Right on the heels of a study showing that people with fibromyalgia have trouble focusing or paying attention comes another study linking cognitive problems to a balky stress response.
One of the major stress response systems in the body – the HPA axis – is impaired in FM and ME/CFS. Is that because of the disease or because of poor stress management?
In “Salivary cortisol is associated with cognitive changes in patients with fibromyalgia“, Taiwanese researchers assessed whether a reduction in functioning of one of the two major stress response systems in the body – the HPA axis – was also associated with cognitive problems in FM. They did this by assessing salivary cortisol levels and cognitive functioning (with subjective questionnaires and objective cognitive tests.)
“Stress” was a strong focus throughout the paper. These researchers believe the HPA axis problems in FM (and presumably chronic fatigue syndrome (ME/CFS), as the issues are similar) are “secondary”; i.e. they derive from the enormous levels of stress the diseases produce. As we’ll see, though, the focus on stress can get tricky.
Dr. Klimas and her team at Nova Southeastern University in Florida, by the way, would disagree about the idea that HPA axis problems are “secondary” in diseases like ME/CFS. Their supercomputer work suggests that they’re so important to these diseases that their two-drug protocol uses drugs which first inhibit neuroinflammation (etanercept) and then reset the HPA axis (mifepristone).
Results
This study found a moderate relationship between low salivary cortisol levels in the morning and late evening, and cognitive issues involving memory, language and executive functioning. The authors reported that a similar pattern of altered cortisol levels and cognition have been found in chronic fatigue syndrome (ME/CFS), post-traumatic stress disorder (PTSD), Cushing’s disease and Addison’s disease.
But why would an inadequate or balky stress response (low cortisol levels) affect cognition? Since cortisol is used to blunt immune activation, low cortisol levels could result in increased inflammation which could result in many symptoms, including cognitive problems, if the inflammation occurred in the brain.
The authors also suggested problems with the hippocampus – a part of the limbic system of the brain involved in both stress processing and memory – may be involved. Problems in the hippocampus have indeed cropped up in FM.
The Gist
- Low morning and late evening cortisol levels in fibromyalgia were linked to problems with memory, language and executive functioning.
- The link between low cortisol levels and cognition may involve higher levels of inflammation.
- The authors suggested that problems with the hippocampus may play a role as well.
- While cognitive deficits were found, people with FM felt they were cognitively worse off than the tests suggested.
- One explanation for that derives from a model called Functional Cognition Disorder, which posits that people with diseases like FM and ME/CFS are paying so much attention to their symptoms that they’re having difficulty focusing on the tasks at hand.
- Several studies, though, suggest why people with ME/CFS/FM often report that thinking is so much more effortful.
- They suggest that people with FM have to recruit more brain regions than healthy people to do the same tasks – an inherently inefficient and effortful process.
- It appears that the “gates” which filter out sensory information from the body may be broken – subjecting the brain to a torrent of information it must process – on top of whatever other tasks are being engaged in.
- The brains of FM patients also appear to have trouble ignoring innocuous stimuli – such a background noises – placing a further drain on the brain.
- Several lines of evidence also suggest low brain energy reserves may make it more effortful and difficult to engage in cognitive tasks.
- Low cortisol presumably means a predisposition to higher levels of inflammation. Given that, a safe way of raising cortisol levels would be helpful. A blog on that possibility is coming up.
Cognitive Disconnect
While the cognitive tests did pick up some problems, the FM patients, in a pattern that’s shown up before, reported more problems with cognitive functioning than the tests indicated; i.e. they reported worse cognitive problems than the tests indicated they had. This same pattern – patients consistently seemingly over-reporting the cognitive issues – has shown up in chronic fatigue syndrome (ME/CFS) and migraine as well.
That, plus the focus on “stress”, helped open the door to something called the functional cognition disorder model. The authors cited studies suggesting that heightened self-monitoring, perfectionism, overloading, etc. could also play a role in the cognitive problems found in FM.
The Functional Cognition Disorder Model
The “functional cognitive disorder (FCD)“, championed by Teodoro and others, proposes that something akin to poor stress management is producing or contributing to cognitive dysfunction which appears in the absence of identifiable brain damage, and in people who report more cognitive problems than the tests pick up.
