CFS - hydrogen sulphide, gut bacteria and mitochondrial dysfunction
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We have good evidence that the fatigue in chronic fatigue syndrome is caused by poor mitochondrial function. We have a test to measure this, i.e. the mitochondrial function test and we can see if this dysfunction occurs because of micronutrient deficiency, or something which is blocking mitochondria. Hydrogen sulphide fits into this picture because it inhibits mitochondrial function and this provides a nice explanation as to why the abnormal gut flora can cause fatigue.
Work done by Professor Kenny de Meirleir has shown that people with chronic fatigue syndrome consistently have higher levels of hydrogen sulphide in their urine compared to normal controls. Furthermore, this is associated with high levels of bacteria which are not normally found in the gut flora He has identified bacteria in the gut responsible for this. The idea is that an overgrowth of streptococcus, enterococcus and Prevotella bacteria results in foods being fermented to produce hydrogen sulphide and it is this which causes the problems. He further noted that overgrowth of these different bacteria correlated with symptoms, in particular:
- enterococcus is associated with headache, arm pain, shoulder pain, myalgia, palpitations and sleep disturbance;
- streptococcus correlated with post-exertional fatigue, photophobia, mind going blank, cervical gland lymphodynia, palpitations, dizziness and faintness.
All these associations were statistically highly significant. Increase in hydrogen sulphide levels can be measured by dint of a simple urine test test that looks at hydrogen sulphide spilling over into the urine. This test has been developed by Prof Meirleir in Belgium and he calls it the "Neurotoxic Metabolite test". This is a simple "DIY at home" test and the kit can be ordered here Hydrogen sulphide in urine or directly from the Protea Biopharma website Neurotoxic metabolite test.
Hydrogen sulphide in low levels has important actions
Hydrogen sulphide (H2S) is produced by normal cells and is an important gaseous signal molecule similar to carbon monoxide and nitrous oxide. It is involved in regulation of blood pressure, neuro-transmission, muscle relaxation and the regulation of inflammation. Endogenous hydrogen sulphide plays a role in regulating blood pressure, body temperature, vascular smooth muscle, cardiac function, blood flow to the brain, and is an important modulator of the hypothalamus-pituitary-adrenal axis. At low dose levels exogenous H2S produces a hibernation like state in mice with a decreasing core body temperature, apnoea-like sleep, reduced heart and respiratory rates and a marked metabolic drop. These symptoms are often experienced by CFS/ME sufferers.
Too much can be very toxic
In excess H2S acts as a mitochondrial poison inhibiting many enzymes involved in oxidative phosphorylation. It also interferes with oxygen transport in red blood cells, a little bit like carbon monoxide. Almost always we see low levels of glutathione in CFS, which is a sulphur containing molecule. From an evolutionary perspective mitochondria are organelles descended from ancient eukaryotic sulphur-using microbes and so it is not surprising that H2S targets mitochondria. H2S inhibits immune cells such as CD8, T cells and natural killer cells so contributing to the immune dysfunction. It also impacts on the hypothalamic-pituitary-adrenal axis. It regulates the use of oxygen by mitochondria.
The gut flora in CFS
The $64,000 question, which as yet nobody knows the answer to do, is what to do about this problem? There are some strategies well worth trying and one needs to understand the normal state of affairs to understand such strategies.
See Fermentation in the gut and CFS
Treatment of a positive result
Again, see Fermentation in the gut and CFS
The joy of the urine test for hydrogen sulphide is that we have a way of checking as to whether or not we are making progress with the gut.
Professor de Meirleir's treatment regime includes all the above factors, but he believes that heavy metals may also be implicated here because they have a synergistic effect with H2S to make it more toxic. Indeed, we know already that mercury vapour from dental amalgam can have a profound effect on gut flora. He suggests that H2S may combine with heavy metals and the resultant compound distorts proteins to form prions. These prions then distort other normal proteins in what is known as the "rotten apple" effect. This magnifies the underlying poisoning by heavy metals and H2S. So, heavy metal detoxification is likely to be an important part of the treatment program.
Related Tests
Related Articles
References
- Lemle MD.Hypothesis: Chronic fatigue syndrome is caused by dysregulation of hydrogen sulfide metabolism. Medical Hypotheses 2009;72(1):108-9. Epub 2008 Sep 16. mdlemle@yahoo.com
- Protea Biopharma Press Conference, London 28.5.09. Prof K de Meileir, Chris Roelant, Marc Fremont.
- Protea Biopharma website
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