Do you have irritable bowel syndrome? If you do, you’re not alone – the presence of irritable bowel syndrome (IBS) alongside ME/CFS may constitute a distinct ME/CFS subgroup. This article reviews and summarizes a new research paper Dr. Bateman and colleagues published on July 3, 2018, titled Insights into myalgic encephalomyelitis/chronic fatigue syndrome phenotypes through comprehensive metabolomics. The study examines how IBS interacts with ME/CFS and draws participants from four sites across the United States, ultimately recruiting 50 individuals with ME/CFS and 50 healthy matched controls.
Of these 50 ME/CFS participants, 24 people, or 48%, had IBS. This rate is far higher than the general population, in which IBS is present in only 10% to 20%. Since it is estimated that 35% to 90% of the ME/CFS population have IBS, a connection between the two diseases seems clear. Further, there are distinct metabolic differences between people with ME/CFS and IBS, and people with ME/CFS but no IBS. Taken together, ME/CFS subgroups of patients with and without IBS are beginning to take form.
Why are subgroups important? In a nutshell, identifying subgroups improves the usefulness of the resulting treatments, similar to how we treat people for lung cancer or breast cancer instead of for cancer generally. This is especially important for ME/CFS — since there are so many variations to the disease, a one-size-fits-all treatment is unlikely. Subgroups therefore let us target treatment to more individualized circumstances.
How does the IBS subgroup vary from general ME/CFS? First up are metabolites. Essentially, metabolites are substances related to metabolism. Tests show tangible differences in metabolites between ME/CFS participants with and without IBS, as well as differences between all ME/CFS participants compared to the control group. Researchers then used these differences to construct a model that accurately identifies select ME/CFS and IBS patterns. Overall, this process helps us better understand more aspects of ME/CFS and IBS symptoms.
Researchers also found differences between ME/CFS participants with and without IBS when they studied ceramides, which are “waxy liquid[s which] might be involved in the pathology of IBS and metabolic disorders.” Other research has reported that patients with IBS and several other diseases tend to have higher levels of ceramides. In this research study, patients with ME/CFS but no IBS had decreased levels of two types of ceramides, while patients with ME/CFS and IBS had increased levels of six types of ceramides.
Finally, the research study examined carnitine, which impacts energy production and metabolism, and found that “compounds in the choline-carnitine pathway were decreased in ME/CFS patients regardless of their IBS status.” Carnitine therefore demonstrates another tangible way that ME/CFS participants vary in biology and energy compared to the general population.
What are the takeaways of this study?
Overall, this study demonstrated evidence for an ME/CFS subgroup based on the presence or absence of irritable bowel syndrome. It also showed clear differences between ME/CFS and non-ME/CFS patients and advanced our understanding of the biological underpinnings of the disease.
What does all this mean? We aren’t sure yet. If ME/CFS participants with and without IBS have different metabolic profiles, then perhaps there are differences in how this subgroup uses energy. We intend to continue pursuing this field, and fields like it, until patients with ME/CFS and Fibromyalgia are readily diagnosed, effectively treated, and widely met with empathy and understanding.
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