A very useful article that could explain the Vagus theory of POIS that is currently being researched at Rutgers.
http://drsircus.com/medicine/vagus-nerve-inflammation-heart-rate-variability/
The article touches upon how if the vagus nerve is not stimulated enough it leads to inflammation and that Acetylcholine helps control the inflammation. This explains Outsider and Floppybanana s treatment success with increasing Acetylcholine, as it helps control the inflammation.
Ejaculation is inflammatory (There are a few articles propsosing this, I have posted one of those articles below) but vagus nerve manages the inflammation by secreting the required Acetylcholine.
https://www.researchgate.net/publication/24421089_Frequent_ejaculation_associated_free_radical_and_lactic_acid_accumulation_cause_noninfectious_inflammation_and_muscle_dysfunction_A_potential_mechanism_for_symptoms_in_Chronic_ProstatitisChronic_Pelvi
When the vagus nerve is not able to stimulate properly the inflammation is not reduced for a long time which is the POIS period for us. As you may all know systemic inflammation to the joints and bones is what causes pain throughout the body. Then the inflammation to brain and parts of eyes is what causes blurred vision, headaches, cognition issues, etc? An inflamed prostate also causes all types of issues including premature ejaculation.
Vagus nerve is also required for increasing testosterone in the body. The body?s free testosterone level naturally drops following ejaculation and again a normal functioning vagus nerve should get it back to normal levels soon, but happens slowly in our case.
So low testosterone and systemic inflammation of the body are the main reasons why we get the POIS symptoms IMO. This explains why Testosterone replacement therapy has worked for a few and anti-inflammatory stuff like Nicain, anti-histamines, fenugreek, acetylcholine stimulators work for some. IMO there will be 100% permanent cure only if the vagus nerve heals and starts functioning as it would in a non-POIS person.
These are all strictly my theories, please let me know your thoughts and challenge me if you disagree with something so that I can research a bit more.
Hi Joelawerence,
Very interesting article, thanks for the link. I also read the article it is based on (
http://onlinelibrary.wiley.com/enhanced/doi/10.1111/j.1365-2796.2010.02321.x/#js-feedback), by Dr Jared M. Huston and Dr K.J. Tracey, pioneers of the research on the cholinergic anti-inflammatory pathway and the Inflammatory reflex. Very detailed and very instructive article.
I agree with you that when the "smart" vagus stimulation is decreased, than, in the light of what those articles explain, inflammation is produced because the cholinergic anti-inflammatory pathway is disrupted. However, the mechanism by which it happens in POIS is not clear yet - it is not clear yet as to why "ejaculation is inflammatory" ( I agree that frequent ejaculations can lead to prostatitis, but only one ejaculation in months can trigger full blown POIS, so I think there has to be something more radical at play in POIS - see below for my ideas on this ).
About testosterone, I am not sure it is central for all POIS sufferers. Many have reported normal T levels, and have POIS. I do agree that testosterone, as well as progesterone, promote immune tolerance ( and that may be a reason why they help some members) , they help calm down the immune system. TRT may also be beneficial when T levels are below normal range. But if T levels are normal, then something else seems to be at play. I believe that inflammatory reflex problems caused by low vagal tone ( or another cause for the triggering of inflammation reactions in the body after ejaculation) appears more attractive as an overall hypothesis for POIS physiopathology.
In addition to the above articles, I also went back the the groundbreaking 2007 article of Dr Tracey about the cholinergic anti-inflammatory pathway ( CAP ), at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783813/ , a briliiant article as well, that have helped me deepen my understanding of the CAP.
The cholinergic anti-inflammatory pathway ( CAP ), which includes the vagal nerve efferent effect on the spleen, is quite new information for me ( nothing of this was known when I was in university - i am too old
) . These are quite new and exciting notions, very much on the edge of health science. For example, a big block of the CAP have been discovered only in 2011 - the existence of specialized T cells in the spleen producing acetylcholine in response to vagus nerve efferent signals, this ACh production then causing the inhibition of pro-inflammatory cytokines productions by other immune cells in the spleen.
