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Low Blood Volume, ME/CFS and Slow, Chronic Sepsis

Summary

A very common cause of sepsis is the leakage of bacteria into the blood from the gut. ME/CFS patients have signs of leakage of bacteria from the gut into the blood and our illness looks a lot like sepsis. Low blood volume and mast cell activation may have everything to do with this process.

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In a 2018 paper, Dr. Maureen Hanson’s group conducted a study on microbiota and ME/CFS patients.  The microbiota is the collection of microorganisms that live in the gut.

Hanson’s team found that a substance called LPS was significantly elevated in the blood of patients. LPS is a substance from the cell walls of certain bacteria.  LPS becomes elevated in the blood when there is an increased permeability or leakiness of the intestines.

Other researchers have had similar findings with regard to LPS and ME/CFS patients.

Dr. David Bell, a longtime ME/CFS physician and member of the Open Medicine Foundation has compared ME/CFS to a slow, chronic version of sepsis.  The commonalities between these two conditions include low blood pressure, low blood volume, a loss of energy production at the cellular level, and widespread inflammation.

LPS, from either a bacterial infection or a damaged or leaky gut, is the most common cause of sepsis, a body-wide inflammatory disorder that kills 40% of its victims. LPS is a powerful trigger of inflammation and, because it spreads through the blood, it can cause inflammation all through body.

At the most recent Open Medicine Foundation Symposium, Dr. Bell’s book on this subject was held up in front of the audience and the speaker said essentially that Dr. Bell was really on to something.

Does a chronic trickle of LPS from the gut into the bloodstream of ME/CFS patients trigger a slow, chronic sepsis? It seems obvious that it could.

What causes this slow leak, this elevated amount of LPS in the bloodstream of patients?

ME/CFS patients have consistently been found to have chronically low blood volume. The loss of blood volume is enough to apparently cause our hearts to shrink in size. In ME/CFS patients with orthostatic intolerance, the amount of blood we are missing is equivalent to stage II hemorrhagic shock.

If ME/CFS is like a slow, chronic sepsis, we might also say that it is like a slow, chronic hemorrhagic shock.

Shock entails a loss of blood delivery to tissues.  This is called a loss of perfusion and the gut is extremely sensitive to losses of perfusion, much more so than many other organs in the body. Hemorrhagic shock, the type of shock that occurs when you lose blood, readily causes the gut to become leaky and release LPS into general circulation.

Mast cells are powerfully activated by LPS and a chronic slow leak of LPS into the bloodstream could be an obvious trigger of Mast Cell Activation Syndrome (MCAS), which so many of us suffer from.

In addition, the damage caused to the gut by problems with perfusion that may be largely caused by mast cells.  

Perhaps an existing propensity towards mast cell activation provides a powerful push towards an illness that looks like ME/CFS. Many more women than men get ME/CFS and female hormones powerfully stimulate mast cells.

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