Tuesday, September 8, 2015

Abundant Energy Summit: Dr. Myhill speaks about the role of mitochondrial function in ME/CFS

This article first appeared on ProHealth.

Following (scroll down) is a transcript from the Abundant Energy Summit’s interview with Dr. Sarah Myhill.

The Summit was held from August 24 - 31, 2015 and featured a number of speakers.

Dr. Myhill is a physician who specializes in ME and other complex illnesses. Her approach is considered "alternative," that is, it draws upon nutritional strategies, hands-on therapies, and supplementation with micronutrients, rather than relying exclusively on pharmaceuticals.

Much like Dr. Cheney, Dr. Myhill believes that mitochondrial dysfunction lies at the heart of ME/CFS. The mitochondria are the power houses of cells. Their job is to form adenosine triphosphate (ATP), the molecule that generates the energy needed for all functions - breathing, digesting, thinking, walking ... everything. When the mitochondria are inhibited from doing their job, less ATP is produced, and, as a consequence, your ability to maintain physical and mental function is reduced. (Skeletal muscle is especially affected, as the mitochondria in muscle cells are less efficient that those in organs. Typically, people with mitochondrial disease find it difficult to walk.)

ATP is composed of three parts: 1) adenine, a purine nucleobase, 2) ribose, a sugar, and 3) three phosphates connected by high energy bonds. When one of those bonds is broken by an enzyme, 7,200 calories are released. That's a lot of energy. And we need all of it. In order to simply lie in bed and breathe, an adult uses roughly 10 million ATP molecules per second.

If your mitochondria are impaired in any way, even a tiny bit, your body will find it difficult to perform even the most basic functions. You will find it difficult to digest your food (the production of stomach acid requires an enormous amount of ATP), your heart will suffer from diastolic dysfunction, which also requires a large amount of ATP, you will be unable to think clearly, you will experience muscle weakness, particularly in the legs, and you will be exhausted after the slightest effort. The more your mitochondria are impaired, the more exhausted you will be, and the less it will take to send you to bed.

Dr. Myhill's site is a goldmine of information. On it, you will find everything from alcohol intolerance to valacyclovir. I encourage you to take a look.

Niki Gratrix: Hi everyone this is Niki Gratrix and welcome to another episode of the Abundant Energy Summit. I have the pleasure today of introducing Dr. Sarah Myhill.

Dr. Myhill worked with the NHS for 20 years before entering into private practice. She was the Honorary Secretary for the British Society for Allergy and Nutritional Medicine for 17 years, and has worked with over 5,000 patients with fatigue.

She believes the central mechanism is mitochondrial dysfunction. She is the author, with colleagues, of three scientific studies in the International Journal of Clinical and Experimental Medicine showing that the level of mitochondrial dysfunction correlates with the degree of fatigue. She is also the author of the book, It’s Mitochondria Not Hypochondria.

Q: You have a car analogy in your book. Please explain that.

Myhill: Let’s start from the beginning. The first and most important thing to grasp about Chronic Fatigue Syndrome is that it is not a diagnosis, it is a clinical picture that may have many causes. It is my job as a physician to find the causes. The second important thing to grasp is that we have symptoms for a very good reason. Symptoms protect us from ourselves. If we didn’t experience fatigue we’d work all day and all night. And we’d be dead in eleven days, because nobody has survived eleven days without sleep.

The symptom of fatigue can arise for many reasons that have to do with delivery systems and energy expenditure - how we spend and create our energy. We always have to keep ourselves where our energy demands don’t exceed our energy delivery. We need to pay attention to both sides of the equation: energy demands vs energy delivery.

The body is just another machine, like a car. Like any machine it needs the right fuel in the tank. That fuel has everything to do with diet and gut function.

How do we burn our fuel to create energy? Mitochondria are essential for creating energy from fuel. They are the little engines that exist in every cell in the body, and in every cell in every living organism. Without mitochondria we wouldn’t have life as we know it.

What mitochondria do is they take fuel from the bloodstream derived from carbohydrates, fats, and proteins (in the form of acetate groups) and burn them in the presence of oxygen to produce ATP. Think of ATP as a molecule with which you can do any function in the body.

The thyroid gland is also terribly important. It determines how the fast those mitochondria go, like an accelerator pedal in a car. We have to be careful about how we spend our energy. Spend it too fast and we wouldn’t have survived a harsh winter.

What allows us to gear up energy spending is the adrenal gland, which I think of as the gear box in a car. Adrenaline is the short-term immediate hormone for energy delivery; cortisol is the intermediary and DHEA is for long-term energy delivery. Those hormones allow us to adjust energy demand to energy delivery very closely.

Of course, all cars have to be serviced regularly. We service our bodies during sleep. Every single living thing, even bacteria, need a time in which metabolic processes shut down to allow healing and repair to take place.

Those are the central, important aspects.

Q: You talk about how the immune system takes up a huge amount of energy.

