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Does ME/CFS have the same symptoms as d-lactic acidosis?

Discussion in 'The Gut: De Meirleir & Maes; H2S; Leaky Gut' started by Glynis Steele, Jan 10, 2011.

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Does ME/CFS have the same symptoms as d-lactic acidosis?

  1. Severe lethargy

    35 vote(s)
    85.4%
  2. Impaired conscious level

    32 vote(s)
    78.0%
  3. Slurred speech/Difficulty in Speaking

    23 vote(s)
    56.1%
  4. Confusion/Disorientation

    28 vote(s)
    68.3%
  5. Headache

    25 vote(s)
    61.0%
  6. Weakness

    34 vote(s)
    82.9%
  7. Irritability

    28 vote(s)
    68.3%
  8. Inability to Concentrate

    33 vote(s)
    80.5%
  9. Ataxia/Gait Disturbance

    20 vote(s)
    48.8%
  10. Nausea

    17 vote(s)
    41.5%
Multiple votes are allowed.
  1. Glynis Steele

    Glynis Steele Senior Member

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    CFS/D-lactic symptom overlap

    As the symptoms of CFS and D-lactate encephalopathy, or d-lactic acidosis are said to be strikingly familiar, according to the De Meirleir study, I have created a poll, which lists symptoms of d-lactic acidosis. Please tick any boxes which apply to your CFS symptoms.

    Thank you

    Glynis

    This is a new poll (I had not set up the first one as it should have been, sorry).
    Fogbuster likes this.
  2. Enid

    Enid Senior Member

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    It is working now - many thanks - multiple choices allowed.
  3. Enid

    Enid Senior Member

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    Glynis - can't help noticing (though not too many yet) impaired consciousness and slurred speech not too well represented yet - something else at work?
  4. Glynis Steele

    Glynis Steele Senior Member

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    Hi Enid,

    Thanks for your interest. I think most will be relevant, but at different times. Also there were other dla symptoms I could have added, but the poll only allows for 10boxes. Could also have had blurred vision, aggressiveness, abusive behaviour, anger, the feeling of being drunk in the absence of alcohol, teeth grinding, stupor and more. I know when a short bowel patient presents with dla, they will not have all the symptoms. I could also have asked folk if they had improved neurologically whilst on antibiotics. In dla, the GI sometimes has to play around to get the right antibiotics, depending on whether there is already resistance. Some dla sufferer's need an ongoing treatment, to keep the dla at bay. Some respond to low carb diets, while some need IV sodium bicarbonate.

    It's such a shame that dla is only taught to GI's though. Imagine if a dr who has known a patient for years and has seen them well, were to be presented with a similar list of symptoms, in that same patient. Makes you think. I've read the KDM study again recently, and wonder whether a dr would be prepared to order a stool test, as a place to start, specifically looking for an overgrowth of dla producing bacteria. If the sample did show a higher degree of d-lactic acid producing bacteria, and they were more aware of the symptoms of dla, they might investigate further. Then again.... probably not :-(. The patient should then be referred to a GI, who could test, monitor and treat the dla.

    Hopefully, more people will respond and do the poll, maybe add other symptoms as above. We'll see.

    Best Wishes

    Glynis
  5. Emootje

    Emootje Senior Member

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    Hi Glynis Steele,

    Thanks for all your posts concerning D-lactate. Very interesting!
    I was wondering what's your opinion on treating D-lactate acidosis with a low fiber diet?
    (soluble fiber raises acidresistant colonic bacteria and they promote the production of short-chain fatty acids and lactate)

    Emootje
  6. Glynis Steele

    Glynis Steele Senior Member

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    Hi Emootje,

    I'm glad you find the possible link between CFS and dla of interest. I don't know about self treatment, dla is seen to be a serious condition, and should be immediately referred to a GI, for monitoring and treatment, at least in short bowel patients. I know once the d-lactate is eliminated, sometimes a low carb diet is recommended, after antibiotic treatment, and in some cased sodium bicarb IV or orally. With antibiotic treatment, it is a matter of finding the correct ones, as bacteria are sometimes found to be resistant, so the GI might have to either test which ones are usable, or play around until they find one that works and the d-lactate returns to normal limits. It seems each patient is unique.

