In this episode, I am speaking with Dr. Sarah Myhill—one of the top experts in the field of chronic fatigue syndrome and myalgic encephalomyelitis, as well as the author of several books such as, The Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis. We will talk about the real causes of chronic fatigue syndrome and how to avoid, counter, and reverse them.
Table of Contents
In this podcast, Dr. Myhill and I discuss:
- Why fatigue is a healthy symptom
- How your mitochondria and fatigue are related
- How much energy your body actually spends on keeping you alive
- How you can improve your energy levels by making small simple lifestyle changes
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Transcript
Ari Whitten: Hi, everyone. I’m here with Dr. Sarah Myhill, who is a chronic fatigue expert, and I have her book with me right here. It is a wonderful, wonderful book. It’s called Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis: It’s Mitochondria, not Hypochondria. I love that little tagline. That’s really, really cool, and I want to talk to you more about why that is in this interview. Thank you for being here. Thank you for speaking with me.
Dr. Sarah Myhill: My pleasure.
Ari Whitten: To give people … To kind of get started, I would love if you could just kind of introduce yourself and talk a little bit about your background and how you got into this.
Dr. Sarah Myhill: Okay. I qualified at medical school in 1981, and then went straight into national health service general practice. I’ve always been a curious sort of person. I always want to know the reason why somebody’s got a symptom, so if somebody comes to me with blood pressure, “Why have you got blood pressure?” If somebody comes with headache, “Why have you got a headache,” or why it happened. That is the whole key to medicine, to ask the question, “Why?” It rapidly became apparent to me that medicine, actually, Western medicine, is not about looking at root causes. It’s all about symptom suppression.
Headache becomes paracetamol deficiency, high cholesterol becomes statin deficiency, depression becomes SSRI deficiency, and the trouble with that is you prescribe drugs and you just get side effects and the whole thing snowballs up. That’s why Western medicine is in crisis at the moment, because we’re not addressing root causes, so I started to ask the question why, and initially got interested in allergy, things like asthma, migraine, which are obviously allergic conditions, and doing elimination diets and so on, but the elephant in the room, the big symptom that people were coming to me with was fatigue.
The awful thing is, the medical profession has got very little to offer patients with fatigue. They just get pawned off. It was quite clear to me that nobody was thinking mechanisms and asking the question why. Of course, that was 35 years ago, and I came at things in a rather disconnected way, if you like, because that person was helped by a wheat-free diet, and then somebody got better when they got their lime disease treated, and then somebody else had their dental amalgams removed and improved, so there wasn’t any real logical framework, and so my first job, I suppose, was to establish a logical framework for the symptom of fatigue. The bottom line is it’s a really important symptom. We all suffer from fatigue.
Why mitochondria are the key for your health and energy
If we didn’t suffer from fatigue, we’d work all day, all night, all day, all night, and we’d all be dead within two weeks, because nobody has survived that long without sleep. We have to listen to our symptoms and abide by them. Again, from a purely logical perspective, fatigue is the symptom we experience when energy demand exceeds energy delivery. I don’t know if you’re familiar with the work of Charles Dickens but there’s a wonderful character in there called Mr. Micawber, who’s talking about income. One of the things he says is, “Income, 20 shillings, outgoing 21 shillings. Result, misery.”
Ari Whitten: Yeah.
Dr. Sarah Myhill: Outgoing, 19 shillings, and such. It’s exactly the same with energy. When it comes to fatigue, we have to look at both sides of the equation. We have to look at the mechanisms by which the body generates energy, and then we have to look at how the body is spending energy. In thinking about energy generation, a very useful analogy is to think of the body as a car. I’ve used this for 30 years with my patients, and they love it, and they can pick up and understand the analogy straightaway. Essentially, for your car to go, you’ve got to have the right fuel in the tank.
It’s no good putting petrol in your diesel engine or vice versa, and so I talk a huge amount about diet and gut function, because it’s a combination of those two things that gets the fuel, the right sort of fuel, into the bloodstream. Then we have to look at the engine of the car. There’s my interest in mitochondria, because mitochondria essentially, they take fuel from the bloodstream, they burn it in the presence of oxygen to generate energy. That’s exactly what the engine of a car does. Our engines are called mitochondria, and every cell in the, every living cell in the body has got mitochondria. If the mitochondria stop, that cell dies instantly. You turn the energy [inaudible] and the cell is dead.
The interesting thing about mitochondria is they’re a common biological unit throughout nature. Every living creature is powered … Well, every [inaudible] that is, is powered by mitochondria. Mitochondria in my dog is the same as mitochondria in my pet frog, and birds in the air, and so on, so it’s a fundamental biological unit. Then there’s mitochondria that they have to have oxygen coming to them, and that’s a function of the heart and the circulation, and we all know that patients with anemia or heart failure present with chronic fatigue. It’s one of the symptoms of that. Then we have to look at how the mitochondria are controlled.
Essentially, the thyroid gland is the accelerator pedal of our car, and that tells how fast the engine goes, and then they have the adrenal gland, which is the gearbox of the car, and that allows us to gear up in response to stress. If a saber-toothed tiger jumped out at me, my gearbox would go into overdrive, pour out adrenaline, I’d run the fastest mile I’d ever run in my life, because that’s a life-saving situation, but I’d pay for it subsequently.
Ari Whitten: Right.
Dr. Sarah Myhill: That is not sustainable longterm. So many patients I see run their whole life on the edge, in high gear, in high stress mode, in high output mode, and it’s just, they can’t maintain that longterm, and so often, it’s a combination of a high stress life, and then they get the viral infection, or as I call it, the last straw that breaks the camel’s back, and they trip over into chronic fatigue syndrome. That’s how I’m thinking with respect to energy delivery mechanisms, and then we have to have a look at how energy is spent in the body.
How much energy you spend on staying alive
Now, one of the things that astonishes me is how much energy you spend on just staying alive.
About two thirds of all the energy we generate is just about staying alive, basic brain function, basic heart function, basic liver function, basic gut function, and so on, which means we only have about a third left to spend on having a life, which we spend, and of course, I always think that spending energy is like spending money. It’s good fun. We love spending energy. We love going for walks. We love being creative and doing things, but when you spend energy in the world of work, you then, suddenly, there’s less and less available for life at the end of the day. There are two common holes, as I call it, in the energy bucket, and I always address these issues with my patients.
The first is the emotional hole. We all know that if we are emotionally stressed by a bereavement or a divorce or some stressful life event, it’s just shattering. We’re exhausted by that, because so much energy is consumed, mentally, in dealing with that. The biggest hole that I see is what I call the immunological hole. If the immune system is busy, it uses up a vast amount of energy. How do I know that? If I give a normal, healthy person the flu, they’re bedbound for days, and sometimes weeks. The emotion, so the immunological hole is a very large one, and in respect to that, I’m thinking of allergies.
If you are spending energy uselessly on dealing with allergies in the gut or wherever, then that will cause the fatigue and exhaustion, and one of the early lessons I learned with my ME patients is they very rarely got well if they would continue to eat wheat and gluten grains. For some reason, that seems, that group of foods seems to be particularly associated with fatigue. Then there’s the infectious hole. We know that many patients with fatigue syndromes are fatigued because their immune system is dealing with some sort of chronic infection, which might be lyme disease, it might be a chronic [inaudible] infection, it might be tuberculosis, or whatever, so we have to think about that.
In that respect, asking what the circumstances were when they started with their fatigue is very helpful. You’re probably aware of work by Dr. Martin Lerner, who’s demonstrated many cases of ME triggered by Epstein-Barr virus. He treated them, or … Dr. Lerner, he died 18 months ago, but often I use antivirals to kill, to reduce the viral load in the body, and that is the trick that allows patients to get well. We get to use drugs for that. There are herbal preparations which are also prone to effectiveness. Then there’s the autoimmune. Some autoimmune conditions will present with a fatigue syndrome. That’s the overall global strategy that I use for treating all patients.
