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A Different Doctor's View Of Oh

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This doctor has a somewhat familiar view of OH but still IMHO is worth reviewing. He actually looks for some causes ... I only copied in a tiny bit of this article. He has a section called "Laboratory TESTS for orthostatic hyptension" that I want to look at further. tc ... d



Timothy C. Hain, MD.buttonb.gif Page last modified: January 21, 2012

Diagnosis of Orthostatic Hypotension

Syndromes with orthostatic dizziness or lightheadedness, not associated with low blood pressure include:

  1. Positional orthostatic tachycardia (POT) syndrome. Here, the pulse races on standing. See below for more information.
  2. Low CSF pressure syndrome
  3. Primary orthostatic tremor
  4. Positional vertigo (i.e. BPPV)

Syndromes with orthostatic hypotension that may be diagnosed include:

  1. Cardiogenic (heart related) orthostatic hypotension. In this instance the heart doesn't respond adequately to demands for greater pumping and blood pressure drops. Conditions such as arrhythmia, heart failure, deconditioning, and pregnancy are examples.
  2. Low blood volume (e.g. anemia, dehydration, dialysis)
  3. Medication related (usually too high doses of blood pressure medications or medications for depression)
  4. Primary adrenal insufficiency. Persons with primary adrenal insufficiency usually also have symptoms of glucocorticoid (cortisone) deficiency. The skin may be dark, serum potassium high, and there may be associated hypothyroidism, diabetes, and vitiligo (Salvatori, 2005).
  5. Neurogenic orthostatic hypotension

    1. Sensory neuropathies (diabetes, alcohol, syphilis, Holmes-Adie syndrome, carotid sinus obliteration by endarterectomy, Riley-Day syndrome)
    2. Central types:

      1. MSA- multiple system atrophy or Shy-Drager, Parkinson's, dementia with Lewy bodies. Orthostatic hypotension is nearly universal in MSA, present in about 50% of patients with dementia with Lewy bodies (Akaogi et al, 2009), and in 5-50% of patients with Parkinson's. (Thaisetthawatkul et al, 2004; Akaogi et al, 2009). However, since Parkinsonism is by far the most common disorder, there may be as many patients with orthostatic hypotension and Parkinson's disease as any of the former. Patients with MSA have intact sympathetic noradrenergic innervation.
      2. Medullary strokes or injuries (rare)
      3. Wernickes syndrome (rare, related to thiamine deficiency)
      4. Output types:
        1. Peripheral neuropathy, especially diabetes and amyloidosis
        2. Spinal cord lesions
        3. PAF - pure autonomic failure or idiopathic orthostatic hypotension. These patients have loss of cardiac sympathetic neurons, and in particular have loss of sympathetic noradrenergic innervation.
        4. Parkinson's disease (post-ganglionic sympathetic denervation). These patients also have loss of cardiac sympathetic neurons.
        5. Dopamine beta-hydroxylase deficiency (hereditary, very rare -- has very high serum dopamine, often ptosis (droopy eyes) and hyperextensible joints. Prolactin may be high)

[*]Unknown type

  1. Orthostatic intolerance in chronic fatigue syndrome (this mainly seems to be a syndrome of adolescents)
  2. Orthostatic intolerance associated with basilar migraine
  3. Delayed orthostatic hypotension. Possibly due to fatigue of autonomic system over 3-20 minutes.

    1. The diagnosis of orthostasis is made by finding that the systolic/diastolic blood pressure drops at least 25/10 mm mercury on going from lying to standing. After measuring the supine blood pressure, it is recommended that one should have the subject stand for 2 minutes (if tolerated) before measuring the upright blood pressure (Tarazi and Fouad, 1983).

