Cyclic vomiting syndrome (CVS) is classified in the medical literature as a “functional” disorder, characterized by stereotypical episodes of intense vomiting separated by weeks to months of wellness. Although it can occur at any age, the most common age of presentation is between three and seven years. There is no gender prominence. The precise pathophysiology is not known but there is a strong association with migraine headaches that affect the patient as well as the patient’s mother, indicating that it may represent a mitochondrial disease. I will explain this association later in the post. These authors have used the word functional appropriately since they indicate the role of mitochondria and report that studies have suggested that an underlying autonomic neuropathy involving the sympathetic nervous system (part of the automatic nervous system) is at fault.
What is a Functional Disorder?
The word “functional” is often used as being virtually synonymous with “psychological” in describing a disease entity. So describing CVS as “functional”, suggests that it is generally regarded as having a psychological background. Indeed, my perusal of the CVS medical literature indicates that the only treatment to try to prevent recurrent episodes is the use of antidepressant drugs. It is as though the act of repeated vomiting is thought of as a process by which the patient is reacting to a state of depression. I have long tried to understand how this term could be used with such a lack of thought concerning the underlying mechanisms. The point that I am trying to make here is that whether we like to recognize it or not, the human brain is a machine that relies on chemistry that is used to supply energy. Therefore, the only proper use of the word “functional” is to describe a change in function due to abnormal structural or electrochemical action.
Mitochondria are literally the “engines” that provide each of our cells with the energy that enables them to function. They have their own genes, inherited only from the mother, and that is why Kaul and Kaul mention the association of migraine headaches in the patient as well as the mother. The autonomic nervous system is controlled automatically by the lower part of the brain and is not a thought process. It provides us with the machinery whereby energy is converted into both physical and mental action. In addition to all this, we have to remember that the genes in the mitochondria, like our cellular genes, also can have mistakes in their construction. Therefore, a breakdown in function has either a genetic background that can be either a defect in the cellular genes, inherited from both parents, or the mitochondrial genes inherited from the mother. The only thing that we can do is either replace the faulty gene (the current attempted approach) or provide the ideal fuel (nutrients) which enables mitochondria to generate the necessary energy.
It is worth noting here that when each one of us is faced with a mental or physical stress (including infections) a surge of energy is required to meet that stress and possibly explains why a given infectious agent has no deleterious effect on one individual, whereas another succumbs to the disease. Can the state of nutrition be that important? My answer is, yes undoubtedly. So let us see if there are other published statements in the medical literature that might support such an answer to the underlying mechanisms of CVS.
Cyclic Vomiting and the Autonomic System
Several cases of CVS are described in chapter 5 of our new book, Lonsdale D, Marrs C. “Thiamine Deficiency Disease, Dysautonomia and High Calorie Malnutrition”, all of whom responded to supplementary thiamine. I scanned the CVS medical literature to see what else has been written to make this connection. I found a manuscript describing the case of a 29-year-old woman with type I diabetes from 10 years of age who developed adult CVS. Beginning at the age of 25 years she was frequently hospitalized for what was described as “stress-induced vomiting” implying a psychological background. Diabetes has been found to be potentially therapeutically related to thiamine supplementation, suggesting that the CVS was thiamine related. I discovered a manuscript reporting a 27-year-old pregnant woman with CVS at the 12th week of gestation. The vomiting was treated symptomatically with a drug that suppresses autonomic nervous system activity.
The book by Lonsdale and Marrs describes how the autonomic nervous system becomes deranged with thiamine deficiency. That is why the word “Dysautonomia” appears in the title. John B Irwin’s book: The Natural Way to a Trouble-Free Pregnancy: The Toxemia/Thiamine connection describes his dramatic experience with the use of supplementary thiamine in pregnancy. This is a book that should be obtained by anyone even contemplating pregnancy.
Lastly, CVS has been described in association with a genetically determined form of autonomic dysfunction. Thiamine deficiency during pregnancy is devastating to the fetus as well as the mother. There is reason to believe that a legacy from this continues in the newborn infant who survives at a marginal asymptomatic level, perhaps succumbing to CVS between the ages of three and seven years because of some unidentified trigger. We know from history that thiamine deficiency can fluctuate, providing what is well-recognized as a prolonged morbidity. The lower part of the brain, highly sensitive to even a mild depreciation in energy metabolism, contains a “vomiting center”, stimulation of which will cause vomiting. Thiamine deficiency is probably the commonest cause of defective energy metabolism, thus providing the stimulation.
Points of Consideration
CVS is a surprisingly common condition and readers of this post are likely to have at least known of a case, if not experiencing it in one of their children. The first impact from this post would naturally be skepticism, since it connects thiamine metabolism to three different states of health, including pregnancy. Skepticism would stem from current acceptance that each disease is a separate entity requiring a specific drug that has to be found as the cure. To read Irwin’s book is an absolute eye-opener in our attitude towards a healthy pregnancy. To find that migraine and CVS might be connected because of dysfunction in a nervous system, about which many of us have total ignorance, is jolting.
The evidence is mounting that disease is a result of a failure to meet the energy demands of the brain/body and that it often starts with everyday symptoms that are disregarded as psychological. I have used the analogy that the body is like an orchestra. The brain is the conductor of the orchestra and perhaps the leader of the orchestra is thiamine. The leader enables an orchestra to come together in unison under the baton of the conductor. It is unthinkable that the conductor of an orchestra would be able to function if he was himself sick. Beethoven, in his deafness, could not conduct the orchestra in the opening performance of his ninth Symphony and the orchestra was told to ignore Beethoven and perform according to the baton of an assistant. Perhaps the same would apply if the all-important leader were sick or missing.
Every cell within an organ, like an instrumentalist in an orchestra, has a specific function and “to and fro” communication with the brain is essential to the orchestration of function. Genetically determined structure of cells or their mitochondria may or may not be 100% normal, but no function is possible without the energy derived from “burning the right fuel”.
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This article was published originally November 15, 2017.