Ari Whitten: Beautiful. One thing I just want to point out to people watching is, what I really love about your work is, basically, what you just explained. This is a very comprehensive, holistic perspective, where you’re taking a lot of factors and a lot of different mechanisms and a lot of different systems of the body into account. One of the things I find with a lot of other practitioners out there is they tend to be kind of myopically focused on one particular mechanism. It’s all about the adrenals, or it’s all about the thyroid, or it’s all about the autoimmunity or the inflammation.
They’re very fixated on that one thing, and I, there’s something weird about us humans that we seem to want to gravitate towards explaining things through just one mechanism. I just love the engine analogy, and all the, you know, the car analogy, I should say, where you’re breaking it down to different parts of the car and corresponding to different body parts and systems of the body. One thing that I would like to ask you, actually, in this general context of fatigue …
Dr.Sarah Myhill: Yeah.
Dr. Sarah Myhill’s take on adrenal fatigue
Ari Whitten: Is kind of to separate out chronic fatigue syndrome versus adrenal fatigue. Do you really subscribe to kind of the adrenal fatigue model, and do you think the adrenals are a primary cause of fatigue in most people?
Dr. Sarah Myhill: No, I don’t think I … Well, it’s … I don’t think it’s a primary cause, but it’s certainly part of the equation. You see, people often come to me with lists of symptoms, and they say, “Oh, this is a symptom of adrenal fatigue,” or, “Oh, this is an example of poor thyroid. Oh, these are all my mitochondrial symptoms.”
How your body requires a lot of energy to function normally
Actually, it’s all about, it’s the whole picture. It’s all about poor energy delivery, because if energy delivery is impaired, as a result of diet, gut, mitochondria, thyroid, adrenal, the whole lot, then that will present with any symptom you care to name. Obviously, physical fatigue, but for example, a very common symptom is variable vision. People get blurred … ME sufferers suffer from blurred vision.
The reason for that is that the muscle that controls the lens in the eye, if you impair energy delivery to it, it can’t contract, and therefore, you can’t focus your eye, so for, so that would be to … Again, growing hair, growing skin, growing new layers of the gut requires a lot of energy, and guess what? If you give somebody chemotherapy, which damages mitochondria and energy delivering mechanisms something awful, the hair falls out, the skin is damaged, the gut is damaged, the immune system is damaged, it damages mitochondria and fatigue increases. Again, if you impair energy delivery mechanisms, the immune system won’t be able to function. The immune system is that standing army. It requires a huge amount of energy to [inaudible].
There are a multiplicity of symptoms that result when you impair energy delivery mechanisms. On the other side of the equation, the immunological hole in the bucket, if you like … The immunological hole happens when the immune system is activated and you produce inflammation. That requires a lot of energy, but the inflammation produces a whole bunch of other symptoms which are characterized by heat, pain, swelling, loss of function, and so on. This allows us to define what chronic fatigue syndrome is and what ME is. Chronic fatigue I see as arising when the energy delivery mechanisms are wrong, so you just can’t deliver energy.
The ME arises when there’s an inflammatory component as well, so it’s chronic fatigue syndrome plus inflammation, which might be inflammation from allergy, it might be inflammation from chronic infection, it might be inflammation from autoimmunity. The adrenal symptoms that people complain of, to my mind, are very similar to the poor thyroid function symptoms that they complain of, which are very similar to the mitochondrial symptoms, which are very similar to the poor diet and gut function symptoms.
Ari Whitten: Right.
Dr. Sarah Myhill: They very much overlap, because they all result in the same clinical picture, fatigue, foggy brain, lactic acid buildup, et cetera, et cetera. Does that kind of make sense?
Ari Whitten: Yes, absolutely, and I’m so glad you pointed out how these symptoms are overlapping. The people who are saying it’s all about the gut are saying, “Oh, do you have this symptom, this symptom, and this symptom,” and the people who are saying it’s all about the thyroid are talking about the same symptoms, and the people who are talking about the adrenals are talking about the same symptoms.
Dr. Sarah Myhill: Correct. That’s [inaudible]. Now, of course, we are terribly influenced by our personal experience, and of course, the reason I got interested in this whole field originally was through allergy. I found very early into my career, I was very allergic. I had allergies to dairy products. In the early days, as far as I was concerned, all chronic fatigue syndrome was allergy, and I was putting people on elimination diets and trying desensitization. Then something [inaudible] you know what? That’s not the elephant in the room, and there are all these other things as well. The way that we get into the subject influences our thinking enormously.
Ari Whitten: Yes, absolutely. There was actually a recent article that I read. I’m trying to remember the name of the website. It was maybe adrenalfatiguesolution.com or something along those lines, and the person writing it did a really interesting survey. They took data from, I believe it was from WebMD, relating to chronic fatigue syndrome, and they did, essentially, a survey of the primary symptoms and the secondary symptoms associated with chronic fatigue syndrome, and they said, they just, they surveyed a bunch of people with chronic fatigue, and they said, “Do you have this symptom? Do you have this symptom? Do you have this symptom?”
Dr. Sarah Myhill: Yeah.
Ari Whitten: They created a graph of a certain percentage of respondents said, “Yes, I have that symptom,” to each one of these symptoms on the list. Then, since this was a site on adrenal fatigue, the person doing the site also decided to do the same survey with people who were suspecting they had adrenal fatigue, and so he created another chart of people responding to all the same list of symptoms, and the percentages were almost identical, meaning people who suspect they have adrenal fatigue were essentially complaining of the exact same symptoms that people with chronic fatigue syndrome were complaining of.
Dr.Sarah Myhill: Yes, yes, yes.
Ari Whitten: There’s one other interesting layer to what this guy did. He did a Google trends search, which is like to look up the trends over the last several years of the amount of people searching for keywords. Since, I believe like the early 2000’s, he did a trend search for chronic fatigue syndrome and adrenal fatigue.
It creates this amazing graph that’s like an x, so what that means is the amount of people searching for chronic fatigue syndrome used to be very high, in the early 2000’s, and now it’s very low, and during that same span of time, adrenal fatigue, which was created in 1998 by James Wilson, that has gone up from nothing, basically, to now being very high, so they’ve, there’s been this kind of switch where people are now thinking of fatigue in the context of adrenal fatigue instead of chronic fatigue syndrome.
Dr. Sarah Myhill: Well, medicine is very fashionable, and that’s a lovely example of a fashion, if you like.
Ari Whitten: Yeah.
Dr. Sarah Myhill: My view is, adrenal … I mean, chronic fatigue is the symptom, if you like. Adrenal is part of the mechanism, but only part of the mechanism.
Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis: It's Mitochondria, not Hypochondria
Ari Whitten: Got you. Let me see. Oh, the other thing I want to ask you here is about the subtitle of your book, It’s Mitochondria, Not Hypochondria. Kind of explain why that is, to people watching this, why hypochondria? Why would that even kind of enter the picture?
Dr. Sarah Myhill: Well, that, because the shameful thing is that the general perception amongst the medical profession is still that it’s a psychological disease, and whilst you and I know that there is a whole bunch of science out there clearly showing it’s neurological, it’s physical, the perception amongst the doctors is that it’s in the mind. The reason they do that is because of intellectual idleness. They cannot be bothered to sit down and work out mechanisms, because they don’t do that for the rest of medicine, either.
Ari Whitten: Yeah.
