Journal of IiME Volume 2 Issue 1 www.investinme.org WHO GETS ME AND WHY - The role of impaired capillary blood flow in ME (continued) Wagnall and the Oxford Concise dictionary define fatigue as the consequence of long-continued exertion, but ME people do not have to run up stairs to feel tired. The authors of a 1921 study of industrial fatigue noted that they could not measure or define ‘fatigue’ and it was recommended that, “The term fatigue should be absolutely banished from precise scientific discussion.” (16) Sir John Ellis noted in a paper titled “Malaise and fatigue,” (17) that patients seldom used such terms. Instead, “They complain of being tired and not feeling well…they say they are knackered, bushed, beat, washed out, drained or utterly exhausted…. They add that it started gradually some time ago, and then say their tiredness is inexplicable.” Although the use of the term ‘fatigue’ may invite controversy, muscle fatigue is an accepted physiological condition. In accordance with the idea that poorly deformable red cells would impair capillary blood flow sufficiently for muscle function to be interrupted by an inadequate oxygen delivery rate, this concept was tested in ME people and in healthy subjects. A healthy young woman acted as a guinea pig and it was found that the repeated pulling of a trigger until trigger finger fatigue, led to a three-fold increase in cells with altered margins in the 35 seconds taken to induce muscle fatigue. (18) Unexpectedly, in applying for approval for a study involving ME people, the Ethics Committee ruled that ME was an unknown entity, but approval was obtained by substituting “subjects with chronic tiredness,” for ME. The study took place at a weekend residential meeting of members of ME support groups where 69 ME volunteers took part. (19) After a 5-drop blood sample had been taken, the trigger of a model revolver was pulled repeatedly until the onset of trigger finger fatigue. A second blood sample was obtained and the number of trigger pulls and the elapsed time were recorded. Five minutes later the procedure was repeated. Subsequently the procedure was repeated in 72 healthy controls who were police officers, firemen, army personnel, nurses and teachers. In general, the results showed that at baseline, ME people had different red cell shape populations from controls and they had fewer trigger pulls with greater changes in their post-trigger pulling blood samples. It was concluded that, “The association of increased nondiscocytes and impaired muscle function could indicate a cause and effect relationship. This would be in agreement with the physiological concept of fatigue as a consequence of inadequate oxygen delivery.” So it is relevant that in his textbook of human physiology, (20) Griffiths noted that muscle fatigue probably was due to oxygen deficiency and the effects of localised accumulations of metabolites including lactic acid, “…when the metabolites were not removed because of impaired capillary blood flow.” Wiles et al (21) considered that energy generation would fail if there was an enzymatic block in Invest in ME (Charity Nr. 1114035) Fig 1: A scanning electron micrograph which shows the red cell population typical of chronic ME, where flat cells are the dominant type. you can find cells with surface features such as bumps, (cells with surface changes) and cells with irregular margins (cells with altered margins). Cells with the shape of biconcave discocytes can be seen at the margins at 2 o’clock, 5 o’clock and 9 o’clock. According to textbooks all red cells have this shape. ‘abnormal’ as they are part of the cell shape populations of normal blood. the glycogenolytic pathway or if there was a failure of oxidative metabolism. They considered the limiting features of energy generation to be blood flow and oxygen delivery. While much has been written about ‘Tired patients,’ and ‘Tiredness,’ a 1960 paper by Ffrench (22) is of special interest. Ffrench considered that, “Tiredness is a symptom rather than a clinical condition,” and that, “Tiredness is a ‘whole’ symptom. It is felt throughout the patient’s body and is not confined to regions, anatomic structures or specific physiological functions, but rather it emanates from the natural whole of the human body and mind.” His study involved 1170 patients, of whom 105 complained of tiredness. After discussing the possible contributions of a number of a number of factors, Ffrench concluded, “There is no doubt that oxygen lack is the first cause of tissue cell exhaustion, which is manifested early by clinical tiredness.” BRAIN DYSFUNCTION AND CAPILLARY BLOOD FLOW It is postulated that the effects of shape-changed, poorly deformable red cells will impair capillary blood flow on a wide basis, with the most severe effects relating to regions small capillaries in tissues which are sensitive to oxygen deprivation. (Continued on page 29) Page 28/34 If you look carefully Note that none of these cell types are
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