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It is hypothesised that these mechanisms occur in a spiralling, progressive way, toppling the hosts homeostatic equilibrium ( Gut dysbiosis ME/CFS patients often have gastrointestinal (GI) symptoms (189) with gut inflammation (190), gut microbiome dysbiosis (191) and changes in the gut microbiome (191, 192)

Most of our patients benefit from combining two or three of these mechanisms in a structured plan rather than chasing one modality alone

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