Dr. Sarah Myhill: I think that’s a … So I put that title in specifically to illustrate that point, but going back to the early 2000’s, that’s when I came to the view that mitochondria and fatigue were related, they had to be involved in some way in chronic fatigue syndrome. I’ve had a very productive relationship with a wonderful biochemist called Dr. John McLaren-Howard, who worked at Biolab in London and now has his own laboratory, Acumen Laboratories in the Southwest. I put to him that I thought that mitochondria were in some way implicated in chronic fatigue syndrome, and he has been brilliant. He has taken tests which are normally done as research tools, and given them clinical application.
Long story short, he developed a test which he called ATP profiles, which essentially is a measure of mitochondrial function. There are, as part of this test, he looks at the ability of mitochondria to make energy, to make ATP, how efficiently ATP gets from mitochondria out into the cell, where it’s required, how efficiently that ATP can be used in order to generate energy, and then how well the ADP is sent back into mitochondria, so there’s a cycle. He measures five different facets of this cycle, any one of which may comprise a rate limiting step. Now, the important point about that is by measuring the parameters and comparing them to normal ranges, we can get what I call a mitochondrial energy score.
The important point about that, because we, together with Dr. John … No, Dr. Norman Booth from Oxford University, the three of us, we published a paper which essentially compares mitochondrial energy scores with the clinical ability of the patients. Now, I know that sounds a bit complicated, but the upshot of it was there’s a very nice relationship. We had 71 patients and it was almost a straight line relationship. The worst affected patients had the worst mitochondrial energy scores, and the mildly affected ones had the best. Now, I saw the patients, Dr. John McLaren-Howard did the studies, did the tests, and it all collated by Norman Booth, so it was effectively blind. John didn’t know how sick the patients were.
I didn’t know what the energy scores were, so I know it was an audit, but it was effectively blinded. The second important point about those tests is Acumen Laboratories are able to determine whether the mitochondria are going slow because they were deficient in something, because obviously, for enzymes to work, you need raw materials such as acetyl-L-carnitine, Coenzyme Q10, Vitamin B3, magnesium, these are all essential raw materials for mitochondria to work, or if the mitochondria are going slow because they’re blocked by something. Something is stuck on the translocator protein. Something is inhibiting oxidative phosphorylation.
In those early days, I was seeing many farmers, because I live in a farming area, who had been poisoned by organophosphates, and organophosphates inhibit oxidative phosphorylation, for obvious biochemical reasons. I had a whole bunch of those in that group, so that was interesting, because of course, that has implications for medicine. Are your mitochondria going slow because you’re just lacking CoQ10 or you’re deficient in magnesium or B-12, whatever, or are they going slow because they’re being inhibited?
Ari Whitten: Yeah.
Dr.Sarah Myhill: It’s a really useful, practical test that not only gives us an objective measure of fatigue, and that has been incredibly helpful for getting benefits for patients. That’s why I call it, you know, It’s Mitochondria, Not Hypochondria. I don’t think we have ever lost appeal for benefits or for pension rights when I’ve got mitochondrial function tests, because it’s an objective measure of fatigue.
Ari Whitten: Yeah.
Dr. Sarah Myhill: That’s very helpful. Then, of course, it’s very helpful because we know if they’re gong to, because patients are deficient in something and we just give them supplements, but of course they’ve got to be able to absorb it, and that’s a little bit more about gut function, or because they need to do some sort of detox rating to get rid of the toxic metals, to get rid of the dental amalgam that’s, you know, the mercury that’s seeping in their mitochondria or whatever, so it has really important implications for management.
Ari Whitten: Yeah. Beautiful. Just to sum up kind of one important point of what you just said, we’ve … Chronic fatigue syndrome is something that used to not have any real objective diagnostic measure of if somebody actually has a real physiological problem.
Dr. Sarah Myhill: Yes.
Ari Whitten: Because of that, my understanding is most conventional MDs have looked at it as mainly hypochondria. It’s all in the head, it’s a psychosomatic thing, it’s …
Dr. Sarah Myhill: Yes.
Why Dr. Myhill chose to focus on the mitochondria and fatigue relationship in her patients
Ari Whitten: Like depression or something like that. With this test, with the ATP profile test, you’ve been able to show objectively, “Hey, there is a real physiological, cellular problem going on here.”
Dr. Sarah Myhill: Correct. Correct, but what you have to remember is those 71 patients that I had were all patients who I had worked with for some, certainly months, and some of them years, already, so they had already had other aspects of their condition tidied up, so they were all doing a Stone age diet, they’d had their thyroid function checked, they’d had their adrenal glands checked, as much I was able to. The ones that obviously got chronic infections that are being dealt with. They’re the patients with whom I was stuck. At that point, I said, “There’s got to be something else going on here,” and that’s when I got started, interested in the mitochondria and fatigue stuff.
I mean, it would be lovely to repeat that work, but it’s not the sole lesion in people with ME. I mean, I’ve got ME patients who’ve got normal mitochondrial function tests, but they’ve got lime disease. They’ve got a massive immunological hole in their bucket, and that’s why their fatigued, or they’ve got chronic Epstein-Barr virus. It’s not particular to each and every patient with chronic fatigue syndrome or ME, but it’s a very common denominator.
Ari Whitten: Got you. Now, going back to this kind of discussion around adrenal fatigue versus chronic fatigue syndrome, do you suspect that a large percentage of people who, let’s say, believe that they have adrenal fatigue, or suspect they might have it, do you suspect that a lot of those people would have mitochondrial dysfunction, to some degree.
The Mitochondria and Fatigue Link: How simple lifestyle changes can help you to fix your mitochondria and overcome fatigue
Dr. Sarah Myhill: Yes. I’m sure, yes. Those two things go in parallel very often, so yes, if you find one, you find the other. I mean, I have to say that, as I get older and perhaps more experienced, my medicine gets more simple. What I find is that the basic things, done really well, get a lot of people a long way.
Ari Whitten: That’s as far as lifestyle interventions?
Dr. Sarah Myhill: Yes, correct. Perhaps the most difficult but the most important intervention is dietary. The diet is so important, and I learned so much of this stuff from two cardiologists. One, a guy called Stephen Sinatra, who is an American cardiologist who uses, who I learned so much about mitochondria from him because he was treating his heart failure patients with CoQ10, D-Ribose, magnesium, all the stuff that I was using.
Ari Whitten: Yeah.
Dr. Sarah Myhill Of course, patients with severe ME, they are in heart failure. Don’t be in any doubt about that, because they cannot deliver energy to their heart. Their heart cannot beat powerfully as a pump, and they’re in a low cardiac output state. Of course, that compounds everything else, because if your heart isn’t beating powerfully as a pump, you can’t get the oxygen to your mitochondria, you can’t get fuel to your mitochondria and fatigue hits, so you know, there are lots of vicious cycles here. Anyway …
Ari Whitten: Yeah. That was an interesting part of the book that I found fascinating, where you’re kind of talking about the heart as being very central, and my understanding is, because the heart is so rich in mitochondria, it’s kind of one of the first things to fail when mitochondria start to fail.
Dr. Sarah Myhill: Correct. The heart if 25% by weight mitochondria. That’s massive.
Ari Whitten: Yeah.
Dr. Sarah Myhill: It’s got a big engine there. By contrast, the skeletal model is 20% by weight mitochondria. Why? Because the heart can’t fail. You’ve got lots of mitochondria to make sure it beats night and day, unrelentingly and without rest. The two interesting things I’ve learned from Dr., well, from Dr. Sinatra and also an Italian cardiologist called Dr. Gabriela Segura, is that the preferred fuel of mitochondria are ketones. They work much better with ketones. Now, I learned a lot more about ketones from the athletic world, because what the top athletes find is that their performance is greatly enhanced when they’re in ketosis. Several reasons for this. First of all, if you’re running on ketones, it means you’re burning fat.
