Dr. Bateman answers IOM questions from the community: Part 2
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Respirator for O2/CO2 balance

Discussion in 'General Treatment' started by Jenny, Dec 1, 2010.

  1. Jenny

    Jenny Senior Member

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    Anyone used a respirator to balance blood gases?

    My doc has suggested this as I have too little CO2, perhaps because of chronic hyperventilation. This seems to be the theory:

    The respiratory centre, situated in the brain stem, paces breathing in order to maintain pH.
    Hence, to maintain pH, the ratio of CO2 to bicarbonate in the cerebro-spinal fluid (CSF) needs to remain constant. Since the blood-brain barrier is extremely permeable to CO2, this is readily accomplished by regulation of breathing.10 If the body is stressed, breathing increases, CO2 is reduced and a state of alkalosis develops. If this stress is sustained, the kidneys compensate by dumping bicarbonate in order to reestablish normal pH in the blood.10,16 However, the blood brain barrier is only very slightly permeable to bicarbonate resulting in a very slow diffusion of bicarbonate from the cerebro-spinal fluid (CSF) into the blood10 if the stress is sustained for a very long time (chronic stress). When the stress eventually dissipates, the cerebro-spinal fluid (CSF) is left with a low bicarbonate concentration.10,16 To maintain pH the CO2 will also have to be kept low and a habituation to low CO2 will have taken place.14 The resulting low CO2 and bicarbonate has a devastating effect on all significant biochemical processes. 7,14,16,18,24, 29


    What happens to patients with Chronic Hyperventilation Syndrome (CHVS)?
    Consider the following population distribution for arterial carbon dioxide. The normal range is between 35 and 45mmHg. Most people could be expected to fall into this range. Those who fall below this range but are not acutely hypocapnic, do not have hypocapnia recognized as the possible cause of their disease by mainstream medicine. 1,16,18,24,29


    Physiological consequences of low CO2.
    1. Poor oxygenation of tissues due to a depressed Bohr effect.5,7,18,29,31 Once oxygen attaches itself to the hemoglobin in the lungs, it is transported to the tissues where it is needed. CO2 is necessary to fully off load the Oxygen into the tissues. When the baseline level of CO2 is too low, the oxygen is not fully unloaded resulting in tissue hypoxia. The consequence is a feeling of breathlessness, which aggravates the condition, frequent yawning and sighing, build up of acids, such as lactic acid, in the body and joints leading to fatigueability,16,18,31,30 exhaustion5 and pain in muscles5,16,18 and joints.


    2. Muscle spasms.5,7,16,24,29 Since calcium transport across the cell membrane involves CO2, hypocapnia results in a redistribution of Calcium, which tends to accumulate inside the cells leaving the extra cellular fluid depleted.24 This directly affects the ability of smooth muscle to relax.11 Hence, hyperventilation is associated with spasms in smooth muscle, resulting in dysfunctional gut motility as in spastic colon24, and irritable bowel syndrome,24 spasm in the bronchioles as seen in asthma,5,7,12,16,24,29 spasm in arterioles5,7,16,24,29,31 resulting in hypertension24 and ischemia,24 as well as spasm in glands and ducts. In addition, esophageal spasm can result in dysphagia,5,165,16,30,31 Globus Hystericus and together with spasms in the diaphragm and sphincter, various degrees of hiatus hernia24 may develop with associated gastric reflux. Hypoxia due to a depressed Bohr effect together with ischemia can produce angina,24 headaches,16 migraines5,24 and syncope.5,7,16


    3. Profound biochemical derangements caused by chronic hyperventilation include: hypophosphatemia,18,29,31 elevated lipids,24 elevated sugar levels24 and elevated lactic16 and uric acid24 apart from disturbances to calcium homeostasis.

