Rigor mortis

It’s a phenomenon I’d given countless hours of consideration to…but not for some time. What is this living rigor mortis that sets in as one of the oh-so familiar symptoms of fibromyalgia (FM)? I’ve already shared about my recent back injury and I’m in steady recovery from that but what I’m left with is the feeling of muscles and sinews being set in concrete all around my body and thus so much indescribable pain and restriction on every movement, which is the way I used to feel for months and months on end when I first developed FM…and I could do without the reminder!

Its worse, perhaps not unexpectedly, at night so I’m waking feeling even more exhausted from the kind of sleep where every movement reminds me of this cast-like restriction and discomfort I’m in, as does lying too long on one particular side (and I walk like a 90 year old when I get out of bed). In this state, the body never fully surrenders to sleep so your dream-state never quite gets you out of there to do the night’s repair work. Within days, you’re contending with chronic fatigue on top of this heinous pain and restriction…oh yes, I can so see how the slippery slope gathers momentum, as it did for me all those years ago; a catch 22 that I’m doing my darnedest to be aware of so I can catch it in free fall, this time around!

And this isn’t something I just made up for literary effect. You’ll find reference to “rigor mortis like pains” all over FM forums and articles, as I have done this week. Yet not being alone in your pain doesn’t necessarily give you answers and the best theory I have come across is that its simply due to lack of movement and the fact you become more aware of pain at night when you’re less mobile…

Hmmm, doesn’t cut it for me…there’s some peculiar mechanism to this type of stiffness in the body, being nothing whatsoever like any stiffness I used to get from, say, a day’s walking or an afternoon digging the garden before I became unwell. This feels like someone opened a stopper and poured quick setting cement into my body and then, of course, every slightest movement, every merest flex (who knew we move so many muscles to do the most subtle things?) becomes a resistance against that barrage of rock. Believe me, the feeling is wall-like enough for me to have deeply plunged the metaphor over the years, looking for clues as to what I am subliminally seeking to block-off, to sure-up or make stronger and, still, I’m not sure I got very far with that…though I must have got somewhere as the symptom eased off over the years. Perhaps (I had assumed) it was good diet and regular yoga but I sense these episodes go deeper than that; there’s a layer of understanding I can’t ignore any longer if I am to prevent the repeat of this, over and over again as soon as I feel fit enough to start being more active and ignoring my own advice. Otherwise I become the very definition of a fool…

Of course, it gets much worse in the cooler months as muscles contract or shiver in response to the chill, which is why September onwards, or a room with a draught, is my trickiest time, even in the relatively good phases. Now I’m into the full monty of the most intense and restrictive pain I’ve experienced for years, I really want to get a handle on what this is all about before it sets in (excuse the pun).

The obvious starting point is to ask, what is rigor mortis when a person dies? Why does it happen, other than the body (of course) stops moving fluids around; are there any clues why that could happen in a living-breathing person? Rigor “stiffness” mortis “of death” says it all really….it is a condition of death so what makes it appear within life for just so many people. I’ve written before about FM being like a series of mini-deaths and here it was again; this conundrum, pressing me to wonder what it is that takes some people into a sort of half-life.

So I looked it up on Wikipaedia and there it was in full view:

After death, respiration in an organism ceases, depleting the source of oxygen used in the making of adenosine triphosphate (ATP). ATP is required to cause separation of the actin-myosin cross-bridges during relaxation of muscle.^[2] When oxygen is no longer present, the body may continue to produce ATP via anaerobic glycolysis. When the body’s glycogen is depleted, the ATP concentration diminishes, and the body enters rigor mortis because it is unable to break those bridges.

Here we are, back at the doorstep of glycolysis, the underlying topic of my last blog since I wrote about the propensity of someone with FM to produce far more lactic acid than most people, with far less provocation, and then to continue producing it long after the exercise-event…and thus for the body to get into a chronic state of glycolysis or anaerobic energy production (oxygen not getting to the cells). The end result is that, whereas an athlete may experience, say, a stiff calf after a marathon, those with FM can experience much more pain than that, with far less provocation and all over their body. The more stiff they get, the less likely they are going to be able to move, which is essential to get blood flow moving again to help remedy the situation. Caught in a catch-22 where to move also generates more lactic acid, the situation can rapidly deteriorate without at least some understanding of what is going on here.

So let’s recap; what is glycolysis?

“All cells require energy in order to work. There are two ways that they can get their energy. Normally energy is supplied to cells by mitochondria (little organelles within cells), which supply energy in the form of ATP (adenosine triphosphate) via a process called oxidative phosphorylation. This process requires oxygen, is extremely efficient and the way in which the vast majority of energy is produced for the vast majority of time.

