The Ultimate Guide To Beating Chronic Fatigue With Specific Vitamins, Minerals, Biohacks & More - A Conversation With Dr. Sarah Myhill.

Hey, it's Ben Greenfield, still coming to you from Estonia. Estonia is actually where I am. I'm based. I'm working out of Estonia. I don't get it when people say based. Where you based out of? I'm located in. Living in. My home is in Northern Europe. Right now, I'm living this nomadic lifestyle. My children are going to a little summer school over here called Mind Valley University. I'm going to it, too, actually. I'm attending classes. I'm teaching some classes. It's very interesting. You should check it out. Mindvalleyu. Just Google it. Anyways, though, in addition to that, I'm of course still coming at you with today's podcast. It's a really good one on chronic fatigue with my friend, Dr. Sarah Myhill. And should you wonder if I wound up making the bread that we talk about in today's show? I did. And it's really tasty. It's ketogenic. It's really good for the gut. Amazing. In this episode of the Ben Greenfield.

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The Ben Greenfield Fitness Podcast. Hey, folks, it's Ben Greenfield. And this month I read two of the better books I've read lately on functional medicine and chronic fatigue. And it delves into concepts that not many people are talking about these days. And frankly, the information in it blew my mind. And I wanted to share with you not only these books, but also the physician who wrote them, Dr. Sarah Myhill. And she's a British doctor who runs a clinic over in Wales, United Kingdom. And it's very hard for me to say that without adopting my accent. How do you like that? And she's got like 920 plus webpages and 6 million visits and just tons of info on there specifically about chronic fatigue and something called. And I actually am gonna wanna clear this up with you, Dr. Mihill. You call it encephalitis, I believe. Myalgic encephalitis, me. So you talk about that in the book as well. I wasn't too familiar with that, but apparently it's a big deal when it comes to chronic fatigue. So these two books were Diagnosis and Treatment of Chronic Fatigue Syndrome. And also Sustainable Medicine is the other book. And in that she takes an even deeper dive into basically addressing a lot of the root causes of disease in a way that, again, is a lot different than any books that I've read lately on these topics. So, Dr. Mihiel, welcome to the show.

Thank you for inviting me, Ben.

I know I have so many questions. I know our time is limited. I feel like I gotta talk fast, so my apologies to the listeners if I don't say much, And I let Dr. Mihiel do a lot of the talking. Now, the first thing I just wanted to ask you before we dive into this whole concept of myalgic encephalitis and chronic fatigue syndrome, syndrome is just your overall philosophy of medicine. I think it's intriguing. Can you describe what your overall philosophy of medicine actually is?

The important point about medicine is it's all about identifying the underlying mechanisms that are resulting in disease. Because if you do that, it has obvious implications for management. So much modern conventional medicine has been usurped by the drug companies who use drugs to suppress symptoms. Now, in the short term, the patient feels better because their symptom has gone away. And that might be high blood pressure or low mood or pain or whatever. But we have symptoms for very good reasons. Symptoms protect us from ourselves. And without the symptom of fatigue or the symptom of pain, then we would succumb very rapidly. So, so much medicine, the diagnosis has been muddied because the mechanisms are not being identified and diagnoses are being muddled with clinical pictures. So, for example, you talked about chronic fatigue syndrome and myalgia encephalitis. Many people think, well, that's the same thing.

That's how you pronounce it. Myalgic encephalitis.

Yes, or myalgic encephalomyelitis. But the point here is that the symptom of chronic fatigue arises when energy delivery mechanisms are impaired. Myalgic encephalitis arises when you've got the symptoms of poor energy delivery mechanisms, plus the symptoms of inflammation. And what causes inflammation? Chronic infection, chronic allergy or autoimmunity. So by using that very simple paradigm, we can break down the various aspects of people with fatigue syndromes, or me or whatever. Now, as you probably gathered, my special interest is in chronic fatigue syndrome and me, and that's why I've written a book about it. And always when I speak to my patients, I have to speak in terms that are understandable and immediately grasped by them, because I'm asking my patients to do difficult things. But if they can understand the intellectual imperative as to why they have to do these difficult things, then guess what, they jolly well get on and do it. So in thinking about energy delivery mechanisms, an analogy which I use all along, and it's very apposite, is the car analogy. So if you think of the body as a car, then the fuel that goes in that car represents our diet and our gut function. If you can't fuel the body with energy, then of course, or rather energy giving fuels, then of course you're going to be fatigued. My special area of interest, and I've published three scientific papers now in this area, has to do with mitochondria. Now, mitochondria are the engines of our car.

Yeah, we've talked about those a lot before. In the podcast I interviewed Dr. Mercola, I've interviewed a lot of folks who have talked about like the, the metabolic theory of cancer, how to, how to enhance mitochondrial health. But that's, that's got a pretty good correlation to addressing chronic fatigue syndrome as well.