A central tenet of this interpretation is that an “excessive attention towards the body, severe pain and fatigue” prevents the patients from focusing on external events; i.e. the cognitive task at hand. The other side of that coin is the possibility that people with ME/CFS/FM are simply getting bombarded by pain, fatigue and other symptoms, but Teodoro apparently rejects that idea.
It’s startling to see the kind of machinations researchers can engage in. For instance, Teodora takes affront at the marked increase in the “perception of effort” which takes place when people with ME/CFS are challenged with increasingly difficult cognitive tests. Teodoro believes that increased “perception of effort” is due to three things:
- an “interpretive bias for somatic information” showing up; i.e. the tougher a cognitive test is, the more people with ME/CFS/FM tend focus on their body sensations;
- “a greater operational demand to control and monitor cognitive processes”; i.e. the more difficult a test is, the more people with ME/CFS/FM focus on monitoring and controlling their thought processes;
- “a sense of insufficiency resulting from unrealistically high expectations about one’s performance”.
It turns out that easier explanations are available…
Are ME/CFS/FM patients’ brains becoming overloaded with information?
A Biological Explanation?
Other explanations suggest that cognitive processes might, in fact, be breaking down, or that one’s brain, when placed under load, might just be running out of juice.
One study, for instance, showed that people with FM must activate more brain regions; i.e. must use more energy to carry out the same cognitive tasks as healthy controls. This study suggests that it’s actually harder and more fatiguing for people with FM to do cognitive tasks.
Other studies suggest that the brainstem may not be filtering all the sensory stimuli that it should – causing the brain to be pummeled with stimuli – and use up resources to deal with that.
Sensory Overload: Study Suggests Brains in Fibromyalgia Are Being Pummeled With Too Much Information
Other studies have shown that the brains of people with fibromyalgia have more trouble blocking out innocuous stimuli. Our brains should be able to assess stimuli and stop paying attention to them if they’re not relevant to the task at hand.
A 2016 study with the charming title, “Habituation deficit of auditory N100m in patients with fibromyalgia“, found that to be a problem. As the participants watched slides, the researchers stealthily introduced small sounds into the headphones the participants were wearing. Then they watched their brainwaves.
Instead of becoming habituated to these sounds, the FM patients’ brains remained stubbornly fixated on them. (The same pattern, interestingly, has also been found in migraine and irritable bowel syndrome.) This suggests all these diseases come with an extra added component – a distracted, inefficient and easily overwhelmed brain.
A recent study suggested that brains of people with ME/CFS have lower energy reserves and essentially poop out more quickly when stressed than the brains of healthy controls. That made sense given the reduced cerebral blood flows and lactate accumulations found – both of which suggested that ME/CFS/FM brains were stuck in a low energy state. So much could seemingly easily be explained by small blood vessel problems that inhibit blood flows to the brain, muscles, etc. The neuroinflammation findings loom large as well.
As was noted in an earlier blog, it’s also very possible that the pain processing centers of the brain are robbing Peter to pay Paul. In this scenario, the pain processing pathways have become so dominant that they’re taking resources away from parts of the brain we usually use to pay attention and carry out cognitive tasks.
The good news about the kind of seemingly whacky conceptions of Teodoro and colleagues is that they’re steadily being supplanted by the march of science.
There’s also the possible intersection between low cortisol and cognitive problems. Hypocortisolism in the form of low morning salivary cortisol levels, in particular, has been found. We don’t know how important it is or what role it plays, but given the supposition that inflammation is a major driver of illness in these diseases, it would be good to get that problem fixed.
One reason we don’t know about the role of low cortisol is the difficulty and controversy around safely raising cortisol levels. A new approach to that popped up in the scientific literature recently. Coming up next:
- A (Too?) Easy Way to Raise Cortisol and Reduce Inflammation?
My brain kept focusing on the high frequency flickering of fluorescent lights in my office and lab, and I couldn’t focus on anything under these artificial lights when music was being played in the lab. I solved the light problem in my office by placing poster board beneath each light panel to diffuse the light, but 30 years later must still ask that fluorescent lights be turned off in doctor and dentist offices.
