Is ME/CFS caused by biological stress and perpetuated by high catecholamines and low blood volume?

[rosie26]

Low blood brain flow is a big issue for me alongside brain inflammation of the meningeal region I believe, very severe stuff from Lyme, Sometimes I feel like I will end up passing away from a more acute flare of meningitis/encephalitis. I definitely notice intense shivering when I herxed sometimes using treatment, also intense feelings of burning, migraines with this really achy feeling in my brain, and the cognitive issues and mental stuff just go off the deep end at those times.. Don't seem to have it with the rest of the body, but in my own case the brain definitely has large impairments and the type of symptoms that come with reduced blood flow, and inflammation.

First time I have heard someone mention Meningitis along with Encephalitis. Know what you mean Martial. I am still nervous to this day about my head symptoms. My head is nowhere near as bad as the severe years and I feel out of any danger zone right now but I fear deterioration back to severe again. And I am sure if I wasn't resting like I do, it could get horrible again.

 

[bertiedog]

If you have low blood volume the heart must beat harder or faster to maintain blood pressure and adrenalin serves that purpose if your adrenal glands are in good shape.

Not sure that statement is correct. I have adrenal insufficiency and am completely dependent on replacement steroid for my cortisol but I tend to over produce adrenaline and need a small dose of betablocker to keep it under control.

There is definitely a situation where one doesn't produce sufficient cortisol but can produce adrenaline in huge amounts probably because its different parts of the adrenals that produce cortisol and adrenaline.

Pam

 

[Martial]

First time I have heard someone mention Meningitis along with Encephalitis. Know what you mean Martial. I am still nervous to this day about my head symptoms. My head is nowhere near as bad as the severe years and I feel out of any danger zone right now but I fear deterioration back to severe again. And I am sure if I wasn't resting like I do, it could get horrible again.

Yes, to be honest it has been much worse in the past few days. Mine always gets worse with treatment though.. More exaggerated. Hallucination audio/visual, very slow response time, confusion, and all kinds of other weird stuff like that.

 

[rosie26]

Yes, to be honest it has been much worse in the past few days. Mine always gets worse with treatment though.. More exaggerated. Hallucination audio/visual, very slow response time, confusion, and all kinds of other weird stuff like that.

Hope it settles soon Martial. Rest up lots.

 

[A.B.]

By coincidence I recently had a second 24-hour urine catecholamine test, and once again, my epinephrine was below the detection limit. I still haven't been able to figure out what this means.

 

[Leopardtail]

Hi Leopardtail

Thanks for your feedback and confirming what I thought.

My Electrolyte tests have all come back within normal range. Everything seems to come back normal. I don't know how one can feel so ill and everything come back normal (Especially in the severe years). I am in my 12 year and at a more moderate level now. I really need to find out my AT and watch my heart rate and see what it is doing like others do here. And then experiment more with taking in more Electrolytes and fluids. I will try to see into all that this year and next. x

Try asking your doctor to check for Selenium status. If low this can cause issues with immunity, can indicate high cystine (hence too much wee wee and low blood volume), and cause thyroid dysfunction despite normal test results. Low Selenium is considered rare, but more common in ME/CFS. It's a less routine test hence it was easier to ask for electrolytes first.

The four causes of massive urination (and low blood volume) I have been able to find are: sugar diabetes, low AVP or Aldosterone (both of which mess up the ratio of Potassium and Sodium) and high Cystine (that causes low selenium).

 

[rosie26]

Hi @Leopardtail I don't get massive urination I think I would be more the other end of that scale.

We do have low Selenium in our soil here. I have a mineral supplement that has it in it. But yes, it's a possibility it could be low.

 

[Leopardtail]

Not sure that statement is correct. I have adrenal insufficiency and am completely dependent on replacement steroid for my cortisol but I tend to over produce adrenaline and need a small dose of betablocker to keep it under control.