    Regards

    Glynis
  7. Glynis Steele

    Glynis Steele Senior Member

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    Hi again Emootje,

    I noticed your tags at the bottom of your page which mention low blood volume, and thought I'd give you this link, which may interest you. The patient in this case had a short bowel due to Crohn's and developed dla. He was suspected of having mild hypovolemia, which might explain why this is seen in some CFS patients. He also took b12, which I gather can help CFS symptoms.

    http://findarticles.com/p/articles/mi_7490/is_20100223/ai_n52343599/

    Hope it's useful.

    Glynis
  8. ggingues

    ggingues $10 gift code at iHerb GAS343 of $40

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    What are the syptoms of d-lactic acidosis? Also, I don't think you meant to have the title as CFS instead of CF, correct?

    GG
  9. Glynis Steele

    Glynis Steele Senior Member

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    Hi GG

    All of symptoms listed in the poll are actually symptoms of d-lactic acidosis, as are the ones I have added to this thread in an earlier post. I kept the title shorter, as I did not know how much space I had when I set the poll up, it should have read Chronic Fatigue Syndrome, sorry for any confusion.

    Glynis
  10. Emootje

    Emootje Senior Member

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    Great article - thank you very much.
  11. ukxmrv

    ukxmrv Senior Member

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    Does D-latic acidosis cause sore throats, glands and flu like symptoms? PEM? Can it occur in epidemics?

    I'm not sure what you are trying to ask us here. There are many conditions that overlap symptoms. Ypu could have put up some of the symptoms of diabetes or MS - for example and I could have ticked a lot of them off as well.

    I'm probably just being thick here sorry.
    onceclever likes this.
  12. Glynis Steele

    Glynis Steele Senior Member

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    Hi there,

    Thanks for your questions. After I read the KDM paper which stated that patients with CFS have more strep and enterococci bacteria in stool samples than healthy people, and these bacteria produce d-lactic acid, and the symptoms of CFS were strikingly similar to d-lactic acidosis, I became more interested in looking at d-lactic acidosis.

    I believe strep bacteria could cause most of the symptoms you mention, strep throat is a known medical condition, and it contagious. If you have a build up of lactic acid, you become sore, so I think it is possible for d-lactic to cause PEM, however in patients with d-lactic acidosis, they are treat urgently, so this has not been documented.

    I found this on the 25 ME group Organisation which mentions the KDM study.

    Bacteria in your Guts?

    Various gastrointestinal and neurological problems that are common in people with ME/CFS are surprisingly similar to the symptoms of “D-lactic acidosis”. This condition arises from bacterial fermentation of carbohydrates in the gastrointestinal tract, leading to increased lactic acid levels in the blood. Could there be an overgrowth of Gram-positive anaerobic lactic acid bacteria in the guts of ME/CFS patients too?
    Scientists at the University of Melbourne in Australia examined the faeces of 108 ME/CFS patients and 177 healthy controls for the presence of the most common of the 500 different bacterial species that inhabit the human gut.
    Their recent paper in the journal ‘In Vivo’ reported significantly increased levels of aerobic Gram-positive intestinal bacteria in the ME/CFS group than the controls, particularly Enterococcus and Streptococcus species which are the common aerobic bacteria in humans.
    Moreover, the organisms found in the patients produced significantly more lactic acid (p<0.01) than those from the healthy subjects, indicating that acidosis was at least a possibility in ME/CFS.
    The researchers postulate that increased colonisation by Enterococcus and Streptococcus could heighten intestinal permeability, assisting the absorption of D-lactic acid into the bloodstream. Increased gut permeability might also aid the release of endotoxins from the bacteria themselves, leading to inflammation, immune activation and oxidative stress, which are prominent features in a large subset of ME/CFS patients.
    While the cause of the increased colonization remains unclear, the researchers point out that eradication of all bacteria is not the answer; indigenous bowel microflora has both positive and negative impacts on health, and the balance of “good” to “bad” bacteria is important. And their next experimental step is to measure D- and L-lactic acid accumulation in the biofluids of ME/CFS patients to confirm whether D-lactic acidosis really is a factor. If so, existing interventions, such as short-course antibiotics, alkalinizing agents, a low carbohydrate diet or dietary glucose restriction might prove to be useful.

