Link between Metabolic Syndrome and ME/CFS?

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by Jody Smith



As is so often the case, the research on a possible correlation between metabolic syndrome and ME/CFS is scanty. When I came across this threadbare research, though, I was desperate enough to check it out for myself.

I recognized myself when I read about the weight gain and difficulties in dropping the weight, but what really rang a bell was when I read that brain function can be severely affected. A poorly-working brain has been one of the worst symptoms of ME/CFS that I struggle with.

Diabetes runs in my family, and the fact that I had so many signs of metabolic syndrome was no surprise. I'd been relatively slim most of my life, though after having my fifth baby I was fighting a certain amount of baby fat that didn't want to cooperate.

This, while lamentable, is not uncommon. What was unusual was that around the time I began to have classic ME/CFS symptoms in my 30s, I was also experiencing an alarming increase in weight, most of it right around the middle.

I found that paying attention to the glycemic index and limiting carbohydrates reduced my cognitive difficulties, and my paresthesia (fancy word for bizarre physical sensations like buzzing, vibrating and swirling in my face, hands, arms and legs).

I was encouraged to find that CFIDS.org had reported that patients with ME/CFS may need to deal with metabolic syndrome. I found that when I began to treat my metabolic syndrome symptoms, I also had a lessening of my ME/CFS symptoms. Changing my diet a la metabolic syndrome caused that weight to disappear.

People with ME/CFS face more challenges than others in dealing with metabolic syndrome. Exercise is generally recommended for this condition, but exercise can also cause relapse or worsening of ME/CFS symptoms.

Diet changes are also recommended for metabolic syndrome, but for many ME/CFS patients buying and fixing foods can be quite daunting, and many must settle for whatever they can afford, and whatever they can manage to heat up and eat. Processed foods that are quick to prepare are all some patients can manage.


Link with cognitive issues

Research from NYU School of Medicine indicated a link between metabolic syndrome and brain dysfunction including cognitive issues for adolescents. The study is online in the September 3, 2012 issue of Pediatrics.

Investigator Antonio Convit, MD, professor of psychiatry and medicine at NYU School of Medicine and a member of the Nathan Kline Research Institute, and colleagues had found previously that metabolic syndrome was associated with neurocognitive abnormalities for adults, but the new research shows evidence of more severe brain dysfunction in teens.

This was noteworthy because this age group does not tend to have vascular disease or long-term slow metabolism which can be found in the adult population.

The teens in the study displayed poor math skills, impaired attention span and less mental flexibility. Brain structure and volume was evidenced by reduced volume in the hippocampus (which is involved with learning and remembering new information), less brain cerebrospinal fluid, and less microstructural integrity in the brain's white matter.

Research from the French National Institute of Health Research, Bordeaux, France was published online in Neurology on February 2, 2011. Metabolic syndrome was seen to have a link with memory loss and dementia.


Also Known As

Dr. Andrew Weil, Director of the Center for Integrative Medicine of the College of Medicine, University of Arizona, calls metabolic syndrome "a collection of conditions that when taken together dramatically increases the risk of heart disease, stroke and diabetes."

Metabolic syndrome is also known as syndrome X, insulin resistance syndrome or dysmetabolic syndrome.

Weil says that 25-30 percent of Americans may have metabolic syndrome. The risk for it increases with age: 40 percent of Americans have metabolic syndrome by their 60s and 70s.


Risk Factors

There are several risk factors for metabolic syndrome. If you have three of these factors, you may have metabolic syndrome:

• A waist circumference of at least 35 inches for women and at least 40 inches for men
• Fasting blood glucose of at least 100 mg/dL
• Serum triglycerides of at least 150 mg/dL
• Blood pressure of at least 135/85mmHg
• HDL or "good" cholesterol that is lower than 40 mg/dL for men or 50 mg/dL for women

Insulin resistance is an element of metabolic syndrome. This means insulin levels are high, causing problems like chronic inflammation, arterial wall damage, decreased output of salt by the kidneys, and thickening of the blood. These issues will only increase over time if the condition isn't treated.

