David Bell about "slow sepsis" in ME

Inara

Inara

Senior Member (Voting Rights)
I came across this article from Jan. 2018
http://simmaronresearch.com/2018/01/chronic-fatigue-syndrome-mecfs-chronic-form-sepsis/
about David Bell's idea that ME could be something like a 'slow sepsis'.

This topic seems to be a little bit older though:
http://cfstreatment.blogspot.de/2015/04/guts-bugs-and-slow-sepsis-in-mecfs.html
This is from 2015.

Dr. David Bell proposed that patients with ME/CFS have what he called "slow sepsis." In his monograph, Cellular Hypoxia and Neuro-Immune Fatigue, he suggests that ME/CFS is a slow, chronic form of septic shock. The sequence of events in septic shock is: 1) a serious infection, 2) production of cytokines, 3) increased nitric oxide, and 4) interference with the production of cellular energy. In severe cases of septic shock, the loss of cellular energy is so profound that it can be fatal.

Dr. Bell suggests that a similar sequence takes place in ME/CFS, but more gradually. In ME/CFS there is: 1) an initiating infection or toxic exposure, which 2) leads to immune activation, increasing the production of cytokines, 3) the increase in cytokines leads to the production of increased nitric oxide (NO), 4) NO increases peroxynitrite and superoxide, which leads oxidative stress, and interferes with mitochondrial function, 5) the cell becomes hypoxic (oxygen-starved), and 6) vasculopathies, neuropathies, and autoimmune processes develop.
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Does anybody know what happened to this idea? And why it might not be correct (i.e. are there findings that contradict this idea)?
 
Inara said:
I came across this article from Jan. 2018
http://simmaronresearch.com/2018/01/chronic-fatigue-syndrome-mecfs-chronic-form-sepsis/
about David Bell's idea that ME could be something like a 'slow sepsis'.

This topic seems to be a little bit older though:
http://cfstreatment.blogspot.de/2015/04/guts-bugs-and-slow-sepsis-in-mecfs.html
This is from 2015.

Does anybody know what happened to this idea? And why it might not be correct (i.e. are there findings that contradict this idea)?
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It does not make any sense. Septic shock is by definition a term for an acute overwhelming cytokine release syndrome. 'slow sepsis' is a bit like saying '3 mph hurricane'. And if we are considering a low level cytokine release syndrome then it is obviously not happening in ME/CFS because the CRP and ESR are normal. It is as simple as that.

And all the study about nitric oxide is I think a red herring. People got interested in the role of nitric oxide in oxidation of proteins and lipids in the 1990s but in the end it never went anywhere. The levels of NO involved in signalling in inflammation are tiny, even with brisk inflammation. And there is no evidence whatever for autoimmunity being downstream of oxidation events, with the possible exception of citrullination, which is not relevant here.

This looks like a rehash of a rehash, via Maes, of ideas that were trendy twenty five years ago and went nowhere.
 
Thank you, @Jonathan Edwards, for your opinion on this.

One question just came into my mind:
Often, medicine sounds like a 0-1-system of illnesses. Either you have a known illness - or you don't. It seems inside an illness, it is not deemed possible that there could be "in-betweens" and "pre-symptoms". I hope I can transport what I mean.

I don't think this mirrors reality.

It's a little with statements like "only high levels of this or that substance are relevant". Substances in the body aren't discrete, they're continuous, and if there can be a "too high", there can also be a "too low" (which doesn't necessarily say something about whether that's bad or good).

So, although I feel it to be likely that you're right (totally share your thoughts about NO), I wonder why something like a "pre-sepsis" or "low-level sepsis" or whatever could not exist.
 
@hixxy, thanks for linking.

Is this the same Australian group that was discussed on another thread (hyping their results etc.)?

For me, it's difficult to say something about the quality of medical research.
 
An interesting aspect though is when increased awareness of sepsis was in the news a number of us commented that it would be hard to tell apart our everyday symptoms from early signs of sepsis.

Charles Shepherd seemed to agree but highlighted not urinating as one for us to look out for (this isn’t part of normal ME).

