Blog - Hypothesis: ME/CFS as a Breakdown in Homeostasis, 2021, Marks

[Andy]

https://davidfmarks.com/2021/03/08/me-cfs-as-a-breakdown-in-homeostasis/

Here I present a new theory of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a disabling and complex illness affecting tens of millions of people worldwide.

The Centers for Disease Control and Prevention (CDC) defines ME/CFS as follows:

People with ME/CFS are often not able to do their usual activities. At times, ME/CFS may confine them to bed. People with ME/CFS have overwhelming fatigue that is not improved by rest. ME/CFS may get worse after any activity, whether it’s physical or mental. This symptom is known as post-exertional malaise (PEM). Other symptoms can include problems with sleep, thinking and concentrating, pain, and dizziness.

There is no agreed scientific explanation of the disorder, no treatment and no cure. The most popular theory has been that the condition is psychosomatic. In my view, this theory is completely wrong.

Here I present a new theory suggesting that ME/CFS is a multi-system disorder disorder in which the homeostasis of the body is broken. Homeostasis is a fundamental physiological principle that ensures equilibrium, stability and safety of the organism in a continuously changing and potentially life-threatening environment.

 

[arewenearlythereyet]

Oh my goodness where to start .... let me try and summarise kindly ....rather a rambled jumble of loose conjecture?

 

[Creekside]

I agree with arewenearlythereyet: this 'Nobel-candidate' hypothesis seems to boil down to: "something in the body is malfunctioning!". Unless there's an effective "repair homeostasis" treatment, it's not a useful hypothesis.

 

[InitialConditions]

This isn't a new 'theory' or 'hypothesis', so I'm not sure why it's being presented as one. There's nothing new being brought to the table. The article is essentially a quick literature review of various strands of in-vogue research topics in ME/CFS.

Also, it seems David isn't familiar with the issues identified with the Myhill mitochondria work. I personally would not be prepared to cite any of that work until the disparities in the findings are cleared up. And surely it wasn't Myhill who first introduced the topic of mitochondrial dysregulation / 'failure' into ME/CFS?

 

[dave30th]

I wasn't aware David Marks, who is the editor of Journal of Health Psychology, maintained his own blog.

 

[MSEsperanza]

There is also a chapter on "Long-term conditions: Diabetes and ME/CFS" in the book Marks co-edited with Michael Murray and Emee Vida Estacio:

Health Psychology: Theory, Research and Practice (2020)

https://uk.sagepub.com/en-gb/eur/health-psychology/book271094#contents

It's the 6th edition already. (Haven't read it.)

 

[Mithriel]

I have not read the article but a breakdown in homeostasis is one of the most severe of my symptoms and one that has been present right from the start.

Nothing reacts quick enough. I am cold but don't heat up for ages, then I can't cool down for instance.

 

[Trish]

This is one of a series of articles about ME/CFS just published by David Marks on his blog.

The rest are focused on the history and problems with the Wessely school BPS model, discussed on this thread:
https://www.s4me.info/threads/articles-by-david-f-marks.19512/
Those other articles are pretty good, I think.

However, I'm less impressed by this attempt to create a biological model. The research papers he discusses are not all of high quality. I think it's better for a psychologist to stick to his area of expertise, not try to create biological theories. His theory of 'breakdown of homeostasis' seems to me to be just saying, something in the nervous system, endocrine system, and/or immune system, is out of balance, which doesn't advance understanding at a deep enough level to be useful.

 

[alex3619]

This isn't a new 'theory' or 'hypothesis', so I'm not sure why it's being presented as one.

I was discussing the general concept of homeostasis failure about CFS in the 90s, and probably mentioned it a few times on Phoenix Rising. To be new we need specifics, including testable predictions, and not just an overview of current hypotheses. As a general concept I think its likely to be valid, just as it was in the 90s. Scientific advances need more than that.

This seems to be a high level umbrella concept, useful for talking points only.

 

[TiredSam]

According to Barbara Ehrenreich (Natural Causes) homeostasis is just another dodgy concept that has been accepted without much question since it was coined about 100 years ago. Your cells do what they want and go to war with each other without reference to you or anything you do. Macrophages actively promote the spread of tumors. Autoimmune diseases happen. The image of the body as a harmonious whole which we should all be striving for is a great way of selling diets, fitness regimes, supplements and persuading people to participate in pointless medical rituals, but it's only one model. Another is one of various parties constantly at war with each other. So first prove that homeostasis / equilibrium is a thing, then we can talk about whether a breakdown in this thing is the cause of ME.

 

[alex3619]

So first prove that homeostasis / equilibrium is a thing, then we can talk about whether a breakdown in this thing is the cause of ME.

That is why you need specific testable mechanisms. Homeostasis is just a term for set points and feedback and feedforward loops in a complex system. Its the specific mechanisms that matter when you want to advance the science or find ways to intervene.

In engineering you might have a sensor connected to an effector mechanism that lowers something when it gets too high, or the reverse. The complication in biological systems is there is not always a sensor nor specific signal, organic molecules often act as their own sensors and effector mechanisms by altering chemical reactions as the concentration changes, including local concentrations (which may not match blood concentrations); this is further complicated by all sorts of mechanisms including enzymatic thresholds, epigenetic changes and so on. These concepts have their place in introducing the topic, but advances come when you go much deeper and make specific testable predictions.

 

[Sean]

Assume the body is a set of Lego blocks, and suddenly everything fits into place.