Role of overstress in CFS

[Hip]

Once the immune dysfunction might in fact have somehow been triggered by inappropriate cortisol secretion (or its synthetic drug equivalents), together with presumed infectious and/or genetic factors, I seriously doubt that any sort of psychological de-stressing therapy is going to be helpful - no more than it is in multiple sclerosis or lupus, etc.

I just had a quick Google check, and surprisingly, a four-year MS study found stress does play a role in the progression of MS, with MS patients receiving stress management therapy showing fewer new brain lesions on MRI scans.

Interestingly, the study made a distinction between negative stress events like bereavement, and positive stress events like the birth of a child, a wedding, or landing a new job; it was only the negative stress events than increased new brain lesions; the positive stress events actually reduced new brain lesions.


However, according to one study, stress is not a factor in triggering multiple sclerosis (though earlier studies found contrary results).

 

[nandixon]

I just had a quick Google check, and surprisingly, a four-year MS study found stress does play a role in the progression of MS, with MS patients receiving stress management therapy showing fewer new brain lesions on MRI scans.

Interesting. That concept likely applies to many illnesses. I was actually thinking in terms of such de-stressing techniques being curative of the disease.

 

[BurnA]

I had been under considerable stress (both psychological and physical) at the time I developed ME/CFS, and the actual trigger could well have been an infection in my case.

Cortisol has a profound effect on immune function. Cortisol binding receptors are actually present on various immune cells.

I think the possibility could exist that inappropriate cortisol levels (transient or otherwise) may make a person more susceptible to some form of immune disregulation as the sequela to an infection that may only be a trigger for the process that unfolds. It could also be vice versa too, i.e., a chronic but otherwise seemingly benign infection may exist which in combination with inappropriate cortisol levels (transient or otherwise) might result in the perpetual immune dysfunction. These may also require some additional genetic vulnerability, too, of course.

I think it must be something more than just stress plus infection. There are possibly thousands of sports people exercising, while carrying some form of infection, everyday. I have searched the internet and couldn't find any specific case of a top level athlete getting cfs/me. ( there are plenty of overtraining or chronic fatigue stories ) Even in anecdotal stories on endurance training forums, they talk about myocarditis but no mention of me/cfs.

I have heard of cyclists completing the tour de France with bronchitis, rugby players playing with the flu, marathon running with a fever and many other tales of crazy endurance but nobody seems to get me/cfs. That's not to say there is no relationship it's just there must be another factor too.

 

[BurnA]

I just had a quick Google check, and surprisingly, a four-year MS study found stress does play a role in the progression of MS, with MS patients receiving stress management therapy showing fewer new brain lesions on MRI scans.

Are you not a bit sceptical of such a study given what we know about PACE. I am not saying it's not true but without reading the paper in detail I'd be a little wary.

 

[nandixon]

@BurnA

I know that there are a couple of professional soccer players, Olaf Bodden (Germany) and Michelle Akers (US), who developed ME/CFS.

 

[Hip]

@BurnA
I have never come across any suggestion that high levels of exercise might play a role in triggering ME/CFS. OK, after ME/CFS manifests, exercise may worsen the condition; but that is different to exercise being a trigger factor.

Are you not a bit sceptical of such a study given what we know about PACE. I am not saying it's not true but without reading the paper in detail I'd be a little wary.

It is always good to be skeptical, but it seems like a very objective and clear-cut study, since it used MRI scans of MS brain lesions, not the very vaguely defined notions of recovery used in the PACE trial.

That concept likely applies to many illnesses. I was actually thinking in terms of such de-stressing techniques being curative of the disease.

It does seem unlikely. But in terms of possible mechanisms, if stress were a factor that was holding back viral clearance (by say cortisol release), then reducing stress may allow the body to start clearing viral infection, which would then slowly result in ME/CFS improvements. That is the sort of mechanism I think might explain it, if such recoveries do indeed occur.

A clinical trial of the Lightning Process is ongoing, but we do not have the results as yet. The ME Association's survey (see page 9) found that around 26% of patients reported they greatly improved after the Lightning Process, compared to only around 3% reporting great improvements from CBT.

Interestingly, around 13% reported they became much worse after the Lightning Process, compared to around 8% reporting becoming much worse after CBT.

However, I would like to see some objective measures of this improvement (or worsening), such as reduced viral loads, or better performance on the 2-day CPET test.

 

[Aurator]

I think it must be something more than just stress plus infection. There are possibly thousands of sports people exercising, while carrying some form of infection, everyday. I have searched the internet and couldn't find any specific case of a top level athlete getting cfs/me. ( there are plenty of overtraining or chronic fatigue stories ) Even in anecdotal stories on endurance training forums, they talk about myocarditis but no mention of me/cfs.

I have heard of cyclists completing the tour de France with bronchitis, rugby players playing with the flu, marathon running with a fever and many other tales of crazy endurance but nobody seems to get me/cfs. That's not to say there is no relationship it's just there must be another factor too.

I wasn't a top level athlete but I did compete in open events against top amateurs and sometimes professionals every week during the racing season. Events were typically half an hour to an hour but sometimes longer, and I trained for ten to fifteen hours a week, half the time at high intensity.

I know, at second hand, of one other athlete at the same kind of level as me who got what was very likely to be ME/CFS, as he had to give up the sport, and ten years later has not been able to resume training in spite of very much wanting to. The account of him I've heard does suggest classic ME/CFS, though the words of the person who relayed the story to me were simply that his health was "broken" by the viral infection that he got ten years before.