‘Several lines of evidence also suggest low brain energy reserves may make it more effortful and difficult to engage in cognitive tasks’ – that would sum up my situation. I have more energy in the morning and I think that my brain function is very good now – earlier in the day. I can feel completely normal.
However, my issue remains trying to replace the used energy reserves because later in the day, the energy in my brain seems to run out and thinking, reading, processing information etc., become much more difficult. So what I do now, is try and complete cognitive tasks, with a fuelled and functioning brain, rather than get frustrated attempting these tasks with a brain that’s run out.
Having said that, when my brain was more (I believe) inflamed, I could hardly think at all or remember anything.
When I read the Teodoro piece, I could feel my hackles rising! They ‘selected 52 studies on FM, 95 on CFS and 39 on FND’ (functional neurological disorder). So the CFS studies, I presume, must include the low quality or very low quality research found in the revised draft NICE guidelines.
brain fog makes everything take more energy, but i feel that the cause is neuroinflammation, ir some byproduct if neuroinflammation
the cortisone that hits neuroinflammation, hope it foes not allow latent viruses to fo more 🙁
if cortisol is like cortisone, maybe it explains high initial cortisol as brain tries to tamp down brain or vagus nerve inflammation?
Dr. Jan Remsick found things causing inflammation in cerebrospinal fluid in covid cases and they think it is causing the “cog-fog” that these persons experiencing.
https://www.thailandmedical.news/news/neurocovid-study-shows-that-covid-19-brain-fog-caused-by-inflammatory-molecules-in-the-cerebral-spinal-fluid
Has anyone heard anything recent from the Ron Davis camp?
Is his test panning out?
Does it corrrlate with disease severity? Or cog-fog severity?
My brain fog started about 1 year into my me/cfs symptoms. That makes it 13 years that I’ve been dealing with it. It’s been 24/7/365 since it started. So on a good day I have mild fog, but have difficulty with many tasks and on a bad day I basically go blind and I can’t function at all too the point where I just shut down and I stare off with no brain activity for a significant amount of time. My energy levels are always low and I have to push myself to get anything accomplished. The fog and cognitive issues have only gotten worse as well. Simply opening my eyes in the morning and surveying the room can overload my brain to varying degrees.
I had my cortisol checked a few years ago when I was diagnosed with FM/CFS (2013), and it would peak early in the morning (3:00am) and fall late morning (10:00am), then normalize in the afternoon…Hence my problem with insomnia…I also have ADD that might have come from having FM/CFS and being a Fragile X carrier…So I end up with so many distractions because of information overload, but find out that my concentration and speech become so fatigued too, that I can’t get out any words…My kids with IBD and one with FM/CFS find the same problem…I noticed on a documentary that a person with a bad case of ME had to use a computered voice machine like Steven Hawkins use to use, because he was too fatigued to speak…
Eric, how were you tested to find out your cortisol at 3am? Thanks for any info
“Cognitive Disconnect
While the cognitive tests did pick up some problems, the FM patients, in a pattern that’s shown up before, reported more problems with cognitive functioning than the tests indicated; i.e. they reported worse cognitive problems than the tests indicated they had. This same pattern – patients consistently seemingly over-reporting the cognitive issues – has shown up in chronic fatigue syndrome (ME/CFS) and migraine as well.”
IMO they picked up the incredible capability of FM/ME/… patients to push themselves and their stress hormones way up when they have to do a challenging task they are not able to do without such focus AND skill to increase the necessary hormones and other biochemicals needed to boost their focus so much.
The end results:
A) (Plenty of) FM/ME/… patients can boost their abilities, both physical and mental, very much to reach near normal levels for 5, 15, 30… 100 minutes depending on how bad their health is.
B) Doctors, friends and family think you are *way* healthier then you actually are because you do a tremenduous effort to stay functional when you feel the need or desire to push yourself so deep.
C) Doctors, friends and family thinking you exagherate and malinger for doing so much less the rest of the day, while you recover from doing those epic burst of deep focus and digging way too deep into your very limited reserves.
