lactic acidosis

Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs. Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion (note confusion). What few people realize is that brain function is really in control of the situation. Notice that fever, increased heart rate and breathing, as well as confusion, all reflect brain activity. Some readers familiar with this website will recognize the analogy that I have repeated many times concerning our survival as individuals and as a species. I have likened the human body to an orchestra in which the brain acts as the conductor. The organs can be likened to banks of different instruments within an orchestra. The instrumentalists all know what to do but have to be kept together by the conductor. The cells within each organ are like instrumentalists. They all know what to do in their various special functions but have to be coordinated. When this coordination fails, chaos reigns.

Important parts of the brain, each known as the limbic system and brainstem, together act very much like a computer. They receive messages from the body organs and from the environment and have to make a decision as to how the whole individual must adapt to a given situation. Such a situation might be defined as “stress”. Messages go from this part of the brain to the organs through a nervous system known as autonomic (automatic) and by messengers released from glands that are known as hormones. Unlike the analogy of an orchestra, the organs send messages back to the brain through the automatic system. The limbic system and brainstem also communicate with the upper part of the brain known as the cortex. This part of the brain controls the so-called voluntary nervous system that provides us with willpower. It also provides what might be called “advice and consent” to the automatic brain and can modify the ensuing action.

The Autonomic Nervous System

As many people know, the autonomic nervous system has two different special actions and is divided into a “sympathetic” and a “parasympathetic” branch. Let us be clear about how these branches cooperate by taking a simple fictitious example. As a caveman, you are confronted by a wild animal that you know to be dangerous. After the perception of danger, there will be an instantaneous reflex action delivered via the sympathetic branch of the autonomic nervous system. You will experience fear or anxiety; you will start to sweat; your heart will race; your breathing rate will increase. You are being prepared for “fight-or-flight” and it is a pure reflex that can govern your subsequent action. It is not a thought process. However, it can be modified by the thinking brain and whether you fight or flee from the scene is influenced by personality. When the action that might be stated as “the adaptation to stress” is completed, the sympathetic branch is withdrawn and the parasympathetic takes over. It preserves an atmosphere of calm throughout the body, enabling housekeeping actions to occur. Eating, sleeping, healthy sexual activity and bowel function are examples. I refer to it as the “rest and be thankful” system. The parasympathetic branch is automatically stimulated as the danger is overcome and the sympathetic is withdrawn.

Understanding Oxidation

In my capacity as a writer on this website, I constantly find that very few people seem to know what is meant by oxidation and indeed they have a very vague view concerning energy. Perhaps it is because we tend to think of energy consumption in terms of purely physical activity. Few people seem to have any idea that the brain consumes energy faster than the body or even that the brain uses energy at all. Energy is simply defined as a force that is capable of producing work. It is invisible and can only be depicted from its results.

When we write a letter, the thinking process and the muscles that move the arm and fingers all consume energy. The human body is kept warm because it produces heat energy. We are all familiar with the fact that any machine that consumes fuel, such as an automobile, burns the fuel to produce energy.  Energy has to be captured to perform desired work in the body, just the same as in a car, for example. Oxidation is another word for burning fuel because the very act of burning is the combination of the fuel with oxygen. Now perhaps we can consider the possibility of “defective oxidation”. Even mild oxidation deficiency will stimulate the fight-or-flight sympathetic reflex, because it signals danger, giving rise to a common symptom called “panic disorder” (repeated fight-or- flight reflexes).

Defective Oxidation and Sepsis: A Story of Three Outcomes

You may think that this is a strange way of addressing the subject of sepsis. The first thing that we have to recognize is that sepsis represents a complex reaction to an attack. The attack can be a serious injury, the invasion of bacteria, viruses or other hostile organisms. A battle follows between the attacking event and the defensive mechanisms of the body organized by the brain. A successful defense would mean that complete recovery occurs. The battle may be short and acute or very prolonged and sometimes leading to death. It is the prolonged war that we refer to as sepsis. The outcome depends upon the wellness of the organism as a whole but the organization by the brain is critical.