There is definitely a situation where one doesn't produce sufficient cortisol but can produce adrenaline in huge amounts probably because its different parts of the adrenals that produce cortisol and adrenaline.

Pam

I ended that sentance with if your adrenal glands are in good shape and it was in response to a comment about inducing shivering. Shivering requires adrenalin. I agree that with later ME if your adrenal glands are maxed out, then that defensive reaction will not be possible. You would end up with NMH or simple OI rather than POTS were your ability to produce Adrenalin seriously impaired..

 

[Leopardtail]

Hi @Leopardtail I don't get massive urination I think I would be more the other end of that scale.

We do have low Selenium in our soil here. I have a mineral supplement that has it in it. But yes, it's a possibility it could be low.

I was taking a supplement with some in (B-Vitamins) but had to take almost 400mcg/day (a lot) for a while to get mine up to snuff. I don't recommend that amount without having tests done. Selenium can be toxic.

 

[Leopardtail]

Hi @Leopardtail I don't get massive urination I think I would be more the other end of that scale.

We do have low Selenium in our soil here. I have a mineral supplement that has it in it. But yes, it's a possibility it could be low.

For me it depends, I either put up with worsened OI, poor brain function and dry mouth. Or I drink mega amounts, feel a bit better for a short time, then pee it all out mega fast. I have worked out what is causing it for me and in the process of establishing how best to fix it.

 

[rosie26]

@Leopardtail Yes, I have to experiment and take note of what is happening. Will let you know how I go when I think I am getting it right. x

 

[leokitten]

Your point 1 above is clear, please explain the science behind your point 2.

In ME/CFS it's not known for sure if chronic biological stress and elevated catecholamines precedes and causes the low blood volume or if the low blood volume caused by something else then causes elevated catecholamines to compensate in order to keep blood pressure and flow to vital organs high enough.

But I would like to show you that chronic elevated levels of catecholamines will cause low blood volume. Take for example a person with an adrenal tumor (pheochromocytoma) which, depending on the tumor, causes either chronically elevated levels of mostly NE or periodic bursts of NE. On the wikipedia page:

The patient with pheochromocytoma is invariably volume depleted. In other words, the chronically elevated adrenergic state characteristic of an untreated pheochromocytoma leads to near-total inhibition of renin-angiotensin activity, resulting in excessive fluid loss in the urine and thus reduced blood volume. Hence, once the pheochromocytoma has been resected, thereby removing the major source of circulating catecholamines, a situation arises where there is both very low sympathetic activity and volume depletion. This can result in profound hypotension. Therefore, it is usually advised to "salt load" pheochromocytoma patients before their surgery. This may consist of simple interventions such as consumption of high salt food pre-operatively, direct salt replacement or through the administration of intravenous saline solution.

 

[Leopardtail]

In ME/CFS it's not known for sure if chronic biological stress and elevated catecholamines precedes and causes the low blood volume or if the low blood volume caused by something else then causes elevated catecholamines to compensate in order to keep blood pressure and flow to vital organs high enough.

Every form of physiological or psychological stress raises Catechols in a healthy person. This includes immune challenge, low blood pressure, simple hunger, energy deficit. Some of the best research around this is in the field of diabetes since it's another energy generation disease..

Also research has been done showing in PWME that if blood volume is increased via saline, blood pressure normalises, OI abates, the heart beats more normally, sympathetic nervous system activity goes down. Hence we do know that correcting blood volume corrects catechols, but no we don't know what causes ME to start with.

But I would like to show you that chronic elevated levels of catecholamines will cause low blood volume. Take for example a person with an adrenal tumor (pheochromocytoma) which, depending on the tumor, causes either chronically elevated levels of NE and E or periodic bursts of NE and E. On the wikipedia page:

Okay hypothesis now understood.

I was reading up on interaction of Thyroid hormones with both Catechols and Water metabolism Williams and OTED) and suspect some of the stuff may interest you.