It means you have a much bigger fuel supply in the body, because the fat in our body will keep us running for miles and miles and miles and miles. If athletes are powering their body with carbohydrates, they can’t, they don’t have enough reserves in the body to last them more than about, well, if they’re doing a marathon, about 17 or 18 miles. In this country, athletes running on carbohydrates, if they don’t top off with sugar or a carbohydrate sometime during the race, they hit a wall at about 17 or 18 miles. They just run out of energy. If they’re in ketosis, that doesn’t happen.
A further advantage to the athletes running on ketosis is that if you are storing fuel in the body as carbohydrates, as glycogen, that has an automatic pressure. It has a water load that comes with it, so they’re carrying an extra maybe one or two kilograms of water in order to store that glycogen, and so therefore the power load ratio is not in their favor, because they’re carrying more weight than they would otherwise need to. There’s a really interesting story here, if you can just bear with me. During the first Gulf War, the soldiers who were working the front line were told, “You’re going to be out there unsupported, possibly for up to five days, so everything you need for the next five days, you’ve got to be carrying with you.”
What the soldiers chose to do, understand me, was to carry ammunition, at the expense of food. By days three, four, and five, they were hungry, because they were running on carbohydrates. They didn’t have the food with them. Most of the cases of friendly fire, death by friendly fire, took place from those half-starving soldiers in the front line, so the American Army commissioned work by a doctor at Oxford, Dr. Kyra Clark, to develop a fuel for those soldiers on the front line. What’s the most weight-efficient fuel? To cut a long story short, she developed beta-Hydroxybutyric acid, which is a ketone body. Having developed that, she then tested it on top athletes.
She took top cyclists, top runners, top swimmers, and she said, “This is the fuel you need,” and she fed them I think it was 18 mils three times a day of beta-Hydroxybutyric acid. Now, remember, these are all Olympic athletes at the top, and they improved their performance anything between 7 and 15%. Now, that is massive. That’s the different between an [inaudible] and a gold metal. Not only are ketones a very desirable fuel, they are actually performance enhancing. Coming back to my chronic fatigue ME patients, the starting point for treating all my ME patients is a ketogenic diet, which cuts out the major allergens, and those major allergens are gluten grains, dairy products, and yeast.
I’ve probably waffled on a bit too long there, but the point is, the PK, the paleoketogenic diet, done really well, gets an awful lot of people a long way.
Ari Whitten: Interesting.
How the Western diet impacts the gut function, mitochondria and fatigue
Dr. Sarah Myhill: There’s a second reason why this diet is so important, because I’m not recognizing that gut function is terribly, terribly, terribly important. One of the problems of eating Western diets where starches and sugars and carbohydrates are the basis of it, is that our gut becomes a fermenting gut instead of a digesting gut. Now, let me jump sideways now, so I haven’t forgotten that point, but the human gut is almost unique in the mammal world, because the upper gut is a sterile digesting gut designed for meat and fat. The lower gut, the colon, is a fermenting gut, designed to ferment vegetable fiber.
That gives, it’s good for gut function, for gut health, and it gives us a certain amount of calories, so we can get maybe up to 500 kilocalories a day through fermenting [inaudible]. If we overwhelm our ability to digest foods by eating a lot of sugars and starches, the upper gut becomes a fermenting gut, and that’s bad news, because if you start fermenting sugars and carbohydrates, first of all, the products of fermentation include things like alcohol, delectate, hydrogen sulfide, all which are toxic, all of which have to be dealt with by the liver, and so it places an unnecessary toxic load on the liver.
Then you get a buildup in the upper gut of bacteria and yeast, which are not friendly to the body because they shouldn’t be there, and these bacteria and yeasts, they very easily get into the bloodstream now. As a medical student, you know, we are taught, as medical students, we are taught all of the bacteria are contained within the gut and there they stay. Not so. They very easily get from the gut into the bloodstream. For example, just chewing food or brushing your teeth, and teeth bacteria, or rather, mouth bacteria, you can find in the bloodstream seconds afterwards. It’s very easy to get there.
If you Google bacterial translocation, that describes the business of bacteria getting from the gut into the bloodstream. Now, thankfully, we don’t get a septicemia and die every time that happens. The immune system is pretty good at dealing with that. They can get excreted in the, by the kidneys and we pee them out. In fact, urine is not sterile. It has a bacterial load, it has a yeast load. Problems arise if the body sensitizes to those bacteria and those yeasts.
I think a whole host of modern conditions are inflammatory conditions driven by bacteria and yeast, and that includes autoimmunity, arthritis, conditions like chronic urticaria, intrinsic asthma, chronic venous ulcers, connective tissue disease. I think these are all downstream of the fermenting gut.
Ari Whitten: Interesting.
Dr. Sarah Myhill: Yeah. I really think …
Ari Whitten: Quick question on the ketogenic diet. I’ve seen a lot of people get better with eating a ketogenic diet. I’ve also seen a lot of people complain that it made them worse.
Dr. Sarah Myhill: Okay. Okay. Now, the thing about the ketogenic diet is it’s difficult to get into it. Now, if we look at how our … Well, human beings have got this amazing dual fuel system. The body can run on sugars and carbohydrates and it can run on fats. We have to ask why that evolved. Now, when man, primitive man, evolved and migrated north, or south, he had to survive the winter. In the autumn, along would come an autumn harvest, a windfall, and there would be his honey and fruits and vegetables and root vegetables and [inaudible 00:34:56] and grains and whatever. If he had a digestion that could cope with that, and he obviously did, he would eat those foods, and in fact, those foods are addictive.
We eat sugars and carbohydrates in an addictive way. When that happens, we produce insulin and those sugars and carbohydrates get laid out as fat. Now, fat has great survival value for winter. It’s insulating and it’s a source of fuel, so it helps us survive the winter. When that autumn harvest came to an end, as it would have done, because foods went rotten or we just ran out or it got too cold, man switched back into fat burning mode.
The problem now is we live in permanent autumn, and we all get a bit addicted, or we get very addicted to those sugars and carbohydrates, and we end up in permanent autumn mode, eating sugars and carbohydrates all the time, so the body doesn’t learn the business of switching into fat-burning, if you like.
Ari Whitten: Yeah.
Dr. Sarah Myhill: Now, the business of switching to fat-burning doesn’t happen overnight, and there is what I have chosen to call a metabolic hinterland, a nasty window of time when you’re trying to get into ketosis, you’re cutting out the fats, [inaudible] you’re cutting out the carbohydrates, so you can’t fuel the body with carbohydrates, but there’s an inertia in the system, there’s a metabolic inertia, and you can’t burn fat because of this inertia in the system. Interestingly, to burn fat, you need thyroid hormones. I suspect that some people can’t get into ketosis easily, they can’t get into burning fat by they don’t have the thyroid function to deal with that, to allow it to happen.
Jumping sideways, because we’re on to thyroids now, you may be aware of the work of a wonderful American endocrinologist called Dr. Blanchard, and he’s written lots of books about hypothyroidism. His estimate is that between 20 and 40% of Western women are hypothyroid. It’s a very common problem. My guess is that the people who can’t get well by going into ketosis don’t have the thyroid hormones to allow them to fat burn, and since, if he is right, hypothyroidism is very common, that could explain a large chunk of the people who struggle with a ketogenic diet.
Ari Whitten: Got you. Okay, so two questions. Well, if it is that common, then how do you get around that? Are you maybe assessing for that, and then telling people who you suspect that is a problem for, are you telling them not to go full ketogenic, or how do …
How an underactive thyroid often is misdiagnosed
Dr. Sarah Myhill: Well, what we have to do is then sort their thyroid out.
