!

"#
FEBRUARY 2014 6
The magazine for
complementary and
alternative medicine
professionals
PLUS How to get your ND I Chronic fatigue and the need to get personal I ASA in
trouble again I Learning Zone new CPD opportunities I Latest news and research
NOW LIVE AND ONLINE WWW.CAM-MAG.COM
Limbic Kindling:
hard-wiring
the brain for
hypersensitivities
Book for Sports
Nutrition Live!
and train with
the Functional
Sports Nutrition
Academy
CAM Student:
how to survive
your course
Immunological arrays:
new ways to test
arrive in the UK
The case is closed:
College of Physicians
abandons science
official
cover.indd 1 23/01/2014 14:16
!"# FEBRUARY 2014 12
FEATURE I !"#$!!
WWW.CAM-MAG.COM
L
imbic kindling is a condition where either
repeated neurological exposure to
initially chronic sub-threshold stimulus,
or a short-term high intensity stimulus (eg
brain trauma), can eventually lead to persistent
hypersensitivity to the stimulus.
Kindling was originally discovered in 1967
by Graham Goddard, who was studying
the effects of electrical stimulation of the
amygdaloid complex in the brain in learning
in rats.(1) He found that after long-term, low
intensity intermittent stimulation from electric
shocks to their brains, the rats began to have
spontaneous, epileptic-like seizures even
when no stimulation was given. Goddard also
found he could create similar reactions using
chemical stimulation.
n 1970, Gellhorn suggested that
under prolonged stimulation of the limbic-
hypothalamic-pituitary axis, a lowered
threshold for activation could occur.(2) Girdano
et al in 1990 proposed that the excessive
arousal could lead to an increase in dendrites
of the limbic system, which can further
increase limbic stimulation and hypersensitivity
to stimuli.(3)
Ashok Gupta was the frst to propose a
similar theory as the basis for CFS/ME in
2002.(4) (A diagram from his paper is below).
Based on the work of Le Doux in the '90s (5),
Gupta suggested that an infectious, chemical
or psychological stressor could create a "cell
assembly within the unconscious amygdala
and that these cell populations are particularly
resistant to extinction. As with Goddard and
Gellhorn, this again implied that people could
become "hard-wired to respond more easily
to stimuli and in turn fnd it more diffcult to
suppress the chronic stress, or "fight and fght
Limbic kindling: hard-
wiring the brain for
hypersensitivity
Its one of the most exciting concepts in neuroscience youve never heard of. And its
becoming a key model being examined as a possible theoretical basis for Multiple
Chemical Sensitivity (MCS) and Post Traumatic Stress Disorder (PTSD). Recently, a
leading researcher in CFS/ME, Dr Leonard Jason, has argued it provides a comprehensive
model to explain CFS as well. CAM contributing editor Niki Gratrix, BA (Hons), Dip ION,
introduces the idea and highlights the connections with infection and toxins.

