Dr. Les Simpson

[Guest guest]

Hi All,

Last week I saw Dr. Les Simpson mentioned in some posts. He is a Dr. from New

Zealand who researched the change of shape of red blood cells in cfs-patients.

If you follow this link http://members.aol.com/rgm1/private/simpson.htm you see

a interview with Dr. Simpson by Dr. Mazlen from 1999. I this interview there is

also a e-mail address where you contact him.

I'll give you also some information I have saved on my computer a couple of

years ago (1996)

Here we go:

Dr. Simpson,

University of Otaga, Otago Mediacal School

P.O. Box. 913

Dunedin

New Zealand

M.E./CFS as a Haemo-Rheological Disorder

----------------------------------------

(These notes were taken at the talk given by Les Simpson on May 18th in

, B.C. )

Simpson's Axiom: " Persistently impaired capillary blood flow is absolutely

incompatible with normal tissue function. "

If ME is a medical entity, changed blood cells should be evident in samples

taken from patients, wherever it occurs. Samples taken from members of ME

patient groups in New Zealand, Australia, South Africa, England, Canada and

the United States (New England) show changed red blood cell shape on

analysis using a scanning electron-microscope. Therefore, ME can be said

to be a medical entity.

A preliminary study in 1984 on blood rheology suggested that impaired blood

flow might be involved in ME. Normal red blood cells are 8 microns in

diameter, yet they have the ability to squeeze through capillaries which

are less than half the cell diameter.

1986 - first report of pathology of ME showed stiffened red blood cells

have a reduced capacity to pass through 5-micron filters. ME is thus a

haemo-rheological disorder. Similarly, in 1987, a study of Multiple

Sclerosis patients showed stiffened red blood cells and poor blood

filterability.

Text-books on haemotology show that all red cells are biconcave discocytes.

Simpson showed that normal blood contains a variety of red blood cell

shapes, including those with surface irregularities, those with irregular

margins, and those that are cup-shaped. This variety can be seen in blood

taken from healthy individuals and occurs whether the sample is taken from

a vein or from the heart, where the blood is under more stress. The

abnormalities involve a shift in the preponderance of one or more cell

types. Similar observations had been made in Japan and Russia in 1972 and

1977 respectively. Thus the information has been available for over 20

years but it's significance has been largely ignored.

Simpson distinguishes between acute and chronic forms of ME. In acute ME,

he finds a preponderance of cells which may be cup, basin or dish-shaped.

The hallmarks of chronic ME are a preponderance of flat cells or cells with

surface changes or altered margins.

A long-term study of ME has shown a pattern of fluctuating symptoms.

Simpson has shown that blood analysis reveals a high correlation between

blood values and the patients perception of 'wellness' at the time the

sample was taken.

Several factors may change the environment of the blood such that red blood

cells change shape. These include: viral or bacterial infections, toxic

agents, any form of extreme stress e.g.. intense exercise, hormones and

severe emotional stress.

Studies of other illnesses show a similar change in red blood cells. These

include Huntington's Disease, Down's Syndrome, pernicious anemia and MS.

For patients with ME, the unknown aspects of the illness are most worrying.

Patients who can reach an understanding of the physical aspects of their

illness tend to worry less and they feel better. Anxiety has the effect of

changing the environment of the blood such that red blood cells change

shape, producing further symptoms. Thus, knowledge of the cause of the

illness, can in itself provide some relief. For those who are helped by

anti-depressants, Simpson speculates that the medication reduces anxiety

and therefore there is a corresponding improvement in blood flow.

Depending on the results of red cell shape analyses, Simpson recommends one

of 3 types of treatment :

1. Injections of B12 as hydroxocobalamin for those with 'cup form' cells -

approximately 50% of patients should be helped.

2. Efamol (evening primrose oil) for those with flat cells or cells with

surface changes or altered margins- it seems that about 70% of patients

with such changes benefit.

3. For those not helped by the above, gingko biloba extract is recommended,

preferably processed in Germany or Japan where there is a long history

of use. Gingko in the form of powdered leaf may not be as effective as

humans cannot digest cellulose.

Although evening primrose oil has less gammalinolenic acid than other oils

much more prostaglandin E1 is produced. Prostaglandin E1 increases the

flexibility and filtrability of red cells.

Red blood cell shape is only one determinant of capillary blood flow. The

main determinant is the mean capillary diameter which may be

determined genetically. Average capillary diameter is between 3.5

and 4 microns. Most red blood cells are flexible enough to squeeze into the

narrow vessels but cells which are stiffened or altered in shape loose the

ability to pass through. Individuals with larger capillaries tend to become

highly skilled athletes and sportsmen. Those with capillaries slightly

below average size are at risk for short term M.E. Those with even smaller

capillaries are most at risk for chronic M.E. and other conditions such as

post-natal depression and P.M.S.

During exercise or exertion, working muscles require extra blood flow to

accommodate increased need for oxygen and nutrients. Individuals with

shape-changed red cells may lack the capacity to deliver adequate amounts

of oxygen and nutrients. For this reason muscle dysfunction is common in

ME.

Capillary density of the hypothalamus is greater than in the other parts

of the brain. It was shown in 1967 that vascular disturbance in the brain

causes symptoms of memory loss, irrational behaviour, anxiety states, sleep

disturbance and body temperature regulatory changes. All these symptoms

are found in ME. Many researchers have shown impaired blood flow in the

brain. Since the brain lacks the ability to store oxygen and glucose these

essential metabolites can be delivered only when capillary blood flow is

normal. When blood flow is impaired, nerve cell function cannot be normal.

In healthy people, there are relatively fixed proportions of red blood cell

shape but it can change very quickly (in seconds).

To cope with ME, Simpson advises:

1. Avoid emotional stress - " if you see a stressful situation - walk away "

2. Avoid exertion. Work out for yourself what you can do without risking

relapse. Establish clear boundaries and extend them only gradually as

health improves.

3. Do not accept advice to exercise.

4. If you find something that helps you, stick to it.

Conclusions:

1. There is good evidence for a correlation between symptom severity and

red blood cell shape analysis.

2. There is no LOGICAL basis for treatment at the present time. I know

that 50% of those with cup forms may be helped by injections of B12 and

that 70% of cases of chronic M.E. will get relief from Evening Primrose

Oil. It is simply not known why the others do not respond.

3. No substantial progress will be made until the big laboratories unravel

and explain the mechanisms which determine red blood cell shape. When

that information becomes available, it may then be possible to devise

logical appropriate treatment strategies.

Have a nice weekend

Dennis