• Firstly in biological stress Thyroid hormones go up along with Cortisol and Catechols (for us more likely earlier in the disease)
• Minor energy deficit acts like a biological stress and invokes this to promote eating
• In major energy deficit that parallels famine different regulation kicks in and lowers thyroid hormones.

• High or low thyroid hormones both cause urination and lowered blood volume each by different methods both independently of Catechols .

I agree that high urination causes low blood volume and low blood volume causes many of the ME symptoms. For this reason the high urination is of special interest to me. Have you managed to find evidence that high Catechols cause urination? I ask since OI is mentioned with high blood pressure in the referenced article.

If could crack this problem together I suspect it would be of great service to many with ME.

Look forward to hearing more,

Leo

 

[Leopardtail]

In ME/CFS it's not known for sure if chronic biological stress and elevated catecholamines precedes and causes the low blood volume or if the low blood volume caused by something else then causes elevated catecholamines to compensate in order to keep blood pressure and flow to vital organs high enough.

But I would like to show you that chronic elevated levels of catecholamines will cause low blood volume. Take for example a person with an adrenal tumor (pheochromocytoma) which, depending on the tumor, causes either chronically elevated levels of NE and E or periodic bursts of NE and E. On the wikipedia page:

Leokitten,

Found it now! This seems different to ME in a couple of respects. High Adrenalin will cause the heart to beat like crazy and raise blood pressure. If blood volume were not reduced that would creates problems, hence there seems to be a compensatory action that makes the pressure high rather than dangerously high.

The normal state is that when we stand, adrenalin goes up to boost heart rate, that may not be possible with already high adrenalin nor desirable if blood pressure is already high. Given this info do you think this is the same OI going on with ME in which people have low-normal blood pressure and become dizzy/faint?

The link with "renin angiotensin" was interesting - I will look into that thanks.

Leo

@MeSci - have you come across much to do with "Renin Angiotensin" & Catechols?

 

[leokitten]

Leokitten,Found it now! This seems different to ME in a couple of respects. High Adrenalin will cause the heart to beat like crazy and raise blood pressure. If blood volume were not reduced that would creates problems, hence there seems to be a compensatory action that makes the pressure high rather than dangerously high.

The link with "renin angiotensin" was interesting - I will look into that thanks.

I disagree it is not much different from ME/CFS. Stress response elevates primarily only NE not E or DA. This kind of adrenal tumor releases primarily NE, not E aka adrenaline. I won't delve into the specific differences between the function of NE and E on the body, but NE actually makes heart rate go down, not up like E.

The wikipedia page is correct as to how chronic elevated levels of NE make blood volume go down, its because NE inhibits the renin-angiotensin system.

 

[Leopardtail]

I disagree it is not much different from ME/CFS. Stress response elevates primarily only NE not E or DA. This kind of adrenal tumor releases primarily NE, not E aka adrenaline. I won't delve into the specific differences between the function of NE and E on the body, but NE actually makes heart rate go down, not up like E.

The wikipedia page is correct as to how chronic elevated levels of NE make blood volume go down, its because NE inhibits the renin-angiotensin system.

I indicated above I had spotted the part about blood volume in my second post and intended to follow up on it - so no argument there.
NE also increases vascal tone and is on the FDA prescribe list for hypotension - it increases blood pressure.

Large numbers of ME patients have low Epinephrine (E) or low Norepinephrine (NE) there are hundreds of papers relating to this on PubMed - it's variable though.
Many functions relating to E (e.g. raising blood glucose) are in newer medical textbooks shown to be due to NE.

The physiological stress response (e.g. hypoglycaemia) raises: free T3, E, NE, Dopamine and Human Growth Hormone.
The fever response (another stress response) raises: free T3 and Glucagon, if sustained moves over to E, NE, Dopa, HGH.

I want to make sure I am understanding you right, do you think all three Catechols are elevated, or a subset of them? What's your simple once sentence change of cause and effect?