Absolutely. And at the first paper that we published in the Journal of Clinical and experimental medicine in 2009, showed that those patients with the worst levels of energy were most fatigued, had the worst mitochondrial function and vice versa. And there's a very, very clear cut relationship between the two. So for me that was a very exciting moment because up until then the whole world or the medical world have been saying, oh, chronic fatigue syndrome, it's all psychiatric. And here we had a clear physical, measurable physiological abnormality that directly correlated with fatigue levels. And that was, I have to say, that was a first in the world. So the mitochondria, vital and actually mitochondria, we now know, are implicated in almost any disease process you care to mention. Cancer, as you already mentioned, dementia, diabetes, susceptibility to infection.

Mitochondria are implicated just pain in general, like muscle pain. I had a guy at my house Yesterday, who hurt his back? And I did. I put him on a pulsed electromagnetic field therapy bed, had him do infrared sauna, did like a little bit of hyperbaric and implemented a bunch of tools to enhance mitochondrial health. And within two hours, he felt like a million bucks. Like all of his pain was, was gone. And it wasn't just blood flow to that area. It was also the fact that he just felt amazing because that was the first time in a long time his mitochondria had been optimized.

Wow. Well, you know, that makes perfect sense to me. It's biologically plausible. And you, I mean, with every diagnosis you make, hypothesis, you put it to the test, and if the patient responds as they should, then you can say, well, we got the diagnosis right. And you just cited the perfect example of just that. So mitochondria, absolutely essential. And then we have to look at the control of mitochondria, in particular the numbers of mitochondria in the body. And that accords with the size of your engine and then how fast those mitochondria go. And that is a function, a combined function of adrenal and thyroid function. And I think of the thyroid gland as the accelerator pedal of your car and the adrenal gland as the gearbox of your car. Now, if you look at things from an evolutionary perspective, I always think to myself, if in doubt, ask nature what happened in the past. From an evolutionary perspective, all living creatures had to match energy requirements with energy delivery. Because if there's a mismatch, that's potential disaster. So for example, if I'm walking through the jungle and a saber toothed tiger jumps out at me, I need massive energy delivery so I can run the fastest mile I've ever run in my life. Otherwise I'm going to get gobbled up by that tiger. On the flip side of things, if I'm primitive man and I have a long cold winter ahead of me, I have to economize on spending energy because the food, food is scarce. And if I burn too much energy unnecessarily, I simply won't survive the winter. So getting the adrenal and the thyroid function right to match energy requirements with energy delivery is a really important part of recovery for these people.

So mitochondria, thyroid and adrenals.

Yes, okay. And that also ties in with diet. Now, you're probably aware of the work of Dr. Rind, who talks about his metabolic monitoring of the body, but the point is, is that the sum total of the fuel supply, that is your diet and gut Function, the mitochondria, that is the engine, the thyroid and the adrenal function is reflected by your core temperature. So if any one of those things isn't working well, then you're going to run cold. And if we can assume people have got the diet right, and believe you me, I could speak all night just because about diet and their gut function is good, that is they are getting the goodness from that food and their mitochondrial function is okay. And I've now done all nearly a thousand mitochondrial function tests and I now am fairly confident that I can correct mitochondrial function reliably. Well, that means that the, what's left is the adrenal and the thyroid function. And at that level, essentially the thyroid controls your core, that your basal temperature, your core temperature, and the adrenal gland controls fluctuations. So if you're running very cold all the time, that's typical of hypothyroidism. And if your core temperature is fluctuating very much, then that is typical of poor adrenal function. And the point about using core temperatures is you don't need a doctor to get in the way to do all this. People can do it themselves. They can measure their core temperature accurately with a good thermometer, plot it, look at the charts, and that gives them a pretty good idea whether they've got a thyroid problem or an adrenal problem or a combination of the two.

How do you test mitochondrial function?

