Carbon monoxide poisoning and multi-sensitivity - a possible explanation for hypersensitivity symptoms
Carbon monoxide poisoning and multi-sensitivity - Ideas from Albert Donnay, President of the MCS Referral & Resources ref: MCS Referral and Resources - Essential reading for all patients with multiple chemical sensitivity, electrical sensitivity and hyper-vigilance/chronic anxiety
Firstly thank you to Alberty Donnay for seeing this handout and checking it for accuracy! Do look at the website which has lots of useful information - see link above.
I see a great many people who are hypersensitive. Sometimes the hypersensitivity is exquisite and is to light, noise, touch, smells (multiple chemical sensitivity) and often to electromagnetic radiation (electrical sensitivity). I have always wondered if there is an underlying mechanism and it appears there is! Donnay has produced a convincing case that this is evidence of past or current carbon monoxide poisoning which may come from outside the body or be made by the body itself as a stress response. This switches on a hypersensitivity and hypervigilence which amounts to chronic anxiety and possibly psychiatric symptoms. The good news is that this is curable!
Where does the carbon monoxide (CO) poisoning arise from?
The outside world
Essentially the incomplete combustion of carbon, so vehicle exhaust fumes, furnaces, water heaters, space heaters, ovens, ranges, stoves, fireplaces, cigarettes and explosives. CO also derives when haemoglobin breaks down or from inhaled dichloromethane, a common ingredient in solvents and spray cans. Also see Modern Household Toxins
AND/OR from within the body
What is most interesting is that CO may come from within the body as a stress response. Stress of any kind induces increased production of haem oxygenase-1 (HO-1), the so-called "universal stress enzyme" found throughout the body, which breaks down haem from haem proteins into iron, biliverdin (which is then converted into bilirubin, a potent anti-oxidant), and carbon monoxide. The stresses that have been shown to induce HO-1 in animals and humans include heat, light, sound, odours, electromagnetic fields, infection, physical trauma and mental or psychological stress. Chronic stress in any of these pathways thus results in chronic destruction of haem and chronic low-level CO poisoning. The ability of so many different types of physical, biological, chemical and mental stressors to induce HO-1 explains why the core symptoms of chronic stress are so similar to CO poisoning regardless of the stressor (see symptoms, below). Stress-induced HO-1 activity and the relatively constant activity of another isozyme, HO-2, that does not respond to stress, together account for about 75% of the human body's CO production. Other sources of CO include the auto-oxidation of phenols, flavenoids and halomethanes, the photo-oxidation of organic compounds, and the lipid peroxidation of membrane lipids (clinically I often see lipid peroxides as part of the DNA adducts test). HO activity can be directly measured in blood and various organs but of course varies widely, while endogenous CO levels, which also include any exogenous contribution, can be measured directly in breath, blood or muscle. The most commonly measured carboxyhaemoglobin level (COHb) only identifies the percent of haemoglobin that is bound to CO, but this is normal in cases of chronic low-level CO poisoning, and even in acute cases not consistently related to symptoms. Having good anti-oxidant status will of course mitigate some of the effects of CO poisoning.
What are the symptoms?
In the short term, CO displaces oxygen from haemoglobin and sticks more avidly so all organs are oxygen deprived. This can result in a multiplicity of symptoms but notably flu like symptoms, headache, fatigue, weakness, muscle pains, cramps, nausea, vomiting, upset stomach, diarrhoea, confusion, memory loss, dizziness, inco-ordination, chest pain, rapid heartbeat, difficult or shallow breathing, changes in sensitivity of hearing vision, smell, taste, touch. There is an obvious vicious cycle here - the stress causes the CO and the CO causes the hypersensitivity. See MCS Referral and Resources for details. There is a lovely description of CO poisoning by Edgar Alan Poe who was a sufferer.
Why Hyper-vigilance/chronic anxiety?
I have always wondered about the evolutionary necessity of hyper-vigilance/chronic anxiety. Worrying unnecessarily seems a terrible waste of mental and emotional energy. But this may be part of the flight or fight mechanism when the body realises subconsciously that it does not have the reserves for a good fight or flight response. In this case there is not the oxygen supply to fuel a mad dash away from the sabre toothed tiger hiding behind the bush! This means that the sufferer has to be constantly hypervigilant to get sufficient due warning of such a threat which may be physical, mental, metabolic, infectious, emotional or whatever.
