Chapter 4

The Basics

Fatigue-related syndromes are complicated conditions that confound quite a lot of the doctors and others who have made a detailed study of them. In order to recover, you are going to need to understand the basics of how the body functions in health, what has gone wrong and why, and what you need to do to heal. This chapter covers the basics on how the various body systems should work and in chapter 7 we examine how these systems are affected in FRS. If science passed you by at school, well, here is a whistle-stop tour and if you are a therapist or have already read widely around this subject and are confident that you have a good grasp of basic physiology, feel free to skip or scan this section.

The Building Blocks of Life

Atoms

Everything in the known universe is made of atoms which are spheres of energy that are 99.9999 per cent space. They have a nucleus in the centre that contains particles that are neutral, but have some weight (neutrons), and particles that have no weight but carry positive charge (protons). Around this dense ‘core’ are little packets of negatively charged electrons held in their orbits by the pull of the nucleus. These electrons prefer to orbit as opposing pairs and atoms are most stable when the outermost shell is full of electrons. There are 92 naturally occurring elements and what gives any element its identity is the unique number of protons and neutrons in the nucleus. Thirty-four of these elements are essential for life with another third being ‘conditionally’ essential and the remaining third proving toxic. The periodic table lists the elements by increasing atomic weight and attempts to group elements that have similar properties, mostly because they have the same number of electrons in their outer shell.

The Cell

The basic building block of the body is the cell and to understand some of what occurs in disease, you need to understand a little of how the cell operates in health. The same genetic material is held in the nucleus of most of the body’s cells. Different parts of this are activated in different tissues such as the brain and the liver, which makes those cells unique. The cell is surrounded by a cell membrane which is largely made of fats and this makes the cells waterproof to some extent. The membrane has receptors embedded in it that are specific for certain hormones, neurotransmitters or other compounds and these act as the ‘doors’ into the cell. When substances dock with their particular receptors, a process is set in motion within the cell, or a specific substance is permitted entry into the cell. The cell contains various organelles (little organs) suspended in watery gel called cytosol that all have different functions, and all these organelles (including the nucleus) have membranes that contain receptors too. All cells are suspended in a salt-water environment from which they obtain their nutrients and spew their waste products and it is this that interfaces with the circulatory system. Lysosomes are a specific kind of cell organelle that contain digestive enzymes that are used to destroy defunct organelles or even the whole cell and have been termed ‘suicide bags’. The compounds that specific cells synthesize are also released into the intercellular matrix after little sacs migrate to the cell membrane and fuse with it. In the case of the thyroid gland this substance would be thyroxine (a thyroid hormone) and in the case of the pancreas it could be pancreatic enzyme. Recent research has determined that much of the intelligence of the cell and organelles relates to the activities of their respective membranes and not to the genetic code as previously assumed.

The Genetic Code

The genetic material is held primarily in the nucleus in the form of deoxyribonucleic acid (DNA), which is a long and elegant molecule structured like a coiled ladder. Each cell contains 2m (6ft) of DNA and the total amount in every human would go around the world five million times! The upright backbone of the molecule supports the ‘rungs’ which are composed of two complementary sugars and it is just four of these sugars that code for all of the information required to make a human. The DNA ladder can temporarily ‘unzip’, allowing counterpart sugars to dock onto the exposed ‘rungs’. Then this small portion of the genetic code is transported in the form of messenger RNA (mRNA) which shuttles to small organelles known as ribosomes where this code is ‘read’ and a particular protein assembled. If one side of the DNA ladder is broken, then the damage can be repaired using the remaining strand as a template. However, if both strands are broken this damage cannot be repaired and this may lead to cancer or a birth defect depending upon the tissue affected.

Energy Production

The main energy source within the body is a compound called adenosine tri-phosphate (ATP) and this is synthesized within the cell, mostly from the carbohydrates that we eat. This process occurs inside an organelle known as a mitochondrion, of which there are a thousand on average in each cell. The mitochondria synthesize ATP from glucose and oxygen and generate waste carbon dioxide in the process. The ATP is then exported from the mitochondrion to another location within the cell where its extra phosphate bond is broken to produce adenosine di-phosphate (ADP) with the release of energy, which can be used by the cell. The spent ADP then returns to the mitochondrion for recycling back into ATP and so the process goes on. The average person makes almost their body weight in ATP every day and for this reason, the mitochondria and their health are of vital importance in energy production. Perhaps critically, the mitochondria are also about twenty times more sensitive to toxicity than other cell organelles.

