Energy production and autonomic dysfunction: how are they connected?

If there was a general dysfunction of the autonomic nervous system, what effects would that have on energy production?

I know that insulin release is (partially?) dependent on signals from the autonomic nervous system.

Autonomic dysfunction of the POTS type can be associated with increased levels of noradrenaline, which if I'm not mistaken increase energy metabolism.

A poor regulation of blood circulation would be expected to have some effect on energy metabolism as cells need to adapt to less than ideal oxygen levels.

I'm not sure but the ANS probably affects the thyroid-pituitary-adrenal axis. Which would affect energy metabolism, and also regulation of fluid balance in the body.

Anything I'm missing?

Could this kind of interaction have significant effects on energy metabolism?

 

For a general simplified overview: they are all inter-related with complex feedback systems. Often I use the term HPA (HP-adrenal) as medical short-hand for the Pineal-Hypothalamic-Pituitary-End Organ (Hormonal Pathways) and all the other organs connected within this feedback loop, and other organs that produce hormones and are also feed-backing into this system. New hormones and understanding of feedback loops are being discovered all the time.

End Organs are, for example pancreas (insulin production and maintenance of blood sugar, when you get low in blood sugar it triggers various sympathetic ANS systems to preserve brain glucose for survival and triggers the adrenals to secrete noradrenaline and adrenaline, works on mobilising various energy stores in the liver, via the hormone glucagon, which acts on adipose tissue indicating it should start burning fat, if insulin gets too low, adrenaline triggers pathways in the brain to feel the sensation of hunger, makes your heart pump faster and redistributes blood supply via vasoconstriction to the muscles to mobilise energy metabolism pathways so can seek out food. It is also tied in with glucocorticoid release (cortisol) from the adrenal gland and it’s feedback loops. Adrenals also produce mineralocorticoids (aldesterone) that regulate fluid balance.

The thyroid produces thyroxine that also regulates energy production and has interconnections with the ANS, excess thyroxine can appear like high adrenaline production because they also affect this pathway and sometimes only blood tests will distinguish the states. If one has excess thyroxine you can burn through fat storage quickly.

Then there is the parasympathetic ANS that adjusts all these sympathetic outputs back to a resting state via feedback loops of hormones in the pituitary and hypothalamus (homeostasis). There are also gender differences due to male and female sex hormones and their influence on this Hormonal Pathway. The kidney produces renin and angiotensin to regulate fluid balance (water and salts) in the body and also has feedback loops into the pituitary via ADH (antidiuretic hormone) and hypothalamus (which is constantly monitoring blood chemistry).

 

What might happen if there is autonomic dysfunction? Not enough stimulation of energy production at the time it's needed, and maybe excessive stimulation when it's inappropriate? Like, not enough during activities, and too much during rest.

Is the noradrenaline release associated with POTS enough to cause alterations in energy production and appetitute?

 

I think the problem is that this is too vague a question.
'Autonomic dysfunction' is a bit like 'bad legs' - it could mean absolutely anything. Any thing could be up or down or more or less. I am not clear that POTS is autonomic dysfunction. The fact that the heart rate goes up suggests that the autonomic response is working well - to something we do not understand, maybe low blood volume.

So there is no point in speculating what might cause what without being specific.

It is a bit like that other vague term 'inflammation' which is blamed for all sorts of things even when by any reasonable criteria it isn't even there.

 

Perhaps some context is useful: a while ago I was putting together a Hollywood swing. During one of these construction sessions I started becoming exhausted and weak in my limbs and dizzy. 5 minutes after drinking some fruit juice I was able to resume working and finish that day's session. Eating often quickly helps improve symptoms, many of which would be considered symptoms of autonomic dysfunction. I'm pretty sure I'm not confusing a response to low blood sugar with autonomic dysfunction. There does seem to a close connection between blood sugar levels and symptoms of "autonomic dysfunction". Or maybe it's just that having higher circulating glucose levels helps counteract poor blood perfusion (less nutrients). And I often eat between meals for this reason. It's like my body is used to this, or maybe appetite is being altered because of effects of noradrenaline etc. on glucose uptake.

The last time I was tested I also did not have diabetes.

 

I am not sure what you are meaning by 'autonomic dysfunction' though?
It sounds as if maybe you feel a lack of maintenance of circulation. But that may not be autonomic. I just don't think anyone knows enough about what is going on to make any sensible predictions.

 

I did some light manual work and became increasingly symptomatic. The symptoms that I remember included fatigue, malaise difficulty applying sufficient strength to the electric screwdriver to fully insert screws, and after repeatedly having to bend down, having increasing difficulty tolerating this movement due to poor blood flow into the brain, and coming close to just falling down. I had to stop because I was beginning to feel unwell, and even if I had wanted to continue, it was getting to a point where I couldn't perform the work safely and properly. I didn't have any sweating or tremors. But I was determined to finish it and so I had half a liter of sweet juice and within 5 minutes I felt better and was able to continue working for 20-30 minutes.

I've seen something like this many times before and that's why I knew drinking the juice would help.

Activity and being upright causes a gradual worsening of symptoms (some of which seem very clearly related to circulation), and shortly after eating, I feel a lot better and can do more.

What is happening in the body? Assuming that blood flow into my brain decreases over time during work, then increasing the blood glucose density could be a way to compensate for the reduced flow rate.

And I've also observed the opposite: I tend to get hungry after activity, and lying down seems to be an alternative to eating. It seems to be a bit of a "two sides of the same coin" situation where the symptoms provoked by activity can be somewhat alleviated by either lying down and resting or eating (or ideally both).

