In this episode, I am speaking with Sarah Myhill, MB BS—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.
In this podcast, Dr. Myhill will cover:
What’s really causing your chronic fatigue and the number 1 driver of disease.
The critical role mitochondria play in fatigue/energy levels.
Top keto diet questions answered! Is it really how our ancestors ate? Is it the key to reversing disease?
Hyper-individualized treatment plans. Do you need one, or can you just adopt basic lifestyle habits?
The one thing you need the most to overcome fatigue.
A guide to probiotics. They all affect your health differently!
Why dealing with emotional stress can reduce your fatigue. How to treat the “emotional hole.”
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Mitochondria and Fatigue - How to Boost Mitochondria to Beat Fatigue - Part 2 with Dr. Sarah Myhill – Transcript
Ari Whitten: Hey there! Welcome to The Energy Blueprint Podcast. I’m your host, Ari Whitten, and today I have with me for the second time, Dr. Sarah Myhill, who is a chronic fatigue syndrome and myalgic encephalomyelitis expert. She’s been working in this field for many, many years. She’s widely regarded as one of the top experts—top doctors in this field. She is the author of several books, including: The Infection Game, The Paleo-ketogenic Cookbook, and this one which is, The Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis. And it’s the subtitle (which I love) is, “It’s mitochondria, not hypochondria.” And she’s also a coauthor—or a co-researcher—in three different research papers relating to mitochondrial dysfunction and chronic fatigue, especially with regard to something called the “ATP profile” test, which is this test that they’ve used to specifically identify mitochondrial dysfunction in the context of chronic fatigue syndrome.
So welcome for part two, Dr. Sarah Myhill! Such a pleasure to have you on again!
Dr. Sarah Myhill: Thank you, Ari, for inviting me back. You always ask the right questions and that makes it very easy for me.
Ari Whitten: Thank you. I was just thinking about it right before we started recording, and I think you were actually, literally one of my first or second interviews that I ever did. So hopefully I’ve gotten a little bit better as an interviewer over the last couple of years since I started doing this.
What causes chronic fatigue syndrome
Ari Whitten: I want to start with kind of a recap with your big-picture paradigm of chronic fatigue syndrome. And I’ll just preface by saying that there’s a lot of people who are sticklers for how these conditions should be referred to: ME/CFS, myalgic encephalomyelitis—or encephalitis—and chronic fatigue syndrome. I’m just going to call it CFS for short, just to make things a little easier, because myalgic encephalomyelitis is kind of a mouthful.
So what is your big-picture paradigm of chronic fatigue syndrome and how it develops? What causes it?
Dr. Sarah Myhill: Okay. Chronic fatigue syndrome is a clinical picture that arises when energy demand gets close to energy delivery mechanisms. Now, let me explain that: we have a certain bucket of energy to spend in a day that has a limit on it. Now, if we spend more than that energy bucket, we die because we don’t have energy in the heart to work, in the brain to work, the muscles to work. So the body and the brain cannot permit that negative energy equation to occur. It cannot allow us to spend more energy than we’ve got. And therefore, to stop us from spending that energy, it gives us very nasty symptoms.
The obvious one is physical fatigue. What does physical fatigue do? It makes you want to lie down and rest up until the energy returns. It gives us foggy brain, depression, anxiety, stress. Why? Because those symptoms stopped the brain spending energy. The people who are depressed or stressed, they just want to go in and sit in a little hole until the energy comes back. It gives us muscle pain. If we do too much and that muscle pain is so severe, it literally stops us moving. We know that pain is caused by lactic acid, and it’s lactic acid for example that stops athletes winning gold medals. If they actually had no lactic acid, barely win everything, but they might die in [inaudible]. So we have symptoms for very good reasons. They protect us from ourselves. And what we mustn’t do is mask symptoms, because that mask is the underlying cause of it all.
Now, I see chronic fatigue syndrome as the clinical picture that arises when energy delivery mechanisms start to fail and we don’t have the energy to spend as we should.
ME is chronic fatigue syndrome plus inflammation. And inflammation gives us any number of nasty symptoms: fever, gland-swelling, arthritis, gut symptoms, or brain symptoms, and feeling ill. And that inflammation—when the immune system is busy, either because of chronic allergy but increasingly because of chronic infection—and we now know that many of the ME patients (and of course, ME is chronic fatigue plus inflammation), many of the ME patients are infection-driven. This is what triggered me to write the book, The Infection Game, because so many MEs are infection-driven. And they’re not infections that are obviously recognizable to conventional medicine. They’re stealth infections—things like Lyme disease, mycoplasma, chronic Epstein Barr virus infection (which is “mono” in American lingo). And in fact, there’s a wonderful American doctor, Dr. Martin Lerner, who demonstrated that Epstein Barr virus is implicated in 80% of the post-viral chronic fatigue patients. And more important, when you treat that with antivirals, a very worthwhile proportion of those can recover.
So if one has an idea of this roadmap, you have an idea of the energy delivery mechanisms, and then how the body is spending energy, and in particular, as I call it, “the immunological hole in the energy bucket”. [I use this] with spending a lot of energy on fighting infection or fighting allergies. Then it’s easy to see how the clinical pictures arise. One of the things that makes me so cross about doctors is that patients come in and consult, and they say, “Oh yes, my doctor tells me that my ME is causing that.” ME doesn’t cause anything! ME is the symptom. We have to turn around and ask ourselves, what’s causing the inflammation? What is causing the poor energy delivery mechanisms?
Now this is an analogy which I may not have talked about two years ago, but that’s kind of crystallized since then. And with respect to energy delivery mechanisms, a car analogy is very helpful here, because I see there are four important players. To get your car to run—to get your body together—you’ve got to have the right fuel in the tank. And the trouble with modern diets is they’re all carbohydrate-based, and those are not good foods for mitochondria. You then have to get the mitochondrial engine right—and this is where I’ve done these three papers that you mentioned earlier about mitochondrial dysfunction in patients with chronic fatigue syndrome. Thirdly, we have to get the thyroid accelerator pedal set correctly. And fourthly, the adrenal gearbox. And if we can balance off those four aspects efficiently, then you have a good chance of optimizing your energy delivery mechanisms.
We know this is the case, not just in the chronic fatigue syndrome field—also in the athletic field. The keto-adapted middle-distance/long-distance runners, function much better—they improve their performance times when they’re running on fats, [robbed of] carbohydrates. As I’m sure you know, Mike Morton holds the world record for this distance run in 24 hours; he ran 172 miles. Why? Because for the keto-adaptive athlete, you have all the fuel necessary onboard to run 72 miles, and so he did. If he had been a carbohydrate-based athlete, he had to be constantly topping up his sugars and snacks and joules in order to fuel himself and keep it.
How the keto diet affects performance
Ari Whitten: If I can comment on that just for a minute—I do think it’s likely, if it’s a race to see how long someone could go before they reach a point of exhaustion (or “bonking”, as runners often call it), I think it’s extremely likely that a keto-adapted athlete would outperform a carbohydrate-based athlete.
Dr. Sarah Myhill: [Every time.]
Ari Whitten: But, however, the flip side of this is that, in any high-intensity activity, it’s been shown that keto diets generally impair performance.