Myhill: That’s on the other side of the equation, where we look at how energy is spent in the body. An astonishing amount of energy – two-thirds of all energy we generate – just goes into staying alive: basic metabolic rate, heart function, lung function, gut function, liver function, brain function. All those things demand energy. The rest we should spend physically, or mentally, in terms of mental exercise.

I think of the immune system as a brain that isn’t contained within the skull, but is spread throughout the body. It’s intelligent, it’s decision-making. It’s highly active, and it’s highly demanding of energy. It likes to run on fat, and so on. But when the immune system is activated it uses up a massive amount of energy.

How do I know that? If a normal person gets flu, they get instant ME. They’re bed-bound for a week or two until their immune system switches off and they get well again. When their immune system is activated because of infection, that’s normal, desirable, and essential to dealing with an infectious threat.

But if the immune system is activated because of allergy, that’s what I call useless inflammation. The body is spending immunological energy on something that is not a threat. That kicks an immunological hole in our energy bucket.

Q: Let’s focus a little more on the mitochondria. Would you please expand on the production of ATP?

Myhill: When ATP is being efficiently recycled, ATP forms ADP. Then it goes back into the mitochondria where it again forms ATP. That is an extraordinary efficient cycle. In fact, when we are functioning at our maximum potential, a molecule of ATP can be recycled back through our mitochondria every ten seconds. If there was no such recycling, then we would burn more than our body’s weight of ATP every day.

We run into problems when energy demand exceeds energy delivery. The body has some emergency mechanisms. Let’s say I have to run for my life, all these energy systems would be employed. One of them is to switch into anaerobic metabolism that produces lactic acid. We all know about that. It’s the lactic acid burn that slows athletes down and stops them, and stops ME patients as well.

Another mechanism is when two molecules of ADP combine to form one molecule of ATP and one of AMP. The ATP can be quickly recycled, but the AMP is recycled very slowly. So suddenly, you’re pulling the plug on your supply of ATP. It’s all draining out of your system. That is what I suspect causes the delayed fatigue in ME.

Interestingly, another paper has come out recently, where they tried to reproduce that idea in a computer using low rates of metabolism and putting in all the variables. And they came up with the same conclusion.

Q: What are some of the causes of mitochondrial underfunction?

Myhill: Broadly speaking, there are two important causes. The mitochondria can be deficient in raw materials – magnesium, CoQ10, acetyl-l-carnitine, vitamin B3, and D-ribose. Those are the 5 things we see that mean the mitochondrial are deficient. We measure these things when we do mitochondrial tests.

Or, mitochondria can be going slow because they are blocked by something. Blocking factors can include environmental toxins, energy delivery blockers, heavy metals, and fermenting gut products.

You can block mitochondria by stacking things on top of the mitochondrial membrane. It’s no good making ATP if you can’t get the ATP out of the mitochondria and into the cell where it’s needed. Mitochondrial membranes are made up of proteins that act like a little shuttle that takes ATP out of the mitochondria and then brings ADP back into the mitochondria where it is turned into ATP. There are lots of things that can block that shuttle. We can do tests to determine what those blocking factors are.

As an aside, I got interested in ME when I started seeing farmers with sheep dip flu. They had been poisoned by organophosphates. Organophosphates inhibit oxidative phosphorylation. That is how they block the mitochondia’s ability to make ATP.

Broadly speaking those blockers fall into two groups: they can be toxins from the outside world, such as pesticides and heavy metals, or they can be products from within the body. I suspect a major source of those is products from the fermenting gut.

Q: And inflammatory processes lead back to the gut.

Myhill: Mitochondria are important, but I spend as much time with my patients talking about diet, and talking about gut function. So many problems start with the gut.

Q: Mitochondrial malfunction explains the illness brilliantly, but it’s not the cause, it’s the effect.

Myhill: The whole thing is circular. We all come into this area with different theories, but we all end up offering similar patterns of treatment – diet, detoxing regime, nutritional supplements, correcting hormones, and so on. But mitochondria are central players.

Q: Diet, pacing, micronutrients and sleep are your four foundational things. Do you want to expand a little on that, especially pacing?

Myhill: It’s back to square one. Fatigue is a mechanism that protects us from ourselves. If someone is experiencing fatigue because they are overdoing, they are constantly stressing their mitochondria and their energy supply and they are constantly going into anaerobic metabolism and producing lactic acid.

Let’s talk about anaerobic metabolism. Normally, mitochondria function on oxygen. When you burn a molecule of sugar in the presence of oxygen, you’ll produce about 26 molecules of ATP. But when you stress your mitochondria and switch to anaerobic metabolism, burning a molecule of sugar only produces two molecules of ATP. If you do this on a regular basis you get a buildup of lactic acid.

To convert that lactic acid back to pyruvic acetate takes six molecules of ATP. What that means is if you overdo things it takes an awfully long time to get back to square one. The point of pacing is to avoid getting into anaerobic metabolism. So, pacing is crucially important. People will get better if they pace. If they don’t pace, eventually there is tissue damage and inflammation sets in, which kicks another hole in the energy bucket.

