The Universal Currency of Human Body Energy - Essay Example

Chronic Fatigue Syndrome, Diagnosis and Solutions Introduction Chronic Fatigue Syndrome (CFS) is sometimes hard to diagnose because many of the symptoms are also found in other illnesses. However, in most cases it a symptom caused by mitochondria dysfunction. The role of mitochondria is to fund energy in form of ATP (adenosine triphosphate): the universal currency of human body energy. It can be used in all sorts of biochemical tasks from hormone production to muscle contraction. When mitochondria fail, there is a poor supply of the ATP, and so the cells go slow as they no longer have enough energy supply to function in a normal speed. The implication is that all the bodily functions go slow: feeling fatigued. The fatigue discussed here is not the kind that comes from heavy exertion, a busy day or week, or even a stressful event, such as a death of a loved one. Bed rest does not cure the fatigue, and daily functions, along with normal cognitive skill levels, are greatly reduced, such as producing a mental fog. Symptoms can last at least six months and beyond, through a lifetime. This seriously affects the patient’s lifestyle, creating problems at work, within family relationships, any educational and outside social activities (CDC, 2014a; WHRC, 2011). In this paper, we review the diagnosis of a patient who has been determined to have CFS, and what some of the solutions can be, based on the symptoms presented. Notably, women (522) are twice as often to get CFS as men (291) do, within a group of 100,000 people (Logan & Wong, 2001). The Patient’s Case History The patient is a 42-year old male, diagnosed with CFS, a body mass index (BMI) of 32, is obese, and is experiencing fibromyalgia, rheumatism, depression and anxiety, a poor sleep pattern of very little at night, with an 18-hour day. Additionally, there is heretic bowel function with nausea, diarrhoea, alternating with constipation, belching, heartburn and indigestion, along with cravings, all of which suggests potential irritable bowel syndrome (IBS). Aside from the lack of energy, the patient presents symptoms of diabetes II. The patient will be checked first for an official diagnosis of diabetes I or II, and will also be tested for muscular oxidative stress (mitochondria), and weakness of satellite cells, along with adrenal fatigue, will also be tested and measured. The patient is currently taking medication for depression, migraine and fibromyalgia. There are two widely-held hypotheses regarding the nature of CFS and associated illnesses commonly found with the overall diagnosis of CFS. The first is that fatigue is caused by psychological factors and that there is a lack of motivation and typical alertness, commonly found in healthy people (Johnson, 2013). While physical metabolism may be functioning properly, it can be assumed that low energy is caused more by stress and anxiety, tension and depression. The alternative is that it is a metabolic dysfunction, particularly in reference to faulty mitochondria oxidation of glucose to water and carbon dioxide (Myhill, Booth, & McLaren-Howard, 2009; NYT, 2008). Why and how mitochondria dysfunction happens in CFS patients The causes of the CFS are unknown, but certain studies have proposed that a defect within the energy producing element of muscle cells, known as mitochondria, may be responsible. Other studies, nonetheless, have not been capable of demonstrating this defect. It is believed that limitations in the approaches used to define mitochondrial function in the human muscle fibres may be the reason as to why causes of mitochondria dysfunction have been difficult to explore. Researchers anticipate developing a new method that will demonstrate if skeletal muscle mitochondria in victims of CFS are dysfunctional, that would result in the muscle fatigue and more complications leading to the chronic inflammation and pain. The mechanisms which lead to debilitating the muscle fatigue CFS patients are actually unknown (Alicia & Anibal, 2011). The time needed for diagnosis even complicates more the identification of factors responsible for triggering this illness. Scientists have theorized that mitochondria malfunction considerably reduce the energy supply to muscle cells which allow the body to perform its daily activities. The fatigue and inflammation which follows may cause further mitochondrial abnormalities hence the vicious cycle of the events continue. In every cell glucose is normally broken down to pyruvate accompanied with the generation of some ATP (two molecules net/molecule of glucose). Pyruvate and also the fatty acids enter mitochondria of every cell where some two coordinated metabolic processes actually take place: the TCA (tricarboxylic acid cycle), also known as Krebs citric acid cycle that produces some ATP, and electron transport chain (ETC), also known as the Respiratory Chain since it uses much of the oxygen we actually breathe in) that regenerates ATP from the ADP through the course of oxidative phosphorylation (ox-phos). Overall, at least 30-odd molecules of the ATP are generated per molecule of glucose. These constitute the principle cellular energy packets used in all life processes. As well as oxygen and food the metabolic pathways need all the nutrients intricate in the production of large number of enzymes that control the numerous biochemical reactions involved as well as all the cofactors required to activate the enzymes. Our body contains characteristically not more than 100 g of the ATP at any given instant, but may consume close to 100 kg each day. Hence, recycling ox-phos process is particularly important and it generates more than 90% of human cellular energy. The key features and processes are demonstrated in the simplified picture below. The ETC concludes with protein complex ATP synthase