118 - Dr Sarah Myhill shares her experience of treating ME/CFS & Long Covid

Episode 118 of the Long Covid Podcast is a chat with Dr Sarah Myhill about her experiences of working with people with ME/CFS and now Long Covid. We chat through her treatment protocol and some ideas to help that are practical & cheap - an important factor!

Dr Myhill's website

Books:
- chronic fatigue book
- paleoketogenic diet
- ecological medicene
- Underactive thyroid book

Dr Rachel Brown MetPsy

For more information about Long Covid Breathing, their courses, workshops & other shorter sessions, please check out this link

(music - Brock Hewitt, Rule of Life)

Transcript

Jackie Baxter  
Hello, and welcome to this episode of the long COVID Podcast. I am absolutely delighted to be joined by Dr. Sarah Myhill today, who has been working for many years with MECFS. And now also long COVID. So we're going to take a bit of a deep dive into Dr Myhill's experience and how it can hopefully help. So a very warm welcome to the podcast.

Sarah Myhill  
Thank you for inviting me, Jackie,

Jackie Baxter  
it's a delight to have you here. So before we kind of go down too many rabbit holes, perhaps you could just kind of say a bit more about yourself and what it is that you do.

Sarah Myhill  
Well, I qualified as a conventional doctor in in 1981. And after a year of house jobs, I went straight into general practice, thinking I knew it all, you know, I'd come out top of my year, you know, I was this brilliant doctor who was gonna go in and change the world, you know, as you do. And I was very rapidly crushed by my patients who said to me, Why have I got arthritis? Why have I got high blood pressure? Why have I got chronic headaches. And of course, we weren't taught that at medical school. 

And, you know, when I became to realize very early on is that medical education is not an education, it's a brainwashing. And that's never been more true than today than ever, because now doctors have become puppets of Big Pharma. And, you know, we all know what Big Pharma's mantra is, which is that a patient cured is a customer lost. So we don't want cures, we want people on symptom suppressing medication for life. And that's what happens. 

So when people go to see their doctors with their high blood pressure, or their obesity, or their depression, or their arthritis, they just get drugs that take away the symptoms of, they don't cure the underlying factors. 

So early on, in the 1980s, I was asking the question, Why? Why do people have migraine? Why do they have irritable bowel syndrome? And why did they have asthma and so on, so forth. And I learned early on that much of that had to do with allergy. And so I got a bit of a reputation for for being interested in allergy. 

And that seemed to pull in lots of patients with chronic fatigue syndrome and ME, some had allergies, and some didn't. So I was asking myself, well, why are they fatigued? You know, what's going on here? And so sort of having spent, you know, 40, odd years plus thinking about this and putting stuff in place.

Jackie Baxter  
Amazing. And when my next question was going to be, how did you come into the sort of chronic fatigue, ME, long COVID sort of world? But actually, you've kind of just answered that question for me. So maybe it would be really interesting to kind of talk through the sort of approach that you would take with these sorts of umbrella of illnesses. And I know that's a super wide open question. So you can make of it what you will

Sarah Myhill  
So my roadmap for treating patients with chronic fatigue syndrome, ME and long COVID. Now, the key point to remember about these things is they are not diagnoses, they are clinical pictures. And people come, when they come see me, they don't present with a diagnosis, they come with a clinical picture. And from that clinical picture, I have to discern what the mechanisms are, by which that clinical picture has been arrived at. 

Now. The clinical picture of chronic fatigue syndrome is poor energy delivery mechanism. So they have physical fatigue, no stamina, brain doesn't work. So they have foggy brains, very often heart problems with low blood pressure and PoTS and all that. And they are typical of poor energy delivery mechanisms. 

And then we have people who have ME, and that's where we've got poor energy delivery mechanisms and inflammation. And that inflammation may be due to allergy, it may be due to chronic infection, it may be due to autoimmunity. 

And of course, now we're seeing people with long COVID, which again is chronic fatigue syndrome ie. poor energy delivery mechanisms, with inflammation due to a persistent COVID 19 infection. And one of the problems of COVID-19 is it also unmasks underlying infections that the immune system has hitherto got under control like Epstein Barr Virus, like shingles, like HSV, or mycoplasma, or fungal infections or whatever. 

So that's the overall roadmap or strategy. And then we have to break that down into into bits. Now, when we talk about energy delivery mechanisms, what allows us to function, the analogy that I like to use is the car analogy. Because basically, we're a machine, okay, we're quite a complicated machine, but basically, we're a machine. 

And for your car to go, there are some essentials. You got to have the right fuel in the tank. You know, I've got a, an ancient diesel truck out there, but if I put petrol in it, it'll chug along but it doesn't like it. It doesn't go well. So you've got to have the right fuel in the tank and that's all about diet and gut function. 

We then have to have oxygen because you can't, you know, generate energy without having some oxygen there. We then need the mitochondrial engines of our cars. And that's my special area of interest where I've published three papers on mitochondrial function patients with fatigue syndrome. 