Well, I'm very lucky because I have acumen. Laboratories run by John McLaren Howard. Now, he is the most brilliant biochemist that's ever existed, in my view. My view is he should get the Nobel Prize for biochemistry because he takes cutting edge research, biochemical tools, and gives them clinical application. Now, I've been working with John since the late 1980s and throughout the 1990s when he was working at Biolab in London. And in the late 1990s, I asked him specifically to see if he could find a test for mitochondrial function to see how well they worked in. And initially he looked at the various respiratory enzymes to see if there's any correlation. Those no correlation whatsoever. So I then said to him, well, what I really want to know about is ATP. As you know, ATP is the energy molecule. It's the currency of energy in the body. With the molecule of ATP, you can perform any task in the body. You can contract a muscle, contract conductor, electrical maker or whatever. So I said to John, I want a test of how efficiently ATP is made and how efficiently it's used by the cell and the whole cycling process because as you know, ATP is very efficiently recycled. It's produced in the mitochondria, it's exported into the cell where it's used to do a job of work, whatever that job of work may be. Then ADP then gets taken, carried back into mitochondria by translocator protein and resynthesized. And that is an incredibly efficient process. In fact, if you weighed all the ATP that the body creates over the course of 24 hours, it would be about 70 kg, you would exceed my body weight. So ATP is an essential molecule. John of Acumen Laboratories came up with the test that measured those various parameters. It measured how efficiently mitochondria made ATP, how well ATP is transported from the mitochondrion into the cell where it's needed, how efficiently ATP gives up its energy to form adp, and that's a magnesium dependent process, and then how well that molecule of ADP is taken back into the mitochondria by a translocator protein to be recycled. Now, as you can well imagine, if any one of those steps go slow, then energy delivery mechanisms are going to be impaired. That is, you can't generate the ATP necessary for that cell. Now, as I mentioned earlier, I have now, well, John has now done nearly a thousand tests for my patients and that's given me a pretty good handle on what's going on and why. So even if you cannot get the test, I now know the regimes that have to be put in place to improve mitochondrial function. And broadly speaking, mitochondria can go slow because they're lacking a raw material. And the commonest rate limiting steps, that is the commonest deficiencies I see are low levels of vitamin B3, niacinamide, low levels of CoQ10, of acetyl L, carnitine of magnesium, and the raw material to make ATP, which is D ribose. So those five supplements are incredibly helpful to improve the mitochondrial dysfunction. Or mitochondria may be going slow because they're blocked by something. Something is getting in the way, something is inhibiting the enzymes that create ATP, or something is stuck onto translocator protein, which stops ATP getting from the mitochondria to the cell or from the cell back to mitochondria. And there are lots of tests of toxicity that can be done. Genova do a urine test. Of course, I'm very lucky, Acumen, because I can get translocator protein studies or fat biopsies done or whatever the problem for Acumen is at the moment, it's the only lab that's doing the biochemistry. And John simply can't take on any more new doctors sending him tests. But there are other labs that are starting to develop these tests. There's one in Germany that's starting to develop this test, so hopefully it will become more widely available. But even without the test, there are other nutritional tests that can be done and there are other tests of toxicity that can impact directly on mitochondria. And I've now done so many follow up tests for patients, I know that these regimes are effective.

Interesting. Okay, so this mitochondrial test that you like to perform, you're testing for ATP, for NAD, superoxide dismutase, carnitine, DNA, glutathione and coenzyme Q10.

Yep, all those things. And they're all impact on mitochondrial dysfunction. And those, you can get those tests at other laboratories and that would be very helpful in the management of anybody with a fatigue syndrome.

Okay, I'll try and hunt the test down. For those of you who are listening who are in the States, you can find the other one from Dr. Mihill's website. But I'll take show notes and put everything along with the books we're talking about over@BenGreenfieldFitness.com MyHill that's BenGreenfieldFitness.com My H I L L so what I want to ask you a little bit about, in addition to this mitochondrial test, what you would do if someone were to come to you with chronic fatigue like symptoms. But before I do, because I promised I would, what's the difference between this myalgic encephalitis and chronic fatigue syndrome?

Okay. Chronic fatigue syndrome arises when the energy delivery mechanisms are poor. So anybody who is hypothyroid, had poor adrenal function, had poor mitochondrial function, who had metabolic syndrome or whatever would be fatigued and they would simply suffer from the symptoms of poor energy delivery. Now with me, we have all those symptoms of chronic fatigue syndrome, plus we have inflammation symptoms. Inflammation is characterized by heat, pain, redness, swelling, loss of function. And inflammation can be driven by chronic infection, chronic allergy, or autoimmunity. That is, the immune system is not functioning perfectly or the immune system is functioning the way the immune system is activated and is causing those symptoms. Now, we often see the two because very often people's chronic fatigue syndrome or ME is triggered by an acute infection like Epstein Barr infection, that comes up as a very common trigger like Lyme disease, Babesia, bartonella, mycoplasma, and we're seeing epidemics of these new infections. Why? Because modern diets are becoming increasingly deficient in micronutrients. So our bodies are no longer healthy and we are being increasingly poisoned by toxins from the polluted world. And those toxins have the potential to inhibit mitochondria, dysregulate the immune system and so on. With time, the clinical pictures are getting more confusing because, you know, it is. If I have a patient who is not taking micronutrient supplements, they will be deficient simply because modern Western diets are deficient. If I have a patient who's not done any sort of detox regime, they will be poisoned. I have never done a fat biopsy, for example, and found a normal result, that is with no toxins.

A fat biopsy?

Yes, that's a test. It's a very helpful test. It's very easy to do because you just stick a needle in the fat of subcutaneous fat, patient and pull the needle out and the amount of fat or oil contained within the core of the needle is sufficient to do an analysis.

An analysis of what?

Well, to look for fat soluble pollutants, volatile organic compounds and pesticides, particularly organic chlorine, organic phosphates and so on. Again, this is an acumen only test, but Genova, I notice, offer a urine test which gives one an idea of one's toxic load of pollutants, persistent organic pollutants, as they're called, or pops. And again, I've seen a few of those tests. I've never seen a normal result. We are all carrying a toxic load whether we like it or not. So you can be doing the very best you can to eat healthily, to eat organically, to avoid toxic stress. But we're inevitably contaminated with some toxins and all we can do is keep the load as low as reasonably possible and mitigate any toxicity with good micronutrient status, that is, take a good multivitamin, take some minerals, take some good essential fatty acids.