that is efficiently a reversible stepping motor where 3 ATP molecules are generated from ADP and the inorganic phosphate (Pi) each revolution. Given the evolutionary history ATP is created inside mitochondrial inner membrane but utilized outside in cytosol where it discharges energy by converting to the ADP and Pi. As a negative ion, the Pi is co-transported back inwards alongside H+, while the ADP3− is transported inwards via Translocator protein or adenosine nucleotide translocase in exchange for the ATP4− shifting out into the cytosol. It`s worth noting that there are potential problems at this point because it is acknowledged that certain specific molecules, such as atractyloside, block this inwards transfer and certain others may block transfer outwards. Again, there is the likelihood that there could be other molecules like environmental contaminants that can block transfers. As such, mitochondria dysfunction will occur. What happens if this process has taken place? What happens when some chunk of these cellular metabolic paths goes wrong is a question worth answering. If mitochondrial source of the energy is dysfunctional several disease symptoms might appear including some symptoms of CFS. When demand for the ATP is greater than the level in which it can actually be recycled, the muscle cells move into anaerobic metabolism in which each glucose molecule is transformed into two molecules of lactic acid. However, this process is highly inefficient (5.2% energy generation compared to 100% of complete oxidation) and may last for just a few minutes. The raised acidity leads to the muscle pain. Moreover, when the level of ADP in cytosol increases and that ADP cannot be recycled fast enough to ATP, extra chemical reaction occurs. This becomes significant if there is some mitochondria dysfunction. 2 molecules of the ADP interact to generate ATP and one of the AMP (adenosine monophosphate). AMP cannot be recycled thus half of the probable ATP is lost. This takes a couple of days to replenish and might account for post-exertional malaise sign experienced by patients. Therefore, mitochondria dysfunction results in an impaired ATP production and the recycling is, in fact, a biologically plausible hypothesis. Moreover, there is considerable evidence indicating it`s a determining factor in CFS. Some of the marginal nutritional deficiencies that are relevant for CFS are in the vitamin B group (B12 in particular), vitamin C, magnesium, sodium, zinc, L-tryptophan, L-carnitine, the coenzyme Q10. Essential fatty acids should also be looked at for deficiencies as well. Serum folic acid levels (also part of cerebrospinal fluid folic acid level) should also be tested as, if it is found to be chronically low, then this indicates a diminished brain folate that impairs brain functions (Werback, 2000). Folate deficiency also affects brain and mood functions, and may be a cause for the depression. If hypoglycemia is diagnosed instead of diabetes, treating adrenal insufficiency is the first step by changing the diet as a starting point. Like diabetes, it is better to have small meals spread out through the day, rather than one or two big ones. There should also be a decrease of carbohydrates such white flour and sugar, and use more whole grains and vegetables. Whole fruit, rather than fruit juices, are also recommended, and there should be a cut in the amount of protein eaten as well. However, if irritable, then eat a very small portion of protein, or even a spoonful of peanut butter. Peanut butter and celery, for example, make a great snack (End Fatigue, 2012). Adrenal therapy, therefore, might be the first step in working with patients with CFS, to determine if that is the source of the problems. If the adrenal glands were brought back to a normal state, then further therapy and medications could be applied in treating CFS directly. Alternative Solutions One of the first steps in providing a change of lifestyle, is getting the patient to sleep more, and more effectively. Melatonin is used to regulate sleep patterns, particularly for those people who may travel a lot and cross time zones or for those who work night shifts, such as doctors and nurses. During that time, the body’s clock is put off track and melatonin helps to nudge the body back into a reasonable sleep pattern (Steefel, 2011). Melatonin is naturally occurring hormone in the body which begins to reduce production in later ages. Most over-the-counter (OTC) Melatonin products come in 1 to 3 mg doses per pill, and the doctor can regulate how much should be taken, particularly if a higher dosage is recommended. Sleep apnoea should also be checked for by monitoring over a few nights by using a pulse oximeter which is clipped to a finger (Steefel, 2011). Other steps to take for better relaxation and sleep is to have a hot bath and/or a small carbohydrate snack, with a warm glass of milk, if tolerant. White noise, such as ocean waves or rain storms, can also be played to help relax and soothe the mind. If deciding to take supplements, it is advised to add a supplement, one at a time, to weigh the benefits (CDC, 2014b). Role of Magnesium and Coenzyme Q10 supplements in CFS patients Coenzyme Q10 (CoQ10) functions as a potent antioxidant which aids in metabolic reactions as well as the process of producing adenosine triphosphate (ATP). The molecule produced is used by our body for energy. It helps mitochondria during the energy production. It is comparable to the other Pseudovitamin compounds since it is vital for our survival. The body normally cannot generate enough for the optimal functioning and as such CoQ10 supplements may be so much helpful. A supplement of it contains components of the microcrystalline cellulose, silica, gelatin, magnesium stearate, stearic acid among other elements. Coenzyme Q10 is particularly utilized in the energy production