Vasodilation all of the time, especially at night

[CFS_for_19_years]

In another article, Jay S. Cohen, M.D. goes on to mention supplements that can increase vasodilation, many due to the increase in Nitric Oxide (NO):

http://medicationsense.com/articles/2012/emsup.php

Amino Acids: Arginine, Taurine
Both arginine and taurine increase levels of nitric oxide in blood vessel cells. Nitric oxide is the primary substance in the vascular system that produces vasodilation.

Bioflavinoids
More than 4,000 naturally occurring flavonoids have been identified in nature. They are potent antioxidants and free radical scavenges. Although studies are few, it appears that bioflavinoids can modestly reduce blood pressure, meaning they may cause vasodilation.

Coenzyme Q10
This potent antioxidant has many uses in the human body. Alternative doctors frequently recommend coenzyme Q10 to offset the side effects of cholesterol-lowering drugs such as Lipitor (atorvastatin) and Zocor. Because levels of coenzyme Q10 gradually drop with age, the supplement is also frequently recommended for maintaining cardiovascular health. Studies show that coenzyme Q10 can also reduce blood pressure.

Fish Oil & Flax Oil Capsules
Fish oil and flax oil are high in omega-3 fatty acids. Both supplements increase the level of prostaglandins in cells. Prostaglandins are potent vasodilators.

Gamma Linolenic Acid: GLA, Evening Primrose, Borage Oils
All have been shown to reduce blood pressure, which means it widens blood vessels. This can worsen EM.

Garlic
Garlic is well known to open blood vessels. This is why alternative doctors frequently use it as one of the natural therapies for treating high blood pressure. Any substance that opens blood vessels usually worsens the symptoms of EM.

5HTP
A derivative of tryptophan, 5 HTP causes the body to produce serotonin. If you benefit from medications such as Cymbalta, Effexor, Prozac, Zoloft or other SSRIs or SNRIs, then 5 HTP should help you as well. If 5 HTP causes worsening, as it did for me, then serotonin antagonists may help you (see feverfew, white willow below).

Lycopene
Lycopene is found in tomatoes, grapefruit, watermelon and papaya. Studies have proven that lycopene can reduce blood pressure, meaning it widens blood vessels. A small amount is probably okay.

Minerals: Zinc, Selenium
Zinc and selenium are sometimes recommended by alternative doctors for hypertension. Both supplements worsened my EM.

N-Acetylcysteine (NAC)
A potent antioxidant and free radical scavenger, NAC increases levels of nitric oxide, the primary vasodilator in vascular cells.

Niacin
Niacin is a potent vasodilator, so potent that niacin preparations can cause skin flushing from dilation of blood vessels. Prescription niacin preparations often do the same. Even in small doses in multivitamin pills, niacin may cause vasodilation in EM. Some multivitamin preparations contain niacinamide, a less potent derivative of niacin, yet niacinamide may still be a problem for some with EM.

 

[JaimeS]

What time of day is it low-normal? IIRC, some studies have shown pwME to have reverse cortisol secretion, so that it is low in the morning, when it should be high, and high in the evening when it should be low.

MeSci, I follow this pattern but not to an extreme degree. My cortisol is low-normal in the morning, but at mid-normal levels in the afternoon. So it is a bit reversed in that way, but never far beyond normal no matter when it's taken.

-J

 

[JaimeS]

I know some of what I take is vasodilatory, but it's not like my meds have changed, @CFS_for_19_years ; or at least, I didn't change them and then have this issue afterwards. I'm pretty sure that the weather is the tipping-point thing that has caused this issue to surface in me, and since a lot of these issues are being raised in (northern hemisphere's) summer, that may be true for others as well.

In a cool, air-conditioned place, my vasodilation is a bit weird, but when I step outside into the heat, it's much worse. I can watch the veins bulge higher in my hands... creepy. This is accompanied by a feeling of increased pressure in my hands which feels achy and uncomfortable; I often tuck my hands in at the elbows so gravity isn't pooling my blood in my fingers!

I saw my friend's hands do the same thing, though, and it makes me wonder. I'm sure heat makes everyone vasodilate a bit, but we seem to have an exaggerated reaction. I wonder if this is compensatory in some way - like, our bodies recognize that we have issues maintaining our internal temperatures and trying to let go of more heat faster in order to keep up with the temperature and pressure change.

Of course, I have no idea what the mechanism would be for that, but it does stand to reason that if one compensatory mechanism fails, another might have to pick up the slack.