So I come to you for chronic fatigue. I'm tired all the time and I feel worn out. Maybe I have inflammation too. So I've got this myalgic encephalitis and you test my mitochondrial function, you test my level of toxins. What else are you gonna do?

Well, I probably wouldn't start off testing you because there is much that can be done to improve fatigue before we even think about doing any tests. And the starting point for the treatment of almost absolutely everything. So it doesn't matter if somebody comes to me with chronic fatigue syndrome or dementia or heart disease or cancer, whatever the Starting point for treating everybody is the same. And that is to try to mimic our evolutionary past, that is do a paleoketogenic diet, improve the micronutrient content of our food by taking supplements so that it's comparable with what primitive man would have eaten to ensure good quality sleep. And so many people are chronically sleep deprived because of western lifestyles. That's what we do. The average sleep that people get is about seven. In Western worlds is about seven and a half hours, whereas our requirement is probably more like eight and a half or nine hours of sleep. So sleep is so important activity. Getting the right amount of physical activity. Now for people with chronic fatigue syndrome, they daren't exercise because it makes them ill. And in fact that is what defines the condition. And I would give them a basic package of nutritional supplements, a good multivitamin, a good multi mineral and some essential fatty acids and a dose of vitamin C. Again, vitamin C is another area where I'm getting so interested in. It's such an important and helpful intervention.

You mean orally or via iv?

No, no, no, no. Taken by mouth. When I first started in medicine, of course I thought I could cure the world as everybody does when they first start off in medicine. And then I rapidly realized, no, no, no, that wasn't going to happen. What I had to do was to give people the information and the tools of the trade as I call it, so they can cure themselves. Why? Because it's not going to come from doctors. Why? Because doctors have become puppets of big pharma and they are just become peddlers of drugs. The word doctor comes from the Greek, it means to teach. And my job is to teach people with the tools of the trade that are available, and believe you me, they are available to cure themselves, to heal themselves. And vitamin C is an incredibly important tool. Now there's a really interesting evolutionary story here because fruit bats, guinea pigs and human beings that can't make their own.

Vitamin C. Wait, human beings? And those two animals you just mentioned, the fruit bat and the guinea pig, can't make their own vitamin C. Correct. Okay.

All other animals can make their own vitamin C. And what's so interesting is that during any sort of illness, those other animals hugely ramp up their vitamin C production in order to deal with disease. Humans can't do that. So if you now, and I'm sure you're aware of the work of Linus Pauling, who's the only guy to won two Nobel prizes single handed, he was only beaten to a third Nobel prize by Watson And Crick, who discovered the double helix. But he was a clever guy and he devoted the latter stages of his life to research into vitamin C. And the bottom line is we should be taking at least 5 grams of vitamin C, that is 5,000 milligrams of vitamin C on a daily basis just to. Just for optimum health.

Not all at once, though. That gives you diaper pants to do that all at once, right?

No. Well, that would be unusual.

Really, to get loose bowels from 5 grams would be unusual.

Spread through the day. It would be unusual to get.

Oh, yeah. Spread through the day. From what I understand, you could absorb like one and a half grams or so at a time.

Well, vitamin C is such interesting stuff because if you have a systemic illness, then your bowel tolerance of vitamin C increases hugely. So the normal, Those should be 5 grams spread through the day. And the way I suggest people do it is they put their daily dose in a bottle of water and slurp it and drink it steadily through the day and that is enough for. That is ideal for optimum health. But at the first sign of any infection or any illness, you greatly ramp up your intake of vitamin C. Why? Because that's what all other animals do when any other animal has any sort of illness. They greatly ramp up their own, the body's own production of vitamin C because it is a vital defense against disease. And what's so interesting about, again, so much interest about vitamin C, it's that other animals can make vitamin C from sugar. In fact, it's a 4 enzyme step to make vitamin C from sugar. Humans lack one of those enzymes, which is why we can't make it ourselves. But I suspect this gives us an insight into the mechanism by which vitamin C works. Because obviously sugar is a fuel for bacteria and yeast. And if sugar levels are low or these bacterial numbers are increasing, if you saturate the body with vitamin C, they will try to use vitamin C as a fuel instead. Vitamin C doesn't work as a fuel and it ends up killing the organism. And the mechanism is exactly the same for killing cancer, as I'm sure you're aware of. Work. Well, there's lots of work showing the benefits of vitamin C in the treatment of cancer. And the treatment of cancer would be exactly the same as the treatment of any infection. That is starve out the tumor cells with a ketogenic diet, a very low carbohydrate diet, and then kill them with vitamin C. In fact, just, just yesterday I had a lovely lady come to visit me. She was Diagnosed with an inoperable malignant esophageal cancer last August and told she had a few months to live. And she has done a ketogenic diet and she is taking vitamin C to bowel tolerance and she is now swallowing her food fine and feeling really well.

