That's why I put "PEM" in quotes, in order to indicate that the food fatigue wasn't from exertion.
Is it fatigue "only" that you have as PEM?
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That's why I put "PEM" in quotes, in order to indicate that the food fatigue wasn't from exertion.
I wonder if PEM isn't actually something that happens in the brain, and so even thinking or listening can cause it.
I wonder if it is only from brain activity or if it is also from bodily activity.
I have a generalized weakness as well, that's been present from the start of this disease, and this also becomes worse - like the ever present debilitating fatigue - during PEM.Is it fatigue "only" that you have as PEM?
That's why I put "PEM" in quotes, in order to indicate that the food fatigue wasn't from exertion.
Nevertheless, the fatigue that I experience from eating certain foods (and certain supplements) feels exactly the same to me as the fatigue I experience from over-exerting myself with too much physical activity, and it occurs with the same sort of delay. (And that's been true since the start of my ME/CFS some 17 years ago.)
It's important to be aware that the physical/mental state that we perceive as "PEM" following exertion could also, in theory, follow from other things that don't actually involve physical or mental exertion.
Just as a simple hypothetical to understand the concept, say that some substance like a cytokine (or whatever) becomes elevated during exercise and this, through some mechanism like activated microglia and/or oxidative stress (or whatever), is what triggers a person's PEM.
Now what if certain foods, for whatever reason, trigger that same cytokine/substance that exercising does and that it has the same biochemical effect? A person could end up feeling the same - with no distinction between PEM from actual exertion and "PEM" from food.
NB: Sufferers less ill who haven't developed a severe form of ME won't experience these reactions to the level severe grade patients will. This allows for inevitable disagreement in patients to occur.
In that case, you might be interested in this:I'm pretty certain that the problem "substance" that I was alluding to, in my case, is actually serotonin (another chemical that, like lactic acid, also increases with exercise).
J Nutr. 2006 Feb;136(2):544S-547S.
A role for branched-chain amino acids in reducing central fatigue.
Blomstrand E.
Abstract
Several factors have been identified to cause peripheral fatigue during exercise, whereas the mechanisms behind central fatigue are less well known. Changes in the brain 5-hydroxytryptamine (5-HT) level is one factor that has been suggested to cause fatigue. The rate-limiting step in the synthesis of 5-HT is the transport of tryptophan across the blood-brain barrier. This transport is influenced by the fraction of tryptophan available for transport into the brain and the concentration of the other large neutral amino acids, including the BCAAs (leucine, isoleucine, and valine), which are transported via the same carrier system. Studies in human subjects have shown that the plasma ratio of free tryptophan (unbound to albumin)/BCAAs increases and that tryptophan is taken up by the brain during endurance exercise, suggesting that this may increase the synthesis of 5-HT in the brain. Ingestion of BCAAs increases their concentration in plasma. This may reduce the uptake of tryptophan by the brain and also 5-HT synthesis and thereby delay fatigue. Accordingly, when BCAAs were supplied to human subjects during a standardized cycle ergometer exercise their ratings of perceived exertion and mental fatigue were reduced, and, during a competitive 30-km cross-country race, their performance on different cognitive tests was improved after the race. In some situations the intake of BCAAs also improves physical performance. The results also suggest that ingestion of carbohydrates during exercise delays a possible effect of BCAAs on fatigue since the brain's uptake of tryptophan is reduced.
PMID: 16424144
I'm pretty certain that the problem "substance" that I was alluding to, in my case, is actually serotonin (another chemical that, like lactic acid, also increases with exercise).
BCAAs raise ammonia and uric acid so I can't take them (unless I take a ton of other stuff to relieve the ammonia and uric acid excess). 30mg of 5-Htp cause me serotonin syndrome due to +/+ MAO-A. I am looking for a solution to that.In that case, you might be interested in this:
I am hoping I can understand what's written thereI think it's going to require an actual TPH2 inhibitor, like I mentioned here:
http://forums.phoenixrising.me/inde...rtion-have-in-common.34799/page-4#post-544218
At this time I am holding to the idea that PEM, or PER, is actually caused by using the brain and not by physical exercise. No one can do any kind of physical activity, even walking, without using their brain to do it, so all physical activity involves brain activity. This is why in the Rest Periods thread I say that anything except lying down with eyes closed and letting your mind drift is an activity.My 2 cents...
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In my view, the massive 'exhaustion' ME causes from using your brain, can have a more extreme affect
than physical effort if we are debating how much 'effort' the person uses Vs muscle power and cardio respiratory input. E.g a PWME with ME who concentrates for 1hr hard, may have a worse relapse, than the same PWME who walks around for 30 mins.