    CO2 is directly involved in all biosynthetic processes including the biosynthesis of amino acids, nitrogenous bases, fats and carbohydrates.14 It is also involved in stimulating the production of hormones such as insulin.14 It also stimulates the production of gastric secretions.14

    CO2 affects the production of acetylcholine in nervous tissue and the excitability of nerves.5,14,31 High CO2 tends to have a calming effect on the nervous system, while low CO2 causes increased sympathetic tone,16,18,29,30,31 decreased parasympathetic tone,5 paresthesia and numbness,1,5,7,16,18,24,29 twitching eyelids,16 visual and auditory disturbances,5,7,16,29,31 seizures and fits,7,16,29 tremors and shaking,5,16,30 ECG and EEG abnormalities.7,24,29,30

    Immune System
    Particularly vulnerable is the immune system, a finely tuned biological warfare mechanism responsible for identifying, differentiating and destroying pathogenic invaders. Disturbances to the biochemical environment in which the immune system has to function can be expected to lead to variable forms of immune system failure.

    As a result the system may over react to pollens or other non-pathogenic invaders. It may fail to deal effectively with bacteria and viruses and could even attack the bodys own cells as in autoimmune diseases such as arthritis, diabetes, and multiple sclerosis. The immune system is also responsible for recognizing and removing cancer cells. It should come as no surprize that post-traumatic, post-viral, post-partum and psychological stresses can lead to major failures of the immune system.


    Other Symptoms and disorders
    Chronic hyperventilation affects every organ, body part and system.16 The protean nature of the symptoms makes this disorder particularly insidious. The symptoms that will manifest in an individual depend mainly on genetic predisposition. Asthmatics, for example, have bronchioles that are particularly efficient at closing up whenever the lungs are hyperventilated.

    Apart from the symptoms already discussed, the mainstream medical literature provides us with an astonishing array of symptoms directly attributable to chronic hyperventilation (CHV).
    For example:


    Cardiovascular:
    Palpitations,1,7,16,18,24 cardiac neurosis,1,5,24 myocardial infarction,24 arrhythmias,5,7,24 coronary artery stenosis,7,24,29,31, tachycardia,5,16,24,29,30 failure of coronary bypass grafts,24 right ventricular ectopy,24 mitral valve prolapse, 1,5,24, 30 low cardiac output/stroke volume.31


    Digestive:
    Dry mouth,1,18,31, flatulence and belching,1,5,18,31 duodenal spasm,24 vomiting,16 bloating,16,18 constipation,16 epigastric pain,16 aerophagia,5,16,24,30 diarrhoea.16


    General:
    Failure of transurethral resections,24 edema,24 restlessness,24 Da Costas Syndrome,18,24,29 excessive sweating,5,29,30 burnout,24 Raynauds Disease, 16,24 chest pains,1,5,7,16,18,24,29,32 weakness and listlessness 1,5,16,18,24,29


    Neuromuscular:
    Muscular stiffness and aching, 16,24 myalgia,5,16 cramps,5 fibromyositis,31 muscle spasm.5,7,16,24,29


    Neurological:
    Paresthesia and numbness,1,5,7,16,18,24,29 headaches,16 syncope,7,5,16, diplopia,16, feeling of chilliness,30 hot/cold sensations,30 dizziness,5,7,16,18,29 hyperactivity,5 epileptic fits and seizures.7,16,29


    Respiratory Disorders:
    Asthma,5,7,16,24,29 choking,30 chest tightness,5,7,16,29 irritable cough,5,16,31 dyspnea,7,18,24,29,30, Shortness of breath or air hunger. 1,7, 16,18,24,29


    Psychological:
    Tension,5,16,31 fear of insanity,5 depersonalization,5,30 hallucination,5 lack of concentration and memory loss, 1,5,31 nightmares,5,16 unreal feelings,5, 30,31 panic attacks,5,24 anorexia,18 depression,18 feelings of inadequacy,18 anxiety, 16,24,29,31 maladjustments in life,18 phobias, 1,5,16,18, 24 obsessional behaviour.18

    Makes some sense, but I think it's more likely that something else is causing the low CO2 (not hyperventilation). So how likely is using a respirator going to get to the root cause? Is it worth trying? (The suggestion is to use it 8 hours a day for a month.)

    Jenny
     
  2. jen jen

    jen jen

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    I might sound daft but what is a respirator?
     
