Can one have an Angiotensin deficiency and is there a way to increase Angiotensin?

[Replenished]

As ever I continue to search for a solution to my ongoing symptoms of dehydration, thirst, frequent urination and what seems to appear more and more like a low blood volume/pressure issue.

Looking at Angiotensin:
Angiotensin (the renin–angiotensin–aldosterone system regulates blood pressure, fluid and electrolyte balance, and systemic vascular resistance)

I'm wondering if I could be deficient/low in angiotensin and if there's anything I can do about it?

 

[LINE]

I would suspect that the adrenal axis has something to do with this (educated guess). Adrenals are constantly responding to the stressors of immune activity and toxins, becoming tired.

 

[Consul]

I think one of angiotensin IIs jobs is to signal for the release of aldesterone/vasopressin. This in turn is supposed to hold water back in the body to increase blood pressure. I think this is sold as a drug. If thats something you should try i have no idea.

 

[LINE]

Mineralcorticoids are produced in the adrenal glands that are responsible for some of your concerns.

Mineralocorticoid - Wikipedia

Mineralocorticoids are a class of corticosteroids, which in turn are a class of steroid hormones. Mineralocorticoids are produced in the adrenal cortex and influence salt and water balances (electrolyte balance and fluid balance). The primary mineralocorticoid is aldosterone.

 

[Replenished]

I think one of angiotensin IIs jobs is to signal for the release of aldesterone/vasopressin. This in turn is supposed to hold water back in the body to increase blood pressure. I think this is sold as a drug. If thats something you should try i have no idea.

I've tried vasopressin, doesn't seem to help, must be a slighty different method of action causing my symptoms.

 

[Replenished]

Mineralcorticoids are produced in the adrenal glands that are responsible for some of your concerns.

Mineralocorticoid - Wikipedia

Mineralocorticoids are a class of corticosteroids, which in turn are a class of steroid hormones. Mineralocorticoids are produced in the adrenal cortex and influence salt and water balances (electrolyte balance and fluid balance). The primary mineralocorticoid is aldosterone.

Thanks. Yes, i've tried lowish doses of fludrocortisone at about 0.1mg. It helps me retain fluid maybe 5-10% better but outside of that I feel as though I may feel worse in other ways when on it so it seems it's not the solution for me.

 

[Shanti1]

I'm wondering if I could be deficient/low in angiotensin and if there's anything I can do about it?

Quest labs in the US has tests for Angiotensin II, but it is only looking for high levels as the reference range is <52ng/mL. Angiotensin II is a medication, but only for IV administration. I would expect low blood pressure if someone had an angiotensin deficiency, not sure what yours is.

I still drink more than the average person, about a gallon a day, but it used to be double that, along with the feeling that I just couldn't drink enough. Clearing my candida, starting valacyclovir, and using immune support greatly reduced my thirst. My theory is the virus or candida byproducts were messing with the thirst center control in my hypothalamus or perhaps my body sensed these pathogens and their byproducts and was trying to flush them.

While my thirst has diminished, I still have orthostatic hypotension and need compression and medication to sit or stand for any amount of time. Over the last year I tried midodrine, desmopressin, fludrocortisone, adrenal glandular, fluid/salt loading, IV saline, pseudoephedrine, phenylephrine, pyridostigmine, Strattera, droxidopa, and Etilefrine.

Of these, only strattera, droxidopa, and etilefrine had significant effect and if I am not moving around, but just sitting reading or working, I can sometimes feel normal using these. This may or may not apply to you as these medications work to increase norepinephrine and/or blood pressure by working on the alpha and beta adrenoreceptors.

 

[Replenished]

Quest labs in the US has tests for Angiotensin II, but it is only looking for high levels as the reference range is <52ng/mL. Angiotensin II is a medication, but only for IV administration. I would expect low blood pressure if someone had an angiotensin deficiency, not sure what yours is.

I still drink more than the average person, about a gallon a day, but it used to be double that, along with the feeling that I just couldn't drink enough. Clearing my candida, starting valacyclovir, and using immune support greatly reduced my thirst. My theory is the virus or candida byproducts were messing with the thirst center control in my hypothalamus or perhaps my body sensed these pathogens and their byproducts and was trying to flush them.

