Presentation: Paul Cheney, MD, PhD New Insights into the Pathophysiology and Treatment of ME/CFS. October 2001
Date: 11 may 2002
Summary of Cheney lecture
Reprinted with permission of Doris Brown
Phase 1 - onset or trigger phase - you came down with something, didn't get over it. This is the elevated RNaseL stage. RNaseL fights virus and intracellular bacteria like mycoplasma. Or it can be elevated without cause. This is why you feel crummy, like you have the flu. Also get TH1 suppression, TH2 activation. Perhaps this immune dysregulation causes your infection to not resolve properly, and you move into phase 2.
Phase 2 - Classic CFS (energy, brain and pain problems) 5% don't have pain 99% have cognitive disturbance in areas of the subcortex.
Phase 3 - dynamic injury phase You can have elements from each at any one time, but one is usually primary
In phase 1 and 2 you have symptoms, feel terrible. Phase 3 he calls dynamic dysfunction. You feel relatively ok, but you can't do things because you know you will suffer later. You go through the push/crash cycle enough that over time you withdraw your boundaries. But another thing that happens is the pathology of the illness knocks out the dynamic hormone response, and causes you to be "in a box". This is a lesion of the hypothalamus which downregulates HPA axis, growth hormone is deranged, DNA gene rearrangements occur.
A. Growth hormone allows you to exercise, controls hypoglycemia, helps phase IV sleep which allows you to detox at 3am. Without growth hormone you lose
B. Cortisol - is supposed to respond to stresses. So you can't work, deal with complexity, with irritable people or stress. This has the biggest effect on your capacity to work.
C. Female sex hormone go crazy. PMS, infertility, ovarian cysts, bleeding or amenorrea.
D. Anti-diurectic hormone controls your fluid balance. No dynamic response and you pee too much, reduce blood volume.
(Note: it is good to generally stay in your box, but occassionally you should try to push past, so you know where the boundaries are. Then you don't make them smaller and smaller unneccesarily.)
Two reasons why antibiotics might be helping PWC's besides killing bacteria like mycoplasma. One is by killing gut bacteria. In a UCLA study, they killed small bowel bacterial overgrowth and got major improvements in symptoms. Another is that antibiotics like erithyromycin and doxycycline affect gene rearrangements. They could be modulating the illness because they are preventing gene rearrangements.
Phase 1 - high RNaseL destroys human RNA. High RNaseL highly affects liver function, so in phase II your liver is not functioning and unable to handle toxicity
There is a lot about physical exams. Interesting was: 92% of PWC's have poor oxygen transport. If you breathe out and hold your breath, your body should pull oxygen out of your blood. In 70% of PWC's this doesn't happen. There is oxygen in your blood, but your body doesn't transfer it into tissues when it should. This would cause fatigue, pain, microorganisms that live in low oxygen environements to thrive (like mycoplasma, chlamydia pneumonia.)
50% of patients have fingerprint destructions, and 10% have no fingerprints. Studies have shown there is an immune activation in the skin cells, and you
Low body temp 30%
Then there is a whole bunch about the biochemistry and what is going on.
Using magnesium loading tests (which still aren't totally accurate but the best they can do) 50% of PWC's are depleted, and 50% of those cannot be repaired with any amount of magnesium you give them. So magnesium is recommended even if tests show it is ok. (I wrote a separate email about magnesium and its other benefits.)
Oxygen transport is screwed up
Discusses mitrochondria and cellular energy
Mitochondrial dysfunction is why exercise makes you worse.
Studies show low B12 levels and high homocysteine levels in the brain, even though not in the blood.
Kutapressin inhibits all known human herpes viruses in a test tube
Phase I: high RNaseL and TH2, coagulation
Isoprinisine (from Europe) is the best for intracellular immunity
Phase II: xenobiotic toxicity phase
Phase III: Hypothalmic injury / dynamic hormone response lost / DNA changes
Step I Lifestyle adjustment
General metabolic support
Step II Neuroprotection via Threshold Potentials
The subject was "Neuroprotection via Threshold Potentials" and is based primarily on research in Scientific American over the past 10 years.
These receptors opose each other and create an electrical potential, a set point where your brain works optimally. The response of the brain to injury is to drop the threshold potential. This causes a number of problems such as lights are too bright, noises are too loud, people are irritating, etc. You also don't sleep well with a lower threshold potential.
On a straight line of threshold potentials, at the left side is Seizure, and at the right side is Coma. Coma is actually a very healing state. (2 Cheney patients went into unrelated Coma's and CFIDS improved dramatically.) So for many reasons you want your threshold potential higher. In CFIDS people it tends to be low, and we need to raise it.
The best drug to raise it is magnesium. This is an NMDA blocker. Also at least people with 50% of people CFS are low in magnesium in their cells (even if it measures ok in the blood), so you get two benefits from magnesium.
Cheney says if you come into the hospital with severe brain problems and they can't figure out what is wrong with you, they inject you with magnesium to raise the threshold potential and protect the brain until they figure out what is wrong. This is the same reason he recommends magnesium, to protect the brain in this way.
(Note: One thing he didn't address and I am not sure of, is he also recommends klonopin which appears at the other side of the equation. So I'm not sure how that fits in. I have seen literature that klonopin is believed to reduce small seizures and thus contribute to better sleep, which would imply it moves it up the threshold potential curve also. But I thought he said "NMDA blockers and Gaba agonists opose each other..." So I am a little confused on this.)
Neuroprotection from CNS toxicity
Step IV Toxic Source Attenuation
Oral Cavity: microbial toxicity source
Heavy metals (metal load is different than how toxic the metal is to you.)
Cheney likes chlorella tablets for mercury. Start slow and work your way up. Believes is safer than pharmaceuticals. If you take 2 chlorella and
Beware that detoxification can immobilize toxins too fast. MSM is particularly troublesome that way. Go slowly.
* Growth hormone injections
Teenagers get better much more than older people. Why? He believe growth hormone. A 10 year old has 10 times the growth hormone as a 30 year old.
6 of 9 in study were good to excellent responders. Other 3 were in the group that didn't get immune modulation, and they had joint pain especially in wrists. At least 3 are back to work in demanding jobs.
Growth hormone must be kept a low dose once or twice a week, or patients get worse patients must be immune modulated before starting GH or GF
Risks of GH: If you have cancer, it mayincrease the growth rates (it does in test tubes, not so clear in animal studies where sometimes the immune system
He gives 0.2mg once a week. This is low enough that isn't a problem in 99% of people. Some people can take more, but is riskier.
The more well the patient is, the better they do. GH is best for people who have gone through the worst, come back up, but are still 30-40% away from
Growth Factor seems to activate the immune system, cytokines, which causes joint pain.
Functional response of GH and GF are much better if you take them together. But GF is packaged in packages large enough for 10 doses and can only be
Q. Should high cholesterol be treated with drugs?
Tests he orders:
He has kits sent to you in the mail so you can get them done cheaply, then you see him when results are in.
Q. Oral Thymus?
Q. Does CFS affect aging?
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