Energy balance in CFS/ME
We all have a pot of energy available to us on a daily basis and we can choose to spend that energy mentally, physically, emotionally or immunologically. When that pot of energy is empty, we have no more to spare. The brain stops us from doing more by making us feel fatigued. Of course, it is normal to feel tired at the end of the day and a night’s rest together with good food restores the energy pot for the next day.
The symptom of fatigue is a very important one – it prevents us spending too much energy in a day. If we didn’t experience fatigue, we would simply go on doing things without rest or nourishment, rapidly get into a situation that was unsustainable, and die. So, for example, a person who has a normal energy pot may develop ‘flu and all his energy goes into the immunological department so he has no energy left for mental, physical or emotional work. That person becomes bed bound for a few days until he gets rid of his ‘flu virus and recovers.
ME patients have a small pot of energy and therefore they have to ration the amount that they spend. We call this pacing and it is an essential part of management. However, my job is to make the energy pot larger and this is achieved using all the interventions described in my book on CFS Diagnosing and treating CFS i.e. improving the engine of our car (mitochondrial function), improving the fuel supply (diet), improving our service record (sleep), accelerator pedal (thyroid function), gear box (adrenal gland) and so on.
One can think of this pot of energy as money in the bank that we can use to spend in various ways. The wise person has a deposit account for rainy days and a current account for everyday expenditure. How much we put in our deposit and current account is determined by the brain and I can certainly see clinical situations where too much money is put in the deposit account and not enough in the current account. I suspect people who have a tendency to anxiety, depression and hypervigilance do this. The brain perceives threats in the future that have to be dealt with – we deal with threats with an outpouring of adrenal hormones that allow us to gear up our engine and to work at a much higher level to cope with that threat. But to be able to do this there must be money in the deposit account. One can easily see how, through bad past experiences, the brain works out that it must put some money in the deposit account to cope with future horrors.
I suspect this is the basis for why psychological techniques such as amygdala retraining, the lightening process etc. do benefit some patients. They allow them to transfer some money from their deposit account into their current account for everyday use but still save some behind for the rainy day.
A promising technique which is being used is neurobiofeedback. I think the idea here is to “remap” the brain so that it responds appropriately to stress – whatever that stress may be. It has been shown to be effective in many conditions such as attention deficit disorder and autism and is being trialled by Dr Lesley Parkinson in ME – (QEEG, brain mapping, brain haemencephalograph). See Neurofeedback on Wikipedia
I think of the immune system as being very similar to the brain – it is intelligent, communicative, responsive and directive. Like the brain it is enormously demanding of energy – indeed, some fascinating work by Caroline Pond at Milton Keynes showed that when wild animals store fat, the first place they dump it is around their lymph nodes – this is because immune cells here require an immediate supply of energy to protect against infection. The obvious way in which the immune system may be activated is through such an infectious threat and, of course, we all feel fatigued with acute infection. I suspect, but do not know, that this may be the mechanism by which allergy, particularly food allergy, causes fatigue. 90% of the immune system is associated with the gut and if there are chronic low grade inflammatory reactions here as a result of a food to which one is allergic, then 90% of the immune system may be activated! Certainly, it is my clinical experience that when patients with fatigue syndromes have put in place all the lifestyle and nutritional interventions to get their car running normally, what often stops them getting well is undiagnosed allergy.
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