 7 - acidic) which leads to both dental problems and disturbed oral flora.

n Patients display delayed gastric emptying. n Biopsies of gastric mucosa on patients show all patients have atrophic gastritis [chronic inflammation of the stomach mucosa, or lining]. n When biopsy of the cecum is performed infiltration of lymphocytes is also found in all patients. [Lymphocytes are white blood cells with specialized immune functions. The cecum is a pouch where the small intestine transitions to the large intestine. Branching off from it is the small worm-like appendix.]

In Kenny's last 100 patients, a point [at] 2 cm right then 2 cm down from the umbilicus is tender after mild pressure. This is the point just above the cecum. Tenderness is a sign of imbalanced intestinal bacteria.

Intestinal Mucosal Health

Patients have a compromised gastrointestinal mucosal integrity which contributes to immune activation and is a major factor in CFS. The cause of intestinal barrier damage is multifactorial and complex. One factor is likely viruses (Epstein-Barr Virus and HHV-6). EBV attacks the immune system of the gut. Kenny has observed that a significant proportion of patients with CFS have relatives with Crohn's Disease. A genetic predisposition to gastrointestinal problems likely exists.

Intestinal Flora

Kenny routinely does a blood test for immunoglobulin A (IgA) and immunoglobulin M (IgM) [antibodies] for a range of intestinal bacteria - called the Immunobilan test.

He generally starts treatment with antibiotics to lower levels of problematic bacteria, then adds in probiotics. Kenny did a small study using the antibiotic ciprofloxacin and high quality probiotics. Patients reported a 58% improvement and elastase dropped 74%.

Kenny most commonly uses a high potency multi-strain probiotic called VSL#3 (http://www.vsl3.com), which contains 450 billion bacteria per serve. Normal probiotics contain 25 billion or less. It mimics the bacteria normally present in the bowel. He also uses MutaflorR, which is a supplement of healthy intestinal Escherichia coli (E. coli) bacteria. At present this product is only available directly from Germany where it is it produced (http://www.metpharmacy.de).

Fructose Malabsorption and Lactose Intolerance

In a study of 143 patients, fructose malabsorption was found in 45.8% of patients. Lactose intolerance was found in 20.3%. Both can be measured via a simple hydrogen breath test:

n 25 grams of fructose or lactose is administered to a fasting patient. n Breath hydrogen levels are measured before administration and at 30 minute intervals for 3.5 hours.

Sugar malabsorption contributes to intestinal dysbiosis (bacterial imbalance), among other issues. Fructose malabsorption is treated with a fructose poor diet, while lactose intolerance is treated with a lactose free diet. A high baseline hydrogen breath measurement indicates intestinal bacterial overgrowth.

Clinicians can buy the equipment to do the fructose and lactose breath testing in their offices. Kenny believes these intolerances were present before the illness onset, acting as a predisposing factor and may also get worse after illness onset. He observes these issues are often present in family members. Common associations with fructose malabsorption are:

Fatty liver. Most patients with fatty liver have fructose malabsorption. Steatorrhea (fat in the stool/fat malabsorption). Constipation. Whereas those with lactose intolerance are more likely to have diarrhea. Hypoglycemia. Most patients with significant hypoglycemia have fructose malabsorption. [Hypoglycemia occurs when blood sugar drops too low to provide enough energy for the body’s activities.] Sensitivity to tyramine. [A compound that is produced as the amino acid tyrosine breaks down and is found in many foods, especially aged cheese, all nuts, and dried, fermented, salted, smoked or pickled foods.] Bloating.

Gluten Intolerance

Gluten intolerance is also found in a subset of patients. He uses immunoglobulin G (IgG) blood testing for testing gluten sensitivity. Sensitivity to gluten is a spectrum with celiac disease at one end and normal tolerance at the other, rather than tolerance being an all or nothing issue. A range of different levels of sensitivity exist.

Diet

Kenny's patients consult with his dietitian. A diet is created based on tolerance to fructose, lactose and gluten. He recommends patients drink 3 to 4 liters of water a day. [slightly more than 3 to 4 quarts.] Continue reading:

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