And then we need the thyroid accelerator pedal, and the adrenal gearbox. And with the accelerator pedal in the gearbox, we can then match energy delivery to energy demand. So you know, when I've got to go fast down the motorway, I can trundle on it at 70 miles now. And if I've got to go slow on these welsh Roads, we're only able to 20 miles an hour, I can trundle along at 20 miles an hour. And all these parts have to be in place in order to generate energy. And we always start off with energy delivery mechanisms. 

Now there's obviously lots of overlaps between the things we do for energy delivery, and the things we do for allergy and inflammation, chronic infection, but let's think about energy delivery, initially. 

Now, the preferred fuel in our tanks, the fuel with which mitochondria run most efficiently on are ketones. Now, most of the world think it runs on sugars. And that's the only thing that mitochondria can run on. And yes, of course, they can run on sugar, but it's not desirable. Sugar goes through and generates a lot of free radicals. If you put some sugar in your petrol tank, well, it would gum up the works. It wouldn't work. You can put other fuels in but they gum up the works, the engine wears out faster, effectively. And that's what happens with sugar. 

So we can run sugar but the preferred fuel of mitochondria are ketones. And we get ketones from eating fiber, and we get ketones from consuming fat. Now fat is the big bad boy. We have been taught. We've had this nonsense. You know the hypothesis that a high fat diet causes high cholesterol and that causes heart disease, rubbish. It is simply not true. And there are any number of books that you can read on this. Malcolm mackendrick The great cholesterol con, more recently Aseem Malhotra consultant cardiologist, a statin free life. 

Fats are good for us. They do not damage arteries, the only damage they cause is when they are processed. And it's processed oils, particularly Omega six oils that are so inflammatory and damaging to arteries. But you know, good old fats that nature provided in unprocessed form are all good for us. Fish Oils, meat fat, lard, coconut oil, cocoa butter, goose fat, all get the thumbs up.

So we need to fuel our body from fat and from fiber. And fiber is a double whammy. It does lots of good things, because in a very important part of the gut is the microbiome. And the more diverse our microbiome is, the healthier we are. What feeds the microbiome? Fiber. Fiber from from pulses, from nuts, from seeds, from vegetables. And you know, we should aim to eat 30 different foods a week to ensure the best quality of microbiome and that needs to be done on the background of a ketogenic diet. 

And the other aspect about diet that's so important is it needs to be paleo. Now, I came into this from the allergy perspective. You know, I'm allergic myself. I didn't know that until I got into doing general practice. My daughter was born, although I was breastfeeding. And of course, I was going to be the perfect and best mother in the world. And actually I wasn't. My daughter had terrible colic. And it wasn't until I gave up consuming dairy products, her colic completely disappeared, as did my chronic snotty nose, rhinitis and asthma and arthritis. So at that point in the early 1980s, I knew that allergy was a big player. 

Now the two biggest allergens that come up time and time and time again are dairy products, and gluten grains. And in third position is yeast; yeast and fungi. They are the three big offenders. So I start people off on the Paleo ketogenic diet. Paleo, because it avoids the gluten grains and the dairy products and cuts down on yeast, and ketogenic because it's very low carbohydrate. 

Now, people listening into this. If they do nothing other than change their diets to paleo ketogenic diet, you will be doing yourself a huge favor, because it's also an anti inflammatory diet. And as we've already demonstrated, ME and long COVID are also associated with inflammation. So you know, this is going to be a very good start to recovery. 

And, you know, when people say to me, Well, how did you come up with a paleo ketogenic? Why not a gap diet? Why not the FODMAP diet, you know, why not the atkins diet? The answer is, whenever I have a difficult question, go back to first principles. And those first principles is all about evolutionary biology. Where did we come from? What did we eat? How do we arrive in this position? 

And the bottom line is for about a million years and probably longer, we've been eating a paleo ketogenic diet. And human beings have been cooking their food, and cooking the food as an important part of getting the goodness from food, reducing its toxicity. And as a result of being able to cook our foods, the foods have been less tough so our teeth have got smaller and our jaws have got smaller, our gut has been able to shrink. 

And nearest relatives are the great apes, the monkeys, the chimpanzees, gorillas, and they have these huge tummys on don't they. They have these huge tummys on them because they get so much of their energy from fiber. And they need a huge tummy in order to be able to ferment that fiber to generate energy. 

But as we started to cook, we could get away with smaller guts, and that made us better hunters. And suddenly, we became a dual fuel animal. Yes, we could survive on fibers. And the last five foot of our gut is a fermenting large bowel for our microbiome. But most of our gut, the first 20 to 25 foot of gut, is for the business of digesting meat and fat. And that's one of the reasons it's made us so successful as a species. 

Now, so we have this very interesting gut, which is half vegetarian. So the lower part of our gut, the microbiome is a vegetarian gut like my horse. So I've got a little horse, and her whole gut is vegetarian. She just lives on grass and hay. All her energy gets from is ketones, and she gets that from fermenting fiber. But it's very inefficient. You need an awful lot of grass to get all that energy from that horse. 

But we mostly get our energy from the upper gut. So our upper gut is a carnivorous gut. So my, my other best friend sitting next to me, here's my little Patterdale Terrier, and she's a carnivore, and she just lives on meat. And our upper gut is designed for the business of eating meat and for fat. And problems arise when we overwhelm our gut with sugars and carbohydrates. 