Insulin resistance makes cells less sensitive to insulin. Glucose in the blood increases, the pancreas overcompensates by manufacturing more insulin. The heightened insulin levels provoke a stress response involving higher levels of cortisol which is a long-acting stress hormone. This leads to an inflammatory reaction in the body that can ultimately damage tissue.

Sleep apnea and other sleep abnormalities can increase insulin resistance and exacerbate metabolic syndrome.


Dietary Recommendations

Weil recommends eating an anti-inflammatory diet. He suggests eating meals that are small and frequent which helps to maintain healthy blood sugar. This prevents the overwhelming of the bloodstream with glucose and insulin.

Weil advises limiting refined sugars and starches. Foods that are low on the glycemic index help to maintain healthy blood sugar levels. He favors monounsaturated oils like olive oil, and avoiding trans fats and saturated fats.

Cold-water fish, like salmon and sardines, are high in omega-3 fatty acids. Supplements of omega-3 fatty acids can also be beneficial. Avoid starchy vegetables and stick with other veggies like asparagus, bell peppers, cucumbers, dark leafy greens and zucchini.

Foods that are high in magnesium may lower the risk for metabolic syndrome. Eat such foods as almonds, avocados, beans, leafy green vegetables and halibut. Limit your alcohol content, especially beer to keep triglyceride levels down.


Conclusion

It certainly seems to me that I deal with metabolic syndrome, and the cognitive problems associated with it. Fortunately I don't have to wait for definitive acknowledgement from any organizations or doctors in order for me to proceed with my decision to incorporate this information into my recovery plan.

And as I have been able to reduce my ME/CFS symptoms this way, I'll continue to do my best to win against metabolic syndrome, and protect my beleaguered brain in the process.


Further reading

Not Depression, More Like Alzheimer's
http://www.ncubator.ca/Depression_Alzheimers.html

Chronic Fatigue Syndrome and a Low Carb Diet
http://www.ncubator.ca/carbs.html

CFS Clinical Pearl: Recognizing Metabolic Syndrome B
http://www.cfids.org/cfidslink/2008/040906.pdf

Directors: Andrew Weil, MD
http://integrativemedicine.arizona.edu/about/directors/weil

Metabolic Syndrome
http://www.drweil.com/drw/u/ART03193/Metabolic-Syndrome.html

Metabolic syndrome associated with cognitive and brain impairments in adolescents
http://www.news-medical.net/news/20...ive-and-brain-impairments-in-adolescents.aspx

Metabolic syndrome linked to cognitive decline in older adults
http://www.theheart.org/article/1181423.do

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Hi Jody, your essay is interesting, but what is the link between ME/CFS and 'metabolic syndrome'? Is there research that suggests one leads to the other? My impression is that many people may have both, but that would just make the conditions 'co-morbid', as I understand the term.

I was fascinated to read on the Wikipedia page on Metabolic Syndrome that there are any number of definitions, just like our very own illness. And when did Blood pressure ≥ 130/85 mmHg become 'hypertension' instead of 'pre-hypertension', which, as I understand it, is not a clinical diagnosis, but a research category that was hijacked by the ever-alert drug industry?

 

I do not think one leads to the other. I do think there are common underlying factors, especially oxidative stress to the SCN in the hypothalamus. I might be blogging on this at some point.

 

jimells,

alex has answered your first question for me. I don't know the answer to your second question about hypertension and pre-hypertension. I was just reporting the stats that I found in my research.

 

if one looks at all the hormonal issues and sleep issues, they all can contribute to metabolic syndrome, insulin resistence. eg men with low testosterone have insulin resistence that can be reversed with testosterone replacement therapy. cortisol levels have a big impact on blood sugar and insulin resistence. the role of cortisol is to raise blod sugar, many intially have very high cortisol levels triggered from the initial stress(infection) causing high blood sugar levels which worsen insulin resistence. As the stress progresses and cortisol levels drop below normal we then find we dont have cortisol there to increase our blood sugar when we need it.

So circadian rythm and cortisol rythm can both have a big impact on metabolic syndrome. I think getting these rythms right, adequate sleep and balancing other hormones is important as well as reducing carbs in the diet to a level one is comfortable with. we all seem to run on different levels of carbs. Also if one is carry abit of extra weight then reducing this can help improve insulin resistence as well as other hormonal issues.

