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Chronic Fatigue and Exercise Intolerance

Sleeping when studying - Nakhon Sawan, Thailand

Sleeping when studying – Nakhon Sawan, Thailand (Photo credit: Wikipedia)

Exercise Intolerance is exactly the thing that people blame themselves (and others for).  Stop being lazy, push yourself harder, nauseous?  here have a half a stick of gum, now don’t give up!

Maybe all these things are valid at one level to get one out of a rut, or complacency, but when you have chronic fatigue these behaviors maybe fairly dangerous.  One young man who pushed himself despite his Exercise Intolerance, died from his efforts.

The Test

Using the same stress tests as used by doctors and sports professionals 8 minutes on an exercise bike, add in a mask to test for oxygen levels, the system tests several systems, cardiac, pulmonary, and metabolic.  Normal people after having this type of stress should recover and have the same performance the next day.   CFS people do not. If you have CFS you know that it takes several days to recover.

The test can give you your “anaerobic threshhold”.  This is the activity level where CFS patients now lose strenth and stamina in a way that is difficult to recover from.  Less than your threshhold you can still “bounce back” from your activities.  That threshold can be referred by heart rate, so theoretically you can exercise as long as you remain below that threshhold.

Disability

Unfortunately some people meet this threshhold while taking a shower, or other daily activities.  Luckily Social Security has been accepting the results from this test as an independent marker of disability.

Categories: Bodywork, Fatigue, POTS, Stress

Chronic Fatigue as a Response to Organ Failure

January 23, 2013 12 comments

 In 2004 a patient of Dr. Cheney, Carol Silverling wrote down her interpretations of the cardiac dynamics of CFS.  Her article was based on interviews with Dr. Cheney and her own knowledge.CS

The premise is that because of mercury poisoning or viruses we are creating too much peroxynitrite which causes oxidation and aging Reduced microcirculation as a result of the mercury  begins to cause organ failure.  In “normal” people this may result in a fast path to organ transplant (or death), but for others (those who have CFS)  it results in organ failure in a progressive slower fashion.  This means you have time to address the problems! 

Heart Failure

Dr. Cheney’s premise is that every CFS individual is in the process of heart failure, this is termed Idiopathic Cardiomyopathy (ICM). The difference between CFS and heart failure is that the body is trying to compensate for the lack of microcirculation  by symptoms found in CFS. 

 Dr. Natelson applied for an NIH grant to find physiological parameters that may independently be a measure for the degree of disability. The purpose of this was to find a quantifiable way to designate those that are disabled from those that are not.  But also a measure of the degree of disability…how disabled are you? This could be significant in a “two-sides-of-the-same-coin” kind of way.  With an objective marker you could not fool anyone into providing disability services that were not needed.

And on the other side, you could get disability services even though you “don’t look sick”. The measure they looked at was “Q”, which stand for cardiac output in liters per minute.  CFS individuals have the largest variation of Q when they stand up.  This lowered Q could result in organ failure due to low cardiac output.  In this measure the higher the score the greater the disability.  Using an FDA approved algorithm to measure impedance of blood,  they determined this Q measure.  The idea was that the Q value would be adjusted for size of the individuals so that the it was a true measure of disability across the population and body types.

There is a another statistic that correlates with Q, and that is post extertional fatigue (PEF).  This is not the “no pain, no gain” kind of pain you want while building muscle. This is a breakdown and can’t repair kind of muscle ache.  As it turns out all disabled CFS patients have PEF. 

At the same time you may be aware of POTS (Postural Orthostatic Tachycardia Syndrome). There are several kinds of POTS, but one is when one stands up and  the drop in blood pressure is large enough that the heart must compensate by beating faster.  The reason for the drop is that the end arteriole or resistance vessel was not doing its job of moving  blood up against gravity from your feet.  When this is not working your body also tries to compensate by increasing the pressure to get it moving.  When this occurs the main line (to the heart)  improves but peripheral blood is not moving optimally and microcirculation is decreased.    These compensations by the heart are just that — compensations.

