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Link between Metabolic Syndrome and ME/CFS?

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by Jody Smith



As is so often the case, the research on a possible correlation between metabolic syndrome and ME/CFS is scanty. When I came across this threadbare research, though, I was desperate enough to check it out for myself.

I recognized myself when I read about the weight gain and difficulties in dropping the weight, but what really rang a bell was when I read that brain function can be severely affected. A poorly-working brain has been one of the worst symptoms of ME/CFS that I struggle with.

Diabetes runs in my family, and the fact that I had so many signs of metabolic syndrome was no surprise. I'd been relatively slim most of my life, though after having my fifth baby I was fighting a certain amount of baby fat that didn't want to cooperate.

This, while lamentable, is not uncommon. What was unusual was that around the time I began to have classic ME/CFS symptoms in my 30s, I was also experiencing an alarming increase in weight, most of it right around the middle.

I found that paying attention to the glycemic index and limiting carbohydrates reduced my cognitive difficulties, and my paresthesia (fancy word for bizarre physical sensations like buzzing, vibrating and swirling in my face, hands, arms and legs).

I was encouraged to find that CFIDS.org had reported that patients with ME/CFS may need to deal with metabolic syndrome. I found that when I began to treat my metabolic syndrome symptoms, I also had a lessening of my ME/CFS symptoms. Changing my diet a la metabolic syndrome caused that weight to disappear.

People with ME/CFS face more challenges than others in dealing with metabolic syndrome. Exercise is generally recommended for this condition, but exercise can also cause relapse or worsening of ME/CFS symptoms.

Diet changes are also recommended for metabolic syndrome, but for many ME/CFS patients buying and fixing foods can be quite daunting, and many must settle for whatever they can afford, and whatever they can manage to heat up and eat. Processed foods that are quick to prepare are all some patients can manage.


Link with cognitive issues

Research from NYU School of Medicine indicated a link between metabolic syndrome and brain dysfunction including cognitive issues for adolescents. The study is online in the September 3, 2012 issue of Pediatrics.

Investigator Antonio Convit, MD, professor of psychiatry and medicine at NYU School of Medicine and a member of the Nathan Kline Research Institute, and colleagues had found previously that metabolic syndrome was associated with neurocognitive abnormalities for adults, but the new research shows evidence of more severe brain dysfunction in teens.

This was noteworthy because this age group does not tend to have vascular disease or long-term slow metabolism which can be found in the adult population.

The teens in the study displayed poor math skills, impaired attention span and less mental flexibility. Brain structure and volume was evidenced by reduced volume in the hippocampus (which is involved with learning and remembering new information), less brain cerebrospinal fluid, and less microstructural integrity in the brain's white matter.

Research from the French National Institute of Health Research, Bordeaux, France was published online in Neurology on February 2, 2011. Metabolic syndrome was seen to have a link with memory loss and dementia.


Also Known As

Dr. Andrew Weil, Director of the Center for Integrative Medicine of the College of Medicine, University of Arizona, calls metabolic syndrome "a collection of conditions that when taken together dramatically increases the risk of heart disease, stroke and diabetes."

Metabolic syndrome is also known as syndrome X, insulin resistance syndrome or dysmetabolic syndrome.

Weil says that 25-30 percent of Americans may have metabolic syndrome. The risk for it increases with age: 40 percent of Americans have metabolic syndrome by their 60s and 70s.


Risk Factors

There are several risk factors for metabolic syndrome. If you have three of these factors, you may have metabolic syndrome:
  • A waist circumference of at least 35 inches for women and at least 40 inches for men
  • Fasting blood glucose of at least 100 mg/dL
  • Serum triglycerides of at least 150 mg/dL
  • Blood pressure of at least 135/85mmHg
  • HDL or "good" cholesterol that is lower than 40 mg/dL for men or 50 mg/dL for women
Insulin resistance is an element of metabolic syndrome. This means insulin levels are high, causing problems like chronic inflammation, arterial wall damage, decreased output of salt by the kidneys, and thickening of the blood. These issues will only increase over time if the condition isn't treated.

Insulin resistance makes cells less sensitive to insulin. Glucose in the blood increases, the pancreas overcompensates by manufacturing more insulin. The heightened insulin levels provoke a stress response involving higher levels of cortisol which is a long-acting stress hormone. This leads to an inflammatory reaction in the body that can ultimately damage tissue.

Sleep apnea and other sleep abnormalities can increase insulin resistance and exacerbate metabolic syndrome.