All easier said then done.

 

Would this be consistent with the non-specific antibodies theory? Autoantibodies damaging the pancreas (?) messing with insulin production causing pre-diabetic conditions, for example. Autoantibodies to the hypothalmus could also be contributing, too.......?

 

Nice piece of intuitive thinking Jody.

I feel that there's a very strong link between metabolic syndrome/diabetes and ME/CFS (and other neuroinflammatory conditions) and I've discussed possible common mechanisms here :

http://www.cortjohnson.org/blog/2013/02/15/glutamate-one-more-piece-in-the-chronic-fatigue-syndrome-mecfs-puzzle-the-neuroinflammatory-series-pt-ii/

I've had similar experiences to you. Not at onset of ME/CFS but in 1997 my health took a sudden downturn with increased and many new symptoms including severe heat intolerance and constantly feeling 'inflamed'. Without any changes in lifestyle I suddenly managed to gain around 10lbs in two weeks and gained it around my waist which was a new one for me.

Now I have many symptoms of neuropathy including numb hands with poor circulation, failing eyesight and frequent allodynia. I too find avoiding pre-prepared foods and simple carbs helpful.

The symptoms of autonomic neuropathy, a common complication of diabetes, are certainly consistent with autonomic dysfunction/neuropathy in ME/CFS :

Possible symptoms of autonomic neuropathy:

Sweating: There may be no sweating or reduced sweating (anhidrosis and hypohidrosis), but excessive sweating (or hyperhidrosis) can occur as a compensatory mechanism

Temperature regulation: Hypothermia and hyperpyrexia can result from disruption of the various temperature regulatory mechanisms. Sweating, shivering and vasoactive reflexes can be affected

Face: Pallor

Reduced or absent sweating

Vision:

Blurring of vision
Tunnel vision
Light sensitivity
Difficulty focusing
Reduced lacrimation
Gradual reduction of pupillary size

Cardiovascular:

Orthostatic hypotension (often associated with or exacerbated by eating, exercise and raised temperature)
Other orthostatic symptoms ( for example, nausea, palpitations, light-headedness, tinnitus, shortness of breath)
Syncope (may occur with micturition, defaecation)
Inability to stand without syncope (severe cases)
Arrhythmias
Supine hypertension
Loss of diurnal variation in blood pressure (BP)

Respiratory:

In diabetics, reduced bronchoconstrictor reflexes have been detected (contributing to reduced responses to hypoxia)

Gastrointestinal:
Constipation
Diarrhoea
Incontinence
Dry mouth
Disturbance of taste

Sexual:
Impotence
Ejaculatory failure
Female sexual dysfunction

Feet:
Burning sensation
Hair loss
Pruritus
Dry skin
Pale, cold feet
Worsening of symptoms at night

http://www.patient.co.uk/doctor/autonomic-neuropathy

 

Interesting article, Jody - thanks.

I gained a lot of weight during a particularly stressful and strenuous time, especially around the middle. Nothing would shift the weight until I tried low-carb. Last year I went gluten-free and reduced carbs further, the excess weight just fell away without effort or hunger, and muscles became usable again (possibly aided by one or more supplements). Many symptoms have improved.

I note these two aspects of metabolic syndrome which are perhaps not typical in ME:

decreased output of salt by the kidneys

higher levels of cortisol

I seem to lose a lot of salt in urine, and have suffered severe hyponatraemia. Many of us crave salt, suggesting perhaps that we are deficient.

I take heapsreal's point about cortisol initially increasing and then falling in the course of some conditions, and I believe ME to be one such.

My father had Type 2 diabetes, but the family diet was heavily carb-based, which won't have helped. My blood sugar seems pretty stable now that I am low-carb. I don't know what it was like before, but it felt as though it was swinging from high to low a lot.