Now, I'm asking people to do a paleo ketogenic diet. It's a difficult thing to do. And the reason it's difficult is because sugars and carbohydrates are so addictive. There are two things that kill people, addictions and ignorance. Now, we know a lot of the addictions kill us, like smoking, like alcohol, like too much caffeine, like heroin, like cocaine, like ecstasy, we know all these addictions kill us.

But the worst addiction of all is sugars and carbohydrates. Because people don't realize they're addictive. We do subconsciously. But we do want to accept that we're addicted to carbohydrates, because it means we have to change our wicked ways. And that's difficult. So we eat carbohydrates because it's because everybody does. You know, it's the old Mars bar advert, isn't it? You know, Mars a day helps you work, rest and play. I don't think so. 

And in the early 1980s, there was this big debate between John Yadkin, who's the fat and fiber man and Ancel Keys who was the sugar and starch man. And Ancel Keys have the whole of the farming industry, the food industry, the military behind him. And in such a debate, power always wins. Money always wins. 

You know, when I was in the 1970s, everybody went to work on an egg. And the breakfast has always bacon and eggs, and then snacking was forbidden. And then it was meat and vegetables at lunchtime, meat and vegetables at supper. Puddings was the occasional treat, it wasn't a staple part. 

And now it's carbohydrates all the way. Suddenly, oh, you got to have your porridge and your musli and your granola for breakfast. And you've got to have that with fruit juice and a piece of toast and some marmalade on. And then you have to have a snack in the mid morning and that's got to them. So the kids all sudden have a tuck shop at school where they go and they buy their chocolate and their crisps. And we are fueling the body with sugars. 

And not only has that driven an epidemic of fatigue syndromes, it's also driven an epidemic of cancer, heart disease and dementia. Any carbohydrates - white bread, brown bread, biscuits, crisps, chocolate, pasta, pastry, within minutes it's converted to sugar and your blood sugar goes flying up into the sky. 

If you've got any doubt, an incredibly useful tool is to buy yourself a continuous glucose monitor. And you don't have to be diabetic to test these out. But they are very revealing. And you can get one from Abbott freestyle Libra. There's another one called Dexcom, but that's a bit more expensive. And it's little thing you stick into your flesh at the back of the arm there. And it will give you two weeks of continuous glucose monitoring, which gives you very good insights into what your blood sugar's doing. 

And there's nothing more empowering than a good test to say you're doing it right or you're doing it wrong. So for people who really struggle with it, I say, well do a two weeks continuous glucose monitor. They cost about 60 quid that gives you two weeks of inflammation, but it's very useful information. 

And see what your blood sugars are doing in response to eating food, because what we want is we want them to be level. We want them to be even Stephens, to run between about four and maybe 6.5 millimoles per liter. And it shouldn't go up above that. If it has - too many carbohydrates in your diet. 

And in parallel with that, what is also very useful is a ketone breath meter. Now, the one I like to use is called ACE track, it's very superior, it's very accurate, but it tells us or it tells you if you aren't doing the diet correctly. Because we should be blowing ketones. 

Now, when we are fuelling our mitochondria correctly, with ketones from fat, or with ketones from fiber, we produce three types of ketones. So we produce beta hydroxy butyric acid, which is the main fuel for our body. We produce acetoacetate, which we pee out, so you can use urine dipsticks to see if you're paying ketones, and we produce acetone, which is volatile, which we exhale, and we can measure that on a ketone breath meter. And that tells us if you we are in ketosis. 

So by dint of continuous glucose monitoring, and measuring breath test, we can tell exactly when we are doing the diet correctly. And that is absolutely the starting point. And there's another point here, because as I say, these diseases, we're talking about long COVID, ME. They're are a mixture of energy delivery mechanisms and inflammation and ketones impacting both departments. 

The worst thing you can do for your body to drive inflammation is eat sugars and carbohydrates. The best thing you can do is to get into ketosis, because ketones are markedly anti inflammatory. And so many conditions are associated with inflammation. So that's the first point, do the Paleo ketogenic diet. 

The second thing we need to do on that, and this again, comes on the fuel, is sought out the upper fermenting gut. Now, we've touched on this already, but as I say, our gut is a dual fuel gut. The upper gut, the first 22 odd foot of the gut is designed to deal with protein and fat, the lower part of the guard is designed to deal with fiber. Yes, we can get away with some sugars and carbohydrates, but not too much. We need insulin and other hormones to control blood sugar levels when we bring in those foods. 

Now, problems arise if we have too many sugars and carbohydrates, just like that person I mentioned earlier, who has you know, toasts and cereals and musli and fruit juice for breakfast. Too many carbohydrates, and you will overwhelm the ability of the upper gut to deal with them. 

And of course, when we eat those foods, those foods are not sterile. They have microbes within them. So if you eat fruit, for example, well, if you eat grapes, while you're eating a bag of sugar that's coated with yeast, ditto apples, you know, ditto pears, ditto in any fruit, if you're eating, you know, it's gonna it's a mixture of yeast and sugar. 