Dietary Recommendations

Weil recommends eating an anti-inflammatory diet. He suggests eating meals that are small and frequent which helps to maintain healthy blood sugar. This prevents the overwhelming of the bloodstream with glucose and insulin.

Weil advises limiting refined sugars and starches. Foods that are low on the glycemic index help to maintain healthy blood sugar levels. He favors monounsaturated oils like olive oil, and avoiding trans fats and saturated fats.

Cold-water fish, like salmon and sardines, are high in omega-3 fatty acids. Supplements of omega-3 fatty acids can also be beneficial. Avoid starchy vegetables and stick with other veggies like asparagus, bell peppers, cucumbers, dark leafy greens and zucchini.

Foods that are high in magnesium may lower the risk for metabolic syndrome. Eat such foods as almonds, avocados, beans, leafy green vegetables and halibut. Limit your alcohol content, especially beer to keep triglyceride levels down.


Conclusion

It certainly seems to me that I deal with metabolic syndrome, and the cognitive problems associated with it. Fortunately I don't have to wait for definitive acknowledgement from any organizations or doctors in order for me to proceed with my decision to incorporate this information into my recovery plan.

And as I have been able to reduce my ME/CFS symptoms this way, I'll continue to do my best to win against metabolic syndrome, and protect my beleaguered brain in the process.


Further reading

Not Depression, More Like Alzheimer's
http://www.ncubator.ca/Depression_Alzheimers.html

Chronic Fatigue Syndrome and a Low Carb Diet
http://www.ncubator.ca/carbs.html

CFS Clinical Pearl: Recognizing Metabolic Syndrome B
http://www.cfids.org/cfidslink/2008/040906.pdf

Directors: Andrew Weil, MD
http://integrativemedicine.arizona.edu/about/directors/weil

Metabolic Syndrome
http://www.drweil.com/drw/u/ART03193/Metabolic-Syndrome.html

Metabolic syndrome associated with cognitive and brain impairments in adolescents
http://www.news-medical.net/news/20...ive-and-brain-impairments-in-adolescents.aspx

Metabolic syndrome linked to cognitive decline in older adults
http://www.theheart.org/article/1181423.do




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I thought I'd put a few links here from the website of one of my specialists.

He calls insulin resistance the Pandora's Box of illnesses... as it can cause soo many different issues or coexisting issues with it. http://www.agale.com.au/PANDORA.htm

Warning on the need to handle insulin tests correctly or results may end up coming in wrong http://www.agale.com.au/assay2.htm

A couple of his CFS case studies which turned out to be caused by insulin resistance (note in the second one, the lady was in a wheelchair due to it) http://www.agale.com.au/CFS.htm
 
I have developed Metabolic Syndrome in the last 2 years. It has severely compounded the ability to manage my disease.


You have my sympathy. I have found dietary changes have made a big difference in managing my metabolic syndrome, and a few supplements. It doesn't get in my way nearly like it used to though I have to make my decisions with it always in mind it seems.
 
The recent Lipkin (and Stanford?) finding of high Leptin strongly implicates that ME may cause metabolic syndrome, and possibly diabetes. It stuffs around with energy pathways and the brain regulation of energy pathways. If even thin ME patients have this, which I strongly suspect but has not so far been explicitly stated by Lipkin etc., then there goes the idea that only obese people get high leptin.
 
As I said in a previous post, I have been struggling with weight gain and water retention for the past two years. I was diagnosed last week with Diabetes ad have been put on a strict diet and Metformin.

Has anyone heard about the fact that obstructive sleep apnea can cause metabolic syndrome and diabetes if left untreated?
 
As I said in a previous post, I have been struggling with weight gain and water retention for the past two years. I was diagnosed last week with Diabetes ad have been put on a strict diet and Metformin.

Has anyone heard about the fact that obstructive sleep apnea can cause metabolic syndrome and diabetes if left untreated?
I think I read that obstructive sleep apnea can increase leptin, so there might be a connection there.
 
As I said in a previous post, I have been struggling with weight gain and water retention for the past two years. I was diagnosed last week with Diabetes ad have been put on a strict diet and Metformin.

Has anyone heard about the fact that obstructive sleep apnea can cause metabolic syndrome and diabetes if left untreated?

They never said anything like that to me when I was recently diagnosed with Apnea, Gabby.

But I get my test for diabetes next week as you know, though the two were again not specifically linked. It was my incontinence and frequency of urination, that has led to the diabetes test - not that I expect a positive result.