-J

 

[JaimeS]

From:

Charkoudian, N. (2010). Mechanisms and modifiers of reflex induced cutaneous vasodilation and vasoconstriction in humans. Journal of Applied Physiology, 109(4), 1221–1228. doi:10.1152/japplphysiol.00298.2010

The active vasodilator system in human skin does not exhibit resting tone and is only activated during increases in body temperature, such as those brought about by heat exposure or exercise. Active cutaneous vasodilation occurs via cholinergic nerve cotransmission and has been shown to include potential roles for nitric oxide, vasoactive intestinal peptide, prostaglandins, and substance P (and/or neurokinin-1 receptors). It has proven both interesting and challenging that no one substance has been identified as the sole mediator of active cutaneous vasodilation.

Note that the author says 'heat or exercise'. Since we know our bodies are pretty much always under lactic stress, this may be part of the picture, i.e. the body is receiving signals via lactic acid that we are or just have exerted ourselves.

Insanely, according to Skin Blood Flow in Adult Human Thermoegulation by the same author,

With body heating, the magnitude of skin vasodilation is striking: skin blood flow can reach 6 to 8 L/min during hyperthermia.

Put another way, up to twice the normal volume. It's nice to know those bulging veins can take a lot, and aren't about to spring a leak!

After reading the article, it seems there are actually quite a few mechanisms behind vasodilation, and probably rather than one being 'right' and one being 'wrong', they're redundant. One of those mechanisms is H1 histamines. I wonder if an OTC antihistamine would help block that vasodilation?

However, now that I know what causes it, I'm not sure if I would want to take away/fix something that is trying to help me maintain homeostasis. I think the best way to address the problem would be working on the initial issue by lowering your body temperature in other ways, like taking a lukewarm shower, sweeping rubbing alcohol at your pulse points and on the soles of your feet (if you can take the smell) or changing into looser clothing. The body may be trying to cool us down! I'm sure we can help.

-J

 

[MeSci]

I know some of what I take is vasodilatory, but it's not like my meds have changed, @CFS_for_19_years ; or at least, I didn't change them and then have this issue afterwards. I'm pretty sure that the weather is the tipping-point thing that has caused this issue to surface in me, and since a lot of these issues are being raised in (northern hemisphere's) summer, that may be true for others as well.

In a cool, air-conditioned place, my vasodilation is a bit weird, but when I step outside into the heat, it's much worse. I can watch the veins bulge higher in my hands... creepy. This is accompanied by a feeling of increased pressure in my hands which feels achy and uncomfortable; I often tuck my hands in at the elbows so gravity isn't pooling my blood in my fingers!

I saw my friend's hands do the same thing, though, and it makes me wonder. I'm sure heat makes everyone vasodilate a bit, but we seem to have an exaggerated reaction. I wonder if this is compensatory in some way - like, our bodies recognize that we have issues maintaining our internal temperatures and trying to let go of more heat faster in order to keep up with the temperature and pressure change.

Of course, I have no idea what the mechanism would be for that, but it does stand to reason that if one compensatory mechanism fails, another might have to pick up the slack.

-J

You may find this thread interesting, @JaimeS. The article says:

To control vasodilation, the endothelium releases endothelium-derived relaxing factors (EDRFs) such as nitric oxide, while to control vasocontriction the endothelium releases endothelium-derived contracting factors such as thromboxane and endothelin.

These chemicals are produced and released directly by the endothelial cells, with the end result being stimulation of the surrounding smooth muscle to either relax or contract, hence dilating or contracting the blood vessel. Through this process of homeostasis, blood pressure can be tightly controlled while this mechanism is also used as an important mechanism in internal heat and temperature regulation.

If this hypothesis proves correct, NO production is disrupted meaning that vasocontriction likely dominates. It is then logical to assume that sufferers of ME have a lowered ability to regulate heat through vascular means. This is clearly supported by the heat intolerance and symptom flares many ME patients experience in both extreme warm and cool weather.

 

[MeSci]

From:
Since we know our bodies are pretty much always under lactic stress, this may be part of the picture, i.e. the body is receiving signals via lactic acid that we are or just have exerted ourselves.

I get extreme hot flushes if I overexert, so maybe it is just due to my ME body trying desperately to lose heat under the stress of lactic acid being produced. It can be quite embarrassing if I am out shopping and this effect is brought on by simply trying to coordinate things at the till - finding somewhere to put my walking stick where it won't fall onto the floor, getting my money out, getting my loyalty card and/or coupons out, putting my shopping in my trolley, and often more. I turn red, start sweating, become breathless, my legs threaten to buckle...all while just trying to pay for some shopping!