Dr. Sarah Myhill: Well, yes, because sugar is like super fuel—it’s like rocket fuel. And yes, that will give you a short-term, mega-hit of energy, but it’s not sustainable long-term. So if I had an athlete who was doing a power event, then I would train them ketogenically, and then carbohydrate-load for them to do their super [inaudible] performance. But the trouble is: what humans are doing at the moment is, they’re eating sugars and carbohydrates all the time. They’re running on rocket fuel all the time. And that is not sustainable long-term. It’s fine for short-term, but not in the long-term.
Ari Whitten: I definitely agree. Like, there’s a mismatch. If you’re taking somebody who’s generally sedentary, who’s not somebody who’s extremely physically active and doing high intensity activities—and they’re consuming lots of carbohydrates, I would definitely agree that’s a mismatch.
Dr. Sarah Myhill: Good, we agree on that! But what this means is that, the starting point to treat all my patients with chronic fatigue syndrome and all my patients with ME is: diet. They’ve got to get the right fuel in the tank. Now, this is probably the most difficult thing that I ask my patients to do. But, it is within the power of us all to do it. You don’t have to go to expensive clinics or on outside the world to do this. Everybody controls what they put on their plate; everybody controls what they eat. And the PK diet is like saying, that is non-negotiable. And that done well is absolutely the starting point.
So people always ask me, “Well, what do you eat?” And I only eat twice a day; I never snack. And I do that because I know I’m an addict at heart, and if I start eating carbohydrates, I can’t stop eating them. So I just eat fat and fiber. Meat. Breakfast will be a good old-fashioned fryer. I’m very lucky—I have my own pigs, so I have my own bacon and sausage and eggs. Maybe mushrooms. I make a PK bread (which is linseed-based) and that is my breakfast. And then that’s it until the evening meal, which will start with my PK bread (which is 2% carbohydrate high in fiber), and then main meal will be meat and green vegetables, and then pudding will be maybe coconut milk (and I have a lovely coconut milk, with only—again—2% carb) with [berries]. And that diet is absolutely starting point. And if you’re going to teach your patients effectively how to do this, and understand the ins and outs of it, and the difficulties, you have to do it yourself. You have to lead by example.
Ari Whitten: Sure.
Dr. Sarah Myhill: And that’s why I’ve written the Diabetes book, The PK Cookbook—and there’s chapters on this in every book I’ve written, because it’s such an important part of that.
Ari Whitten: Yeah. So just quick question. There are a lot of stories (I’m sure you’ve encountered some of them) of people—I think this is especially true of women—who try long-term ketogenic diets, and then after three months, six months, nine months, something like that, they generally—they often report that their symptoms were made worse, and they crash, and they experience all kinds of health problems that generally resolve when they reincorporate carbohydrates. And there’s also some pretty well-known keto advocates that have been around for a long time who kind of warn of the dangers of long-term ketogenic diets, and talk about incorporating carbohydrates, at least cyclical in some capacity.
I’m just wondering if you have any thoughts on that, or if you really recommend keto all the time, forever.
Dr. Sarah Myhill: Okay. If they—and as you rightly point out, this problem is more common in women—if they cannot keto-adapt, is almost always because they are hyperthyroid. Now normally, the body uses thyroid hormones to fat-burn. If it can’t, if it doesn’t have the thyroid hormones for whatever reason, it’ll switch to using adrenaline. And that’s no good at all. No, you can’t run the body on adrenaline; that’s a short-term stress for them. So those that fail to keto-adapt within two or three weeks, immediately you think hypothyroidism, and do the test, do the blood tests, look at your temperatures, look at the clinical picture… But so often a supplement of thyroid glandular—such as that the best-case [thyroid] are Armour Thyroid or Metavive—makes the world of difference. Suddenly they can fat-burn easily, and all those problems to keto-adapt then just melt away. And hypothyroidism is very common.
Ari Whitten: Yeah. So I think we might be talking about two different things. One is this keto-adaptation period at the beginning where there’s this kind of well-known “keto flu” and this adaptation period of training your body to be more metabolically flexible and burn fats and ketones for fuel—can be challenging and can make someone feel bad temporarily. But actually, what I’m talking about is, there’s a lot of reports I’ve seen—honestly, probably half of the people I’ve seen who go keto successfully for long periods of time, and honestly, I think a large portion can’t adhere to the diet for anything longer than a few months…
Dr. Sarah Myhill: They are the ones that are hyperthyroid.
Ari Whitten: Maybe. I think there’s just—I think, for the reason you mentioned about carbs—a lot of people like carbohydrate-containing foods, so it’s also hard to just chronically deprive yourself of foods you like. But there’s a large number of reports I’ve seen of people saying, “I went keto, I felt amazing the first three months; I felt amazing the first 5-6 months, and then I crashed hard, and then I started to experience health problems.” So these seem to be people who are keto-adapted, but after a period of time of several months of staying in that place, then they start to experience problems. Have you seen that at all?
Dr. Sarah Myhill: Well, yes, I have seen it. And when you actually look at the nitty gritty of their diet, [inaudible] slipped. And they’re like, “A bit of this or a bit of that,” and they end up in what I call, “the metabolic hinterland”, which is the worst of both worlds. Because in “the metabolic hinterland”, you can’t get fuel from carbohydrates because you’re not eating enough of it. And you can’t fat-burn because you’re having a little bit of carbs, you’re spiking insulin, and that switches off fat-burning.
So whenever somebody comes to see me, if they say to me, “Yes, I am PK diet,” I always say, “I want to know exactly what you are eating.” It’s not good enough to say, “Yes, I’m PK.” And there’s always a slip-up—they think sweet potato is okay, they think cashew nuts are acceptable, and/or they think that artificial sweeteners are okay. And artificial sweeteners are not okay! Why? The body’s intelligent. If it tastes something sweet in the mouth, it will anticipate a sugar spike, and poor out [inaudible] in anticipation of that. And that switches you right out of ketone-burning, right out of fat-burning.
So I hear what you’re saying, but I would want to know in each individual case what the issue was. Now, if I had somebody who was truly well, doing the keto diet properly, and experienced that, they’re almost certainly are hyperthyroid. And [one of] the possibilities is they run out of carnitine, because you need carnitine in order to get ketones into mitochondria. And the other thing that people often forget is, when you’re on a keto diet, your requirements for salt increase, and therefore you should be eating more salt. And just lack of salt will make people fatigue, as any Roman centenarian will be able to tell you.
Ari Whitten: Interesting.
Dr. Sarah Myhill: So I am absolutely of the view that the PK diet is [what happened is] evolved eating. It’s what all other mammals consume. Horses, cattle—they just live on fiber. You give them starches and they end up fermenting up; the horses get laminitis, the cattle get D-Lactic acidosis. So all mammals, and indeed all birds, run on fats and ketones, and it’s only very few species that can run on joule fuel. Pigs can do it; pigs can run on almost any food—and so can humans. Now the reason we evolved that ability is because, in the old term, we have a free bonanza of carbohydrates! We have fruit, we have honey, we have root vegetables—and if we eat those foods in an addictive way during the autumn, we get fat. And getting fat in the autumn is survival value for the winter. But primitive man gave up eating those carbohydrates because he had no choice. He ran out of them. He would gorge himself on bananas and fruit and get fat, and then the food supply would run out. And you’d be back to Ketogenesis.