While my thirst has diminished, I still have orthostatic hypotension and need compression and medication to sit or stand for any amount of time. Over the last year I tried midodrine, desmopressin, fludrocortisone, adrenal glandular, fluid/salt loading, IV saline, pseudoephedrine, phenylephrine, pyridostigmine, Strattera, droxidopa, and Etilefrine.

Of these, only strattera, droxidopa, and etilefrine had significant effect and if I am not moving around, but just sitting reading or working, I can sometimes feel normal using these. This may or may not apply to you as these medications work to increase norepinephrine and/or blood pressure by working on the alpha and beta adrenoreceptors.

Thank you. This is very very interesting and the medications you speak of sound applicable to me. I was going to speak to a doctor this week re midodrine prescription as I definitely have some POTS like, autonomic symptoms. Although strangely my symptoms are often worse when resting. If I get my blood pumping and can do some light exercise, generally I feel a bit better for an hour or so, even if I still have some lightheadeness when exercising. It's as if being inactive somehow maybe leads to blood pooling or low blood volume I start to feel depleted, fluttery in the chest and my thrist and dehydration/urination just get worse and worse. Hence I thought maybe midodrine to increase the general pressure while resting might help. My blood pressure is about 105/55 when resting, although this is normal for me and always has been even when I was healthy so I can't say that's the cause of my symptoms but perhaps midodrine is worth a try as i'm on the lower end of normal anyway.

I tried desmopressin with no benefit. Fludrcortisone seemed to help me retain fluid but only about 5% better than usual.

Maybe i'm a similar case to you and need to increase norepinphrine. Is there anyway I can work out if that's the sort of avenue I should explore?

 

[Shanti1]

Midodrine seems like a good next option, some people have a positive response and doctors are often willing to prescribe it.

Since the movement of our leg muscles squeezing against the venous vasculature helps move blood back to the heart, some people can feel better with some movement. I can do some slow walking, but anything beyond that and I feel worse.

I tried the desmopressin while I was still experiencing the extreme thirst. It actually did help me initially and I thought, "this is the answer! I had ADH deficiency!", then over the next three weeks it started making me feel worse, until I had to give it up all together.

My resting blood pressure has always been around 90/70, but last April I was in a pretty decent remission and decided to go for a bike ride. It was after that bike ride that I developed the orthostatic intolerance with resting bp of 70/50. It seems to be a failure of some portions of my sympathetic nervous system. If you have POTS, or tachycardia when your BP drops, Strattera, droxidopa, and Etilefrine can increase BP, but make the tachycardia worse, so I would say to try these meds with caution.

If you are interested in Droxidopa or Strattera, I detailed my experience with both here:
https://forums.phoenixrising.me/thr...wisdom-regarding-this-med.42680/#post-2408808

My symptoms that led me to suspect norepinephrine deficiency were: Low BP, orthostatic intolerance with little increase in heart rate when standing, apathy and low catecholamines )norepinephrine included) on whole-body urinary neurotransmitter test.

Have you tried compression? Getting the stocking on is a real pain, but compression has been a life saver for me. I put on my compression before I even get out of bed. Compression + Meds allow me to function. I use full length compression and abdominal compression. Helps prevent pooling (I get neuropathy if I allow pooling) and increases venous return to the heart, and thus cardiac output. In a way it can compensate for low blood volume.

 

[redsun]

Midodrine seems like a good next option, some people have a positive response and doctors are often willing to prescribe it.

Since the movement of our leg muscles squeezing against the venous vasculature helps move blood back to the heart, some people can feel better with some movement. I can do some slow walking, but anything beyond that and I feel worse.

I tried the desmopressin while I was still experiencing the extreme thirst. It actually did help me initially and I thought, "this is the answer! I had ADH deficiency!", then over the next three weeks it started making me feel worse, until I had to give it up all together.