      Of course, we all know he missed the boat here but otherwise, his info looks ok so far ...
Unknown type
  • Orthostatic intolerance in chronic fatigue syndrome (this mainly seems to be a syndrome of adolescents)

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This doctor really has some interesting info here. I like the way he lays it out for us too ... granted, I dont' understand it all but I thought you might ... tc. d


Autoimmune Brain Disease (ABD)

Last edited: April 4, 2010

Autoimmune Brain disease or "ABD" consists of a syndrome of central nervous system which is caused by antibodies or immune cells which are attacking the brain. There is considerable overlap between autoimmune disorders that attack the ear and those that attack the brain.

The immune system is complex and there are several ways that it can damage the brain. Traditional "autoimmune diseases" including Systemic Lupus Erythematosis (SLE), Sjoegren's syndrome (dry eye syndrome), Wegener's granulomatosis, and rheumatoid arthritis can cause or be associated with ABD.

There are are also organ specific disorders such as Hashimoto's thyroiditis and Celiac disease (sprue) which occasionally are accompanied by ABD. In Celiac disease, antibodies have been found directed against transglutamase 2 (an autoantigen in the gut), and transglutamase 6 - an antigen independent of intesinal involvement (Hadjivassilou M, et al, 2008).

Antibodies to glutamate receptors have been reported in cerebellar degenerations (Gahring et al, 1997), in patients with downbeating nystagmus (Antonini et al, 2003), and palatal myoclonus.

Antibodies to GAD are also reported in "stiff person syndrome", typlified by muscular rigidity and episodic muscle spasms. Anti-GAD antibodies are also very common in diabetes. Autoimmune mechanisms have also been suggested for the opsoclonus-myoclonus syndrome (Pranzatelli 1996; Lapenna, Lochi et al. 2000; Dale 2003; Pranzatelli, Travelstead et al. 2004; Pranzatelli, Tate et al. 2005)

How common is autoimmune brain disease ?

ABD is rare, probably accounting for less than 1% of all cases of central disturbances.

What causes autoimmune brain disease ?

The cause of ABD is generally assumed to be related to either antibodies or immune cells that cause damage to the brain. There are several theories as to how these might arise, analogously to other putatative autoimmune disorders:

Bystander damage: In this theory damage to the brain causes cytokines to be released which provoke, after a delay, additional immune reactions. This theory might explain the attack/remission cycle of disorders such as multiple sclerosis.

Cross-reactions: In this theory, antibodies or rogue T-cells cause accidental brain damage because the brain shares common antigens with a potentially harmful substance, virus or bacteria that the body is fighting off.

Intolerance: The brain, like the eye may be only an partially "immune privileged" locus, meaning that the body may not know about all of the brain antigens, and when they are released (perhaps following surgery or an infection), the body may wrongly mount an attack on the "foreign" antigen. In the eye, there is a syndrome called "sympathetic ophthalmia", where following a penetrating injury to one eye, the other eye may go blind. This theory is not presently in favor for the ABD.

Genetic factors: There is increasing evidence that genetically controlled aspects of the immune system may increase or otherwise be associated with increased susceptibility to brain injury.

<a name="diagnosis">How is the diagnosis of autoimmune brain disease made?

The diagnosis is based on history, findings on physical examination, blood tests, and the results of other tests.

Blood tests for autoimmune disorders include:

  • Sed Rate and CRP
  • ANA
  • anti-GQ1b antibody (for eye muscle weakness)
  • Rheumatoid Factor
  • Complement C1Q
  • Thyroid screen (TSH, anti-microsomal antibodies, for Hashimoto's thyroiditis and encephalopathy)
  • anti-gliadin and anti-endomysial antibodies (for Celiac disease).
  • anti-GAD antibodies (for stiff-person syndrome and diabetes)
  • Anti-Purkinje cell antibodies (anti-Yo)
  • Anti-HU, anti-Ri (for paraneoplastic antibodies to neurons)
  • HLA testing

Blood tests for conditions that resemble autoimmune disorders include:

  • FTA (for Syphilis)
  • Lyme titer
  • HBA1C (for diabetes, which is often autoimmune mediated also, and is asociated with anti-GAD)

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We're getting some good articles lately. Very thought provoking. I've often thought there is an autoimmune and also inflammation component to our issues. Mayo clinic does have a test called - Autoimmune Dysautonomia Evaluation. So, there is testing specifically for this.