Ari Whitten: So just to be clear—I want to just clarify one thing, which is: you’re saying, this is kind of how we evolved? This is—the natural diet is to be on a ketogenic diet? So are you saying that our ancestors—historically, our hunter-gatherer ancestors—existed on a ketogenic diet all the time, or they existed in the winter months on a ketogenic diet?
Dr. Sarah Myhill: Well, certainly in the winter months, and certainly in the spring months, and probably many of the summer months, because the autumn harvest doesn’t arrive until the autumn! And it evolved as a wonderful survival tool because primitive man can get fat in the autumn and survive the winter.
Ari Whitten: Let me just insert some data here: so there’s lots of modern day hunter-gatherer tribes that actually have been studied—for example, the Hadza, the Simani, the Kuna, the Tukisenta in Papua New Guinea, the [Kidivans] who are not quite hunter-gatherers but are close in the South Pacific—so there’s lots of tribes. Many of them are eating carbohydrate-based diets, and many of them exist in in equatorial regions where they actually have access to carbohydrate-containing foods pretty much year-round, so they don’t really have a harsh winter where there’s no carbohydrates available. The [Kidivans] are eating 67% carbohydrate. The Hadza are eating, I think, close to 50%—lots of honey that they get from bees, lots of Baobab fruits, and things like that—berries and various other kinds of fruits and root vegetables. The Tukisenta in Papua New Guinea are eating like 95% carbohydrate, pretty much all root vegetables.
So I’m just wondering—I mean, the actual data on modern-day hunter-gatherer tribes that have been studied, generally does not show any indication of a ketogenic diet. The closest thing would be the traditional Inuit diet, which is obviously an extreme, very harsh, polar climate, where not a lot of plants grow. But I’m just wondering if you can kind of clarify that.
Dr. Sarah Myhill: Well, in my view, if you look at where—I live here in mid-Wales. In the winter, there is nothing to eat except meat. There is nothing that grows. So, whilst those rules may apply to people who live on the equator and have lived on the equator for hundreds of thousands of years and are well-adapted to that, they don’t apply to people who have migrated further away, and they don’t have those carbohydrates available throughout the year. And that’s going to be a large portion of the population. But we have genetic roots which are very different from those guys who live in the equator. And again, the point is that [inaudible] eating carbohydrates gets us to childbearing age. Now nature—once you are beyond childbearing age, evolution-nature don’t care. If I die tomorrow, it doesn’t matter. [And I’ll] pass my genetic flame onto the next generation.
So if you rocket-fuel yourself to childbearing age (which of course is quite young for humans, as teenagers and 20s), then if you’re on the evolutionary scrap heap [thereafter], the nature doesn’t care. If you want to live to a good age, then you have to kind of abide by these evolutionary principles more thoroughly, and get off the carbohydrates. And you look at people in… There are more centenarians in Japan. Now they’re probably not [inaudible] than any other country. Now they’re probably not a perfect ketogenic diet, but traditional Japanese food is fairly low in carbohydrate, so it makes good sense to me. And again, we know that so much modern pathology—cancer, heart disease, dementia—is carbohydrate-driven. (Dementia is called type 3 diabetes.)
Ari Whitten: I agree—if we’re talking refined carbohydrates and refined sugars, I completely agree—if we’re talking about modern processed foods and hyper-processed foods in the Western diet, unquestionably linked with lots of disease, a huge disease burden. However, if we’re talking about things like lentils, or sweet potatoes, or beans, or something like that, I mean, these are decidedly linked with good health, both in randomized controlled trials, as well as the blue zones—the longest-lived healthiest populations in the world—consume diets that are based on those foods. So I do think it’s what you’re saying is reasonable to say, if based on one’s ancestry—if they’ve migrated to very Northern latitudes, for example, then it is very likely that they did have to deal with at least a winter and spring where they were predominantly fat-based. But I don’t necessarily agree with the claim that all of our ancestors—our human ancestors—were consuming a ketogenic diet.
Dr. Sarah Myhill: Okay. But again, those—the tribes that you’re talking about are essentially healthy people, which have been eating those foods and tolerating them fine. But what I see in my ME patients is, they’re carbohydrate addicts, and they have ended up with a fermenting gut with the wrong microbiome, and the whole thing rolls on from there. And therefore, to get those people to a state of health, we have to be paragons of virtue with their diet. Give absolutely no excuse for [wobbly] blood sugars, and no excuse for fermenting gut—both of which are major problems for my ME chronic fatigueian patients. So I hear what you’re saying, but as we get sick and as we age, I do think that we have to go more paleo and more ketogenic in order to stay well and function at a high level.
And I’ll give you an example of the work of Dale Bredesen, who’s a Californian neurologist who reversed—he took 10 patients with Alzheimer’s disease, put them on a ketogenic diet, and reversed their Alzheimer’s disease. It was outstanding results. The point is, now he’s dealing with patients who are necessarily sick and has to go the whole hobby—I mean, with the diets he recommended did not include [inaudible] and sweet potatoes…
Ari Whitten: So, I’ll just play devil’s advocate and I’m not a—by the way, are you drinking a methylene blue in your water there?
Dr. Sarah Myhill: Oh no, it’s just the color of the—it’s just the color of the glass or—
Alternative diets for improving health and reversing disease
Ari Whitten: Okay, I thought that that might be a nice, interesting aside on mitochondrial function and methylene blue. But so the counterpoint that I was going to bring up—and I like Dale Bredesen’s work, I think it’s great—however, I think you can also point to examples where, for example, a vegan high-carb/low-fat diet was in—for example, in Dean Ornish’s work—was responsible for reversing cardiovascular disease. There’s a number of other studies that have shown a vegan high-carb/very low-fat diet can reverse diabetes, and it caused dramatic improvements—
Dr. Sarah Myhill: You will have to send me those references.
Ari Whitten: Oh, I’m happy to! But they’re easily accessible. For example, Michael Greger has videos on it. If you just Google “nutritionfacts.org, diabetes”, you can see him with videos guiding you with the exact references—but I can post them on this page. But keep in mind, I’m not a vegan, and I’m not a low-fat diet advocate. I’m just trying to bring other data points to this discussion so that—because I don’t think it’s reasonable to paint a picture that a keto diet is the only path that can reverse disease, when we have good data to suggest that even high-carb/low-fat diets—if they are whole food-based—we’d get rid of all the processed junk, and the processed refined grains and added sugars. Even those diets can dramatically improve people’s health and reverse disease.
Dr. Sarah Myhill: I know, but you see the trouble is, by saying you could do this and you could do that, you could the other—adds another layer of complication for my patients.
Ari Whitten: It does.
Dr. Sarah Myhill: And what I know is a complicated disease, and we don’t have all the tests to show, you’re doing this right, you’re doing that right, you’re doing the other right. So we have to get some building foundation stones in there—solid—in order to add in the others. And we know without a shadow of a doubt, with a preferred fuel of mitochondria on ketones, and that’s why people should be eating fat and fiber. And having established that, we can then go onto the mitochondrial dysfunction.
And obviously mitochondria—the engine of your car—they’ve got to have the right fuel in the tank. And then they may be going slow because they’re deficient or they’re blocked, and tests help us with that. And then we go on to the control mechanisms, the [inaudible] and the accelerator pedal. And when those four issues are balanced up, you start to get the [big] picture. But if the diet is all over the place, and the trouble is the carbohydrate addicts look for any excuse to put carbohydrates in there. And if they say, “Oh, I found a study where this diet worked and I can eat high carbs,” then I say, “No, no, no, no—that’s not acceptable! It’s back to square one. You’ve got to do the PK diet.” And what I find is that the people who didn’t have the greatest problem with addiction have the best rationalizations for not doing the paleo-ketogenic diet.
