Something I've added for nutrient value is spirullina. It is a good source of absorbable iron, iodine and amino acids. Might be worth looking into. I think it helps with moving food through as well, so might be worth a look.
Oh and re mutaflor, if that is hard to get you may want to look at symbioflor 2 (a multistrain probiotic ecoli). I found grow it in much the same way as Myhill grows mutaflor (on soy in a yoghurt maker).
&@Alvin2 I do not know that we know this but RichvanK considered the low acid in ME/CFS to be a straighforward result of having low energy: the biochemical pathways we use for producing acid use a lot of energy, but we don't have the energy so we don't have the stomach acid.
In 2018 I could look back and say that I had spent 15yrs trying various combinations of prebiotics and probiotics with some short term improvements but no success.
(well the exception was that I found that some strains of l rhamnosus and l paracasei helped with anxiety/PoTS, I stayed with them for almost a year and then found that they were no longer needed.)
So I decided one terrible night that I just had to accept that whatever was wrong with my gut could not be helped with any of these techniques. I accepted that a fecal transplant might work but that was ouside my budget so I did not consider it. I instead swapped to a diet of meat and fat which presumably starved my bad microbiome.
I spent a bout 3/4 of a year still taking the l rhamnosus with oligosaccharides and betaine HCL, enzymes and bile but found that when I stopped all the supplements and just followed the PKD I seemed to produce enough bile and presumably acid (I don't get GERD). (I already knew from my own experimentation that I produced my own bile if I ate enough liver - so that part was not a complete surprise.)
This group in Hungary claim that they have lots and lots of clinical data showing that eating this way reduces gut permeability (as measured by a PEG 400 test).
And gut permeability is certainly something I see as an important issue in ME. On it I am in some respects in the best health I have been in since 2015. This month I have twice managed to walk two blocks to a taxi rank without inducing PEM or even feeling pushed. But something like 4yrs of being bedbound (or being mostly bedbound but often sitting in a reclining chair and very occasionally sitting on the front step in the sunshine or (much harder) sitting at the computer a couple of times a week) has cost me a lot of muscle.
And when I was trying to follow this diet strictly according to the advice of paleomedicina I lost some more muscle, so I will add that with respect to fibre and probiotics I am essentially on their diet. But I am eating to satiety (which they do actually say to do) and not worrying and second guessing when that turns out to be more than they recommend.
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But yeah Mutaflor is easy to grow, just treat it like yoghurt
You wont need a whole capsule maybe a just a quarter (when I was using symbioflor I just used two drops of the suspension) to culture in a litre of of 38-40C soy milk.
After you have made that first batch you can use a tablespoon of the thin drinking "yoghurt" you end with to start the second batch. But as with yoghurt you will usually find that somewhere in that succession of batches that were started with a sample of the previous one you will get a batch that dose not seem quite right and need to start again from a new capsule.
It follows ration of 2g fat to 1g of protein in theory - in reality the people at Paleomedicina advise using some rules of thumb that should lead to meals with the right ratios. So one is that with muscle meat one can usually say add 35g of fat to every 100g of lean to get the right ratio. Another is that if the meat appears to be 1/3rd fat by volume it is in balance.
If I was exactly following the PKD as formulated for someone as ill as we are, I would have at least 400g liver, and 250g of brains and/or bone marrow each week and then eat some mixture of muscle meat and other organ meats, animal fat and bone broth to fill out my needs. In Australia and the US they favour pastured lamb and beef having found that their clients do less well on pork, chicken and feedlotted beef. And water and perhaps some salt and that would be it.
Oh they also allow some honey (very little because you are meant to stay below 4.2mMol blood glucose and over 2mMol blood beta-hydroxy butyrate), and if you are well they would allow some cooked or fermented vegetables and fruits (about 1/3rd by volume). Eggs may or may not be ok, it depends upon the person and the source of the eggs.
I drink coffee, which is not on the PKD and does apparently increase intestinal permeability - so it is something I plan to stop - but I am drinking it now.
They are against supplements. They have collected data from the PEG 400 tests of people who did not quite follow the diet and have found that vegetable oils and supplements and medicines are the things most likely to increase permeability. With the supplements and medicines this is often intentional - increased intestinal permeability equals a higher plasma concentration of the drug or supplement.
I have what I hope is some very pure vitamin K2 (menaquinone 4) bought as a powder and dissolved in animal fat. I am taking some at the moment because it seems to help with PoTS and back/base of the head pain and because I felt the lack when I gave it up for about 5 or 6 months. I also took some supplemental vitamin C (as powdered ascorbic acid so I hope pure) when I was fighting a virus.
These supplements may not be strictly necessary. I know that I was eating something like 700g -1Kg of brains a week when I was not supplementing with K2 and drop back to about 400g/wk when I started supplementing. And that I went from desiring them to been indifferent to them.
I get the logic of the paleo approach. Animals evolve in a context, if they are not in their natural environment and they are ill changing that environment to make it more like their natural one makes sense. It has worked with zoo animals. It may generally lead to a healthier environment but it is not always going to be sufficient.
And I really don't know what will, could, should or ought to work. This just seems better than all I have tried before. It is not advice.
So my current version is way too much coffee (@ 50-80ml of instant powder per day - which is both way too much and much less than the 12-18 x 50ml espresso I use to consume every day) plus occasional honey ( maybe 500g in 6 months - its just an occasional hedonic thing). Some Vitamin K2. Vitamin C when ill. Plus something like 400-600g liver (mostly beef but also lamb) 400-500g lamb brains, and maybe 300g beef marrow a week, and lots of beef brisket, kangaroo mince, lamb trim fat and beef or lamb kidneys, hearts and tongues. I buy the brisket on the bone and use the bones to make bone broth. Its winter so I pan fry the liver and eat everything else as a stew.
I also eat some bones. When I have finished making bone broth in the pressure cooker I am left with some edible spongy bones and if I feel like it I have probably <10g. (This is not based on any advice from Paleomedicina I just read about inuit eating bones in something written by Vilhjalmur Stefansson and decided to try the bones instead of throwing them out. I think of it as being a land based equivalent of eating canned sardine, mackerel or salmon bones - something which seems normal to me.)