Re: Midodrine (Pro-amatine), orthostatic hypotension, and CFS

[Guest guest]

Rich - Would supplementation of tyrosine be helpful then?

Beth

" As regular readers may recall, I have suggested in the past that

PWCs who have orthostatic hypotension may have a shortage of

norepinephrine in the sympathetic nerves that serve the veins of the

lower body, thus allowing pooling of blood there when they stand

up. This was based on the work of the late Dr. Streeten.

I have suggested that this shortage of norepinephrine results from the large

continuous demand on tyrosine, the amino acid precursor of norepinephine, by

sympathetic nerves serving the arterioles in the skin. "

Rich

[Guest guest]

Rich

how might Raynaud's phenomenon fit in here? I believe that Raynaud's

is a hyperconstriction of the blood vessels in the hands and feet in

response to cold temperatures.

thanks

bill

> Hi, all.

>

> A recent paper by Naschitz et al. was posted on Co-Cure by Ray

> Colliton:

>

>

> " Dysautonomia in chronic fatigue syndrome: facts, hypotheses,

> implications.

>

> Journal: Med Hypotheses. 2004 Feb;62(2):203-6.

>

> Authors: Jochanan E. Naschitz, Yeshurun and Itzhak Rosner

>

> is available in PDF format at

> http://www.cfids-cab.org/rc/Naschitz-1.pdf

>

> [AOL: <a href= " http://www.cfids-cab.org/rc/Naschitz-

1.pdf " >Here</a>] "

>

>

> The main thrust of this paper is that measurements of

cardiovascular

> reactivity might be helpful in the diagnosis of CFS.

>

> However, the paper also reports on a small study of the use of

> midodrine (Pro-amatine) in CFS. This drug is an alpha-1 adrenergic

> agonist, and as such it acts as norepinephrine would to cause

> constriction of blood vessels, thus remedying orthostatic

> hypotension in some people.

>

> As regular readers may recall, I have suggested in the past that

> PWCs who have orthostatic hypotension may have a shortage of

> norepinephrine in the sympathetic nerves that serve the veins of

the

> lower body, thus allowing pooling of blood there when they stand

> up. This was based on the work of the late Dr. Streeten.

>

> I have suggested that this shortage of norepinephrine results from

> the large continuous demand on tyrosine, the amino acid precursor

of

> norepinephine, by sympathetic nerves serving the arterioles in the

> skin. Because of the low metabolic rate in CFS (which I have

> suggested is caused by partial blockades in the Krebs cycles of the

> red, slow-twitch skeletal muscle cells resulting from peroxynitrite

> elevation (the latter also theorized by Prof. Pall),

> secondary to glutathione depletion there), the sympathetic nervous

> system decreases blood flow to the skin to decrease the heat loss

> and thus to conserve scarce body heat.

>

> I think that this new paper supports this model. These researchers

> find that use of midodrine helps the orthostatic hypotension

problem

> as well as improving the state of fatigue. I think that the use of

> midodrine probably improves the blood flow to the brain by

> constricting the veins in the lower body. Perhaps it also relieves

> some of the demand on tyrosine and also on glutathione, which is

> needed to detox some of the products of excessive norepinephrine

> production. This could be the explanation for improvement in the

> fatigue status.

>

> I think that the success of FIR heater or sauna treatment also

> figures into this. I think it warms the tissues, raises the

> metabolic rate, and relieves the demand on norepinephrine,

tyrosine,

> and glutathione, as does the use of midodrine.

>

> So far, I think this model is hanging together.

>

> I do want to caution people that midodrine can cause elevation of

> blood pressure in the supine position (lying on one's back) in some

> people. But it may be helpful as part of a treatment program for

> some PWCs. Of course, people should consult their doctors about

the

> advisability of using it in individual cases.

>

> Rich

[Guest guest]

Hi, Beth.

If my hypothesis is correct, supplemental tyrosine should be

beneficial in relieving some symptoms of CFS in PWCs who have low

peripheral body temperature, who feel cold much of the time, and who

have orthostatic hypotension, since these people would be most

likely to be low in tyrosine.

A paper was published last year by Georgiades, Behan et al.

reporting that blood plasma levels of tyrosine were " significantly

lower at all time points in the CFS patients. " I think this

observation supports my hypothesis. There was also a paper from

India published last year by Kurup and Kurup that reported that

decreased levels of tyrosine catabolites--dopamine, noradrenaline

and morphine were found in patients with ME. This may also be

consistent with my hypothesis.

Rich

> Rich - Would supplementation of tyrosine be helpful then?

>

> Beth

>

>

> " As regular readers may recall, I have suggested in the past that

> PWCs who have orthostatic hypotension may have a shortage of

> norepinephrine in the sympathetic nerves that serve the veins of

the

> lower body, thus allowing pooling of blood there when they stand

> up. This was based on the work of the late Dr. Streeten.

>

> I have suggested that this shortage of norepinephrine results from

the large continuous demand on tyrosine, the amino acid precursor of

norepinephine, by sympathetic nerves serving the arterioles in the

skin. "

>

> Rich

>

>

[Guest guest]

Bill,

Yes, Raynaud's phenomenon and Raynaud's disease involve

hyperconstriction of the arteries supplying blood to the fingers or

toes, not just the skin on the fingers or toes, but the entire

fingers or toes. It isn't understood what causes this, but there is

evidence that adrenoceptor blockers will prevent it, so it appears

that the sympathetic nervous system is secreting too much

norepinephrine from the nerves that control the arterial blood flow

to the fingers or toes, as the case may be.

It would be interesting to know whether Raynaud's phenomenon or

disease are observed to occur in PWCs who have low body temperature

and orthostatic hypotension. I would expect that this would not be

very likely, since I would expect that norepinephrine would be in

short supply in these folks.

Rich

> Rich

>

> how might Raynaud's phenomenon fit in here? I believe that

Raynaud's

> is a hyperconstriction of the blood vessels in the hands and feet

in

> response to cold temperatures.

>

> thanks

> bill