Interesting thought about it attacking the brain.

Just a little note about the first article. It list one illness as being connected to thiamine deficiency - I did some research awhile back and thought there were a lot of similiarties to our POTS issues and beriberi - which is also a thiamin deficiency. There have also been some on the forum in the past with positive results to an increase in thiamine or B1. I'm trialing this right now and do seem to be increasing my energy. I want to later add alpha lipoic - but, was told that I needed to make sure my B1 levels were high enough before adding it or it would make me sick. When I first started the B1 it increased my sympatetic system considerably. I stuck it out and it settled out. (You also need to always take a B-complex if you take one B vitamin or you will imbalance your B's and that could cause issues. So, I also use a B-Complex.)

It gives us something to think about as for testing possiblities too.

Thanks for the links.


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Hi Issie

Thanks for reminding me about thiamine. I bought the active type and keep forgetting to take it. I took ALA for about a year but didn't notice anything from it but I'll try it again ..

fwiw tho .. I have almost all of the problems this doctor listed in this section detailed above. I put it in red in the first post too so it would be easier to pick out ... rats ... d ..

Syndromes with orthostatic hypotension that may be diagnosed include

BUT ... on the upside, most of my problems have been related to gluten so there's a teeny tiny chance this one is too and I've just been getting too much gluten still. I've had high gluten antibodies in my stool until my last test in March. But even then it was low. I can't really remember right now but I "think" I ate something questionable ..

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Me too now that I'm taking it again. What ala do you take ? My doc has a long list of supplements she'd like

for me to be on but I just can't afford these and healthy foods.

In an odd way knowing I have so many possible causes of my io makes me feel less frustrated. I'd never seen

Them summed up like this. Fwiw. I've seen most of these related to gluten ..

1 - My left bundle branch block didn't change at all after I started walking normally in sept 2006. My cardiologist says it's still the same as of march last year even. It's considered minor but causes a bad ekg.

I read up

On this and learned it was a ticker problem. And that purkinje cells were involved. And since purkinje

cell damage is implicated in gluten ataxia, I thought my lbb might resolve itself too. Bummer ..

2 - I have chronic dehydration via last years frequent urine tests.

4 - Diagnosed with adrenal fatigue via saliva test. My doc may have run something I'm unaware of too tho.

Diagnosed with hashimoto's via thyroid antibody test ..

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Oh, I know about the cost of so many supplements. But, that's mostly what I'm on. I have been for years doing my own thing and didn't try to find meds. until I got in my 40's. Managed myself for that long with just natural supplement things. Too many to list here - and if I did would have to tell what warnings for certain ones not to do and why not to. So, rather just give out a little bit at a time - instead of a whole list. I can PM it to you if you want to know though. I have found a place and get my supplements 30-50% off retail and they are great to do business with. Saved me a lot of money over the years.

I haven't started on ALA yet. Still making sure that my B's are up and ready for that to add in. I will be looking for a very low dose amount when I start it. I remember someone saying they took Puritan's Pride (I think). Said they had tried different ones and that was the better one for them. I'll have to look back and see who that was and what they said.


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Thanks for offering to pm me the list but I'm really broke right now. My integrative doc opted out of medicare

and trying to deal with that.

I'm leaning towards sticking with diet mostly anyways. Esp since I can afford to do this .. I have a freind who gave me some valuable

guidance on my diet in march and he suggested I stick with mostly raw foods and juicing. The wahls diet

pretty much except more raw veggies and very little meat.

So far other than eating too many cruciferous veggies by mistake, it's going well. Rookie mistake.

Tc .. D

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  • 1 year later...


Really interesting article. Shows how much a part diet plays into things. I have a feeling B1 will be something that a lot of others will soon be trying. Just keep in mind that it could potentially ramp up the sympathetic system ----some will have paradox reactions and each person will react differently. Always go low and slow.


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