within the cells. There are close to 100 trillion cells within the human body and every cell must generate its own energy to perform its functions. The cells generate energy by primarily burning carbohydrates and fats. This burning or oxidation procedure occurs due to oxygen combining with foodstuffs to generate carbon dioxide and water and Coenzyme Q10 is needed in all these. Another supplement which needs to be administered in CFS patient is magnesium. Magnesium is a mineral used by every cell in the body and it participates in the energy metabolism as well as the protein synthesis. The body watchfully protects the blood magnesium levels since 350 enzymatic processes are pegged on magnesium status for activation. The mineral magnesium is usually stored inside tissues and bone where it shares skeletal residency with phosphorus and calcium. Aside from medication and the vitamin supplements above, other ways of coping with various issues are also listed below to help assist in achieving a better lifestyle in coping with CFS. Alternative Medical Plan for Treatment of Symptoms Suggestions Symptom Solution What it Does Lack of Sleep Melatonin Regulates sleep patterns naturally. No caffeine products after 8 p.m. Hot bath, small carbo snack with warm milk. White noise played at night. Depression CBT Aside from medication, cognitive behavioural therapy (CBT) can assist a patient with a better outlook on life. Pain Management Massage, Acupuncture Every CFS patient must find what works best for their body and both of these (not at the same time) may provide relief and a sense of well-being, including relief from severe pain. Stiff Body, Tightness Hatha Yoga and Tai Chi This type of yoga is less active and promotes flowing, stretching movements rather than active strenuous movements. Tai Chi is a flowing movement program – a type of body positioning. Anxiety, stress response MBSR Mindfulness-based stress reduction is a meditation process (8-weeks long) whereby the patient learns to manage stress from chronic illnesses. Immune system deficiency Vitamin supplements Using the list already given, adding one at a time, is a good start. All supplements should be reviewed and monitored by the doctor first for interaction problems with medications. Lack of Support Advocacy Local and National CFS Advocacy This can be a professional who works with you and the health care provider. Also supportive family and friends. Being able to ask for help from someone who knows what you are going through. PANDORA. Poor Eating Habits Change of Diet Eating smaller meals during the day, and more often. Rather than two big meals, breaking them up into four to five smaller ones. Conclusion Elevated peroxynitrite causes dysfunctions in mitochondria processing, lipid peroxidation, as well as elevated cytokine levels. Nitric oxide forms from the elevated cytokines, and this combined with superoxide, forms potent oxidant peroxynitrite, creating a domino effect (Logan & Wong, 2001). Therefore, observing and testing the cellular processes, is the first important step in diagnosing CFS. Every CFS case is different and, therefore, it can start by tackling one problem at a time, such as in the case of oxidative stress and adrenal fatigue, as both are central players in providing the necessary hormones for further oxidation processes with mitochondria and its functional process (Parikh, 2014; Pierini, 2013; Logan & Wong, 2001). Proper diet is also very valuable, as regards diabetes and hypoglycaemia, if that is diagnosed instead. In eating the six smaller snacks during the day, this ensures that there not the rollercoaster ride of blood sugar and high or low blood pressure variables (Landa, 2012; Houdenhowve, Eede, & Luyten, 2008). It is clear that the digestive system is a big part of rehabilitation in CFS and, therefore, should be taken seriously (Fibro Friends, 2013). A strict regulated menu should be followed of all the right foods needed, and a journal should be kept of symptoms that occur when any food is eaten, particularly at the beginning, when trying to find out which ones cause problems and which can be on the menu. With the right rehabilitative program in place, along with supportive advocates, a person with CFS, can look forward to a more active life ahead. Additionally, hypnotherapy and neuro-linguistic programming (NLP), are also helpful in reformulating the thought processes, such as moving out of depression, towards a more harmonious outlook on life (NHS, 2013). Appendix: Sample Food Diet The first step is to eliminate wheat, milk, benzoates, nitrites, nitrates, food colourings and other additives, as Logan & Wong (2001) have presented in their studies. In secondary research, they observed in one study that 90% of the patients showed marked improvement in overall multiple body symptoms. In some cases, celiac disease may be diagnosed if there is improvement with the elimination of wheat products alone (Logan and Wong, 2001). Organic fruits and vegetables are also shown to be important, particularly where elevate serum levels of chlorinated hydrocarbon pesticides are observed. Therefore, pesticide use in the patients’ environment should be noted and dealt with. Here is a basic list of items to eat during the day, although each individual will have specific requirements attached to the diet, based on their medical work up. Note: Milk, wheat and corn should be eliminated as well, or at least tested for intolerance (Logan & Wong, 2001). The use of a dietary journal is essential to determining issues that arise when a new diet is begun. The journal should note when each food was added to the diet and the health status afterwards. Reference List ALICIA J. K & ANIBAL E. (2011). Mitochondrial damage induced by conditions of oxidative stress. Molecular Psychiatry journal. 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