My resting blood pressure has always been around 90/70, but last April I was in a pretty decent remission and decided to go for a bike ride. It was after that bike ride that I developed the orthostatic intolerance with resting bp of 70/50. It seems to be a failure of some portions of my sympathetic nervous system. If you have POTS, or tachycardia when your BP drops, Strattera, droxidopa, and Etilefrine can increase BP, but make the tachycardia worse, so I would say to try these meds with caution.

If you are interested in Droxidopa or Strattera, I detailed my experience with both here:
https://forums.phoenixrising.me/thr...wisdom-regarding-this-med.42680/#post-2408808

My symptoms that led me to suspect norepinephrine deficiency were: Low BP, orthostatic intolerance with little increase in heart rate when standing, apathy and low catecholamines )norepinephrine included) on whole-body urinary neurotransmitter test.

Have you tried compression? Getting the stocking on is a real pain, but compression has been a life saver for me. I put on my compression before I even get out of bed. Compression + Meds allow me to function. I use full length compression and abdominal compression. Helps prevent pooling (I get neuropathy if I allow pooling) and increases venous return to the heart, and thus cardiac output. In a way it can compensate for low blood volume.

Ever experimented with physiological doses of iodine (as potassium iodide) to raise your BP? I knew of someone who had this issue of low NE and was taking copper in high amounts to curb symptoms, but only when he took iodine (due to his diet, he was getting almost none) did his symptoms go away, which were very similar.

 

[Shanti1]

Ever experimented with physiological doses of iodine (as potassium iodide) to raise your BP? I knew of someone who had this issue of low NE and was taking copper in high amounts to curb symptoms, but only when he took iodine (due to his diet, he was getting almost none) did his symptoms go away, which were very similar.

Hi @redsun thanks for sharing your thoughts. I have tried Iosol and Nascent Iodine. With both, I feel better the first two days I take it but then it loses its effect or I feel worse, which is pretty much the story with most things I try. However, I have never tried supplementing copper. As it is a cofactor to convert dopamine into norepinephrine, it is worth a try. I do think this is more of a neurological, possibly centrally mediated, issue that is somehow connected to a dysregulated immune system and EBV (I get better with immune stimulants and antivirals), but I have had single nutrients make a big difference in my function before. For example thiamine has been instrumental in controlling brain fog and B12 is also very helpful. I will try copper for a week or so and see if I get any increase in function. How much did your friend take, dare I ask?

 

[redsun]

Hi @redsun thanks for sharing your thoughts. I have tried Iosol and Nascent Iodine. With both, I feel better the first two days I take it but then it loses its effect or I feel worse, which is pretty much the story with most things I try. However, I have never tried supplementing copper. As it is a cofactor to convert dopamine into norepinephrine, it is worth a try. I do think this is more of a neurological, possibly centrally mediated, issue that is somehow connected to a dysregulated immune system and EBV (I get better with immune stimulants and antivirals), but I have had single nutrients make a big difference in my function before. For example thiamine has been instrumental in controlling brain fog and B12 is also very helpful. I will try copper for a week or so and see if I get any increase in function. How much did your friend take, dare I ask?

I have seen that autoimmunity can definitely either cause or contribute to CFS symptoms but this is the first time I read about immunostimulants for this kind of thing. Was curious if you are one of those people that feel better when you have a fever?

He used 4mg a day of copper bisglycinate.

 

[crussher]

As ever I continue to search for a solution to my ongoing symptoms of dehydration, thirst, frequent urination and what seems to appear more and more like a low blood volume/pressure issue.

Looking at Angiotensin:
Angiotensin (the renin–angiotensin–aldosterone system regulates blood pressure, fluid and electrolyte balance, and systemic vascular resistance)

I'm wondering if I could be deficient/low in angiotensin and if there's anything I can do about it?

I actually tested my Ang II levels. The range here in France is 19-38, my result was 11. Likely due to RAA axis suppression in the illness.
one thing I have also learnt is that magnesium suppresses all RAA axis hormones. Quite a few supplements do , so check if nothing you are taking is making this already downregulated axis have a hard time.
I have gone from drinking 8+ litres of fluid daily to no more than 3. I drink two litres of Normalyte daily.
I needed a period of 18 hours where I didn’t drink anything at all (10 PM to 4pm next day) over which time my body regained some capacity to concentrate my urine. From there, drinking ORS has been very helpful.