My limited understanding of sepsis is that the body over reacts to a threat. At least in early ME, this seems like it could be relevant in terms of a general narrative of what the body is doing?

[Edit: now the full article has loaded (Virgin Media WiFi :banghead:) I see that this view of sepsis is out of date. But interested in the mention of EBV and similar reactivation. Also post sepsis as a thing :thumbsdown:]

I agree with @Inara that medicine isn’t very good at recognising in between definitely abnormal and optimal. Although I try to remain sceptical about alternative medicine (as well as conventional medicine ;)) I do think there is something in Adrenal Fatigue in this way. Eg I had physical signs of Addison’s. I did the short synacthen test on the NHS, “well you’re within normal range” (tone was ‘just about’, I was too green to ask for full results back then). Later I did a private test which showed low DHEA and low cortisol (except for 8am). How do they decide? For them is everyone sub optimal?! Was I similarly sub-optimal both times?

But anyways, just an illustration to show that how you decide the abnormal cut off is often socially constructed. For many tests people are distributed across different readings and someone somewhere decides the cut off between ‘disease’ and ‘healthy’. This is possibly different in something like sepsis though, as almost everyone definitely doesn’t have it if we tested randomly.
 
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Inara said:
So, although I feel it to be likely that you're right (totally share your thoughts about NO), I wonder why something like a "pre-sepsis" or "low-level sepsis" or whatever could not exist.
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Of course it exists but we have a perfectly good word for it - bacterial infection.
We have a perfectly good word for low level hurricane - wind.
And you can tell there is wind because the trees sway a bit and you can feel cool on your face. You can tell there is infection because the ESR and CRP go up.
So this low level hurricane Dr Bell is suggesting is such a teeny weeny low-level hurricane that you cannot even feel it on your face and the trees are completely still. The smoke from the chimney goes straight up into the sky and all you hear is the faint humming of bees in the lime trees whose scent hangs motionless in the warm afternoon. It makes no sense.

I actually think that Chris Armstrong has a much more sophisticated theory with an initiating event and then a chronic state of metabolic dysfunction that is not itself infection.
 
Jonathan Edwards said:
The smoke from the chimney goes straight up into the sky and all you hear is the faint humming of bees in the lime trees whose scent hangs motionless in the warm afternoon.
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I am transported, but can't help wondering why anyone would light a fire on such a beautiful summer's afternoon. I would take it as a sign that something's amiss and needs investigating.
 
Jonathan Edwards said:
It's Monday and Snow White is heating a cauldron to do the dwarves' washing. Further down the hill Mrs Bear has just got the porridge ready on the stove.
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And in the tradition of Roald Dahl, Little Red Riding Hood has set down her Revolver, lit a fire, put her feet up on her pigskin travelling case and no doubt is enjoying a large gin
 
Jenny TipsforME said:
But anyways, just an illustration to show that how you decide the abnormal cut off is often socially constructed. For many tests people are distributed across different readings and someone somewhere decides the cut off between ‘disease’ and ‘healthy’.
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I doubted these statements the moment I understodd how 'normal ranges' are obtained. If people used their common sense and brain, maybe there wouldn't be a problem. But common sense is a rarity.
 
Jonathan Edwards said:
Of course it exists but we have a perfectly good word for it - bacterial infection.
We have a perfectly good word for low level hurricane - wind.
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But are we absolutely sure there isn't a state which one could call 'slow sepsis', something where some processes are known, and maybe some are not? Something that actually is new to us? Something that doesn't lead to death, but to a slow progression of degeneration?

I cannot say if it is correct that the findings about ME fit something like a chronic low-level sepsis. Do you have some explanations from research, like 'this or that doesn't fit these or those findings' etc.?

And why is it more plausible that some infection starts a certain cascade, and then there is a 'slow/low-level starvation mode'? Which - at first glance - doesn't sound more plausible. WHY is that cascade started? The infection alone can't be the answer. Wouldn't that have been found up til now, maybe?

Please don't get me wrong - no criticizing here, only the wish to understand a bit more. Thank you :)
 
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