Dr Les Simpson travelled the world to meet with ME patients and give talks to groups. Despite collecting thousands of blood samples from ME sufferers around the world and testing them, he, like many researchers into the pathophysiology of ME, had great difficulty in getting his research published. Now cardiovascualr problems are being more acknowledged in ME his work is being recognised.
BRAME published his paper in our newsletter ME TODAY issue 7 in March 1998, a copy of which has been sent for inquiry, please do try to read this paper.
• In his research over the past decade, Dr Simpson has found that more than 80% of ME patients have changed red blood cell shape population
• His earlier published work with ME patients showed altered blood rheology and subsequent tests using scanning electron microscopy of immediately fixed blood samples, which provided a basis for understanding the poor blood filterability.
• The blood of ME patients contains higher than usual proportions of one or other of the different cell shapes, notably increased percentages of cup transformed cells (stomatocytes), which are considered as a ‘marker’ for ‘acute ‘ ME, however these may persist for some years.
• Data presented at the Cambridge Symposium in 1990 also showed that increased cup forms was the most common change, but it also showed that a smaller number of both sexes had increased cells with altered margins. Increase percentages of these cells, or of flat cells or cells with surface changes are markers for ‘chronic’ ME.
• Impaired capillary blood flow results in inadequate rates of delivery of oxygen and nutrient substrates, having the greatest adverse effect on the tissues with great metabolic activity and high demand for substrates, eg muscles and glands
• Nervous tissue is particularly sensitive to oxygen deprivation – the brain has no capacity to store oxygen and can store only a minuscule amount of glucose. Normal brain function is dependent on normal rates of capillary blood flow to deliver these metabolites.
• Such observations imply that when reduced cerebral blood flow can be demonstrated brain function must be impaired commensurately.
• While it is claimed that psychological, psychiatric and cognitive problems are features of ME, it seems more likely that such morbidity is due to impaired cerebral blood flow.
• The different cell shapes, and an associated reduction in cell flexibility reduces their capacity to pass through capillaries smaller in diameter than the cell. This slows the flow of blood and increases it viscosity. As a result the oxygen, nutrients and hormones transported in the blood are delivered at a reduced rate and cell exhaustion may occur.
• A percentage of the population has unusually small capillaries that leaves them at risk of developing ME-like symptoms if their red cells become less flexible.
• The most severe symptoms will be associated with tissues and organs containing the smallest capillaries. This could account for different ME patients having a slightly different cluster of symptoms.
• The hypothalamus has an extremely dense capillary bed. Decreased blood flow to this part of the brain would account for the cognitive problems, sleep disturbances and emotional lability experiences by people with ME.
• The changes in red blood cell shapes correlate to physical and emotional stresses experienced by the patient, and patients who have improved can relapse following over-exertion.
• Capillary size cannot be changed. The solution is to try to improve the shape and flexibility of the red blood cells so they will flow more easily through the capillaries.
Dr Simpson suggests some possible treatments (not cures) to help patients improve.
• For those with cup-transformed cells – B12 injections help 50% (why the other 50% do not respond is not known)
• For those with other types of red cell shape change – 70% or more of cases respond to evening primrose oil. The effects of the oil are to increase the blood levels of prostaglandin E1. This hormone has been shown to increase red cell flexibility. Those who do not respond to evening primrose oil should explore the effects of fish oil rich in omega-3 fatty acids. These fatty acids improve red cell flexibility by a different mechanism to that of evening primrose oil. The suggested dose is 2 x 1000 mg capsules with food 3 times daily