What kind of vitamin C? Is it like a specific form?

No, just ascorbic acid, which is the cheapest and the best. Works fine.

Interesting.

I mean, lots of people swear, but take liposomal vitamin C on the grounds that it's supposed to be absorbed better. But I got in touch with the company that makes liposomal vitamin C and asked for the science on which that was based. Where are the trials that show that liposomal vitamin C is better absorbed? They could only come up with a study that involved two patients or two people. One took ordinary vitamin C to bowel tolerance, the other took liposomal vitamin C to bowel tolerance. And the blood level of the liposomal vitamin C was marginally higher than that of the person just to ordinary vitamin C. So I said to them, well, you've got to be joking. You can't make a general prediction on the basis of a study involving two subjects, at which point they cut off all communication with me. So I don't rate liposomal vitamin C and ordinary vitamin C as ascorbic acid. Works perfectly well. And there is lots and lots and lots of very good science showing that to be the case. By Robert Cathcart. Robert. Work by Dr. Frederick Klenner. And in fact, there was a lovely study published recently by Dr. Paul Marik, who is a consultant in infectious diseases and he specializes in treating septicemia. Now, septicemia is blood poisoning. It's real bad news. And even in intensive care, with the best antibiotics, the best supportive treatment, high dose oxygen and so on, the mortality is about 40%. Now, Marek found that when he added intravenous vitamin C in his regiment, he reduced the mortality to less than 1%.

Wow.

No side effects, no complications. It's a highly effective treatment. It's extremely safe.

And is there the best time of day to take it?

I don't think so. You just take it throughout to spread it through the day. I mean, that's what the body would normally do if we were able to make vitamin C. All other mammals make vitamin C regularly throughout the day from sugar, and at the sign of any first symptom of any disease or infection, greatly ramp it up. So my view is little and often throughout the day is mimicking nature.

Okay, got it. You also talk about magnesium. Quite a bit in the book. In addition to vitamin C, you're a real fan of magnesium in your practice, is that correct?

That is correct. Now, magnesium deficiency is pandemic. It's again, I don't think I've ever seen a normal red cell magnesium in somebody who's not taking magnesium supplements. And there are lots of reasons for this. But a major reason for this, well, is vitamin D deficiency. Again, as I'm sure you're aware, vitamin D deficiency is pandemic and we need vitamin D in order to be able to absorb magnesium from the gut. That's the first problem. The second problem is that people are told to have lots of dairy products because they're good for them. But again, dairy products are not evolutionary correct foods. Dairy products are meant for young mammals. When young mammals are young, they're very small, they have to grow very quickly. And dairy products are ideal for the fast growing young mammal, but they are not good for mature adults. And they're. One of the reasons for that has to do with the ratio of calcium and magnesium. We have 10 parts of calcium to one part of magnesium in dairy products. But our physiological requirements are possibly 2 to 1, probably more like 1 to 1. Now, calcium and magnesium compete for absorption. So if you're taking a lot of calcium, you block magnesium absorption, so you induce a magnesium deficiency. My guess is those two factors are the main reason why magnesium deficiency is so common. But again, there's a another little quirk here with my chronic fatigue syndrome patients. Because magnesium is essential for mitochondrial function. Without magnesium, you can't make ATP and you can't release energy from ATP. But magnesium has to get inside cells. And for magnesium to get inside cells, it's moving against the concentration gradient, that is you need energy to do that. So you end up with a terrible vicious cycle where you can't get magnesium into cells because you haven't got the energy to do it. But you need magnesium inside cells in order to generate energy. Now, in that event, I do have some patients who benefit hugely from injected magnesium. Why? Because I think what happens when you inject magnesium is you have a window of time, a brief window of time where you spike magnesium in the bloodstream, you reduce the concentration gradient, you make it much easier to get magnesium into the cells, into the mitochondria and you kick start the mitochondrial engine. And having kick started it and got it spinning, it's then creating more energy and therefore has the energy to drag more magnesium into the cell and into the mitochondria.

This is so interesting. So magnesium Intravenously, vitamin C. You like that at like 5 grams a day. And you also talk about, in the book, the link between the fermenting gut and chronic fatigue. I didn't realize there was such a big link between gut fermentation and chronic fatigue. Can you get into that?