Free Radicals

Our growing understanding of free radical damage is probably one of the greatest recent breakthroughs. Free radicals are unstable and greedy atoms or molecules with an unpaired electron in their outer shell. The free radical is disposed to steal an electron from another molecule, which in turn snatches an electron from another molecule, and this process can start a whole cascade of devastation. The more recent term reactive oxygen species (ROS) is now more properly used because not all damaging oxygen species are free radicals. An antioxidant is a generous and stable molecule that can donate an electron to the hungry ROS and not be adversely affected itself.

The generation of energy using the oxygen that we breathe inevitably produces ROS within the cell – like sparks from a flame. Other factors such as poor nutrition, drug use, smoking and sunbathing also generate ROS. The damage created is constantly being mopped up, provided that the ROS produced are within reasonable limits and that the person has consumed adequate quantities of antioxidants in their diet. Problems arise when the diet is deficient and/or the system is overloaded with ROS, in which case permanent damage starts to occur to the cells that cannot be repaired. The mitochondria are furnaces of energy production and any damage sustained by the mitochondria will lead to compromised function – which means compromised energy production. ROS damage is thought to lead to ageing and degenerative illnesses and may cause cancer or birth defects if the genetic material is affected.

Understanding the Body

The following is a brief description of the various body systems. It should be understood, however, that these distinctions are a purely artificial construction to aid understanding, and that in reality every cell in the body is communicating with, and is dependent upon, every other cell. It is just not possible that one part can become diseased whilst the rest of the body remains healthy as per the dictates of allopathic medicine. On the contrary, the whole system becomes compromised and whilst it has a remarkable capacity to compensate for adversely affected organs or systems, this is not infinite and eventually one of these will fail first.

The Digestive System

Essentially, we humans are just elaborate and mobile feeding tubes! Unlike single cell creatures that can absorb nutrients from, and expel waste products into, their surroundings, we are large and complex. For this reason we are designed to take in a supply of food at one end of a tube, absorb the nutrients from it and then excrete the waste through the other end. This tube is variously referred to as the gut, intestine, gastrointestinal tract or alimentary canal and is technically an external surface. Of course, there’s a little more to it than that – so here’s a simplified version of what your intestines do for you.

The Intestines

As we chew food, we mince it up with our teeth and coat it with the first of many digestive enzymes which are present in saliva. This mixture, known as a bolus, is then swallowed and passes down to the stomach where it spends some hours being churned and bathed in more digestive enzymes. The stomach contents at this point are very acidic and this helps to break down proteins, to kill any swallowed organisms and to activate the protein-digesting enzyme, pepsin. Protein-digesting enzymes are produced in an inactive form and then activated in situ, otherwise they would digest the very organs that contain or produce them. When it is ready, this semi-liquid purée known as chyme is discharged into the small intestine. Here it meets almost immediately and simultaneously with bile from the gall bladder and other digestive enzymes from the pancreas. Between them these secretions essentially complete the chemical breakdown of the food into nutrients that can then be utilized by the body.

Your small intestine is over 7m long (23ft) and is coiled and folded in the central part of your abdomen, behind your navel. The chyme is moved along by a wave-like squeezing contraction of the muscular walls known as peristalsis. The small intestine lining has finger-like projections known as villi which are covered in further velvety projections known as microvilli and this means that the surface area of the intestine is absolutely enormous, with one square centimetre representing an area the size of a tennis court. The majority of the nutrients are absorbed directly into either the bloodstream or the lymphatic system through this vast internal membrane. These nutrients are then transported to the liver and on to the rest of the body to be used as fuel and building materials. The majority of the bile is reabsorbed in the terminal part of the small intestine and recycled back to the liver in the portal vein and this is known as the enterohepatic circulation (‘entero’ refers to the intestine and ‘hepatic’ to liver) or bile loop.

