Link between Metabolic Syndrome and ME/CFS?

June 21, 2013

by Jody Smith

pixabay-metabolic-syndrome-link-cfs-o

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/20120903/Metabolic-syndrome-associated-with-cognitive-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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38 comments

{ 38 comments… read them below or add one }

jimells June 21, 2013 at 3:12 pm

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?

alex3619 June 21, 2013 at 3:44 pm

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.

Jody June 21, 2013 at 4:12 pm

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.

heapsreal June 21, 2013 at 4:23 pm

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.

SOC June 21, 2013 at 4:45 pm

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…….?

Marco June 21, 2013 at 10:06 pm

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

MeSci June 22, 2013 at 3:45 am

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.

John H Wolfe June 22, 2013 at 3:55 am

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’

alex3619 June 22, 2013 at 10:35 am
SOC

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.

Rrrr June 22, 2013 at 6:00 pm

thanks for this article!

Allyson June 22, 2013 at 11:41 pm

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.

Jody June 23, 2013 at 7:27 am
Rrrr

thanks for this article!

Glad you liked it, Rrr.:)

Jody June 23, 2013 at 7:29 am
Allyson

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.

Nielk June 23, 2013 at 4:46 pm

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?

Jody June 23, 2013 at 5:12 pm
Nielk

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.

Allyson June 23, 2013 at 8:13 pm
Nielk

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

heapsreal June 24, 2013 at 5:00 am
Jody

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.

taniaaust1 June 24, 2013 at 5:04 pm
Nielk

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…

taniaaust1 June 24, 2013 at 5:09 pm

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).

taniaaust1 June 24, 2013 at 6:18 pm

I thought I'd put a few links here from the website of one of my specialists.

He calls insulin resistance the Pandora's Box of illnesses… as it can cause soo many different issues or coexisting issues with it. http://www.agale.com.au/PANDORA.htm

Warning on the need to handle insulin tests correctly or results may end up coming in wrong http://www.agale.com.au/assay2.htm

A couple of his CFS case studies which turned out to be caused by insulin resistance (note in the second one, the lady was in a wheelchair due to it) http://www.agale.com.au/CFS.htm

August59 September 21, 2013 at 1:07 am

I have developed Metabolic Syndrome in the last 2 years. It has severely compounded the ability to manage my disease.

Jody September 21, 2013 at 7:01 am
August59

I have developed Metabolic Syndrome in the last 2 years. It has severely compounded the ability to manage my disease.

You have my sympathy. I have found dietary changes have made a big difference in managing my metabolic syndrome, and a few supplements. It doesn't get in my way nearly like it used to though I have to make my decisions with it always in mind it seems.

alex3619 September 21, 2013 at 12:37 pm

The recent Lipkin (and Stanford?) finding of high Leptin strongly implicates that ME may cause metabolic syndrome, and possibly diabetes. It stuffs around with energy pathways and the brain regulation of energy pathways. If even thin ME patients have this, which I strongly suspect but has not so far been explicitly stated by Lipkin etc., then there goes the idea that only obese people get high leptin.

Nielk February 25, 2014 at 7:57 pm

As I said in a previous post, I have been struggling with weight gain and water retention for the past two years. I was diagnosed last week with Diabetes ad have been put on a strict diet and Metformin.

Has anyone heard about the fact that obstructive sleep apnea can cause metabolic syndrome and diabetes if left untreated?

SOC February 25, 2014 at 9:30 pm
Nielk

As I said in a previous post, I have been struggling with weight gain and water retention for the past two years. I was diagnosed last week with Diabetes ad have been put on a strict diet and Metformin.

Has anyone heard about the fact that obstructive sleep apnea can cause metabolic syndrome and diabetes if left untreated?

I think I read that obstructive sleep apnea can increase leptin, so there might be a connection there.

Bob February 25, 2014 at 9:39 pm
Nielk

Has anyone heard about the fact that obstructive sleep apnea can cause metabolic syndrome and diabetes if left untreated?

I don't know a great deal about sleep apnea but I have heard that it is thought that obstructive sleep apnea can be exacerbated by weight gain.

heapsreal February 25, 2014 at 10:28 pm

Might not just be high leptin but leptin resistance. Seems to go hand in hand with insulin resistance and circadian issues.

Firestormm February 26, 2014 at 3:33 am
Nielk

As I said in a previous post, I have been struggling with weight gain and water retention for the past two years. I was diagnosed last week with Diabetes ad have been put on a strict diet and Metformin.

Has anyone heard about the fact that obstructive sleep apnea can cause metabolic syndrome and diabetes if left untreated?

They never said anything like that to me when I was recently diagnosed with Apnea, Gabby.