Ari Whitten: Okay.
Dr. Sarah Myhill: I can do that. There’s a section of my book on precisely that problem, but underactive thyroid is hugely, massively underdiagnosed. Why? Because doctors rely on blood tests. They don’t listen to what patients tell us. Now, in chronic fatigue, I mean, the [inaudible] world, the, short of hypothyroidism that most doctors recognize is what’s called primary hypothyroidism, when the thyroid gland itself isn’t working properly. We’re seeing epidemics of that. Why? Because iodine deficiency is pandemic.
We’re probably all exposed to things which knock out the thyroid gland, like mercury, like fluoride, like radioactive 13 iodine, 131, from Chernobyl or Fukushima, like viruses that the thyroid gland is susceptible to viral attack. Underactive thyroid, because the thyroid itself is failing, is very common. Now, as the thyroid gland starts to fail, there’s a feedback loop and the thyroid stimulating hormone is produced by the pituitary. Now, most people run a TSH of about one or two. The normal distribution of TSH is negatively skewed. What that means is that, as the thyroid starts to fail, level of TSH increases, and the point at which we cut it off and say we need treatment or we don’t need treatment is very variable.
In this country, you have to run a TSH of maybe 5 or 6 before the doctors consider treating it. In America, the threshold is 3 before the doctors consider treating it. If you’re pregnant and you’re, well, obviously female, and pregnant, then the threshold is 2. Where you lie on the spectrum determines whether or not you will receive treatment.
Ari Whitten: Yeah. Actually, they changed it recently in the U.S. I think it may be 3 now, but it used to be more like 7 or 8, actually.
Dr. Sarah Myhill: That’s correct, that’s correct, but I mean, that’s a reflection of how common the, well, essentially, the people are suffering, when their TSH is so-called normal. The commonest source of hypothyroidism I see in my ME patients is more to do with the pituitary gland. It’s what we call secondary hypothyroidism. In that event, the TSH is often normal because the pituitary’s working well, but the level of T3 and T4 are right at the bottom end of the reference range.
Now, the trouble with it in this country is that, I mean, the normal range of T4 is set at about 12 to 22. If your level T4 came out at 12.1, you’d be told, “It’s normal. You don’t need [inaudible].” Guess what? You might feel much better running at 22 …
Ari Whitten: Yeah.
Dr. Sarah Myhill: Which is in the reference range.
Ari Whitten: Right.
Dr. Sarah Myhill: In fact, recently, a professor of endocrinology in this country, a guy called Anthony Toft, who’s based in Edinburgh, he stated in his book, and some people don’t feel well until they’re running at a T4 of 30.
Ari Whitten: Wow.
Dr. Sarah Myhill: Looking at the actual level of T4 in the blood is a really important part of this.
Ari Whitten: Yes.
Dr. Sarah Myhill: Then, jumping sideways, well, the next possibility has to do with T3, because actually, T4 is the inactive hormone, and it’s T3 which is the active hormone. Now, to convert from the inactive T4 to the active T3, you need minerals like selenium, like iron, and guess what? Deficiency of that is extremely common, so I always like to measure a T3. Some people don’t feel well until they’re taking a preparation that includes T3, and that’s when that [inaudible] is extremely useful, so there’s another wrinkle.
Ari Whitten: Yeah.
Dr. Sarah Myhill: Then we have another group of problems with thyroid, which have to do with thyroid hormone receptor resistance. Now, let’s jump sideways to diabetes. I’m sure in America, it’s the same in this country, we’re seeing an epidemic of diabetes at the moment. Some people are saying by the year 2030, maybe 50% of the population will be diabetic. It’s extremely common, but the interesting thing is, when you measure levels of insulin in these patients, they’re normal. Well, that doesn’t make sense. You’d expect there to be an insulin deficiency, but it’s, and of course the medics aren’t asking the question here, what’s going on here? They’re just calling it.
This is insulin resistant diabetes, so the insulin is there but the … That, of course, [inaudible] why are we getting resistance to the insulin molecule? Now, the recently published book, the Oxford Textbook of Diabetes and Endocrinology, lists all the mechanisms for insulin resistance, and guess what? It’s all our old friends. It’s mercury, it’s organic phosphates, it’s pesticide residues, it’s chemicals that are causing insulin resistance. In fact, this was all flagged up when … I don’t know if you recall, but some years ago, there was a fire at a chemical factory in Seveso in Italy, and all of these nasty toxic chemicals, organic chlorines, dioxins, all poured into the air.
It became apparent, some years down the line, that there was a real hotspot of type 2 diabetes around this factory. That prompted some work in Japan where they took people off the street and they measured their toxic load, their toxic load of chemicals. What they found is that those people with the highest level of chemicals in their blood and their fat, were 38 times more likely to have diabetes compared to those people with the lowest level.
Ari Whitten: Wow.
Dr.Sarah Myhill: There was a big paper in the [inaudible] an editorial in the [inaudible], saying, “We’ve got it wrong with diabetes. We should be looking at insulin resistance.” Guess what? That’s all guided there. Now, that is not part of, you know, conventional medical workups of patients with diabetes, but the point here is the same principles apply to thyroid, and I think that whatever it is that’s causing insulin resistance is also causing thyroid hormone resistance.
There’s a patient I was talking to yesterday, and she’s got a very peculiar combination of Addison’s disease and Cushing’s, which you wouldn’t think possible, but the only way we can explain that, she’s got high levels of adrenal hormones, but they’re not impacting, is she’s got adrenal hormone receptor resistance. It may be that we are messing with our hormone receptors because of the toxic loads that we’re all experiencing, because we live in a polluted world.
Why nutrient deficiency is a major cause of weak mitochondria and fatigue
Ari Whitten: Yeah, absolutely. Let’s jump back to mitochondria, if you don’t mind. I know we brushed over some of things related to that with now toxins, the gut, thyroid issues, but talk to me a little bit more about some of the bigger causes of why mitochondria dysfunction.
Dr. Sarah Myhill: Okay. Well, probably the major causes are nutritional deficiencies. If you don’t have the raw materials for enzyme systems or oxidative phosphorylation for chemiosmosis, for Krebs citric acid cycle, if you don’t have the raw materials, they’re just going to get slow. What Acumen now offer are, as part of the profile, is measures of levels of Acetyl-L-carnitine, levels of coenzyme Q10, levels of magnesium, which may or may not need correcting in order for mitochondria to work well. Now, I don’t think … I mean, I’m thinking, what are the important supplements? I don’t think I’ve ever seen a patient with a normal level of coenzyme Q10 who isn’t already taking supplements.
Ari Whitten: Right.
Dr. Sarah Myhill: CoQ10 deficiency seems to be extremely common. If somebody couldn’t get the test or couldn’t access the test, I’d say, well, whatever else you do, take Ubiquinol, which seems to be the most biologically available form of a hundred or two hundred milligrams a day. Potential for harm, zero. We can only do good with CoQ10. I think about CoQ10 as the oil of the engine. For the biochemists, it’s a very important electron donor and receiver within the [inaudible] enzymes of the mitochondrial membranes, so CoQ10 is really, really important. Again, Acetyl-L-carnitine, I think of that as the nozzle of the fuel pipe that takes fuel from the bloodstream and from the cell cytosol and delivers it into mitochondria.
It allows acetate groups to get from the cytosol into the mitochondria by what’s called the carnitine shuttle. Carnitine sticks onto an acetate group, gets into mitochondria, delivers the acetate group, gets converted back into carnitine, and then goes back out. It’s another little, I say, shuttle that delivers fuel into mitochondria. Then magnesium, I think of magnesium as the spark plug of the engine. It’s such an important cofactor for so many enzyme reactions. If you haven’t got the magnesium there, the enzyme just isn’t activated and doesn’t work. There’s a very particular vicious cycle here, because believe you me, I’ve been struggling with magnesium for decades.