D) FM/ME/… patients doing plenty and plenty of effort to be somewhat functional to not let down other people and being rewarded by PEM, utter depletion AND being viewed as a malinger and parasite on society.
I slowly try and learn to NO LONGER step in this trap that we so easily step into. At the same time, we are prone to step into it. It’s not just about personality, it’s just as much about the combined action of hormones like adrenaline and dopamine.
Both are stress hormones helping us to push way harder then what we can do on average. But adrenaline makes us temprarily able to do so much more by eating deeply into our reserves AND it is designed to make us blind for the cost of doing so. Dopamine temporarily increases our abilities too but at the cost of making this feeling of accomplisment addictive.
It’s not that we are prone to addiction, but having such huge combined boost in abilities given us by the combo adrenaline and dopamine sort of lifts us out of the misserie of the daily reality we live in, makes us time and again (at the moment it is happening, as high bursts of adrenaline are designed to not let us see we are trying to do the near impossible) blind for the cost even if we experienced it a hundred times and associates this very strong increase in ability and feeling of wellbeing with the addiction hormone by definition: dopamine.
=> Where so many researchers see us as being malingers and unable or unwilling to use the tools psychology, behavioral training and graded exercise hands us to improve our condition, we actually have become far TOO good at using our bodies and minds to change, alter and boost our hormones in order to temporarily boost our abilities two, three, four or five-fold depending on case and patient…
I’d love to see researchers doing us such too difficult tasks we indeed rate as very difficult, have us complete them reasonably well and do real time minute by minute or second by second measurements of nor-adreanline, adrenaline, dopamine, oxcytocin, serotonin… and so on. I wouldn’t be surprised they are awe-struck by our mental abilities to change our hormone levels so dramatic on such short notice by nothing but the power of our minds. I’d imagine they’d never dare to use the words malinger, imagined disease or lack of willpower ever again when talking about us.
Well said!
Hear, hear djurgen, you’re so right. Again, well said. I felt quite offended by the idea that we are too busy focussing on our problems etc. How could they possibly have measured it anyway. What rubbish.
I have just had to complete a government form and am now so exhausted my whole body is trembling can hardly type this and will have to rest on my daybed for the remainder of the day. Greetings Cort you’re wonderful. Feeling ? now.
hugs to you Peach Blossom,
glad that u can say and recognize it is rubbish,
ssorry you are experiencing such bad illness that makes you be able to know it is rubbish,
wishing for you a better today
Yes, really well put Dejurgen. I’m trying to live on the energy I naturally have, rather than using adrenaline to boost me beyond my limits. But I find ‘explaining’ myself and the last 13 years very difficult – even to myself at times. This was highlighted at Christmas. Like what do I write in a Christmas card? Merry Christmas, I’m ummm… what exactly? I didn’t send any. So felt bad and have bought packs of bright, cheery Just a Note cards. I want to be true to myself and my experience but I know word was put out that I had mental health issues and seen as I have sort of dropped out of communication with most people, that just backs up that viewpoint. I think the issue for me is about my identity – I know who I am but that seems to be at odds with how others see me.
“The “functional cognitive disorder (FCD)“, championed by Teodoro and others, proposes that something akin to poor stress management is producing or contributing to cognitive dysfunction which appears in the absence of identifiable brain damage”
@Teodoro:
It’s time to keep up with recent articles in the two very best scientific journals of the world: Science and Nature. The published observations that ME/… patients mitochondria all over the body having severely decreased abilities to produce energy/ATP does NOT equal absence of identibiable brain damage.
Indeed!!
I have a feeling the Teodoro’s influence is waning every day. I assume that he now attributes the cognitive problems long COVID patients report to the same process. I don’t think that’s going to work out well.
Touche! So true. ?
Been meditating for three years now, in the hope of improving memory defecits that seemed to come along with ME/CFS.
Can’t comment on memory, but my awareness of breath holding, physical tension and other has risen substantially. Now I’m aware of these things I’m able to let them go. Same with rising emotions – I just focus on my breath for a while and watch them dissipate.