Stages and severity of chronic fatigue
Ari Whitten: Yeah, I wouldn’t debate you on that; I’m sure that’s the case. So I want to come back to something you were explaining at the beginning as far as your big-picture paradigm of chronic fatigue, as far as energy demands exceeding energy supply. Now, do you see this as a spectrum of chronic fatigue of different degrees of severity? And where does the cutoff exist for when it’s chronic fatigue syndrome?
So let me just add one layer here, which is: there’s obviously more mild states of fatigue that wouldn’t necessarily be characterized as chronic fatigue syndrome: somebody who’s just sleep-deprived and stressed at work, and they just haven’t slept in a couple of weeks enough, and they’ve got too much stress in their life, and they’re going through a hard time, and they’re going to be much more tired than normal. So, how do you conceptualize this kind of continuum of fatigue, and what is the criteria for when you think it’s chronic fatigue syndrome?
Dr. Sarah Myhill: Well, anybody who is not functioning at 100% their potential arguably has a chronic fatigue syndrome. It is just a descriptor. And chronic fatigue—because when they say the gap between energy delivery mechanisms and energy expenditure starts to narrow—I mean, one guy came to see me and his definition of chronic fatigue syndrome was that, he could only do his marathons in 2 hrs 40! And he had exactly the same work as my other patients, and you’ve got it down to 2 hrs 20, and he was a very happy guy—[I went to one of his] marathons. So I don’t find these definitions terribly useful; they are just symptoms. And if people and doctors accepted that, then we will be much more effective at preventing chronic fatigue syndromes and ME, which sometimes results when you haven’t got the energy dealing with the infection.
Then if we say, “Oh no, we’re not going to diagnose you until you’re that sick; we’re not with diagnose you until you can’t get out of bed,”—I don’t have a kind of shaped diagnostic category of chronic fatigue syndrome and ME. Anybody who’s not living their full potential has chronic fatigue syndrome, and we need to ask the question, why.
And all the things that I apply to my patients, I apply to myself. Why? Because I want to live to my full potential! Energy’s my most precious possession. I love spending it! Love spending it mentally, physically, emotionally—[trotting around the garden] and so on. And so I prepare with a lot of effort to make sure I got lots of energy. So I discipline my diet, I discipline my sleep, I take basic practice of supplements—I don’t burn the candle at both ends.
Ari Whitten: Yeah.
Dr. Sarah Myhill: And we should all be doing this.
Ari Whitten: Yeah, I’m with you. So it sounds basically like you see it as almost a perfect continuum without a lot of distinctions. It sounds like you don’t really see chronic fatigue syndrome, per se, as a distinct thing. It’s basically just, arguably, a more severe version of the same thing that is characterized by more mild states of fatigue.
Dr. Sarah Myhill: Absolutely! And say, we’d be much better doctors if we all thought of things like that. In fact, I now see the whole of life through—from the energy perspective. And of course, when we’re young, we have very efficient energy-delivery mechanisms, which means kids can often get away with eating complete rubbish. They then have their mitochondria buzzing because they’re young and work well, and haven’t had any chance or time to acquire thyroid and adrenal disorders. So the young got lots of energy to spend. And guess what: as parents, we run around making sure they’ve got lots and lot of food, and they don’t have to work, and all they have to do is trot off to school—so young people are bursting with energy.
And then as we age, our energy delivery mechanisms become less efficient. Maybe we don’t eat as well as perhaps we should, and then we’ll become deficient in things because we don’t absorb micronutrients as efficiently as we should, and then we get infected because that’s the nature of life. We’re going to go through life picking up infections. The whole thing starts to crumble down. So by the time you get to 80 or 90, you’re expected to be fatigued. You’re expected to potter around and crawl from one situation to the next. That’s normal. It’s aging. Yeah, but what is aging? And that’s why I have to ask that. You can’t put things down to, “Oh, it’s your age.” There has to be a mechanism for that. And if you always think causation, you always tried to distill things down to their component parts, then you have a good chance of fixing them. And say, the data is the starting point. Again, the reason why the mitochondrial engines—like I call it—the reason why they are so important is because they determine energy delivery at the cellular level.
And if mitochondria goes slower in the heart, you get heart failure. If mitochondria goes slow in the brain, you get brain failure. If mitochondria go slow in the kidneys or liver, you get kidney and liver failure. So they are such an important engine, and mitochondria are a common engine to all mammals and all plants. So my little dog [Max] has the same mitochondria as I do. So do those cows out there; so do those sheep out there. It’s a fundamental biological union.
Now, I got interested in this in the 1990s, that mitochondria might be implicated in chronic fatigue and energy delivery mechanisms. And that’s why I teamed up with Dr. John McLaren-Howard to develop mitochondria function tests. Now, those tests are technically very difficult to do, and [this lab is] currently trying to redo those—reproduce them in Germany. But even without mitochondria function test, we can still help patients, because I’ve now done, I think—last count was 984 of them, and essentially mitochondria goes slow because they’re lacking the raw material to function.
And I started getting interested in this after reading Dr. Stephen Sinatra’s book, The Sinatra Solution. He is a cardiologist, and demonstrated that, of course, mitochondria is central in cardiac OR cardiac disease, particular cardiac failure. But by giving what he described as, “his awesome foursome supplements”—D-ribose, magnesium, CoQ10, and [inaudible] L-carnitine. He saw a reversal of cardiac pathology. Why? Because he was correcting the mitochondria.
Funny enough, I’ve just been dealing with a patient recently, who had very severe heart failure, and he had most appalling prognosis. We started him on the “awesome foursome” of those supplements, and clinically he got—he’s markedly improved so much so, he was able to go play badminton again, something he would never consider doing. And he went back to the Brompton for a follow-up, where he had his usual echocardiogram, and they told him his ejection fraction was 5% of what he should be. They looked at him and said, “You should be dead! Nobody functions with an ejection fraction 5%.” Now I can’t quite square that with the mitochondria stuff, but we were doing something very right. He was off his drugs of heart failure, he was just taking nutritional supplements, and he was playing badminton. So he was substantially improved.
So mitochondria may be going slow because of those deficiencies, OR they may be going slow because they are blocked by something. The obvious thing that would block it would be organophosphate pesticides.
Now the business of making energy is called oxidative phosphorylation. And guess what? It’s blocked by organophosphates. What is the most widely used pesticide in the world? Glyphosate. Glyphosate is an organophosphate. And it may well be that that is a major problem for mitochondrial dysfunction in the West. And guess what? When we do toxicity studies, it’s not uncommon for organophosphates and glyphosates to appear as cause of blocking. But it’s another major cause of blocking of products of the fermenting gut.
And this brings us back to diet again. Because if you have a fermenting gut, you are producing products like alcohol, D-lactate, hydrogen sulfide, ammonia compounds, and all of these have the potential to inhibit mitochondria.
The effectiveness of probiotic supplementation
Ari Whitten: Speaking of D-lactate, there’s been some studies recently that have come out on actually probiotic supplementation showing that certain kinds of probiotic supplementation may actually cause D-lactic acidosis like you can—as a result of consuming these potentially healthy supplements (or sometimes healthy, depending on the strain), some strains seem to make your gut produce tons of D-lactate, which actually can make you unhealthier. Do you have any thoughts on that, or have you seen that research?
