Healing the Emotional Hole in the Energy Bucket
(By Dr Sarah Myhill and Craig Robinson)
Stylistic note: Use of the first person singular refers to me, Dr Sarah Myhill. One can assume that the medicine and biochemistry are mine, as edited by Craig Robinson, and that any classical and mathematical references and quotes or historical and linguistic notes are Craig’s!
Life’s Energy Equation
The main symptom in CFS/ME is fatigue. The brain gives us this important symptom when the gap between energy demand and energy delivery narrows. The point here is that the brain can never allow energy demand to exceed delivery. Why? Because the heart would stop pumping and we would die! The brain may give us additional symptoms to prevent us spending energy such as low mood, depression and, to a certain extent, anxiety. I think the symptom of stress arises when the brain perceives we do not have the energy ‘to hand’ to cope with the ‘expected’ demand. Given unlimited energy, one can tackle any problem!
Two thirds of all energy spent simply goes on basal metabolism - -ie basic brain and body (heart, liver, gut, kidney, muscle etc) function. That leaves us with one third with which to spend energy on surviving and enjoying life. Normally this is spent physically, mentally and emotionally.
- Chronic fatigue syndrome [‘CFS’] is characterised by poor energy delivery mechanisms. All energy goes to basal metabolism, little is left for life.
- Myalgic-encephalitis [‘ME’] is characterised by poor energy delivery mechanisms AND inflammation.
Inflammation occurs when the immune system is activated and produces symptoms of local inflammation such as pain, redness, heat, swelling and loss of function together with symptoms of generalised inflammation such as malaise, fever, lymphadenopathy and of course more fatigue! The immune system is activated in allergy, chronic infection and auto-immunity.
In both CFS and ME there may also be an emotional hole in the energy bucket.
Please see here for an overview of the ‘Energy Equation’ and its various component parts - Overview of CFS/ME protocol
The symptom of Anxiety
The brain is greatly demanding of energy. Although it weighs just 2% of body weight, it consumes 20% of total energy production. When in an anxiety state, the brain never rests. It is constantly active, often with the same recurring, circular thought patterns. I think of this as a pathological form of an earworm – if I hear a familiar jingle on the wireless I am humming it all day!
Many anxieties date from deeply unpleasant life events. We now have a name for this – post traumatic stress disorder (PTSD). We recognised this all too late from World War One. 306 front line British and Commonwealth troops were shot for cowardice when in fact they had shell shock – ie PTSD. I see many patients with CFS/ME which date from childhood abuses. They too have PTSD.
Remember that CFS/ME are not diagnoses but rather collections of awful symptoms which may have many causes, with the mechanism of CFS being poor energy delivery and the mechanism of ME being poor energy delivery PLUS inflammation. So, anything which adds to poor energy delivery and / or inflammation can therefore be another mechanism for CFS and / or ME. Most sufferers of CFS/ME have multiple mechanisms [causes] of their individual CFS or ME.
We are all subject to deeply unpleasant and shocking life experiences. I have many skeletons in my cupboard. If we all dwelt on these forever all energy would be consumed by such and nothing would get done. So how does the brain deal with these horrible experiences? How does it stuff them in a cupboard in the brain, lock the door and never go there again?
What we do know is that bullying with mental, physical and emotional/sexual abuse are all major risk factors for CFS. These traumas, often occurring in childhood, leave children constantly hard wired for hypervigilance with sleeplessness a common feature. These little ones cannot sleep feeling safe.
I stress that this is not to EQUATE CFS/ME with PTSD or any other emotional or psychological reaction to such bullying. Rather it is to recognise that being in a state of hypervigilance that affects the quantity and quality of sleep, will, by definition, affect Life’s Energy Equation because sleep is a key component on the energy delivery side of the equation. Therefore, where sleep is adversely affected, the energy equation will be tipped less favourably for the individual concerned. This leaves the affected individual in a precarious situation and more susceptible.
I have learned so much from Matthew Walker’s book “Why We Sleep”. Essentially, we have a sleep cycle every 90 minutes. This is split into two phases– Rapid Eye Movement (REM) sleep and non-REM sleep. It is during non-REM sleep that the brain goes through the experiences of the day, hangs on to the important stuff (we call this memory) and chucks out the unimportant. So, for example tonight I shall want to remember the stuff I am writing now but I want to forget the mundane details of everyday life. If I remembered everything my brain would be full of rubbish! Sherlock Holmes was of the same opinion:
“I consider that a man's brain originally is like a little empty attic, and you have to stock it with such furniture as you choose. A fool takes in all the lumber of every sort that he comes across, so that the knowledge which might be useful to him gets crowded out, or at best is jumbled up with a lot of other things, so that he has a difficulty in laying his hands upon it. Now the skilful workman is very careful indeed as to what he takes into his brain-attic. He will have nothing but the tools which may help him in doing his work, but of these he has a large assortment, and all in the most perfect order. It is a mistake to think that that little room has elastic walls and can distend to any extent. Depend upon it there comes a time when for every addition of knowledge, you forget something that you knew before. It is of the highest importance, therefore, not to have useless facts elbowing out the useful ones.” “A Study in Scarlet” - Sir Arthur Conan Doyle, KStJ DL , 22 May 1859 - 7 July 1930
It is likely that when we have a nasty life experience we deal with that during sleep, probably non-REM sleep. In order to make us remember the important bits (ie let’s try and avoid that in future) but forget the nasty bits (cripes that gave me a terrible fright) that memory has to be experienced again during sleep in a safe place. In such a safe place the experience is associated with safe thoughts and safe dreams. The brain learns to deal with that trauma in a “let’s not destroy ourselves” way. This takes time and many nights of quality sleep.