  3. Glynis Steele

    Glynis Steele Senior Member

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  4. jimm

    jimm

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    hi this is fascinating becuase I too also have mystery low blood levels of carbon dioxide....initially I was sent to physiotherapist becuase they thought I was stressed and sorta having panic attacks, which I wasnt, the physio couldnt seem to find anything I was doing that could cause it, i.e me accidetnally hyperventilating due to stress.

    then I was sent to a lung function test and the nurse was shocked to find I had very low blood carbon dioxide levels in my blood, and she said during the testing I didnt hyperventilate, so I have exactly the same as you, i,e low blood levels of carbon dioxide.

    So I would LOVE to know how to rebalance the levels! your doctor sounds quite forward thinking, I assume this isnt in uk, our docs are not that forward thinking. I have been concerned about the low levels for quite a while now but every doc I mention it to just blanks it out
     
  5. Jenny

    Jenny Senior Member

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  6. Jenny

    Jenny Senior Member

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    Glynis - thanks for the link, I've been reading your posts on this with interest.

    jimm- yes this is the UK - my doc is at the Breakspear Hospital in Hemel Hempstead.

    Jenny
     
  7. Glynis Steele

    Glynis Steele Senior Member

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    Hi Jenny. I often feel no-one is interested in this possibilty, so thank you.

    Did you see the dla stuff mentioned in the Breakspear newsletter? Not sure if they test for dla, but bio labs in London test for it, if you are interested. I've just googled Breakspear d-lactic acid test, and found a postviral/me forum where someone said they had tested positive for dla at Breakspear, and had been prescribed antibiotics, and had eventually improved, after a few rounds. The worrying thing is anyone who tests positive should be urgently referred to a GI, to oversee treatment and monitor dla levels. This would be done on the NHS! It it usually seen as a serious condition, though this is in short bowel patients. I can usually find dla articles to match most CFS symptoms ;-))))))))!
     
  8. Glynis Steele

    Glynis Steele Senior Member

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  9. richvank

    richvank Senior Member

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    Low CO2 in ME/CFS more likely due to mito dysfunction than to hyperventilation

    Hi, all.

    There are four published studies that report finding hypocapnia (low CO2 partial pressure in the exhaled gas) in ME/CFS. There is one published study that reports on measurement of ventilation in ME/CFS, and it did not find hyperventilation.

    It's true that the standard medical explanation in cases of hypocapnia (low CO2 partial pressure in the exhaled gas) is hyperventilation, and that interpretation is usually valid in non ME/CFS cases. That explanation, however, assumes that the rate of production of CO2 in the body is normal. But in ME/CFS, based on the work of Myhill et al. as well as a variety of other data, we know that the mitochondria are dysfunctional. The mitochondria are normally the main producers of CO2 in the body, and mito dysfunction is very likely to decrease the rate of CO2 production. So it seems reasonable to suspect that the hypocapnia in ME/CFS is due to the mito dysfunction.

    Anecdotally, many people with ME/CFS report that they "have to remind themselves to breathe." This would suggest that hypoventilation (or even apnea) is more common in ME/CFS than hyperventilation.

    As to what can be done about this, if what I'm suggesting is correct, then the mito dysfunction must be corrected. In my hypothesis (the GD-MCB hypothesis for M/CFS), the mito dysfunction results from glutathione depletion and a partial block in the methylation cycle (the former allows buildup of toxins and oxidative damage in the mitos, observed by Acumen Lab, and the the latter decreases in both carnitine and coenzyme Q10 in the body, also observed by lab testing, both of which are needed by the mitos.)

    The way to correct the glutathione depletion and the partial methylation cycle block is to use one of the methylation protocols. I have suggested one (the Simplified Treatment Approach), and there are also several others that are being used now (the one suggested by freddd on this forum, the full Yasko treatment, the DAN! treatments, those associated with Drs. Myhill, Enlander, or Vinitsky, the revised current Pall protocol, and the PamLab prescription "medical food" Cerefolin-NAC). It's not clear which of these is best, and each may offer some advantages. But in general, they include high dosage B12 (either hydroxocobalamin or methylcobalamin, but not cyanocobalamin) and folate (the chemically reduced forms folinic acid and 5-methyltetrahydrofolate, also known by the trade names Metafolin or FolaPro, are best, and the protocol I've suggested includes both of them).