The second way in which cells can get energy is through glycolysis. From an evolutionary point of view this is a very much more primitive way of supplying energy. It does not require oxygen, it just needs sugar. It is extremely inefficient and the result of glycolysis is the production of large amounts of lactic acid. All athletes recognise the moment when they switch from aerobic metabolism (requiring oxygen) via mitochondria to anaerobic metabolism (glycolysis) resulting in a build up of lactic acid. It is this build up of lactic acid that causes the pain, heaviness, feeling exhaustion, deadened muscles and muscles will not work or go any faster sensation.

I am also interested in this idea because in horses there is a condition known as azoturia (tying up), which does not have an obvious human parallel. I suspect, however, that this parallel is fibromyalgia. This condition occurs in some susceptible horses when there is a huge build up of lactic acid in their muscles which causes extremely severe muscle damage, massive amounts of pain and distress and in severe acute cases the horse can die from it.” (Dr Sarah Myhill – Fibromyalgia – Possible causes and implications for treatment.)

By the way, a high-carb diet can provoke this even further so any urges to take refuge in comfort eating can badly backfire as the body is geared to shut off blood flow to tissue (which would damage it) rather than unleash too much sugar into the cells during such a crisis.

So what can you do about getting more oxygen to your cells when this crisis sets in (that pun again, sorry)?

Wiki continues:

Additionally, calcium enters the cytosol after death. Calcium is released into the cytosol due to the deterioration of the sarcoplasmic reticulum. Also, the breakdown of the sarcolemma causes additional calcium to enter the cytosol. The calcium activates the formation of actin-myosin cross-bridging. Once calcium is introduced into the cytosol, it binds to the troponin of thin filaments, which causes the troponin-tropomyosin complex to change shape and allow the myosin heads to bind to the active sites of actin proteins.^[1] In rigor mortis myosin heads continue binding with the active sites of actin proteins via adenosine diphosphate (ADP), and the muscle is unable to relax until further enzyme activity degrades the complex.^[2]

Normal relaxation would occur by replacing ADP with ATP, which would destabilize the myosin-actin bond and break the cross-bridge.^[1] However, as ATP is absent, there must be a breakdown of muscle tissue by enzymes (endogenous or bacterial) during decomposition. As part of the process of decomposition, the myosin heads are degraded by the enzymes, allowing the muscle contraction to release and the body to relax.^[4]^[5] Decomposition of the myofilaments occurs 48 to 60 hours after the peak of rigor mortis, which occurs approximately 13 hours after death.^[1]

Of course, hopefully, I am not dead…and I certainly don’t choose for this state of rigor mortis to perpetuate so I’m not prepared to rest on my laurels over this. Apart from the obvious discomfort and pain, glycolysis is well known to for offering a growth advantage to cancer since it is this anaerobic state that enables the cellular process to misfire, making those cells “immortal” rather than dying and being cleared away as they should be, as one article descriptively put it. “In the early 1920s, Otto Warburg observed that cancer cells were highly fermentative. He hypothesised that it was due to a metabolic injury [1,2]”. This led to “the discovery that cancer cells produced large quantities of lactic acid and that extracellular/intratumoral acidification” can be “shown to be a major and fundamental factor in local growth and in the metastatic process” (Glycolysis, tumor metabolism, cancer growth and dissemination. A new pH-based etiopathogenic perspective and therapeutic approach to an old cancer question – Khalid O Alfarouk et al). Taking this into consideration, I don’t intend to provide the favoured environment for cancer cells for longer than I have to.

The immediate question that springs up for me is, what am I missing from my body that is resulting in reduced levels of ATP and can I supplement this?

One of the supplements frequently listed as a possible boost of ATP is coenzyme Q10…which I am already taking, so there’s a tick in that box.

Along with CQ10, two other supplements are often touted for ATP encouragement but this information is seldom presented in a fibromyalgia context and so I reserve judgement and suggest you do your own research or seek professional advice. One is creatine – see this article Creatine for fibromyalgia and chronic fatigue syndrome and the other is a B-complex vitamin supplement, which I always take anyway (see this article How to boost ATP levels article on all three of these supplements but, again, remember this is not FM specific information and more studies are called for).

Another that springs to mind is acetyl L-carnitine (which is synthesised in the body, however levels decrease in the body after the age of 40), known for its support role in mitochondrial activities. However, studies suggest that L-carnitine can increase glycolysis (L-carnitine increases glucose metabolism and mechanical function following ischaemia in diabetic rat heart” – T L Broderick et al). In my own case, I supplemented with it for a long time but reached the conclusion it felt “too much” and was making me feel worse at some point, then I recall reading something that suggested this could be due to a by-product of increased oxidative damage so I decided against continuing. Now, as a vegan (given it is supplemented from animal flesh) I would struggle to go back to it anyway. However, I do take 1000mg of L-lysine a day for Epstein Barr management and this helps the body to make its own carnitine, presumably at the appropriate rate (note: you can now buy vegan acetyl L-carnitine…it is synthesised from L-lysine). Dr Jacob Teitelbaum speculates in this article that those struggling with chronic fatigue syndrome who supplement lysine for herpes often enjoy improvements in their other symptoms because of this effect of increasing natural carnitine levels (which is, I speculate, a more gentle way of supplementing it that the FM or CFS body can handle).