Organ Failure Progession

Peripheral organs fail first without enough Q, but they are sacrified in priority.  Here is that priority in normal circumstances. See if this lines up with the progession of illnesses in yourself or family/friend:

  • Skin and hypothyroidism. The skin and nails are at the extreme “end” of your body and therefore will suffer the most from loss of microcirculation. Now you can’t regulate your temperature from your skin so your body turns down your thyroid ON PURPOSE.  Your skin which is one way to detox is now unable to do this and so detox through sauna is often recommended.
  • Muscles.  Not only do you get pain when you exercise, you get NO GAIN.  The more capillaries (like male athletes have) the less likely this is going to happen, and if you are a sedentary female…well you can guess. This is because women have fewer capillaries then men on average and based on the  lack of activity do not grow (or maintain the ones you have).  This could explain how with intense exercise you are still unable to gain muscle.
  • Gut.  Since your gut needs microcirculation to function, you won’t be able to digest, and will develop food allergies, and be unable to detoxify.  You could get flatulence, constipation and all sorts of overgrowths.  Less digestion also means less absorption. 
  • Brain.  As the master controller of your bodily functions if this doesn’t work, neither does anything else really.  You could get autonomic problems to hypothalamus regulation of hormones, decreased processing speed, memory and cognition.  The combination of thinking and being sedentary (office work anyone?) is the worst possible combination.  Meditation might help those who are sedentary, but even slow deliberate exercise would be good.  In the worst cased you could get a rebounder, a small trampline and just bounce on it.
  • Heart.  Now your heart struggles with even the smallest amount of exertion, if the microcirculation problems get worse your hearty heart cells begin to die.  If  this in turn causes more microcirulation problems you have begun a feedback loop of cardiac failure. 
  • Kidneys and Lungs are the last to go and are considered the cause of death.  The only thing that can save you is a transplant.  In CFS though it’s different. You may have most of the early steps, but you don’t end up with extreme pulmonary edema and renal failure.

Causes

ICM can often caused by infectious diseases; Dr. Cheney thinks there might be a link to some viruses.  The other contributing factor could be heavy metal poisoning.  An Italian study found that ICM hearts had 23K times more mercury than control and 18K more mercury than other types of heart disease.

Peroxynitrite

Dr. Pall has another angle on CFS and that is Peroxinitrite.

NO + Super Oxide = Peroxinitrite

Peroxynitrite is deadly and this is the celluar cause of “old age” and death.  However it is made from two compounds that are essential for life, Nitrous Oxide (NO) and Superoxide (SO). Peroxynitrite participates in oxidation with free radical formation. Dr. Pall studied these dynamics in CFS which can be explained as follows:

Nitrous Oxide  (NO)

 There are three kinds of Nitrous Oxide, iNOS, eNOS and nNOS. iNOS is created to fend off bugs and allergies.  eNOS is for microcirculation, and nNOS is for memory and learning, but also makes you sensitive to (Electro Magnetic Radiation) EMR and noise. The NMDA receptor makes NO when activated; some practitioners use GABA to downregulate NMDA.

Superoxide (SO)

is made while manufacturing energy, in the mitichondria. NO is found outside the mitochondria, thus NO and SO have no way of interacting with each other to create peroxynitrite. Until SO starts to leak out.  Within the mitochondria, SO should be broken down by SOD before leaking out, but this assumes that glutathione is present.  If you have the CBS mutation you may not be making enough glutathione.  If you are very toxic, the glutathione you make might be attending to other problems and not be around to help.

Mercury can block the binding site of selenium on a cell and therefore not allow the SO to be broken down, now it begins to leak out of the cell. The more energy you generate the more SO begins to leak in the presence of mercury. Eventually having not enough glutathione will result in injury to the mitochondria membrane.

CoQ10 in the mitochondria and ALA in the cytoplasma bind to SO to prevent leaking out and unable to form peroxinitrite in the when it does.  CoQ10 is tricky in that there is an optimum amount and taking more than that you may generate more SO than you wanted. (It appears that Idebenone may be better than CoQ10 in that case) 

Without CoQ10 and ALA to help, your body stops making energy in order to reduce the creation of peroxynitrite.  Provigil is often used to create energy by activating the NMDA receptor, but this is creating more NO, which can contribute  to peroxynitrite in the presence of SO. 

So what gets rid of peroxynitrite once it is created?  CO2.  CO2 is a peroxynitrite scavenger and is created when ATP is made. Normally this would work great, but as ATP is reduced (because peroxinytrite is not being scavenged) so is CO2 and thus the scavenging of Peroxynitrite gets reduced further.

You can increase CO2 by rebreathing your own breath. This will also improve microcirculation.  Have you notice you or family member sleeping comfortably entirely under the covers?  Could this be the mechanism going on?

How do you reduce NO and SO?

    1. Klonopin gets rid of the enzyme that creates NO.
    2. You could live at or below sea level to increase CO2. POTSIES often feel better at these elevations.
    3. Uric acid is a scavenger of peroxynitrite and is found to be low in CFS.  It is made from RNA and DNA metabolism, and fasting!  So those religious folks had it right. 
    4. Sushi is very high in digestible RNA and DNA. Microwaving kills RNA and DNA efficiently.   You can also eat “young food” such as eggs and raw milk. If you can’t get raw milk consider raw milk cheeses.  Nuts and seeds and baby lettuces and spinach as well.
    5. B12 injections (if you have the MTHFR mutation this means Methyl B12 injections)
    6. Magnesium Sulfate blocks NO production. Finally you can take Zinc and Selenium to block and/or chelate mercury.  

