…There is considerable evidence to highlight an abnormality of the autonomic nervous system as a unifying pathological factor. Newton et. Al.
Newton’s shown that people with chronic fatigue syndrome tend to display an interrelated trio of problems; increased acid in their muscles during exercise, reduced cardiac energetics and autonomic nervous system problems. She believes autonomic dysfunction may be causing all these issues.
Now she’s moving up to the brain. In this study, she’s determining whether poor pH handling in the muscles (acid removal) is associated with reduced blood flows in the brains. If it is, she will be to connect the brain problems with autonomic nervous system problems found in the body.
Because this study is correlational it will not prove anything, but a positive result would buttress the autonomic nervous system’s role in ME/CFS.
Keep This in Mind
The group started by pointing out a study indicating that orthostatic intolerance can be associated with prolonged bouts of vasoconstriction in the blood vessels of the brain.
(Interestingly the people this occurred in did not have racing heart beat upon standing (POTS – postural orthostatic tachycardia syndrome) or lowered blood pressure upon standing (orthostatic hypotension), but they did have orthostatic intolerance. The blood vessels in their brain constricted when they stood up – a normal reaction – but then they remained constricted when they should have relaxed – which may be a common pattern in ME/CFS.
The blood vessels should apparently constrict and then open, constrict and then open; the opened blood vessels fill with blood, and then the constriction pushes the blood forward. Chronically constricted blood vessels, therefore, end up impeding the flow of blood.
A condition called reversible cerebral vasoconstriction syndrome caused the arteries in the brain to narrow – sometimes for months at a time – triggering severe headaches, nausea, weakness, light sensitivity and confusion. This condition, not surprisingly, can be misdiagnosed as migraine, and women, not surprisingly given the gender balance in ME/CFS/FM and allied disorders, appear to be affected more than men. )
Newton’s studies are getting more and more complicated. In this one, she measured pH loading by the muscles and cerebral blood flow – while the ME/CFS patients did the Valsalva maneuver, an autonomic nervous system stressor, which simply requires that they pinch their nose, close their mouth and then blow hard.
It is possible that CFS is driven by a primary peripheral abnormality….where a compromised skeletal muscle cellular membrane function underpins the observed abnormalities. Newton et. Al.
The Newton team found that high pH in the muscles was associated with reduced blood flows in the brain and with prolonged tightening (vasoconstriction) in the brain’s blood vessels.
Most central nervous system (CNS) ME/CFS/FM research focuses on how the CNS affects the body, but this study suggests the opposite – that problems in the body, specifically the muscles, are affecting the brain.
Free Radicals Smack the Cellular Membranes?
Those problems, the Newton team believe, could originate in the cellular membranes surrounding the muscle cells, and they noted that several studies (as well as the widespread use of Omega-3 fatty acids) suggests the cellular membranes may be damaged in chronic fatigue syndrome.
Increased rates of fatty acid membrane damaging free radicals are consistently found in ME/CFS studies, and Shungu et. al have found evidence of a diminished antioxidant response in the brain. (From Shungu – “the results of this third independent study support a pathophysiological model of CFS in which increased oxidative stress may play a key role in CFS “. )
This muscle pH problem could be showing up in the breathing patterns of some people with chronic fatigue syndrome, as well. Natelson’s and Naschitz’ studies suggest that about 20% of adults with ME/CFS hyperventilate. (Natelson’s study did not suggest anxiety or emotional distress caused the hyperventilation.)
An earlier study from a behavioral group found a tendency toward hyperventilation during a stressful even that could not be explained by psychological stress. That study suggested ME/CFS patients systems were teetering on the edge of a physiologically damaging breathing response.
The reduced CO2 levels that result from hyperventilation can themselves result in cerebral vasoconstriction, dizziness, visual problems, anxiety, muscle cramps and “nerve and muscle ‘excitability’”.
(Given recent findings suggesting brainstem involvement in ME/CFS/FM, it is interesting that the brainstem regulates breathing rate. Reduced brainstem blood flows found in a large 1995 UK study possibly suggest another reason why breathing rates could be off.)
The Muscle Hyperventilation Connection
“We postulate that a compromised skeletal muscle cellular membrane function may lead to the equalisation of the pH between the skeletal muscle intracellular environment and blood, where an increase in intracellular pH (more alkaline) and decrease in blood pH (acidosis) take place, triggering hyperventilation to buffer the pH change in the blood.” The authors
That hyperventilation, Newton suggests, could be the result of acid conditions in the bloodstream that reflect a more alkaline environment in the muscles. Several studies have shown problems with pH handling in the muscles of people with ME/CFS. (This situation, interestingly enough, also occurs when one exceeds ones anaerobic threshold.)
Increased carbon dioxide in the bloodstream is a by-product of this process. Increased carbon dioxide levels will trigger an increase in breathing rate an attempt to return your system to balance.
That increased breathing rate increases oxygen levels in your blood, which also causes your blood vessels to vasoconstrict (clamp down), thus impairing blood flows to the muscles and the brain – and allowing more acids and waste products to build up.
Verifying what’s going on here is going to take quite a bit of disentangling, and the Newton group stated that ‘extensive further work” with blood composition analysis is needed.
A Growing Confidence
As Newton’s mostly small but positive studies continue to pour out, she appears to be more and more confident that she’s probing an essential facet of ME/CFS. In an earlier interview, she stated she considers the problem in ME/CFS to be systemic; i.e., something that affects every system in the body. A systemic issue obviously requires a dysfunction in a body-wide system, and the vascular system, largely controlled by the ANS, is a excellent candidate.
“A relationship between the abnormalities that we have found suggesting that any problem is not just related to one organ but is generalized across a number of organs.” Dr. Newton.
In this study, she went so far as to propose that autonomic nervous system functioning problems could underlie all of ME/CFS.
The fact that she is getting very positive results (high significance levels) even in small studies, in what is probably a heterogeneous group of patients, suggests that ANS dysfunction is not only rampant in ME/CFS, but in different patients, may give rise to different types of ME/CFS.
This would make sense given her ANS findings in other fatiguing disorders (primary biliary cirrhosis, Sjogren’s Syndrome, HIV) and other conditions (the elderly). In an interview Dr. Newton stated the muscle and cardiac problems seen in ME/CFS are exactly the same as seen another extremely fatiguing disease, primary biliary cirrhosis. Even if differences do occur, it is possible a dysfunction in this multi-faceted system may cause fatigue, problems standing, problems thinking, etc. in a variety of disorders.