• The defense wins: every human body is equipped with enormously complicated machinery known as the immune system, whose functions are dependent on fitness. Fitness is dependent on efficient oxidation from the resultant supply of energy. Bed rest ensures that all the excess energy is focused on healing. The automatic brain is in command and its efficiency depends on a healthy genetic profile and nutrition. Modern medicine pays an almost exclusive attention to the nature of the attack by “killing the enemy” the bacteria, virus, or cancer cell. This paradigm gave rise to the antibiotic era.
• The attack wins: This may depend on the severity of the injury, the virulence of the attacking organism or the weakness of the defensive system. The result is death.
• Stalemate: the attacking agent and the defensive system are locked in a struggle, giving rise to chronic disease.

A New Way to Think About Sepsis

Although we must keep paying attention to “killing the enemy”, it must be done safely and without doing harm, as advised by Hippocrates. The new paradigm focuses on assisting the defensive system. There is only one way of doing this and that is by the skillful use of nutrients. Drugs, with the exception of antibiotics, only address symptoms and do nothing for the underlying cause of disease. Sepsis results from inefficient oxidation, particularly in the brain. Without going into the abstruse details we can say that too little oxidation is as bad as too much and it is too much that is associated with sepsis.

To use a simple analogy, sepsis is rather like a fire that has got out of control. For example, if we try to set a fire in an open grate and it expires spontaneously, there is no heat energy to warm the house. On the other hand, if it takes off and becomes too vigorous, it can throw sparks onto a carpet and set the house on fire. To prevent this, we can place a fire guard in front of the fire. This is a simple exposure of the philosophical concept “everything in moderation”. It matters little whether the attack on the body is a severe injury, an infection or some form of prolonged mental stress, the energy for the defensive mechanism must be kept under control. Presently the only defensive assistance is provided by the use of antibiotics, because bacterial infection is the commonest cause of an attack and the reason that we refer to it as sepsis. All of us are now aware that antibiotics are giving rise to their own complications. The only treatment for an injury is rest or appropriate surgery. Healing from an injury requires energy because it is an active process.

Can We Prevent Sepsis?

Frankly, the only way to think of this is strengthening the defense. Obviously, the virulence of infection or the seriousness of injury might be great enough to overwhelm a perfect defense system. However, my experience in practice is that few people are truly “fit” in the sense that I have expressed here. It enabled me to perceive that recurrent episodes of febrile lymphadenopathy (sore throat with fever and swollen glands) in two six-year-old children were caused by thiamine deficiency induced by sweet indulgence. In each child, the brain was experiencing inefficient oxidation. This makes the brain irritable, causing it to initiate a complex defensive reaction under the false impression that its owner was being attacked by a microorganism.

I have already stated that the brain must be in command of the defense. Notice that sepsis is associated with confusion. This indicates that the brain is ineffectively energized to meet the demand and is the center of an ineffective defense. The fuel for the brain is glucose and its combination with oxygen (oxidation) is brought about with the assistance of important chemicals known as oxidants. Gasoline is ignited by a spark plug. Glucose is “ignited” by thiamine. The ensuing oxidation must be kept under control and fireguards known as antioxidants have to be provided. Oxidants and antioxidants (vitamins) come from naturally occurring food. Without providing the scientific details, thiamine is both an oxidant and an antioxidant. Vitamin C is an antioxidant and hydrocortisone is well known by most people as a defense against virtually any form of stress.

The Newest Treatment for Sepsis

It is now possible to understand why thiamine deficiency is such an important consideration in critically ill patients. Thiamine deficiency can develop in patients secondary to inadequate nutrition, alcohol use, or any form of acute metabolic stress. Patients with sepsis are frequently thiamine deficient. Patients undergoing surgical procedures can also develop thiamine deficiency, giving rise to complications such as heart failure, delirium, neuropathy, gastrointestinal dysfunction and unexplained lactic acidosis. The global burden of sepsis is estimated as 15 to 19 million cases annually, with a mortality rate approaching 60% in low-income countries.

The outcome and clinical course of 47 consecutive sepsis patients treated with intravenous vitamin C, hydrocortisone, and thiamine during a seven-month period, were compared with 47 patients who received the present standard therapy. The hospital mortality in the treatment group was 8.5% (4 of 47) compared with 40.4% (19 of 47) in the standard treatment control group. Because this is published material, you would think that this treatment would be immediately taken up in every hospital emergency room. However, until the use of nutrients in the treatment of disease enters the collective psyche of the medical profession, it is unlikely that it will be generally accepted.

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