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Paul Cheney's NMH (Neurally-Mediated Hypotension) Treatment Protocol for Chronic Fatigue Syndrome

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By Carol Sieverling • • April 17, 2002

Many CFIDS/FM patients suffer from a condition called NMH or Neurally-Mediated Hypotension. (Hypotension means low blood pressure and neurally-mediated means caused by the brain.) Many doctors are not aware that it is often a symptom or side effect of CFIDS/FM. NMH is a miscommunication between the brain and the heart that can cause lightheadedness, dizziness, weakness, fatigue, nausea, mental confusion, headaches, muscle aches and profuse sweating.

It can occur after exercise, a period of standing (or even just sitting upright), or exposure to a warm environment. Some experience the symptoms after emotionally stressful events, since an inappropriate response to adrenaline is involved. Some experience the symptoms soon after eating, when blood flow shifts to intestinal circulation.

Instead of sending signals to speed up the heart, the brain tells the heart to slow down and the vessels in the arms and legs to dilate. Blood pools in the extremities and not enough stays in the brain. Keep in mind that even people with high blood pressure can experience NMH. NMH is a symptom of CFIDS, not its cause. NMH is part of the larger picture of disregulation of the autonomic nervous system common to CFIDS.

NMH is often treated with a drug. However, many national CFIDS specialists recommend a salt and water protocol. The following is Dr. Cheney's protocol and is based on a taped conversation and notes he made. This is distributed and with his permission.

1) Drink 6 to 8 glasses (8 oz each) of fluid a day. (48 to 64oz total daily intake) Two or three times a day dissolve 1/4 to 1/2 tsp of sea salt in 3 to 4 oz of water and drink it. (This liquid is part of your total intake, not in addition to it.) Cheney strongly urges that sea salt be used for this, not table salt. Sea salt matches the mineral balance of our bodies. As with all drugs, supplements, and treatments, start with the lower dose and work up.

2) Don't drink excessively. Do not drink more than 64 oz. of water a day (unless you're sweating a lot or something.) Excessive water intake sets in motion a chain of events that leads to excessive water loss, worsening the very condition you are trying to address.

3) If NMH symptoms still persist take 2 licorice root tablets with glycerizzin two times a day. Do not buy deglycerizzed licorice root. Blood pressure must be monitored when taking licorice root! It's not uncommon to become hypertensive. Taking licorice root is almost like taking the drug Florinef (commonly prescribed for NMH) but without the side effects.

4) If symptoms have not improved or have become worse ask your doctor to check you for Diabetes Insipidus (DI). (This is not the same condition as the more familiar Diabetes Melitus in which the pancreas does not produce enough insulin. Diabetes Insipidus results when the pituitary or hypothalamus are not functioning normally. The only thing the two conditions have in common are the symptoms of excessive thirst and frequent urination.)

If the DI test is positive, Cheney usually treats it with Vasopressin nasal spray. Cheney finds that about 50% of CFIDS patients show low-level DI. (Not surprising, given that the HPA axis - hypothalamus/ pituitary/adrenal - is suppressed in CFIDS.) Low level DI might respond to salt and water and licorice treatment. High level DI will not respond at all to those treatments, and without Vasopressin those patients cannot keep their blood volume up high enough.

Note: Dr. Cheney has found that Florinef is not a good treatment option for NMH in most CFIDS patients. Florinef forces potassium depletion and further suppresses the HPA axis, which is already suppressed. Initial short-term benefits are seen with Florinef, but they degrade over time. With extended use Florinef actually exacerbates the disease in many patients.

Source: Thank you to Carol Sieverling.

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