Free blood gases analysis [Netherlands]

[Emootje]

I bought a blood gas analyzer (Christmas gift to myself ) to confirm, monitor and treat my blood alkalinity. I would like to research if other people with ME/CFS or POTS have high blood pH as well. If you want to join my small humble study and you are able to visit my home in Lunteren, please pm me.

Test panel: pH, PCO2, PO2, tHb, SO2, Na+, K+ , Ca++ and lactate.

Possible reasons why we are alkaline:
Reason one (metabolic alkalosis):
Low blood volume with compensatory neurohormonal activation of the renin-angiotensin-aldosterone system and sympathetic nervous system that promotes HCO3 retention in the kidney.
Reason two (respiratory alkalosis):
Inflammation induced peripheral chemoreflex hypersensitivity.

Clinical consequence of alkalosis:
Decrease ability of hemoglobin to release oxygen in peripheral tissues (Bohr effect) > tissue hypoxia
Vasoconstriction (especially in the brain) > tissue hypoxia, brain fog, angina, arrhythmias.

Video of me running two quality controls (SRC level 1/ 3) and the actual test:

 

[Valentijn]

I'm pretty sure I'm more acidic. Had a nice bit of lactic acidosis with a diabetes med that can cause it in those predisposed, and I start producing ketones and getting symptoms at pretty much the lowest possible blood glucose levels (13.5). Blood lactate also tests high sometimes, despite no exertion and resting for hours beforehand.

Would be nice to measure the blood gases though sometime. I'm about 45 minutes away How much does it cost to run each test (supplies)?

 

[Emootje]

Had a nice bit of lactic acidosis with a diabetes med

Metformin?

Would be nice to measure the blood gases though sometime. I'm about 45 minutes away How much does it cost to run each test (supplies)?

No problem, I could measure your blood gases a couple of times for free. To bad you are messing with my alkaline theory I pay 220 euros for 25 tests and for the lactate I use an Accutred plus btw...

 

[Valentijn]

Metformin?

Yup. 500mg was some weird mild & intermittent symptoms. 3 days of 1000mg was absolute hell, even after my brain stopped burning, with some weakness and cognitive problems lasting weeks or months. My huisarts (GP) is still in complete denial that metformin can ever cause those symptoms, despite it being in the insert. But I don't care what she thinks, since I see a endocrinologist for management now

I pay 220 euros for 25 tests ....

A bit steep, especially if you're covering that for everyone. I'd be quite happy to donate 8-10 euros if I drop by for a test, and most other people would be too I bet.

... and for the lactate I use an Accutred plus btw...

I've got The Edge lactate meter. About 2 euros per test strip I think, and a good reputation for accuracy. I don't test with it regularly, since those strips really add up! But I have it handy now if I have another episode of suspected lactic acidosis.

 

[valentinelynx]

Just curious. As an anesthesiologist more used to doing blood gas analysis on patients under anesthesia, undergoing major surgery, septic, etc... wondering what pH levels you are calling alkaline vs acidic?

 

[Emootje]

Yup. 500mg was some weird mild & intermittent symptoms. 3 days of 1000mg was absolute hell, even after my brain stopped burning, with some weakness and cognitive problems lasting weeks or months.

Metformin inhibits mitochondrial complex I... a recipe for disaster in ME/CFS.

I'd be quite happy to donate 8-10 euros if I drop by for a test, and most other people would be too I bet.

I don't expect that many people, most of them are to sick to travel or are living to far from Lunteren. If it escalate I might ask a small donation

I've got The Edge lactate meter. About 2 euros per test strip I think, and a good reputation for accuracy.

Maybe you could donate a run on your Edge lactate meter with my blood so I could compare it with my lactate meter?

 

[Emootje]

wondering what pH levels you are calling alkaline vs acidic?

I use the standard reference values of the Osmetech Opti cca ts (<7.35 = acidosis, >7.45 = alkalosis)

 

[ryan31337]

Cool toy @Emootje!

I can offer results from earlobe blood gas test I had last year, I hope they help:
pH 7.52 H (7.35 - 7.45)
PCO2 28.8 L (37.5 - 45)
PO2 99.0 H (82.5 - 93.7)
HbO2% 99.0 H (96 - 98)
H2CO3 25.7 (21 - 28)

Suggestive of hyperventilation/respiratory alkalosis. Doctors sent me to a respiratory physio but they found zero signs of chronic hyperventilation syndrome - I had long breath holds & good technique.

I bought an ambulatory etCO2 monitor and tested myself periodically, unfortunately the act of testing changed my breathing habits so I could not put any faith in the results. Subjectively I find myself over-breathing on orthostasis but not at rest, this effect was magnified & became very clear during a positive tilt table test. POTS was confirmed, orthostatic hyperventilation is a known POTS issue so I assume further investigation was abandoned for this reason.

