Chronic Fatigue Syndrome / FMS Symptoms Caused by Lactic Acidosis

Is Lactic Acidosis Behind Many Chronic Fatigue Syndrome / Fibromyalgia Symptoms? By Ken Lassesen | October 12, 2015

As a person who’s been gifted with being in remission from chronic fatigue syndrome (for the third time), I adhere to a model of what I believe causes typical ME/CFS in hope of staying in remission.

The model is stable and consistent with the latest (and older) research studies. It follows William Osler’s principle basing diagnosis and treatment on a strict observation of symptoms (not forgone conclusions and KISS (Keep It Simple Stupid).

“Listen to your patient, he is telling you the diagnosis”
– William Osler

Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome. [2009] [Full Text]

Recently, I added another narrative to the model: that the symptoms  in ME/CFS are caused by the over production/under clearance of lactic acid. Lactic acid is produced when you exercise and makes you tire as it accumulates.

The Key Study

Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome. [2009] [Full Text]

“Patients with chronic fatigue syndrome (CFS) are affected by symptoms of cognitive dysfunction and neurological impairment, the cause of which has yet to be elucidated.

However, these symptoms are strikingly similar to those of patients presented with D-lactic acidosis… this might explain not only neurocognitive dysfunction in CFS patients but also mitochondrial dysfunction, these findings may have important clinical implications.”

Faecal microbial flora of CFS patients and control subjects.

The mean viable count of the total aerobic microbial flora for the CFS group (1.93×108 cfu/g) was significantly higher than the control group (1.09×108 cfu/g) (p<0.001).

There was a significant predominance of Gram positive aerobic organisms in the faecal microbial flora of CFS patients.

…This study confirms the previous observation (22), and those reported by other investigators (23) that there was a marked alteration of faecal microbial flora in a sub-group of CFS patients…..

In this study the mean total count for Enterococcus and Streptococcus spp. for the CFS group was 52% of the total aerobic intestinal flora, which is significantly higher than the 12% seen in the control subjects (p<0.01). ”

“In this study the NMR-based metabolic profiles of the three intestinal micro-organisms, E. faecalis., S. sanguinis. and E. coli showed that the Gram positive bacteria (Enterococcus and Streptococcus spp.) produce more lactic acid than the Gram negative E. coli. Not surprisingly, these Gram positive bacteria were shown to lower the ambient pH of their environment in vitro as compared to that of E. coli.

When Enterococcus and Streptococcus spp. colonization in the intestinal tract is increased, the heightened intestinal permeability caused by increased lactic acid production may facilitate higher absorption of D-lactic acid into the bloodstream, henceforth perpetuating the symptoms of D-lactic acidosis.

Increased intestinal permeability is also associated with endotoxin release from Gram negative enterobacteria, leading to inflammation, immune activation and oxidative stress, which are cardinal features in a large subset of CFS patients “

My model’s core element has been that CFS/FM/IBS are caused by microbiome dysfunction. This has been reported multiple times in the literature by Butt [1998] and Schloeffel [2001], and preliminary results from the Lipkin/Hornig microbiome study suggest major alterations in gut flora occur.   

Anecdotal reports indicated that fecal transplants can result in immediate remission in a significant set of ME/CFS patients. (Unfortunately, many did not stay in remission beyond six months).

This lactic acid/chronic fatigue concept is not new, and has been reported in the literature before:

However the lactic acid findings may have been viewed as a consequence and not a cause. The opposite may be more accurate.

The Treatment

I checked for recommended treatments on  the large research citation database, PubMed as well as EMedicine, and the popular website, WebMD.  The news – that there is no known effective treatment for lactic acidosis – was not unexpected.

“Probiotics Provoked D-lactic Acidosis in Short Bowel Syndrome: Case Report and Literature Review” [2006]

The antibiotics proposed bear a strong similarity to the protocols advocated by Cecile Jadin, MD and Phillipe Bottero, MD; both of which report over 70% remission rates. The treatment they used for lactic-acidosis was:

“The patient received kanamycin (Kanamycin Capsules, Meiji Seika Pharma, Tokyo, Japan) 1000 mg/d.  … metronidazole (Flagyl, Shionogi & Co, Ltd, Osaka, Japan) 500 mg/d and kanamycin 2000 mg/d were administered for 5 days under fasting conditions.

Polymyxin B (Polymyxin B Sulfate, Pfizer Japan Inc, Tokyo, Japan) 500 3 103 U/ d and vancomycin (Vancomycin Hydrochloride Powder, Lilly, Kobe, Japan) 1000 mg/d were administered over the subsequent 5 days.

After the use of antibiotics, a purgative (Niflec, Ajinomoto Pharmaceuticals Co, Ltd, Tokyo, Japan) was used…..Overgrowth suppression was approached by starting synbiotics, specifically B breve Yakult (prepared by Yakult Co, Ltd, Tokyo, Japan) 3.0 g/d and L casei Shirota (Biolactis Powder, Yakult Co, Ltd, Tokyo, Japan) 3.0 g/d as probiotics, and galactooligosaccharide 8.4 g/d as a prebiotic.” [2013]


Type A lactic acidosis—due to hypoperfusion and hypoxia—occurs when there is a mismatch between oxygen delivery and consumption, with resultant anaerobic glycolysis.”

  • SPECT scans shows hypoperfusion in CFS patients[2006][2006][2000][2012]. Coagulation (common with CFS [1999][2000]) causes hypoxia!
  • Chemical sensitivity and fatigue syndromes from hypoxia/hypercapnia[2000].
  • Hyperbaric oxygen for CFS do show symptom improvement in many [2003] [2013][2015]

herbs, spices and probiotics have anti-viral, anti-fungal and antibiotics characteristics. In a few cases, they have found to be more effective against some species of bacteria than the strongest prescription antibiotics

Things I tried after finding research supporting them on PubMed and which appeared to work for me, or for others I know  that have tried  are included below. The different possible treatments are linked to blog posts for those who are interested.

Why is There Not a “Canned” Recipe?

The reason is simple, each person’s complement of gut bacteria is unique, more unique actually than their DNA (and more complex too!). When the gut flora goes bad, the mixture of bacteria strains found differs from person to person.

It’s possible that the heterogeneity in gut flora may contribute to the complex symptom picture found in ME/CFS.

The microbiome model (gut bacteria), suggests this symptom heterogeneity is to be expected, however.  It suggests we are not dealing with a single bacteria, but a shift of the entire population involving thousands, perhaps millions of strains.

Treating the gut flora is an art which requires systematically trying good candidate herbs and probiotics for a reasonable length of time and seeing if they cause change. 

This certainly can’t be accomplished in a 12-minute doctor’s visit.

If they cause a change, then they should be tried again — later – we want to keep rotating the antibiotic herbs and spices to prevent resistance from building up.

Other thoughts?

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