Low Anion Gap, alkalotic Blood, hyperviscosity syndrome

[Guest guest]

Hi all

Heres my latest understanding of some of the symptoms of CFS.

Ive always felt like my muscles were full of acid just like after you

have done too much exercise only it doesn't get better.

I recently read interesting info by a Dr Cheney which reinforces this

theory giving a possible explanation for this.

I have also just had a anion gap test which showed a negative anion

gap and my doctor has requested a blood gases test to see if I have

the alkalotic blood Dr cheney talks of. I wrote this piece below for

my doctor. Included is a paragraph from an article by Dr Cheney.

My Anion Gap Results

[NA]141+ [k]4.5 - ( [cl]107 + [bicarb]30 )

145.5 - 137

AG =8.5 ref-range 12-20

I did a search on the net and found another Cfs patient with an anion

Gap of 4.8 ref rage 10-18

This was her only abnormal result.

Low Anion Gap, alkalotic Blood, hyperviscosity syndrome

Dr cheney ( prominent Cfs Doc ) says that blood gases results in Cfs

patients often show alkalotic blood which accompanies increased serum

bicarb levels .

His explanation is as follows.

Blood alkalosis inhibits the transport of oxygen to tissues and

organs, constricts the blood vessels, and lowers overall circulating

blood volume. The putative cause of the alkalosis is the glutathione

deficiency that is pervasive in CFIDS. Low glutathione causes an

elevation in citrate, which in turn lowers a substance (2,3 DPG) that

controls the release of oxygen from the haemoglobin. Our blood could

be full of oxygen, but without enough of this substance it cannot

break free of the haemoglobin and get into the cells. This causes

oxygen deprivation in the tissues (hypoxia), which makes the body

switch over to anaerobic metabolism, and that produces tissue

acidosis, which can be painful. (The acidosis here is unusual because

instead of generating a lot of carbon dioxide, it generates a lot of

organic acids that stay inside the cell.) The body compensates for

tissue acidosis, in part, by increasing renal bicarbonate re-

absorption, and hence developing blood alkalosis.

This blood alkalosis is unusual in that Cheney usually sees venous

blood pH values over 7.4 and urine pH values under 6.0. (Optimum

venous pH values are 7.30 to 7.35.) When both blood alkalosis and

urine acidosis are seen, it's a metabolic problem – not a

psychogenic

reaction to a needle stick. A blood pH above 7.4 shows impairment,

and above 7.5 there is significant impairment – almost no oxygen

transport at all. A urine organic acid test will also reveal this

problem: elevated citrate and/or low 2-oxo-glutaric are markers.

My Comment

Researchers in Australia have found high citric acid levels in the

urine of CFS patients. I have had this test and had this increased

urinary citric acid.

The reactions to foods which many cfs patients have may be due to

attempted adjustment of the bodies acid base mechanism and resulting

hypoxia in the muscles. This could also be happening when exposed to

chemicals as the respiratory system also effects the acid base

metabolism. Breathing in chemicals which might effect the acid/base

balance and could trigger a cascade of symptoms which may continue to

worsen without some sort of intervention. This also may explain why a

low carbohydrate diet helps calm symptoms. Consumption of

carbohydrates probably effects the acid base metabolism more than

other food type.

Dr Cheney recommends increasing the gluthathione levels to increase

2 3 DPG thus breaking the cycle. He uses a product called immunicol

for this which contains a large amount of the amino acid cysteine. I

have used just the amino acid cysteine and found it to be very

beneficial for reducing symptoms.

An illustration of this possible mechanism.

When I was doing up an old house the fumes from paint would make my

muscles very sore quickly. I would return home and take 1000mg of l-

cysteine and within 1 hour my muscle pain would subside

substantially. If I didn't take the l-cysteine the muscle pain and

all symptoms would not subside but would bring on a long term

worsening of symptoms. L cystein seems to calm most of my reactions

quite a bit.

All this could have some relationship to Dr Simpson's ( New

Zealand

scientist ) work showing changes in red blood cell shape. The rapidly

changing red cell shape could be a reaction to the blood alkalosis

which would in turn perpetuate this cycle. If the red blood cells

cannot move through the capillaries easily as in another condition

called hyperviscosity this alkalotic blood and low anion gap might

occur as it does in hyperviscosity syndrome.

Dr Simpson breaks this cycle by prescribing evening primrose oil

which helps the red blood cells become more pliable enabling them to

move through capillaries more easily.

In hyperviscosity syndrome they place importance on hydrating the

patient to help the red cells move through capillaries thus calming

down this situation somewhat and protecting the internal organs .

Organ damage can result from this situation. The current line of

thinking about some autoimmune diseases is that hyperviscous blood

may be responsible for organ damage, pain and fatigue. Thick or

hyperviscous blood may be more likely to affect women because their

blood vessels are smaller.

The reason Cfs patients waken feeling so bad may be that the the

capillaries have really clogged up overnight making the whole

situation worse.

I find that often although my hands and feet are warm, parts of me

will be very cold eg any fatty part of the body. This may be due to a

lack of blood moving through the capillaries.

Hyperviscosity might be responsible for the low blood flow through

the brain of Cfs Patients and difficulty with concentration.

Re-hydration is important but I would not use salt as salt produces

more acidity in the body which the body would then have to counter

thus perpetuating the cycle. I would also not use glucose as it may

require buffering and therefore increase the problem.

I find hot baths very helpful for reliving pain. This may be because

the heat helps the blood flow through the capillaries.

Sleeping on a water bed with the temperature turned up also makes all

my symptoms better the next day. This can be a bit umcomfortable but

definitely lessens my symptoms. This may help the blood circulate in

the capillaries more easily thus calming the acid base muscle hypoxia

cycle.

This instability of blood and muscle PH may cause the acute

hypersensitivity to foods and chemicles which cfs patients often

experience. Inhaled chemicals may lower glutathione therfore

decreasing 2 3 DGP and increasing symptoms.

All of this may point to a new treatment protocol of a low acid

forming diet plus high water intake plus Dr Simpsons remedy for the

red cells of evening primrose oil together with other treatments such

as L Cysteine to increase intracellular glutathione.

I will be trying this protocol as soon as I have had the blood gases

test done.

squirel