But I get my test for diabetes next week as you know, though the two were again not specifically linked. It was my incontinence and frequency of urination, that has led to the diabetes test – not that I expect a positive result.

Like Bob said though, weight gain – especially around the neck – can cause or exacerbate breathing issues at night that can then lead to a diagnosis of Apnea. But really you need to get a sleep study organised – though with what you have been through lately I can understand if you don't want to yet.

I do think weight gain and diabetes are linked. I also think that Rheumatiod Arthritis can play a part in swellings about the body – if what Mum tells me is anything to go by.

Seems like – as in everything in life – more than one factor might be at play :hug:

When I gave up smoking I added the pounds, and because of the ME I can't shift them as quickly as I would normally perhaps have been able. It is a bind and no mistake – especially when the clinicians are all geared up to recommend exercise at every single opportunity :aghhh:

Still. I exercise as much as I can and I have yet to meet a clinician who gets in my face about it or about me doing more. But then maybe I scare them :lol:

Nielk February 26, 2014 at 11:08 am
Firestormm

They never said anything like that to me when I was recently diagnosed with Apnea, Gabby.

But I get my test for diabetes next week as you know, though the two were again not specifically linked. It was my incontinence and frequency of urination, that has led to the diabetes test – not that I expect a positive result.

Like Bob said though, weight gain – especially around the neck – can cause or exacerbate breathing issues at night that can then lead to a diagnosis of Apnea. But really you need to get a sleep study organised – though with what you have been through lately I can understand if you don't want to yet.

I do think weight gain and diabetes are linked. I also think that Rheumatiod Arthritis can play a part in swellings about the body – if what Mum tells me is anything to go by.

Seems like – as in everything in life – more than one factor might be at play :hug:

When I gave up smoking I added the pounds, and because of the ME I can't shift them as quickly as I would normally perhaps have been able. It is a bind and no mistake – especially when the clinicians are all geared up to recommend exercise at every single opportunity :aghhh:

Still. I exercise as much as I can and I have yet to meet a clinician who gets in my face about it or about me doing more. But then maybe I scare them :lol:

See this link – http://content.onlinejacc.org/mobile/article.aspx?articleid=1699341

Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis.

This new primary care doctor that I went to yesterday explained to me this correlation which I never heard of before. I was diagnosed with sleep apnea 8 years ago and used a cpap machine for a while but was not comfortable with it and stopped using it. This doctor say that the newer models are more comfortable and even if I don't feel a difference, the cells in my body are effected. I am scheduled for a sleep study in a few days. I am sure that i have a problem because I snore a lot and keep waking up at night. This doctor says that he sees the difference in his patients who do use the cpap machine as far as their general health and especially glucose problems and metabolic syndrome problems.

Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients.
Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients.
Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. In patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (∼60%). In this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients.

Firestormm February 26, 2014 at 2:13 pm

@Nielk

I am using the CPAP at the moment – well, not right now, obviously! :)

I was impressed with how well it works – how comfortable it is – until I smashed my face into the wall one night and did something to my nose that has affected by ability to breathe as easily via this route. My CPAP was the nasal one – by choice – as I don't breathe through my mouth as a rule. Hopefully the issue will resolve itself and I can get back to using the device, or change to the full mask option which might now be more comfortable.

I'd only been using it tentatively for a couple of weeks before this incident, so it's too early to report any progress in terms of functional improvements but my specialist had also said of the success – and not so success – in patients he sees with ME/Apnea. About 50% he thought report improved function either with sleep quality or with improved daytime symptoms such as fatigue, morning hangovers, and even muscular pain/aches…

Proof for me is in the pudding, so I shall patiently wait and see. But I was pleased to observe the results from my own sleep studies. Very interesting. And you don't have to snore to have Apnea of course, but CPAP can also help resolve snoring issues.

Thanks for the info. all a bit too much for me to absorb at the moment but I shall come back to it :)

Ema February 26, 2014 at 3:46 pm
taniaaust1

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…

I avoid apples because one small one has about 20 g of carbs.

But a small orange only has about 10 grams of carbs.

Obviously the size matters when trying to compare.

I wonder why oranges are on the "high sugar" list? I like them because they have a lot more nutrients, including Vit C and calcium.

But I too only eat one small one a day and then only after a protein meal.

Ema February 26, 2014 at 3:48 pm
Nielk

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 would think you would also have to consider hormones like estrogen, progesterone and cortisol as well.

Ema February 26, 2014 at 3:51 pm
jimells

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?

Exactly. When the drug industry wanted everyone to take statins.

My doctor goes by the old rule of 100+your age/90 for high blood pressure.

Ema February 26, 2014 at 3:59 pm

I decided to try very low carb again at the first of the year and had an interesting anecdotal experience.

I ate less than 10g/carb a day for almost two weeks and could never get a urine strip to test positive for ketones.

