Cardiovascular Abnormalities

Cardiovascular dysfunction refers to the impaired functioning of the heart, blood vessels, and related systems. In patients with CFS, abnormalities in cardiovascular regulation have been observed, such as decreased heart rate variability and orthostatic intolerance. Orthostatic intolerance is a condition in which individuals experience symptoms like lightheadedness, fatigue, and fainting upon standing. Other symptoms like blood pooling, pain, cognitive impairment, exercise intolerance, pain, and others are related to poor circulation, poor blood flow and low blood volume. 

RAAS paradox
The renin-angiotensin-aldosterone system (RAAS) is a key regulator of the cardiovascular system, which is involved in maintaining blood volume and blood pressure. In chronic fatigue syndrome, alterations in the RAAS have been observed, leading to what is known as the RAAS paradox.

The RAAS paradox refers to the abnormal RAAS activity in CFS patients despite the absence of increased blood pressure or volume expansion. Specifically, CFS patients have been found to have elevated levels of aldosterone, a hormone that regulates sodium and potassium balance and is normally suppressed when blood volume is low.

The elevated aldosterone levels in CFS patients are thought to be a compensatory mechanism in response to low blood volume, which is frequently observed in CFS/ME/SEID. However, this response is paradoxical because patients tend to have normal or low blood pressure rather than high blood pressure, which would typically be associated with high aldosterone levels.

The exact mechanisms underlying the RAAS paradox in CFS are not fully understood, but some possible explanations have been proposed. One theory suggests that the increased aldosterone levels in CFS patients may be related to impaired blood volume regulation, which can lead to low blood volume and reduced blood flow to tissues. Another theory suggests that the RAAS alterations in CFS may be related to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is thought to play a role in CFS pathophysiology.

Klaus Wirth’s Research Contribution:
Klaus Wirth, a German cardiologist and scientist, has played a significant role in advancing our understanding of the cardiovascular aspects of CFS. Wirth conducted research that highlighted anomalies in cardiovascular responses to various stressors among CFS patients.

His work demonstrated that the imbalance between vasoconstrictor and vasodilator forces is causing a disruption. The vasoconstrictors are currently dominating, resulting in limited blood flow. As a result, the muscles, which are lacking in energy, are desperately calling for more blood. In response, the body releases painful vasodilating substances in an attempt to widen the blood vessels. One specific vasodilator, bradykinin, may be responsible for various effects such as the renin-angiotensin-aldosterone system’s inability to increase blood volume to the necessary levels, intracranial hypertension, small fiber neuropathy, sleep apnea, and sleep problems, with vast of symptoms like cognitive impairment, brain fog, headache, hypersensitivity, sleep disturbances and dysautonomia. This hypothesis resonates to me as a grand and unifying explanation.

One of Wirth’s studies utilized non-invasive methods, such as transcranial Doppler ultrasound, to measure blood flow in the brains of CFS patients. The findings revealed reduced cerebral blood flow, particularly in the frontal cortex and basal ganglia, leading to cognitive impairments frequently experienced by CFS patients.
I find that the work of Dr. Wirth resonates with me the most, as it effectively connects and makes sense of seemingly random and surprising symptoms.
You can check for yourself here.

Pharmacological Approaches:
Medications Targeting Cardiovascular Symptoms
Dealing with cardiovascular dysfunction in chronic fatigue syndrome can be a real challenge. One approach involves the use of medications specifically designed to target cardiovascular symptoms. These medications aim to regulate heart rate, blood pressure, and improve overall cardiovascular function. While they may not cure chronic fatigue syndrome, they can help manage the cardiovascular symptoms associated with the condition. However, because of the RAAS paradox, we need vasoconstriction and vasodilation targeting specific function, and so far there is no such drug.
Various medications have been investigated to manage cardiovascular dysfunction in CFS. For example, fludrocortisone and midodrine, which increase blood volume and constrict blood vessels, respectively, have shown some benefit in improving symptoms of orthostatic intolerance.
On the other hand, some great improvements have been reported with nitroglycerine and syldenafil with are vasodilatory drugs.

Intranasal Insulin Therapy: Some research identified a potential therapeutic approach involving intranasal insulin. By enhancing blood flow in specific brain regions, this therapy may help improve cognitive dysfunction associated with CFS.