Also some endocrine results:
Plasma aldosterone level 70 L (90 - 700)
Plasma renin level 1 (0.5 - 3.10)
Plasma aldosterone/PRA ratio 70 (<680)
24hr urine sodium 109 (40 - 220)

I believe this shows the paradoxical isolated low aldosterone noted in POTS. I also understand that whilst the 24hr urine sodium is within normal range it would be considered low by POTS standards and is contentiously considered a sign of hypovolemia, in the absence of more sophisticated testing.

 

[ryan31337]

You might be interested to know I also had 2x isolated CPETs at this time. Both showed significant cardiovascular limitation, presumably oxygen delivery and/or oxygen utilisation - I understand it is impossible to tell which without invasive testing. Regardless, given my earlier results I would assume Bohr effect & lowered stroke volume would both be at least partly responsible for the limitation.

It's interesting that you mention inflammation induced peripheral chemoreflex hypersensitivity. Do you have any good links with more info on the topic?

 

[Research 1st]

I bought a blood gas analyzer (Christmas gift to myself ) to confirm, monitor and treat my blood alkalinity. I would like to research if other people with ME/CFS or POTS have high blood pH as well. If you want to join my small humble study and you are able to visit my home in Lunteren, please pm me.

Great video and neat machine, well done. I remember having an arterial blood gas test in hospital, and it wasn't very nice. I had no idea all these years later you can test blood peripherally! Would there, however, be any 'argument' that the results aren't as accurate, as it's not an arterial sample? All I can find is this paper, and they seem to think your method is OK and didn't cite any huge differences from what I can understand with my battered brain.If you can, try and get multiple sources that confirm that peripheral is nearly or as accurate as arterial OR people can trash your little research project data too easily and you don't want to go the trouble of doing your own research only for that to happen.

Peripheral venous blood gas analysis: An alternative to arterial blood gas analysis for initial assessment and resuscitation in emergency and intensive care unit patients

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173550/

I think if you can get enough people you should consider doing a little study.
A few things that may alter your results:

1) Glucose intake, are the patients fasting, if so did they all stick to 9hrs, 12hrs etc? Did they eat a huge
pizza and soda 3hrs before the test, or was it 1hr? With a disease like ours, all of these things can affect acid levels in the blood Vs a 'normal person'.

2) Level of activity as blood sample is taken e.g. is the ME CFS sufferer feeling:

*Unusually good - ''a good day''.
*As good as they can be considering the circumstances, so average.
*Feeling they're about to crash as the journey did them in.
*In a crash

3) How thirsty are they? Dehydration will effect blood composition.

4) Level of perceived mmune activation and inflammation. E.g are they
in a virus/flu episode and much more SOB than usual at baseline? How bad is their pain? Where is the pain and how would they describe it? Ticking a box 'in pain' doesn't help if they mean joint pain, but we think they mean neurological, or metabolic pain etc etc. So you need to know precisely as possible.

5) Any unusual activity noted by the patient before the test? E.g. for moderate sufferers, e.g. I walked a mile as I missed the bus/had to put the kids in the bath and then walk to the car which broke down so I cycled here. Or
for severe sufferers, I'm burning all over as I had to have a wash (very rare) and now I'm burning in pain all over. Normally I wouldn't have a wash etc.

6) Medications and illnesses the patients have that can affect results.

I think these and many other factors should be noted in patients, perhaps with a questionnaire.
Ideally you want to 'control' the situation as much as possible for variable factors I listed and many more:
So set some rules: Please fast, and if they cannot they tick a box 'not fasting'.

 

[Emootje]

Cool data @ryan31337

Subjectively I find myself over-breathing on orthostasis but not at rest

It's a well known finding in POTS and CFS with orthostatic intolerance. Btw the Stewart group found that loading the baroreflex with phenylephrine prevents the orthostatic hyperventilation.

I believe this shows the paradoxical isolated low aldosterone noted in POTS

I have a special interest in the hormone atrial natriuretic peptide (ANP), I know that it is one of the factors that can lower aldosterone secretion. Ever tested for that?

Btw are you on fludrocortison for the low aldosterone?

 

[Emootje]

It's interesting that you mention inflammation induced peripheral chemoreflex hypersensitivity. Do you have any good links with more info on the topic?

I didn't study this extensively but can give some links: This study mentioned the diseases/factors which can increase carotid body (CB) hypersensitivity (superoxide, 3-nitrotyrosine, pro-inflammatory cytokines, H2S, endothelin-1 and angiotensin).

Mechanism of carotid body sensitivity due to disturbed H2S and carbon monoxide balance in this study:

Wondering if induction of the NRF2-HO-1-CO pathway by dietary supplements would work for chemoreflex hypersensitivity...

Peripheral chemoreflex (carotid body) hypersensitivity treatment to reduce hyperventilation in heart failure in this study:
* CO donor
* NO donor
* AT1R antagonist (lowers oxidative stress)
* Ang-(1–7) (low in POTS)
* CSE inhibitor (lowers H2S)
* Superoxide dismutase (lowers oxidative stress)
* Exercise
* Statins

 

[Emootje]

Would there, however, be any 'argument' that the results aren't as accurate, as it's not an arterial sample?

