I think there should be some additional information about this paper, and also replying to some of the questions from the other comments. I'll give it a go.
- When 3/4 authors on a paper share the same surname, some eybrows will be raised, often for good reason. Looking them up, one of them is actually a dentist, not an M.D. Not sure how the dentist contributes here.
-
Just realized these figures do not add up: the prevalence of IBS in the general population is estimated to be between 10% and 20%. So if 65% of those with IBS go on to get ME/CFS, that would be a lot of cases of ME/CFS, much higher than the generally agreed ME/CFS prevalence of 0.2%.
You are so right. According to those numbers, approx 7% to 13% of the general population should have M.E. with the ICC criteria. There might be several reasons for this misleading result.
In fact, three of these authors have been running their own IBS clinics for some time. So the only M.E. patients they get, are the M.E. patients who have severe problems with their digestive system - a.k.a. IBS. So the results here are not representative for the general IBS population, and certainly not the general M.E. population.
The authors never, throughout the paper, claim that they have chosen patients randomly either. So the results in this research paper are from selected cases that have gone through their clinics during a period of 26(!) years, and hence, it can not support anything other than a questionable hypothesis.
- One serious oddity about this paper is the claim that they have used ICC, International Consensus Criteria, for the definition of M.E. The first ICC paper was published in 2011, and was not used clinically until many years later. How, then, do they know for sure that patients who visited their clinics 26 years ago could be diagnosed with M.E.? Do they have psychological profiling at their clinics to exclude primary mental illnesses? This seems really questionable.
- In addition, the main author (A. Berstad), is a retired M.D., over 80 years of age. He has definitely done a lot of good for IBS in Norway. However, his theories from the recent years that IBS can cause M.E. has not been proven anywhere, and seems to be an unfounded causality claim. In fact, there are more researchers saying that IBS can come from the effects M.E. has on the immune system, hence also affecting our digestive system.
In
this interview (in Norwegian) he claims that up to 85% of M.E. cases are a result of bad gut bacterial flora. Also, that 70% of Fibromyalgia cases start with the same bacterial flaw. There are no research papers to support these claims. He also claims that a bad bacterial flora is also behind people becoming allergic, getting autoimmune diseases in general, and chronic fatigue in general.
- Some of the main claims of the paper talks about Tryptophan being a solution, and that by ingesting more tryptophan your body will heal. However, Ron Davis himself have warned about this pathway, saying that
it might even be possible to induce autoimmunity by inserting Tryptophan into your body. So if you try it out, do it at your own risk. If M.E. is an autoimmune disease, you might become sicker than you already are.
---
So, to add up, the hypothesis might seem intriguing, however, the paper could be criticized in a lot of ways. Even thogh the hypothesis can be criticized, I am still super happy that there is research being done on M.E. and the digestive system
Be sceptical, live long and prosper!