 

[JaimeS]

@MeSci - I've certainly heard a lot about NO and ME, but after reading that article, it looks like there are backups on backups for vasodilatory response to heat. I think we are looking at either an issue with several of the mechanisms gone haywire, or an issue with Systems Control telling us it's a lot hotter than it is, in order to keep our temperature from varying too much, because we can't handle it.

-J

 

[JaimeS]

I get extreme hot flushes if I overexert

@MeSci, I don't recall if you are one of those with ME who over-react to introduction of new chemicals, but I might try some Actea racemosa if I were you. Just a dropperful of tincture in the AM can help with hot flushes and is really gentle and well-tolerated by me. It tastes like an old boot, though, so be aware.

-J

 

[MeSci]

@MeSci, I don't recall if you are one of those with ME who over-react to introduction of new chemicals, but I might try some Actea racemosa if I were you. Just a dropperful of tincture in the AM can help with hot flushes and is really gentle and well-tolerated by me. It tastes like an old boot, though, so be aware.

-J

Thanks. I'm taking a lot of things already, and regard the hot flushes as more annoying than a serious problem, and maybe they serve a purpose by stopping me from continuing to overexert. I don't react adversely to all things I try - some work well and some give me adverse effects. I'm well past the menopause, BTW.

 

[MeSci]

@MeSci - I've certainly heard a lot about NO and ME, but after reading that article, it looks like there are backups on backups for vasodilatory response to heat. I think we are looking at either an issue with several of the mechanisms gone haywire, or an issue with Systems Control telling us it's a lot hotter than it is, in order to keep our temperature from varying too much, because we can't handle it.

-J

And/or we produce one or more uncoupling proteins on exertion, which cause the mitochondria to produce heat instead of chemical energy. There are a few threads which refer to this phenomenon/possibility.

 

[JaimeS]

And/or we produce one or more uncoupling proteins on exertion, which cause the mitochondria to produce heat instead of chemical energy.

Most of what I've seen lately has pointed to glycolysis errors. Glycolysis occurs in the cytosol and Krebs/Citric Acid occurs in the mitochondria. It might be that people with ME all have errors in ATP generation somewhere or other, but the location of the problem differs person to person?

-J

 

[MeSci]

Most of what I've seen lately has pointed to glycolysis errors. Glycolysis occurs in the cytosol and Krebs/Citric Acid occurs in the mitochondria. It might be that people with ME all have errors in ATP generation somewhere or other, but the location of the problem differs person to person?

-J

Yes - and some/many of us may have more than one abnormality in energy generation. I think that most of mine is of the aerobic/anaerobic imbalance type, and the CPET tests carried out on pwME indicate that this occurs in most of us, hence the usefulness of heart rate monitors.

 

[Lolinda]

I have the exact same issue as described in this thread: warm skin, lowish BP, and when laying down even more warm skin. I got recently tested for adrenergic and muscarinic receptor autoantibodies. Turned out that I have huge levels of A1 receptor autoantibodies. Now, this means, that vasoconstrictory efforts of my body, mediated by exactly these adrenergic receptors, are not heard by the blood vessels. The receptors are blocked by the antibodies, so the vessels stay dilated... Here I wrote down all the details in case anyone is interested.
I liked the posts on erythromelalgia on this thread. I would find it plausible if the difference between the two possible causes, adrenergic receptor autoantibodies and erythromelalgia could be made based on redness: the first does not, the second does imply redness.

 

[CFS_for_19_years]

I would find it plausible if the difference between the two possible causes, adrenergic receptor autoantibodies and erythromelalgia could be made based on redness: the first does not, the second does imply redness.

The hallmark of erythromelalgia is that pain increases as the ambient temperature rises or one is exposed to other sources of heat, such as bath water. Redness may or may not occur. My tipping point is 67 degrees F. There are very few pain syndromes that are affected by heat in this manner. Some doctors mistakenly believe that redness is necessary for the diagnosis of erythromelalgia, but it is not.

 

[Lolinda]

I do not have any pain upon heating. This fits well what you write that in erythromelalgia, which I don't have, one should have that.