Sarah Myhill has done testing that shows that in ME/CFS there are problems with energy production in the neutrophils from blood, which shows that the energy problem isn't limited to the CNS. I think that the brain is the part of the body that is sensitive to whatever is causing PER, but it is occuring in the whole body. However, the rest of the body has more resources for energy production because the BBB limits the amino and fatty acids available to the brain, and so the problem is probably more severe in the CNS than in the peripheral parts of the body.There has to be an explanation for this, the simple one being the energy defect is brain centered/CNS, and not muscle based. It could also be explained by oxygen utilization. Someone far clever than I will be able to tell you the oxygen and glucose demand on the BRAIN from reading for 1hr, Vs the oxygen and glucose demand on the BODY for gently walking around for 30 mins.
I think you may not have this quite correctly. PER usually occurs many hours after the exertion begins. I think the brain is using an alternative pathway for ATP production, and the alternative pathway causes an increase in something else, whether that is lactic acid or serotonin or whatever it is, and that something else causes the PER. It is that something else that makes the brain cell unable to work correctly. I am trying to figure out what that something else might be, and how it causes PER.If your brain cells cannot use glucose efficiently, then your brain cells won't work correctly and will 'wilt' quickly.
I think that the increase in symptoms from the oxidative stress can be attributed to an increase in damage of the iron-sulfur clusters in the electron transport chain (you may not have read my hypothesis about how these illnesses are caused by oxidative damage to the iron-sulfur clusters in the electron transport chain of the mitochondria, but bear with me, this all is according to a hypothesis that I am working out.). Hopefully I am correct about this because this type of damage would be much more easy to correct than DNA damage.This utilization of oxygen from exercise in people with elevated oxidative stress AT REST (PWME CFS) will cause a cascade of further oxidative stress in the body (from gentle exertion) and DNA damage, that presumably is higher than 'thinking' with the brain.
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These symptoms in severe PWME are in reaction to MENTAL exertion, and thus the brain cells ATP is depleted/cells are likely inflamed and targeted by a form of autoimmune process. No other condition does this to this level, to my knowledge in which if rested the patients can return to 'normal'. (Normally disabled). Yes MS, Parkinson's can and will relapse from exertion of mental effort, but these people have permanent damage, such as paralysis, or the Parkinson walk ('shuffling gate'). Hence, ME is disbelieved.
It isn't really clear to me what you include in the word "pacing". In my post on Rest Periods I suggest breaking up period of activity with periods of complete rest. Since activity includes listening or actively thinking, rest means lying with eyes closed and thoughts drifting along, not active thinking. So do I understand you to mean that when you say do literally, nothing, you mean this kind of rest or do you mean that the person might be thinking about or listening to something? Is there a possibility of having short thinking activity times interspersed with not thinking rest periods?None of the above extreme PER or PEM can be predicted for or managed, hence 'Pacing' does not and cannot 'fix' the underlying cause by trading of energy from one task to another or simply cutting back on total energy expenditure.
Pacing to 'manage' ME and return people to consistent activity levels, is a myth. The immune system activation simply doesn't allow for consistency, neither does the metabolic ATP defect. Each day we feel very ill, ghastly, a little better, or like we're dying - irrespective of what we do. This is how ME works. We are made worse by any activity, but we fluctuate anyway, even when we don't over exert and do literally, nothing. We also relapse, via stress or infections (inflammation and hormone associated) or indeed, 'unknown' factors of the pathology no one understands...yet.
Pacing is a sensible common sense approach to energy management, not over doing things. All patients with ME CFS do this once they are diagnosed and (late in the day usually) forced to learn how to listen to their bodies when experiencing this terrible illness. However, in ME, pacing as an effective 'therapy' does not apply.
Have you ever taken any 5-HTP? If you did and it caused PEM for you that would be strong evidence. The other things you mention don't seem be to that strong of evidence, to me.@Elph68
Thanks. No, I've had extensive testing for lactic acid, i.e., testing by exercise followed by blood draws and/or multiple muscle biopsies. It's always been perfectly normal.
I'm pretty certain that the problem "substance" that I was alluding to, in my case, is actually serotonin (another chemical that, like lactic acid, also increases with exercise).
Yes, I've taken 5-HTP (50mg). It causes me significant extra fatigue (drug-like) shortly after taking it (without actually making me sleepy) that lasts for at least 6 hours (if I remember correctly).Have you ever taken any 5-HTP? If you did and it caused PEM for you that would be strong evidence.