Dr. Sarah Myhill: Well, I’m very aware of that, yes. And I’m also very aware that many of my patients just don’t seem to tolerate probiotics. Some people get great benefit from them. But the bottom line is that, probiotics that you buy in a capsule or in a ferment are all oxygen-tolerant; they will survive in oxygen perfectly well. But actually 90% of most of the prebiotics in the gut are anaerobes—they don’t tolerate oxygen at all. And what that means is that we can only get 10% of the gut microbiome in a capsule and 90% fit. We cannot swallow. And you’ll probably wear a fecal bacteria therapy, which of course is the only way you can properly recanalize the gut with anaerobic microbes.
Ari Whitten: Just out of curiosity, what about something like kimchi or sauerkraut?
Dr. Sarah Myhill: I agree there are some anaerobic bacteria in there, but if your gut is functioning properly, they shouldn’t survive the upper gut. The upper gut should be a sterile, acidic, digesting gut that kills all bacteria that are consumed. Even dead bacteria will do some good in the gut further down, because of the enzymes that contain it because they’re a new programming. But I don’t think you can expect to recanalize the gut using probiotics, whether it’s kimchi, or sauerkraut, or whatever—simply because if your gut is working as it should, then the upper gut should sterilize that. [Because if they] don’t do good [en passant], but they won’t—you can’t expect the microbes to recanalize the gut. You’d have to have a special gut preparation for that to happen, is my guess. And the only really effective way to [not get] the gut would be to use the Thomas [Floridi] techniques that he developed in Melbourne, whereby you sterilize the gut and then introduce fecal samples from a fresh donation from a guy who has got—or from a woman—who has got a healthy gut microbiome.
Ari Whitten: Do you do that in your practice?
Dr. Sarah Myhill: No, I don’t, because what I find is, if I put all the other things in place, that very rarely becomes necessary. And all the other things are—you have the ketogenic diet, the paleo-ketogenic diet with lots of fiber. And another very useful tool that I find myself using all the time is: vitamin C. Now, the joy of vitamin C: it’s cheap, it multitasks, anybody can get it. And the point about vitamin C is, you can choose a dose of vitamin C that is sufficient to kill the few, maybe a hundred thousand microbes in the upper gut, but not the trillions in the lower gut. And that’s called taking vitamin C to bowel tolerance. And it’s a tool I very regularly use to treat the fermenting gut. Because you can up the dose, and up the dose, and up the dose—until you start to get loose stools [inaudible], and then you write about [inaudible], you just drop it back a little. So most people need 8-10g a day to get to bowel tolerance. But those who got a major problem with upper-fermenting gut, or those who are very toxic, or those who’ve got a large infectious load, may need 30, 40, 50 or 60 grams to get to bowel tolerance. And the job of vitamin C is that it multitasks. It doesn’t just sort out for [inaudible] gut; it’s a starting point to treat any infection, whether it’s chronic or acute. It’s a very good antioxidant; it helps us to detox, and so on. So it’s a great tool. And that combination of the paleo-ketogenic diet combined with vitamin C to bowel tolerance is one I use a lot.
The effectiveness of vitamin C
Ari Whitten: What’s the protocol for that? So is it something that you recommend vitamin C indefinitely, or just for an initial phase of, let’s say, a week or two, and it’s very high doses, and then you scale it way back?
Dr. Sarah Myhill: No, it should be used—well, it depends on how sick the patient is, but it should be used indefinitely. I mean, humans, fruit bats, and guinea pigs are the only mammals that can’t make their own vitamin C. So dogs, goats, horses, cows—when they get sick, they can scrape up and ramp up the body’s own product of vitamin C to deal with any infectious challenge. And then it drops back down again.
Humans can’t do that. It’s a four-enzyme step; we’ve lost one of those enzyme steps. So we have to use our brains to achieve the same thing. And thankfully, we are intelligent like that. You can easily manufacture [inaudible], and we have used our brains to take it to best advantage. [inaudible] I always put Linus Pauling, [inaudible] who received two Nobel prizes in his own rights for [inaudible]. He devoted the last third of his life just to the research for ascorbic acid in vitamin C, and maintained one of the most important tools we can use for longevity and good health. And I think you’re absolutely spot on.
Ari Whitten: Yeah. I want to circle back to mitochondria for a minute—you were talking about some of the ways that mitochondrial function can be inhibited. At the end of our podcast a couple of years ago, I mentioned Robert Naviaux’s work to you on the Cell Danger Response. I’m curious, did you actually look into that at all?
Dr. Sarah Myhill: Oh gosh, yes! He goes into enormous depth and I think his work is fantastic, but we have to step back and ask ourselves, what happens in the Cell Danger Response? And basically it’s not the mechanism by which the body stops itself spending too much energy. So initially, when a cell is challenged, it pauses that energy to fight that challenge, whatever it may be—infectious challenge or toxic challenge or whatever. But it knows it can’t spend energy endlessly; it would just die. And therefore it has to greatly ramp down energy generation and cell mechanics and cell metabolism, in order to just to survive. It’s [effectively]—cell goes into almost the hibernation phase, and of course that’s going to manifest clinically with a chronic fatigue or an ME.
So yes, he’s done some fantastic work there.
Ari Whitten: Yeah. Very cool. I’m glad that you had some time to look into that. I feel like it connects so well with everything you are already doing. I was amazed that you hadn’t encountered it before, but I feel like it was going to be such a fun thing for you to read his work and connect the dots with what you were already doing.
Ari Whitten: Related to mitochondria, a couple other things that I wanna mention here. One is: are you familiar with Garth Nicolson’s research on lipid replacement therapy at all?
Dr. Sarah Myhill: Absolutely, yeah. In fact, at the conference (about ’97) I think I sat next to him and his wife, Nancy, and we had a long chat.
Ari Whitten: Nice. I mean, there’s some remarkably impressive research on people with fatigue in just a matter of—some of the studies are 4 weeks, 8 weeks, 12 weeks—showing huge reductions in fatigue just from using phospholipid formulations to replace some of these damaged phospholipids into mitochondria.
Dr. Sarah Myhill: Correct. It’s one of the wonderful tools, which I call, it multitasks. It helps the detox, it’s going to be anti-microbial, it rebuild membranes, organize cell chemistry more efficiently, and so on and so forth. So yes, it’s a fantastic tool. My [inaudible] doing intravenous therapy here; it is expensive, it’s unaffordable for many of my patients. But yes, it’s a very useful tool that we can always move on to. [Thankfully] I have a colleague, Dr. [inaudible], who does do this, and yes, I refer patients onto her if I got stuck. We felt that was appropriate.
Ari Whitten: So actually a lot of the studies are just using an oral formulation—or oral phospholipid formulation.
Dr. Sarah Myhill: Yes, well I do that almost as a routine part of my treatment—for the basic package of somethings that people get would include high-dose phospholipids, and lecithin, and [inaudible]. So that’s part of the standard workup. I wouldn’t do that in isolation. The condition is, one of those things where the more tools you can use to tackle the problems that are going on, the better the chance of success. And because it’s hard work and it’s expensive, we have to start off in the cheap and cheerful, so like diet, and basic supplements, and vitamin C, and [mitochondrial supplements], and then build it from there. And I have to say, the most frustrating aspect of my work is when I know exactly what’s got to be done to get that patient well, but they don’t have the resources to be able to put those things in place.