Like Bob said though, weight gain - especially around the neck - can cause or exacerbate breathing issues at night that can then lead to a diagnosis of Apnea. But really you need to get a sleep study organised - though with what you have been through lately I can understand if you don't want to yet.

I do think weight gain and diabetes are linked. I also think that Rheumatiod Arthritis can play a part in swellings about the body - if what Mum tells me is anything to go by.

Seems like - as in everything in life - more than one factor might be at play :hug:

When I gave up smoking I added the pounds, and because of the ME I can't shift them as quickly as I would normally perhaps have been able. It is a bind and no mistake - especially when the clinicians are all geared up to recommend exercise at every single opportunity :aghhh:

Still. I exercise as much as I can and I have yet to meet a clinician who gets in my face about it or about me doing more. But then maybe I scare them :lol:
 
They never said anything like that to me when I was recently diagnosed with Apnea, Gabby.

But I get my test for diabetes next week as you know, though the two were again not specifically linked. It was my incontinence and frequency of urination, that has led to the diabetes test - not that I expect a positive result.

Like Bob said though, weight gain - especially around the neck - can cause or exacerbate breathing issues at night that can then lead to a diagnosis of Apnea. But really you need to get a sleep study organised - though with what you have been through lately I can understand if you don't want to yet.

I do think weight gain and diabetes are linked. I also think that Rheumatiod Arthritis can play a part in swellings about the body - if what Mum tells me is anything to go by.

Seems like - as in everything in life - more than one factor might be at play :hug:

When I gave up smoking I added the pounds, and because of the ME I can't shift them as quickly as I would normally perhaps have been able. It is a bind and no mistake - especially when the clinicians are all geared up to recommend exercise at every single opportunity :aghhh:

Still. I exercise as much as I can and I have yet to meet a clinician who gets in my face about it or about me doing more. But then maybe I scare them :lol:

See this link - http://content.onlinejacc.org/mobile/article.aspx?articleid=1699341

Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis.

This new primary care doctor that I went to yesterday explained to me this correlation which I never heard of before. I was diagnosed with sleep apnea 8 years ago and used a cpap machine for a while but was not comfortable with it and stopped using it. This doctor say that the newer models are more comfortable and even if I don't feel a difference, the cells in my body are effected. I am scheduled for a sleep study in a few days. I am sure that i have a problem because I snore a lot and keep waking up at night. This doctor says that he sees the difference in his patients who do use the cpap machine as far as their general health and especially glucose problems and metabolic syndrome problems.






Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients.
Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients.
Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients.
 
@Nielk

I am using the CPAP at the moment - well, not right now, obviously! :)

I was impressed with how well it works - how comfortable it is - until I smashed my face into the wall one night and did something to my nose that has affected by ability to breathe as easily via this route. My CPAP was the nasal one - by choice - as I don't breathe through my mouth as a rule. Hopefully the issue will resolve itself and I can get back to using the device, or change to the full mask option which might now be more comfortable.

I'd only been using it tentatively for a couple of weeks before this incident, so it's too early to report any progress in terms of functional improvements but my specialist had also said of the success - and not so success - in patients he sees with ME/Apnea. About 50% he thought report improved function either with sleep quality or with improved daytime symptoms such as fatigue, morning hangovers, and even muscular pain/aches...

Proof for me is in the pudding, so I shall patiently wait and see. But I was pleased to observe the results from my own sleep studies. Very interesting. And you don't have to snore to have Apnea of course, but CPAP can also help resolve snoring issues.

Thanks for the info. all a bit too much for me to absorb at the moment but I shall come back to it :)
 
so on my low carb diet Im restricted to one small piece of fruit per day and some fruits are completely out on a low carb diet eg bananas are high carb, oranges...

I avoid apples because one small one has about 20 g of carbs.

But a small orange only has about 10 grams of carbs.

Obviously the size matters when trying to compare.

I wonder why oranges are on the "high sugar" list? I like them because they have a lot more nutrients, including Vit C and calcium.

But I too only eat one small one a day and then only after a protein meal.
 
And when did Blood pressure ≥ 130/85 mmHg become 'hypertension' instead of 'pre-hypertension', which, as I understand it, is not a clinical diagnosis, but a research category that was hijacked by the ever-alert drug industry?

Exactly. When the drug industry wanted everyone to take statins.

My doctor goes by the old rule of 100+your age/90 for high blood pressure.
 
I decided to try very low carb again at the first of the year and had an interesting anecdotal experience.

I ate less than 10g/carb a day for almost two weeks and could never get a urine strip to test positive for ketones.

