Hi 'Husband of',
sorry not to get back sooner; you need to go back to the beginning of my post; Ketosis is not exactly the aim and would be dangerous, but a Ketogenic or Palao diet, best explained on Dr. Sarah Myhills web page https://drmyhill.co.uk/wiki/The_Paleo_Ketogenic_Diet_-_this_is_a_diet_which_we_all_should_follow
The aim is to find alternative food sources to avoid, what to all intents and purposes, is a hidden Gut 'infection' due to the abnormal increase of naturally occurring Bacterial in Overgrowth causing fermentation of Simple Carbohydrates; that will not allow you to process many of the 'normal' foods to energy that we have been using since we started Farming and using grains around 40,000 years ago; the very low Carbohydrate diet is a return to a more primitive diet that would have been used pre-farming; but FODMAPS diets utilize starches (complex Carbohydrates) that your body takes longer to break down and will not ferment easily, especially in the small intestine (very simple explanation). You could start with Dr. Myhills Stoneage or Palao diet to see if your symptoms improve. Many ME/CFS have related gastrointestinal symptoms.
This is about reducing abnormal levels of D-Lactic producing Bacteria and reducing abnormal fermentation of D-Lactic producing Bacteria, or other Organic acids produced by other Bacterial Overgrowth; by reducing Simple Sugars and using Low Fermenting Carbohydrates so that the Bacteria cannot produce high levels of D-Lactate (it is now believed that we can process a small ammount of D-Lactate unless that ability is missing, which is another possible cause of D-Lactic acidosis). The FODMAP diet is similar to diets used for IBS, Diabetes and other forms of SIBO with low Fruit Sugars https://thefoodtreatmentclinic.com/low-fermentation-diet/; I now use a FODMAP diet, but used a very Low Carbohydrate diet for a year or so after diagnosis in 2017.
ME/CFS has been related to altered and less diverse microbiome with decreases of Firmicutes and increase of Bacteroidetes (Gram positive bacteria). Firmicutes are more effective in extracting energy from foods.
Low fermenting diets will also assist with other forms of Bacterial Overgrowths or SIBO, causing the production of Organic acids with similar neurotoxicity that may be associated with ME/CFS.
In D-Lactic acidosis diet needs to reduce any abnormal fermentation of certain Carbohydratres to D-Lactate instead of L-lactate (which is our normal source of energy when converted to Glucose and Energy in the Pyruvate/Glucose Chain). ''l-lactate formation occurs via the reduction of pyruvate catalyzed by lactate dehydrogenase. l-lactate removal takes place via its oxidation into pyruvate, which may be oxidized or converted into glucose. ... Enzymes of the gluconeogenesis pathway sequentially convert pyruvate into glucose.'' ''By digesting food, you break it down into smaller and smaller parts. Carbohydrates turn into glucose. Protein becomes amino acids. Fat breaks down to triglycerides and fatty acids. All these smaller parts of food can be used for energy. '' So we can also get energy from proteins and fats as we did pre farming.
You have to cut out all simple sugars and alcohol such as Lager and Beers which are high in Carbohydrates; The worst Carbohydrates for me are Bread, Pasta or wheat based products that ferment easily eg. Pizza.
I used a very low close to non-Carbohydrate Diet at first; mainly Meats, Fish, Eggs, Hard Cheese, some Veg and low sugar fruits such as Blueberries and Cranberries; This diet was the best for me, but I found it very hard to stick to permanently and it takes great imagination to create meals (Dr. Myhill has produced a Palao Ketogenic Cook Book); but would be a good place to start (after checking with your health professionals first). But I was later offered a FODMAP diet that allows low fermenting Carbohydrates and use this coupled with antibiotics that only temporarily stop the symptoms by reducing the Overgrowth, but I have found that symptoms still come back gradually even though reduced, there must still be some fermentation, enough to cause me symptoms.
Antibiotics can also make things worse but give me temporary reprieve; and long term use has already caused resistance in several antibiotics, and antibiotics have been implicated in causing other heath ptoblems due to the effect on other microbiome species, including low or lack of significant species; but there may be some light at the end of the tunnel, because Phage Therapy for Superbugs is already being tested in Belgium and it may eventually become an acceptble treatment for these forms of Microbiome disorders;
The only other alternatives for me is Probiotics or Faecal Transplant; FMT although successful in some patients (and has been used for C.diff infections, MS, ME etc.) may not work for all and may also need more than one treatment.https://neurosciencenews.com/microbiota-transplants-19966/
I have found specific Non-D-Lactic producing Probiotics in combinations that will stop my symptoms, but they are expensive and hit and miss in terms of quality and quantity needed (the NHS will no longer fund Probiotics because they state that they are deemed to have low efficacy) ; but there is interest in Micobiome replacement therapy at the Dove Clinic; GFRT - Gut Flora Replacement Therapy - The Dove Clinic
although D-Lactic producing Bacteria would need to be avoided for a Subset of patients who have D-Lactic producing Overgrowths.
You can also have a Microbiome test performed at Atlas The Atlas Microbiome Test shows how gut bacteria impact your health (atlasbiomed.com).
You may have missed this report at the beginning of my posts; Increased D-Lactic Acid Intestinal Bacteria in Patients with Chronic Fatigue Syndrome; https://iv.iiarjournals.org/content/23/4/621.short?ssource=mfr&rss=1.
D-Lactate is an unwanted abnormal fermentation to the Organic acid; D-Lactate, which is a Neurotoxin and Poison; directly related to lack of energy, because D-Lactate causes fluctuating acidosis and greatly affects Mitochondrial Function and Neurological symptoms are caused when the Neurotoxin enters the Blood Stream and Spinal Fluid to cause abnormal fatigue, encephalopathy and multiple symptoms including pain (as in Myalgic Encephalitis).
It is possible to have more than one form of Bacterial Overgrowth once the microbiome becomes compromised; In D-Lactic acidosis there are often at least two different competing species and possibly other Overgrowths. It is what is driving these changes that is important; you could also try drinking water that is not Chlorinated or contain Fluoride; because these chemicals also affect the microbiome. We have most probably caused these problems that allow other competing elements such as Virus in Covid-19 to make changes to our microbiome similar to ME/CFS https://www.bmj.com/company/newsroom/make-up-of-gut-microbiome-may-be-linked-to-long-covid-risk/
We are all different and it may take some experimentatioin!
I had not fully realised that GFRT is a Colonic treatment from the Dove Clinic and would not be affecing the small bowel; ''It is the process of implanting the beneficial intestinal bacteria and yeasts, from specific varied probiotic supplements, in significant quantities, not affecting the small intestine. I will have to try it if I can get funding. It has reportedly had a beneficial effect on the microbiome for ''Allergies, Asthma, Obesity, Cancer, Chronic. Fatigue Syndrome, Parkinson's Disease, Irritable Bowel Syndrome and Ulcerative Colitis.''