I’m still prone to typical human irrationality and emotional outbursts, but can often let them pass by without impacting my inner and outer environments too much. And when I do mess up in these ways, I let go of the thought patterns of beating myself up about it and the physical and mental tension that comes along with it.
All this has been happening with greater frequency in the last few weeks, so it was interesting to read about this study talking about it. Obviously I can’t say for sure with my sample size of 1, but I’m almost entirely certain it’s due to the changes brought about by regular mediation practice. So is propose that meditation is a way that FM patients may address the issues airlines in this blog.
Congratulations Man Shadow…I hope to get to where you are at some point. I think ME/CFS/FM actually pushes against success with meditation but that could mean that something like that is more necessary than ever.
Cort – absolutely it does. 20 years ago I was able to focus for up to 30 minutes at a time, without being distracted by the monkey mind. Fast forward to now and probably 10 minutes is my best, and it would occur maybe only a few times a year. Typically it would be only a few minutes between losses of focus.
So prolonged focus is out of the question for me. But I think what is still of benefit is the repeated act of letting go of whatever thought we are distracted by and returning to our point of focus, without judgement or assessment. I believe that the few thousand times I’ve done this over the years has translated to my non-meditative mindset also. Some of the time anyway, Hahahaha.
Another problem is the physical sensation of fatigue and adrenalised feeling at other times. Either of these can make it really hard and sometimes impossible to get to any sort of relaxed state. But the benefit of not getting caught up in our thought, and letting go of judgement when we do, is still attainable even if we are tired or too full of adrenaline.
So yeah, even with all the added challenge, there are still some very useful benefits to be gained for PWMEs and FMers.
I looked into Ability (aripiprazole) and apparently it can modulate dopamine levels up or down – whichever way the persons system requires. Fascinating that some substances work irrespective of lack or excess in the system.
And you can definitely get there Cort. Best advice I ever got was to practice daily. I do like a challenge so it’s probably easier for me than some people, but either way a regular daily practice can make a nice difference.
I’ve been to two specialists in 6 months, one a cardiologist who said in my report that my palpitations and light-headed episodes were due to my focusing on these symptoms as I don’t have actual heart problems. The next was a rheumatologist/Internal medicine specialist and she also said my issues were due to my focus. I would add several swear words here but…I’m so sick and tired of the fact that I know far more about fibromyalgia and ME than most health care workers. The most recent, after asking me what I’ve been doing the past 20 years, told me to exercise more. Ok I want to swear again. Honestly so sick of this pathetic treatment by too many.
And by address the issues, I mean free up a bit more mental and emotional energy. I don’t agree in any way that people with FM or ME/CFS are causing these conditions.
I’m speaking from experience that we are probably all familiar with- it can be impossible to focus and easy to be instantly and completely overwhelmed by sensory input.
My proposal is that we do become conditioned somewhat by this (completely logical response by our physiology and psychology) and it can perpetuate somewhat. Lately I’ve been able to sense moments when I would typically tense up physically, become emotionally fixated or have other reactions to both external and internal conditions. Awareness gained via daily meditation practice has enhanced my perception to the point where I can interrupt these processes before they take hold and return to equilibrium.
I still get PEM, I still have sleep problems, I still get excessive adrenaline as a warning sign of having overdone it, cognitive issues, internes headaches, etc.
It’s actually not really groundbreaking, I just let go of the thoughts, make sure to breath slowly and deeply into my abdomen and try and be calm in my mind and body.
I only became aware of breath holding fairly recently, ManShadow. My heart rate would suddenly jolt into speeding up and I didn’t know why, until I just caught myself sort of freezing – as though I was trying to listen out for something. I was completely unaware that I was doing it.
I was doing it all the time.
– executing a physical movement (EG, rolling over in bed, redjusting the bedding to accommodate new position. Plus probably every other movement during the day)
– thinking about stuff (running a scenario through my mind, having a conversation in my head)
I think I was doing it maybe 100+ times per day, which can’t be normal?
I wonder which of the nervous systems it’s controlled by and what sort of source might be indicated. Is there a physical abnormality in the brain region, is it a stress response, etc.
