The Chronic Catabolic State in MS
Metabolism refers to the bio-chemical process of life, and consists of two essential processes, catabolism and anabolism. Put simply, catabolism is an energy releasing process. Large molecules are broken down into smaller building blocks. It is a breaking down process. Anabolism is an energy using process. Smaller molecules are built into larger molecules. It is a building up process.
When things are working well, there is a balance between anabolism and catabolism, and mostly fat and sugar is burned in the catabolic process to release energy. But things can go awry, and the body can fall into a chronic catabolic state, where muscle is burned for energy or to provide an essential building block that the body needs, and in this situation a person can experience unexpected weight loss, extreme fatigue, joint and muscle pain, and sleeplessness. Most people with MS (around 80%) consistently report fatigue as their worst symptom, and fatigue is most often cited as the reason for people leaving work. When people with MS turn to the literature for information on fatigue, they are likely to learn that fatigue in MS is ‘poorly understood’ and the best they might manage is some vague suggestion of ‘impaired nerve transmission’ being involved without any clear proof being offered.
Fatigue and pain of course reduces people’s capacity to exercise. A spiral of deconditioning may then result, with energy conservation strategies leading to wheelchair use and/or bedrest, all conspiring to reduce function and involvement.
People with MS often complain that although they can move their limbs, ‘there is nothing in the tank’ to sustain that movement. Could a chronic catabolic state be draining the tank and preventing it from refilling, resulting in exercise intolerance?
Many people have noted that exposure to cold, physical and mental trauma, and infection can precipitate an MS attack, and these adverse events could be consistent with the onset of catabolism, with the greatest likelihood of chronic catabolism arising due to chronic infection. But where catabolism exists in PWMS, does catabolism cause the slowly worsening cascade of pain, fatigue and physical dysfunction that we associate with progressive MS, or does the MS disease process initiate the catabolic cascade? How can we find out if we are in a chronic catabolic state, and if we are, how do we snap out of it? Will managing a person with MS out of chronic catabolism improve their function?
The author has spoken to nurses, MS nurses, physiotherapists, MS physiotherapists, exercise physiologists, biochemical researchers, dieticians, doctors and other specialists such as neurologists and infectious disease specialists, but has been unable to find any medical professional who can clearly explain the processes of catabolism, how to test for it clinically and in the laboratory, and how to switch a person out of this catabolic state.
There seems to be very little scientific literature that puts the subject into a simple diagnostic and treatment context either, and certainly not in relation to MS. Professor Tim Roberts of Newcastle University (Australia) has been investigating chronically fatiguing illness for many years and has concluded that chronic infection drives a chronic catabolic state in fatiguing illnesses such as ME/CFS and others. With certain infections, the body will remain infected forever. The body knows the infection is there, but there is not a lot it can do about it. In this state of chronic immune activation, the body can go into survival mode, slowing digestion, and diverting bodily resources. In this state it is believed that the body begins to catabolise muscle to create the building blocks for the immune war against the infection. Progressively, the body runs out of ammunition, leaving the person without the resources to fund normal activities of daily living. http://www.fatiguereviva.com/science/professor-tim-roberts/
The hallmarks of this state would be;
Chronic infection is thought to be the main contributor to catabolism, and in chronically fatiguing illnesses such as Myalgic Encephalomyelitis or Chronic Fatigue Syndrome, Fibromyalgia, Multiple Sclerosis and so on, the catabolic state may not be obvious, but subtle and maintained for a very long time. Viruses, Borellia, Mycoplasma, Chlamydophila pneumoniae, Ehrlichea, Bartonella, Babesia,
Q Fever and Rickettsia are implicated in this state. http://www.rickettsialab.org.au/#!__page-7/diagnostic-services
Anyone with MS who is experiencing unexplained weight loss, muscle wasting, and exercise intolerance, may consider the possibility that they are in a chronic catabolic state which is producing symptoms independently of any loss of nerve transmission, and contributing to their pain and fatigue, and discuss this with their health care provider(s).