 

[Leopardtail]

Leokitten, Aleks
On why TH! may remain active. (It may just be ongoing infection, of course)..
Post sarcoidosis fatigue which occurs in a significant percentadge of "recovered" sarcoid patoents may be instructive. it is believed to be TH1 mediated as is active sarcoid. PSF symptoms overlap with ME/CFS/FM spectrum. Active sarcoid inflammation with granuloma is apparently resolved, thoiugh there may of course be occult granuloma..
It has been speculated if granuloma are absent that TH1 remains active post sarcoid due to LOW adrenaline in a post "knock put"illness state and for that reason some patients have been treated with exercise to get the adrenaline pumping. It may be very controversial to promote exercise/behavioural activation in any form fro ME/CFS/FM, but I have often wondered if e.g. Lightning Process rather than lowering adrenaline might actually work by raising it, in some cases where it is claimed to help..
(Of course if candida and adrenal suppression + potassium loss have set in due to steroid administration in a sarcoid patient then raising activity alone will not work).

On cortisol/catecholamines

Is it possible that activated sympathetic response may be a way of producing cortisol to dampen down inflammation in earlyish stage infection or autoimmunity? I have certainly had periods of high cortisol, but also of low. Further the diurnal aspect must be remembered - illness is exhausting. You might be fired up to produce cortisol against inflammation at one time of the day, but be unable to sustain production, with a diurnal boom and bust pattern for some months into illness and a declining pattern of lower and lower production as time goes on unless the cause of the inflammation is resolved. Catecholaminse might follow a similar boom and bust, then declining pattern.

Later reactive depression, with which many of us are familiar, may raise both catecholamines and cortisol again, if the system is strong enough to sustain a response, creating more confusion.

On psychological stress
Imo we must be careful not to dismiss psychological stress or be open again to accusation of mind body dualism and denigration of mental illness (unwarranted accusations of course). It is now believed that psychological stress can alter bone marrow production and promote inflammation, offering an insight into bio mechanisms but also implying that psychologuy is important in some inflammatory disease. This may please the shrinks and will not be news to e.g psoriasis sufferers, but the correct deduction would not be "see a psychotherapist or remain voluntarily ill" but "yes, stress can make us physically ill, so we will treat the physical illness for that very reason, and the stress too, as we might in e.g. psoriasis, diabeted,".

Overall too many things going on in too many people over too long a time to tie things down definitively..

On Catechols

I have to monitor the Cortsiol/Catechols situation very closely since I have type I diabetes as well as ME. I have noticed considerable variation in both. Firstly if I get an infection I can't shake my body attempts (but fails) to fever causing elevation of various hormones in the short term, but eventually my adrenals exhaust and things become highly erratic - much depends on the level of and duration faitigue. This is reflected in the research with a very mixed picture as @Richie indicated.

So far as the urination part goes - yes hyperglycaemia does goes urination (and if unchecked some de-hydration) but it does not come close to the degree of de-hyrdation seen in ME nor does it cause severe OI. The Wikiepedia article references has a split personality, referencing Norepenprhine in once place and hyperglyceamia in another. High Norepineprhine would cause hyperglycaemia. The level of unrination I suffered (more than 14litres / day) caused shock in an experienced consultant who did all the relevant tests - it was so heavy I could not carry the tests to the doctors. Diabetics in ICU are often not able to drink this amount of water, nor do they receive this amount of saline.

On Urination

I agree compleletly again with Richie, that this sitaution is horribly complex and it's unwise to try blame a single cause for any issue in ME.

Any of the following could cause high unrination:

• Primary failure in Aldosterone production causing a high Potassium / Sodium ratio.
  
• Primary failure in AVP production causing a low Potassium / Sodium ratio
• Hyperglycaemia causing regulatory depletion of Aldosterone
• High levels of Citrulline causing dumping into urine.
• The lelels of NE causing urinnation in the tumour article could refer hyperglycaemia (above) or a separate issue.
• (theoretically) any forms of toxic stress causing the hypothalamus to do a toxic dump into urine.