 

Interesting article. For me it’s perfectly possible that there is/are (a) common pathophysiological link(s) that knock(s) metabolic systems out of kilter; in ‘Wolfe Hypothesis’ I touch on links between: 'long-form CNDP1 gene', 'NF-KB activation', and increased rates of glycolysis in ME/CFS

The later may be epigenetic, which is where, arguably, the development of ME/CFS may be said to enhance a (latent) potential for growing/enhanced metabolic dysfunction e.g. dysmetabolic syndrome. Given the fact that many believe ME/CFS to be a neurological disorder, and many of us believe that the central nervous system (including the hippocampus) has a very important role to play in the pathology, the extent to which the purported correlation between dysmetabolic syndrome and these cerebrospinal abnormalities may enhance disorder associated with ME/CFS should be fairly apparent

ME/CFS is often associated with blood sugar balance/control abnormalities, along with associated overproduction/dysregulation of stress hormones (intended, by the body, to correct for such abnormalities) e.g. epinephrine (adrenalin) and cortisol

This may lead to enhanced weight gain or indeed weight loss, depending on how (the) common link(s) manifest(s) and how we adapt, in terms of our eating/activity habits - hence the differential presentation of ME/CFS patients in terms of weight: many 'overweight', but also many 'underweight'

ME/CFS and dysmetabolic syndrome may therefore be viewed as intimately linked co-morbid diseases in a sub-set of PWME, whereas metabolic dysfunction more broadly, for me, may be interpreted as being part of the same disease state that we currently characterise (by symptomatological presentation) as ‘ME/CFS’

 

Would this be consistent with the non-specific antibodies theory? Autoantibodies damaging the pancreas (?) messing with insulin production causing pre-diabetic conditions, for example. Autoantibodies to the hypothalmus could also be contributing, too.......?

Not just the pancreas, but so many hormone receptors that feed into insulin resistance, including steroid and insulin receptors, steroid binding proteins, etc.

 

thanks for this article!

 

Thanks Jody - I had also quereid this link as my famly has a strong history of tyoe 2 diabeties and cardiovascular illness - lookin gback now i see also probable UnDx ME/cfs too
ANd i think the enforced inactivity alone could cuntirubute substantially.

When ihad my blood volume measured recently and found i was low by about 700 mls I had even more reasone to suspect a link.
Thanks again..hope it leads to some more research.

 

thanks for this article!

Glad you liked it, Rrr.

 

Thanks Jody - I had also quereid this link as my famly has a strong history of tyoe 2 diabeties and cardiovascular illness - lookin gback now i see also probable UnDx ME/cfs too
ANd i think the enforced inactivity alone could cuntirubute substantially.

When ihad my blood volume measured recently and found i was low by about 700 mls I had even more reasone to suspect a link.
Thanks again..hope it leads to some more research.

I hadn't really noticed till long after I became ill, that there are many diabetics on my mother's side of the family. I never thought about it having anything to do with me, but once I saw the possible connection and looked further into it, a few things began to fall into place.

 

Thanks Jody for this article. I have gained a lot of weight around my waist and am swollen all over my body. So, is watching sugar and simple carbs the only remedy?

 

Thanks Jody for this article. I have gained a lot of weight around my waist and am swollen all over my body. So, is watching sugar and simple carbs the only remedy?

Nielk,

Speaking just from my own experience, I'd have to say, it probably isn't the only remedy. But it can make a big difference. And as has been mentioned in one of the comments above, each of us have our own unique needs when it comes to amounts of carbs in the diet. The diet I referred to from Dr. Andrew Weil is one regimen. I don't follow his recommendations to the letter, trial and error has helped me to know what works best for me.

In the summer of 2002 I began to eat a low carb diet, and found that most of my worst symptoms decreased, or disappeared. During that summer I was hoping that maybe I was just hypoglycemic and that that was all that was wrong with me. Come fall, I began to fail and weaken again and I realized that there must be other factors to my poor health. But even with my autumn crash, I did not get as sick as I'd been in previous falls and winters.

I'd recommend doing a google search on metabolic syndrome, and see what else may turn up that applies to you.

 

Thanks Jody for this article. I have gained a lot of weight around my waist and am swollen all over my body. So, is watching sugar and simple carbs the only remedy?

i understand that - ahem - exercise esp weights i svery good for stavig off and even reversing type 2 diabeties Neil.
Another reason we are porne to it perhaps ans esercise - though i love it - cna make me so ill.