Then I had a stressful setback and ended up having to take a mega-dose of steroids. The next day, my urine strip was dark purple indicating high ketones.

I continued the higher doses of steroids for a few days and the strips started to lighten up again – some ketones but much less.

Then another stressful setback…higher steroid dose again…more dark purple.

So clearly, cortisol is intricately involved *somehow* in producing ketones. Either too high or too low seems to throw me out of ketosis, no matter what I eat.

So I think my blood sugar metabolism is dysregulated as shown by testing on a blood sugar meter, so I'm not producing adequate energy via that pathway.

And I think my ketone pathway is also disturbed somehow due to hormonal problems – primarily with cortisol.

Now I'm on a physiological steroid dose of 25 mg HC (tapering down again) and the ketone strips are consistently light pink. But still no blood ketones.

No matter what the urine strips say, I can never get any ketones to show up in my blood.

No ketones and no proper glucose metabolism equals no proper pathway to energy to me. And so all the food I eat must just end up stored somehow as fat. :(

heapsreal February 26, 2014 at 5:59 pm

ketones are the major fuel source on a low carb diet, small amount of glucose are made from amino acids.
@Ema i am the same, very hard to get those urine strips to turn purple. I think my morning cortisol has taken a nose dive of late as i just cant get going for the first 2 hours, maybe a longer acting steroid so i have enough in my system when i wake up?

taniaaust1 February 26, 2014 at 8:28 pm
Ema

I decided to try very low carb again at the first of the year and had an interesting anecdotal experience.

I ate less than 10g/carb a day for almost two weeks and could never get a urine strip to test positive for ketones.

Then I had a stressful setback and ended up having to take a mega-dose of steroids. The next day, my urine strip was dark purple indicating high ketones.

I continued the higher doses of steroids for a few days and the strips started to lighten up again – some ketones but much less.

Then another stressful setback…higher steroid dose again…more dark purple.

So clearly, cortisol is intricately involved *somehow* in producing ketones. Either too high or too low seems to throw me out of ketosis, no matter what I eat.

So I think my blood sugar metabolism is dysregulated as shown by testing on a blood sugar meter, so I'm not producing adequate energy via that pathway.

And I think my ketone pathway is also disturbed somehow due to hormonal problems – primarily with cortisol.

Now I'm on a physiological steroid dose of 25 mg HC (tapering down again) and the ketone strips are consistently light pink. But still no blood ketones.

No matter what the urine strips say, I can never get any ketones to show up in my blood.

No ketones and no proper glucose metabolism equals no proper pathway to energy to me. And so all the food I eat must just end up stored somehow as fat. :(

Interesting post. I dont produce ketones myself easily.. even eatting 15g carb per day. I was on the Atkins diet for a while in which one wants to be eatting at a point where ketones as produced (meaning ones body then is feeding on ones fat reserves) but couldnt get it happening. I guess in a world hunger situation if there was a drought where I are, I'd be better off but its not fun not being able to easily loose more weight just with diet. I wouldnt be at all surprised if our bodies are screwed up here too.

MeSci February 27, 2014 at 4:05 am
Ema

I avoid apples because one small one has about 20 g of carbs.

But a small orange only has about 10 grams of carbs.

Obviously the size matters when trying to compare.

I wonder why oranges are on the "high sugar" list? I like them because they have a lot more nutrients, including Vit C and calcium.

But I too only eat one small one a day and then only after a protein meal.

This site ranks oranges and apples as very similar in carb, sugars and fibre.

(Per 100g)

apple: carb total 12.9, carb available 10.7, sugars 8.11, fibre 2.2

orange: carb total 11.5, carb available 9.5, sugars 8.2, fibre 2.0

Maybe the acidity also needs to be taken into account?

MeSci February 27, 2014 at 4:25 am
Ema

I decided to try very low carb again at the first of the year and had an interesting anecdotal experience.

I ate less than 10g/carb a day for almost two weeks and could never get a urine strip to test positive for ketones.

Then I had a stressful setback and ended up having to take a mega-dose of steroids. The next day, my urine strip was dark purple indicating high ketones.

I continued the higher doses of steroids for a few days and the strips started to lighten up again – some ketones but much less.

Then another stressful setback…higher steroid dose again…more dark purple.

So clearly, cortisol is intricately involved *somehow* in producing ketones. Either too high or too low seems to throw me out of ketosis, no matter what I eat.

I had acute hyperglycaemia and also urine ketones when I was not on a low-carb diet but had been through a lot of stress and overexertion. I had eaten very little due to nausea, and was feeling extremely ill. I also had near-life-threatening hyponatraemia.

I do urge all who have excess abdominal fat to trying cutting out gluten if they haven't yet tried it.

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