limbic.indd 12 23/01/2014 14:19

WWW.CAM-MAG.COM
response established by Selye's classic
model of stress.(3-5)
Where limbic kindling takes our
understanding of stress to new levels is the
idea that this kindling leads to "hard-wiring
in the brain for an unhealthy response
to stress. This was boosted by a 2002
paper in the British Journal of Psychiatry,
where a systemic review of brain images
of patients with PTSD found "increased
activation of the amygdala after symptom
provocation.(6)
n 2009, Dr Leonard Jason and
colleagues suggested that chronic long-
term hyperarousal of the central nervous
system from this "kindling leads to
chronic sympathetic nervous system
arousal and will in turn result in the
physiological abnormalities documented in
ME/CFS patients. This includes:
immune system activation and movement
from TH1 to TH2 dominance;
up-regulation of the hypothalamic-pituitary-
adrenal axis initially, which over time leads
to reduction of cortisol output and glandular
depletion;
disruption in ion channel transport;
reduction of grey matter in the brain;
reduction of GABA;
depletion of neurotransmitter acetylcholine;
depletion of antioxidants;
and eventually the oxidative stress,
opportunistic infection and reactivation of latent
infections, poor mitochondrial function and
cardiomyopathy.(7)
n addition to those symptoms Jason et al
cited, chronic sympathetic nervous system
stress is also known to cause dysbiosis; for
example pre- and post-natal stress causes
dysbiosis in infant monkeys (8, 9) and
numerous papers now show CFS patients
often have gut dysbiosis and leaky gut.(10)
Methylation, detoxication
Stress has been identifed as a primary cause
of pyrroluria (compromised haemoglobin
synthesis) by the late great Dr Carl Pfeiffer,
one of the co-founders of orthomolecular
psychiatry. This is important, as McGinnis et
al have explained that pyrroluria may also
be linked to leaky gut and it appears to also
induce porphyria the "downstream cousin of
pyrroluria, in which heme-producing enzymes
are dysfunctional. This in turn down-regulates
the CYP450 liver enzymes (11 and covered
in CAM in the October 2013 issue). Many
patients with MCS have been found to have
porphyria (a topic covered in CAM in October
2012). Pyrroluria also means the patient
excessively excretes vitamin B6 and zinc,
which would slow the methylation cycle, again
reducing the ability to detoxify.
The lymph connection
Also of great interest is the possible link
between chronic stress and lymph stasis. Dr
Raymond Perrin, an osteopath specialising
in CFS, has theorised that lymph fow is
stimulated by a rhythmic pump governed
by the sympathetic nervous system, which
becomes dysfunctional in states of chronic
stress.(12) Perrin has developed a form of
deep lymphatic massage called the "Perrin
Technique specifcally for CFS (13) and has
published two studies on his work with CFS
patients.(14,15) n a UK study of more than
4217 patients in 2010 by the ME Association,
ranking how helpful different treatments are
for ME/CFS, after pacing and relaxation
techniques, the Perrin Technique ranked as
number three above at least 22 other types of
treatment.(16)
The vicious cycle of chronic
stress
The limbic kindling model explains how multiple
types of stressors, which can be psychological,
electrical or chemical, can all result in the
same outcome: chronic sympathetic nervous
system stress which reduces the body's ability
to "rest, digest and detoxify, and often results
in allergies and sensitivities to all these types
of stressors as well. Limbic kindling may also
explain electro-hypersensitivity.
The biochemical changes which result from
chronic sympathetic nervous system stress
include oxidative stress, infammation
and toxin build-up, which in turn,
causes more limbic kindling and
explains how illnesses like CFS and
MCS become chronic.
The fact that limbic kindling
can both cause and be caused by
stressors, refects the bi-directional
relationship between the brain and
the body, and the fact that the human
body is a complex adaptive system
where essentially everything affects
everything else.
nitial underlying causes of
environmental sensitivities and
illnesses like CFS may therefore
come from stressors directly acting on
the brain and triggering biochemical
changes downwards in the body, or
via factors acting directly on the body,
triggering changes upwards in the limbic
system through chronic infammation.
Factors linked to psychology which create
limbic kindling in CFS include personality
issues such as proneness to being an
achiever, anxiety, or being an excessive
"helper type.(16-19). Emotional trauma in
childhood is a well-established risk factor for
CFS onset in later life.(20-23) Emotional stress
related to how patients cope with becoming ill
with CFS (which is traumatic in itself) has also
been found to be a major factor in recovery.(24,
25) Emotional stress is also a well-established
trigger for onset of the illness.(26) Commonly-
used psychological or energetic techniques for
CFS include NLP, CBT, EMDR, yoga, Qi Gong,
Mickel Therapy and meditation.(16)
Physical factors which can lead to chronic
infammation and thus limbic kindling
include chronic infections, type V delayed
hypersensitivity to toxins, and food and gut
infammation.
n a second paper by Jason et al on
kindling theory and ME/CFS in 2011, the
authors argued that infammation from chronic
infections could also cause limbic kindling. The
diagram here summarises their conclusion
that "we need studies based on systems
biology that explain the illness, in combination
with more details about the environmental
contributors to the illness as well as validation
of fndings with functional studies.(27)
Dr Stejskal, the researcher involved
with developing the Melisa test for type
V hypersensitivity to heavy metals, has
completed numerous large studies confrming
metal sensitivity in CFS patients (discussed in
CAM, November 2013).