The author knows of no current therapy that reliably and safely restores nerve transmission in MS. However, a chronic catabolic state, even if initiated by slowed nerve transmission due to lesion development is potentially something that can be reversed and prevented from reoccurring, improving function and quality of life.
Links:
Disturbed amino acid profiles in chronically fatiguing states http://www.sacfs.asn.au/publications/talking_point/2001/2_jun/update_2.htm
Summary of University of Newcastle work on chronically fatiguing illnesses by Hugh Dunstan
http://sacfs.asn.au/publications/talking_point/2001/2_jun/update_print.htm
The link between low blood protein (particularly albumin) and infection http://www.mercola.com/article/colds/hygiene_systems.htm
Professor Tim Roberts explains his research into chronic fatigue and catabolism http://www.fatiguereviva.com/science/what-is-fatigue/
Comprehensive outline of the catabolic state and its consequences https://www.drlam.com/blog/catabolic-state-and-adrenal-fatigue-syndrome/5441/
This article discusses cachexia (a severe form of catabolism) and sarcopenia (age related muscle wasting) http://www.lifeextension.com/protocols/health-concerns/catabolic-wasting/page-01
Low blood proteins (immunoglobulins) and low natural killer cells (chronic immune activation due to chronic infection) and the link to chronically fatiguing illness http://www.ei-resource.org/articles/chronic-fatigue-syndrome-articles/immune-dysfunction-in-cfs/
IgG immune deficiencies in chronic fatigue http://www.cidpusa.org/IgG3deficiency.html
An outbreak of ME/CFS suggesting infectious cause – note similarities to progressive MS http://www.mesupport.co.uk/index.php?page=the-symptoms-of-m-e
Similarities between ME/CFS and MS http://www.biomedcentral.com/1741-7015/11/205
Sleep Apnoea
Metabolism refers to the bio-chemical process of life, and consists of two essential processes, catabolism and anabolism. Put simply, catabolism is an energy releasing process. Large molecules are broken down into smaller building blocks. It is a breaking down process. Anabolism is an energy using process. Smaller molecules are built into larger molecules. It is a building up process.
When things are working well, there is a balance between anabolism and catabolism, and mostly fat and sugar is burned in the catabolic process to release energy. But things can go awry, and the body can fall into a chronic catabolic state, where muscle is burned for energy or to provide an essential building block that the body needs, and in this situation a person can experience unexpected weight loss, extreme fatigue, joint and muscle pain, and sleeplessness. Most people with MS (around 80%) consistently report fatigue as their worst symptom, and fatigue is most often cited as the reason for people leaving work. When people with MS turn to the literature for information on fatigue, they are likely to learn that fatigue in MS is ‘poorly understood’ and the best they might manage is some vague suggestion of ‘impaired nerve transmission’ being involved without any clear proof being offered.
Fatigue and pain of course reduces people’s capacity to exercise. A spiral of deconditioning may then result, with energy conservation strategies leading to wheelchair use and/or bedrest, all conspiring to reduce function and involvement.
People with MS often complain that although they can move their limbs, ‘there is nothing in the tank’ to sustain that movement. Could a chronic catabolic state be draining the tank and preventing it from refilling, resulting in exercise intolerance?
Many people have noted that exposure to cold, physical and mental trauma, and infection can precipitate an MS attack, and these adverse events could be consistent with the onset of catabolism, with the greatest likelihood of chronic catabolism arising due to chronic infection. But where catabolism exists in PWMS, does catabolism cause the slowly worsening cascade of pain, fatigue and physical dysfunction that we associate with progressive MS, or does the MS disease process initiate the catabolic cascade? How can we find out if we are in a chronic catabolic state, and if we are, how do we snap out of it? Will managing a person with MS out of chronic catabolism improve their function?
The author has spoken to nurses, MS nurses, physiotherapists, MS physiotherapists, exercise physiologists, biochemical researchers, dieticians, doctors and other specialists such as neurologists and infectious disease specialists, but has been unable to find any medical professional who can clearly explain the processes of catabolism, how to test for it clinically and in the laboratory, and how to switch a person out of this catabolic state.