 

[Shanti1]

He used 4mg a day of copper bisglycinate.

That seems like a reasonable dose to try, I was worried it was going to be much higher. I took 4mg last night and actually do feel better this morning, but it is way to early to know if it is due to the copper or just the normal ups and downs.

I have seen that autoimmunity can definitely either cause or contribute to CFS symptoms but this is the first time I read about immunostimulants for this kind of thing. Was curious if you are one of those people that feel better when you have a fever?

I think autoimmunity and immunodeficiencies can both play a role. For those with smoldering infections from pathogens that are usually cleared or kept latent by the immune system, some genetic default in the immune system or some alteration caused by the pathogen itself seems to suppress TH1 function. This manifests in the findings of low NK cell function/count and T-Cell senescence in PWME. Some of the agents that have been used successfully by some to address the issue are Ampligen, Oxymatrine, and Imunovir/inosine. For myself, I get good results from oxymatrine, cycloferon (Russian immunostimulant medication), and, surprisingly, the COVID vaccine also consistently puts me in a semi-remission for 6 weeks.

Infections and immune dysfunction are also linked to autoimmunity. Fortunately, autoimmunity doesn't seem to play a role in my case (extensive autoimmune panels and cell trend all negative for me), but it sure seems to for a lot of us.

Edit: To answer your question, I don't feel better from a fever caused by the flu or a cold, but a slight fever associated with use of some of the above immune stimulants seems to herald improvement.

 

[Shanti1]

He used 4mg a day of copper bisglycinate.

That seems like a reasonable dose to try, I was worried it was going to be much higher. I took 4mg last night and actually do feel better this morning, but it is way to early to know if it is due to the copper or just the normal ups and downs.

Gave the copper a good try but it doesn't seem to be a piece of my puzzle. Took 2-4mg per day but started feeling worse after taking it and no improvements in any other symptoms. Oh well, thanks for suggesting, worth a try,

 

[redsun]

Gave the copper a good try but it doesn't seem to be a piece of my puzzle. Took 2-4mg per day but started feeling worse after taking it and no improvements in any other symptoms. Oh well, thanks for suggesting, worth a try,

Did the low resting blood pressure exist before your use of thiamine? Also you mention little change in heart rate from standing. Do you also have a low heart rate in general? Usually if catecholamines are low, it can be genetic predisposition. In a way, low catecholamines naturally is a good thing. These individuals tend to be more calm due parasympathetic dominance and don't deal with anxiety and overstimulation like other people. But too little sympathetic activity (of which NE is the main neurotransmitter for) of course can cause bad symptoms. Unless you did not always have these symptoms.

 

[Shanti1]

Did the low resting blood pressure exist before your use of thiamine? Also you mention little change in heart rate from standing. Do you also have a low heart rate in general? Usually if catecholamines are low, it can be genetic predisposition. In a way, low catecholamines naturally is a good thing. These individuals tend to be more calm due parasympathetic dominance and don't deal with anxiety and overstimulation like other people. But too little sympathetic activity (of which NE is the main neurotransmitter for) of course can cause bad symptoms. Unless you did not always have these symptoms.

I think my catecholamines have always been low based on mental symptoms and two whole body urinary neurotransmitter tests prior to orthostatic intolerance (OI) onset which showed low (but not absent) levels. No associated SNPs have been found to explain it (MTHFR, COMT, MAO, DBH) and BH4 workup is normal.

Heart rate is normal at 75. Always had low BP but never had orthostatic intolerance or POTS. In fact, once time before OI onset I decided to try full compression stockings to see if they would improve my cognition and fatigue since my BP was so low, but they had no influence.

In spring of 2022 I was in a pretty decent remission after addressing some infections and using Goldstein meds and decided to go for a bike ride. I was thinking the worst that would happen was a bout of PEM and a few days recovery, but it precipitated the sudden onset of OI, from which I have never recovered. Full compression and and droxidopa are now my lifelines. I have tried many other OI meds, both on and off-label.

