The 12th Invest in ME Research Conference June, 2017, Part 2
MEMum presents the second article in a series of three about the recent 12th Invest In ME International Conference (IIMEC12) in London.
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Case for BioPsychoSocio Cause of CFS

Discussion in 'General ME/CFS Discussion' started by Stretched, Feb 2, 2018.

  1. Stretched

    Stretched Senior Member

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    Apply Biopsychosocial BPS abuse model to GWI (PTSD), which Dr. Nancy Klimas parallels with CFS and you get a reasonable basis for examining non-viral CFS causation. (“You live with constantly heightened cortisol levels. this has its effects on first gut, the immunesystem and so on. these are simple facts. That's the Bio part of BioPsychoSocial.” - @Sundancer, PR, 2/2/18.)

    GWI fits the BPS abuse model, accelerated. IOW, look at the symptoms of BPS abuse over time and you indeed get similar symptoms to the otherwise accelerated symptoms of GWI and CFS.

    I’m curious if Dr. Klimas has thought along these lines in modeling her GWI and CFS similarities? It certainly seems to take the viral component out of the equation (which hasn’t solved anything as yet) and focuses on the immune system gone awry, ergo the HPA axis dysfunction.
     
    Last edited: Feb 2, 2018
  2. Sundancer

    Sundancer Senior Member

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    hm...firstly I think the BioPsychSocial model is misused.

    to me it should mean. Patient gets sick of say a nasty virus, that's the most common = BIo
    patients needs care = social (+ bio+psycho), no care means getting well is compromised, also means that patient can feel abandoned - psycho. This worsens the illness

    Patient gets ME, bomb exploding in his body, feels very sick, can't move, breathing problems etc etc. Patient becomes anxious = psycho.

    patient needs care, care for body so he can rest and gets the right foods etc. Patient needs soothing = psycho ( and maybe calming sups,medicin = bio)

    so it goes on.

    In general, when you get sucked in by fear, you're fighting a loosing battle ( been there, that fear, living alone, no care, not anything, not able to move, fucking scary)

    regarding causes, whether viral/toxines ( including medicines and anesthesia) or psychological stress.
    fort he body( HPA axis) it is all one, a too large stressload.

    Methinks that ME is caused by a stressor that is too large for the body to handle. Then the body becomes stuck, cannot repair itself and starts deteriorating because body is producing large amounts of wrong thingies, just my idea of course.

    those with a virus have a problem besides having ME, because not only the bodyreaction from getting ME, but also the virus is ruining the body.

    those with toxins overload have a problem besides having ME, because they are stuck with toxins the body can't handle.
     
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  3. lnester7

    lnester7 Seven

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    God no!!!! She tends to be very heavily in immune system and NKs....
    Her background is AIDS and she is very reasonable, listens and works with you on your particular situation.
    I was sooo impressed with a consult I had w her!!!! I think her group is big on NK activity disfunction ( not sure if their view is still on that particular egg).
     
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  4. Stretched

    Stretched Senior Member

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    Great stuff, re stressors! Coincidentally, This is where my personal speculation/interest lies - stress. Here are some comments I posted a couple of years back on such:

    While the research terminology is specific to those needing such specificity the concept is key, IMO. Stress, like art is hard to quantify and each of us requires a unique exposure of each before an affect results. An hypothesis is, that once this threshold is reached (or maxed out,⎇,) the system capacity for such is full; any more is like a cup running over which triggers a release of epinephrine (or other affecting hormone) into the system which in turns spreads to wreak the many havocs known (and unrecognized as yet). ...Don't most PWC's report such stress prior to a crash... ?

    Stress at the root of CFS? Oh my from the mainstream - hmmm, correction - stressors?

    Just because the in crowd continues to look to the skies for a UFO, doesn't give credence that something alien will show up there - possibly explaining Bigfoot and other myths.

    Might it be that this analogy is an apt description regarding the directions of the CFS bio-medical research field? That "in crowd" has been repeatedly hammering the metaphorical square block into the cylindrical void by dogmatically pursuing hypothecated pathogenic origins of CFS?

    If the research crowd were on the right track then surely a strong singularity of hints leading to such a culprit would have been dug out after 30 years - and a consensus formed. As it is, the field has become mired by probing multiple tributaries of the same river, ad nauseum, only to arrive at adding to an ever increasing number of similar causative theories.


    Substantive healing results to date - S.O.S! (same old stuff, for Victorian eyes). Yet it continues, another related study follows a variation of the last. To date a virus has not been shown to be the culprit.

