I just had a "Eureka!" moment. I have been researching possible causes of my CFS and finally found something that explains how and why my exhaustion occurs. Dr Sarah Myhill has written a book and posted it for free download from her website www.drmyhill.co.uk
I have read so many articles about CFS that detail possible causes and proposed treatment plans, but no other doctor had illustrated, step by step, just how the mitochondria in our cells make energy so that they can function. She explains it all very clearly, although it is a complex bio-chemical process. I still don't know what caused my mitochondria to malfunction in the first place, but at least now I understand what I'm doing to my body when I PUSH myself through my day. And how bad it is. And how I can make things better.
The treatments and supplements she recommends make sense to me, based on my new understanding of the creation of energy on a cellular level. It's eye-opening, and refutes all those "It's all in your head, it's psychosomatic, it's emotional, it's mind over matter, you're just being lazy.." comments. HA! Now to find someone in my locality to do the specialised bloodtests which a biochemist colleague of Dr Myhill's in England devised to test mitochondrial function.
Here's the relevant part of Dr Sarah Myhill's book:
Explanation of the Fatigue Problems in CFS Patients.
Energy to the body is supplied by mitochondria, which firstly produce NAD (nicotinamide
adenosine diphosphate) from Kreb’s citric acid cycle and this is used to power oxidative
phosphorylation which generates ATP (adenosine triphosphate).
These molecules are the “currency” of energy in the body. Almost all energy requiring processes in the body have to be “paid for” with NAD and ATP, but largely ATP. The reserves of ATP in cells are very small. At any one moment in heart muscle cells there is only enough ATP to last about ten contractions. Thus the
mitochondria have to be extremely good at re-cycling ATP to keep the cell constantly supplied with
energy.
If the cell is not very efficient at re-cycling ATP, then the cell runs out of energy very quickly and
this causes the symptoms of weakness and poor stamina. The cell literally has to “hibernate” and
wait until more ATP has been manufactured.
In producing energy, ATP (three phosphates) is converted into ADP (two phosphates) and ADP is
re-cycled back through mitochondria to produce ATP. However, if the cell is pushed (ie stressed)
when there is no ATP about, then it will start to use ADP instead. The body can create energy from
ADP to AMP (one phosphate), but the trouble is that AMP cannot be re-cycled. The only way that
ADP can be regenerated is by making from fresh ingredients, but this takes days to do. This
explains the delayed fatigue seen in chronic fatigue syndrome.
So to summarise, the basic pathology in CFS is slow re-cycling of ATP to ADP and back to ATP
again. If patients push themselves and make more energy demands, then ADP is converted to AMP
which cannot be recycled and it is this which is responsible for the delayed fatigue. This is because
it takes the body several days to make fresh ATP from new ingredients. When patients overdo things
and “hit a brick wall” this is because they have no ATP or ADP to function at all.