The CAP mechanism brings more clarity as to why certain elements of my method of prevention and control of POIS are effective, in particular those elements like meditation, yoga, and hanging with people I enjoy being with. Other part of my method are more straightforward ( for the description of my current method, see
http://poiscenter.com/forums/index.php?topic=2090.0 ). I have already accepted that pro-inflammatory cytokines were at work in POIS, based on Dr Waldinger hypothesis, and have included this in my own vision of POIS physiopathology, as you have read in many of my posts here. I have included in my method natural products that block the production of those cytokines ( antioxydants and TNF alpha blockers and IL-6 and other pro-inflammatory cytokines blockers like green tea and turmeric, and also Moducare, that I have talked about last year , milk thistle, lycopene, ...), and I have also included products targeting some of the effects I suppose those pro-inflammatory cytokines have, and in particular, immune upregulating of the IDO and TDO enzymes, disrupting the metabolism of tryptophan and causing my severe emotional symptoms ( anxiety, mood swings, ...). I have included too NMDA blockers, to help protect the brain cells against the excitotoxicity caused by the inflammatory reaction reaching the brain, and reduce the anxiety and other emotional symptoms caused by my POIS. But now, this new notion that pro-inflammatory cytokines production can be stopped by a control reflex through the vagus nerve, and then the splenic nerve, is a scientific basis for the efficiency of meditation, tai chi, and yoga in reducing my POIS, as well as is enjoying quality time with people I love. All these are raising HRV ( heart rate variability), which is a measure of the vagus nerve activity - the "smart" vagus, the most evolved one, as described in the Polyvagal Theory. Even if Dr Huston and Dr Tracey suggest that we may be able one day to trigger the CAP without affecting the heart, I think it is safe for now to say that if HRV is raised, we have also activated the CAP and have reduced inflammation in our body.
If the CAP disruption hypothesis applies to POIS, this means that everything raising HRV is good for POIS ( I think there is a quite extensive list of things raising HRV in the HRV thread)
It is still not clear to me what causes, in POIS, the inflammation and the release of cytokines in the first place. Is it a hypersensitivity reaction, type I and Type IV, as proposed by Dr Waldinger, caused by some component in the semen? Or is it an autonomic dysfunction that shuts off the "smart vagus" ? Now that I know about CAP, it is clear that shutting it down leads to a massive production of pro-inflammatory cytokines in the spleen, because the inhibitory action of the vagus in no longer inhibiting them - but is CAP shut down in POIS, and if it is, how and why ?. That's an interesting new hypothesis for me. Is it possible that the firing of one reflex ( the ejaculation reflex) interferes with another reflex loop ( the anti-inflammatory reflex), so its efferent part, the cholinergic anti-inflammatory pathway, in shut down? This would free the way for massive pro-inflammatory cytokines production, and explain POIS symptoms. Allergy-like symptoms, flu-like symptoms, cognitive, dermatological and gastro-intestinal symptoms, as well as emotional symptoms, can all be explained by too much TNF-alpha, IL-6, PAF and the like. Restoring the proper feedback control of the CAP by vagus nerve stimulation would then be a treatment, as proposed by the Rutgers study.
When writing about the Polyvagal Theory, at the start of this thread, I was wondering if POIS could be a problem of our autonomic system getting out of the "smart"vagus response into the sympathetic response when ejaculation occurs, and then, instead of returning to "smart" vagus, goes the other way, in the "old" vagus direction. I would be very interested to know if that would make sense and fit with Polyvagal Theory. If the cholinergic anti-inflammatory pathways is a smart vagus feature, shutting down the smart vagus would shut CAP down, and "Old" vagus does not support CAP, and POIS appears. That sounds like a programming error in the operating system, and a bad command causes the software to crash and regress to an older version...! Well, too soon to know what really happens. However, the current Rutgers Study may shed some light on this!
As a way of integrating this new information in my anti-POIS method, I may add a little lecithin whenever I have some residual symptoms of POIS. Lecithin, and also eggs, are good source of choline, a precursor of acetylcholine ( ACh). ACh is the agonist of the immune cells receptors in the spleen, at the end of the CAP. Those receptors are alpha-7 nicotinic ACh receptors, and are very specific for ACh ( there are many a7 NAChR agonists in the pipeline study of big pharma, but none on the market so far). Having more acetylcholine in your system does a job similar in the spleen as does vagus nerve stimulation.
Thanks again for your great input, Joelawerence. You seems to be very active in your search about POIS, keep up the good work. The more we write and share about our ideas, the more we have chances to solve the POIS puzzle!