Yeah, it's a very, very big problem. And again, the idea here is let's go back to nature for the basics. Now, humans have a gut that is almost unique in the mammal world because we can deal with so many different foods. You know, we can eat meat, we can eat vegetables. You know, if I give my horses meat, that's not good for them, if I give my dog loads of carbohydrates, that's not good for her. So, and the reason that is because we have a dual purpose gut. Now, the upper gut should be a sterile digesting gut in order to allow us to deal with meat and fat. And the lower gut, either colonial, a fermenting gut. And that allows us to ferment vegetable fiber where we can get more fuel and more goodness from that. The problem is, if we eat a high carbohydrate diet, and the shameful thing is we have had 35 years of very poor nutritional advice which says we should be eating lots of sugars and carbohydrates. If we do that, then we risk overwhelming our ability to sterilize the upper gut and to break down those foods. And of course, with our modern culture of snacking, so we're eating all the time. You know, the upper gut is never really free from carbohydrates or free from sugars. And the result of that is the bacteria and the yeast move in. Now, bacteria and yeast are incredible microorganisms. If they can find a food, you will find some bacteria and yeast, and in fact, you'll find bacteria and yeast throughout the whole world. There are even bacteria specific to clouds because there's something in the cloud that those bacteria love to ferment. So all our bodily surfaces, the whole body, is colonized by bacteria. And it's a simple numbers game. We have to keep them at a low level. Now, if we eat a lot of carbohydrates, we overwhelm our ability to deal with those. And instead of having a sterile digesting upper gut, we have a fermenting upper gut. Now, that is really bad news because those bacteria or yeast in the upper gut cause low grade inflammation of the lining of the gut. And that means we have leaky gut. And if we have leaky gut, then gut contents can get from the gut into the bloodstream where they cause immunological havoc. Now, when I was at medical school, I was taught, yes, we have some bacteria, we have yeast in the gut, and there they stay. We now know that is not true. Bacteria and yeast get into the bloodstream very easily.

They just cross. Do they just cross the gut barrier?

Correct. And if the gut is leaky and that's what happens when there's inflammation, then they get across even more easily. And once in the bloodstream, they will activate the immune system. And if they get stuck in any part of the body, they will activate the immune system there because there's a threat of infection. And I think that a great many modern pathologies, such as arthritis and muscle stiffness and connective tissue pain, is allergy to microbes from the fermenting gut. We're seeing epidemics at the moment of interstitial cystitis, which is a bladder and irritating bladder condition where, no, no, the tests don't show there's any infection, but there's low grade bacterial or yeast presence with inflammation. And the inflammation in the bladder causes all the symptoms of cystitis with frequency, pain, urgency of micturition. I suspect chronic urticaria is driven by allergy to microbes from the fermenting gut. Intrinsic asthma, the same. We know that Crohn's disease and arthritic colitis, inflammatory bowel diseases, are associated with abnormal gut microbiome. And there's some lovely work done by a Japanese researcher called Nishihara. And what he has shown is if you've got fermenting gut, you've got fermenting brain. That is, you have microbes in the brain which have the potential to ferment out neurotransmitters in the brain. Now, if you are fermenting noradrenaline and adrenaline and dopamine, that is neurotransmitters into the brain, into amphetamine like substances, into LSD like substances that could be the basis of psychosis. Now, obviously lots more work is needed on this, but it is a biologically plausible mechanism. And guess what? We know from the work of people like Carl Pfeiffer and Abram Hofer that treatment for any psychosis is a ketogenic diet. A very good treatment for any epilepsy is a ketogenic diet.

Is that just because there's no carbohydrates to be fermented?

Correct. There's no carbohydrates to be fermented, you starve out those microbes in the brain that are fermenting brain neurotransmitters and causing psychosis and you settle the whole problem down. And my guess is though, any benefits of ketone diet could be made even more profound by adding vitamin C because that helps little wretches as well. So that dual approach, the ketogenic diet combined with vitamin C to bowel tolerance, and anybody can do this, it's not an expensive treatment, would be a great treatment for any brain pathology for anybody with the chronic fatigue syndrome, for anybody with dementia. In fact, you're probably aware of the work of Dale Bredesen, who is a neurologist from California, and he took 10 patients with quite dementia and nine out of 10 of those patients he was able to reverse the dementia simply with the ketogenic diet and various other things like correcting the thyroid, correcting adrenals, ensuring good quality sleep and so on. Now if that had been a drug that had had that effect, my word, it would have been headline news in every newspaper in the world. But guess what? It's just a boring old diet and a bit of vitamin C and nobody's going to make any money doing that. So guess what? It doesn't get the headlines.

So a ketogenic diet addressing gut fermentation, vitamin C, magnesium testing, a lot of like ATP and mitochondrial function issues, all that seems to make sense. Another thing that you mentioned in the book is something about allergic muscles. You talk about fibromyalgia and allergic muscles. As somebody who works with a lot of like athletes who get muscle pain, stuff like that, I'm curious, I hadn't heard that term thrown around before. Can you talk about allergic muscles and what those are?

Well, that's a term that I made up to try to explain the mechanism of what goes wrong now. And do you know what? I get probably more emails and questions about allergic muscle than any other subject.

Oh, wow.