    Here is a link to the full article, which you might have already read.

    http://www.cfids-cab.org/rc/Sheedy.pdf

    D-lactic acidosis is not taught to anyone other than gastroenterologist's and biochemist's, and they only recognise it as a consequence of a shortened bowel. It needs a specific test, and does not show up in routine testing, although in short bowel patients there is usually an increase in the anion gap. It can occur without this increase however, making testing just about impossible, see below. If you take a look on the Latest Research section, I have put a thread there about d-lactic acidosis, if you are interested.

    Second, metabolic acidosis may be present without a rise in the plasma anion gap. In
    this latter setting, either the D-lactate anion was retained in the
    lumen of the GI tract (with the H being absorbed or titrated by
    bicarbonate in the lumen of the GI tract), or it was excreted in the
    urine, but in either case, the cation lost with it was Na and/or K
    ion [671 (not a H or NH4 ion, lower right portion of Fig. 6).
    This latter type of metabolic acidosis is akin to the over-production
    of hippuric acid in glue sniffers [68]. Since D-lactate anions
    are reabsorbed by the kidney much less readily than is L-lactate
    [54, 69, 70], as time progresses, the anion gap may decline without
    resulting in a rise in the plasma bicarbonate concentration-that is,
    D-Iactate is excreted as its Na or K salt (Fig. 6). Hence there
    are a number of mechanisms that may contribute to the presentation
    whereby the rise in the plasma anion gap might not match
    the fall in the plasma bicarbonate concentration. Not only might
    this lead to a diagnostic problem, it has implications for therapy
    because, once the organic anions are excreted as their Na or
    salts, these anions are no longer available for metabolism to
    regenerate bicarbonate, and the patient might have developed a
    deficit of Na and/or K4.

    This article below talks about d-lactic in calves and states "The mechanism is likely similar to that documented for D-lactic acidosis in SBS in humans except the etiology of the malabsorption is viral infection–induced villous atrophy rather than surgical removal of the small intestine." It goes on to say "There is a possibility, although it has not been described, that a similar scenario could occur in diarrheic monogastrics, including humans. Villous atrophy and malabsorption certainly occur in humans suffering from viral diarrhea, but whether there is sufficient fermentation to cause excess D-lactate to accumulate is not known. Metabolic acidosis was identified in human rotaviral diarrhea, and was attributed to carbohydrate malabsorption; however, the identity of the acids was not determined."

    http://jn.nutrition.org/content/135/7/1619.full

    Given the KDM study, I think more investigation needs to be done in this regard, and I thought the poll might help me and others who might be interested, to see whether the two conditions are more strongly linked, and if we a missing an important part in diagnosing CFS.

    Hope this helps.

    Glynis
  13. Enid

    Enid Senior Member

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    It's such an interesting area of research (viz Kenny de Meileir's findings) and on whose test I was positive high - at the same time (to be blunt black coloured faeces and neon coloured urine - adrenals) So very many suffer gastro problems along with all the rest - perhaps this is an additional symptom thrown up by ME/CFS. My own onset (perfectly healthy - no bowel problems) was sudden inexplicable vertigos with a sore throat which refused any treatment. Bowel problems persist and I'm using IBS protocols which do aid - and your findings. Many thanks.
  14. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    Just came back to this fascinating topic raised by Glynis, and done the poll once I realised what was being asked! Most of the symptoms applied to me