And if that is there in large amounts, then those yeasts will ferment that sugar, and so that you become an upper fermenting gut. Some foods we eat with bacteria, and those bacteria will ferment those carbohydrates, that potato that is fermented into sugars and starches. So we end up with an upper fermenting gut because of bacteria and because of yeast, and that causes a whole host of other problems. 

Now, the first thing is if you're fermenting by yeast, you're producing alcohol, and you're not producing a little bit of alcohol, you're producing a lot of alcohol. And if somebody said to me, you're gonna have a glass of wine for have breakfast, guess what, nothing would get done that day. I'd be in foggy brain, I'd be tired, I'd be fatigued, and I wouldn't be functioning well at all. 

But it's not just etha alcohol we are producing, we're producing propyl alcohol, butyl alcohol, D lactate, hydrogen sulfide. ammoniacal compounds, a whole load of toxins, which have to be dealt with by the liver. And that takes energy. The liver needs a lot of raw materials and energy to deal with those toxins. 

And then we have toxins from the microbes themselves. Because if you look at life from the point of view of a microbe, it doesn't want to be eaten. It wants to have its own ecological space, where it can survive without other microbes getting in the way. And to achieve that microbes produce their own toxin. So bacteria produce bacterial endotoxin. Fungi produced fungal mycotoxins and they're poisonous to the body too, and they have to be dealt with by the liver. And some of them aren't well dealt with by the liver, some get into the bloodstream and poisonous. 

And the other really fascinating issue of having a fermented gut are the microbes themselves. Now, we are taught at medical school. Yes, there are bacteria and yeast and viruses in the gut. And there they remain. And we now know that's not true. We now know that some of those microbes get from the gut into the bloodstream. 

Now if those microbes come from of the lower bowel, from the microbiome, the last five foot of bowel, well, the immune system is well used to seeing and dealing with those microbes. It's been dealing with them for hundreds of 1000s of years. And it says Oh, those are friendly microbes, we'll just neutralize those, pee them out and job's done. 

But problems come with these new microbes, microbes that are fermenting sugars and starches that are not evolutionary correct. You know, we've only been looking at them for a few 1000s of years. And from an evolutionary perspective, that's neither here nor there. And we're now seeing them in large amounts. It's not just the few that sneaking out there, it's a lot. 

Now where those microbes get stuck in the body. The immune system is activated, and that drives pathology. Some people call it molecular mimicry, some people call it autoimmunity. It doesn't matter what the mechanism is, but the point is, we get inflammation at distal sites, and most arthritis is allergy to microbes from the upper fermenting gut. 

If you get these microbes stuck in the lungs, you can develop intrinsic asthma. If they get stuck in the bowel wall, you get Crohn's disease and ulcerative colitis. If they get stuck in the muscles, we get Fibromyalgia which is a painful condition. They get stuck in the skin we can drive eczema or psoriasis, or urticaria, if they get stuck in the brain, they can drive psychosis. 

Fascinating paper by Japanese researcher called Nishihara, you've got fermenting microbes in the in the gut, they get up the vagus nerve into the brain, where they ferment out neurotransmitters into LSD and amphetamine like substances. And this may well be the basis of psychosis. Friend of mine in Scotland, in fact you need to look at her website, Dr. Rachel Brown, she works very closely with Ally Houston. And they set up a wonderful website called metabolic psychiatry. I think it's met psy. Rachel is baced in Edinburgh, she starts all her psychiatric patients off on a carnivore diet - gets fantastic results. 

But for many people, a carnivore diet is the starting point to treat many of their conditions. Why - it's a meat diet, you, you suddenly the upper fermenting gut is cured, you're suddenly not got the fermenters in the brain. And you've suddenly you know, the psychosis melts away. So diet is not just a little bit of a nuisance, and we can skip that bit because there's some other more important parts, it is absolutely the starting point to treat fatigue syndromes wherever they come from.

Jackie Baxter  
Wow. Yeah, I mean, I'm just trying to digest that, so to speak. I mean like, looking into my diet did virtually nothing for me in my recovery. But hearing you speak here, there's just so much that I feel like I want to look into more, you know, the importance of what we put into our bodies is just huge.

Sarah Myhill  
Still on the fuel in the tank and the upper fermenting gut. So there's a two pronged approach to treating after the upper fermenting gut. First of all, starve it out, stop feeding the sugars and carbohydrates and starches. Secondly, kill those microbes. Now, generally speaking, you know, I am dealing with people who are not wealthy, they're not rich. Why? Because they've got fatigue syndromes, and they can't work. 

So the interventions I'm looking for have to be cheap, not on prescription, easy, available, safe and do lots of other good jobs as well. And all those assets, all those apply to vitamin C and to iodine. Vitamin C and Iodine are my two favorite multitasking tools because they do so much. They contact kill all microbes. So I like everybody to take vitamin C and Iodine. Not at the same time because they knock each other out. One's reducing agent. The other is an oxidizing agent. So we take them separately. 