In my own case, I have an identical twin who is also a committed amateur athlete as I used to be, but his health is fine. On balance I would say he has endured more stress than I have, but the one thing he didn't go through that I did is a serious road accident in his youth.

 

[BurnA]

@BurnA

I know that there are a couple of professional soccer players, Olaf Bodden (Germany) and Michelle Akers (US), who developed ME/CFS.

Bodden is an example. Akers continued to play national level football after her diagnosis so I am not too sure if she is a good example. You will find many more top level athletes who have either claimed or have been diagnosed with cfs yet most of them returned to high level sports within a year or two. For me that is probably not cfs, it's overtraining or chronic fatigue.

 

[Mij]

It's known that it's quite common for professional tennis players to come down with mono/ebv/glandular fever. Some recover but others aren't as fortunate- it ended their careers.

 

[Marky90]

I had a lot of stress i suppose.. And low vitamin D.. Might have been factors, might not..

 

[Jonathan Edwards]

In medical terms is physical stress on the body considered to be a stress the same as a stress on the brain. Ie would someone who exercises to a high level be considered stressed the same as someone under a lot of pressure from work or money or relationships etc.?

The problem is that the medical definition of stress is the response to stimuli, not the stimulus itself. So running a marathon is not stressful if you and your body feel good about it. This confusion constantly occurs in discussions of stress. I suspect that in discussions of disease causation the term stress is pretty much useless.

 

[Jonathan Edwards]

I just had a quick Google check, and surprisingly, a four-year MS study found stress does play a role in the progression of MS, with MS patients receiving stress management therapy showing fewer new brain lesions on MRI scans.

That looks a pretty hopeless study to me. Reporting of negative and positive events is almost bound to be influenced by how well the patient is. If they have had more attacks they are pretty sure to report more negatives and less likely to get to weddings!

 

[chipmunk1]

The concept of stress remains prominent in public health and owes much to the work of Hans Selye (1907–1982), the “father of stress.” One of his main allies in this work has never been discussed as such: the tobacco industry.
After an analysis of tobacco industry documents, we found that Selye received extensive tobacco industry funding and that his research on stress and health was used in litigation to defend the industry's interests and argue against a causal role for smoking in coronary heart disease and cancer.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036703/

 

[BurnA]

I had a lot of stress i suppose.. And low vitamin D.. Might have been factors, might not..

Without knowing your specifics, I think in a lot of cases people look back and think they were under a lot of stress but I am sure there are plenty of people out there under much more stress who dont get sick.
It's hard to know.

 

[Skippa]

Ooh, this ties in to one of my personal pet hypotheses re CFS/ME.

SOMETHING... SOMEHOW... Has led to an insensitivity or even outright intolerance to cortisol level fluctuations in the body (or perhaps one of the other stress hormones/HPA axis etc).

This does not depend on "high levels" of cortisol, but merely changes above some "base level" idiopathic to each patient. This explains why some patients have high levels of cortisol in their tests, some are low and some are normal. The effect is seen as marginal.

What do exercise, stress and illness behaviour all have in common? They have all been measured to increase cortisol (and other stress hormones).

That is why some of us can walk for an hour before the onset of PEM, but others can barely manage 5 minutes. At some point, a threshold is crossed and the body starts responding to the presence of raised cortisol as a pathogen rather than a normal response. Immune response ensues.

The real question is why? How did the body learn to get this way?

 

[BurnA]

@BurnA
I have never come across any suggestion that high levels of exercise might play a role in triggering ME/CFS. OK, after ME/CFS manifests, exercise may worsen the condition; but that is different to exercise being a trigger factor.

There is certainly not much in the literature about it. ( nothing apart from a few cases of athletes getting chronic fatigue ) However, I did start a thread on this topic a while ago - read it here.

It seems Alastair Miller observed an association with marathon runners and as I mentioned earlier in this thread my cardiologist did the same. Dr Bansal has also suggested physical stress can play a role.( especially stress during the initial infection ) See this thread.
Hardly evidence by any stretch of the imagination and I am as sceptical as they come but because I associate physical exercise during the acute phase of my initial infection I am curious if there is anything in this or not.
If autoimmunity is the cause then I would agree exercise does not play a role.

 

[TiredSam]

I wasn't stressed at all when I became ill. In fact, things were working out very well at the time.

Me too. Life was a bowl of cherries. Then I got ME.

 

[Marky90]

Without knowing your specifics, I think in a lot of cases people look back and think they were under a lot of stress but I am sure there are plenty of people out there under much more stress who dont get sick.
It's hard to know.

I agree, but I think i pushed my body to the limit as i was studying law, singing in a choir, singing in a band, beeing an actor in a cabaret three years in a row,, working part-time - all this - while participating in student binge drinking 2-3 times a week.

However - loads of people have had a similar lifestyle without getting ME/CFS.. As you point ou
t.

 

[BurnA]

It's known that it's quite common for professional tennis players to come down with mono/ebv/glandular fever. Some recover but others aren't as fortunate- it ended their careers.

I found this report on tennis players.

Seems like Robin Soderling never played again but he remains active within the sport ( whatever that means )

 

[BurnA]

I agree, but I think i pushed my body to the limit as i was studying law, singing in a choir, singing in a band, beeing an actor in a cabaret three years in a row,, working part-time - all this - while participating in student binge drinking 2-3 times a week.

However - loads of people have had a similar lifestyle without getting ME/CFS.. As you point ou
t.

Sounds like you were busy alright ! But if you were enjoying yourself then I don't think it would be as stressful as someone who lost their job or is going through a divorce or bereavement etc.