The importance of melatonin and sleep
Ari Whitten: Right, yeah. I’m curious, also, if you’ve looked into melatonin and mitochondrial function. There’s some really fascinating research on how melatonin may be the single most potent protector of our mitochondria. And obviously, this connects with the fact that in the modern world, we’re all being exposed to so much artificial light in the evenings that it’s suppressing our brain’s natural production of melatonin—this thing that most people just think of as a sleep hormone, but people don’t realize, it’s also—like I said—this probably the most powerful protector of our mitochondria. I’m just curious if you’ve read any of that research, and if you have any thoughts on kind of sleep and melatonin, and all of this picture of chronic fatigue.
Dr. Sarah Myhill: Of course. I mean, the point here is that no mitochondria are generating energy. You cannot use energy without producing free radicals, and free radicals are extremely damaging. Every living cell unit in the world has to have—right down to bacteria—have to have a period of quiescence when they shut down, and the healing repair mechanisms can move in. And that’s what melatonin triggers. And that’s why sleep is so important. We can easily test—melatonin is a simple a saliva test, and yes, you want the optimal amount of melatonin. So again, as part of my standard workup, I would talk at length about sleep: When you’re going to sleep? What’s your quality of sleep? When do you wake up? And if it’s less than perfect, yes, let’s measure melatonin levels. Absolutely essential part of healing and repair.
Ari Whitten: Excellent. In your book, you spend a lot of time talking about immunological holes in the energy bucket. I think it’s maybe the bulk of your book—or a big chunk of it, at least—is talking about that. And then you have a section on reprogramming the immune system. Can you talk a bit about what “reprogramming the immune system” entails?
Dr. Sarah Myhill: One of the problems of switching the immune system on is there’s no guarantee that it’s going to switch itself off. So many patients have their ME triggered by a flu-like illness, and as if the flu has never gone away, the new systems never dealt with it properly, it remains in an activated form. Now, the trouble with modern Western lives is they’re very pro-inflammatory. There are lots of things that we do that switch on inflammation. The obvious one is high-carbohydrate diets: sugar tends to switch on inflammation. Allergies to foods like gluten and dairy (which are very common) tend to switch on inflammation. We vaccinate so much, and guess what vaccination does: it tends to switch on inflammation in the body. And we now know that many autoimmune conditions are switched on by vaccination.
Using metals in surgery for hip replacements or knee replacements—many of those metals are immunogenic; they switch on inflammation. And once we switch the information on, it’s very difficult to switch it off. And so sometimes, we need extra tools to do that. Now some of those—they are natural anti-inflammatory that we can use, like melatonin for example, like vitamin D (high-dose vitamin D is a good anti-inflammatory), and vitamin C again—helps to stab that inflammation. But sometimes we need use immune-therapy, if you’d like, to reprogram the immune system. Now the one that I’d been using for decades (since the early 1980s) is enzyme potentiated desensitization. I think in America it’s called a low-dose antigen LDA. But that is a profound benefit in switching off allergies, and maybe help in some autoimmune conditions.
In this country, neutralization is used in a few centers. On the continent, there’s a technique called micro-immunotherapy, which is preferred. So there are various techniques for switching off a badly or incorrectly-programmed immune system. What you have to be mindful of is that the newly-switched system maybe switched on for very good reasons. Why? Because there’s a chronic infection there. And that chronic infection might be tuberculosis or hepatitis, and that’s something that the conventional doctors are very aware of. And guess what all those conditions will present with: the chronic fatigue syndrome! But increasingly, we are seeing infections that the conventional medical profession do not recognize, the most obvious, of course, being Lyme disease, infection with Borrelia, the Epstein-Barr virus (mentioned by Dr. Martin Lerner’s work earlier), mycoplasma—that’s what Geoff Nicholson was doing: he recognized that many cases of Gulf War syndrome were caused by chronic load infection [inaudible]. And the one I’ve become interested in most recently is the idea that many ME patients have a chronic fungal infection.
Now, you may be aware of the work of Dr. Joseph Brewer, who demonstrated that 90% of ME patients carry a load of mycotoxins. He established that by developing a urine test to measure mycotoxins in the urine. Now you’re going to say to me, “What are mycotoxins?” If you look at life from the point of view of a bacteria or of a fungi having made itself come [to a home] in an environment, it doesn’t want anybody else moving in; it wants that environment for itself, and therefore it produces toxins to prevent that happening. In the bacterial world, we have clostridial toxins, we have tetanus toxins, we have staphylococcal toxins. In the fungal world, we have mycotoxins. So for example—the examples we will know about would be penicillium, which produces penicillin. Fungi produce catalyst spores, fungi produce streptomyces. So many antibiotics are actually fungul mycotoxins, but they’re all mycotoxins, which are very toxic to us, like aflatoxin, like ochratoxin, like mycophenolic acids. And these we can measure in the urine. And this is what Dr. Brewer did. Simple urine tests having demonstrated the presence of mycotoxins in you.
And he then asked the question, “Where are these coming from?” And what’s so fascinating is that he showed that most of them exist in the upper airways and the sinuses. And he used topical antifungals—systemic antifungals—to reduce the fungal load in the airways. In those patients that tolerated the treatment (about 34% didn’t), 80% [inaudible] saw worthwhile clinical benefits from that. And that was paralleled by falling levels of mycotoxin urine. So that’s a very useful clinical study. And in my ME patients, that has been a very useful clinical tool. So anybody who presents with a history of sinusitis, rhinitis, postnasal drip, polyps, [inaudible] conditions—always think mycotoxins. They may well have a chronic fungal infection of the upper airways, and that is kicking an immunological hole in their bucket by activating the immune system and actively poisoning them, because these, been no doubt, are poisonous. They’re nephrotoxic, they’re immunotoxic, they’re [hydrotoxic], et cetera. So that has been a very useful addition to my armamentarium since we last spoke.
Dealing with the many layers of chronic fatigue
Ari Whitten: Yes. Very interesting. So I want to point something out here that I think is important, which is: you’ve talked about a lot of different potential contributors to chronic fatigue. I think a lot of people have a tendency—I think this is a very human tendency—to kind of latch onto one specific thing and say, “Ah, it’s the mycotoxin! That’s what it is! So now—my next attempt to cure myself will be to use antifungals in my upper respiratory tract!” Or, “It’s the gut! And so I need to just fix my gut and that’s the thing!” Or, “It’s the Epstein Barr-virus, and I need to just kill off the Epstein Barr-virus!”
I think if you really pay attention to what you’re saying here—and please correct me if you disagree with my interpretation—is that, there is widespread dysfunction in multiple systems of the body. So latching onto just one of these layers and trying to just attack that one layer is almost guaranteed to result in failure. Is that…?