Non-pharmacological Approaches:

Hydration – Water + electrolytes

Supplements:
Gingko to improve blood flow and oxygen delivery
Beetroot increases levels of nitric oxide (NO)
Coenzyme Q10 for enhanced circulation
L-Arginine for improved blood flow
Butchers Broom vasoconstrictor that reduces capillary permeability (natural midodrine)
Rosemary stimulates blood flow to the brain, improves blood flow and is potent antioxidant

Reduce bradykinin naturally:

The plant Mandevilla velutina contains potent pregnane glycoside compounds that have shown great promise in some studies. It is native to South America and has been traditionally used for treating inflammatory conditions and snakebite incidents.These compounds have proven to be effective in counteracting bradykinin responses and have also demonstrated strong and long-lasting analgesic and anti-inflammatory properties. However, it is important to note that the plant itself is toxic, so preparations must be handled with caution and expertise.

Areca nut (betel): In certain parts of India, areca nut is used to relieve migraines. In a study conducted on rats, an extract from this nut significantly reduced inflammation caused by bradykinin. However, it’s important to note that chewing betel has been associated with various health issues, including oral cancer. Therefore, we strongly advise against chewing betel, and wait for special extracts or formulations may be developed in the future.

Bromelain: Extracted from pineapple stems or cores, bromelain is known for its anti-inflammatory and anti-swelling effects. It also possesses analgesic properties, which are believed to be due to its direct influence on bradykinin and other pain mediators.

Aloe: Researchers have discovered that aloe contains a substance that may break down bradykinin and inhibit its effects. This could explain why aloe has powerful anti-inflammatory properties.

Linseed or flaxseed oil: This oil has been found to reduce inflammation caused by bradykinin and histamine. It contains a high percentage of alpha-linolenic acid, an omega-3 fatty acid, which has shown to counteract the effects of bradykinin and histamine in rodents.

Ginger: Ginger may help alleviate some of the negative effects of bradykinin. One of its components, 6-shogaol, has been found to block the production of inositol triphosphate in tissue studies. Since bradykinin normally stimulates the production of inositol triphosphate, this suggests that ginger may decrease the levels of bradykinin.

Polyphenols: Scientists have found that polyphenols interact with bradykinin. These compounds can be found in dark chocolate, red wine, blueberries, and spinach. Studies have shown that polyphenolic molecules affect the structure of the peptide and may inhibit its activity.

Exercise and Physical Activity Recommendations
When it comes to managing cardiovascular symptoms in chronic fatigue syndrome, exercise and physical activity can be your secret weapons. However, it’s important to approach exercise with caution and listen to your body. Start with gentle activities, such as walking or yoga, and gradually increase intensity and duration as you build up your stamina. Finding a balance between pushing yourself and avoiding overexertion is key. Remember, a little movement can go a long way in improving cardiovascular function and overall well-being.
I find The Nishi System of exercise applicable, not just because it addresses blood flow and circulation, but also because the exercises can be done in almost any of the stages of the condition.

Dietary Considerations for Cardiovascular Health in Chronic Fatigue Syndrome
In chronic fatigue syndrome, adopting a heart-healthy diet can help manage cardiovascular symptoms. Focus on consuming whole foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats. Avoid excessive intake of processed foods, sugary snacks, and alcohol, as they can negatively affect your cardiovascular system. Don’t forget to stay properly hydrated by drinking enough water throughout the day.

High-Fat Diets: In rats, a diet rich in fish and soybean oils has been shown to decrease the release of bradykinin in inflamed tissue. This suggests that further investigation should be done on the potential benefits of a high-fat diet, particularly one that includes healthy fats like polyunsaturated fatty acids (PUFAs), in relation to bradykinin.

Stress Management Techniques and Relaxation Strategies
Stress and chronic fatigue syndrome often go hand in hand, and managing stress is crucial for cardiovascular health. Incorporating stress management techniques and relaxation strategies into your daily routine can help reduce the impact of stress on your cardiovascular system. Try deep breathing exercises, meditation, yoga, or engaging in activities you enjoy, such as listening to music or spending time in nature. Finding what works best for you and making time for relaxation can make a noticeable difference in managing cardiovascular symptoms.