CFS is Heart Failure Secondary to Mitochondrial Malfunction

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CFS is Heart Failure Secondary to Mitochondrial Malfunction

 

 

I think this is one of the most important handouts I have ever produced

in terms of my understanding of CFS and what to do in order to recover!

So please read this very carefully and several times over because for

many sufferers it contains the keys to unlock their illness!

 

Two papers have come to my notice recently which make great sense of

both my clinical observations and also the idea that CFS is a symptom of

mitochondrial failure. The two symptoms I am looking for in CFS to make

the diagnosis is firstly very poor stamina and secondly delayed fatigue.

I think I can now explain these in terms of what is going on inside

cells and the effects on major organs of the body (primarily the heart).

More importantly, there are major implications for a test for CFS and of

course management and recovery.

 

If mitochondria (the little batteries found inside every cell in the

body) do not work properly, then the energy supply to every cell in the

body will be impaired. This includes the heart. Many of the symptoms of

CFS could be explained by heart failure because the heart muscle cannot

work properly. Cardiologists and other doctors are used to dealing with

heart failure due to poor blood supply to the heart itself. In CFS the

heart failure is ,caused by poor muscle function and therefore strictly

speaking is a cardiomyopathy. This means the function of the heart will

be very abnormal, but traditional tests of heart failure, such as ECG,

ECHOs, angiograms etc, will be normal.

 

Thanks to work by Dr Arnold Peckerman

www.cfids-cab.org/cfs-inform/Coicfs/peckerman.etal.03.pdf we now know

that cardiac output in CFS patients is impaired. Furthermore the level

of impairment correlates very closely to the level of disability in

patients. Dr Peckerman was asked by the US National Institutes of Health

to develop a test for CFS in order to help them to judge the level of

disability in patients claiming Social Security patients. Peckerman is a

cardiologist and on the basis that CFS presents with low blood pressure,

low blood volume and perfusion defects, he surmised CFS patients were in

heart failure To test this he came up with Q scores.

 

" Q " stands for cardiac output in litres per minute and this can be

measured using a totally non-invasive method called Impedence

Cardiography. This allows one to accurately measure cardiac output by

measuring the electrical impedence across the chest wall. The greater

the blood flow the less the impedance. This can be adjusted according to

chest and body size to produce a reliable measurement (this is done

using a standard algorithm). It is important to do this test in the

upright position and again when supine (lying flat on your back). This

is because cardiac output in normal people will vary from 7 litres per

min when supine to 5 litres per min when standing up. In healthy people

this drop is not enough to affect function, but in CFS sufferers the

drop may be from 5 litres lying down to 3.5 litres standing up. At this

level the sufferer has a cardiac output which causes borderline organ

failure.

 

This explains why CFS patients feel much better lying down. They have

acceptable cardiac output lying down, but standing up they are in

borderline heart and organ failure. CFS is therefore the symptom which

prevents the patient developing complete heart failure. Actually,

everyone feels more rested when they are sitting down with their feet

up! The subconscious has worked out that the heart has to work less hard

when you are sitting down with your feet up, so we do so because we feel

more comfortable!

 

This explains the symptoms of CFS

The job of the heart is to maintain blood pressure. If the blood

pressure falls, organs start to fail. If the heart is working

inadequately as a pump then the only way blood pressure can be sustained

is by shutting down blood supply to organs. Organs are shut down in

terms of priority, i.e. the skin first, then muscles, followed by liver,

gut, brain and finally the heart, lung and kidney. As these organ

systems shut down, this creates further problems for the body in terms

of toxic overload, susceptibility to viruses which damage mitochondria

further, thus exacerbating all the problems of the CFS sufferer.

 

1. Effects on the Skin

If you shut down the blood supply to the skin, this has two main

effects. The first is that the skin is responsible for controlling the

temperature of the body. This means that CFS patients become intolerant

of heat. If the body gets too hot then it cannot lose heat through the

skin (because it has no blood supply) and the core temperature

increases. The only way the body can compensate for this is by switching

off the thyroid gland (which is responsible for the level of metabolic

activity in the body and hence heat generation) and so one gets a

compensatory underactive thyroid. This alone worsens the problems of

fatigue.

 

The second problem is that if the micro-circulation in the skin is shut

down, then the body cannot sweat. This is a major way through which

toxins, particularly heavy metals, pesticides and volatile organic

compounds are excreted. Therefore the CFS suffererýs body is much better

at accumulating toxins, which of course further damage mitochondria.