I did ask a clinical chemist about this and he said that capillary blood from the hand is pretty accurate if you warm the hand with hot water before sampling (arterialization).

I think if you can get enough people you should consider doing a little study.

I don't think that many people will join my little study, more than tree people will exceed my expectation but I hope for more. Good point about taking a history. One of my explanation why I feel better when I don't eat is that the ketone bodies are making my blood more acid...

 

[Emootje]

Dr. Paul Cheney seeing alkaline blood results in patients for years:

"Dr. Paul Cheney recently began prescribing oxygen for patients with alkaline venus blood. Up to an hour of oxygen in the morning can provide half a day of significant improvement and numerous benefits. He has been seeing alkaline blood results in patients for years, but dismissed it as insignificant, based on his medical school training. His growing suspicion that it was a very significant factor was confirmed when a speaker at an international conference on fatigue in London began a presentation by announcing "Ladies and gentlemen, I'm here to tell you that CFS patients are alkalotic"... Blood alkalosis inhibits the transport of oxygen to tissues and organs, constricts the blood vessels, and lowers overall circulating blood volume..."
http://www.prohealth.com/library/showarticle.cfm?libid=8812

 

[Gijs]

Very interesting Emootje but if patiënts are alkalotic you don't need more oxygen but less! That is why these patiënts have oxygen toxicity. If Ph is high you need more carbon dioxide (Bohr effect) So oxygen get delivered to the tissue.

Cheney said: We conclude that CFS is an oxygen toxic state and that oxygen toxicity status appears to determine outcome in therapeutic trials and is therefore, a locus of control in chronic fatigue syndrome.

 

[Emootje]

If Ph is high you need more carbon dioxide (Bohr effect) So oxygen get delivered to the tissue.

Cheney uses a rebreather mask with the O2 so that CO2 rise:
"Oxygen through nasal prongs will not work. Oxygen alone in a mask will not work. It has to be a parietal rebreather mask, which has a bag attached. This allows you to rebreathe your expired carbon dioxide along with the oxygen that is flowing into the mask. Breathing increased levels of both CO2 and O2 at the same time is essential. The CO2 breaks the cycle. It corrects the alkalosis and frees the O2 in your blood to move into your cells. With proper functioning, vessels dilate and you start perfusing your brain and tissues, bringing out the toxins and brining in the nutrients"
http://www.prohealth.com/library/showarticle.cfm?libid=8812

For me, it's not entirely clear why he use oxygen when he thinks it's toxic...

 

[Emootje]

Alkalosis (low H+) increases serum and brain lactate by increasing the rate-limiting step in glycolysis (phosphofructokinase) in normal people (Con) and even more in people with panic disorder (PD):

http://ucdirc.ucdavis.edu/people/papers/maddock_JNCN2001.pdf

 

[Lolinda]

MY LITTLE LIST OF BREATHING AND OTHER TRICKS FOR CFS

Cheney uses a rebreather mask

I did this: took a big plastic bottle, such as you get in every shop for mineral water. a more sturdy one. empty it and drill a hole at the bottom. breathe trough the mouth of the bottle where you would drink normally.
the effect differs depending on the size of the hole, so one can experiment a lot and see the results.
warning:
It is good, but not good when used before bed.
all yoga books tell to never do breathing exercises before sleep. I certainly ignored. today I know why: choking at night

alternatively, one can do 5-2-5 breathing. you find this technique in online texts on panic attacks. you dont need to have any panic attack to profit . good against any unwanted symp. activation

if you want to spend money, there is buteyko. there are some youtube videos on all sort of marvelous effects, to make you enthusiastic

an unrelated little wonder that has, however, somewhat similar effects: bed of nails. I built my own more exactly, my bed of screws it is really gooooood

one post above mentioned the carotid body. you can play with that, too: just jawn. jawning increases blood flow to the brain because it modulates the pressure on the carotid body. when needed, I did a series of jawning, and so I had more energy as desired. works like a charm. research

So, these were some yoga-like tricks I used back when I had CFS and then ME.
I enjoy yoga since I was 16. . people think of yoga like some fitness class thing they need to for in order to get into nirvana . but it is for me sthg to be done for myself, for free, to achieve goals: do breathing, stretching or meditation to gently put my body and mind to where I want them to be

I liked the most the 5-2-5 (for decreasing unwanted symp activation) and the yawning (for increasing energy levels): both are simple, need no device, take only minutes. The king is the combo: first 5-2-5, then yawning (or generally: first a calming thing and then an activating thing). While it didnt resolve any illness, it was a nice quickfix that often made me turn from a tired wrack with unwanted symp. activation into happy-go-lucky power. Wish you the same

enjoy

 

[Avengers26]

@Lolinda This sounds interesting. Are there any videos or links to how to do any of these correctly?

 

[Emootje]

Thank you Lolinda I just measured a respiratory alkalosis in a fibromyalgia patient so I could use some great tips how to treat this... although I've noticed not all patients are ready for a bed of nails