But I think what happens is that when we damage ourselves and we have a fall, a bruise or whatever, whenever we damage, we get bruising. Now when there's bruising, blood comes in direct contact with connective tissue. Now of course that's not supposed to happen. Blood is meant to be contained within a blood vessel. So there is potential at the moment of bruising for that connective tissue, wherever that may be. It might be in your back, it might be in your foot, it might be in your shoulders. There is potential for that tissue to sensitize or become allergic to whatever is in the bloodstream at the time. Now that might be a food antigen because guess what? We Know that food antigens from the gut easy get into the bloodstream. You can find milk protein and wheat protein in the bloodstream, or it might be a microbe from the fermenting gut. Now what that means is that after the bruising has settled down and healing and repair has taken place, but you are left with sensitization of that tissue. So if subsequently that tissue comes in contact with a tiny bit of milk protein or a tiny bit of wheat protein or a tiny bit of microbe, it will react with inflammation. Now there's one lovely example of this are bunions. Now bunions are a painful arthritis of the first joint of the big toe. And I now have three patients whose bunions have completely resolved just doing a dairy free diet. I think what happens is that that joint is a very prominent joint and if your foot gets crushed, because, I don't know, in my case a horse treads on it or you drop something on your foot, that is the joint that gets crushed because it's the biggest one. And when it gets crushed, there's bleeding, there's damage, there's bruising and that joint has sensitised. And then subsequently, when the person eats that offending food, you get inflammation there because very often you get people who've got bunions and they've only got it on one foot, they haven't got it on the other side. So you ask yourself, well, it's not a systemic issue, then there must be a local problem local to that joint. But the same can occur with muscles. So if you tear a muscle, guess what you're going to get bruising and potential for that muscle to sensitize to whatever's in the bloodstream at the time. The commonest food that does it are the dairy products. And the point here is then when that patient or that person subsequently consumes dairy products, they get muscle spasm. Now, muscle spasm is incredibly painful. I don't know if you've ever had cramp, but it's absolute agony.

I used to get horrible, horrible cramps in water polo, which is horrible because you're in the water and you basically have to use your arms to get yourself to the edge before you sink. Because both your calves, typically from the egg beater kit, go into these horrible cramps and spasms. So yeah, definitely, absolutely.

And you know, some people almost drown when they get that in the pool. But the interesting thing about the allergic muscles is the pain is suddenly extremely severe, agonizing. Then as soon as the muscle goes out, great, that patient is as right as Rain. So anybody watching them would think, well, they're right old hypochondriac. One moment they scream with agony, and the next moment they're as right as rain. And I've now had so many patients who have got rid of their allergic muscles, got rid of their screaming agony, simply by doing a paleoketogenic diet that is cut out the major allergens, grains, dairy, yeast, and reduce the load of fermenting microbes in the gut, because you're starving them out with a low carbohydrate diet.

Interesting. Okay, so this idea with low carbohydrate diet and fermentation actually links directly to allergic muscles then. And by cleaning up the diet. When it comes to the fibromyalgia that often accompanies chronic fatigue, a lot of these things address that, too.

That's absolutely right. In fact, if you sat in with me for a day whilst I was talking to my patients, you'd think I led a really boring life. Because. Because I'm talking about diet and gut function all the time. So much so that I've ended up writing another couple of books. One, diabetes, which is why we tend to eat high carbohydrate diets. And the second, the Paleok Ketogenic Cookbook, which tells you how to go about eating a low carbohydrate diet, the difficulties that you can anticipate, and the sort of foods to eat to get around that.

Now, this is probably kind of related to the fermenting gut issue, but at the end of your book, you go out of your way to include this recipe that you apparently make yourself and use quite a bit for live cultures. Can you go into that and what that actually is and why you wouldn't just take probiotics?

Okay, the point about taking probiotics is if you've got good function, gut function, they're unlikely to colonize the gut. That is, they should be killed by stomach acid. So it really is a numbers game. And if you're going to take probiotics, you've got to take enough of them in order to be able to impact on the gut. And the only way, well, the most effective way to do that is to grow live cultures. And guess what? It's also very inexpensive. So I usually start off with kefir, because that's very easy to grow and grows really well on a range of substrates. I personally like to grow it on coconut milk. Some people like to grow it on soy milk. You can grow it on almond milk or whatever. But there's another microbe called Lactobacillus rhamnosus, and that has been shown in at least two well conducted trials to be effective in switching off allergies. So I suspect it is the microbe that induces oral tolerance to foods. So if I've got somebody who is allergic to a food, then I always ask them to grow Lactobacillus rhamnosus on kefir or on soy milk or on coconut milk. That reduces the sensitivity to that food in the gut. It's a very good way of switching off allergies.

So you, you use the milk, you got to purchase the culture, then you just grow the culture on top of the milk medium.

Correct. And guess what? It's very cheap because you only have to buy one culture and that lasts you for years and years and years and years. Okay. Sometimes you might make mistake and go and hold it and forget about it and have to start again. But again, it's a very inexpensive treatment. And these patients who are really sick often can't afford expensive probiotics or fecal micro bacteria therapy or whatever, but they jolly well can easily grow fermented foods.

Cool. This is actually a recipe I want to try. Maybe I'll have my kids try it because they do like a food podcast and sometimes when I have a recipe that I want to try, I just have them do a podcast about it. So maybe they'll, maybe they'll make me some live cultures tonight.

