What’s Going on in ME/CFS (and top tips) with Cort Johnson

Ari: Right there, that’s one of the big shifts in mainstream thinking around ME/CFS over the last few decades is what was once thought to be a purely psychosomatic thing. It’s all in the head, these are just hypochondriacs, these are depressed people. Now, we actually have quite a lot of solid research showing that there are very real physiological abnormalities in these individuals. Is that accurate to say?

Cort: Yes. It’s getting better. A couple years ago, a Harvard pulmonologist named David Systrom, he started doing invasive cardiopulmonary tests on people with chronic fatigue syndrome. In these invasivecardiopulmonary test, he puts a catheter into an artery, a catheter into a vein. He can measure the amount of blood that’s going to the muscles, he can measure the amount of oxygen and all sorts of things. When he did these tests on people with chronic fatigue syndrome, he found that about half of them, they were not utilizing oxygen, that is, he could measure the oxygen content going to the muscles and then when it came back on the other side, the oxygen levels were too high that for some reason, their muscles were not utilizing oxygen properly.

He’s uncovered three different reasons for this and chronic fatigue syndrome, one of which is mitochondrial dysfunction, if mitochondrial dysfunction is happening in some patients, one of which is hyperventilation. This is not a psychological reaction, this is a physiological problem, which is causing somehow, the signals for breathing are getting disrupted. When a significant number of people get on a bicycle, they are breathing too deeply and too rapidly, which is reducing the CO2 levels which is in their blood, which actually makes it more difficult for oxygen to leave the red blood vessels and flow into the mitochondria.

The third one is problems with the microcirculation. He’s finding that he’s measuring the blood going down to the muscles, and he’s measuring it coming back from the muscles, and there’s less blood coming back from the muscles. Somewhere along there, blood is getting dispersed into the system. He believes it’s getting shunted away from the muscles at some point. Here’s another real validation, this guy is from Harvard, this guy is well respected, he didn’t start out in this field, he’s somebody people will listen to. It’s been hard. It’s been hard to get other researchers to listen to the exercise physiologist in the field, these findings are so unique that they say, well, your machine must be broken because we’d never seen this before.

Ari: Just to summarize that, did you say there’s a defect from as far as the blood going to the muscles or to the cells, is there a defect there? Did he find that there’s less blood flow or less oxygen in the blood?

Cort: Yes, it’s somewhere blood is being lost probably before it reaches the muscles, therefore, it makes it hard to produce energy.

Ari: We have a defect there somewhere in the cardiopulmonary system. There’s a defect, we have a number of lines of evidence suggesting that defects at the cellular level and at the mitochondrial level, as far as the ability to use oxygen and efficiently produce energy. Then there’s also defects after that, as far as the blood going back to the heart and decreased CO2 levels and too high of oxygen and the returning blood and so on.

Cort: Oh, you got that very quickly.

Ari: One of the things that I think is interesting, and maybe this is something we’ll explore now or later on, but as I see it, I see two very different fundamental ways of thinking about solving these problems. On the one hand, I think you have the allopathic paradigm, a conventional medical paradigm that is very much looking for the physiological defect. The biochemical mechanism that is problematic in this condition and then looking for some kind of drug intervention that will correct this dysfunctional biochemical pathway.

The analogy if somebody is not following is, let’s say blood pressure is too high, let’s use a drug that alters some of the signaling of something involved in the blood pressure regulation system so that we lower blood pressure or cholesterol levels are too high, then let’s use statin drugs and just help the body make less of those cholesterol molecules. That’s how conventional medicine thinks about solving problems, but even just with what you’ve said so far with what’s going on in ME/CFS and I think you’d probably agree even that’s just scratching the surface as far as all of the findings of all the different things that we know are going wrong in people with ME/CFS.

My point is there is no one specific system and one specific biochemical pathway that seems to be the thing that’s going wrong. From my perspective, I think it’s going to be unlikely that we’re going to find a drug cure to ME/CFS. It’s possible that I’m wrong, especially if Dr. Robert Navio is right, maybe something that would block pure energy signaling. Maybe that could be some universal cure, but in my experience, I think it’s very rare to find drug cures for most diseases. Anyway, all of this is to say, what do you think of these two fundamental approaches to solving this problem? Do you think that it is likely, are you hopeful that there will be a drug cure? Do you think that that’s the most likely answer?

Cort: Well, that’s the answer I would like to have.

[laughter]

Ari: I think we’d all like to have it for everything.

Cort: As you say, this is unlikely in disease in general let alone something as complex as chronic fatigue syndrome. Now, I do believe it’s possible that a drug and I actually believe that ME/CFS will be most resolved. Well, at some point a drug will come along that will make a big difference. It’ll take a lot more research, but I just think it has to because unless we come up with some super supplement and I should say that we have a bunch of recovery stories on Health Rising and they cover the gamut.

There are people who’ve recovered using ketogenic diets. There are people who recovered using blood volume enhancers. There are people who recovered using antivirals. There are people who’ve recovered using functional medicine in which they do a whole bunch of things and they just slowly work their way out of this illness. That is certainly a possibility.