In the early days, the test we all used for magnesium, and still do test, is a red cell magnesium, which is a level of magnesium within cells. In my chronic fatigue syndrome patients, it was always low. Now, there’s a particular vicious cycle here, because if magnesium is low within cells, then it’s very hard work to get the magnesium … Well, this is not the magnesium for mitochondria to work. Now, about 40% of all the energy generated by mitochondria does nothing but power the ion pumps, kicks sodium out of cells back to potassium and kicks calcium out of the cells, drags magnesium in. If the mitochondria don’t go slow, the ion pumps don’t work.
If the ion pumps don’t work, you can’t get magnesium into mitochondria, and therefore the mitochondria go slow. There’s a very obvious vicious cycle when you become deficient in magnesium, everything starts to spiral down. I think that explains why magnesium injections are often helpful, because if you inject somebody with magnesium, you spike the levels in the serum, only for a short window of time, and during that window of time, the concentration gradient is less.
It’s easier to get magnesium into cells, and suddenly the mitochondria can get the magnesium they couldn’t previously, and so suddenly they start to work a bit faster, and as they work a bit faster, the ion pumps work a little bit better, and you can suddenly get magnesium in. It’s been my clinical impression for decades that sometimes the injections of magnesium will kickstart the mitochondria in a way that taking orally or transdermally or by nebulizer just doesn’t do.
Ari Whitten: Interesting. What else? We’ve got nutrient deficiencies … What else kind of screws up the mitochondria?
Dr.Sarah Myhill: Oh, vitamin B3 is a very important cofactor. We need vitamin B3 as the raw material to make NAD, which is how … The first bit of energy generated into Krebs citric acid cycle, and it takes NAD and converts it to NADH, and it’s NADH which drives chemiosmosis, so it’s a very important intermediary. Again, in the early days when we were still looking at what’s going to be the best test for mitochondria, John McLaren-Howard at Biolab measured levels of NAD, and there’s actually quite a good correlation between NAD levels and the level of fatigue. Again, so NAD levels are magnesium. Again, I think if you just measure those two, it’s quite a useful indirect measure of mitochondrial function.
Ari Whitten: Interesting. On that note, if I can interrupt real quick, are you familiar with the supplement that’s come out recently called Niagen?
Dr. Sarah Myhill: Is that the NADH?
Ari Whitten: It’s … Jeez, I’m forgetting the …
Dr. Sarah Myhill: It’s a B3 product, is it?
Ari Whitten: No. It’s … Well, actually, it might be related to B3. It’s a nicotinamide riboside, I think.
Dr. Sarah Myhill: Okay. Well, that will be, well, nicotinamide is the B3 bit.
Ari Whitten: Right. It’s …
Dr. Sarah Myhill: My guess it’ll be …
Ari Whitten: It’s, yeah, and a micro riboside.
Dr. Sarah Myhill: We’re talking, we’re singing from the same hymn sheet there, yes.
Ari Whitten: Yes. Yeah, so it’s kind of …
Dr.Sarah Myhill: [inaudible]
Ari Whitten: It’s like the hot new aging supplement on the market. They’re …
Dr. Sarah Myhill: The logic for that is that it will help mitochondria. The interesting thing about mitochondria, and I don’t, if you’re aware of some wonderful work, or wonderful books by a guy called Nick Lane.
Ari Whitten: Yeah.
Dr. Sarah Myhill: He writes beautifully, and one of his early books was Mitochondria: Power, Sex, and Suicide. You remember that?
Ari Whitten: The Meaning of Life, yeah.
The mitochondria and fatigue link: How your mitochondria control your health
Dr. Sarah Myhill: Correct. Well, mitochondria are responsible for why we have sex, why we have males and females. The power, obviously, as we’ve discussed, and also cell suicide. Mitochondria and fatigue determine our longevity, and a lovely illustration of this is the Dolly the sheep story. Stop me if you’ve heard this, but Dolly the sheep was the first cloned sheep. Now, she was cloned from her mother’s mammary cells, and those cells, of course … Her mother was six years old when Dolly was cloned, and so the mitochondria that Dolly acquired had already aged by six years. Interestingly, Dolly the sheep died at age six, which is half the age she should have died at.
Ari Whitten: Oh, wow.
Dr. Sarah Myhill: I think she died because her mitochondria aged.
Ari Whitten: Yeah.
Dr. Sarah Myhill: She was born with mitochondria that were already six years old.
Ari Whitten: Wow. How interesting. I remember hearing about that in the news when it happened, but I had never heard that story.
Dr. Sarah Myhill: Well, I don’t know if that’s right or wrong, but it squares with the idea that mitochondria are responsible for our longevity.
Ari Whitten: Right.
Dr. Sarah Myhill: None of us will live forever, because mitochondria are slowly aging.
Ari Whitten: Yeah.
Dr. Sarah Myhill: My view is, if you look after your life and your mitochondria, you’ll improve your longevity.
Ari Whitten: Yeah.
Dr. Sarah Myhill: Chronic fatigue syndrome is almost like an accelerated aging, isn’t it?
Ari Whitten: Yeah.
Dr. Sarah Myhill: It makes sense. I mean, I had a patient who came to see me the other day, and when I asked her to describe her fatigue, she said, “Well, it’s like my grandmother. I have to behave like I’m 90 years old. I have to waddle around. I don’t go very fast. I’m very creaky.”
Ari Whitten: Yeah.
Dr. Sarah Myhill: [inaudible]
Ari Whitten: Yeah. By the way, have you seen Robert Naviaux’s work?
Dr. Sarah Myhill: About …?
Ari Whitten: He’s at University of California San Diego, and he’s a, I think he’s the head of the institute for mitochondria or something, but he came out with a huge paper, I think in the last couple years, called The Cell Danger Response. Have you seen that?
Dr. Sarah Myhill: I don’t think I have. No.
Ari Whitten: Oh, yeah. I’m actually shocked that you haven’t seen it, because it’s so related to your work. You would absolutely love it, and …
Dr. Sarah Myhill: Oh, gosh.
Ari Whitten: Be fascinated with his work. I mean, for me, I put your work and his work together, and everything just started to make sense for me.
Dr. Sarah Myhill: I’m ashamed of myself.
Ari Whitten: I was certain that you must’ve …
Dr. Sarah Myhill: Oh, I’m shocked at myself. I’ll just have to go find that and look at it.
Ari Whitten: No, I mean, I’m not saying, I don’t think it’s so popular or so well-known or something like that, but I think it’s absolutely an incredible piece of work. I know, you know Niki Gratrix, right?
Dr.Sarah Myhill: Yes. Yes, yes, yes, very well.
Ari Whitten: She’s a friend of mine, and she and I both found this paper from Robert Naviaux, and we were like, both of our minds were blown, and just, between your work and his work, everything, for both of us, just kind of clicked and it started to make sense.
Dr. Sarah Myhill: That it fantastic.
Ari Whitten: One of the cool things, you know, kind of to sum up his work very, very simply, and hopefully I do justice to it by summing it up in this way, but the basic idea of it is toxic insults of various kinds, whether toxins or nutrient deficiencies, or emotional traumas, or you know, lots of different kinds of stressors, essentially kind of engage the mitochondria in a sort of defense mode where they’re now, their role is now kind of to defend against threat. The basic idea is the more that you kind of put …
Dr. Sarah Myhill: Stress load.
Ari Whitten: With that stress load on the mitochondria, the more you put them in defense mode and take energy production mode offline. And I thing that is a link between mitochondria and fatigue
Dr. Sarah Myhill: Yes.