The chyme then moves from the small intestine into the large intestine (or colon) – so called because of their respective girths. The large intestine is 1.6m long (5ft) and passes up the right-hand side of the body, across the abdomen (above the navel) and down the left-hand side of the torso to the rectum and anus. Where the small intestine empties into the large intestine, there is a valve known as the ileocaecal valve (pronounced il-ee-o-see-kal). This valve regulates the passage of chyme into the large intestine and also prevents the backflow of contaminated bowel contents into the small intestine where they would be absorbed. This valve is located halfway between the right hip crest and the navel and when dysfunctional can often be painful – a pain that can often unfortunately be mistaken for appendicitis.

The large intestine is inhabited by several kilos of 500 different species of bacteria – which is ten times as many bacteria as there are cells in the body! These friendly bacteria complete the digestion of the remaining food, produce vitamins and minerals that are absorbed and used by the body and are responsible for 25 per cent of detoxification. The colon is also thought to house 75 per cent of the immune system since it is the biggest area of exposure to the environment. Once in the colon, water is absorbed from the chyme to form a solid mass of waste, which is packaged, ready for defecation. Mucous helps to lubricate the waste and protect the body from the toxic stool.

The Liver

The liver constantly filters the blood and has at least 500 and possibly thousands of different functions. The liver detoxifies; redirects nutrients to other parts of the body; synthesizes bile; removes ageing blood cells and any parasites from circulation and generally monitors blood contents. Your liver is critical to your overall health and its function is usually severely compromised in all chronic diseases. Fortunately, the liver has a remarkable capacity for regeneration and given the right nutrients it is possible to nurse your liver back to health.

The liver processes toxins through two different biochemical phases. The first of these (phase I) is known as hydroxylation and this is where substances are made water-soluble and often results in temporarily making a toxic substance even more toxic. The second phase (phase II) is known as conjugation, whereby the liver adds various substances to the products of phase I. There are six different biochemical pathways in this second phase. These processes have a high requirement for minerals, vitamins and nutrients which, if deficient, mean that the body is unable to adequately detoxify. ‘Pathological detoxifiers’ are people who can adequately process substances through phase I liver detoxification but are then unable to process a substance through phase II for lack of an enzyme or mineral, for instance.

The Gall Bladder

The gall bladder acts as a storage organ which concentrates the bile that the liver is constantly producing. The gall bladder contracts (when chemically signalled to do so) just as the chyme leaves the stomach and enters the small intestine. The function of bile is to emulsify fats (make them into little droplets), so that other enzymes can work to digest them. It is also the body’s favoured method of excreting any toxic fat-soluble substances and large particles, such as parasites.

The Pancreas

The pancreas is a dual-purpose organ in the upper left of the abdomen. It produces digestive enzymes which empty into the small intestine along with bile from the gall bladder. These pancreatic enzymes help to break down proteins and complete digestion of all foodstuffs. The other role of the pancreas is as an endocrine organ and this is addressed below.

The Endocrine System

The prefix ‘endo-’ means ‘within’ and here it refers to a system of widely separated intercommunicating and interdependent glands within the body that release hormones directly into the circulation. These circulating hormones act as messengers that find their way to a specific target tissue receptor and cause some sort of effect. The whole endocrine system is very finely balanced and the glands compensate for each other. This means that one dysfunctional gland can ultimately affect the entire endocrine system.

The endocrine system consists of the following organs:

• the testes in men and the ovaries in women, which produce sex hormones;

• the thyroid gland, which controls metabolism and growth;

• the parathyroid glands, which regulate mineral balance;

• the thymus, which plays a key role in the immune response;

• the pancreas, which regulates blood sugar;

• the adrenal glands, which are primarily responsible for the stress response but also have other functions.

Orchestrating all this activity are three controlling glands in the brain: the pineal, the hypothalamus and the pituitary gland.

All of these glands are affected to a greater or lesser extent in FRS, however the thyroid and adrenal glands are invariably involved along with the hypothalamus in the brain and for this reason we will examine them in a little more detail.

The Thyroid Gland

The thyroid gland is a small gland at the front and base of the throat. It mainly produces inactive thyroxine (sometimes known as T4), which is then converted into its active form of tri-iodothyronine (T3) in the tissues and liver. Thyroid hormones are a kind of growth hormone and govern the metabolism in practically all the body’s tissues and also enhance the effects of other hormones.