And I like everybody to build up slowly to five grams of vitamin C every day. That's 5000 milligrams. That might sound like a lot of vitamin C, but it isn't. We know it isn't because it's humans, fruit bats and guinea pigs are the only mammals that cannot make their own vitamin C. If you look at how much vitamin C dogs, goats, horses, cows make, they can make up to 15 or 20 grams a day, according to demand. So, five grams a day is what we would normally expect to get if we were any other mammal other than the human. So that's a good start. 

So I tend to take vitamin C - either take them in one in the morning, one in the afternoon or one afternoon, the other in the morning. It doesn't matter so long as they're separate. And then last thing at night I take Iodine and I like to use Lugols Iodine. It's a 15% solution, and it's very cheap. That bottle costs about seven pounds, so that will last you a long time. Vitamin C is also extremely cheap. And build up to three drops of Lugols Iodine last thing at night. 

And in parallel with this maybe do time restricted eating. So a very good thing would be to Take the vitamin C in the morning. And then midday, have your lunch and supper. So you're having your food within a six hour window of time, because intermittent fasting is also very good for ketosis and very good for health. And then last thing at night for bedtime, I have a pot of Lugols Iodine next to my toothbrush and - Oop don't forget the iodine. And that goes down the hatch last thing at night. 

So with all those things in place, you've then got the right fuel in the tank, and you've tackled your upper fermenting gut. And by eating a diverse, at least 30 Different foods, diverse diet with lots of you know, lots of different pulses, and lots of different seeds, lots of different nuts, lots of different salad vegetables, lots of different vegetables, you can have to achieve that 30 is not hard. 

That's very good for the microbiome, which is the last say five foot of gut which does so much good for us. And much of our control of inflammation takes place in the microbiome, the way we program the immune system, where we ferment fiber not just to produce fuel, but also to produce happy neurotransmitters, to produce vitamins to nourish the body with. So the microbiome is really important. 

So we've now got to the point where we've got to say the right fuel in the tank. And the next thing you have to think about is oxygen. Obviously, we need a good supply of oxygen too, so our mitochondria can burn ketones in the presence of oxygen to generate fuel. Now, obviously, we get oxygen by breathing. And the way we get oxygen is we breathe in, we take a breath in, which is full of oxygen, and that oxygen jumps on to hemoglobin in the bloodstream. And hemoglobin is what makes red cells red. 

So the hemoglobin is then carried around the body to the mitochondria. And every single living cell in our body is full of mitochondria. And the oxygen then hops off the hemoglobin to the mitochondria where it's needed to burn fuel. 

But the big question that asks is, How does oxygen know to jump onto hemoglobin in the lungs and jump off hemoglobin in the tissues where it's needed? And the answer is acidity - it's all down to the acidity of the blood. And what creates the acidity of the blood is carbon dioxide. So when mitochondria are working hard, they're generating carbon dioxide and that dissolves in the blood to form a weak carbonic acid. And therefore where the blood is acidic, oxygen jumps off hemoglobin to the mitochondria. 

Converse in the lungs, we're exhaling carbon dioxide, we were getting rid of it. And as we get rid of it, the blood becomes slightly alkali. And of course when the blood is slightly alkali, oxygen goes the other way, it jumps on to hemoglobin. So you have to get the breathing just right. Because if we breathe too much we wash out carbon dioxide, we become too alkaline, and we can't get oxygen to mitochondria where it's needed, it remains stuck on to hemoglobin. 

So breathing exercises are often very helpful. And we need to slow the breathing down using Buteyko breathing exercises. And I'm sure you're well aware of that. For some people the breathing exercises as described by Buteyko are very helpful. 

Jackie Baxter  
Ah ha! Breathing. Yes, this is absolutely my wheelhouse and I can attest to how helpful that's been.

Sarah Myhill  
So now we find ourselves in the position where we need the mitochondrial engine to be working well. Now it's got the right fuel now, it's got some nice ketones coming in from our diet. It's got the oxygen flowing in and it needs to burn those. Now mitochondria can go slow for a number of reasons. They can go slow because they are deficient in something they can go slow because they're blocked by something, or they can go slow because the control mechanisms are wrong. 

And the bare minimum of raw materials we need for mitochondria to flow we can get from nutritional supplements. And the top three probably magnesium 300 milligrams, plus vitamin D 10,000 iu for its absorption. Coenzyme Q10 100 milligrams. Vitamin B3 is Niacinamide 1500 milligrams. Acetyl l carnitine One gram. If you're a vegetarian, you definitely Acetyl l carnitine, because that is rich in meat, maybe D ribose five grams as a Rescue Remedy. For some people they need a Thyamine vitamin b1. So that's the sort of the package of nutritional supplements that we need to feed our mitochondria. 

Now, the key point here is don't take any nutritional supplements until you sort out the upper fermenting gut. Because from an evolutionary perspective, mitochondria are bacteria. Mitochondria derive from bacteria. And any bacteria that we've got in our gut will also love the mitochondrial supplements. They too are hungry for magnesium, CO Q10, Acetyl L carnitine, vitamin B three and D ribose. So we have to clean up our upper fermenting gut in order to get the benefit from the nutritional supplements that we are taking. 