Ari Whitten: I mean, it just obviously fits perfectly with everything that you’re talking about.
Dr. Sarah Myhill: Yes. Yeah, well that would make perfect sense. Whether the mitochondria shut themselves down consciously or it’s an inevitable result of translocator proteins being inhibited or [inaudible]. One of the interesting things about the ATP studies that John McLaren-Howard did is that there’s, if mitochondrial energy falls below a certain level, I mean, well, there was a very obvious cutoff of mitochondrial energy.
If it falls below that level, it triggers cell suicide. If you think about it, that makes perfect sense. If the cell doesn’t have the energy delivery mechanisms, it’s going to be damaged and cause massive problems to the body, so it just commits [inaudible]. That is triggered by Cytochrome C, which is in one of respiratory enzymes.
Ari Whitten: Yeah.
Dr. Sarah Myhill: The mitochondria commit suicide, if you like, in order for the greater good, and my guess is that the muscle wasting of age is all about that.
Ari Whitten: Yeah.
Dr. Sarah Myhill: Muscle is lost with age and that mechanism of that is cell suicide by mitochondria because of poor energy delivery mechanisms.
Ari Whitten: Yeah.
Dr. Sarah Myhill: When I’m speaking to my aging populations, take the mitochondrial package. You can’t do any harm with it, and you will improve energy delivery mechanisms and protect against muscle loss and bone loss and heart muscle loss and glandular loss and brain loss and everything else loss.
Ari Whitten: Yeah. Beautiful. We talked about nutrient deficiencies, as far as that relating to kind of inhibiting the mitochondria.
Dr.Sarah Myhill: Yeah.
How toxic stress is impacting on mitochondria and fatigue
Ari Whitten: What else is causing mitochondria and fatigue problems for people?
Dr.Sarah Myhill: Well, obviously, the tops of what’s inhibiting mitochondria, which is often toxic stress, and the obvious things are like heavy metals, dental amalgam, pesticide residues, and so on, but I’m increasingly coming to the view that products of the fermenting gut can also inhibit mitochondria.
Ari Whitten: Right.
Dr. Sarah Myhill: Of course, those products, yes, of course, and alcohol. Guess what, you know, I love alcohol, but if I have a glass of wine, it wipes out all my mitochondria, because I always want to sit down and have a snooze. Gut fermentate and hydrogen sulfite, of course, is a product of the fermenting gut, but another product of the fermenting gut is just bacterial endotoxin, just the toxins from bacteria themselves. Another fascinating statistic has to do with how much energy different parts of the body use. At rest, the heart uses about 7% of the total energy generated by the body. The brain uses about 20% of all the energy generated by the body, but the liver consumes 27% of all the energy generated in the body, which is massive.
Ari Whitten: Yeah.
Dr. Sarah Myhill: I just, that blows my mind away. The liver is consuming more energy than the heart and the brain put together.
Ari Whitten: Wow.
Dr. Sarah Myhill: What’s it doing? The answer is, it’s dealing with everything that comes from the gut. You see, if you look at the anatomy of the gut, it’s supplied from the heart, the blood supply comes from the heart, but all the venous drainage from the gut goes to the liver by the portal vein, where it has to be sorted out. If the contents of the portal vein bypassed the liver and went straight into you, you’d be unconscious and out of it within minutes.
Ari Whitten: Yeah.
Dr. Sarah Myhill: The liver does a massive job in taking out the bacteria endotoxin, sorting the products of the fermenting gut, ironing out blood sugar levels and all that stuff, and that requires a vast amount of energy. Now, if you offload the liver, if you reduce the work the liver has to do by eating a paleoketogenic diet, then you’ve got energy to spend in other parts of the body.
Ari Whitten: Beautiful. Okay, so toxins, the gut …
Dr. Sarah Myhill: Yes.
Ari Whitten: Nutrient deficiencies … Is there anything else?
Dr. Sarah Myhill: They’re the big things that I look at. I can’t think of anything else off the top of my head.
Ari Whitten: What about infections?
How infections affect mitochondria and fatigue
Dr. Sarah Myhill: Oh, well, infections is the other side of the equation. Infections, as I call it, kick an immunological hole in it, but you’re absolutely right. Occasionally, I mean, one of the extra tests that I ask John to do, if I’ve got somebody who’s got translocator protein problems, so they can’t move ATP and ADP around, is he does translocator protein studies. We often find immunoglobulins stuck onto mitochondria, so it’s another way in which infections can impair energy delivery mechanisms.
You get virus particles or antibodies or immunoglobulins stuck onto translocator protein, then that will interfere with how mitochondria function. Of course, when I talk about toxins, oh, simply drugs, and many drugs will inhibit mitochondrial function directly, like statins, for example.
Ari Whitten: Yeah.
Dr. Sarah Myhill: Now, the mechanism they inhibit mitochondria has to do with enzyme CoQ10, because they block the body’s own production of coenzyme Q10. That’s one of the many reasons why I hate statins in particular.
Ari Whitten: Yeah.
Dr. Sarah Myhill: Beta blockers inhibit mitochondria and slow them down. Chemotherapy, you know, completely targets mitochondria and knocks them out. A lot of drugs are a problem now, and again .
The Mitochondria and fatigue relationship and how medication affects mitochondria
Ari Whitten: Yeah, I was actually shocked as I was reading your book. I didn’t know how common it is for prescription drugs and over the counter drugs to be toxic to the mitochondria when taken in the longterm. I didn’t realize it was like over 50 or 60%, or 70% of these different drugs become toxic when taken longterm.
Dr. Sarah Myhill: Absolutely, yeah.
Ari Whitten: Yeah. It’s amazing to think how many people, as they get older and start to have medical problems … I’ve seen so many people who are on 10 or 12 or 15 or 18 different prescription drugs.
Dr. Sarah Myhill: Shameful. It’s absolutely shameful, but this is what happens when your physician doesn’t think causation, doesn’t ask the question why. Oh, we can suppress this symptom with that drug. Another of my particular hates are the acid blocking drugs, like the letrozole, proton pump inhibitors, or the H2 inhibitors like Ranitidine or Zantac or whatever you call them, because if you knock out stomach acidity, that’s real bad news. A, it’s a major risk factor for fermenting gut, because we need acid in our stomach to stop it fermenting, or to digest our protein. B, we can’t digest protein without acid there.
You need to hydrolyze the protein first. C, you can’t absorb minerals. If you’re having a, you’ve got a, if you can’t produce stomach acid, you can’t absorb the magnesium, the zinc, the selenium, all the essential cofactors, and in fact, those drugs, they’re all risk factors for osteoporosis. Now, I routinely ask my patients, if they come with proton pump inhibitors, “Did your doctor warn you that this is a major risk factor for osteoporosis?” “No.” Never had them say yes.
Ari Whitten: Wow.
Dr. Sarah Myhill: I’m now … I don’t know. I mean, I was talking to a friend of mine who’s an oncologist, and he was saying that the fastest-growing cancer in this country is esophageal cancer. Yeah. I think it’s to do with proton pump inhibitors. Why? Because as soon as you fail to sterilize the upper gut, you get a fermenting upper gut, and a great many tumors are driven by infection. I mean, we know [inaudible] drives stomach cancer, but many viruses, particularly herpes viruses, drive a whole range of tumors, and my guess is that the fermenting gut is a major risk factor for esophageal cancer, for stomach cancer, and for colon cancer.
Ari Whitten: You’re tying that down, back to proton pump inhibitors?
Dr. Sarah Myhill: Because proton pump inhibitors greatly increase your risk of fermenting gut. I mean, there’s …
Ari Whitten: You’re not able to sterilize the upper gut as well …
Dr. Sarah Myhill: Correct.