limbic.indd 14 23/01/2014 14:19

WWW.CAM-MAG.COM
n Neuroendocrinology Letters
in 1999, Dr Stejskal discussed
studies linking infammation to
heavy metals and concluded:
"Chronic metal-induced
infammation may dysregulate
the HPA-axis and contribute to
fatigue.(28) The authors went
on to state that other xenobiotics
such as formaldehyde and
isothiazolinones would have a
similar infammatory impact and
that the genetic ability to detoxify
xenobiotics, together with the
individual susceptibility to the
toxin, are probably the most
important factors in whether a person develops
sensitivity.
Other sources of chronic infammation can
include delayed type V hypersensitivity to
foods, especially gluten (CAM, September
2013). An extensive referenced discussion
of the links between gluten sensitivity, gut
infammation and CFS can be found on
Cort Johnson's CFS advocacy site; www.
cortjohnson.com.(29)
Physical treatment interventions
for detoxication
A key point to take away from the limbic
kindling model is that the nervous system
can become sensitised to toxins and become
"programmed to react to them.
While the intervention for type V delayed
immune system sensitivity to a toxin entails
testing for and removing the toxin from the
environment of the patient, and the intervention
for genetic polymorphisms affecting
methylation and other detox pathways may
entail recommending a "nutritional bypass to
modulate and improve detoxifcation, sensitivity
to toxins due to neurological programming
may be served better by interventions to reset
the unconscious amygdala such as NAET
therapy, a form of non-invasive acupuncture
therapy, or similar energy-psychology
techniques such as EFT (tapping).
Other physical treatment interventions
which should be accompanied by concurrent
psychological support commonly include the
Perrin technique for lymph stasis, cleanses
such as sauna and chelation therapy, as
well as nutritional support for
metabolic imbalances including
pyrroluria, porphyria, poor
mitochondrial function, leaky
gut, low adrenals and thyroid,
chronic infections and immune
system imbalances.
Conclusion
Practitioners and
researchers would be wise
not to downplay or ignore
either psychological factors
or environmental factors
as primary causes and
perpetuating factors in
chronic complex illnesses like CFS and
MCS. Treatment interventions should
ideally be concurrent and multifactorial.
A thorough comprehensive physical and
psychological history and approach to
treatment may yield the highest rates of
success with patients. cam
References
1. Goddard GV. Development of epileptic seizures
through brain stimulation at low intensity. Nature
1967, 214:10201.
2. Gellhorn E. The emotions and the ergotropic and
trophotropic systems. Psychologische Forschung
1970, 34: 4894.
3. Girdano DA et al. Controlling stress and tension. A
holistic approach. (Prentice Hall, 1990).
4. Gupta A. Unconscious amygdalar fear
conditioning in a subset of chronic fatigue syndrome
patients. Med Hypoth 2002, 59: 72735.
5. LeDoux J. The emotional brain: the mysterious
underpinnings of emotional life. (Simon & Schuster:
1996).
6. Hull AM. Neuroimaging fndings in post-traumatic
stress disorder. Br J Psychiatry 2002, 181: 102-10.
7. Jason LA et al. Kindling and oxidative stress as
contributors to Myalgic Encephalomyelitis/Chronic
Fatigue Syndrome. J BehavNeurosci Res 2009, 1,
7(2): 1-17.
8. Bailey MT et al. Prenatal stress alters bacterial
colonization of the gut in infant monkeys. J Pediatr
Gastroenterol Nutr 2004, 38:414-421.
9. Bailey MT, Coe C. Maternal separation disrupts
the integrity of the intestinal microfora in infant
rhesus monkeys. Dev Psychobiol 1999, 35: 146-155.
10. Lakhan SE, Kirchgessner A. Gut infammation in
chronic fatigue syndrome. Nutr Metab (Lond) 2010,
7: 79.
