This is from an interview with Dr. Myhil about the central role of mitochondria in fatigue. She believes that CFS/ME is a cluster of symptoms that can have many causes. She’s the author of the book, It’s Mitochondria Not Hypochondria
Q: You have a car analogy in your book. Please explain that.
Let’s start from the beginning. The first and most important thing to grasp about Chronic Fatigue Syndrome is that it is not a diagnosis, it is a clinical picture that may have many causes.
The second important thing to grasp is that we have symptoms for a very good reason. Symptoms protect us from ourselves. If we didn’t experience fatigue we’d work all day and all night.
The symptom of fatigue can arise for many reasons that have to do with delivery systems and energy expenditure – how we spend and create our energy. We always have to keep ourselves where our energy demands don’t exceed our energy delivery. We need to pay attention to both sides of the equation: energy demands vs energy delivery.
The body is just another machine, like a car. Like any machine it needs the right fuel in the tank. That fuel has everything to do with diet and gut function.
How do we burn our fuel to create energy? Mitochondria are essential for creating energy from fuel. They are the little engines that exist in every cell in the body, and in every cell in every living organism. Without mitochondria we wouldn’t have life as we know it.
What mitochondria do is they take fuel from the bloodstream derived from carbohydrates, fats, and proteins (in the form of acetate groups) and burn them in the presence of oxygen to produce ATP. Think of ATP as a molecule with which you can do any function in the body.
The thyroid gland is also terribly important. It determines how the fast those mitochondria go, like an accelerator pedal in a car. We have to be careful about how we spend our energy. Spend it too fast and we wouldn’t have survived a harsh winte
What allows us to gear up energy spending is the adrenal gland, which I think of as the gear box in a car. Adrenaline is the short-term immediate hormone for energy delivery; cortisol is the intermediary and DHEA is for long-term energy delivery. Those hormones allow us to adjust energy demand to energy delivery very closely.
We service our bodies during sleep. Every single living thing, even bacteria, need a time in which metabolic processes shut down to allow healing and repair to take place.
Those are the central, important aspects.
Q: You talk about how the immune system takes up a huge amount of energy.
That’s on the other side of the equation, where we look at how energy is spent in the body. An astonishing amount of energy – two-thirds of all energy we generate – just goes into staying alive: basic metabolic rate, heart function, lung function, gut function, liver function, brain function. All those things demand energy. The rest we should spend physically, or mentally, in terms of mental exercise.
Think of the immune system as a brain that isn’t contained within the skull, but is spread throughout the body. It’s intelligent, it’s decision-making. It’s highly active, and it’s highly demanding of energy. It likes to run on fat, and so on. But when the immune system is activated it uses up a massive amount of energy.
Q: Let’s focus a little more on the mitochondria. Would you please expand on the production of ATP?
When ATP is being efficiently recycled, ATP forms ADP. Then it goes back into the mitochondria where it again forms ATP. That is an extraordinary efficient cycle. In fact, when we are functioning at our maximum potential, a molecule of ATP can be recycled back through our mitochondria every ten seconds. If there was no such recycling, then we would burn more than our body’s weight of ATP every day.
We run into problems when energy demand exceeds energy delivery. The body has some emergency mechanisms. Let’s say I have to run for my life, all these energy systems would be employed. One of them is to switch into anaerobic metabolism that produces lactic acid. We all know about that. It’s the lactic acid burn that slows athletes down and stops them, and stops ME patients as well.
Another mechanism is when two molecules of ADP combine to form one molecule of ATP and one of AMP. The ATP can be quickly recycled, but the AMP is recycled very slowly. So suddenly, you’re pulling the plug on your supply of ATP. It’s all draining out of your system. That is what I suspect causes the delayed fatigue in ME.
Q: What are some of the causes of mitochondrial underfunction?
The mitochondria can be deficient in raw materials –
- vitamin B3, and
Those are the 5 things we see that mean the mitochondrial are deficient. We measure these things when we do mitochondrial tests.
Or, mitochondria can be going slow because they are blocked by something. Blocking factors can include environmental toxins, energy delivery blockers, heavy metals, and fermenting gut products.
You can block mitochondria by stacking things on top of the mitochondrial membrane. It’s no good making ATP if you can’t get the ATP out of the mitochondria and into the cell where it’s needed. Mitochondrial membranes are made up of proteins that act like a little shuttle that takes ATP out of the mitochondria and then brings ADP back into the mitochondria where it is turned into ATP. There are lots of things that can block that shuttle. We can do tests to determine what those blocking factors are
Broadly speaking those blockers fall into two groups:
- they can be toxins from the outside world, such as pesticides and heavy metals, or
- they can be products from within the body. I suspect a major source of those is products from the fermenting gut.
Q: And inflammatory processes lead back to the gut.
Fatigue is a mechanism that protects us from ourselves. If someone is experiencing fatigue because they are overdoing, they are constantly stressing their mitochondria and their energy supply and they are constantly going into anaerobic metabolism and producing lactic acid.
Let’s talk about anaerobic metabolism. Normally, mitochondria function on oxygen. When you burn a molecule of sugar in the presence of oxygen, you’ll produce about 26 molecules of ATP.
But when you stress your mitochondria and switch to anaerobic metabolism, burning a molecule of sugar only produces 2 molecules of ATP. If you do this on a regular basis you get a buildup of lactic acid.
To convert that lactic acid back to pyruvic acetate takes six molecules of ATP.
What that means is if you overdo things it takes an awfully long time to get back to square one. The point of pacing is to avoid getting into anaerobic metabolism. So, pacing is crucially important. People will get better if they pace. If they don’t pace, eventually there is tissue damage and inflammation sets in, which kicks another hole in the energy bucket