Donnay suggests that these symptoms of hypersensitivity, hypervigilance and constantly feeling "wired" may be symptomatic of low oxygen consumption. This for example could be caused by lack of oxygen supply from respiratory or heart disease and indeed we know clinically that patients in respiratory failure or heart failure are indeed anxious. In their case this is very understandable! What is less easily understood, but the same principles apply, is the hypersensitivity from poor oxygen supply at the tissue level. In the case of these poor sufferers the situation is made much worse because there is no general understanding amongst doctors of their plight. The obvious example is hyperventilation - in this case over-breathing results in a washing out of carbon dioxide which changes the acidity of the blood (called respiratory alkalosis) in such a way as to make oxygen stick more avidly to haemoglobin. So the arterial blood is full of oxygen, it does not get into the tissues and indeed the venous blood will also be full of oxygen! Donnay suggest a similar problem with tissue delivery of oxygen resulting from CO poisoning which is different from hyperventilation. This mechanism is obvious in acute CO poisoning but less obvious in chronic CO poisoning - see above.
Other Effects of CO poisoning
As well as impairing oxygen delivery, CO can destabilise blood sugar levels, dysregulate the autonomic nervous system to disturb heart rate, respiration, blood vessel tone, upset mental function (learning and memory), disturb sexual function and trigger sensitisation to smells, light, sound, touch etc.
Diagnosing acute and chronic CO poisoning
1. Firstly fill in the "Carbon monoxide poisoning" questionnaire and symptom score;
2. Look at your face in a mirror. CO sufferers have a lopsided face with facial asymmetry. This may look like Bell's Palsy, but may be the opposite - i.e. droopy eye one side but raised edge of mouth the same side.
3. See if you have any CO related disorders as listed on the questionnaire;
4. Arterial and venous blood gas testing. This is difficult because blood gases are not an out-patient procedure! (page 1 of the above questionnaire gives details)
Furthermore, the bloods have to be taken directly to the lab for testing. Donnay states that there should be a greater that 30% difference between arterial and venous oxygen levels - one of his patients had a result of just 0.2% - as he commented - this should not be compatible with life! I am currently making enquires as to where these tests could be done.
5. Response to treatment with oxygen. The protocol is supplemental oxygen at 5 litres per minute for 2 hours a day for 3 to 4 months). A response should be seen within 1-2 weeks.
Treatment of suspected carbon monoxide poisoning manifesting and multisensitivity with oxygen
In a study done by Donnay of 34 CFS patients, 68% had multi-sensory sensitivity, with 100% of these reporting hypersensitivity to noises, lights, and odors, and 48% reporting hypersensitivity to electromagnetic fields (compared to just 9% of those without multi-sensory sensitivity). In a follow-up study that Donnay did of 54 people with multi-sensory sensitivity whom he advised in 2007 to seek oxygen treatment, an improvement in sensory tolerances was reported by 20% of those who did not receive any oxygen treatment and by 22% of those who were treated by other oxygen protocols. This compared to 100% improvement rate of those treated by Donnay's protocol, including 25% who claimed to be cured of all their sensory sensitivities and 38% who were cured of all but their chemical sensitivity. It is clearly critical that the Donnay protocol is followed! Indeed Donnay claims multi-sensory sensitivity, (but not MCS alone, can be cured with appropriate oxygen therapy.
Funnily enough, I have several patients with severe MCS who know their symptoms can be relieved by inhaling pure oxygen. I have not been able to explain this until now!
Treatment with oxygen
As with all patients with these clinical problems, treatment has to be started slowly and gradually built up. Oxygen is poorly tolerated by people who do not have CO poisoning. If oxygen is to be helpful then responses can be seen after the first week of therapy. It is wise to ensure good anti-oxidant status prior to therapy because additional oxygen will for some people create a pro-oxidant stress (indeed this may be the mechanism by which some people worsen on oxygen). The treatment requires 5 litres per minute for 2 hours a day and continued for 3-4 months. Donnay states symptoms resolve in 1-2 months and blood gases normalise in 3-4 months. My experience with patients with severe MCS is that sometimes symptoms can usually be aborted with oxygen therapy as a first aid measure. Oxygen can be supplied either by cylinders or by using an oxygen concentrator. If you are thinking of purchasing one, then be mindful that I can probably find a home for your concentrator when you have finished with it! There are many companies that provide these, but start with ebay for a second hand concentrator.
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