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A Link Between the Gut Microbiome and Post-Exertional Malaise

Dr. Sanjay Shukla

Dr. Sanjay Shukla

For every 1 human cell in our body there are 10 microbes.  We are now beginning to appreciate the roles of these diverse microbial communities in health and disease. The various parts of our bodies have distinct microbial populations called microbiome. In a study published today in PLOS ONE titled “Changes in Gut and Plasma Microbiome Following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)”,

Dr. Sanjay Shukla and colleagues describe how the microbiome might be causing post-exertional malaise (PEM). More than 100 people were screened to select the 10 patients and 10 healthy controls that participated in this study.  Study participants gave stool and blood samples before a maximal exercise challenge and 15 minutes, 48 hours and 72 hours after the exercise challenge. The research team used a maximal exercise challenge to try to calibrate ME/CFS symptoms. Shukla and his team hypothesized that following exercise bacteria would move out of the gut (translocate) and cause worsening of symptoms.

ME/CFS patients had large increases in pain, fatigue and confusion following the exercise challenge.  At 72 hours there were significant increases in 7 of 9 major bacteria classes (called phyla) in ME/CFS patients compared to only 2 of 9 in healthy volunteers suggesting the exercise challenge caused an increased bacterial load in patients. While bacterial sequences were detected in the blood of both ME/CFS patients and healthy controls, there were rapid increases in specific bacterial clusters were detected in the blood of ME/CFS patients and the rate that bacteria was cleared from the blood differed for patients.

PEM occurs following exertion and underscores the need to collect temporal data to determine what is causing PEM. This research found temporal differences in the gut microbiome and detected transient bacteremia. These microbiome changes could explain what exercise makes some ME/CFS patients sicker.

You can access the full text of this paper here: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0145453