For me ‘thinking about stuff’ too, especially intensely negative thoughts. Also, I think I stop breathing at the end of the out breath – so I don’t take the next in breath. I’ll try and catch it next time I notice.
I have been trying to learn and understand more about what research has shown about cortisol and HPA axis dysfunction in FM. From what I read on PubMed, it seems like the literature is totally inconsistent. Do FM patients have higher than normal cortisol levels (ie, associated with more stress?) or lower (as stated here). I realize that cortisol levels vary in a cyclical nature during the day but it seems like there is no clear consensus. I was trying to understand this as my current functional medicine doctor tested my AM cortisol levels and they were really high, but this is confounded by the fact that I take oral contraception with estrogen, which impacts cortisol. Anyone have any insight on this?
There has been quite a bit of inconsistency in both ME/CFS and FM. My understanding in ME/CFS is that its now pretty clear that low salivary cortisol in general dominates – but obviously there’s room for differences as well – hence the inconsistencies. I’m not up on cortisol in FM.
There’s still quite a bit of research going on on cortisol in these disorders. This recent study found low basal cortisol levels – https://pubmed.ncbi.nlm.nih.gov/31591938/
Thanks Cort – I am not up enough on it either and wish I understood the findings more (especially in light of the other article that was posted today). I guess I am just confused about the low vs high and whether it is testing differences (salivary v blood), time tested, etc? It seems like it varies so much and from the article posted today a lot of practitioners vary in what they think about it and if they are willing to try to give hydrocortisone to correct it at all. I think for me personally it is complicated by being on oral contraception as my doctor did admit that will make levels higher, since estradiol impacts cortisol levels, but then I wonder what that says about why I still feel so horrible and have gotten progressively worse with my FM over 18 years? My current doctor seems to think that high cortisol is indicating overall inflammatory state I am in (plus other indicators moreso metabolic) but then I can’t make sense of how it squares with the idea that people with FM might actual have low basal levels?? Mysteries to dig into!
Good article Cort, thanks so much as always. Just a comment that I have both ME and fibro but my morning salivary cortisol levels were off the charts high. My doctor says this is very indicative of neuroinflammation and a dysfunctional HPA axis, confirmed by my equally very high oxidative stress markers.
Well we are a mixed bunch aren’t we? It took a long time to come to the conclusion that in general low morning salivary cortisol are present. That’s because we present such a mixed bag. Some people like you have sky high cortisol numbers! I now somebody else who does as well.
The HPA axis – one of the two major stress response axes – appears to be getting tweaked one way or the other.
I think the cortisol level thing, relates to the length of time one has been in a highly stressed state (could be situational or health) and how functioning the adrenals are when they are measured. Most of what I have read, from docs who believe in what they claim adrenal fatigue, say that at first when in severe stress states it goes high. With time it depletes and malfunctions in the other direction and is low. No one really agrees as some say its impossible for there to be adrenal fatigue.
But speaking for myself, this is not a new idea at all. Decades ago, I was checked and found low in cortisol. I took it and got sicker. I got more fatigue and could not function. BUT, I do still have to have adrenal support when having surgeries as I will crash right on the table. I was told to make sure that with any surgeries my adrenals are supported. This can be given with IV at that time. I did not find supplementing cortisol to be helpful as a treatment.
Cort,
Thank you!
Issie. I think you are right about cortisol levels. When under long periods of stress the cortisol levels increase which weakens the immune system and with lowered immune response viruses are able to reactivate. Once reactivated the immune response has now got to react to keep the virus under control. While fighting the virus inflammation is created which must be controlled by cortisol which in turn weakens the immune response. With continuing ongoing stress and inflammation over time it becomes a losing battle and eventually the adrenals can no longer supply enough cortisol to deal with the inflammation caused by the immune response to an active infection (viruses). People in early ME/CFS may show high level cortisol, and people well down the road of CFS show low cortisol. Hope this reads right.