AVP and Aldasterone have both been found in ME patients by different physicians, as yet I have not found research in which they are both looked at simultaneously. @alex3619 was kind enough to point me at research from Adelaide University showing significant variation in Serum potassium which would point to variation in which of AVP or Aldosterone is low. It gave to clue though as to whether they were differences in population, in triggers or in fatigue levels.

On the Theory as a Whole

@leokitten is without doubt correct on several points and I wish him to feel supported in that.

The low blood volume certainly creates a raft of symptoms on ME - given a couple of litres of saline my OI is GONE, my brain function is near normal and I feel fantastic.

Early in the disease or during a down turn, physiological stress does cause relevant hormones to go up (as hey should). That can also create some particular problems (exclusively in ME patients) since our bodies are less tolerant of stress hormones hence they can trigger it and they can make it worse. However are bodies are also less able to sustain long term production (as a rule) at very severe illness hence they cannot maintain it.

 

[manna]

i tested as low on adrenaline. i thought adrenal fatigue was common. the connection between nervous system and high catecholamines is a guess though yeah?

I have only read that people with the disease exhibit sympathetic dysfunction and dominance and elevated levels of catecholamines.

this doesn't factor in that me/cfs may have different affects on the disease process, in that theres no fight as opposed too much fight- high catecholamines.

ive heard of the hyper-arousal state and the idea that we can be releasing too much adrenaline. well if my hormones were being manifactured so well i had enough to fuel this hyper-arousal, id be very surprised. if someone had that much adrenaline, being somehow synthesized from food despite poor digestion, id be surprised...and wonder why all this adrenaline wasn't helping symptons and why, if this hormone was plentifull, aren't the others. this hyper-arousal is closer to a permanent allergic reaction or mild anaphylaxia. anaphylaxia is actually helped by adrenaline, i.e. "epi pens".

the same chemicals that control bodily functions, like seratonin, also affect mood and how relaxed we feel. id guess hyper-arousal is depletion of these hormones leading to a state of physical panic where one feels very "unrelaxed"/hyper...not due to more hormones but less, imo.

 

[Leopardtail]

i tested as low on adrenaline. i thought adrenal fatigue was common. the connection between nervous system and high catecholamines is a guess though yeah?this doesn't factor in that me/cfs may have different affects on the disease process, in that theres no fight as opposed too much fight- high catecholamines.

ive heard of the hyper-arousal state and the idea that we can be releasing too much adrenaline. well if my hormones were being manifactured so well i had enough to fuel this hyper-arousal, id be very surprised. if someone had that much adrenaline, being somehow synthesized from food despite poor digestion, id be surprised...and wonder why all this adrenaline wasn't helping symptons and why, if this hormone was plentifull, aren't the others. this hyper-arousal is closer to a permanent allergic reaction or mild anaphylaxia. anaphylaxia is actually helped by adrenaline, i.e. "epi pens".

the same chemicals that control bodily functions, like seratonin, also affect mood and how relaxed we feel. id guess hyper-arousal is depletion of these hormones leading to a state of physical panic where one feels very "unrelaxed"/hyper...not due to more hormones but less, imo.

Yes manna a lot of people do test low on Adrenalin, its a very mixed picture with hormones and ME. Different hormones are affected in different people, low in some, raised in others. Personally I vary over time thus greatly complicating things.

Most of the mood hormones cause some kind of depression both when too low or too high.

 

[manna]

Yes manna a lot of people do test low on Adrenalin, its a very mixed picture with hormones and ME. Different hormones are affected in different people, low in some, raised in others. Personally I vary over time thus greatly complicating things.

Most of the mood hormones cause some kind of depression both when too low or too high.

hi LT, i heard recently that 95% of serotonin was stored in the mucous membrane of the gut. if thats so then ibs, poor digestion, leaky gut, dysbiosis etc would all count to depleting that store, i would have thought. you say mood hormones being too high can cause depression too. i find that hard to understand. not that i disbelieve it