The Adrenal Glands

The adrenal glands are small glands that sit on top of the kidneys and are located under the ribs in the back. They have several different and important functions, but are primarily responsible for our response to stress. The adrenal glands produce (amongst many other hormones) adrenaline (epinephrine), which provides an immediate and short-term response to stress and the steroid hormone, cortisol, which provides a medium-to-long-term stress response.

Both the adrenal and thyroid glands receive their instructions from hormones released by the pituitary gland in the brain under the direction of the hypothalamus, which contains sensors that are constantly monitoring all hormone levels. These are respectively known as the hypothalamus-pituitary-adrenal axis (HPA axis) and the hypothalamus-pituitary-thyroid axis (HPT axis) and it may be the master glands, these axes and/or the whole endocrine system that are compromised in FRS and not just one component.

The Hypothalamus

The hypothalamus is a highly organized collection of nerve tissue at the base of the brain that is about the size of an almond. The small size belies the overarching importance of this gland which processes information gathered from the five senses and various regions of the central nervous system. It also constantly monitors levels of hormones and other substances in the circulation and the cerebrospinal fluid (the fluid that surrounds the brain and spinal cord). The hypothalamus then relays information to the adjacent pituitary gland which releases hormones into the circulation. It also controls the autonomic nervous system which is the ‘automatic’ nervous system that controls all functions that operate beneath conscious awareness. In these various capacities, the hypothalamus acts as the interface between the mind and body and indirectly controls virtually every cell. In this way variables such as temperature and blood pressure are maintained within narrow parameters by means of constant adjustments that result in the seemingly steady state of homeostasis.

It is hard to overemphasize the importance of the hypothalamus in maintaining health since it controls such functions as sleep/wake cycles; the immune response; body temperature; hunger and appetite; urination and defecation, and testicular and ovarian function. Were that not enough, the hypothalamus also governs emotional behaviour including feelings of anger or rage, sexual behaviour and feelings of either pleasure and energy or emptiness and depression. It also plays a key role in enhancing memory and learning and, perhaps significantly, has a different structure in men and women and also differs between heterosexual and homosexual individuals. The protective blood–brain barrier is perforated adjacent to the hypothalamus to allow for monitoring of blood contents and excretion of substances directly into the circulation. As a consequence, the hypothalamus is the most vulnerable part of the brain to toxic insult.

The Nervous System

For convenience, the nervous system is regarded as being composed of the central and peripheral nervous systems. The central nervous system includes the brain and spinal cord, and the peripheral nervous system is the system of nerves that connect it to distant body parts. These peripheral nerves can be either sensory or motor nerves. Sensory nerves convey information to the central nervous system concerning the outside world (via the special senses such as sight and hearing) and from within the body (such as pain or joint positions). Motor nerves relay instructions from the central nervous system to the tissues and usually cause the body to respond in some way to the information it has received from the sensory system. Whilst these signals pass along the length of the nerve using electrical means they ultimately stimulate the release of chemicals known as neurotransmitters at their terminal end. There are over a hundred of these different chemicals which either transmit the signal to another nerve at a ‘junction’ or produce some other sort of effect.

The Brain

The brain is quite literally the ‘nerve centre’ of the body and whilst it accounts for 2 per cent of our body weight, it receives 20 per cent of our circulating blood and oxygen delivered by approximately tens of thousands of miles/kilometres of blood vessels. It constantly processes the millions of incoming pieces of information to keep all the body parameters operating within narrow limits. Your brain consists of about 100 billion nerve cells (neurones), each of which has between 1,000 to 10,000 synapses (connections). The living brain has the consistency of blancmange in that it is 85 per cent water and of the remainder, two-thirds is fat. Neurones have more mitochondria and a greater demand for both glucose and oxygen weight-for-weight than any other tissue. The brain is protected from the circulation by the blood–brain barrier which is composed of membranes and their associated cells and is also suspended in a watery fluid known as cerebrospinal fluid. This fluid supplies essential nutrients and provides an additional layer of protection from the chemicals, microbes and/or parasites that may be present in the blood. The body will always prioritize the function of its two most vital organs – the heart and brain – at the expense of other less ‘essential’ organs or tissues such as the joints or the uterus.