So L-lysine rather than an acetyl L-carnitine supplement is worthwhile…just so long as the body has a source of carnitine but could this positive effect be taken further? In a study where supplemented acetetyl L-carnitine was paired with Alpha Lipoic Acid, the ALA seemed to balance out the increased oxidative damage triggered by the acetyl L-carnitine supplement (see below), forming a partnership which the following article enthusiastically describes as the “elixir of life”:

“Alpha lipoic acid (ALA) is a sulphur-containing antioxidant, which occurs naturally, in small amounts, in such foods as spinach, broccoli, beef, yeast, kidney, and heart. alpha lipoic acid (ALA) is readily soluble in water and fat, enabling it to exert an antioxidant effect in almost any part of the body, including the brain. In the mitochondria, alpha lipoic acid (ALA) can act both as an antioxidant, capable of recycling other antioxidant nutrients such as vitamin C and vitamin E, and as a coenzyme for key metabolic enzymes involved in energy production. In addition to its role as an antioxidant, alpha lipoic acid (ALA) also raises the levels within cells of a substance called glutathione, which is critical for neural function, and aids in glycolysis, the first stages of breaking down carbohydrates for energy.” (Article Alpha lipoic acid and acetyl L-carnitine in Peak Performance magazine.)

The article continues:

The initial excitement about ALC/alpha lipoic acid (ALA) supplementation began when a team of researchers in California fed elderly rats both nutrients for a period of seven weeks and then compared them with young rats⁽¹⁾. They were testing the theory that mitochondrial decline is caused by free radical damage (see panel opposite). There was already evidence that supplementation with acetyl L-carnitine (ALC) could reverse the age-related decline in mitochondrial activity in rats, increase fatty acid oxidation and boost general metabolic activity⁽²⁾. However the down side to this increased mitochondrial function was that more oxidative damage occurred⁽³⁾, so the researchers decided to add the powerful mitochondrial antioxidant alpha lipoic acid (ALA) to the mix to see if they could get the best of both worlds: increased mitochondrial energy output, with reduced mitochondrial damage.

This two-pronged ‘punch’ to ageing cells seemed to work, with the two supplements together producing better results than either one alone. After a month on the supplements, elderly (24-month-old) and lethargic rats had more energy and did better on memory tests, while their mitochondria worked better. The decline in overall activity typical of aged rats was reversed to the level of young-to-middle-aged adult rats, aged 7-10 months. The researchers likened this result to a group of 80-year-old humans throwing away their walking sticks and starting to act 35 years younger! (Article Alpha lipoic acid and acetyl L-carnitine in Peak Performance magazine.)

This was of especial interest to me because I usually take ALA every day for nerve pain but, about 3 weeks ago, I ran out and didn’t replace it so I had still been taking L-lysine but not ALA throughout this whole sorry episode. Needless to say, I have now reordered my ALA supplement as a matter or urgency and, for the record, I take Life Extension‘s Super R-Lipoic Acid, about which the website states:

“Super R-Lipoic Acid is more bioavailable, stable, and potent, achieving 10–30 times higher peak blood levels than pure R-lipoic acid. This unique sodium-R-lipoate can help you reach peak plasma concentrations within just 10–20 minutes of supplementation. Super R-Lipoic Acid provides more of the active “R” form than conventional alpha-lipoic acid products”.

Considering how much to take, Livestrong states “ALA supplementation for general anti-oxidant support should typically range from 20 to 50 mg per day in adults. Diabetics and people with diabetic neuropathy may be required to take up to 800 mg per day”. The “super” supplement I take comes at 240mg a day, which is what I stick to given it is in a more bioavailable form.

If I wanted another hint that ALA is really very useful as a means for tackling the rigor mortis effect, it was the study I happened upon that found “that dietary ALA treatment significantly slowed down the decrease of pH values in postmortem muscle” and therefore, it concluded, that ” dietary ALA supplementation is a potential way to reduce the incidence of pale, soft, exudative (PSE) meat” (Effects of dietary α-lipoic acid on glycolysis of postmortem muscle – Shen & Du), which is a condition known to occur in pork, beef and poultry and if we need a reminder that if we eat meat we are, basically, eating ourselves, there it is. So ALA it is…and this time I hope to remember to keep ordering it (its so difficult remembering why you take each of your supplements when you take so many but I have to try harder).

