Journal of IiME Volume 2 Issue 2 www.investinme.org “ “TThhee mmoorree tthhiinnggss cchhaannggee,, tthhee mmoorree tthhiinnggss ss ttaayy tthhee ssaammee”” ( (ccoonn tt ii nnuueedd )) are allowed to vary in this way are the brain, the immune system and the endocrine system. If these systems are changing appropriately, the whole organism is healthy. Disorder or disease happens when their changes are not appropriate. Ample research has shown that the major selfregulatory systems are involved in the causation of ME/CFS (brain plus CNS and ANS, endocrine and immune systems). Additional research has indicated that the fluid and energy transport system, including the circulatory system and mitochondrial transport may also be seriously involved. What we don’t know is how this all fits together and works as a self-regulatory system. It is only in the intact patient that we can observe or infer their various dysfunctions. We do not know if a single glitch can upset a lot of biochemistry (e.g. B12 deficiency, aberrant ribonuclease-L molecules, cytokine production, etc) with cure by replacement. But the whole control system that we must focus on is that regulating physical activity/rest, including the subjective feeling of fatigue as one of its essential parts. Dynamical disturbances of other sorts will be causally coordinated with other kinds of fatigue that may be implicated- cognitive fatigue, stress fatigue, immune fatigue, cardiac muscle fatigue, mitochondrial fatigue, acceleration fatigue, etc. While the overall effect of pathophysiology is inappropriate fatigue in a system designed to self-regulate overall activity in a dynamical and holistic system, any glitches responsible for this fatigue may be quite specific. Unfortunately the currently approved treatments for this condition in the U.K. (CBT and GET), are attempting to adjust symptoms using an external site of control. Thus these approaches ignore the crucial self-organizing aspect of any biological control system. I would like to compare this situation with that of the system regulating blood glucose level, Invest in ME (Charity Nr. 1114035) one implicated in the genesis of diabetes mellitus. Many patients with diabetes do not have a serious control problem. Their blood sugars may be too high, but the level is stable or changes slightly and gently. The diabetics who have a control problem are those that are designated as “brittle” because their blood sugars go up and down violently. Before the discovery of the hormonal protein insulin, the more severe diabetics mostly ran the higher blood glucose levels, and many died of diabetic acidosis. Pre-insulin physicians tried to regulate the glucose level using diet and fluid manipulations. (23) With the advent of insulin therapy, most diabetics did well, but a few remained “brittle” because they were sensitive to the insulin so that their blood sugars fluctuated up and down between tolerably high and low blood glucose levels. Because of the effectiveness of insulin therapy, new disease of hypoglycemia or low blood sugar became prominent. The biochemical system underlying this glucose control became more and more complex as problems of insulin resistance, anti-insulin hormones such as glucagon and cortisol were added to the control system as did allergic hypersensitivity to foreign insulin and contaminants of human insulin. With the new iatrogenic disease of hypoglycemia, a new system of anti-insulin hormones were engaged as the adrenalin release that a sudden drop in blood sugar caused became more important. Experienced diabetics could often consciously discern where their blood sugar was, by how there body felt when sugar was up, down, falling slowly or fast, etc. but this estimate was only rough. These estimates were originally vague but became more precise with experience. These symptoms depended not so much on the level of glucose, but on its rate of fall. Because of all these complexities, it has been a great boon for this type of diabetic to be able to measure glucose levels “on-line” as it has improved their ability to regulate their blood sugars immensely. However they have to fall (continued on page 30) Page 29/74
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