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Clinical Autonomic and Mitochondrial Disorders

Abstract

Cellular energy production from mitochondria via the citric acid cycle and the electron transport chain is fundamental to health and wellness and life itself. Glucose is the molecule that fuels life, in the presence of oxygen, via cellular respiration, and ATP is the energy molecule that stores and transfers energy to where it is needed. Sufficient levels of cellular respiration are required for health and wellness. A lack of ATP can cause autonomic (P&S) and mitochondrial dysfunction, significantly effecting quality of life (QoL). Typically as ATP production decreases, free radical (including reactive oxygen species) production increases, affecting both mitochondrial and P&S health. The levels of P&S dysfunction include advanced autonomic dysfunction (AAD), also known as diabetic autonomic neuropathy (DAN, if the patient is diagnosed with diabetes), involving morbidity risk, and cardiovascular autonomic neuropathy (CAN) involving mortality risk. Normal system functions may generate oxidants (e.g., free radicals and reactive oxygen species). A small amount of oxidants are actually helpful to the body, especially the immune system where they are used to “burn out” infections (i.e., bacterial, viral, mold, and mildew). There are many adverse environmental and lifestyle sources of oxidants as well, including stress and disease. Too many oxidants lead to disorders, including atherosclerosis, autonomic neuropathy, and mitochondrial dysfunction, and the diseases that often follow those disorders. All in all, it is easy to overwhelm the body with oxidants. This is the basis for the need to have as large an antioxidant pool as possible, both from a healthy diet and from supplements. As people age or become ill, the naturally occurring antioxidant-oxidant ratio declines, and diet becomes not enough, requiring supplements to help establish and maintain healthy antioxidant-oxidant ratios.

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Notes

  1. 1.

    “Dynamic balances” or “dynamic imbalances” are P&S ratios (P&S activity levels relative to each other) under challenging (e.g., non-resting or dynamic) conditions. For example, as measured during the standard clinical autonomic test, during the challenges, the P&S ratio (aka sympathovagal balance or SB = S/P) is expected to change as follows: for deep breathing (a parasympathetic challenge), where P is expected to increase and SB is expected to decrease, and for Valsalva and stand or postural change (net sympathetic challenges), where S is expected to increase and SB is expected to increase. There are normal ranges for these SB changes [1]. These normal SB changes define “dynamic balances.” Abnormal SB changes define “dynamic imbalances.”

  2. 2.

    These agents help to maintain healthy levels of NADH to boost ATP synthesis. In the brain, NADH increases the production of the neurotransmitters dopamine, norepinephrine, and serotonin, which help elevate mood and improve sleep.

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Authors and Affiliations

  1. Franklin Cardiovascular Associates, PA and Autonomic Dysfunction and POTS Center, Sewell, NJ, USA

    Nicholas L. DePace MD, FACC

  2. TMCAMS, Inc., Franklin Cardiovascular Associates, PA and Autonomic Dysfunction and POTS Center, Richboro, PA, USA

    Joseph Colombo

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DePace, N.L., Colombo, J. (2019). About the Program. In: Clinical Autonomic and Mitochondrial Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-17016-5_2

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  • DOI: https://doi.org/10.1007/978-3-030-17016-5_2

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