PEM: a continued stress response / failure to enter a rest-recovery phase?

The other day I learned that exercise is a strong trigger of the release of various hormones and signalling factors that we might label as stress signals.

Some of the after effects of exercise that I experience feel exactly like my body continues to be stressed for hours afterwards, or even becomes increasingly stressed as time passes. This is visible in heart rate measurements as well. I'm pretty sure this is not how it should be: after exercise we should be able to relax and recover. But my body seems to have difficuly entering that state. Therefore one could say that exercise appears to trigger an abnormally long stress response with a failure to enter the appropriate rest-recovery phase. And PEM after a night of unrefreshing seems to be the typical result of this.

Now I wonder if this is reflected in blood levels of these stress signals remaining high. What kind of problem could prevent the switch to a rest-recovery phase? The proposed dynamic ("difficulty switching off after activation") seems to have some similarity to how ion channel dysfunction might manifest. Is there any evidence in ME/CFS of these stress signals remaining high, and/or of ion channel dysfunction affecting the hypothalamus/endocrine glands?

An alternative interpretation could be that the stress response continues because there's a continued emergency of some sort, perhaps some kind of hypoxia related damage to some tissues, or immune cells being irritated by exertion and doing some damage.

Or that there is a metabolic failure to enter that rest-recover phase and so the repair and cleanup that should begin does not happen and the stress response continues.

 

@rvallee posted the following thread:

https://www.s4me.info/threads/high-...tomated-collection-2023-lightman-et-al.33799/

Which has some interesting methodology for measuring cortisol EDIT: adrenal hormones more continually, noting also that it is pulsatory

This might have the added benefit, if a good technique/method were to be deveoped of being able to look at options for samples to be taken at appropriate times without what would be for pwme the catch of causing exertion to take them too ie given both PEM and exertion might change things.

 

It's not just cortisol

Box 1. Major stress-related hormones typically affected substantially by an acute exercise session

• Adrenocorticotropic hormone
• Atrial natriuretic peptide
• Arginine vasopressin
• β-endorphin
• Brain natriuretic peptide
• Corticotropin-releasing hormone
• Cortisol
• Cytokines
• Dynorphins
• Enkephalins
• Epinephrine
• Growth hormone
• Norepinephrine
• Prolactin
• Renin–angiotensin–aldosterone
• Testosterone

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953272/

(and maybe the problem is not enough stress hormones in response to stressors)

 

For me, sleeping well or not doesn't make any difference, I will always experience the same level of PEM.

 

Sorry if I didn't make clear - I was making the point about the method of taking samples (whatever they are looking at/measuring) being developed so that it can be done without requiring trips and waking up etc is something that could be very important indeed. Particularly noting how and when PEM strikes - and its being measured through the night-time as well as day etc. so we could see the full cycle.

 

One of the reasons for graded exercise therapy was this idea of a strong stress response to exercise, and the assumption that regular exercise would dampen the response (as has been shown in healthy people).

This again raises the question of whether this stress response was assumed to exist in patients based on what they described, or if it had been measured in studies.

It also seems that exercise in ME/CFS leads to further sensitization rather than the expected desensitization, or at least no meaningful desensitization in the long term.

Are patients feeling the stress response to exercise or is it something else that might be confused for it?

 

Sleep length and quality didn't affect my ME symptoms either, including PEM.

 

The only stressors that negatively affect my PEM are viral reactivations.

 

You wrote several times that exercise doesn't affect your PEM either.

 

I think some post exercise hormone responses were investigated by Light and Light (Alan and Kathleen I think) some years back. Some of them are very high even on a logarithmic scale. I do not think this has been properly followed up on but I could be wrong.

 

My experiences with PEM seemed to point to a chemokine from muscle cell damage, with IFN-g matching the consistent 24 hr delay. I doubt that washing one window or climbing a few steps up a ladder triggers major body stress chemical release, while a 20 km bike ride wouldn't.

Not for me. My exercise tolerance built up normally. The first long bike ride of spring might have triggered PEM, but the without-triggering-PEM distance increased as my muscles got used to it. I expect the same would have held true for window-washing if I did that every day.

Yes, I don't think my fitness level changed the severity of my PEM symptoms. I can't offhand think of any factors that did affect the severity, aside from the triggers. Maybe some food/nutrient factors did, but I don't recall noticing a specific correlation.

Given the advances in disposable micro-flow devices, where a drop of blood goes through various microchannels for various measurements, this should be practical and not overly expensive.

 

Over the years I've come across pts that explained how their PEM negatively affects their cognitive function and not so much their physical abilities.

PEM affects both my physical and cognitive function.

I can sleep 10 hrs and it won't make any difference. In fact I could lie down for 20 years w/o moving and I would still get PEM if go over my energy limit.

I could die and still experience PEM lol

 

Finally, proof zombies are real. They are all people death pemed.

 

PEM has put me in a zombie-like state at times.

 

Many of us describe it that way, hence my jest.