Ari: Yes, I can speak to my work in that regard and not that I specialize in ME/CFS specifically, but I certainly have lots of people that have followed my work, done my program, and used my supplements. I have with specifically ME/CFS, probably somewhere in the order of 50 to 100 recovery stories-

Cort: Oh, great.

Ari: -with full-blown ME/CFS that have fully recovered from that. Using nutrition, lifestyle modification, nutritional supplements, a comprehensive regimen of lots and lots of strategies, but that’s not to say that everyone with ME/CFS has recovered. I think that there are some people with very, very severe ME/CFS that maybe is from a combination of severe mold poisoning or mercury poisoning or I’ve had one story of a woman who grew up in England in a specific town. I forget the name of the place, but it was famous for having a lead poisoning incident in the public water supply.

From the time she was eight years old, she had insanely high levels of lead in her system, and now in her 55 years old and she’s been toxic in lead for 40 years. I think there are scenarios like that where it’s probably very difficult to get back to the level of health that you were in your pre-eight-year-old self, but all of this is to say that I do think recovery seems to be possible for a large number of people.

Cort: Yes, I’m not sure what to say. You’re getting a lot of recovery stories so that’s great. On the website, I deal with so many people who have tried so many different approaches and nothing has worked. Maybe they’re just not, and I’ve tried so many different things and I am always hopeful that maybe I’m just missing something. That I’m missing that essential ingredient and one of the challenges really with the functional medicine approach is that there are so many different things to try. Certainly, we have stories on Health Rising where people, they put the right endpoints in and they’ve done their pacing, and they’ve been careful with their diet and they just worked their way out of it.

It’s amazing really to go from such a functionally debilitated state to health and it seems like some people, they get to a point, and all of a sudden they turn. There’s somehow it’s all come together and there they are. With me, I’m pretty mild relative to most people. For many people, it’s a problem of money getting the right help, and certainly, your courses can really help with that since they are available online. It’s certainly worth a try by certainly. It actually makes me think I should try.

[laughter]

Ari: Well, happy to help out and one thing I don’t advertise, you mentioned people financially struggling there I don’t necessarily advertise this, but I guess I am now, people who are in financial difficulties, if they provide some evidence to that, bank statements or something to that effect, we never turned someone down who was in need of the course, but can touch. Anyway, we talked about some cardiopulmonary deficits, you mentioned mitochondrial dysfunction. I know you’re familiar with Dr. Robert Navio’s work around the metabolomic studies and the cell danger response and all of that.

What is your opinion about the idea that there’s a hibernation aspect of what’s going on in terms of the physiology of people with ME/CFS.

Cort: I think it’s a fascinating idea. Intuitively it kind of fits. It’s interesting because it’s coming at the problem with energy production from a different angle, and it’s finding the same thing and that is these metabolic studies where they assess the metabolites in the blood and the urine. They also suggest that people with ME/CFS are in a hypometabolic or a hibernation state. Naviaux has been a real leader here with the cell danger response, and interestingly, the mitochondria being the quick alert, providing the quick alert system for the body. I think it’s a very viable hypothesis.

Some researchers from Australia, Neil McGregor, and Chris Armstrong, they’ve been doing metabolomics studies for quite a while. They have found that people with ME/CFS are preferentially using amino acids for energy, that they’re not doing well with carbohydrates, which again are the glucose which provides quick clean bursts of energy. For some reason, their results indicate that people with ME/CFS are breaking down their muscles to produce energy. It’s an inefficient way to produce energy.

Then there’s Marian Lemle who, gosh, 10 or 15 years ago, she came up with the hydrogen sulfide hypothesis. She got that out of looking at hibernation presentation. She got onto that. That’s being studied at John Hopkins right now. I think it’s a very interesting hypothesis. I should mention that the metabolomic results they mirror what happens with people who are starving. When you’re starving, you go to your muscles to produce energy. For some reason, that seems to be happening in chronic fatigue syndrome, and that’s actually driving with some of the mitochondrial results, which suggests that the electron transport chain is working okay, but the point right before that is broken.

In your program, how do you attack this hypometabolic problem? Is there a specific strategy to deal with that or?

Ari: Yes. I think what I was getting at a minute ago when I asked you about these two fundamental approaches to how people approach and think about solving health problems. I think there’s a real important dividing line. There are different levels of analyzing and understanding a problem, and when you analyze and understand the problem in a totally different way, you’re going to arrive at different solutions.

I’ll give you an example. Let’s imagine two different people who are trying to farm land. I’m writing a script for a video I’m about to film. People listening might hear me talk about this in another video, but let’s imagine you have two different groups of scientists who are trying to farm land and make it as productive as possible. One of those groups of scientists has a very naturalistic paradigm and appreciation for nature, a desire to mimic nature and nature’s ways of doing things, and the other one says, “No, nature smature.”