Dr. Sarah Myhill: Correct. Getting people from chronic fatigue is like building a house. You could get all the foundation stones in place first with the diet and the sleep and the micronutrients, and then you build on that with the micro-stuff and the thyroid stuff and the adrenal stuff. And then you look for the immunological holes. You have to see the whole picture. And the important bit about this is, this isn’t just a treatment for chronic fatigue. This is the treatment for the whole of human disease. You put all this stuff in place and you will live a long life to your full potential, and you won’t get cancer, and you won’t get heart disease, and you won’t get dementia. You see it as investment in the future, and yes, it’s hard work now, but one of my favorite Chinese saying is, “If you don’t change direction, you may end up where you’re heading.” That’s why I say to my patients, “I can see that you’re heading for the rocks. There’s disaster ahead! Change direction now BEFORE you get that nasty diagnosis! Don’t give me a ringer in a year’s time saying you’ve had a heart attack or you’ve been diagnosed with dementia. Do something about it NOW because I can see where you’re heading!”
Ari Whitten: Yeah, I think that’s a nice segue to what I also wanted to add to this, which is—given that there’s this widespread dysfunction, the way I see this happening is, let’s say, it might start—and there’s probably 20 different scenarios that could occur—but let’s say it just starts with somebody being overly stressed, and then being sleep-deprived from the stress, and then going through a period of maybe mild or moderate fatigue, but if that continues, and then maybe they have some traumatic thing that happens in their life, and then they get Epstein Barr-virus, and now they have post-viral fatigue that’s much more severe, and as this goes on, if they don’t take really serious action to correct their health and bring themselves back into balance, if this goes on for many years, things can spiral out of control, and now multiple systems of the body start to dysfunction: you get chronic inflammation, you lose your immune health such that you now get infections with mold and with chronic viral infections—and all these other things are getting out of control…
When we talk about something like a chronic Epstein Barr-virus infection, or the chronic mold infection, from my perspective, it’s just important to understand that those things are usually very downstream. Those things are usually like, much later on after lots of initial causes have already generated very severe dysfunction in the body. Would you agree with that?
Dr. Sarah Myhill: Correct. I absolutely agree with that wholeheartedly. And that’s why, when somebody comes and sees me, I want their history from birth. What happened as child? Did they get sick then? What were they like as teenagers? Did they have Epstein Barr-virus? Did they get irritable about it?—so that I can see the progression. And as you put all these interventions in place, then that whole thing goes into reverse. But you’re so right. Say we didn’t have a diagnostic [partly] for pain. And we just said, “Oh, you’ve got chronic pain syndrome.” Would anybody say, “Oh, well, have I got a pain in my foot? Is my foot there at all? Is it active? Is there a chronic infection?”
We are much more analytical about pain than we are fatigue. They’re just subjective symptoms, aren’t they? So you are so right. We have been brainwashed or less by doctors into believing one symptom, one cause, one drug to treat it. And it’s just not like that! It’s the whole thing. If your car’s going to go, it’s got to be regularly serviced, it’s got to have the right fuel, you’ve got to get the engine timing right—and the body is infinitely more complicated than a car. But the general basic principles are the same. We have to do as much as we can, for as long as we possibly can, with every inch of our strength—or every ounce of strength, rather—in order to function to our potential.
And believe me, it’s always going to be a battle. We know it’s a battle that we’re gonna lose. If I lose that battle when I’m 100, I’ll settle for that. Bloody good in life, I’ve thoroughly enjoyed myself, and I’ve got the most out of it—and that’s what I want for my family, my friends, and all my patients, too. And what I’m saying is, it’s within the power, too! And what do the doctors do? The symptoms’ suppressed, and this, I have to say, drives me insane because we have symptoms for good reasons. They stuck with me—they protect us from ourselves. And what’s the man on the street do? His symptom suppresses with addictions. His symptom’s suppressed his fatigued with caffeine. His symptoms suppresses stress with alcohol and nicotine. His symptoms suppresses fatigue with, what, maybe he goes out and get cocaine the next year or whatever. That’s just [inaudible].
How universal basics are more beneficial than individually-personalized therapies
Ari Whitten: Yeah. One of the other things I want to mention here—I think what your commentary on the conventional medical approach is very pertinent, but also—I think, within more holistic medicine and functional medicine communities, there’s also one distinction that I think is important—and this is not true of all practitioners certainly—but I think is true of a lot of them: there is such a hyper-focus now on the personalization aspect that everybody is a unique individual, and that we need to find out this specific person’s unique triggers. And so we do this battery of tests and we identify their unique things and it’s this genetic variation of the MTHFR gene and, and COMT gene; and this gut test showed this and this organic acid test showed this—and so we do these very targeted interventions. And I think a lot of those practitioners are skipping over the foundational steps that you’re talking about here, which are these universal basics of, as you said just now, we got to—before we even get there—we gotta get the diet in place, we got to get the sleep in place, we got to get stress management in place—all these other foundational pieces must be in place. And these are the universal basics that apply to everyone, I personally believe are the most important thing and are the biggest factor in recovery, not the hyper-personalized very-targeted therapies, but the universal basics, I think, cure a huge percentage of people.
Dr. Sarah Myhill: I so agree with you. And as I get older, my medicine gets more simple because what I know is that the basic things, done really well, get you an awful long way there. I mean, for example, I never do gene studies. Why? Because they’re not sufficiently prescripted. They don’t tell you exactly what’s going to be done. They just tell you when you might have a problem here, and you might have a problem there.
90% of disease is environmental. Only 10% is genetic. So get the environment as best as you possibly can, and the important thing about this is it’s within the powers of everybody to do this. You don’t have to have any expensive [conventional] doctor who does fancy tests. You just get your act together, and do the diet, do the vitamin C, and take the basic [inaudible].
And all the details are in my book. Anybody can access those. You can’t afford the book, it’s all on my website. The information is there, the dose of this, the dose of that, the detox region—is all there, free. (It’s just some people prefer the book version, but [you know I] hated the books.) But these tools are at everybody’s disposal. Okay, there will be the rare occasion when you diagnose Lyme disease, and yes, you’ll need the [patented] antibiotics, or you’ll have done absolutely everything and you’re still down with Epstein Barr-virus and you’ll need the antivirus for whatever. But they are right at the end of the road. And I would never start people on anti-microbials until I’ve got full [patch] in face first. Why? Because for many, that’s all they need to do. I mean, if I tested people off the street, 90% of them are going to test positive for Epstein Barr-virus; we’ve all been affected by it. But those people who get practitioners—they’re the ones who are right on the edge. They’re living life on the edge of the equation and they haven’t got the energy to deal with that, and then they fall into a hole.
Ari Whitten: And so their body’s reserve capacities is so low that their body is not able to keep the Epstein Barr-virus at bay.
Dr. Sarah Myhill: Correct. It switched into Robert Naviaux’s Cell Danger Response. They haven’t got the energy to deal with it, and they just go into hibernation until they hope things will pick up and normal function can be restored.
Ari Whitten: Yeah. I want to be sensitive to your time, but I have a couple more quick questions. One: I want to contrast this paradigm that you’re painting here—which I very much agree with, by the way—it’s the big-picture paradigm: the focus on these universal basics, addressing multiple factors, the fact that it’s not just “one cause, one treatment”’s going to fix it, but it’s this big-picture paradigm of how do we bolster the health of the entire system of our body through many different strategies—from nutrition to many other lifestyle factor strategies—as well as maybe targeted therapies for specific things. But there are also other approaches out there that are—for example, the Ashok Gupta method, or the Lightning Process, and kind of these very stress-focused approaches that kind of conceptualize chronic fatigue as almost entirely caused by psychological and emotional stressors.
