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Mitochondrial Function
All cells require energy to function, and this is produced as ATP (adenosine triphosphate) in the mitochondria found in every living cell. ATP powers almost every reaction in the body, so any problem in ATP production can be expected to have very widespread and profound effects. Cells obtain energy from ATP by converting it to ADP (adenosine diphosphate) plus energy. In the mitochondria, the ADP is converted back to ATP in a process called oxidative phosphorylation. People with CFS often have slow reconversion back to ATP. If someone requires ATP faster than it can be produced, ADP builds up, and some is shunted into AMP (adenosine monophosphate) which can’t be effectively recycled, and is therefore lost from the energy system. This means that the body has to make new ATP from d-ribose, but this process takes 4-5 days, as the d-ribose needs to be synthesised from glucose via the pentose phosphate shunt. This could explain why some people with CFS feel ‘wiped out’ for several days if they overdo things. ATP can also be made in small amounts from glucose, by converting it into lactic acid through anaerobic metabolism. Lactic acid build up can lead to pain, heaviness and aching, and its production depletes the glucose which is needed to produce d-ribose.
The biochemistry of energy production is very complex; more information on this can be found in the book ‘The Sinatra Solution: Metabolic Cardiology’ by Stephen Sinatra (2005). This American cardiologist pioneered the use of the mitochondrial support supplements now used in Chronic Fatigue Syndromes in Cardiac Failure and angina initially, before making the link to CFS. (The heart is, after all, a muscle).
Mitochondrial function can be measured through blood tests developed by Dr McLaren Howard at Biolab. The degree of mitochondrial failure correlates with the severity of CFS symptoms (Robinson et al 2006). Robinson et al concluded that ‘we now have an objective test for chronic fatigue syndrome which also indicates the site of the biochemical lesion, its severity and most importantly gives clear direction to treatment’.
Mitochondrial function profile tests measure:
- Magnesium status – (ATP production is highly dependent on magnesium)
- The efficiency with which ADP is converted to ATP
- ADP-ATP translocator (the protein which transports ADP and ATP across the mitochondrial membrane).
- Co-enzyme Q10 and SODase (both important antioxidants) and NAD (produced from vitamin B3, it powers oxidative phosphorylation)
- Cell free DNA (provides an indication of illness severity, as cell free DNA is a result of damaged/dead cells)
The good news is that nutritional supplements can be used to correct or circumvent problems with mitochondrial energy production (Myhill 2007). The mitochondrial function tests guide the decision about which supplements are needed, and together with the other elements outlined on the Chronic Fatigue Syndrome page, may form part of a Balanced Medicine Programme.
References:
Myhill, S., 2007. The biological basis of fatigue: a proposed underlying pathophysiological model for Chromic Fatigue Syndrome with implications for treatment and a diagnostic test. Awaiting publication later in 2007.
Robinson, C. et al, 2006. Clinical Research: Results from the Mitochondrial Function Test in Patients with Chronic Fatigue Syndrome. (Unpublished).
Sinatra, S., 2005. Sinatra Solution: Metabolic Cardiology. Basic Health Publications