11. McGinnis W et al. Discerning the mauve factor,
Part 1. Alter Therap 2008, 14: 2. Dekel S et al.
Secondary salutogenic effects in veterans whose
parents were Holocaust survivors. J Psychiatr Res
2013, 47 (2): 266-71.
12. Perrin R. Lymphatic drainage of the neuraxis in
Chronic Fatigue Syndrome: a hypothetical model for
the cranial rhythmic impulse. J Am Osteopath Assoc
2007, 107 (6): 218-24
13. Perrin R. The Perrin Technique. (Hammersmith
Press: 2007).
14. Perrin RN et al. An evaluation of the
effectiveness of osteopathic treatment on symptoms
associated with myalgic encephalomyelitis. J Med
Eng Technol 1998, 22 (1): 1-13
15. Perrin RN et al. Muscle fatigue in chronic fatigue
syndrome/myalgic encephalomyelitis (CFS/ME)
and its response to a manual therapeutic approach:
a pilot study. nt J Osteopathic Med 2011, 14 (3):
96-105.
16. www.meassociation.org.uk/wp-content/
uploads/2010/09/2010-survey-report-lo-res10.pdf
17. Van Houdenhove B et al. Does high "action-
proneness make people more vulnerable to chronic
fatigue syndrome? A controlled psychometric study.
J Psychosom Res 1995, 39: 633-640.
18. Lewis S et al. Psychosocial factors and chronic
fatigue syndrome. Psychol Med 1994, 24, 661-671.
19. Arroll MA et al. A qualitative investigation
of everyday worries in individuals with myalgic
encephalomyelitis and chronic fatigue syndrome
(ME/CFS). Poster presented at the European Health
Psychology Society: Cluj-Napoca, Romania, 2010.
20. Taylor RR et al Sexual abuse, physical abuse,
chronic fatigue, and chronic fatigue syndrome: a
community-based study. J Nervous & Mental Dis
2001, 189 (10): 709-15.
21. Heim C et al. Early adverse experience and
risk for chronic fatigue syndrome: results from a
population-based study. Arch Gen Psychiat 2006,
63: 1258-66.
22. Heim et al. Childhood trauma and risk for chronic
fatigue syndrome association with neuroendocrine
dysfunction. Arch Gen Psychiatry 2009, 66 (1):
72-80.
23. Staudenmayer H et al. Adult sequelae of
childhood abuse presenting as environmental
illness. Ann Allergy 1993, 71: 538-46.
24. Van Houdenhove B et al. Victimization in chronic
fatigue syndrome and fbromyalgia in tertiary care: a
controlled study on prevalence and characteristics.
Psychosomatics 2001, 42 (1): 21-8.
25. Howard A, Arroll M. The application of
integral medicine in the treatment of myalgic
encephalomyelitis/chronic fatigue syndrome. J
ntegral Theory Practice 2011, 6 (4): 25-40.
26. De Meirlier K, Englebienne P. Chronic Fatigue
Syndrome: a biological approach (CRC Press 2002).
27. Leonard JA et al. An etiological model for
myalgic encephalomyelitis/chronic fatigue syndrome.
Neurosci Med 2011, 2 (1): 1427.
28. Stejskal J, Stejskal V. The role of metals in
autoimmunity. Neuroendocrinol Lett 1999,20: 351-64.
29. www.cortjohnson.org/blog/2013/10/01/celiac-
disease-gluten-sensitivity-chronic-fatigue-syndrome-
modern-malady-obscured-testing-next-steps.
About the
author
Niki Gratrix, BA (Hons),
Dip ION, mBANT, is one of
the UKs leading nutritional
therapists specialising in
Chronic Fatigue Syndrome/
ME and related illnesses. She is one of CAMs
contributing editors and a former CAM Award
winner. See her website for practitioners at
www.ExpertPractitioner.com.
Limbic kindling and CFS/ME: a
model proposed by Jason et al (27).
limbic.indd 16 23/01/2014 14:19