Immunostimulants cause an improvement, sodium benzoate seems to help for a few hours. I just started trialing clindamycin and am feeling surprisingly better, but too early to conclude anything. With ME, it seems that each of us is a unique puzzle, no one's key to solving it is the same as another.

 

[redsun]

I think my catecholamines have always been low based on mental symptoms and two whole body urinary neurotransmitter tests prior to orthostatic intolerance (OI) onset which showed low (but not absent) levels. No associated SNPs have been found to explain it (MTHFR, COMT, MAO, DBH) and BH4 workup is normal.

Heart rate is normal at 75. Always had low BP but never had orthostatic intolerance or POTS. In fact, once time before OI onset I decided to try full compression stockings to see if they would improve my cognition and fatigue since my BP was so low, but they had no influence.

In spring of 2022 I was in a pretty decent remission after addressing some infections and using Goldstein meds and decided to go for a bike ride. I was thinking the worst that would happen was a bout of PEM and a few days recovery, but it precipitated the sudden onset of OI, from which I have never recovered. Full compression and and droxidopa are now my lifelines. I have tried many other OI meds, both on and off-label.

Immunostimulants cause an improvement, sodium benzoate seems to help for a few hours. I just started trialing clindamycin and am feeling surprisingly better, but too early to conclude anything. With ME, it seems that each of us is a unique puzzle, no one's key to solving it is the same as another.

It doesnt have to be due to norepinephrine metabolism itself. It could be due to genetics related to acetylcholine metabolism. Acetylcholine has both blood pressure lowering effects as well as blood pressure raising effects based on receptors it attaches to. Nicotinic receptors are what the body uses to release norepinephrine and epinephrine which can then bind to adrenergic receptors to exert their action on the heart and blood vessels (to affect BP), raising blood pressure. Muscarinic receptors inhibit norepinephrine release.

There is a constant balance being maintained between nicotinic and muscarinic receptors so when one raises acetylcholine in some fashion they won't suddenly get low BP. Some people (rare) have more muscarinic receptors than nicotinic receptors, tilting the balance in favor of low BP which is made worse by cholinergics. You could also have problems degrading acetylcholine which would also lead to a similar problem and could be made worse by AChE inhibitors in food or supplements, herbs.

How does your BP and orthostatic intolerance respond to a choline supplement?

In short, you may some genetic predisposition related to acetylcholine metabolism that reduces catecholamine release even though there is no SNPs related to norepinephrine that directly explain the problem.

 

[Shanti1]

Choline supplementation or cholinesterase inhibitors do not seem to impact my BP. Pyridostigmine did not make it worse or better. Doesn't seem to be related to acetylcholine.

 

[redsun]

I think my catecholamines have always been low based on mental symptoms and two whole body urinary neurotransmitter tests prior to orthostatic intolerance (OI) onset which showed low (but not absent) levels. No associated SNPs have been found to explain it (MTHFR, COMT, MAO, DBH) and BH4 workup is normal.

Heart rate is normal at 75. Always had low BP but never had orthostatic intolerance or POTS. In fact, once time before OI onset I decided to try full compression stockings to see if they would improve my cognition and fatigue since my BP was so low, but they had no influence.

In spring of 2022 I was in a pretty decent remission after addressing some infections and using Goldstein meds and decided to go for a bike ride. I was thinking the worst that would happen was a bout of PEM and a few days recovery, but it precipitated the sudden onset of OI, from which I have never recovered. Full compression and and droxidopa are now my lifelines. I have tried many other OI meds, both on and off-label.

Immunostimulants cause an improvement, sodium benzoate seems to help for a few hours. I just started trialing clindamycin and am feeling surprisingly better, but too early to conclude anything. With ME, it seems that each of us is a unique puzzle, no one's key to solving it is the same as another.

I see. Past Epstein Barr viral infection may have affected the brain stem, where blood pressure is regulated, despite heart rate being normal.