The Energy Disorders: Diabetes, ME/CFS and FM

The Energy Disorders: Diabetes, ME/CFS and FM – Can Diabetes Tell Us Anything About Chronic Fatigue Syndrome and Fibromyalgia? :: Health Rising

In the last year or so we’ve seen four studies published (1,2,3,4) that have found objective evidence of small fiber polyneuropathy in FM patients suggesting that the ‘central sensitization’ theory of FM may be at best incomplete. In fact peripheral nerve damage may be driving pain in FM – but what’s causing the nerve damage?

Small fiber neuropathy can also cause enteric (digestive) and autonomic dysfunction (5).

Peripheral neuropathy is an expanding public health problem, seen in nearly 40 million individuals in the United States. Many of these individuals will have specific damage to small myelinated and unmyelinated nerve fibers, either in isolation or in combination with injury to larger myelinated nerve fibers.

Despite extensive diagnostic evaluation, up to 50% of individuals with small fiber neuropathy ultimately may be given a diagnosis of “idiopathic”. Regardless of the underlying etiology, pain is a common and often problematic feature of small fiber neuropathies. Therefore, therapy is tailored toward identification and treatment of the underlying cause of the neuropathy, when possible, while simultaneously managing symptoms of pain

One of the diseases most associated with neuropathies is beriberi that results from a deficiency of the B1 vitamin (thiamine) which is involved in a wide variety of glucose  metabolism-related and neurological functions.

Benfotiamine (a fat soluble thiamine analogue) is commonly used to counter peripheral neuropathy in Germany (7). The ME/CFS and FM patients reporting improved symptoms using high dose B1 supplements could be improving their glucose (as well as fat) metabolism and neurological functioning.

Diabetes and Related Disorders – The High Sugar/Low Energy Connection: a Short Primer

What may be discussed less often are the daily consequences of the inability to efficiently extract sufficient energy from blood glucose, such as fatigue and exercise intolerance.

Leptin, one of the hormones implicated in diabetes, is involved in appetite regulation and fat storage.  Increased leptin levels tell the body that you’re fully fuelled allowing you to increase your energy level, metabolism, and mental sharpness. Low leptin levels tell the brain that you need to eat, slow your metabolism, and reduce your mental sharpness. Leptin is also an anti-depressant that reduces neuronal excitation.

The fact that low HRV often predates diabetes and is commonly found in ME/CFS and FM suggests ME/CFS and FM patients should take care with their diet and, to the extent they can, maintain some  sort of mild exercise regimen. (34)

The findings underscore the multidimensional impact a low-grade systemic inflammatory state involving the innate immune system may have in various disease

The slowed thinking and problems with ‘mental flexibility’ found in ME/CFS and FM appear to mirror both research findings and subjective experiences in ME/CFS.

Interestingly, ‘major’ changes in glucose regulation may not be necessary to cause brain damage and cognitive decline.  Frequent spells of mild hypoglycemia may be all that’s needed to induce microglial activation and neurodegeneration in diabetics (16).

A chronic inflammatory state appears to be the cause of the peripheral neuropathy in diabetes and the resulting neuropathic pain, and could underpin widespread pain in FM and ME/CFS.

“What if skin biopsy suggests that you have small-fiber polyneuropathy (SFPN)?Identifying the cause of SFPN can help doctors and patients choose better treatments, so we recommend that patients with skin biopsies interpreted as SFPN seek advice from nerve specialists to look for its underlying causes.”If you have some of the symptoms of peripheral neuropathy, objective testing might just confirm this and identify an underlying and treatable condition.

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