Iid not make the point before that in havein g my blood volume tested It made me realise the link too. Low blood volume is going to cause temendous issues and is also going to combine with symdrome X to cause a much greater risk of embolism and thrombosis.


cheers,
Ally

 

Nielk,

Speaking just from my own experience, I'd have to say, it probably isn't the only remedy. But it can make a big difference. And as has been mentioned in one of the comments above, each of us have our own unique needs when it comes to amounts of carbs in the diet. The diet I referred to from Dr. Andrew Weil is one regimen. I don't follow his recommendations to the letter, trial and error has helped me to know what works best for me.

In the summer of 2002 I began to eat a low carb diet, and found that most of my worst symptoms decreased, or disappeared. During that summer I was hoping that maybe I was just hypoglycemic and that that was all that was wrong with me. Come fall, I began to fail and weaken again and I realized that there must be other factors to my poor health. But even with my autumn crash, I did not get as sick as I'd been in previous falls and winters.

I'd recommend doing a google search on metabolic syndrome, and see what else may turn up that applies to you.

diabetes medication metformin which improves insulin sensitivity through a few mechanisms greatly helps weightloss when combined with a low carb diet and this combo also slashed cholesterol and trigylerides greatly. Its also used and recommended by many antiaging doc to helps prevent chronic illnesses and improve quality of live. worth talking to your doc about it. very different to insulin and doesnt lower blood sugar levels to below normal like insulin.

 

Thanks Jody for this article. I have gained a lot of weight around my waist and am swollen all over my body. So, is watching sugar and simple carbs the only remedy?

There is more to the treatment of insulin resistance then then watching ones weight and lowering carbs (of all kinds.. simple sugars and other kinds too), diet thou plays a huge part in treatment of this.

I have seen 3 specialists (2 doctors and also a nutritionist who has the issue herself) who specialise in the area of hyperinsulinemia and metabolic syndrome (things I have) and throu doing what Im supposed to do for it, my hyperinsulinemia (prediabetes) is just worsing... Im probably needing a med for this eg metformin is commonly used. In my case I have these issues due to having polycystic ovulation syndrome (PCOS) rather then due to to the ME but I know from my own experience that these conditions do make ones ME symptoms worst.

Since being on extremely low carb diets for my insulin issues .. I completely got rid of GERD which I'd been on prescription drugs previously for, have less first thing in the morning tiredness..the kind which keeps you in bed, have less throats (so the insulin issue must knock around my immune system), my moods are far more stable. I had intense mood swings when my insulin is too high, I suspect due to I also having MCS that my body is abnormally sensitive to insulin too. (I cant think now what other symptoms it helped but it helped more then just those ones).

Those who have this issue should also follow a few more eatting rules then lowering carbs.
- Always have protein every meal such as meat or eggs

my specialist has told me to do this actually before eatting anything else (it helps the carbs be digested slower and hence to balance insulin)

- Dont buy low fat dairy products.. you need the full cream/fat products .. as if you have an insulin issue you need the fat the the milk etc (helps with the insulin).

- Those with severe insulin issues will even need to consider the carbs coming from things such as dairy and nuts and not be exceding certain limits. (one of nutritionists told me that to not eat more then 10-12 nuts per day due to their carbs.. her extremely strict low carb diet, far stricter then diabetic, diabetic diets are far too high in their carbs for my body.. really helped me a lot).

-Note.. root veg are often high in carbs so Ive been told to avoid. Sweet corn is quite high in carbs.

Fruits.. of cause contain fructose.. so on my low carb diet Im restricted to one small piece of fruit per day and some fruits are completely out on a low carb diet eg bananas are high carb, oranges...

 

Management of hyperinsulinemia and metabolic syndrome can be very difficult and one of the more difficult issues Im dealing with as far as its hard to cook special diets when you have ME too to deal with.

I notice just breaching the diet once can have huge impacts on my body eg an immediate weight gain by the next day, it can also make my body hold fluids but not in a good way (so unfortunately not in a way to help my POTS but it can bloat me).