 

2. Symptoms in Muscles

If the blood supply to muscles is impaired, then muscles quickly run out

of oxygen when one starts to exercise. With no oxygen in the muscles the

cells switch over to anaerobic metabolism, which produces lactic acid

and it is this that makes muscles ache so much.

 

As well as the above problem, muscles in the CFS patient have very poor

stamina because the mitochondria which supply them with energy are

malfunctioning.

 

3. Symptoms in the Liver and Gut

Poor blood supply to the gut results in inefficient digestion, poor

production of digestive juices and leaky gut syndrome. Leaky gut

syndrome causes many other problems such as allergies, autoimmunity,

malabsorption, etc., which further compound the problems of CFS.

 

If liver circulation is inadequate, this will result in poor

detoxification, not just of heavy metals, pesticides and volatile

organic compounds, but also toxins produced as a result of fermentation

in the gut again further poisoning the mitochondria.

 

4. Effects on the Brain

Last October I attended a conference sponsored by the late Dr John

Richardson. A Canadian physician Byron Hyde showed us some functional

scans of the brains of CFS patients. If I had not known the diagnosis, I

would have diagnosed strokes. This is because the blood supply to some

area of the brain was so impaired. The default is temporary and with

rest, blood supply recovers. However, this explains the multiplicity of

brain symptoms suffered from, such as poor short term memory, difficulty

multi-tasking, slow mental processing and so on. Furthermore brain cells

are not particularly well stocked with mitochondria and therefore they

run out of energy very quickly.

 

5. Effects on the Heart

There are two effects on the heart. The first effect of poor

micro-circulation to the heart is disturbance of the electrical

conductivity which causes dysrhythmias. Many patients with chronic

fatigue syndrome complain of palpitations, missed heart beats or

whatever. This is particularly the case in patients with poisoning by

chemicals since the chemicals are also directly toxic to nerve cells.

 

The second obvious result is poor exercise tolerance. Heart muscle

fatigues in just the same way that other muscles fatigue.

Symptomatically this causes chest pain and fatigue. In the longer term

it can cause heart valve defects because the muscles which normally hold

the mitral valve open also fatigue.

 

The difference between this type of heart failure and medically

recognised congestive cardiac failure is that patients with CFS protect

themselves from organ failure because of their fatigue symptoms.

Patients with congestive cardiac failure initially do not get fatigue

and often present with organ failures such as kidney failure or overt

heart failure. At present I do not know why there is this difference.

 

THIS APPROACH TO TREATING HEART DISEASE IS EXACTLY THE SAME REGARDLESS

OF THE CONVENTIONAL DIAGNOSIS. So patients with angina, high blood

pressure, heart failure, cardiomyopathy, some valve defects as well as

patients with cardiac dysrhythmias also have mitochondrial problems and

will respond in the same way to nutritional therapies and detox therapies.

 

6. Effects on Lung and Kidney

The lung and kidney are relatively protected against poor

micro-circulation because they have the largest renin angiotensin

system, which keeps the blood pressure up in these vital organs.

Therefore clinically one does not see patients with kidney failure or

pulmonary hypoperfusion in CFS.

 

Explanation of the Fatigue Problems in CFS Patients.

Energy to the body is supplied by mitochondria, which produce NAD

(nicotinamide adenosine diphosphate) and ATP (adenosine triphosphate).

These molecules are the ýcurrencyý of energy in the body. Almost all

energy requiring processes in the body have to be ýpaid forý with NAD

and ATP, but largely ATP. The reserves of ATP in cells are very small.

At any one moment in heart muscle cells there is only enough ATP to last

about ten contractions. Thus the mitochondria have to be extremely good

at re-cycling ATP to keep the cell constantly supplied with energy.

 

If the cell is not very efficient at re-cycling ATP, then the cell runs

out of energy very quickly and this causes the symptoms of weakness and

poor stamina. The cell literally has to " hibernate " and wait until more

ATP has been manufactured.

 

In producing energy, ATP (three phosphates) is converted into ADP (two

phosphates) and ADP is re-cycled back through mitochondria to produce

ATP. However, if the cell is pushed when there is no ATP about, then it

will start to use ADP instead. The body can create energy from ADP to

AMP (one phosphate), but the trouble is that AMP cannot be re-cycled.

The only way that ADP can be regenerated is by making from fresh

ingredients, but this takes days to do. This explains the delayed

fatigue seen in chronic fatigue syndrome.