And so the solution therefore is to lower your stress load, to stop negative thinking, to meditate, and do other kind of cognitive behavioral processes to reduce psychological stress. I’m just wondering if you have any thoughts on that approach?
Dr. Sarah Myhill: There are certainly people who have been improved by that. The point here being is that, the two biggest holes in any bucket or the immunological hole we’ve talked about: an emotional hole. You can use up a huge amount of energy that the brain going ‘round, ‘round, ‘round, thinking about things and almost being out of control of their thoughts. And we know that hyper visions in childhood, sexual abuse in childhood, physical abuse in childhood, bullying—are all major-risk factors for chronic fatigue, because I say that just kicks a hole in the energy bucket. It stops people sleeping well, and so on and so forth. I mean, as we speak, I am doing it: a lot of work with soldiers, with veterans of wars with post-traumatic stress syndrome, and they have discovered that there are ceremonies that they can attend in South America using [Ayahuasca] or various traditional herbs where they can kind of relieve those experiences and hopefully dismiss them. And they’ve been substantially improved that way. I don’t tend to be an expert in that, but these are incredibly fit top guys who are just wiped out by posttraumatic stress.
Ari Whitten: Yeah, and there’s a breakthrough research happening now with MDMA and post-traumatic stress disorder, and it’s actually going through, I think, phase 2 clinical trials here in the United States now.
Dr. Sarah Myhill: Voila! But that illustrates the emotional hole that we can have in our energy bucket. And that fits very nicely into the roadmap as I looked at. Now, I don’t pretend to be as skilled in psychotherapy or good to any—but at least I say, “That’s the problem, matey,” and, “You gotta find a good counselor,” and you improve the quality of your sleep. Again, we seem to be seeing epidemics of posttraumatic stress in them. And I think again, I said, “This has to do with carbohydrate diet.” Because if you are eating a carbohydrate diet, then you’re spiking adrenaline throughout the night. Now as you know, there are two phases of sleep: there’s REM sleep, where we dream and problem solve for the future—and there’s non-REM sleep, where we’re not dreaming, but we deal with the problems of the past.
And what I think happens is that if we are in non-REM sleep with spiking adrenaline, we’re reliving the memories of the day in an adrenalized environment, and thereby perpetuating the bad ones. And interestingly, this means good work done by giving people who with post-traumatic stress, a beta blocker at night, to stop—blocks the effects of spiking adrenaline, and allows them to get rid of their posttraumatic stress much more quickly. It’s been a good treatment for them. So again, first thing I would do with post-traumatic stress is back to ketogenic diet! So you can relive those memories in a non-adrenaline-fueled environment, and deal with them more rationally than otherwise.
Ari Whitten: Interesting. One more comment on another person’s method that I was hoping to get—again, your colleague there in the UK, who’s Raymond Perrin, who is a very nice guy and I’ve had on the podcast before and he’s got a very interesting theory of chronic fatigue syndrome—and he seems very hyper-focused on the lymph system, and has developed a specific lymph-drainage protocol that I have seen some people report success with, but definitely doesn’t seem to be a cure for everyone by itself. I’m just curious if you have any thoughts on his theory and how that connects with what you’re doing?
Dr. Sarah Myhill: Well, again, I see that as another detox technique. And if through the lympathic you can mobilize them and help the body detox, then that’s going to benefit in many ways. If you detox, your mitochondria are going to function better, hormone receptor resistance state is going to be improved… Having a poison in the body is like throwing a handful of sand into a finely-tuned engine: it messes it up in all sorts of unpredictable ways. So yes, I think Raymond Perrin’s a good guy, he’s asking all the right questions, and there’s no doubt his techniques have been helpful for patients. But it needs to be part of the greater package. And I wouldn’t do that as a one-off, “Off you go, boy, let’s see if that one works.” In isolation, it’s not going to work; it’s got to be part of the whole building.
Ari Whitten: Yeah. On a final note, I am wondering if you could leave people with maybe your top one or two kind of big takeaways, or pieces of advice—if somebody’s been dealing with chronic fatigue or chronic fatigue syndrome for a long time now, what are the top one or two things that you want to leave them with, after listening to this interview?
Dr. Sarah Myhill: Well, the most important thing they do is realize there is much they can do for themselves. You do not need an expensive doctor or therapist to get the ball rolling and to make things happen. And the first thing they’ve got to do is the wretched PK diet. Take a basic package of substance. Really think about sleep, and be disciplined about that. And don’t exercise. If you exercise, you would just slow your recovery. And get that basic patch in place, and establish, and then move on to the other things. And the strategies I outline in detail in my books, and they’re there on my website if you can’t afford the books. But we all have it within us to improve matters substantially. I don’t say “cure” because I would never promise that. But certainly is moving in the right direction. And as I say to my ME patients and my chronic fatigueian patients, you may be feeling jolly awful now, but when we get you right, you will have [ideal ideas]. You will get to 80 and 90 and 100 years of age, because you have put in place all those interventions you need to do to not die young from heart disease or cancer or dementia. So there is no excuse for anybody not put these ratios in place for immediate benefit, and for long-term benefit. But it’s difficult.
Ari Whitten: Yeah. Beautiful. I want to recommend everybody listening to get this book off Amazon: The Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis: “It’s mitochondria, not hypochondria.” It’s a great book. It was one of the books that was very influential on me many years ago when I read it for the first time. And I highly, highly recommend it. I think it’s an amazing resource for people dealing with chronic fatigue.
Dr. Myhill, if people want to reach out to you directly, if they are interested in working with you, do you have a place where they can reach out—Can people work with you?
Dr. Sarah Myhill: Well, my problem is time, and actually now I’ve got to the stage where I know I’ve written the important books that needs to be written, and I’m going to start a series of what I call “road shows”. So I’m going to get myself a [little low-bar] and camp with them, and I’m going to go into people’s houses where maybe 15 or a dozen people will gather and we will sit round and I’ll explain how they can sort themselves out. I won’t be treating individual patients. I’ll be saying, “This is the roadmap. These are strategies. This is what you’ve got to do. Here are the books you’ve got to read. This is where you go.” And that I hope then to spread the word more efficiently, and by doing that, more people learn.
I’ve also set up a website just called Natural Health Worldwide where any doctor, qualified health professional, or experienced patient can log in and be available to help others. So it’s a networking system based on these ratios in order to spread the word, and most importantly, to get the message across to people: “You can do it yourself!” I try to empower people, give them the information and the confidence to give it a go.
Ari Whitten: Beautiful. Again, everybody, go grab this book on Amazon. Dr. Myhill, thank you so much for your time. It was really a pleasure to connect with you for podcast number two. I really, really enjoyed this. Thank you.
Dr. Sarah Myhill: My pleasure, Ari. Thank you for your time.
Mitochondria and Fatigue - How to Boost Mitochondria to Beat Fatigue - Part 2 with – Show Notes
What causes chronic fatigue syndrome (1:38)
How the keto diet affects performance (7:38)
Alternative diets for improving health and reversing disease (23:52)
Stages and severity of chronic fatigue (26:56)
The effectiveness of probiotic supplementation (35:33)
The effectiveness of vitamin C (39:45)
Robert Naviaux’s Cell Danger Response (41:00)
The importance of melatonin and sleep (44:38)
Dealing with the many layers of chronic fatigue (52:12)
How universal basics are more beneficial than individually-personalized therapies (58:22)