What is the connection between orthostatic intolerance and impaired oxygen extraction?

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I often see ME/CFS patients that undergo exercise tests to be diagnosed with two problems: orthostatic intolerance (preload failure) and impaired oxygen extraction (mitochondrial dysfunction).

They seem to be pretty well connected, but I've never seen anyone explaining which one is driving the other, and what is their relationship. Could someone please point me to some studies that explain this?
 

Violeta

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That's a very interesting question!

This is a start, B vitamins helping resolve orthostatic hypotension.https://www.hormonesmatter.com/tag/postural-hypotension/

This is interesting:
My big breakthrough came when I discovered that I had been taking the wrong form of niacin. I had been taking niacin and inositol hexanicotinate for the last three years, but it wasn’t until I returned to taking niacinamide that the symptoms dysautonomia dialed down.


From the study about niacin.
Our evidence indicates that blood analysis is useful in identifying NAD+ deficiency and points niacin to be an efficient NAD+ booster for treating mitochondrial myopathy.


https://www.sciencedirect.com/science/article/pii/S155041312030190X

Editing in a paper that explains the electron transport chain.

https://www.sciencedirect.com/science/article/pii/S0005272813001746
 
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Judee

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They seem to be pretty well connected, but I've never seen anyone explaining which one is driving the other, and what is their relationship.
Look for videos/studies by Dr Systrom. I don't think he and his team have it figured out yet though. He was thinking it was caused by small fiber neuropathy but the tests they did didn't seem to bear that out. I heard him discuss that in this VIDEO.
 
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Look for videos/studies by Dr Systrom. I don't think he and his team have it figured out yet though. He was thinking it was caused by small fiber neuropathy but the tests they did didn't seem to bear that out. I heard him discuss that in this VIDEO.
Thanks for the suggestion, I am familiar with the video and Dr Systrom, I had my ICPET test with him, and also on Mestinon myself.
He does talk about these two problems in the video, they are the "Preload Failure" (which is basically OI) and "Peripheral limitation" which is the mito dysfunction. He does seem to hint on a link involving the small fibers, but he does not seem to know for sure yet. It is very murky

I was asking because I was wondering if there are other researchers also studying this. Dr Systrom can't be the only one in the World studying this disease, right? Sometimes it seems his lab is the only one coming up with substantial information about the causes of our exercise intolerance and therapies.
 

Belbyr

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Dr Grubb is another big name in dysautonomia, and he is aware of the muscle mitochondria issue because I saw he mentioned it in one of his talks...

I've seen Dr Chemali, he ran every autonomic test along with lots of digging into the immune system, skin punch biopsies, EMG, and more. He said about half of his patients have neuropathy, which is an autoimmune thing. The other half don't have damage going on, but they still present autonomic symptoms just like the autoimmune group. His last note on me was "I have not ruled out a mitochondria issue"