Hormonal problems in CFS - a clinical picture - the ectomorph

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It is now quite clear there is a distinct hormonal disturbance in CFSs with abnormalities in the hypothalamic-pituitary-adrenal axis. There is plenty of evidence to suggest abnormalities of the thyroid glands. Hitherto I have been reluctant to prescribe hormones to my CFS patients simply because I felt I did not know enough. However, two papers recently out in the Journal of Environmental and Nutritional Medicine have clarified matters to me.

CFSs are often Ectomorphs

The first is a paper from an Australian psychiatrist Paul Holman, who noticed that very slim individuals seem particularly prone to chronic fatigue, anxiety and environmental sensitivity. He then reviewed the literature and discovered reports from doctors who tried to classify people in terms of their constitution. Of most interest was that done by Sheldon in 1940 when he published The Varieties of Human Physique, where he described three dominant types - the endomorph, the mesomorph and the ectomorph.

It is the ectomorph who interests us because he/she seems susceptible to CFS. Sheldon noted ectomorphs were introverts under 'strong inhibitory control'. They tend to be extremely sensitive to noise and 'distractions'. They usually revealed histories of allergies, skin complaints, chronic fatigue and insomnia. They needed to eat more and oftener than other types, needed protein in 'large quantities' and had difficulty adjusting to changes in climatic conditions. A similar description is given by Tintera, who described a group of 200 patients whom he characterised as having suboptimal adrenal cortical function. These individuals showed an asthenic habitus, crowded lower incisors, cold extremeties, postural hypotension and tenderness in the adrenal angle. Their commonest complaints were anxiety, depression, headaches, salt and sugar craving, drug reactions, allergies, pre-menstrual syndrome, gastrointestinal problems (particularly alternating constipation and diarrhoea) and dermatoses. Laboratory findings included a flat glucose tolerance test, eosinophilia and low urinary 17-ketosteroids. Tintera hypothesised that the main problem for these people rested in a constitutional adrenal weakness which expressed itself in symptoms when the person was chronically stressed. His treatment was a high protein diet, low refined carbohydrates, more salt, hydrochloric acid (to help protein digestion), B vitamins, vitamin C and whole adrenal gland injections.

The ectomorph has a constitution associated with anxiety and insomnia. These people are more 'aroused' and have a higher demand for nutrients, energy requirements and repair of body tissues. Normally the body repairs damaged tissues during sleep. Hormonally this is marked by a switch from cortisol and adrenalin in the day to testosterone and growth hormone at night, catabolic or breaking down by day to anabolic or building up by night.

We know that carbohydrates such as sugar, wheat, potato etc), stimulate the thyroid gland, reduce pain thresholds, and elevate mood (combating anxiety and depression) and so the ectomorph likely to be tired and stressed, craves sweet foods in an attempt to attain calmer alertness. However excess carbohydrate in the long term raises metabolic rate, is stimulating, depletes nutrients (vitamins and minerals) and eventually damages the body resulting in chronic fatigue.

This makes sense to me. I know that dieting and restricting carbohydrate intake makes people cold, depressed and they lose energy. Similarly if I want to keep going working beyond 10.00pm, a bar of chocolate keeps me awake to midnight if necessary!

Treatment for Ectomorphs

Holman's advice to ectomorphs is that prevention is better than cure. He suggests:

Ectomorphs learn the virtues of relaxation, regularity and stress management at an early age.

Maintain good regular sleep. This is of paramount importance and insomnia should be seen as an early warning sing of hyperarousal.

Protein in the middle of the day is essential to prevent the 'catabolic run down of mid to late afternoon'. Animal protein in stews or casseroles is best as ectomorphs are poor digesters. Vegetarians should supplement their diet routinely with amino acids.

Ectomorphs should be wary of food sensitivity, especially to wheat and legumes.

Ectomorphs need more of everything - food, vitamins, minerals, antioxidants (i.e. vitamins A,C,E and selenium), water (they tend to dehydrate readily), amino acids. (To this I would add essential fatty acids and salt). Modest exercise to build muscle mass is helpful. Avoid refined carbohydrate and alcohol.

Recovery takes time. Use thyroid and adrenal supplements.

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