IMPORTANT edit (2022) regarding ALA, there are contraindications for taking ALA and one is if you are vitamin B1 (thanine) deficient, see my article on this and how it is linked to chronic conditions. If so, only a tiny or no amount of ALA might be tolerated and potential side effects can also include muscle cramps and tingling, amongst others. I realised this at the point in time I was dosing 600mg per day, during a phase when intense muscle cramp and nerve pain had become pretty-much the daily norm, so has ALA been potentially making my symptoms worse? I have now removed ALA from my mix (in line with continuing my mega-dose B1 therapy) with a view to adding in a very small amount of ALA in powdered form to establish what I can tolerate…at some point, if needed.

Also interesting is that I have been actively craving sulphur in the form of MSM, a supplement I keep on my kitchen counter but often forget to take. “Sulfur is a mineral that is present in every cell of the body. It plays a key role in liver metabolism, the function of joint cartilage and the creation of keratin in our skin and hair. It is also critical for metabolism and antioxidant defence systems that protect the ageing patterns of the brain” (Article The Top 5 Health benefits of MSM). However, modern farming methods and lifestyle have left it sadly depleted in most people. The attached article offers an outline of reasons why I may have been craving this supplement, and I have been prompted to increase my dose, having now been reminded of these benefits. MSM is also useful for tackling arthritis, anxiety (cause of tension in the body) and allergies (muscle pain is an allergy of the muscles according to Dr Myhill) so the wide-ranging potential benefits of MSM, in this circumstance, speak for themselves.

Treating magnesium deficiency (a modern scourge) is essential, with good supplements and epson salt baths or magnesium spray straight onto the muscle. A high carbohydrate diet (as I mentioned) can be a trigger so best to cut back on junk carbs, concentrate on slow burn carbs in moderate portions and perhaps aim for eating lighter meals and at an earlier time in the evenings, as I now am. Caffeine can be an issue so consider cutting back or stop for a while. Stress, as I have found out many times, will only worsen this situation since anxiety or states of high-alert work the muscles, and cause tension in them, far more than we tend to realise plus mitochondrial failure around the muscle os the heart can start to mimic angina (as well I know), with the knock-on effect that the heart struggles to pump blood to the very tissue that awaits a fresh supply of oxygen. Stress, of any kind (physical or emotional) will launch excess free radicals into cell tissue. You can start to see how FM becomes a downward spiral if you are not aware of its mechanisms, poised to waylay any issues before they become chronic.

Alternatively, you look to your diet, your supplements, the amount you move every day (little but not too much and, to paraphrase Dr Myhill, when it hurts known that means free radicals are being released so stop the activity as soon as possible). At the same time as not moving too much during a flare-up, don’t take that as a cue not to move at all but get up and move around the house or garden or do little chores at regular intervals. I have started using my yoga mat as more of a pop-in clinic than a yoga “session”, lying down on it to do some rolls, twists and stretches when I happen to be going past the door, which has a marked positive effect on mobility, pain levels and mood. Doing various side twists such as with legs and arms on alternate sides or supported bridge and pigeon if I can manage it (sometimes I cant and thats OK), finishing with dancer; these are my mainstay. I also have a Gravity Life back stretcher and use that for as long as I can bear it (up to 20 mins) to ease out any compression around nerve ganglions around my back and neck. Use heat, such as a hot water bottle, hot bath or infrared sauna whenever you can; I fill my hot water bottle multiple times a day and take it to bed, even in summer.

Perhaps try to add in as many antioxidant sources as possible; I use vitamin C and olive leaf, daily juices and smoothies incorporating blueberries and barley grass juice, for instance, plus a daily cup of chaga mushroom extract (with a 10:1 ratio of typical chaga potency) which is so delicious made with a dash of whisked coconut milk like a cappuccino that I prefer it to coffee.

Aim to get to bed earlier, turn off technology devices even earlier than that and use dim lighting, or a good eye protection software to adjust the light coming from your screen, if you must go on a computer in the hours before bed (I use Iris and wouldn’t be without it). I’ve made it perfectly OK to meditate (which is more important than ever) lying down as long as I do it; daily if possible.

So, this might feel the same as any other flare up…but its not because I’m onto it with all new clarity, understanding, tools and determination whilst going gently on myself and knowing I need to be self-supportive and unreproachful above all else. This is nobody’s fault and I am not a victim. There is nothing in my life that can’t be cancelled, rescheduled or delegated to someone else (my husband is a legend), there’s nothing that I “have” to do and everything can be adapted to fit the way I currently am. The MOST important thing is not to get into the mindset that this is here to stay since nothing makes that an inevitability so reliably as thinking it. I remind myself I have been here before and have seen many months of improvement since those times; otherwise I wouldn’t have overdone it in the first place. Seeing these episodes as passing seasons or temporary weather fronts is crucial to losing the word “chronic” to replace it with “variable” and where would we be without variety (apart from in rigor mortis); its a condition of life!