This really needs to be tracked over time. Certainly the long COVID patients provide a way to do this.
wish the docs, busy tho they are,
could all read all of the comment
—especially ones like Peach Blossom’s and Kathryn Larouche Imler‘s comment
—as well as comments such as from Issie and dejurgen.
maybe if docs take a course in compassionate care,
the course designers could include reading from blogs, comments, and forums, here
Sunie thank you. Tracey Anne this is a cruel isolating disease I know it’s hard but we can only have faith in ourselves be accepting, very very hard, I know, and every day try and be thankful for what we do have.
Maybe Cort might do a survey where we all enter the mean, stupid, rude and downright cruel things doctors have said to us when we have gone to them for help.Would probably fill a book ? Then we can publish it. Ha Ha. Might teach them something.
Thanks Peach Blossom ? I know I’m very lucky I’m able to do much more than others but as you say – it’s very isolating and I don’t have anyone to help me. I’m a mum with an unidentified chronic illness, a teenager, on my own, working part time on a zero hours contract in people’s home in a pandemic and that can be terrifying…
When my cortisol level was first taken it was as far as the medical profession was concerned within range. This is the problem with a lot of pathology tests, especially for M/E CFS. The margins are too wide and this is why doctors find nothing wrong with patients . Although I was within range my blood cortisol was always at the low end. I then had a saliva cortisol test which came back possible adrenal insufficiency. Some time later I seen an Integrative doctor who prescribed me 10mg hydrocortisone for one month,during which time I felt a lot better. At the same time I was to see an endocrinologist who told me to cease the hydrocortisone and wanted to check my adrenal glands for adrenal insufficiency. I had the test done which involves an injection of ACTH to see how the adrenals respond. They responded normally, but my morning cortisol level before the test was considerably higher than the previous five cortisol tests. When I asked the endocrinologist why,he said I didn’t know. I suspect the low dose hydrocortisone helped the adrenals recover, but unfortunately this is only a temporary solution as you can’t keep taking hydrocortisone as the longer you take it the beneficial effects weaken as your own adrenal glands begin to produce less cortisol in response to supplementation.
Another correlational study; the cortisol response could be just another symptom of FM/CFS rather than the cause for the cognitive problem.
It seems rather obvious to me that you’d have a cognitive difficulty when you are fatigued or sick. I know I do when I’m in PEM. So, the real question is why we are sick at the first place. Since the cortisol anomaly doesn’t explain the main symptoms, it’s probably just another symptom rather than the cause. But I suppose it’s still possible that the sickness causes the cortisol problem which in turn cause cognitive difficulty. And I suppose that theory could be tested by raising the cortisol level and see if the cognitive function improves.
Have you seen this research below Cort, proposing several distinct stages to CFS? I certainly feel that I was much more pro inflammatory in the early days, I had lots of food allergies in years 1-10 but then they began to dissipate. Has anyone else experienced this? I am not complaining, it’s one of the few things that has got noticeably better for me 🙂
Sorry, can’t paste link for some reason. But it’s from late 2020, and title is:
‘How Myalgic Encephalitis/CFS (ME/ CFS) progresses: The Natural History of ME/CFS’
This disease is as Nancy Klimas says is neuroinflammatory and systemic inflammation causing a myriad of symptoms, like thick blood from inflammation of blood vessels leading to constriction of blood vessels and problems with red blood cells deformability and micro circulation problems. This can be verified on MRI scan as discussed on previous subjects. Both my MRI scans in 2014 and 2017 showed ischemic gliosis on the first and chronic ischemic change on the latest. Both showing damage to small blood vessels or micro circulation. This systemic inflammation also effects organs and glands throughout the body, like the thyroid gland and adrenal glands. Inflammation of the thyroid can stimulate it and make too much T3 and T4 and prolonged inflammation can have a major affect on the body. Also inflammation within the adrenals can cause number of abnormal hormonal results. Increased cortisol levels from stimulation by inflammation to start with until the adrenals eventually become fatigued and then constantly low cortisol and more fatigued and inflammation. Also inflammation of adrenals will stimulate adrenaline production and other hormonal problems. Some people early stages may have conflicting cortisol levels, but those with long term ME/CFS would likely have persistent low cortisol as it becomes a vicious cycle of more fatigue more stress more cortisol needed and so on.