I am unsure of the mechanism, but I am sure that my insulin resistance is related to or somehow caused by my ME/CFS. I wasn't insulin resistant until after I caught EBV and came down with ME/CFS and, indeed, the doctor that diagnosed me with insulin resistance said it was a very common condition among his ME/CFS patients.
I was not previously aware of a link between insulin resistance and chronic fatigue syndrome, but
this study found an association between ME/CFS
metabolic syndrome.
Metabolic syndrome (which is also called insulin resistance syndrome) consists of
elevated fasting plasma glucose (hyperglycemia), abdominal obesity, elevated blood pressure, high serum triglycerides, and low high-density lipoprotein (HDL) levels.
I wonder if ME/CFS patients should be routinely checked for insulin resistance, especially those with abdominal obesity (like myself). Though when I last checked with a home blood glucose meter, my morning fasting levels were well below 100 mg/dL, usually around 80 to 90 mg/dL when I first get out of bed.
I came across
this article on how one might use a blood glucose meter in a simple home test to check for insulin resistance (though it's author Chris Kresser is a bit of an alternative health apologist). He explains the oral glucose tolerance test here:
Oral glucose tolerance test (OGTT)
The OGTT measures first and second stage insulin response to glucose. Here’s how it works. You fast and then you’re given 75 grams of glucose dissolved in water. Then they test your blood sugar one and two hours after. If your blood sugar is >140 mg/dL two hours later, you have pre-diabetes. If it’s >199 mg/dL two hours later, you’ve got full-blown diabetes.
I am presuming you may be able to do this test yourself at home, simply with 75 grams of glucose and a blood sugar meter.
As you say, they are finding that many patients need to be on the MP for a long time. The length of time it takes seems to depend upon how long you've been ill, gender (men seem to improve quicker than woman) and age (younger people recover more quickly). I've now been on it (with a few breaks) for around 7 years and have seen pretty significant, but slow, improvement. It is definitely not a quick fix: I spoke to a guy who had CFS/Lyme who is now completely recovered after 11 years on the MP.
I would like to try the MP again for longer periods, but I find it hard to motivate myself (and pay for the drugs) if I have to think in terms of say 5 years before I reach significant improvements (which may or may not manifest). And even if you do get better over such a long period, there is always the issue of wondering whether you may just have got better naturally.
If you take a medication that leads to improvements in your ME/CFS symptoms quite quickly (say over weeks or months), and if those improvements also disappear again within weeks or months of stopping that medication, then you can feel quite confident it was the medication that was responsible for the improvements. But when the improvements take place over half a decade, unfortunately it can be harder to link the improvements to the medication.
Another discouraging factor is that I have not seen that many reports of improvements in ME/CFS using the MP. Although I did come across
two ME/CFS recovery stories on the inflammation therapy website (inflammation therapy appears to be an offshoot of the Marshall Protocol, but is basically pretty much the same thing).
I did get the impression that even after just two months on the MP, my anhedonia symptoms appeared to improve. So that is motivation to try it again.
If only it were that easy! As many of us found on the Resistant Starch thread, concentrated prebiotic sources are just not tolerable in anything but tiny amounts. I can eat any amount of inulin rich vegetables (and I do) but 1/4 tsp of inulin/FOS causes problems.
It is intriguing that quite a few ME/CFS patients (48% according to
this poll) cannot tolerate prebiotic supplements. This requires some careful thought to try to figure out why this occurs in some patients. This phenomenon might provide some clues as to the nature of ME/CFS, or at least as to the nature of the gut problems often experienced in ME/CFS.
I wonder though if those prebiotic-sensitive patients also have a problem with foods high in prebiotics, such as the following foods:
Top Foods Containing Prebiotics
Raw Chicory root: 64.6% prebiotic fiber by weight
Raw Jerusalem artichoke: 31.5% prebiotics by weightchicory-2-high1
(NOTE: Jerusalem artichoke is NOT the green globe artichoke you see at the store. It’s a totally different plant.)
Raw Dandelion greens: 24.3% prebiotic fiber by weight
Raw Garlic: 17.5% prebiotics by weight
Raw Leek: 11.7% prebiotic fiber by weight
Raw Onion: 8.6% prebiotics by weight
Cooked Onion: 5% prebiotic fiber by weight
Raw Asparagus: 5% prebiotics by weight
Raw Wheat bran: 5% prebiotic fiber by weight
Wheat flour, baked: 4.8% prebiotics by weight
Raw Banana: 1% prebiotic fiber by weight.
Are you sensitive to any of these foods?
In any case and despite what the manufacturers of inulin supplements would like to convince us, inulin feeds just some of the gut flora. To have a healthy gut a wide range of prebiotics are needed and a ketogenic diet omits some very important categories of flora food.
Do you have any good references for the inability of inulin to feed all the friendly bacteria in the gut?
In any case, I don't see why in a ketogenic diet you can't eat a wide range of prebiotics, such as some of the foods listed above that don't have a high carbohydrate content.