Health rising blog post, by Cort Johnson: The Exercise intolerance in ME/CFS, Fibromyalgia and POTS Explained?
Dr. Systrom’s huge study on people with unexplained exercise intolerance suggests that the current explanation (deconditioning, lack of effort) couldn’t be more wrong. In fact, Systrom’s study suggests that when these peoples hearts were asked to pump more blood during exercise they couldn’t.
He concluded that the problem was every bit as functionally debilitating as heart failure and other major diseases. He also concluded that the problem was not in the heart. Is he explaining what’s going on in ME/CFS and FM?
Introduction:
It’s always encouraging to see established researchers from outside the chronic fatigue syndrome (ME/CFS) and fibromyalgia fields converging on them. David Systrom, a pulmonologist at Brigham and Women’s hospital in Boston, has been interested in idiopathic or unexplained exercise intolerance for at least a decade.
A significant number of people who cannot exercise have been a medical mystery to cardiologists and pulmonologists
He and Oldham recently published their magnus opus on exercise intolerance; a study employing over six hundred patients that stretches back nine years.
Unexplained exertional dyspnea caused by low ventricular filling pressures: results from clinical invasive cardiopulmonary exercise testing. William M. Oldham,1,2,3 Gregory D. Lewis,3,4 Alexander R. Opotowsky,2,3,5 Aaron B. Waxman,1,2,3 David M. Systrom1,2,3. Pulm Circ 2016;6(1):55-62. DOI: 10.1086/685054.
In it they proposed that a significant subset of patients with exercise intolerance and heart abnormalities have simply slipped through the cracks. No diagnosis has been able to explain their low energy production (VO2 max) during exercise; they don’t have heart failure or arrythmia or cystic fibrosis or known mitochondrial problems. Aside from telling them that they’re deconditioned or depressed the medical profession hasn’t known what to do with these patients.
How a field that gets over $2 billion in funding year in and year out could let any significant group “slip through” the cracks is unclear. Systrom’s use of invasive cardiopulmonary testing techniques apparently has given him a unique insight into these patients.
“In this study, we tested the hypothesis that failure of these mechanisms to increase cardiac preload during exercise….may be the primary limitation….in an undiagnosed population of patients with unexplained exercise intolerance.”
Some of them, perhaps many of them, have ME/CFS/FM or POTS (or would be diagnosed with it if anyone tried) and those that don’t must have something close. (At least three people with ME/CFS/FM have ended up in Systrom’s office, and probably many more were in the study.)
Systrom, though, is ignoring the ME/CFS/FM for the moment – and probably rightly so. He has bigger fish to fry; his goal right now is to enroll his colleagues in the idea that they haven’t been correctly diagnosing a significant subset of their patients.
If my reading of medical history (I highly recommend “The Biography of Cancer” and “The Death of Cancer”) is representative, that conclusion is probably not going to go over well.
Systrom found that hearts of the exercise intolerant patients did not expand when they exercised. This inability to fill with more blood during exercise was why they exhibited low energy production (VO2 max). (We just saw a similar pattern in ME/CFS in “Chronic Fatigue Syndrome: A Small Heart Disease” and A Mestinon Miracle.)
