Special Studies: Post-Exertional Malaise (PEM)

This is a common symptom for both ME/CFS and Long COVID. This is reported often in samples, and thus being examined if it reaches our threshold for inclusion as defined in A new specialized selection of suggestions links.

Beyond the goal of identifying bacteria involved, I am curious on the intersection of the bacteria with ME/CFS and Long COVID – i.e. bacteria in common and not in common.

Study Populations:

SymptomReferenceStudy
Post-Exertional Malaise (PEM)108662
  • Bacteria Detected with z-score > 2.6: found 181 items, highest value was 6.2
  • Enzymes Detected with z-score > 2.6: found 237 items, highest value was 7.0
  • Compound Detected with z-score > 2.6: found ZERO items

The highest z-scores above are less than other symptoms. There are two possible reasons:

  • Smaller Study Population
  • A more varied population in the study group.

Interesting Significant Bacteria

All bacteria found significant had too low levels.

We have two dominant bacteria group, both Bifidobacterium and Sporolactobacillus. The latter we know little about. I should point out that these bacteria may not be the cause, rather they may be ‘the canaries in the coal mine’ of the microbiome. These studies’ methodology determines association and not causality.

Bacteria (Rank)Reference MeanStudy Meanz-score
Sporolactobacillus (genus)174606.2
Sporolactobacillus putidus (species)174606.2
Sporolactobacillaceae (family)173606.2
Bifidobacterium cuniculi (species)81245.9
Bifidobacterium asteroides (species)58235.9
[Ruminococcus] gnavus (species)742133365.4
Mediterraneibacter (genus)787037175.3

Interesting Enzymes

All enzymes found significant had too low levels.

I will leave it to the reader to go to Kyoto Encyclopedia of Genes and Genomes to learn about these enzymes (a steep learning curve).

There are some items of special interest appearing which I drill into below.

EnzymeZ-Score
hydrogen-sulfide:ferredoxin oxidoreductase (1.8.7.1)7
D-fructose:ubiquinone 5-oxidoreductase (1.1.5.14)6.2
D-fructosyl-L-lysine 3-epimerase (5.1.3.41)6.1
L-tryptophan carboxy-lyase (4.1.1.105)6
aromatic-L-amino-acid carboxy-lyase (4.1.1.28)6
CTP:N-acylneuraminate cytidylyltransferase (2.7.7.43)5.9
protein-Npi-phospho-L-histidine:L-ascorbate Npi-phosphotransferase (2.7.1.194)5.8
propane-1,2-diol hydro-lyase (propanal-forming) (4.2.1.28)5.7
N-methylhydantoin amidohydrolase (ATP-hydrolysing) (3.5.2.14)5.5
D-ribopyranose furanomutase (5.4.99.62)5.5
3-dehydro-L-gulonate:NAD(P)+ 2-oxidoreductase (1.1.1.130)5.5

hydrogen-sulfide:ferredoxin oxidoreductase (1.8.7.1): This is connected to iron. The blood uses iron to carry oxygen, and thus an absence/low level could [speculation] result in an impact on the blood’s ability to deliver oxygen (thus fatigue).

D-fructose:ubiquinone 5-oxidoreductase (1.1.5.14): This is also connected to iron.

For those wishing to explore more, you may wish to read Oxidoreductase

It does hint at an experiment to try: After exercise, try a dosage of Ubiquinol to see if it influences things.

Common Bacteria Shifts Observed in ME/CFS

We have 45 bacteria in common, they are listed below. A LOT of them are bifidobacterium, and no lactobacillus. This implies that bifidobacterium probiotics may be a good choice for ME/CFS with PEM

Tax_NameTax_rank
Thiorhodococcus pfennigiispecies
Candidatus Tammella caduceiaespecies
Veillonella atypicaspecies
Tammellagenus
Myxococcalesorder
Gemella cuniculispecies
Bifidobacterium catenulatumspecies
Nannocystineaesuborder
Olivibactergenus
Campylobacteralesorder
Epsilonproteobacteriaclass
Campylobacteraceaefamily
Pedobacter kwangyangensisspecies
Haemophilus parainfluenzaespecies
Haemophilusgenus
Clostridium aestuariispecies
Sterolibacteriaceaefamily
Lactococcus fujiensisspecies
Bifidobacterium bifidumspecies
Atopobiumgenus
Balneolagenus
Balneola vulgarisspecies
Balneolaceaefamily
Thiobacillusgenus
Pigmentiphagagenus
Thiobacillaceaefamily
Balneoliaclass
Balneolalesorder
Balneolaeotaphylum
Ruminococcus flavefaciensspecies
Hydrogenophilaliaclass
Hydrogenophilalesorder
Hydrogenophilaceaefamily
Atopobiaceaefamily
Veillonella disparspecies
Veillonellagenus
Clostridium chartatabidumspecies
Actinobacillus pleuropneumoniaespecies
Sporolactobacillaceaefamily
Sporolactobacillus putidusspecies
Sporolactobacillusgenus
Bifidobacterium kashiwanohense PV20-2strain
Bifidobacterium catenulatum subsp. kashiwanohensesubspecies
Bifidobacterium gallicumspecies
Bifidobacterium cuniculispecies
Bacteria COMMON to ME/CFS and PEM

Common Bacteria Shifts Observed in Long COVID

We have 42 bacteria in common, they are listed below. We notice some interesting difference from above:

  • Lactobacillus at the genus level as well as the retail probiotic Lactiplantibacillus plantarum (AKA Lactobacillus plantarum)
  • Bifidobacterium is still there, but one of them is available as a retail probiotics.
    • Bifidobacterium animalis
Tax_NameTax_rank
Paenibacillusgenus
Veillonellagenus
Actinomycetaceaefamily
Lactiplantibacillus plantarumspecies
Actinomycesgenus
Flammeovirgagenus
Flammeovirga pacificaspecies
Flammeovirgaceaefamily
Lactiplantibacillusgenus
Phocaeicola massiliensisspecies
Prosthecobactergenus
Fusobacterium gonidiaformansspecies
Candidatus Tammella caduceiaespecies
Gammaproteobacteriaclass
Tammellagenus
Coriobacteriaceaefamily
Fusobacteriaphylum
Fusobacteriiaclass
Fusobacterialesorder
Coriobacterialesorder
Bifidobacterium thermophilumspecies
Dolichospermum curvumspecies
Blautia wexleraespecies
Atopobiaceaefamily
Actinobacillus pleuropneumoniaespecies
Eggerthella lentaspecies
Fusobacteriaceaefamily
Atopobiumgenus
Schaaliagenus
Bifidobacterium gallicumspecies
Eggerthellagenus
Bifidobacterium animalisspecies
Aerococcaceaefamily
Coriobacteriiaclass
Bifidobacterium cuniculispecies
Schaalia naturaespecies
Phocaeicola sartoriispecies
Leptospira licerasiaespecies
Leptospiraceaefamily
Leptospiragenus
Leptospiralesorder
Alkalibacteriumgenus

Bottom Line

There appear to be differences between ME/CFS with PEM and Long COVID with PEM. The main difference is with Long COVID: Lactobacillus probiotics is a suggestion; for ME/CFS it is not.

Remember suggestions that are specific to your unique microbiome are available on the Microbiome Prescription web site.

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