    Isn't it about time for a paradigm shift - to focus on the brains of PWCs, which even at rest are messed up? [There are small, brave numbers who cautiously probe on an emerging threshold by posting limited studies from time to time that just might explain where lies the actual underpinninings of CFS, AND which can account for myriad manifestation of its symptoms.] but problem, how to get an agreeable handle on the idea of stress as causative?
     
    Last edited: Feb 3, 2018
  5. duncan

    duncan Senior Member

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    Stressors as predicators for real ME-CFS??? I'd look first to viruses and bacterium.

    Take short term cases and angle against long term, and symptom cluster differences may emerge, e.g. febrile vs non-febrile.. Deliberately compare acute cases to chronic.

    I think there have been many cogent arguments made here for the continuence of stealth viruses and bacteria that elude one's immune system.

    Of course, equally good arguments have been made about autoantibodies...
     
    Last edited: Feb 3, 2018
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  6. boombachi

    boombachi Senior Member

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    I don't think any abuse model fits GWI. It is more likely to do with toxic exposure whilst in combat.
     
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  7. alex3619

    alex3619 Senior Member

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    If you want to look at stress or stressors then its best to avoid BPS entirely. A broken bone, a car accident, a stabbing, an ebola infection, a lightning strike, all fit in BPS. Its so broad its meaningless.

    Second, that ebola infection ... thats multiple stressors right there. A stab wound ... more stressors. Ditto all other physical trauma. The stressor thing is also too broad. Now focusing on cortisol is fine as a theoretical approach ... but its been looked at for a very long time. Heck, it was the basis for many ideas on ME in the 70s, at least in the thoughts of doctors. Decades later and we have ... what? They stopped using cortisol to treat ME at around that time.

    Now there is unpublished UK research that we have cortisol resistance due to elevated beta cortisol receptors. I want to see that published so we can look at the data. This however does not tell us if this is primary, or secondary, or even tertiary to the disease process.

    A great many patients with ME and CFS have more or less normal cortisol as well. It takes a larger cohort to identify subtle deficits, including circadian deficits, and it looks secondary, at best, not primary. It probably contributes to symptoms.

    Now there might be subgroups where cortisol issues are a big thing. This applies to many theories of ME and CFS, not just cortisol.
     
  8. femtosecond99

    femtosecond99 Senior Member

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    Cortisol is quite often normal in CFS, but studies show that the HPA axis itself is generally underresponsive, so there is a lower cortisol response to a stressor. Treating with cortisol doesn't work, as it's just one small part of the problem. Although it might potentially be a useful biomarker (the HPA axis, not cortisol).

    Toxic exposure in GWI isn't holding up, as the same number of Afghanistan veterans have chronic multi-symptom illness (30%). 98% of the veterans with CMI also have PTSD (https://www.research.va.gov/currents/0516-2.cfm).

    A lot of people don't like stress as a cause for CFS because:

    1) They think that it means you're weak, and should be able to push through.
    2) They think it means that the symptoms are purely mental, and don't involve the immune system, ANS, digestion, etc.
    3) They think it means that the symptoms are mild.
    4) They didn't have any child abuse. (It's actually mostly stress in the preceding year that seems to trigger CFS/GWI, although childhood stress may alter the HPA axis so you are more likely to develop CFS later).
    5) The think that the person themselves is somehow responsible for their body's response to stress, or that the person is to blame because they should be able to use their own willpower to recover.
    6) They think that because they're not under stress any more, the symptoms should disappear immediately.

    If you do a little research into stress, you see pretty quickly that all these arguments are bogus.
     
    Last edited: Feb 3, 2018
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  9. Stretched

    Stretched Senior Member

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    ‘Toxic exposure, etc’ is anothermoniker for stress. Do yo think PWC’s otherwise experience ‘toxic exposure?’ Combat upegulates the HPA ACTH, raises Cortisol levels and other PTSD symptoms that Klimas parallels to CFS, e.g. the trauma symptoms experienced by an abused child. In BPS/PTSD, the Bio and Immune parts are equivalent.

    We need to follow this rabbit hole, paying attention to the stress dynamic, treating the broken HPA axis and giving the virus treatments a break. They are not curing anyone, over and over again.
     
    Last edited: Feb 4, 2018
  10. Diwi9

    Diwi9 Senior Member

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    Nothing in the article you linked makes the conclusion that because veterans served in Afghanistan vs. the Gulf, that they did not experience toxic exposure. This is your conclusion. My interpretation is that there must be something endemic within the military that is causing problems. Nancy Klimas is looking at genetic differences between soldiers' abilities to blockade acetylcholine receptors as a possible protective factor from neurotoxic exposures.