There seems to be very little scientific literature that puts the subject into a simple diagnostic and treatment context either, and certainly not in relation to MS. Professor Tim Roberts of Newcastle University (Australia) has been investigating chronically fatiguing illness for many years and has concluded that chronic infection drives a chronic catabolic state in fatiguing illnesses such as ME/CFS and others. With certain infections, the body will remain infected forever. The body knows the infection is there, but there is not a lot it can do about it. In this state of chronic immune activation, the body can go into survival mode, slowing digestion, and diverting bodily resources. In this state it is believed that the body begins to catabolise muscle to create the building blocks for the immune war against the infection. Progressively, the body runs out of ammunition, leaving the person without the resources to fund normal activities of daily living. http://www.fatiguereviva.com/science/professor-tim-roberts/
The hallmarks of this state would be;
- The continuous production of defence proteins. A simple blood test may show if a patient has low immunoglobulins and/or albumin, creating a net protein deficit in the blood. Could this be a marker for such a state?
- Wasting of muscles, but potentially an increase in body fat (especially stomach fat) or oedema (swelling of the stomach) or feet and ankles.
- A net deficit of amino acids which cannot be replaced by food.
- Possibly an altered cholesterol metabolism.
- Possible lowering of testosterone and DHEA
Chronic infection is thought to be the main contributor to catabolism, and in chronically fatiguing illnesses such as Myalgic Encephalomyelitis or Chronic Fatigue Syndrome, Fibromyalgia, Multiple Sclerosis and so on, the catabolic state may not be obvious, but subtle and maintained for a very long time. Viruses, Borellia, Mycoplasma, Chlamydophila pneumoniae, Ehrlichea, Bartonella, Babesia,
Q Fever and Rickettsia are implicated in this state. http://www.rickettsialab.org.au/#!__page-7/diagnostic-services
Anyone with MS who is experiencing unexplained weight loss, muscle wasting, and exercise intolerance, may consider the possibility that they are in a chronic catabolic state which is producing symptoms independently of any loss of nerve transmission, and contributing to their pain and fatigue, and discuss this with their health care provider(s).
The author knows of no current therapy that reliably and safely restores nerve transmission in MS. However, a chronic catabolic state, even if initiated by slowed nerve transmission due to lesion development is potentially something that can be reversed and prevented from reoccurring, improving function and quality of life.
Links:
Disturbed amino acid profiles in chronically fatiguing states http://www.sacfs.asn.au/publications/talking_point/2001/2_jun/update_2.htm
Summary of University of Newcastle work on chronically fatiguing illnesses by Hugh Dunstan
http://sacfs.asn.au/publications/talking_point/2001/2_jun/update_print.htm
The link between low blood protein (particularly albumin) and infection http://www.mercola.com/article/colds/hygiene_systems.htm
Professor Tim Roberts explains his research into chronic fatigue and catabolism http://www.fatiguereviva.com/science/what-is-fatigue/
Comprehensive outline of the catabolic state and its consequences https://www.drlam.com/blog/catabolic-state-and-adrenal-fatigue-syndrome/5441/
This article discusses cachexia (a severe form of catabolism) and sarcopenia (age related muscle wasting) http://www.lifeextension.com/protocols/health-concerns/catabolic-wasting/page-01
Low blood proteins (immunoglobulins) and low natural killer cells (chronic immune activation due to chronic infection) and the link to chronically fatiguing illness http://www.ei-resource.org/articles/chronic-fatigue-syndrome-articles/immune-dysfunction-in-cfs/
IgG immune deficiencies in chronic fatigue http://www.cidpusa.org/IgG3deficiency.html
An outbreak of ME/CFS suggesting infectious cause – note similarities to progressive MS http://www.mesupport.co.uk/index.php?page=the-symptoms-of-m-e
Similarities between ME/CFS and MS http://www.biomedcentral.com/1741-7015/11/205
Sleep Apnoea