Well, I thought you were going to say was my recipe for paleo ketogenic bread, which I make from linseed, right?

Well, yeah, fill me in. What's that recipe?

Well, as I say, the starting point for treating absolutely everything is a paleo ketogenic diet. But what people miss more than anything else is bread, because it's very quick, it's very convenient, it's very delicious, it's got great texture. So every morning for about six months, I got up early in order to experiment making a loaf. And to cut a long story short, I've made a loaf and the only ingredients are linseed, water and salt. And how to make it's online and I can send you the link, but it takes five minutes. The point is it looks like a small brown loaf, it cuts like a small brown loaf, it makes great toast, it makes great fried bread, and it makes the paleocutionic diet so much easier and doable.

What is linseed exactly?

Well, linseed is a seed, but the key thing about linseed is it's only 2% carbohydrate it's about 26% fibre, so it's very good for the gut. So it's a great substrate for the lower gut, which does need to ferment. And it needs to ferment fiber.

Is it the same thing as flaxseed?

Yes.

Oh, okay. Yeah. All right. Yeah. We call it flaxseed more often over here on this side of the pond. That's interesting. I did not know that. I'm gonna have to look up that recipe too, obviously. For those of you listening in, all of these recipes are in the book and I'll link to the book over at BenGreenfieldFitness.com My MyHill. That's BenGreenfieldFitness.com my H I L L One other thing that you talk about that is kind of controversial in medicine, and I think you mentioned this in the sustainable medicine book, is the acid alkali balance and why that's so important to you. And a lot of people would argue that your kidneys do just a perfect job themselves maintaining the body's acid alkali balance. And so it's not something that should be targeted quite as much. Why is it that you focus on the acid alkali balance and what do you do?

Well, I don't focus that much on it these days, I have to say, simply because when you get the diet right and you get the fermenting gut right, the acid alkali balance looks after itself. So it's quite useful. I mean, very often people come to me with sets of bloods and you can work out the acid alkali balance by looking at their electrolytes, by looking bicarbonate levels in the blood. So it gives you a point. But I wouldn't concentrate a lot of fire on correcting that simply because, as I say, it sorts itself out. Once you get people on a paleo ketogenic diet, sorting out the fermenting gut, good micronutrients and so on.

Okay. All right. So basically, with this whole acid alkali balance thing, are you testing that or are you giving people any form of bicarbonate to adjust their acid alkali levels or anything like that?

Well, no, I wouldn't with bicarbonate, as you say, because there are two ways of balancing it out. One is via the kidneys and the other is via the lungs. And the body does quite a good job of that. Again, testing for it is awkward. It's not as easy as you might think because all our stuff secretions are slightly acidic and they're meant to be slightly acidic. Why? Because acid is a very good defense against disease, against bacteria. So saliva should be slightly acidic, urine should be slightly acidic, even earwax should be slightly acidic. So to really test the acid alkali balance, you've got to do blood tests to get a good idea what's going on. And again, I'm trying to make my medicine simple so that people don't have to rely on expensive blood tests to sort themselves out. But say my experience is the acid alkali balance looks after itself. When you get everything else in place.

There is a host of information we didn't even delve into. Like you talk about everything from how you use infrared to this concept of the PACE study that's kind of a controversial study when it comes to chronic fatigue. A whole host of stuff in both these books, Sustainable Medicine and also Chronic Fatigue. And of course you address in a lot more detail the we even got a chance to dive into mitochondria, ATP detoxification and again, I know a lot of this stuff for those of you listening in. Sounds like things that I've addressed before, but never in as much detail and with as much practical experience specifically for chronic fatigue as Dr. Myhill gets into in these books. One is called sustainable whistleblowing on 21st century medical practice. Then the other one is Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis. I'm going to link to these over@BenGreenfieldFitness.com MyHill and I'm also going to let you know if your linseed paleo ketogenic bread and live cultures go over with my family or not. Dr. Myhill, you have to see how tasty those actually are, but I'll keep you posted. I'm gonna make them. I actually do that when I find cool things in books. I do make them and try them and some stick around and some don't. But this paleo ketogenic bread looks like it could be something to go hand in hand with my wife's current bread, which is slow fermented sourdough bread from a non GMO local wheat. But this looks pretty good too and obviously even better for gut fermentation issues. So anyways though, you're a wealth of knowledge. Thanks so much for coming on the show and sharing this stuff with us.

My pleasure. Do ask me again because I'm sure there's lots we haven't touched upon. I'd be very happy to help anytime in the future.

Yeah, absolutely. I would actually like to have you back because there is a lot we didn't get into. So stay tuned. And in the meantime, folks, you're listening. You can go to BenGreenfieldFitness.com Myhill that's BenGreenfieldFitness.com my h I l l for the show, notes for Dr. Myhill's books, and much more. Thanks for listening in and have a healthy week. You've been listening to the Ben Greenfield Fitness Podcast. Go to Ben Greenfield Fitness podcast.com for.

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