Hey guys I haven't posted in a long time, but I have some new ideas about POIS, and I've been testing some new supplements over the past month or two and have found some that significantly reduce my POIS symptoms based on these ideas. When I first started testing out these new supplements I felt a little weird and my blood pressure shot up, but I've since cut a few supplements out and although I still get POIS, I've never felt better during it and it's cut it in half (from 4 days to 2 days). With that being said, I want to focus on what I've learned about POIS.
First, I think we were all born with defects in our immune systems due to our genes (from the prevalence of allergies among people with POIS), or acquired immune system dysfunction from viruses, low levels of vitamins (especially B & D which may not show up on blood tests because they almost always test the inactive form of the vitamin, could also have a mutation for that vitamin receptor), leaky blood brain barrier, or other causes. These immune system problems lead to excessive mast cell activation, and subsequent histamine release, which when combined with the natural histamine release in sex leads to major stress and immune dysfunction. I believe the defects in our immune system lead to a slowed rate of histamine clearance, which is something I know I have due to SNPs in the DAO and HMNT genes. During sex histamine is released by basophils, and is supposed to drop right after, but does not because of our decreased histamine clearance rate. This could explain why many POIS sufferers report lifelong premature ejaculation, something that people with elevated histamine levels tend to report.
The inability of to clear histamine after sex puts excessive stress on our bodies, as a result the immune system classified something in our seminal fluid as an antigen, which is a "toxin or other foreign substance that induces an immune response in the body, especially the production of antibodies." The body's recognition of the antigen causes mast cell activation, which is the first phase of inflammation, and releases a large number of chemicals that cause both short and long-acting effects. First histamine, tryptase, chymase, and tnf alpha are released causing the immediate effects of POIS. Shortly after mast cells can produce prostglandin D2 and leukotriene C4, the second phase. Interestingly, niacin flush causes the body to release both of these mediators, as well as serotonin. I have been taking a leukotriene inhibitor lately (Singulair) because both PGD2 and LC4 are both molecules involved in inflammation linked to asthma (which is what I was prescribed Singulair for, also note that these molecules may have some role in resolving inflammation, I just choose to avoid them because of my asthma). Phase #3 of POIS is the last step of mast cell activation, and the cause of most POIS symptoms, the up-regulation of cytokines and chemokines leading to an inflammatory state.
Finally, although it is just a theory, the evidence I have for it just keeps on growing the more I learn about POIS. I think the constant and unavoidable stress of POIS, and the role of systemic vagus nerve activation in sex (something we have Dr. Komisaruk to thank for proving), as well as certain risk factors like allergies (which signals that the immune system is over reactive), eventually leads to the body attacking the vagus nerve. Although it sounds impossible to have your body attack such an important part of your body, there are a number of important CNS self-antigens.
(listed here
https://www.ncbi.nlm.nih.gov/books/NBK299208/table/ch29_t29.1/?report=objectonly)
Furthermore, Vagal nerve antibodies have been found in people with diabetes, and are associated with a significantly lower HRV (
http://care.diabetesjournals.org/content/13/10/1084). If POIS is an autoimmune disease with the Vagus Nerve as a target tissue, theoretically it would result in systemic effects effecting the ANS (the Vagus Nerve being the longest cranial nerve, an essential part of the autonomic nervous system). I have attached a picture that relates diseases and their bio-markers to how far reaching the symptoms are in the body, take a look because ANA is at the far end of the "Multi-systemic autoimmune diseases." An autoimmune disease affecting the Vagus nerve would certainly be systemic, as the main effects would be related to the function of the Vagus nerve, which includes (from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4082307/): "metabolic homeostasis by controlling heart rate, gastrointestinal motility and secretion, pancreatic endocrine and exocrine secretion, hepatic glucose production, and other visceral functions. In addition, the vagus nerve is a major constituent of a neural reflex mechanism?the inflammatory reflex?that controls innate immune responses and inflammation during pathogen invasion and tissue injury...Inflammation is normally a local and temporary event and, upon its resolution, immune and physiological homeostasis is restored. However, disrupted innate immune regulation can result in continual pro-inflammatory cytokine activity and excessive or chronic inflammation. This state underlies the pathogenesis of a range of disease syndromes, including sepsis, rheumatoid arthritis, inflammatory bowel disease and other inflammatory and autoimmune disorders."
POIS certainly presents strong effects relating to a lack of homeostasis and dysfunction of the autonomic system. I could give countless examples, but the most recent/relevant example would definitely be Demografx and his problems with fainting lately. Fainting is the result of an overactive Vagus nerve, and although POIS is associated with an under active Vagus nerve, fainting can be the result of dozens of different triggers and is simply a malfunction in the autonomic nervous system's ability to maintain homeostasis. This is a serious problem, as it leads to numerous diseases, and could be one factor in why there are so many, and such a broad range of symptoms in POIS.
"It is also possible for an individual to have two different autoimmune diseases (e.g. thyroid disease and rheumatoid arthritis) simultaneously. This happens far more frequently than would be expected by chance." This could be another factor in why the symptoms of POIS vary so much, but could link these outlier symptoms to common conditions other than POIS. "Similarly, there may be clustering of autoimmune diseases within the same family. This phenomenon can be explained partly by the underlying genetic basis of these diseases." (
http://www.phadia.com/en-GB/3/Diseases/) These factors could explain why the autoimmune/hormonal aspect of POIS is clear, but the cause is so mysterious with the many different POIS types and symptom clusters.
Although the positive ANA result could be from one of the factors leading to varied symptoms, I think it's more likely related to POIS, and people need to test for it during POIS (since antibody's are produced in response to an antigen, it needs to be tested during POIS). Even though ANA is most often linked to lupus, it is a collection of over a dozen antibodies that are linked to many conditions, and only a few of these antibodies are linked to lupus. I would ask your doctor to follow this flowchart for a positive ANA result if they dismissed it (
http://www.questdiagnostics.com/hcp/intguide/Immuno/ALG_ANA_MultiplexCascade.pdf), since lupus symptoms are similar to POIS.