    Background information on the hypothesis behind this, the revised protocol I've suggested, and reports on a clinical study of this type of treatment can be found at www.cfsresearch.org by clicking on CFS/M.E. and then on my name.

    I hope this is helpful, and please feel free to pass this information on to others who might be interested.

    Best regards,

    Rich
    Best regards,

    Rich
     
  10. Jenny

    Jenny Senior Member

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    Thanks for the link Glynis.

    Rich - thanks for your thoughts. I really don't think I hyperventilate, and the mito explanation makes more sense to me, particularly in view of my Acumen tests which showed mito dysfunction. Do you think using a respirator for 8 hours a day for a month could help to rebalance the gases? This is the rationale for the treatment.

    Jenny
     
  11. Jenny

    Jenny Senior Member

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    Well I've finished this treatment. I used the respirator for 4-5 hours a day for 12 weeks. My CO2 is now in the normal level - it went up from 35 to 42. The doc says that my brain and kidneys will have readjusted (not sure how he knows this).

    He thinks my low CO2 was due to allergies or 'an infection'. He doesn't think I was hyperventilating.

    After about 6 weeks on this treatment I started to have a little more energy and this has increased so that I can now leave the house most days and walk for 20 minutes. I've been mostly in bed for the last 18 months so this is good! I used to have constant nausea and this has lessened, and my appetite is better.

    I've been doing other things as well though - started low dose Valtrex in December and several new supplements, so I can't say it was definitely the respirator that helped.

    I hate writing this sort of thing - can't help but think I'm tempting fate and I'll be back in bed tomorrow.

    Jenny
     
  12. insearchof

    insearchof Senior Member

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    Hi Jenny

    Thanks for posting about Co2. I have been reading along with interest. Am really happy to have read your last post. It may well be a combination of the new supplements and O2?

    I have been wondering about 02 therapies and how that sits with Cheney's ideas about 02 toxicity?

    For everyone one therapy, there seems to be some thing to suggest it might not be benefical.
    Very difficult.

    Will you be continuing with your 02 or C02 therapy?
     
  13. Jenny

    Jenny Senior Member

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    Hi insearchof

    It seems that my O2 has remained the same - it was always at a normal level. The main point of trying to increase Co2 is not to influence O2 levels but to stop the kidneys dumping bicarbonate and to get the brain used to a normal Co2 level (see my first post).

    Yes, Cheney has in the past recommended Buteyko-like breathing exercises to increase Co2 but I haven't heard him talk much about it lately.

    Doc says I can stop the mask now, but should restart if I start to get worse again.

    Jenny
     
  14. aquariusgirl

    aquariusgirl Senior Member

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    Jenny
    were u breathing oxygen or CO2?
    I wanted to look into this, but I went to get my arterial blood gases today and it was incredibly painful. The tech dug around with a needle for a couple of minutes and didn't even hit the arterial vein.
    I'll have to screw my courage to the sticking point to do that again.

    Rich: would supplemental oxygen correct the mito CO2 problem?
     
  15. Jenny

    Jenny Senior Member

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    Hi aq

    The respirator was a rebreathing mask, so I was rebreathing CO2. The tests I had weren't for blood gases, they were for subcutaneous gases. No needles, just electrodes etc. The tests took 2 hours or so - lots of different exercises to see how the gases changed.

    Jenny
     
  16. aquariusgirl

    aquariusgirl Senior Member

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    tnx jenny.
     
  17. Jenny

    Jenny Senior Member

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    Update on this treatment - after starting to feel progressively worse again in September I did another 12 weeks of the respirator, 4-5 hours a day. It made no difference. So I think my improvement in the spring was coincidental. I often feel better in the spring/summer and worse in autumn/winter.

    Jenny
     

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