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== Evidence of gastrointestinal dysfunction in CFS == === Dysbiosis === {{main| page_name =Dysbiosis}} There is strong evidence that [[dysbiosis]] or an imbalance in the microbial ecology of the gut plays a role in the symptoms of [[ME/CFS]]. On average, ME/CFS patients have lower levels of ''[[Bifidobacteria]]'', ''[[Escherichia coli]]'' and higher levels of [[aerobic bacteria]],<ref name=":0">{{Cite journal | last = Logan | first = Alan C | last2 = Venket Rao | first2 = A | last3 = Irani | first3 = Dinaz | date = Jun 2003 | title = Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value | url =http://www.medical-hypotheses.com/article/S0306-9877(03)00096-3/abstract|journal=Medical Hypotheses|language=English|volume=60|issue=6 | pages = 915–923|doi=10.1016/S0306-9877(03)00096-3|issn=0306-9877}}</ref> in particular ''[[Enterococcus]]'' and ''[[Streptococcus]]'' species.<ref>{{Cite journal | last = Sheedy | first = John R. | last2 = Wettenhall | first2 = Richard E.H. | last3 = Scanlon | first3 = Denis | last4 = Gooley | first4 = Paul R. | last5 = Lewis | first5 = Donald P. | last6 = McGregor | first6 = Neil | last7 = Stapleton | first7 = David I. | last8 = Butt | first8 = Henry L. | last9 = DE Meirleir | first9 = Kenny L. | date = Jul 2009 | title = Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome | url =http://www.ncbi.nlm.nih.gov/pubmed/19567398|journal=In Vivo (Athens, Greece)|volume=23|issue=4 | pages = 621–628|issn=0258-851X|pmid=19567398}}</ref> The latter produce [[D-lactate]], a form of lactic acid only produced by non-human cells that is poorly metabolized in humans. [[D lactate]] is associated with a wide variety of cognitive and neurological symptoms, such as in patients who suffer from [[Lactic acidosis|D-lactic acidosis]]. A study found that higher levels of enterococcus bacteria in CFS patients were associated with more severe neurological and cognitive dysfunction.<ref>https://getinfo.de/en/search/id/BLCP%3ACN055885616/%60Bacterial-Colonosis-in-Patients-with-Persistent/</ref> CFS patients may suffer from [[small intestinal bacterial overgrowth]] (SIBO).<ref name=":0" /> One hypothesized consequence of dysobiosis is an overproduction of [[hydrogen sulfide]] (H2S) by pathogenic bacteria. H2S can inhibit [[Mitochondrion|mitochondria]]l respiration by blocking [[cytochrome c oxidase]].{{Citation needed}} A study of Norwegian and Belgian patients found significantly decreased proportions of [[Firmicutes]] genera ''[[Holdemania]]'' and increased proportions of [[Bacteroidetes]] genera ''[[Alistipes]]'' in the Norwegian but not the Belgian sample. Significantly increased proportions of [[Firmicutes]] genera ''[[Lactonifactor]]'' were found in both.<ref>{{Cite journal | date = 2013-08-01 | title = High-throughput 16S rRNA gene sequencing reveals alterations of intestinal microbiota in myalgic encephalomyelitis/chronic fatigue syndrome patients| url = https://www.sciencedirect.com/science/article/pii/S1075996413000929|journal=Anaerobe|language=en|volume=22 | pages = 50–56|doi=10.1016/j.anaerobe.2013.06.002|issn=1075-9964}}</ref> === Intestinal permeability === {{main| page_name =Intestinal permeability}} In a healthy digestive tract, the intestinal walls provide a tight, selective barrier to allow the absorption of nutrients prevent the entry of bacteria or pathogens. However, in CFS patients, there is evidence of increased [[intestinal permeability]] or "leaky gut." Intestinal permeability can allow for the [[translocation]] of bacteria across the mucosal lining and inside the blood stream. One study found higher levels of serum [[Immunoglobulin A|IgA]] and [[Immunoglobulin M|IgM]] against [[lipopolysaccharides]] (LPS), a major component of the outer membrane of [[gram-negative]] bacteria, indicating translocation.<ref>{{Cite journal | last = Maes | first = Michael | last2 = Mihaylova | first2 = Ivana | last3 = Leunis | first3 = Jean-Claude | date = Apr 2007 | title = Increased serum IgA and IgM against LPS of enterobacteria in chronic fatigue syndrome (CFS): Indication for the involvement of gram-negative enterobacteria in the etiology of CFS and for the presence of an increased gut–intestinal permeability| url = http://www.jad-journal.com/article/S0165-0327(06)00355-7/abstract|journal=Journal of Affective Disorders|language=English|volume=99|issue=1-3 | pages = 237–240|doi=10.1016/j.jad.2006.08.021|issn=0165-0327}}</ref> Serum IgA was significantly correlated to the severity of illness. === Malabsorption === CFS patients may have malabsorption of micronutrients. Lactic acid bacteria have therapeutic potential in malabsorption of micronutrients by supporting the intestinal epithelial barrier.<ref name=":0" />
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