 

So to summarise, the basic pathology in CFS is slow re-cycling of ATP to

ADP and back to ATP again. If patients push themselves and make more

energy demands, then ADP is converted to AMP which cannot be recycled

and it is this which is responsible for the delayed fatigue. This is

because it takes the body several days to make fresh ATP from new

ingredients. When patients overdo things and " hit a brick wall " this is

because they have no ATP or ADP to function at all.

 

Implications for Treatment

The vast majority of patients I see get well with my standard work up

with respect to vitamins and minerals, diet, pacing, sleep, B12,

magnesium, detoxing, etc, etc. All these things must be put in place to

repair and prevent ongoing damage to mitochondria so allowing them to

recover. For mitochondria to recover they need all the essential

vitamins, minerals, essential fatty acids and amino acids to manufacture

the cellular machinery to restore normal function.

 

However, despite doing that, I am still left with a hard core of

patients that I still struggle with. This is where direct micronutrient

support for mitochondria may prove to be an extremely useful

intervention. I have learned what to do through reading a book " The

Sinatra Solution " produced by an American metabolic cardiologist, Dr

Stephen Sinatra, who has used these techniques for treating patients

with heart disease such as congestive cardiac failure, angina,

arrhythmias and so on. Sinatra worked initially using entirely

conventional techniques ý drugs, pacemakers, surgery or whatever.

However, he realised that cardiac disease was not all about poor blood

supply to the heart. For many the problem was heart muscle disease due

to mitochondrial failure. Once he tackled this aspect, patients made

dramatic recoveries, were able to come off medication, avoid surgery and

return to their normal jobs and sporting activities.To understand his

ideas, you need to understand a little bit about how mitochondria work.

 

How Mitochondria Actually Work

The job of mitochondria is to get the energy contained inside foods (ie

sugars and fats) and convert it into a form the body can use, i.e. NAD

and ATP. This requires a series of reactions (Krebýs citric acid cycle

for the chemists in the audience!). This process is called oxidative

phosphorylation and chemically speaking needs electrons to move about

from one molecule to another changing their chemical make up as they go.

These reactions require enzymes, which are made up of many different

vitamins, minerals, fatty acids and amino acids. However one of the most

important electron handlers is Co Enzyme Q 10.

 

Once ATP has been made, it then has to be delivered to where it is

needed, ie out of the mitochondria, through its membrane. This it does

with a shunting reaction. ATP is made inside mitochondria from ADP and

has to be shunted across the mitochondrial membrane so the cell can use

the energy in the ATP by converting it back to ADP. ADP then needs to be

shunted back across the cell membrane. This shunting reaction involves

acetyl L-carnitine, which effectively shunts energy in the form of ATP

from inside mitochondria, through the mitochondrial cell membrane into

the cell, where it gives up its energy and converts to ADP. L-carnitine

then shunts ADP back through the mitochondrial membrane, where it is

reformed into ATP. Obviously, if this shunting reaction does not run

smoothly, energy supply will be impaired.

 

All the molecules involved here are re-cycled. There is another

essential element which is magnesium. If you think of glucose and short

chain fatty acids as the fuel of the engine, acetyl L-carnitine and

Co-enzyme Q10 are the oil and magnesium is the spark plug!

 

In order to make new ATP, one needs a sugar, namely D-ribose. Normally

the body can manufacture this for itself from glucose, but if energy

levels are very low, then it may be unable to synthesise this essential

sugar. So when the CFS sufferers push themselves too much, ADP is

converted into AMP, which they cannot recycle. It normally takes a few

days to make new ATP from D-ribose, but the CFS sufferers may be unable

to make D-ribose.

 

In order to make new NAD one needs vitamin B3.

 

Implications for Treatment - details

If the body is functioning normally and has access to all essential

minerals, vitamins, essential fatty acids and amino acids, it can make

all these essential ingredients, in particular co-enzyme Q 10, acetyl

L-carnitine and D-ribose. Magnesium must be supplied. This explains why

most patients get well on my standard work up of treatment because this

supplies all the essential ingredients for the body to heal itself.