Q: You have a basic protocol for micronutrients, what is that?

Myhill: Although I began by seeing patients with ME, I have come to the conclusion that no matter what a patient comes to me for, there is a basic package of treatment that we should all be doing. In terms of diet, this consists of a “stone age diet”: meat, fish and eggs, nuts and seeds, lots of veggies, and low-fructose fruits, such as berries.

Number two is sleep. Most people are sleep deprived. If you need an alarm clock to wake up in the morning you are sleep deprived.

The third thing I talk about is micronutrients. Because modern farming depletes the soil of minerals, we should all be taking a basic package of micronutrients – vitamins, minerals, and amino acids.

Q: Talking further about the Stone Age Diet, are you recommending a grain-free diet?

Myhill: Grains are too toxic for humans to consume. So, remove all gluten completely. The fermenting gut is a very big problem.

The upper gut should be a near-sterile carnivorous digesting gut to deal with meat and fat. The lower gut, which is teeming with bacteria, digests vegetable fiber. So, the lower gut is a fermenting gut. If we overwhelm our liver with sugar, for example, we switch into the fermenting gut and have all the problems of metabolic syndrome.

What I am saying is that a modest amount of carbohydrate is fine if you’ve got perfect digestion. But my ME patients don’t have perfect digestion. So, carbohydrates are a major risk factor for chronic fatigue syndrome.

I consider being vegetarian a major risk factor for chronic fatigue syndrome for two reasons. Vegetarian foods tend to be high GI, that is, grains and fruits. They are also high in the major antigens: dairy, gluten, and yeast.

Q: Would you talk a little about B12 and magnesium?

Myhill: Magnesium is centrally important for mitochondrial function. In fact, 40% of all the energy that comes out of mitochondria simply maintains the ion pumps that kick calcium out of cells and drag magnesium in. If the mitochondria are going slow, they can’t kick the calcium out, which is toxic within cells, and they can’t drag the magnesium in. So they don’t have the magnesium they need to make the mitochondria even work. There is a vicious cycle here. If you can’t get the magnesium in, the mitochondria won’t work, and if the mitochondria can’t work, you don’t get the magnesium in.

The reason magnesium injections are so helpful is that you are spiking the level of magnesium in the blood for a short period of time. All of a sudden it’s much easier to drag the magnesium into the cells. The mitochondria then start working again properly. Magnesium injections kick start the mitochondrial engine.

With B12 I think there may be a similar mechanism going. The thing about B12 is that it is very poorly absorbed. Even people with the best gut function will only absorb 1% of the B12 that they are taking. Only about another 1% actually gets into the brain, where it is very important for cognitive function.

The point about B12 is that if you inject it, you spike the levels in the blood, and you get the B12 into the brain. I’m only hypothesizing, because so many of my ME patients find their brain function and their mood is so greatly improved with B12 injections. B12 is performance enhancing in athletes, and even in horses. Trainers give horses B12 injections, and they go faster. That means their mitochondria are working better. And, B12 injections are an incredibly safe thing to do.

Q: Are you having much luck with transdermal forms?

Myhill: Transdermal forms of B12 are better than oral forms. They get about 6% absorption. But again, it’s not as good as the injection because you don’t spike blood levels.

Q: You mentioned the mitochondrial cocktail?

Myhill: When we do tests, we tailor treatments to individuals because we measure CoQ10, carnitine, B12, magnesium, and ATP. But if you can’t access those tests, you can do no harm by taking those supplements.

I have yet to find an ME patient with normal levels of CoQ10. These days I tend to use ubiquinol, which gets much better blood levels. 200 mg of ubiquinol will correct all my patients.

Q: Diet and environment need to be under control for any of this to work.

Myhill: That’s very important. We are living in an age in which we are being overwhelmed with toxins. A supplement I routinely prescribe for my ME patients is glutathione, which is essential for getting rid of heavy metals and is a potent antioxidant. With 250 mg a day of glutathione you can do no harm.

Another interesting facet of mitochondria is that they determine aging. We age at the rate that our mitochondria age.

Q: There have to be different approaches for different people. Some may need thyroid support, some adrenal support.

Myhill: I always say that getting people well from chronic fatigue syndrome or ME is like a jigsaw puzzle. You’ve got to have all the pieces in place at the same time. You can’t try one thing, and when it doesn’t work, you try another. You’ve got to start with the foundation stones of pacing, diet, supplements, sleep. Then you build on that with the mitochondrial stuff, thyroid stuff, adrenal stuff, gut fermentation stuff. You can do a lot of this yourself with simple nutritional therapy. It’s very doable.

Q: What about tests?

Myhill: The tests we use are all documented research tests. We apply them clinically. The problem with new, innovative tests is that they are hideously expensive. But don’t wait for the tests to come out to start to get better. Put the basic package in place as well as you possibly can. It’s all about tipping points.

I say to my patients, all we have to do is get you 51% better and your body will do the rest.

You can find out more about Dr. Myhill at DrMyhill.co.uk
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