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==ME/CFS== A growing body of evidence suggests that an [[dysbiosis|altered microbiome]]; [[intestinal permeability|mucosal barrier]] dysfunction;<ref name="Lakhan2010">{{Citation| doi = 10.1186/1743-7075-7-79| issn = 1743-7075| volume = 7|issue = | pages = 79| last1 = Lakhan | first1 = Shaheen E| last2 = Kirchgessner | first2 = Annette| title = Gut inflammation in chronic fatigue syndrome| journal = Nutrition & Metabolism| access-date = 2016-12-13 | date = 2010-10-12| url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964729/| pmid = 20939923}}</ref> the translocation or crossing of bacteria from the gut into the [[blood|bloodstream]]; and subsequent immune response may pay a role in the pathophysiology of [[myalgic encephalomyelitis]]\[[chronic fatigue syndrome]]. A 2021 study by Damiano and colleagues observed significant differences in several types of bacteria in the saliva and gut in CFS/ME patients compared to controls, but was unable to determine if the alteration of the microbiome is a cause or a consequence of the onset of CFS/ME and if the changes in the microbial composition are related to any of the several secondary symptoms.<ref name="Damiano2021" /> The study showed that the intestinal microbial profile recorded in a group of ME/CFS patients was consistent with the reported for other autoimmune conditions, such as Crohn’s disease, [[ulcerative colitis]] and [[systemic lupus erythematous]].{{citation needed | date = 2021}} ===Immune response=== A study of 128 [[ME/CFS]] patients found significantly increased [[IgA]] response to [[lipopolysaccharide]]s from the cell walls of commensal bacteria. Increased IgA response was associated with increased serum [[interleukin 1|IL-1]], [[TNFα]], [[neopterin]] and [[elastase]]. The study concluded that increased translocation of commensal bacteria may be responsible for the disease activity in some ME/CFS patients.<ref name="Maes2012" /> ===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]]. ME/CFS patients have higher levels of [[D-lactic acid]] bacteria,<ref>{{Cite journal | last = Sheedy | first = John R. | authorlink = | last2 = Wettenhall | first2 = Richard E. H. | authorlink2 = | last3 = Scanlon | first3 = Denis | authorlink3 = | last4 = Gooley | first4 = Paul R. | authorlink4 = Paul Gooley | last5 = Lewis | first5 = Donald P. | authorlink5 = Donald Lewis | last6 = McGregor | first6 = Neil | authorlink6 = Neil McGregor | last7 = Stapleton | first7 = David I. | last8 = Butt | first8 = Henry L. | authorlink8 = Henry Butt | last9 = De Meirleir | first9 = Kenny L. | authorlink9 = Kenny De Meirleir | date = Jul 2009 | title = Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome|url=https://pubmed.ncbi.nlm.nih.gov/19567398|journal=In Vivo (Athens, Greece)|volume=23|issue=4 | pages = 621–628|doi=|issn=0258-851X|pmc=|pmid=19567398|access-date=|quote=|via=}}</ref> decreased levels of [[bifidobacteria]],<ref>{{Cite journal | last = Logan | first = Alan C | authorlink = | last2 = Venket Rao | first2 = A | authorlink2 = | last3 = Irani | first3 = Dinaz | authorlink3 = | date = Jun 2003 | title = Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value|url=https://linkinghub.elsevier.com/retrieve/pii/S0306987703000963|journal=Medical Hypotheses|language=en|volume=60|issue=6 | pages = 915–923|doi=10.1016/S0306-9877(03)00096-3|pmc=|pmid=|access-date=|quote=|via=}}</ref> and may suffer from [[small intestinal bacterial overgrowth]] (SIBO) at higher rates.{{citation needed}} ===Exercise=== A small study of ten CFS patients found significant changes in the composition of the microbiome and increased bacterial translocation (movement from the [[gastrointestinal system|intestine]] into the [[blood|bloodstream]] following [[exercise]]). In the blood, the study found increased [[Clostridium]] fifteen minutes after exercise and increased [[bacilli]] 48 hours later.<ref name="Shukla2015" /><ref>{{citation | last = Johnson | first = Cort | date = December 21, 2015 | title = Exercise Triggers Gut Changes in Chronic Fatigue Syndrome (ME/CFS)|url= http://www.cortjohnson.org/blog/2015/12/21/exercise-gut-chronic-fatigue-syndrome-me-cfs/|newspaper= HealthRising|location= Houston|access-date= 2016-12-12}}</ref>{{citation needed | date = 2021 | reason=Add original research}} ===Sleep=== In a very small study, CFS patients treated with [[erythromycin]] who had clinical response (i.e., reduced [[streptococcus]]) had improved sleep. Higher [[lactobacillus]] was associated with poorer mood.<ref name="Jackson2015" /> ===Gender=== A study of 274 [[ME/CFS]] patients found sex-specific interactions between [[Firmicute]]s ([[Clostridium]], [[Streptococcus]], [[Lactobacillus]] and [[Enterococcus]]) and ME/CFS symptoms (including neurological, immune and mood symptoms) and symptoms in spite of similar overall composition across sexes.<ref name="Wallis2016" />
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