 

However, for those who do not get well, it is likely that there is some

sort of metabolic defect which prevents them from manufacturing these

essential ingredients. I call this metabolic dyslexia! It may well be

that genetically poor mitochondrial function alone is the problem, or

there may be toxins or pesticides stuck in the system which stop the

mitochondria functioning properly. It may well be that once the patient

has dropped below a certain critical level, all cellular processes are

going so slow that the sufferer is unable to manufacture the very things

required to restore health. With age, our metabolism becomes less

efficient anyway and we may need more raw materials in order to maintain

the status quo.

 

Either way there is a cocktail of micronutrients that could be taken to

kick start the system. This cocktail is already of tried and tested

value. It has been used in America by many metabolic cardiologists to

treat cardiomyopathies, ischaemic heart disease, dysrhythmias,

congestive cardiac failures, high blood pressures and anginas with great

success. Not only have patients felt better, but they have come off all

their medication and avoided life threatening interventions such as

cardiac transplants, arterial surgery, pacemakers and so on.

 

Dr Sinatra has developed several schemes for age management, high blood

pressure, arrhythmias, mitral valve prolapse, congestive cardiac

failure, syndrome X, for professional and world class athletes, but also

for fibromyalgia, chronic fatigue syndrome and mitochondrial

cytopathies. He recommends the following daily cocktail for CFS:

 

Co-enzyme Q 10 300 - 360mg (the oil of the engine - moves electrons from

one molecule to another) L-carnitine 2,000 - 3,000mg (the oil of the

engine - moves ATP and ADP across mito membranes) D-ribose 15grams (raw

material to make new ATP) Magnesium 400 - 800mg (the spark plugs - fires

up many enzyme reactions)

 

To this I would also add niacinamide 500mgs daily (the raw material to

make NAD). I would expect this cocktail of supplements to work best

taken together, not as individual supplements.

 

I have tried a number of my patients on this cocktail of supplements and

have already had some very encouraging feedback.

 

Reference:

The Sinatra Solution Metabolic Cardiology by Stephen T Sinatra.

Available from Amazon

 

Incidentally this helps explain why some CFS sufferers have such

problems with drug medication and indeed this may help to point towards

treatment. All my CFS patients feel much worse on statins because these

stop the body from making its own Co Q 10. Beta blockers, tricyclic

antidepressants and phenothiazines also block Co Q 10 synthesis.

 

Practical Details There is no point taking this cocktail until you have

done my standard work up to treating CFS. This is because normally the

body is perfectly capable of making its own Coenzyme Q 10 and its own

D-ribose so long as it has all the vitamins, minerals, EFAs and amino

acids to do so. Vitamin B3 and magnesium comes from supplements and

acetyl L-carnitine from red meat.

 

The supplements in the Sinatra protocol are expensive, so for those who

would like to try it I suggest:

 

Measure levels of Co Q 10 to show there is a deficiency. Phone the

office to order a kit, cost ý28 (5mls blood red speckled top tube).

 

Measure NAD levels. Phone office to order a kit, cost ý28. (Green top

lithium heparin tube)

 

Measure red cell magnesium. Phone office to order a kit. Cost ý17.

(Green topped lithium heparin tube)

 

Eat red meat daily for acetyl L carnitine. Vegetarians will have to take

the supplement. If you have poor digestion then you may need to

supplement with L carnitine anyway

 

D-ribose - I have found a reasonably priced source and can dispense

500gms for £23.

 

If You Are Found To Be Deficient Co-enzyme Q 10. This must be in a

hydrosoluble or oil form or it is not well absorbed. Co Q 10 is fairly

widely available - Lamberts 01892 554 312 do a preparation of 100mgs Co

Q 10.

 

L-carnitine - this is an amino acid with highest levels in meat. This

may explain why vegetarians are at risk of CFS. It also partly explains

why my CFS patients do best on high protein diets. Lamberts 01892 554

312 supply L carnitine. Eat red meat (the word carnitine comes from

carne meaning meat).

 

D-ribose - needs to be taken throughout the day.

 

Niacinamide 500mgs available from Solgar 01782 634 744

 

Magnesium in Myhill's Magic Minerals (or other such mineral supplement).

But if there is a severe deficiency, then magnesium by injection may be

required.

 

How long before you see improvement? Not sure at the moment. However,

heart transplant patients whose cardiac output is improved overnight can

take up to a year before they start to feel fully well again. However, I

would expect sufferers to see improvements after a few weeks of supplements

 

What is important is that these interventions are done in combination

with all my other recommendations with respect to diet, micronutrients,

pacing, sleep, detoxing, etc. Firstly get the regime tight, then start

to feel better and then start to increase activity.

 

 

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