Contact: Mike Houghton, telephone 01244 378276 or e-mail Mike@chestermesh.org.uk

We first came across Dr Andrew Wright in 1997. Dr Wright is the Medical Director of The Complete Hormone Clinic which is part of Chronobiology Ltd, in Bolton. He specialises in the clinical applications of chronobiology in medicine, not only CFS(ME), which he has treated for many years, but also a wide range of problems e.g. sleep disturbances, stress disorders, menstrual disorders and infertility.

He trained as a General Practitioner, which he now practices part-time and also works in the NHS, doing hospital sessions in General Medicine and Gastroenterology, Genito-Urinary Medicine and Dermatology.

He also has wide experience in using Complementary Therapies to assist in the restoration of health.

Dr Wright has had CFS(ME) himself, but now has it under control using his own treatments. We continue to be taken by his ideas concerning ME and Hormones.

Here is one of his earlier papers where he outlines his ideas:

Restoring the Balance and Rhythms in CFS(ME)

When you think about it, your body faces a daunting task as you go through life, even when you are fit and well. It has to ensure the survival of the body under many different conditions, so that you have a good chance of passing on your genetic code, present in your chromosomes, to the next generation. This, biologically speaking, is your purpose in life.

As an illness, CFS(ME) does not usually stop this prime objective, but because we rightly expect and should get much more out of life than simply passing on our genes, it is vital that we get to grips with the causes of this disease which ruins the ‘quality of life’ of so many people. If we just go back a few steps and look at how the body manages to ‘survive’ at all in an ever changing and challenging world, then we can hopefully go forwards and correct problems when they arise.

The body has to deal with two main problems. The first is size. We are made up of microscopic cells, but these are joined together into a body of up to two metres in height.

Secondly, we have to deal with time. The fundamental chemical processes that happen in the body may only take a few milliseconds, but the body itself can last for up to about a hundred years. No mean feat at all to get round these difficulties. How do we do it. Here is where the three ‘C’s come in.

COMMUNICATION, COORDINATION and CONTROL.

Basically the body has to regulate itself all the time to survive i.e. it has to talk to itself. We achieve the 3 ‘C’s by having three highly evolved systems-

• The Nervous system comprising the brain and all your nerves

• The Immune or defence system

• The Endocrine or hormone system.

These three systems, which are all interconnected, perform the three ‘C’s. We call this Homeostasis. Together they maintain a stable environment within the body, so that, for example, we keep our body temperature fairly constant, or keep our blood sugar levels within an acceptable range.

The other problem though is that things change all the time, from day to day, month to month and year to year. We get older! Therefore the body also needs to adapt with the passage of time and new challenges. We call this Homeodynamics.

A useful way of visualising this would be to imagine that you are resting peacefully in the garden and all the processes in your body are ticking over nicely. This would be homeostasis. Then the kids come and throw water bombs all over you, and you have to react to this enforced change. This is where homeodynamics is important, bringing about alterations in your body’s internal environment to cope with new circumstances.

Over the past few years much has been written and researched about abnormalities in these two different but integrated processes. For example hormone level abnormalities, the failure of the nervous system to work correctly or measurable differences in the function of some parts of the immune system, such as certain types of white blood cells.

Now however, it looks as though we may have to consider changes happening in another of the body’s processes. We often do not take them in to account, because they are so much a part of our lives. These are the inbuilt Biorhythms, such as the sleep-wake cycle and the menstrual cycle.

Health is also dependent on the rhythmical changes of these inbuilt cycles, imposing order on the body, thereby enforcing stability through change! Rhythms are so much a part of our lives, be it in music or dance or whatever, that it is not surprising that they play a part in keeping us well. The science of looking at biological rhythms is called Chronobiology.

Although we accept that the length of complete day is taken as 24hrs, in fact our bodies have an inbuilt rhythm of their own which is around this length i.e. it is a Circadian rhythm, from the Latin ‘circa’ and ‘dies’ meaning about a day.

In humans our inbuilt rhythm is around 24.5 hours and if we were isolated from the environment then we would soon adopt this length of day. This was shown to be the case by a French cave researcher, Michel Siffre, who isolated himself in an underground cavern for 62 days. This state, whereby you rely on the body’s own internal clock to tell you when to be awake and active or asleep is called ‘freerunning’. Fortunately you can make the necessary adjustment to this internal clock on a daily basis, otherwise it could have some very interesting consequences! This is done by using external events, called Zeitgebers (‘time-givers’) to ‘entrain’ the rhythm. The most important is the light and dark cycle, but others such as social clues, like having to get up ‘to go to work’ play a part also.

Now following on from this there must be somewhere in the brain that controls these processes. It has been shown that it is in an area called the Suprachiasmatic Nucleus, of which we all have two (a left and a right), and this forms part of the Hypothalamus, another area of the brain intimately involved in the homeostatic and dynamic mechanisms outlined above. Many abnormalities of this region have been discovered in CFS(ME). The hypothalamus in turn controls the pituitary, which in turn controls many other of our hormone glands like the thyroid, adrenals, ovaries and testes.