 

Eating tends to decrease my ability to do things, being diabetic I do not drink fruit juices, so more of a general comment.

 

I'm not diabetic but I have the same experience with eating. Afterwards I can feel extremely sluggish with very intense brain fog, drowsiness etc and I often have to even lie down and sleep. It may sound like what healthy people sometimes feel after a big meal but it is actually much worse and much more intense for me. Total KO and I don't have to eat a lot for it to happen, a small sandwich is enough. So I actually don't like eating so much because of the aftereffects and tend to keep it to breakfast-lunch-dinner and nothing else because it would mean even less energy throughout the day otherwise. It feels as if the little energy I have left is reduced even more during digestion, so I'm just useless after eating.

Edit: about sugar: When I feel worse, I have very serious cravings for it. I've always thought it might be because of the probably shitty energy production I have and that my body may be telling me to get more energy right now. And when I do, it satisfies the craving a bit, so in that sense it feels good, but otherwise it doesn't improve my symptoms.

 

I don't normally buy and drink fruit juice either. Some family friends had brought it a few days earlier.

I also often feel worse after eating large amounts, so I tend to eat smaller amounts more frequently.

I do wonder if I have a neurometabolic disorder instead of ME/CFS.

 

Do you find that it is nothing to do with what you've eaten that day (Ie as you say not low blood sugar causing it) but what you've just done re: exertion (but feels like 'empty' energy cells) and only a hit of basically pure sugar works, and even then only for a short while and needs to be topped up for each exertion (as if you've run out but if you run your mobile while plugged in, except the sugar is like 'pure energy' vs being able to access whatever 'food' might have been in your body/muscles that normal people would have and not have run out of)?

I don't think it is either low blood sugar or dysfunction, feels like there is a blood pressure issue in there given how awful you feel (you have to sit or lie down or you'll collapse) and how to carry on you have to keep 'topping up'. Have you tried adding salt into the mix as well? and does the sugar mean that you are actually ignoring body signals to rest and using it constantly to keep 'continuing'?

 

I got told to go to the gym when I was first diagnosed. That first trip every time I stopped each activity I had to go to the changing room in a hurry and half-blindness to lie down (and just got there in time before passing out), this happened 10+ times. It just so happened the next time I bought a drink before going in, which was a rather sugary squash. I had exactly the same thing coming on each time but if almost immediately as I stopped I slugged the sugary drink before it could kick in I just about managed to stay standing and would force myself round.

Of course I slowly could do less and less sessions each week over the space of maybe a year (probably less) until I was eventually just not going and had a big relapse. Because that's what exertion does. I particularly never got better on the aerobic (which being a sporty athlete years ago was the one I thought I knew what I was doing on) in fact teh harder I tried the worse I got so the workwell stuff when it came out was like 'ahhh' moment. The more ill I was the more problematic/pointless/almost damaging any of the (very small repetition) non-aerobic was. But at least the constant sugar stopped me from collapsing all the time at the time (I didn't collapse anywhere else so 10+ times in one session was definitely a correlation). It sometimes works for waking the brain momentarily.

Sort of explained why certain periods of my life I'd got through by basically munching massive bags of sweets constantly. But again it has to be constant. Not reccommended for its long term help for the condition to use this 'survive day by day tactic'. And the issue isn't caused by low blood sugar. I could have had a big meal 1.5hrs before (so digested) and teh exhaustion feeling is sudden in response to exertion.

 

I don't normally consume sugar or sweet drinks. The positive effect of eating is most noticable during or right after exertion and the food is carbs. This is usually not a large meal. I've had symptoms triggered by exertion nearly disappear within minutes.

It seems like an important hint of what's wrong with me. I can't tell if this is more a circulatory problem or something to do with energy metabolism.

Maybe I have a disease that makes it difficult for the body to maintain adequate energy reserves and so the reserves are depleted quickly and when they get low symptoms appear and eating something alleviates this, at least for a short time?

 

For many years after onset, long before I knew I had ME, I used Dextro tablets to get me out a hole when out and things got weird. I had discovered fairly quickly that eating, even high GI foods like chocolate, only made things worse (this was 20 years before I was diagnosed with diabetes) and discovered by accident that dextro tablets helped, for a short time, enough to get home anyway.

 

Funny coincidence: I just got a call from the rare diseases clinic for a muscle biopsy on 7 June. If the problem is metabolic there is a chance it can be discovered that way.

 

Well, if you have, so have I - they are the same symptoms! I think that they are typical of M.E. Don't ask me what causes them - despite my Masters degree in medical science I have pretty well lost the ability to find the info in my brain now!

 

Yes - definitely in my case. When I was mild a good dose of sugar would allow me to carry on physically. One memory I have is of feeling exhausted and that I couldn't go any further walking around in a market. I bought a very large bottle of lemonade, sat down and drank most of it. In 10 minutes or so I was walking around again. No doubt this was a bad idea but seemed to work.

By the time I was moderate I either realized this wasn't wise or it wasn't effective any more - likely a combination of the two.

Now being severe I have developed some kind of fructose? intolerance and can't eat sugar including even small amounts of fruit without experiencing gut pain. But that's another story.

 

Well - that was just one example. More embarrassingly, at that time of my life if I was exhausted but needing to drive and do something I'd stop in the corner store and buy a soda to get me through. Always gave me a boost, more than water would have I think.

........hmm - now you've got me reassessing. I just looked up soda and see it has a fairly high salt content so this may have been a major factor.

Interesting, after all these years thinking it was sugar. Thanks Trish!