Ari Whitten: Without the acidity.
Dr.Sarah Myhill: Correct.
How infection, dysfunction of mitochondria and fatigue are all related
Ari Whitten: Okay. Got you. To jump back to infections real quick, I’ve heard … It seems to me that there’s quite a lot of differing opinions on infections. Some people seem to believe they’re kind of the crux of everything, when it comes to chronic fatigue syndrome or many other conditions, and then I’ve also heard a number of people kind of talk about them as being secondary to, you know, once you get some of these other holes in your immune bucket, or your mitochondria start to dysfunction, then the infections come into the picture.
Dr. Sarah Myhill: Well, neither, both sides are right, but the way I look at the infection story is, life is an arms race. You and I are a free lunch for bacteria, viruses, yeast, parasites, worms, the whole lot, that would love to make themselves at home in our extremely comfortable bodies. It’s nice and warm there. There’s lots of water there. There’s free food.
Ari Whitten: Yeah.
Dr. Sarah Myhill: We are just a perfect target. Our whole body, we have defense against that. We have skin, we have saliva which is acid, we have stomach which is acid. These are all major defenses against infection, but if we compromise those defenses, and a major way would be by taking drugs, for example. If you don’t acidify your stomach, then you’re much more prone to getting infections in there. If you render yourself deficient in micronutrients, so your immune system can’t fight, lack of Zinc, lack of Vitamin C is a major risk factor for infection. It’s a constant battle that we should never let the defenses down. The trouble is, we have become anesthetized to that battle by antibiotics and vaccinations.
We think we’ve won the infectious disease battle. We think they’re not a problem anymore. All we have to do is go and see our doc, and we’ll get injections or get some pills and that’s that, but all those things, I mean, those are very important tools, don’t get me wrong, but they’re just postponing the inevitable, and there will be a plague coming along. Now, what it’ll be, whether it’ll be Ebola virus or Zika virus or West Nile Fever, or whatever, or I don’t know, but there will be a plague come along.
What I’m saying to my patients is, “Don’t wait for it to come along. Put the defenses in place now, so eat a paleoketogenic diet. Don’t take drugs. Do your best to live a clean life so you’re not poisoning yourself with all these various toxins. Make sure you get a good night’s sleep. Put all these things in place now.” The treatment regime for my chronic fatigue ME patients is exactly the same as my ‘Let’s stay well’ regime for people who are otherwise fit and healthy and want to live to their full potential for as long as they can.
Ari Whitten: Yeah.
Why vitamin C is important to help with mitochondria and fatigue
Dr. Sarah Myhill: The basic fundamentals are the same. An incredibly useful tool, which again, is ignored by the medical profession, and, but one used increasingly is good old Vitamin C. Now, there’s a lovely story about Vitamin C. It’s humans, fruit bats, and guinea pigs can’t make their own Vitamin C. Now, if you, I mean, the reason my dog Maxie doesn’t get scurvy is because she can make, just by eating pure [inaudible] she can make Vitamin C herself. Humans lost that ability somewhere along the line in evolution. What that means is that we’re all Vitamin C deficient. Now, the recommended daily amount of Vitamin C is what I call the ‘Let’s stop scurvy’ dose. It’s 30 milligrams a day, which is completely inadequate.
Doesn’t do any good at all. We should be taking much higher doses to help with mitochondria and fatigue. Now, you’re probably aware of the work of Linus Pauling, who is the only guy to win two Nobel prizes of his own [inaudible]. He wasn’t part of a team of scientists, he won. He devoted the last part of his life to Vitamin C, to ascorbic acid, and maintained that many modern conditions, heart disease, cancer, were simply caused [inaudible] just cause lack of Vitamin C in their diet. He was a great advocate of taking a big dose of Vitamin C, and this I advocate almost as the routine now for my ME patients. Why? Because it helps cure the fermenting gut, because it acidifies the upper gut.
It greatly facilitates the digestion of protein and the absorption of minerals. As you gradually increase the dose, you become much more tolerant of it, and therefore, you get much more into the bloodstream. It’s a really important starting point for treating all infections, and guess what? It’s cheap. Everybody can access it. It’s incredibly safe, and it dovetails beautifully with the paleoketogenic diet, with the nutritional supplements, with the stuff to support mitochondria, and so on, so Vitamin C is a really important part of our defense.
Ari Whitten: Got you. Okay, so we’ve gone a little over an hour. I don’t want to take too much of your time here, but I would love if you could just wrap up with maybe kind of the three to five top strategies that you have for increasing energy and overcoming fatigue.
Dr. Sarah Myhill: Okay. Well, one thing we haven’t talked about at all is sleep. My view is it’s diet, it’s the paleoketogenic diet, it would be a good package of nutritional supplements which allows the fact that modern diets are deficient, and also feeds mitochondria, in particular CoQ10, Vitamin B3, carnitine, and magnesium …
Ari Whitten: D-Ribose?
Dr. Sarah Myhill: And D-Ribose, what Stephen Sinatra describes as his awesome foursome.
Ari Whitten: Yeah.
Dr. Sarah Myhill: Good quality sleep, really important, and of course, pacing activity. Now, it’s the most boring part of treating people with ME, but the fact of the matter, we all have to pace our activity. I would love to work 24 hours a day, but I know I can’t do it. Getting that work lifestyle balance right, when you’ve got enough energy to do the work, and then adequate rest periods and good quality sleep. This is particularly important with people who have ME, because if they exceed the ability of their mitochondria to produce energy, they switch into anaerobic metabolism. In anaerobic metabolism, you produce lactic acid.
Well, A, lactic acid is painful, B, getting lactic acid back to pyruvate requires a huge amount of energy, and C, lactic acid inhibits mitochondria directly, so constantly overdoing things and not pacing well is a real bar to recovery. Boring, but really, really important. You’ve got to pace. If you’re getting post-exertional malaise, then you’re constantly overdoing things and you’ll never get well while that state of affairs prevails.
Ari Whitten: Wonderful. On that note, this has been absolutely a pleasure, and it’s so wonderful, you know, after having read your book and being so impressed with everything, it’s so great to actually talk to you in person and get to hear it straight from you.
Dr. Sarah Myhill: Very kind. Thank you.
Ari Whitten: Yeah. I just want to thank you so much for taking the time to share your wisdom …
Dr. Sarah Myhill: My pleasure.
Ari Whitten: And brilliance with my audience. Thank you very much, and I hope to talk to you again very soon.
Dr. Sarah Myhill: That’d be great. Thank you. Nice to meet you, too, Eric. Okay.
Ari Whitten: Okay.
Dr.Sarah Myhill: Bye for now.
Ari Whitten: Bye.
Show Notes
The Mitochondria and Fatigue Link: Why mitochondria are vital for your health and energy (2:52)
How much energy you spend on staying alive (6:30)
Dr. Sarah Myhill’s take on adrenal fatigue (10:40)
How your body requires a lot of energy to function normally (11:15)
Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis: It’s Mitochondria, not Hypochondria (17:40)
Why Dr. Myhill chose to focus on the mitochondria and fatigue relationship in her patients (23:38)
The Mitochondria and Fatigue Link: How simple lifestyle changes can help you overcome fatigue (25:18)
How the western diet impacts the gut function, mitochondria and fatigue (31:03)
How an underactive thyroid often is misdiagnosed (37:34)
Why nutrient deficiency is a major cause of weak mitochondria and fatigue (44:28)
Why the mitochondria and fatigue link is responsible for health and lifespan (50:50)
How toxic stress is impacting on mitochondria and fatigue(56:26)
How infections affect mitochondria and fatigue (58:46)
Why vitamin C is important to help with mitochondria and fatigue (1:05:35)
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