And then of course mitochondria can go slow because they are poisoned by something. And the commonist poison - and we know this because of the most wonderful biochemist called Dr. John McLaren Howard, who developed mitochondrial function test, translocator protein studies, DNA adducts. That purpose is to measure the toxic load in our bodies. And I've done enough of those tests now that I don't have to do the measurements because I know common things are common. 

And the commonist thing that block our mitochondria are products of the upper fermenting gut, and addictions. So guess what we've done, that haven't we, we've got rid of our addictions, you know, we're not drinking alcohol, we're not smoking, we've got rid of our caffeine, we've got rid of our sugar. You know, that's a very good start. We've got rid of our upper fermenting gut because products of the upper fermented gut, like alcohol, like hydrogen sulfide, like delactic all inhibit mitochondria. So that's a great start. 

And then we can be poisoned. Because we live in a toxic world. The fact of the matter is, I've never seen a normal test for toxicity, we all carry a load of volatile organic compounds and pesticides. And so we have to do our best to reduce our exposure to that. And again, I know it's another expense. But I think eating organic food is so so so important. But thing is, we can get rid of many of those toxins through heating regimes. 

And I know this because I've collected data, as have other doctors. And the business of getting hot, literally boils off these toxins that concentrate in our subcutaneous fat onto the fatty layer on the surface of the skin because the skin is the largest organ in the body, and it covered in a fatty layer, and then we wash it off. And my favorite heating regime for doing this are Epsom salt baths. Most people have got a bath. And if you put Epsom salts in there, which you can buy very cheaply from Epsomsalts.co.uk. So I get 20 kilos delivered to my door for about 35 quid, and each bath needs half a kilogram of Epsom salts, so nice one bar, half a kilogram Epsom salts. 

First of all that detoxes, pulls out the pesticides and the volatile organic compounds. It also gives a nice dose of magnesium and a nice dose of sulfate. Sulfate also helps us to detox. And magnesium is very good for our connective tissue, for our muscles, our joints and also for mitochondria. So we're doing much good with Epsom salt baths. 

Now, the only problem they have is they don't pull out the heavy metals. And we get heavy metals from aluminium foil, from dental amalgam, from lead in petrol, from vaccines and such, so we all have a bit of a load of toxic metals. And there are various ways we can get those out. We can get those out with minerals, with glutathione, with clays like diatomaceous earth with chelating agents, and the details of how to do that are all in my books. And we haven't got time to talk about the details today. We talked about the principles of treatments. 

So now we are we find ourselves in a state where we've got our mitochondria that are working well because they've got the right fuel inside, they've got some oxygen. They're free from toxic stress, and they have the raw materials to function. And we then move on to the control mechanisms. And that's all about the thyroid accelerator pedal and the adrenal gearbox. 

Now of the two, the thyroid problem comes up most commonly, and here we are talking about not the overactive but the underactive thyroid. And as the thyroid gland goes slow, then our accelerator pedal goes slow. You know, we could be in a Formula One car on the starting line, ready to go. But if it only goes at 15 miles an hour, it's going to come last isn't it? So we do need the thyroid accelerator pedal going. 

And blood tests can be very helpful. Well, blood tests are essential to make sure that you are not overactive. But that's all the doctors do. They treat the whole of the thyroid problem by just looking at the blood tests. Oh, they're in normal range. You're normal. There's nothing wrong with it. 

But that's just part of the diagnosis. We also have to ask the question, what are the clinical symptoms? And what are the clinical signs? Many people got blood tests which look normal. But clinically, they're obviously underactive, and they do benefit from taking thyroid replacement. And thankfully, we don't need a doctor to do that. We can do that ourselves with thyroid glandulers. 

Now, I've been very naughty. I've written a book, The underactive thyroid, and the subtitle is, "do it yourself because your doctor won't." And the awful thing is, the shameful thing is, that is the fact of the matter. You know, you have to work it out and do it to yourself. And as I've said I've written a book about it, which is helpful. 

But the key symptoms are signs often the pulse is going very slow, very often you're running cold, so the core temperature is low. Very often you retain fluid, another name for the underactive thyroid is mixed edema, and a facial edema gives you a puffy face. The vocal cords are puffy and sometimes you get voice changes. You get swelling of the tissues and the wrists, you can present with Carpal Tunnel Syndrome or sciatica. 

Very often there's sleep disturbance because thyroid hormones are responsible for our circadian rhythm. And often people are owls. So if you're an owl, you can't get off to sleep till midnight, you don't wake until eight or nine o'clock in the morning, think thyroid. So these are all useful clues that the thyroid is underactive, and as I say we can correct that with thyroid hormones. 

And again, the clues that the adrenal gland is under active is if you don't deal with stress well, you can't gear up to deal with stress. You can just about tick along at a level but when the demand comes along, oh, and you crash, you can't cope with that. 

And all these issues, I've actually written books about. If you could, if you don't want to buy a book, because I do see they're expensive. All my information is on my website free for anybody to access. Some of the nitty gritty detail, you get more of that in the books, perhaps, but I've tried to put as much up on my website as I can.