    BTW - Even the VA acknowledges potential exposures from service in Afghanistan: https://www.publichealth.va.gov/exposures/wars-operations/oef.asp
     
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  11. perrier

    perrier Senior Member

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    Dear Inester,
    What meds does she tend to use to treat immune dysfunction?
     
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  12. femtosecond99

    femtosecond99 Senior Member

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    The VA has publicly said they are moving away from stress as a cause, as many veterans don't like the idea of stress causing their symptoms. However they seem to be clutching at straws. Most of the things listed in the article you quote (noise, heat, cold, etc) are stressors rather than toxins, and we already know that stress causes these symptoms.
     
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  13. Stretched

    Stretched Senior Member

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    The point was/is addressing PTSD, IRRESPECTIVE of which war. GWI is simply a familiar focal point. ‘Vietnam vets were exposed to same stressors, which is stress - an attack on the HPA axis, affecting in an accelerated manner the same immune system dysfunction as in the slower to evolve actively CFS symptoms: the gut, hormones, the hypothalamus, cognition, et al.

    Genetic differences are consequently differences in each individual’s ability or not, to tolerate different levels of the symptoms of stress caused by the same onslaught of the dysfunctional immune system.

    An even faster manifestation of these stress symptoms could be to lock an individual in a dark house and put a black mamba in the back door. In fact you would not need to actually insert the killer snake - just tell the subject s/he will be locked in a dark house for a month with a black mamba. This accelerates Immune dysfunction symptoms at an even greater rate than combat.
    (A simpler, less catastrophic simile is a pilot landing the jet on a carrier at night... . Puckered,
    but not too systemically damaged - per flight surgeons).
     
    Last edited: Feb 4, 2018
  14. Stretched

    Stretched Senior Member

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    Toxins can be a systemic (Immune system) reaction to stressors e.g. agent orange, napalm and other poisons of combat.
     
    Last edited: Feb 3, 2018
  15. Stretched

    Stretched Senior Member

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    Please go back to the original post, above for the premise. It is that ‘Bio’ part: a child is abused. S/he grows up with major stress disorders as a result (some manifest overtly; others are deeply buried within). It first attacks the gut, then the hypothalamus, and then all sorts of immune hyper dysfunction follows. This is what the PTSD (BPS) model parallels, only accelerated. Not Wessely’s theories!

    There are a number of studies related to these immune system dysfunctions, coming back around from losing speed in the early 90’s, not 70’s. (I was part of the more recent CFS outbreak from Incline Village in the mid 80’s, when the CDC was only then called into investigate, which we all now know they bumbled.)

    IAE, here’s just one or two of a number of articles (abstract form) supporting the role of Stress in CFS, which we can further build upon:

    Does hypothalamic–pituitary–adrenal axis hypofunction in chronic fatigue syndrome reflect a ‘crash’ in the stress system?
    Boudewijn Van Houdenhove a,*, Filip Van Den Eede b, Patrick Luyten c
    a Department of Liaison Psychiatry, University Hospitals K.U. Leuven, Herestraat 49, B-3000 Leuven, Belgium
    b Collaborative Antwerp Psychiatric Research Institute, Department of Psychiatry, Antwerp University Hospital, Antwerp, Belgium c Department of Psychology, K.U. Leuven, Leuven, Belgium
    article info
    Article history:
    Received 18 November 2008 Accepted 21 November 2008 Available online xxxx
    summary
    The etiopathogenesis of chronic fatigue syndrome (CFS) remains poorly understood. Although neuroen- docrine disturbances – and hypothalamic–pituitary–adrenal (HPA) axis hypofunction in particular – have been found in a large proportion of CFS patients, it is not clear whether these disturbances are cause or consequence of the illness. After a review of the available evidence we hypothesize that that HPA axis hypofunction in CFS, conceptualized within a system-biological perspective, primarily reflects a funda- mental and persistent dysregulation of the neurobiological stress system. As a result, a disturbed balance between glucocorticoid and inflammatory signaling pathways may give rise to a pathological cytokine- induced sickness response that may be the final common pathway underlying central CFS symptoms, i.e. effort/stress intolerance and pain hypersensitivity. This comprehensive hypothesis on HPA axis hypo- function in CFS may stimulate diagnostic refinement of the illness, inform treatment approaches and suggest directions for future research, particularly focusing on the neuroendocrine–immune interface and possible links between CFS, early and recent life stress, and depression.

    And more familiar psychiatric reference results, paralleling the above hypothesis:

    Childhood Trauma Raises CFS Risk
    Researchers Also Say Stress Is a Factor in Chronic Fatigue Syndrome

    By Daniel J. DeNoon
    Listen
    This article is from the WebMD News Archive
    This content has not been reviewed within the past year and may not represent WebMD's most up-to-date information.