I really found this topic very interesting.  It explains a progression of symptoms that are familiar and for me points back to mercury being the culprit.  Luckily we have ways to remove the mercury even if is a complex process.  Other ways to help with microcirculation in the meantime are L-Arginine and Black Pepper Essential Oils.  

In summary, instead of running headlong into heart failure, PWCFS are going through the same progression just much slower…giving us time to maybe address the problem.

POTSies! I have brought down my heart rate during exercise!

December 10, 2012 1 comment

For those who don’t know POTS stands for Postural Orthostatic Tachycardia Syndrome.  Often found in people who have CFS and found in those who don’t…technically.  I don’t recall having had it before but after I delivered my awesome son, I decided that I MUST workout and bounceback.  So I joined a gym and didn’t make progress.  So I got a personal trainer to kick my butt.  He had us get on treadmills to warm up, and I have to tell you I could barely walk.  So I decided to test my heart rate and it was 170…walking….slowly!

 To decode POTS a bit, “P” for postural means that it is dependent on your posture.  “O” for Orthostatic means standing up.  “T” for Tachycardia means high heart rate, and Syndrome.  Typically the more distance between your feet and head, the more difficult it is to get your blood up to your head.  Normally your vessels in your feet/legs will constrict to push the blood up. But if you have POTS it is not happening.   So either you heart beats faster to get the blood up there, or you faint.  Unfortunately the fainting part can be very dangerous, but the racing heart rate can be dangerous in a longer term way. 

Pulsometr donnay

Pulsometr donnay (Photo credit: Wikipedia)

For the longest time, I thought that my high heart rate came from the thyroid medication I was taking, so I decided (all on my own) to come down off of it.  That’s another story, but suffice it to say my heart rate did not come down, and several other (bad) things happened. 

I have a great friend I walk with, on the same course. The advantage is its the same work out every day.  So I got myself a little heart monitor and started seeing how high it got.  My max value had come down to 140! What had I done in the intervening time?  About a hundred different things!

But I had a hunch.  That hunch had to do with Alpha Lipoic Acid (ALA). I had been on a low and slow protocol for this several times and did not think it had made any difference in my day to day life.  I did know however that it was good for the liver. But I decided to test it.  I made sure I wasn’t trying any other interventions and went through a couple rounds of this protocol.  What did I notice immediately afterwards?  My max heart rate is down to 120 on the same path.

I still get really tired, and don’t have tons of energy, but at least I can now exercise without fearing I’m going to give myself a heart attack!

Tricyclics for Mast Cell

October 22, 2012 2 comments

There are several tricyclics in the market.  These were used as antidepressants before SSRIs became popular.  They can help children who wet the bed when they get older, or help you sleep.   For me, I used it for sleep but lost interest in food.  This made for an easy diet and a 60lb effortless weightloss.  My friends worried that I did not have proper nutrition but I finally got my body to use my fat stores. Yeah! 🙂

Now what are mast cells? From Wikipedia:  “is a resident cell of several types of tissues and contains many granules rich in histamine and heparin. Although best known for their role in allergy and anaphylaxis, mast cells play an important protective role as well, being intimately involved in wound healing and defense against pathogens.[2]” 

Many people with POTS (Postural Orthostatic Tachycardia Syndrome) also have mast cell problems. This means there is a lot of inflammation and allergic reactions. This often manifests as skin inflammation, and for me sometimes I think it results in me taking  a “power nap” soon after eating items that activate mast cells.

Tricyclic antidepressants may be beneficial in CFS because of their ability to inhibit brain mast cell activation and release of proinflammatory molecules. (1)   Interestingly these happen in the brain.

There are several types of tricyclics.  The one I used is amitriptylene for sleep.  It takes about 6 weeks for it to go into full effect I lost weight easily and was not hungry.  Finally I saw that I was beginning to look gaunt. So I stopped sure that my weight gain would return….NOT!  Slowly I began to get an appetite again, and it was a normal hunger not craving.  Weight gain?  NOT!

It was only after 3 years, when under a lot of stress that my weight gain began and has continued steadily for the last 5 years.  I tried the amitryptiline again, but did not have the same effect :(.

Nonetheless, there is something significant about its effect. It may histamine related, maybe not.   Needs discovery.

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