D-lactate acidosis in chronic fatigue syndrome

A recent paper on chronic fatigue syndrome tried to prove a hypothesis that a subset of chronic fatigue syndrome sufferers could possibly be due to d-lactate acidosis, which is produced by lactic acid producing bacteria in the gut. The theory they have is these bacteria can also produce hydrogen sulfide in certain circumstances, which many body odor sufferers will know as 'rotten egg' smell.

This paper was conducted by a few researchers, including the Belgian researcher Dr Kenny De Meirleir, mentioned on the blog recently. He has a track record in researching dysbiosis as a factor in chronic fatigue syndrome.

D-lactic acid is very similar to the L-lactic acid we build up when exercising, but the difference is that L-lactic acid is very easily metabolized into a nontoxic excretable product, whereas D-lactate is very slowly metabolized. D-lactate acidosis is known to be a danger in those with parts of their small intestine surgically removed or missing, presumably because the lactic acid producing bacteria that normally reside at the ileum, are forced to move higher up to the more absorptive jejunum area.

An interesting point about d-lactic acid is that normally it is gram-positive bacteria that produce it, including lactobacillus, which is often in probiotics.

The Belgian researcher, Dr Kenny De Meirleir, has developed a home test where he tests for metabolites of excess hydrogen sulfide (presumably hydrogen sulfate). However this test is currently very new and experimental. It relies on color-change for diagnosis.

MeBO is hoping to arrange a small number of inexpensive 'gut dysbiosis' studies in the UK totalling £71 each for anyone who wants to test, including a D-lactate blood test for £13. More will be posted about this later. MeBO hopes to check various areas of testing to see if there are one or more factors involved in 'fecal body odor syndrome'. In this case looking at gut dysbiosis as a possible factor.

Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome.

Sheedy JR, Wettenhall RE, Scanlon D, Gooley PR, Lewis DP, McGregor N, Stapleton DI, Butt HL, DE Meirleir KL.

Vrije Universiteit Brussel, MFYS, Pleinlaan 2, 1050 Brussels, Belgium. Kenny.De.Meirleir@vub.ac.be.

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. A significant increase of Gram positive facultative anaerobic faecal microorganisms in 108 CFS patients as compared to 177 control subjects is presented in this report. The viable count of D-lactic acid producing Enterococcus and Streptococcus spp. in the faecal samples from the CFS group (3.5x10(7) cfu/L and 9.8x10(7) cfu/L respectively) were significantly higher than those for the control group (5.0x10(6) cfu/L and 8.9x10(4) cfu/L respectively). Analysis of exometabolic profiles of Enterococcus faecalis and Streptococcus sanguinis, representatives of Enterococcus and Streptococcus spp. respectively, by NMR and HPLC showed that these organisms produced significantly more lactic acid from (13)C-labeled glucose, than the Gram negative Escherichia coli. Further, both E. faecalis and S. sanguinis secrete more D-lactic acid than E. coli. This study suggests a probable link between intestinal colonization of Gram positive facultative anaerobic D-lactic acid bacteria and symptom expressions in a subgroup of patients with CFS. Given the fact that this might explain not only neurocognitive dysfunction in CFS patients but also mitochondrial dysfunction, these findings may have important clinical implications.

http://www.ncbi.nlm.nih.gov/pubmed/19567398

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related links:
pdf file of original 'H2S' proposal : http://aboutmecfs.org/Rsrch/H2S.pdf
Blog post about CFS and H2S theory : http://aboutmecfs.org/blog/?p=613
http://www.prohealth.com/library/showarticle.cfm?libid=14579
http://www.prohealth.com/library/showarticle.cfm?libid=14579
http://cfsandmeawareness.com/blog/?p=659