Jackie Baxter  
Yeah, I mean, this is fascinating. And I'll put links to all your books and things in the show notes as well. So if anyone is interested in following that up as well, then I'll make sure I get the links from you there. 

I mean, you were talking a lot about sort of meat and meat fats and things like that, and sort of the carnivore versus the carbohydrates. What about somebody who was a vegetarian, because I feel like this would be quite difficult for them.

Sarah Myhill  
Okay, well, it is possible to a paleo ketogenic diet and be a vegetarian, but it's difficult. But it is perfectly possible. The vegans struggle even more. The vegetarians can get their good protein from eggs. So eat lots of eggs. So that's a great start. But you can be ketogenic and be vegetarian. It is possible. 

And you have to give the the high fiber, low carbohydrate foods. So linseed, desiccated coconut, coconut cream is a fantastic food. Coconut oil is fantastic for cooking. Palm oil. And Cocoa butter is fantastic for making biscuits and cakey things. So it is possible and there are some good recipes in the PK cookbook. The vegans struggle, but I do have one or two vegans who are paleo ketogenic. 

Well, I know I've talked about the carnivore diet, because that's low allergen and low inflammation, but otherwise, the Paleo ketogenic diet. It's not a high protein diet, you eat normal amounts of meat, normal amounts of fish, normal amounts of eggs, and we make up the rest with lots of vegetables, lots of nuts, lots of seeds, but go for the low carbohydrate ones. 

And generally speaking, raw often has a low glycemic, lower glycemic index than cooked. So carrots, raw carrots, every evening, I will always have a salad which is as often as not, it's grated raw carrot, grated celeriac, grated celery, maybe some cold pulses mixed in there. So it's low carb, but a wide variety of fibers that are in there. And that's feeding the microbiome. So it is possible to be veggie and vegan. But I don't encourage that. 

Jackie Baxter  
No, that's fair enough. I was kind of just curious about that. And then, you know, there are a lot of people that are talking about MCAS and histamine intolerance and things. How does that play into this?

Sarah Myhill  
Well, that is all about the upper fermenting gut. Because MCAS, too much histamine. That's not the cause, that's the messenger. And the messenger comes from either eating sugars and carbohydrates directly that are getting fermented, or, you know, unfriendly microbes in the upper gut that we need to kill off Vitamin C and Iodine and maybe other things as well. 

But yeah, you're right, MCAS is part of the pro inflammatory state. That's part of what I call the inflammatory hole in the energy bucket. Because when you're in an inflamed state, A. inflammation on its own causes symptoms. And B, it kicks a hole in the energy bucket because it takes a lot of energy. So it's bad in both departments. 

Now, of course, if you've got an acute infection, if you've got acute flu, of course, we need inflammation, we need inflammation to get rid of that flu, to get rid of that cough and cold or get rid of that virus or that measles or that chicken pox. And in that event, it's totally desirable. But we need to get rid of that infection efficiently. And then the inflammation can die down and turn off. 

But problems arise when people end up in a chronic inflamed state. And we have been asked the question, what switches on inflammation? And one of the worst things that switches on inflammation are vaccines. And then of course, sugar is markedly pro inflammatory, that will switch on inflammation better than anything else. So again, this is where the Paleo ketogenic diet is such an important start. 

But so often with people with ME, and with long COVID, we are dealing with chronic infection. And those chronic infections include things like Lyme disease, like Epstein Barr Virus, like mycoplasma, like chronic fungal infections, and we know all these diseases drive pathology. We know that dementia, cancer, heart disease all have an infectious pathology, an underlying infection associated with them that's driving them. 

So the key to infection is first of all, don't get it in the first place. And so when you do get the acute infection, deal with that with high dose vitamin C, with Iodine, with fasting regimes and the regimes are all on my website, and I call that groundhog acute. 

I'll just explain briefly why I call these regimes groundhog regimes. I'm sure you'll know the comic film Groundhog Day, where our heroe is in a time loop, that keeps coming back to replay the day to try and get a different outcome. I call my routines groundhog regimes because I keep coming back to them. 

And there are three levels of Groundhog. There's groundhog basic, which is what we should all be doing all the time. We should all be doing a paleo ketogenic diet, taking vitamin C, taking Iodine, taking a basic package of supplements, doing basic detox regimes and so on. 

Then we have groundhog acute, which is what we should be doing in the event of any acute infection, acute cough, cold, gastroenteritis, urinary tract infections, skin infection, it doesn't matter. Any infection we deal with w ith groundhog acute. 

And then we have what I call groundhog chronic. And that's what we put in place when we have a chronic disease or chronic problem like arthritis, like cancer, like long COVID, or ME. And much of that is all about reducing the infectious load. Now all that we do, all the diet, of course efficiency and the Iodine. 

But these days, instead of looking for the infection, you know, because everybody wants to be told Your disease, your problem is caused by Lyme disease. And we can cure that with a month of antibiotics, how much it costs. Your problem is caused by chronic viral infection, Epstein Barr Virus, and we can cure it with antivirals, however much it costs. And so often, I see people who have done that, and are no better. 