    FROM THE WEBMD ARCHIVES
    Nov. 6, 2006 -- Childhood trauma raises a person's risk of chronic fatigue syndrome by three- to eightfold, CDC researchers find.

    Another study, based on data from the Swedish twin registry, shows stress to be a triggering factor for chronic fatigue syndrome (CFS). It also shows that emotional instability is a significant CFS risk factor, although genetic and family factors determine whether this personality trait leads to fatigue.

    "Our observations lend support for the hypothesis that CFS represents a disorder of adaptation that is promoted by early environmental insults, leading to failure to compensate in response to challenge," conclude CDC researcher Christine Heim, PhD, and colleagues.

    "Stress is a significant risk factor for chronic fatigue-like illness, the effect of which may be buffered by genetic influences," conclude Karolinska Institute researcher Kenji Kato, PhD, and colleagues. "Emotional instability assessed 25 years earlier is associated with chronic fatigue through genetic mechanisms contributing to both personality style and expression of the disorder."

    This also represents an assault on the immune system going unresolved. By inference, if you subscribe to mainstream CFS etiology you also buy into the possibility of the viability of BPS as a cause since it’s the other side of the viral/immune system etiology which all our wonderful clinicians treat but can’t cure. This is simply a call to look down this rabbit hole since we’re not finding any along the viral tracks!
     
    Last edited: Feb 4, 2018
  16. ukxmrv

    ukxmrv Senior Member

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    I'm guessing that Dr Klimas has found the same low cortisol in her CFS patients that other researchers have so hasn't taken this further.

    It's not a "reasonable" basis if the science doesn't match the spin.

    The Psych lobby has had decades to prove their case but if you look at the papers you are quoting they are just theories with no tests or research or proof to back them up. They had an idea and have done nothing over time to show that there is any basis. Time moved on and no one apart from them would take it seriously.

    Patients and CFS researchers are interested in science based evidence. The Psych lobby hasn't produced anything and appears more like a religion than science. Their arguments only work if you ignore the evidence from published research so far on abnormalities.
     
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  17. Stretched

    Stretched Senior Member

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    It seems some responders are lumping in BPS theories with the maligned Wessely papers. This PTSD theory does in fact parallel with Nancy Klimas’s and other mainstream researchers with a common CFS premise - that the two illnesses share common symptoms. I am not supporting psych causes; “BioPsychoSocio” is a different animal. (See explanation above)

    By inference, if you subscribe to mainstream CFS etiology you also buy into the possibility of the viability of BPS as a cause since it’s the other side of the viral/immune system etiology which all our wonderful clinicians treat but can’t cure. This is simply a call to look down this rabbit hole since we’re not finding any along the viral tracks!
     
    Last edited: Feb 4, 2018
  18. boombachi

    boombachi Senior Member

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    I don't have a great understanding of biochemistry but I do know that stress is a normal part of life that we are designed to deal with. It is not realistic to avoid bacteria, viruses, injuries, divorce, bereavement, traffic jams, etc...

    The argument that some people are predisposed to certain illnesses or vulnerable to stress surely means it is whatever is causing the vulnerability that is responsible.

    I have heard stress blamed for everything from migraines and autoimmune flares to heart attacks. There needs to be a better explination for why some people get sick and others don't.

    The reason I reject the stress hypothesis is not because I think it makes me seem weak or a preference for organic over psychological causes. I work in mental health and reject the idea that stress causes mental illness too. Stress might trigger symptoms, but it can't explain why some people get sick and others don't .
     
  19. femtosecond99

    femtosecond99 Senior Member

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    For something like PTSD, which is generally agreed that it is caused by stress, not all people who experience the same conditions develop PTSD. I'm not sure it makes sense to completely reject stress as a cause, simply because we don't know why some people don't develop PTSD. In terms of stress causing mental health issues, we also have a lot of research on animals showing that stress triggers depression. For bipolar and schizophrenia, stress just seems to be a trigger rather than the main cause.

    This review shows some of the factors responsible for stress-related illnesses:

    http://psycnet.apa.org/doiLanding?doi=10.1037/0033-2909.133.1.25

    " the time elapsed since stressor onset, (2) the nature of the threat posed, (3) the core emotions likely to be elicited by the stressor, (4) the controllability of the stressor, and (5) the psychiatric characteristics of the person"
     
  20. Stretched

    Stretched Senior Member

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    Genetics? Systemic makeup - brain abnormalities, etc.?
     

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