The suprachiasmatic nucleus receives its light signals from the eye and it in turn passes them to another gland in the centre of your brain, the Pineal. This produces Melatonin, which you may of heard being taken by people to combat jet-lag. This hormone is released when it goes dark and falls as it becomes light. You could think of the suprachiasmatic clock being the internal mechanism of a watch and the melatonin acting as the hands of the clock telling you the time. You could also visualise this integrated system as being the ‘conductor of your hormone orchestra’, co-ordinating all the other hormones. For example, if you take too much melatonin, you eventually diminish your sex hormones! At the same time as melatonin goes up and down during the night, your body temperature falls, becoming lowest when melatonin is highest, and climbing back to normal when melatonin is at its early morning low. When your temperature is low, then so is your metabolism, (which is the rate at which you use up energy in your internal chemical processes), and this is important to remember. What does all this have to do with CFS(ME)?

Well, several interesting things have been noticed in CFS(ME). Often people have low body temperatures in the morning, usually less than 36.5ºC and it is thought that this may be a reflection of the constant low metabolism people often feel they have. This in itself can have many causes. This can be because of thyroid hormone problems, elevation of a brain chemical called neurotensin, and too much of the hormone cortisol, as well as having too much melatonin ‘spilling over’ into the morning, when it should have almost disappeared from your body. These should be born in mind and if necessary tested for. How you test for it seems to be important, saliva testing being better than blood testing.

An interesting study published by Prof. Williams from Liverpool University showed that in CFS(ME) patients the usual direct relationship between melatonin ups and downs and temperature down and ups is lost suggesting a defect in rhythms governed by the internal clocks (Clinical Physiology 1996 16, 327-337).

It is also interesting that a lot of the problems found with pesticide poisoning and the similarities with the problems experienced by sufferers, centre around the brain chemical serotonin (Bakheit, Behan et al BMJ 1992 304 1010-2). This chemical is concerned with mood and also is the way the brain seems to know when it itself is fatigued (central fatigue), commonly described as ‘ brain fog’. In the brain serotonin is converted into melatonin, and it will be interesting to see what future research reveals about these connections.

Another rhythm that I personally test for a lot, and find abnormalities in, is the one governing the Hypothalamus-Pituitary-Adrenal axis, which also goes through a daily cycle. It is in circumstances of chronic illness such as in CFS(ME), that these abnormalities become evident and this has widespread effects throughout the body on all our homeostatic and homeodynamic mechanisms. I see this daily, with almost everybody who has CFS(ME) having problems with, for example, their immune system, as a result of their disturbed rhythms and hormone ratios.

To get the best out of testing one should also consider other hormones, such as another used widely (and often incorrectly) in the USA, Dehydroepiandosterone or DHEA for short. The reason is that the body often controls the effects of hormones, by balancing two hormones which have opposite actions, such as cortisol and DHEA. The former tends to break your body tissues down, known as catabolism, and the latter builds them up, known as anabolism.

Indeed as far as cortisol and DHEA are concerned, to blindly take one without knowing what their ratio is, can do more harm than good. This is often what happens in the USA, as this and other hormones can be bought over the counter, not only in reputable pharmacies and health food stores, but also places such as petrol stations where the professional advice you get may not be up to scratch. Unfortunately because people have read a few books and think it may be good for them, they take huge amounts! Fortunately over here they are prescription only. They are hormones, the same as insulin and thyroxine, and should only be used under medical supervision, by law.

Once you know by measurement what is going on, you can try to rectify the problem by restoring balance and resetting rhythms. This then forms the basis of my approach. To do this you may need for example nutritional help or, as I often have to use, actual hormone replacement. These are not given in pharmacological or drug doses, but just enough to get you back to normal physiological levels. This is combined with as removing as many ‘stressors‘ as possible. These may be, for example, mental or emotional stressors, secondary to pain and tissue inflammation, toxin problems, or hidden, as in gut parasites such as Giardia. There are many others, and again these should be tested for. This seems to me to be the best way forward.

Here we may draw a comparison with acupuncture and homoeopathy, where the remedies are supposed to restore balance in the ‘Life Force’, and then the body heals itself. Just the same way, by restoring as far as possible normal physiology, you allow yourself a far better chance of getting better.

This is of course somewhat of a simplification of what needs to be done, and the whole process can take months, as well as having to be tailored according to the individuals problems and results of investigations. Everyone is different!

May I make the important point here that how you feel does not necessarily tell you how your body is internally. You may feel better, but it only by measurement, of e.g. hormone levels, that you really know what is happening to your physiology. This is a common error in all illnesses, and also when trying to judge the response to treatment. In part this is due to the fact that often for a given amount of internal disturbance to the body’s normal state, the brain does not respond in the same way to the problems as your other tissues and cells. Your brain can often become desensitised, by for example chronic elevation of the stress hormone cortisol. However the tissues in your body, on which these high levels are acting, cannot as easily become desensitised, and are silently suffering. This is the so-called ‘dissociation of feeling and physiology’.

To finish, sufferers are often told to pace themselves and listen to their bodies. Are we not saying in doing so, that we recognise the need to get back ‘in tandem’ with your internal rhythms, which increasingly seem to be the very processes that are upset by the many various trigger factors for CFS(ME). I myself believe this may be the case. The very varied and often multiple insults that people endure prior to their illness could eventually, destabilise and desynchronise the body’s own rhythms. If you are unable to reset your rhythms quickly, you end up in situation where the body can no longer control its own functions, and consequently, one in which the chance of spontaneous recovery is small.

I am hopeful that research will shed light on the role of ‘dys-rhythmia’ in the treatment of the ‘dis-ease’ CFS(ME), and that we can develop new ways of reconstructing our rhythms, safely and quickly.

Dr Andrew Wright

September 1997

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Whilst all statements are given in good faith they are for information only. Any mention of treatments or products does not imply that they have been tested or endorsed by Chester MESH