Then I had a stressful setback and ended up having to take a mega-dose of steroids. The next day, my urine strip was dark purple indicating high ketones.

I continued the higher doses of steroids for a few days and the strips started to lighten up again - some ketones but much less.

Then another stressful setback...higher steroid dose again...more dark purple.

So clearly, cortisol is intricately involved *somehow* in producing ketones. Either too high or too low seems to throw me out of ketosis, no matter what I eat.

So I think my blood sugar metabolism is dysregulated as shown by testing on a blood sugar meter, so I'm not producing adequate energy via that pathway.

And I think my ketone pathway is also disturbed somehow due to hormonal problems - primarily with cortisol.

Now I'm on a physiological steroid dose of 25 mg HC (tapering down again) and the ketone strips are consistently light pink. But still no blood ketones.

No matter what the urine strips say, I can never get any ketones to show up in my blood.

No ketones and no proper glucose metabolism equals no proper pathway to energy to me. And so all the food I eat must just end up stored somehow as fat. :(
 
ketones are the major fuel source on a low carb diet, small amount of glucose are made from amino acids.
@Ema i am the same, very hard to get those urine strips to turn purple. I think my morning cortisol has taken a nose dive of late as i just cant get going for the first 2 hours, maybe a longer acting steroid so i have enough in my system when i wake up?
 
I decided to try very low carb again at the first of the year and had an interesting anecdotal experience.

I ate less than 10g/carb a day for almost two weeks and could never get a urine strip to test positive for ketones.

Then I had a stressful setback and ended up having to take a mega-dose of steroids. The next day, my urine strip was dark purple indicating high ketones.

I continued the higher doses of steroids for a few days and the strips started to lighten up again - some ketones but much less.

Then another stressful setback...higher steroid dose again...more dark purple.

So clearly, cortisol is intricately involved *somehow* in producing ketones. Either too high or too low seems to throw me out of ketosis, no matter what I eat.

So I think my blood sugar metabolism is dysregulated as shown by testing on a blood sugar meter, so I'm not producing adequate energy via that pathway.

And I think my ketone pathway is also disturbed somehow due to hormonal problems - primarily with cortisol.

Now I'm on a physiological steroid dose of 25 mg HC (tapering down again) and the ketone strips are consistently light pink. But still no blood ketones.

No matter what the urine strips say, I can never get any ketones to show up in my blood.

No ketones and no proper glucose metabolism equals no proper pathway to energy to me. And so all the food I eat must just end up stored somehow as fat. :(

Interesting post. I dont produce ketones myself easily.. even eatting 15g carb per day. I was on the Atkins diet for a while in which one wants to be eatting at a point where ketones as produced (meaning ones body then is feeding on ones fat reserves) but couldnt get it happening. I guess in a world hunger situation if there was a drought where I are, I'd be better off but its not fun not being able to easily loose more weight just with diet. I wouldnt be at all surprised if our bodies are screwed up here too.
 
I avoid apples because one small one has about 20 g of carbs.

But a small orange only has about 10 grams of carbs.

Obviously the size matters when trying to compare.

I wonder why oranges are on the "high sugar" list? I like them because they have a lot more nutrients, including Vit C and calcium.

But I too only eat one small one a day and then only after a protein meal.

This site ranks oranges and apples as very similar in carb, sugars and fibre.

(Per 100g)

apple: carb total 12.9, carb available 10.7, sugars 8.11, fibre 2.2

orange: carb total 11.5, carb available 9.5, sugars 8.2, fibre 2.0

Maybe the acidity also needs to be taken into account?
 
I decided to try very low carb again at the first of the year and had an interesting anecdotal experience.

I ate less than 10g/carb a day for almost two weeks and could never get a urine strip to test positive for ketones.

Then I had a stressful setback and ended up having to take a mega-dose of steroids. The next day, my urine strip was dark purple indicating high ketones.

I continued the higher doses of steroids for a few days and the strips started to lighten up again - some ketones but much less.

Then another stressful setback...higher steroid dose again...more dark purple.

So clearly, cortisol is intricately involved *somehow* in producing ketones. Either too high or too low seems to throw me out of ketosis, no matter what I eat.

I had acute hyperglycaemia and also urine ketones when I was not on a low-carb diet but had been through a lot of stress and overexertion. I had eaten very little due to nausea, and was feeling extremely ill. I also had near-life-threatening hyponatraemia.

I do urge all who have excess abdominal fat to trying cutting out gluten if they haven't yet tried it.