    I am interested to note that villous atrophy can occur in humans suffering from viral diarrhea. I had assumed that villous atrophy almost always indicated coeliac disease. I did a quick Google and found that it could have a number of causes.
  15. Glynis Steele

    Glynis Steele Senior Member

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    Sorry about the confusion with this thread. Two mistakes I made. First one was to call CFS Chronic Fatigue in the poll title. I did this at the time because I did not think I had enough room in the box to put the whole title, and so missed the word syndrome out. Stupid me, as I could have said ME/CFS. I have asked a mod if they can change the title of the poll.

    Secondly I should have pointed out that the symptoms listed in the poll are actually symptoms of high d-lactic acid.

    Sorry for the stupid:redface:
  16. eve789

    eve789

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    Hi Glynis! Glad we keep meeting :)

    I did remember reading somewhere (and I will try to find a link) a relationship between viral infection and intestinal bacterial imbalance. To ukxmrv's comment, it's possible that mild acidosis or a susceptibility to mild acidosis could either precede or be a consequence of a viral infection in some patients. Anyway, there's a ton of research now on lactic acid & CFS, mostly by De Meirleir and others, and is definitely something to either rule out or treat if you're suffering from it.

    Now convincing my doctors to do it! That's another matter. Thanks for your advice on that score, Glynis. My local lab does not do d-lactate, but they do measure lactic acid. Will try and explore that avenue!
  17. Glynis Steele

    Glynis Steele Senior Member

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    Hi back to you! :hug:

    I remember reading something interesting about how virus's might modify gut bacteria, hang on...................... here's a thread I started from an article in Nature magazine. Not quite what you might be looking for, but still fascinating.

    http://forums.phoenixrising.me/inde...s-friendly-viruses-revealed.8782/#post-164692

    Best of luck with convincing your doc's.
  18. MeSci

    MeSci ME/CFS since 1995; activity level 6

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    Apologies if I've posted this here before, but I have been looking further into this issue and found an article relating gut permeability to auto-immune disease. The most promising bit is perhaps the conclusion which states: "This new theory implies that once the autoimmune process is activated, it is not auto-perpetuating, but rather can be modulated or even reversed by preventing the continuous interplay between genes and environment. Since TJ dysfunction allows this interaction, new therapeutic strategies aimed at re-establishing the intestinal barrier function offer innovative, unexplored approaches for the treatment of these devastating diseases."

    In other words, it's possible that over time (maybe years) a gut alkalinising regime could reverse the autoimmunity that may underlie ME. Thus actually CURE it? I live in hope...

    The paper is here:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886850/
    Sparrowhawk and aimossy like this.
  19. Mimi

    Mimi Senior Member

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    http://www.nutritionandmetabolism.com/content/7/1/79/


    Gut inflammation in chronic fatigue syndrome

    Shaheen E Lakhan* and Annette Kirchgessner

    ...People with CFS were shown to have higher concentrations of intestinal bacteria than normal, which probably leads to higher levels of H2S. Professor Kenny De Meirleir of the Brussels Free University and his team say high levels of H2S caused by an intestinal overgrowth of Gram positive D/L lactate-producing bacteria play a major role in CFS and lead to a series of reactions in your body that leave cells devoid of oxygen and energy.

    I see: bad bacteria --> D-Lactate overproduction --> H2S formation --> mitochondrial asphyxiation

    This means we are getting brain toxicity from both D-Lactate and H2S as well as fatigue from mitochondrial dysfunction
    Sparrowhawk likes this.
  20. Mimi

    Mimi Senior Member

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    fyi, hydrogen sulfide theory and gut dysbiosis:

    http://phoenixrising.me/wp-content/uploads/H2S1.pdf

    this original paper was written by the mother of an ME/CFS patient and the idea was picked up afterwards by KDM.
    very interesting and worthwhile reading if you ask me

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