Tuesday, December 23, 2014
Chronic Fatigue Syndrome, Multiple Sclerosis, IBS - Any Connections?
<<A Norwegian study of ME/CFS patient records that found two age peaks in Chronic Fatigue Syndrome, one starting from ages 10-19, the other from 30-39, could tell us something about the disorder.
Two age peaks in the incidence of chronic fatigue syndrome/myalgic encephalomyelitis: a population-based registry study from Norway 2008–2012 Inger Johanne Bakken, Kari Tveito, Nina Gunnes, Sara Ghaderi, Camilla Stoltenberg, Lill Trogstad, Siri Eldevik Håberg and Per Magnus Bakken et al. BMC Medicine 2014, 12:167
The high rate of females with ME/CFS combined with the unusual pattern of incidence points a finger directly at female hormones. Three periods of major hormonal fluctuations occur in women; during puberty, during pregnancy and during menopause. Spikes in ME/CFS incidence occurred during two of these; puberty and when women often get pregnant, but not during menopause.
Sex Hormones, ME/CFS and IBS
A CDC study indicating women with ME/CFS have greatly increased rates of gynecological disorders also suggested that sex hormones could play a major role in the disorder. Despite the female predominance in ME/CFS and FM sex hormones have not been well studied in either disorder, but they have been better studied in another female dominated disorder that often co-occurrswith ME/CFS and Fibromyalgia – irritable bowel syndrome.
The same pattern of disease development over time is found in IBS. The incidence of IBS peaks in women from their teens to about their mid-forties and then declines over time. By the time women reach their seventies their incidence of IBS drops to that found in men.
Estrogen is the major female hormone produced. Its many effects on the body and its widely varying production had made it difficult to study, but Broderick’s ME/CFS model suggests that estrogen triggered dysregulation of the HPA axis may play a key role the development of Chronic Fatigue Syndrome in females.
That’s Low Estrogen – If estrogen plays a role it’s probably low not high estrogen levels that are the problem. Estrogen effects neurotransmitter production and activity and electrical excitability, and has a neuroprotective effect on central nervous system functioning.
Pain Connection – Some evidence suggests low estrogen level may play a role in chronic pain. The greater degree of emotional arousal women with IBS display in response to pain could reflect reduced estrogen levels. The association of high estrogen levels with increased opioid receptors suggests higher estrogen levels may reduce pain.
Gut Connection – Female hormones not only influence gut motility – a key feature of IBS – but also gut secretions, gut contractions, immune functioning and pain sensitivity. The fact that about a third of women with IBS issues have them only during menstruation again suggests reduced sex hormone levels could play a role. Reduced hormone levels during menstruation have been linked to abdominal pain and bloating.
Overall, the evidence suggests that estrogen probably plays a protective role in IBS, multiple sclerosis, pain disorders and possibly chronic fatigue syndrome. However, the lower incidence of ME/CFS during menopause – when estrogen levels tend to be low – suggests that more than estrogen is involved.
A Positive Role for Male Hormones
In contrast to women, age appears to play little role in the development of IBS in men: they experience no significant changes in IBS incidence throughout their lifespan.
Male hormones often get a bad rap :) but the lower rates of incidence and the lack of a discernible pattern of incidence in men suggests they may have a protective function. Broderick’s modeling studies suggest that male hormones such as testosterone are protective in ME/CFS and some evidence suggests the same may be true in IBS.
Testosterone also appears to have pain reducing properties that provide protection against the development of pain disorders. Low testosterone levels in men, for instance, have been associated with increased sensitivity to rectal pain. Some men with ME/CFS have find testosterone supplementation helpful.
Hormones, or the lack of them, may very well be a contributing factor to getting ME/CFS, but the spikes in incidence also point a finger at two other factors: viruses and autoimmune disorders.>>