 

[drob31]

I have the exact same issue as described in this thread: warm skin, lowish BP, and when laying down even more warm skin. I got recently tested for adrenergic and muscarinic receptor autoantibodies. Turned out that I have huge levels of A1 receptor autoantibodies. Now, this means, that vasoconstrictory efforts of my body, mediated by exactly these adrenergic receptors, are not heard by the blood vessels. The receptors are blocked by the antibodies, so the vessels stay dilated... Here I wrote down all the details in case anyone is interested.
I liked the posts on erythromelalgia on this thread. I would find it plausible if the difference between the two possible causes, adrenergic receptor autoantibodies and erythromelalgia could be made based on redness: the first does not, the second does imply redness.

I may be different in that I'm sensitive to cold, and it will cause my blood vessel to over constrict and stay constricted for too long.

 

[CFS_for_19_years]

I may be different in that I'm sensitive to cold, and it will cause my blood vessel to over constrict and stay constricted for too long.

Do your fingers or toes turn ghostly white when this happens? If so, it could be Raynaud's phenomenon.
See photo here: https://en.wikipedia.org/wiki/Raynaud's_phenomenon

My toes do this once in a while since I'm barefoot 99% of the time.

 

[drob31]

Do your fingers or toes turn ghostly white when this happens? If so, it could be Raynaud's phenomenon.
See photo here: https://en.wikipedia.org/wiki/Raynaud's_phenomenon

My toes do this once in a while since I'm barefoot 99% of the time.

Nope, they never turn any color. It seems that the cold does it, either the room temp is too cold, or I drink something cold.

 

[Lolinda]

For anyone interested: vasodilators & vasoconstrictors

here I have summarized all vasodilators for which I got tested. Equally, vasoconstrictors. Lack of a vasoconstrictor is in effect a vasodilator, and vice versa. The text is written from POTS or OH perspective, but you can ignore that and simply see it as a vasoconstrictor/dilator list. This I say because the relationship between vasoconstrictors/dilators and POTS or OH is complex, and most of all there are other factors such as blood volume, heart, muscle pump by the legs, vasoconstrictory reflexes built specifically into the leg vessels, etc etc that all influence things. A vasodilator or constrictor can cause warm or cold skin or low or high BP or headache or 100 other things without any POTS or OH. Or with. In short: if one has some symptoms of vasodil. or constriction, dont think too much, get tested. Think later, when the results are there. I found doctors utmost not knowledgeable regarding vasodilators and -constrictors. Essentially useless. All they were good for was to order tests. Sad, but I dont care as long as I succeed to make them sign requisition forms... I can read research, they can't because either too dumb or no time when treating patients 8h a day. (the usage of the word 'dumb' should not sound arrogant here. I describe myself as dumb in so many things ranging from e.g. history, ... to literature but I am not amused about so many doctors because there is a difference: the health of other people is at their mercy!)

--> a special vasodilator is nitric oxide, for which I only have an experimental testing method. Contributions welcome! Unfortunately, NO is the most important one in many issues!

And I have already posted here the link to adrenergic and muscarinic receptor antibodies. They act mostly as vasodilators. Simply consider them as kinda "non-traditional vasodilators". Just one more comment: These antibodies can cause various illnesses depending on which antibodies in which combination are present, and if they are dysfunctional (i.e. blocking) or activating (i.e. agonistic) antibodies. All in all: this is again complex matter, dont expect any doctor to help (except for these). My take as usual: get tested first, read research later, when the results are there. Unfortunately, these receptor antibodies cannot be precribed by doctors on any health insurance in any country. They are brand new research. So its a question of expenses, which you pay. The prices are here, at the end of the posts, in the attached requisition form, at the bottom of the form.

btw my story:
For years I have been chasing reasons for my unusually warm skin, doubly so when laying down / at night, my lowish BP, my orthostatic difficulties, my cooling out easily. It is in me like with the drunk homeless in winter: they drink alcohol in the cold, then their blood vessels dilate, that means warm skin, so they cool out and get sick or even die. I have the same, without drinking a drop...

 

[JaimeS]

came here again because this problem is happening again. It's definitely lactic acidosis for me: this happened after I typed for 7 hours straight -- quite a few days ago! -- and I still haven't recovered. It's not summer in this case; it's definitely overactivity-related.

But evidence still supported: I keep having hot flushes, and thinking I must have a fever. Maybe for someone with ME I do. My temp usually runs a little low. But regardless, the temp I am "feeling" does not correlate at all to what the thermometer keeps telling me. I think I resolved with baking soda and lots of CoQ10 last time?