Brain waste drainage and fatigue by Dr Nina Bailey

In the late 1980s Dr Raymond Perrin, a registered osteopath, theorised that an accumulation of toxins in the central nervous system due to the “backflow” of the lymphatic drainage system was likely to be the direct cause of conditions such as chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME).  A new study published in the Journal of Science Translational Medicine(Iliff et al., 2012) has shown that a network of previously unrecognised vessels exists with the primary function to rid the brain of unwanted extracellular fluids.

Dr Raymond Perrin

Iliff and colleagues, conducting their research at the University of Rochester Medical Centre, New York, were intrigued by the fact that there appeared to be no obvious lymphatic vessels in the brain and that, without such a system, substances including amyloid-beta – a peptide that accumulates in the brains of people with Alzheimer’s – would accumulate, with possible detrimental effects.  Such findings certainly support Dr Perrin’s theory that the failure of the body’s drainage system to function optimally can result in the accumulation of toxic substances.

The significance of the body’s clearing system

The body requires appropriate levels of nutrients to support the myriad of metabolic processes that occur on a daily basis.   The ability of the body to remove the by-products of metabolism is, however, as vital to normal tissue and organ function as it is to receive the nutrients that nourish them.   Whilst blood capillaries deal with smaller molecules, larger bulky molecules of toxins must drain into the lymphatic system part of the body’s immune system comprising a series of organs, ducts and nodes that transports lymph fluid throughout the body.  This fluid works in combination with the circulatory system to drain fluid from cells and tissues, whilst also distributing immune cells throughout the body to protect against viruses and bacteria.   Once these bulkier toxins enter the system, they are broken down into smaller molecules in the lymph nodes on their way to the two large subclavian veins found under the collarbones, where they then enter the bloodstream and are transported to the liver for final detoxification.  Failure to clear the body of waste products, with the consequential toxic load, can impact on neurological, immunological and endocrine symptoms.  Not surprisingly, symptoms associated with CFS/ME can include fatigue, ‘brain-fog’, alterations in mood, such as anxiety and depression, down-regulation of white blood cells and, in some cases, adrenal burnout.

Implications of a brain drain

The presence and function of the body’s lymphatic system is well known. The presence of a similar system functioning to transport cerebrospinal fluid within and around the brain has not until now been observed.  What is particularly interesting in this study is that the flow of cerebrospinal fluid ground to a halt if the researchers deactivated a second system, which helps transport water around the central nervous system and involves star-shaped cells called astroglia, suggesting that these glial cells, which support and protect neurons, play a key role in the newly identified drainage network. Iliff’s team has named the new network the glymphatic system, in recognition of the importance of glial cells and the resemblance to the lymphatic system.

This newly identified ‘glymphatic system’ flushes waste, including around half of the amyloid-beta, from the brain through large drainage veins. With amyloid-beta considered to be responsible for most deleterious effects of Alzheimer’s, the significance of these findings may also relate to the efficiency of the system to remove toxic substances.

To flow or back flow, that is the question

Unlike the circulatory system, where the heart pumps blood through the system, the lymphatic system does not have a pump. In contrast, lymph is moved through the lymphatic vessels by contractions of these vessels and the surrounding skeletal muscles.  Veins have leaflet valves that function to prevent blood from flowing backwards.  When veins become varicose, the leaflets of the valves no longer meet properly and the valves do not work fully, allowing the blood to flow backwards.  Dr Perrin was the first to suggest that the lymphatic system, like the circulation system, is also equipped with valves to prevent backflow of lymph fluid.   It was and remains his belief that the breakdown of the lymph valve system (with the resulting varicose vessels), impedes on the body’s ability to eliminate toxins (Perrin, 2007).  His technique to restore the lymphatic system from a sluggish state to an effective drainage system (known as The Perrin technique) is now a well-established effective treatment for CFS/ME patients (Perrin et al., 1998).

Cleaning out the brain’s cobwebs

The importance of an effective clearing system has been highlighted by the efficacy of Dr Perrin’s technique and the improvements described by his patients, such as reduced fatigue, increased energy, decreased pain and improved cognition and clearing of ‘brain fog’.   Still unclear from this recent study is if this newly recognised network of piping also contains valves similar to that of the circulatory and lymphatic systems, then could there be potential for a technique such as Perrin’s Technique to improve the clearance of waste from the brain itself?  If this is, indeed, the case, this may have significant implications for the progression of neurodegenerative diseases.  Certainly, our understanding of how the brain copes with waste (that is, the accumulation of protein waste products that essentially lead to death of the neuronal network of the brain), is critical to the onset and progression of all neurodegenerative diseases, including Alzheimer’s.


ILIFF, J. J., WANG, M., LIAO, Y., PLOGG, B. A., PENG, W., GUNDERSEN, G. A., BENVENISTE, H., VATES, G. E., DEANE, R., GOLDMAN, S. A., NAGELHUS, E. A. & NEDERGAARD, M. 2012. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid beta. Science translational medicine, 4, 147ra111.

PERRIN, R. N. 2007. Lymphatic drainage of the neuraxis in chronic fatigue syndrome: a hypothetical model for the cranial rhythmic impulse. The Journal of the American Osteopathic Association, 107, 218-24.

PERRIN, R. N., EDWARDS, J. & HARTLEY, P. 1998. An evaluation of the effectiveness of osteopathic treatment on symptoms associated with myalgic encephalomyelitis. A preliminary report. Journal of medical engineering & technology, 22, 1-13.

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Dr Nina Bailey

About Dr Nina Bailey

Nina is a leading expert in marine fatty acids and their role in health and disease. Nina holds a master’s degree in Clinical Nutrition and received her doctorate from Cambridge University. Nina’s main area of interest is the role of essential fatty acids in inflammatory disorders. She is a published scientist and regularly features in national health publications and has featured as a nutrition expert on several leading and regional radio stations including SKY.FM, various BBC stations and London’s Biggest Conversation. Nina regularly holds training workshops and webinars both with the public and health practitioners.