“Healing is a matter of time, but it is sometimes also a matter of opportunity.” Hippocrates, the Father of Medicine, 460 BC - 370 BC
Sleep is the Great Healer
It follows that in order to deal with these nasty experiences, and therefore help the energy equation move in the right direction, we need to encourage ‘safe sleep’.
So, what constitutes “safe sleep”? First, we have to put in place, all the interventions to improve sleep quantity and quality and those are detailed in the chapters on sleep in My book “Diagnosis and Treatment of Chronic Fatigue Syndrome & Myalgic Encephalitis - it’s mitochondria not hypochondria”. The important things are a quiet, dark, cool room with a comfortable warm bed. Sleep duration (8-9 hours) and timing (10pm - 7am), more in winter, less in summer are also critical.
We then must think of the hormonal background. I know from my clinical experience that both thyroid and adrenal hormones impact directly on the quantity and quality of sleep. One of the important adrenal hormones is adrenalin. The idea here is that if one relives the experiences of the day when there is a background of high adrenalin during sleep then those nasty life experiences are replayed in a state of high stress. This may manifest with nightmares. This produces even more adrenalin …. that is to say this switches on a chronic vicious cycle of nasty experiences plus adrenalin and this can easily develop into an all-consuming PTSD where these experiences are triggered in the day with flashbacks, adrenalin symptoms (sweating, trembling, nausea, pain), negative thoughts often with guilt or shame. No surprise that these kick an emotional hole in the energy bucket, along side the poor quantity and quality of sleep.
Treatment of PTSD
What we want is for that nasty life experience to be replayed during non-REM sleep in the absence of adrenalin. If we can achieve this, then it will mean that every time we sleep, we ‘dumb’ down the experience until eventually the PSTD is switched off. Yes, it takes time! The first and most important way to reduce adrenalin at night is to do a ketogenic diet! A ketogenic diet will reduce the adrenalin spikes. Indeed, I suspect our modern Western epidemic of PTSD has much to do with modern sugar and starch-based diets, which give rise to adrenalin spikes.
A ketogenic diet irons out blood sugar levels and so irons out the hormonal responses to blood sugar levels, one of which is adrenalin spikes. For many this may be all that is required. See Ketogenic Diet - the practical details and My book "The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds"
However, and there are some good studies to support this, low doses of drugs at night to block adrenalin may be very helpful. The most obvious one to use is propranolol starting with a modest dose of 10mgs at night and building up to perhaps 40mgs (not for asthmatics!).
Please see “Propranolol’s effects on the consolidation and reconsolidation of long-term emotional memory in healthy participants: a meta-analysis”  by Lonergan, et al, which concluded that:
“Propranolol shows promise in reducing subsequent memory for new or recalled emotional material in healthy adults. However, future studies will need to investigate whether more powerful idiosyncratic emotional memories can also be weakened and whether this weakening can bring about long-lasting symptomatic relief in clinical populations, such as patients with posttraumatic stress or other event-related disorders.”
And also see “Propranolol's impact on cognitive performance in post-traumatic stress disorder”  by Mahabir et al which concluded that:
“Our preliminary results demonstrated that cognitive functioning improved following propranolol administration in PTSD patients. The implications are discussed with regards to the processing of traumatic events.”
Another possibility would be the alpha blocker clonidine starting with 25mcgms at night and building up to perhaps 100mcgms. Indeed, sufferers of PTSD also report that their nightmares become less severe on these regimes suggesting a mechanism in REM as well as non-REM sleep.
Please see “The use of clonidine in the treatment of nightmares among patients with co-morbid PTSD and traumatic brain injury.” , by Alao et al, which concluded that:
“Clonidine should be considered as an alternative in the treatment of nightmares among patients with PTSD.”
Finally, the more ways one can tackle this problem the better. Psychotherapy and other ‘mind-based’ techniques may be very helpful, and therapists can be found at the "Natural Health Worldwide practitioner portal"
- Overview of CFS/ME protocol
- My book “Diagnosis and Treatment of Chronic Fatigue Syndrome & Myalgic Encephalitis - it’s mitochondria not hypochondria”
- Ketogenic Diet - the practical details
- My book "The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds"
External Links and Articles
- Matthew Walker’s book “Why We Sleep”
- “Propranolol’s effects on the consolidation and reconsolidation of long-term emotional memory in healthy participants: a meta-analysis”
- “Propranolol's impact on cognitive performance in post-traumatic stress disorder”
- “The use of clonidine in the treatment of nightmares among patients with co-morbid PTSD and traumatic brain injury.”
- "Natural Health Worldwide practitioner portal"
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