So these days, my starting point is to put in place interventions to reduce the total infectious load. And the three tools I use for that are methylene blue, DMSO, and photodynamic therapy. All three in isolation, have broad spectrum antimicrobial effects, and in combination, are highly effective. And none of these, we don't need prescription, anybody can access these, they're reasonably inexpensive. And they do lots of other good things, too.

Jackie Baxter  
Yeah, I mean, I feel like that's blown my mind a little bit. So and  you've covered so much as well, it's just fantastic. You know, the the main thing I'm kind of taking is that we need to be allowing our bodies to run in the most efficient way possible. And that is partly by what we put into them. And partly by cleaning them up, I guess, in some ways. 

I mean, you know, breathing is my wheelhouse. And, you know, so I'm deep down that rabbit hole already. And you know, it's very, very much about being efficient with your breathing. And then using the breath to then influence things like the nervous system to allow the body to run as well as it can, once it's kind of at a functional level. And it is just, it sounds like you're kind of doing the same thing with diet, with breathing, with inflammation and just allowing that body then to be in that position where it can function.

Sarah Myhill  
And the body wants to be healthy. It wants to be well, it wants to function at the high level. And it can, we've got to give it the energy, and we've got to give it the raw materials and then let it go. And it will function, you know, at a high level throughout life. 

And of course, this is the starting point to prevent heart disease, to prevent cancer, to prevent dementia. I know I'm gonna die one day, but I don't want to die before my time is up. I want to live my life to its full potential. 

And just to give an example, there's a gentleman that I look after, who lives in my granny flat, he's no relatives of mine, but he's been a friend for some years. And obviously, I do all his food for him. So I feed him, and he trots through for his breakfast or supper. And in July, we celebrated his 101st birthday, and he has a sharpest attack, he's got a good heart, he has no cancer. And you know, he will die one day of old age, which is what we should all die from. But you know, he does all this stuff that we've been talking about, but he lives well. 

Jackie Baxter  
Yeah, I mean that there must be some genetic components as well, are there to this? Where certain people are more prone to certain things?

Sarah Myhill  
Correct. But as the World Health Organization, as any scientist will tell you, a disease is probably 5% genetic and 95% environmental. So even if you have a genetic weakness, you can compensate that through environmental inputs. 

So longevity, for example, comes down the female line. That's because mitochondria come down the female line. Now my mother, her mother and her mother, none of them got to 60. But you know, I've got past 60, and I feel well and I think I'm going to live to good age. So they may be had genetic lesions that predispose them to conditions, but you know, by dint of putting all this stuff in place. 

So I've learned this stuff through the 40 plus years of, of medical experience and my patients being willing guinea pigs, and of course, I'm always guinea pig number one to try new things on. So yes, genetics does have a part to play. So, you know, we use addiction to deal with stress, and I have every sympathy for people who have stress, and just the business of being fatigued is horribly stressful. But you just got to get to say it's addictions and ignorance, they are the two things.

Jackie Baxter  
Yeah, I mean, you've just touched on something there that, you know, we are all told to, you know, reduce stress. And, you know, I think a lot of people before they became ill were probably living very stressful lives. I know that I was, I didn't realize at the time, but in hindsight, whoa, what was I doing? 

And then, you know, while being ill, it's like, okay, well, you know, we need to remove stressors, basically. So you know, that stresses, causes flare ups, and all of these things. And, you know, you can remove some stresses in your life and that are new, and you should reduce some stressors in your life, you know. But you can't remove everything, you know, there are always going to be stressors aren't there? 

Sarah Myhill  
And there are some stressors that are good for you. So, you know, a bit of competition, you know, is good for us. And it doesn't matter, it's competition playing cards, or dominoes or, or doing athletics or being on a horse or whatever. So, you know, there's good stress, and there's bad stress. And we need a certain amount of stress to function at a high level, but too much, and it goes down. And getting that just right amount of stress and the rest commensurate with that, is an essential part of living well, and living life to our full potential.

Jackie Baxter  
Yeah. And I guess the better our body is working, the more resilient we are to stress when it does come along. 

Sarah Myhill  
Absolutely. 

Jackie Baxter  
Yeah. 

Sarah Myhill  
You know, I'm in I don't get everybody well, not by a longshot, and I don't get everybody 100%. Well, and therein lies the challenge, you know, what new thing can we put in place to get that much better, and that much better? And that much better? Until they are all functioning to their full potential. Because that's what it's all about? 

Jackie Baxter  
Yeah absolutely. And it comes back to what can we do? And if we can do something that will make a small amount of improvement, then that's great, because then that might open the door to the next thing, which will allow you more improvement. 

Sarah Myhill  
Absolutely. You've got it in one. 

Jackie Baxter  
Well, thank you so much for joining me today. I think my head needs to go and take a rest. And yeah, it's been absolutely fascinating. I will make sure that all the things that you mentioned, the links go into the show notes. And also there are all sorts of complicated names that you have mentioned. So if anyone is frantically trying to work out what they are, I'll make sure that they are correct when they go into the transcript. So that's my homework. So thank you so much.

Sarah Myhill  
My pleasure.

Transcribed by https://otter.ai