Regions of the Brain

The central nervous system is arranged in three layers. The ‘reptilian’ brain responsible for survival responses is innermost, enclosed by the limbic system or emotional brain. Outermost is the conscious or thinking brain. The limbic system incorporates several structures at the base of the brain including the amygdala (a small cluster of nerve cell nuclei), the hypothalamus and the hippocampus, and these intercommunicate with the sense of smell in the reptilian brain. The hippocampus plays an important role in short-term memory and orientation in space and is one of the first regions to be affected in Alzheimer’s disease. The amygdala is involved in emotional responses and memory; the information processed here is not filtered by the conscious mind. The history of all unpleasant events is thought to be recorded in the left amygdala; all projected events (including nightmares) are thought to originate in the right amygdala. The amygdala is involved in activating the hypothalamus and therefore indirectly in the stimulation of the autonomic nervous system (see below) and the production of stress hormones. The reticular activating system (RAS) is a region where the spinal cord and brain meet which contains 70 per cent of the brain’s nerve cells, and it has come under particular scrutiny in relation to FRS. It acts as a filter between conscious and unconscious awareness and is associated with motivation, arousal, sleep-wake cycles, muscle tone, heart rate, breathing and modulating pain.

The Autonomic Nervous System

The autonomic nervous system (ANS) monitors and controls all the automatic functions necessary for life that occur beneath conscious awareness. Eighty per cent of the ANS is thought to be devoted to sensory, incoming information and 20 per cent to regulating processes like digestion, maintenance of blood pressure, breathing, urination, sweating and penile erection. The autonomic nervous system is governed by the emotional right brain and is composed of two opposing systems, the parasympathetic (PSNS) and sympathetic nervous systems (SNS). These work respectively like the brakes (PSNS) and the accelerator/gas (SNS) in a car. There are so many branches of the ANS involved in digestion that this network is often referred to as the ‘second brain’. This system is also responsible for sexual sensation, sexual arousal and erection of the penis in the male and engorgement of the vagina and clitoris in the female. Adrenaline (epinephrine) produced by the adrenal glands also potentiates the actions of the sympathetic nervous system.

The Lymphatic and Immune Systems

The lymphatic and immune systems are closely connected and are often regarded as different components of the same system.

The Lymphatic System

As you probably already appreciate, the blood is pumped by the heart inside a closed system of vessels known as the circulatory system. This system delivers oxygen (from your lungs) and nutrients (from the intestines) to your tissues, and then transports away waste products. These waste products are then either filtered by the liver and eliminated in the bile or excreted by the kidneys as urine. The waste gases such as carbon dioxide are eliminated by the lungs. What you may not appreciate is that the circulatory system is intimately connected to a parallel and larger system of lymphatic vessels which accompany the blood vessels one way only from the tissues. These lymphatic vessels both drain away excess fluid and also filter the lymph produced through a series of lymph nodes, ultimately to return the lymph back into the circulation in the chest. The lymph nodes monitor the lymph and activate an appropriate immune response if anything untoward is detected. Unlike the circulatory system, the lymphatic system has no central pump. Instead it relies upon the pulsing of the walls of the larger vessels, the movement of adjacent muscles and arteries and a series of internal valves that prevent backflow. There are also several clusters of lymphatic tissue that are open to the surface of the body in various locations and these include the tonsils and lymphatic patches in the intestines known as Peyer’s patches.

The Immune System

This is an immensely elegant, complex and sophisticated system of initiating and terminating responses to perceived threats, which can include bacteria or foreign proteins from a substance such as an egg – in which case the response would be regarded as an allergy. It comprises the white blood cells (leukocytes) which have been broadly grouped into those that have many lysosomes (which appear granular when dyed) and those that do not. The granular leukocytes include neutrophils (which engulf and digest microbes and debris), eosinophils (which attack parasites and are involved in allergy) and basophils (which are also involved in allergy and release histamine). The nongranular leukocytes are known as lymphocytes and originate in the bone marrow, forming two main groups which are then activated either in the thymus gland, for which reason they are known as T-lymphocytes, or in the bone and classified as B-lymphocytes. These two arms of the lymphocyte system of cells then interact to aid one another in both initiating and terminating immune responses and in defending the body against microbes, fungi and rogue cancer cells. They also act to keep a ‘library’ of previously encountered proteins for future reference. A third group of lymphocytes are referred to as natural killer cells and these combat viruses and cancerous cells. The entire system works on the basis of being able to identify cells marked as ‘self’ from those that are ‘non-self’.