We can use modern technology and modern science and do way better than nature can do. For example, we don’t have to rely on manual labor to plant all the seeds in the ground and irrigate all the things and put chemicals on the crops. We can just automatize that and use machines to do it all by just planting the same crop. On this whole field of 100 acres, we can just plant one plant instead of a diversity of plants like it’s in nature. You can just do one plant, right?

Cort: Modern agriculture.

Ari: Right. We only farm soy, or we only farm corn or something like that. Great, it is hyper-efficient in many ways. You don’t have to use so much manual labor. You can use machines to plant and to harvest and so on, but then you run into certain problems. You find, oh, those methods are depleting the top soil, and they’re heavily depleting the soil of minerals.

Because there’s no diversity of plants, now, the plants are very susceptible to pests. They say, “Oh, no problem. Science to the rescue, we’ll just create chemical fertilizers that replenish the minerals and we’ll create chemical herbicides and pesticides to deal with all the weeds and pest problems that we’re getting. Problem solved. We’ve got our chemical drug solutions to all of our health problems of our field.”

Then you discover there’s other problems. Now, all these chemical fertilizers and herbicides and pesticides are running into the rivers and the lakes and the oceans where they’re wreaking havoc on the wildlife, where they’re bleaching the coral reefs and disturbing the whole ecosystem of the entire planet. Now you have other groups of scientists trying to develop drugs to solve those problems.

There’s a whole cascade of problems that emerge because you didn’t start from the right set of assumptions, but there’s another way of doing things, which is to replicate nature to use more permaculture systems that rotate the crops in a certain way that use a diversity of plants that minimize, that make it so you don’t deplete the top soil, you don’t deplete the minerals in the soil and you make everything resistant to pests. You don’t wire all of those chemical inputs that led to all of that whole cascade of problems on the whole planet.

These are, in my mind, two fundamentally distinct problems. Now I start with an appreciation for nature. Just as if you break a bone or you smack your head or you smash your toe on something, or you fall off your bike and scrape your skin, your body has a natural drive, an innate drive to heal itself to recognize where there is damage and to heal itself, but it does that a lot better if you provide it with the right inputs. If you don’t provide it with the right inputs, then it doesn’t heal very efficient.

Routine infections, I just moved to Costa Rica recently, and I heard stories of people who are living in poverty, who don’t have the ability to give their children with routine infections, with diarrhea, with common cold, with flu, they don’t have the ability to feed them proper nutrition. You have little kids, one, two-year-old kids who are dying from common colds and normal childhood infections just because they’re not given the proper inputs that their body needs to be able to recover from that injury, that stressor, that insult.

I fundamentally conceptualize things from that paradigm, and I think that’s, in general, a good guiding paradigm. My fundamental question is basically how can we provide all of the right inputs for human physiology to thrive and work at its optimal? Anyway, I’m talking too much in your interview, but that’s how I conceptualize thoughts.

Cort: There are some really interesting techniques, and I wonder what you think of some of these, and some of these interesting nutrient delivery systems. There has been some like Nancy Klimas at Nova Southeastern. She’s experimenting with a two-drug approach that’s staggered overtime to get at the neuroinflammation and the stress response problems in chronic fatigue syndrome, but she’s also really interested in finding other ways to calm down neuroinflammation, one of which is through inter-nasal glutathione, and I believe she’s interested in inter-nasal insulin. I don’t know if you’ve tried those.

That’s an interesting way to perhaps get stuff into the brain. There’s increasing evidence of neuroinflammation in chronic fatigue syndrome, which could be at the heart of all of this.

Ari: I was going to ask you about the brain component. In my experience, I’ve seen people with ME/CFS,

I’ve seen them recover from nutritional interventions, and circadian and sleep interventions. I’ve seen them recover from mitochondrial-targeted supplements. I’ve also seen people who haven’t had a lot of success with those things but who have had amazing success where their big key was actually the brain-based interventions, was learning [crosstalk] techniques and other techniques and all key-based techniques to calm the negative thought patterns and the strike that’s going on in the brain. I’ve seen people say, “Nothing’s worked for me except these brain-based modalities.” There are certain people out there that group their program and a few others that are doing very brain-focused programs. I think for a subset of people, that’s quite effective.

Cort: Sure. Yes. I agree. We have some stories on Health Rising. It’s a touchy subject, but there is something going on with the stress response system. I feel it. I intuitively feel it. This fight or flight system that just will not quit. There’s physiological evidence to back that up. The limbic system of the brain, hyperactivated, hypervigilant. It’s there. It’s there for me. I don’t know where it comes from. It’s not a psychological. It came with chronic fatigue syndrome. When I got chronic fatigue syndrome, it came with it. This hyped-up, difficult to relax, difficult to rest and digest, difficult to get the parasympathetic nervous system going.

I think anything that can calm the fires down is helpful. I just intuitively feel. I actually feel that if I could get that under control, I would be in really good shape. I have actually worked at these things for a while. I don’t know if it’s because I just work too hard or I’m too driven. If I could just relax for six months, I don’t know. [laughs]