The newborn baby’s immune system is primed by the first milk that the mother produces (known as colostrum) and thereafter by breast milk until the young infant’s system can be independent. The organ believed by many holistic therapists to orchestrate the immune response is the thymus gland which lies behind the breastbone. Allopathic medicine, however, regards this organ as not serving any important function after acting as a stopgap in the newborn until they can get their own immune system up and running.

The immune system is invariably compromised in fatigue-related syndromes. An underactive immune system will not be able to mount an effective response to infections, which can then become recurrent or chronic. The creation of a cancerous cell is not a rare occurrence at all. In fact, at any moment we all probably have dozens, if not hundreds, of cancerous cells in our bodies. An efficient immune system, however, will detect and destroy these cells whereas an underactive immune system may either not recognize these rogue cells or be unable to destroy them. It is for this reason that many consider cancer to be a consequence of an underactive immune system. Equally, an overactive immune system may attack seemingly innocent cells flagged as ‘self’ as in so-called ‘autoimmune’ diseases.

Detoxification

Channels of Excretion

If your body wishes to excrete a toxic substance it has the relatively few options outlined below at its disposal.

Intestines

Most fat-soluble wastes, toxic metals and other fragments such as parasite, fungal or bacterial remains are extracted from the circulating blood by the liver and ultimately excreted as bile in the faeces. This toxic bile may be reabsorbed if there is insufficient fibre or poor peristalsis, resulting in further concentration of toxins in the bile and compromising gall bladder function. Flatulence is the expelling of toxic gases produced by bacterial or fungal fermentation along with swallowed gases and this may be used as a route of excretion of toxic gas wastes.

Kidneys

Water-soluble wastes are excreted as urine by the kidneys which filter 180 litres (320 pints) of fluid out of the blood every day. The body then selectively draws back 99 per cent of the resulting fluid under hormonal instructions as to what it needs to retain. Due to the volumes of fluid processed, any water-soluble toxins in circulation such as toxic metals will rapidly have an adverse effect on the kidneys. The resulting urine is temporarily stored in the bladder until it is convenient to urinate.

Skin and Mucosa

Some toxins are excreted through the skin as sweat. This route means that the toxins are unlikely to be reabsorbed as can happen with elimination via both the kidneys and intestine. This may also be the preferred route if the other excretion routes are blocked, or possibly if the toxins are stored more superficially in body fat. Substances can also be secreted through the mucosal lining of the vagina, mouth and nose. Tears may be a minor route of excretion.

Lungs

Vapours and gases may be excreted via the lungs and this may occasionally produce foul-smelling breath.

Men Only

Seminal fluid may be used as a minor route of excretion.

Women Only

In women, the body also uses the uterus for storage and excretion of toxins in the monthly blood flow. Unfortunately, this propensity also means that pregnant mothers are estimated to pass two-thirds of their body burden of toxins into their developing foetus.

Toxin Storage

If these detoxification routes are blocked, then the body resorts to temporarily storing toxins in body cavities such as the joints, sinuses and muscles until such time as nutrients are available to excrete the toxins. Body fat is also a convenient toxin storage depot and as such may prove extremely resistant to removal using all the usual means. The body will always try to protect the vital organs and so another favoured technique is to store toxins in the extremities and then restrict the blood supply to those regions and this can lead to cold hands and feet, fungal finger- and toenails and Reynaud’s-type symptoms. A naturopathic principle is that the body attempts to excrete or store toxins superficially, at first resulting in symptoms such as eczema. Then, over time the toxins are stored in deeper and deeper body compartments so that symptoms progress from asthma and/or hyperactivity to migraines, for instance. With time, irritable bowel syndrome may transition into tiredness and ultimately to end-stage debilitating illnesses such as multiple sclerosis or rheumatoid arthritis. Many think that they ‘grew out of’ asthma or eczema, but in reality the problem has just gone deeper to manifest at a later date as another more chronic disease. Conversely, as toxins are brought out of deep storage, they may be excreted superficially through the skin.