Explanation of Mitochondrial Failure by Dr. Sarah Mhyll to Dr. Rigau (Part 2)

Food Allergy
Food allergy – many of my patients are intolerant of a number of foods. Food allergy is a greatly overlooked cause of symptoms, which again masquerade under other diagnoses. For example, the commonest manifestations of food allergy are migraine, irritable bowel syndrome, asthma, skin inflammations (eczema, urticaria etc.), chronic rhinitis and arthritis, all of which are symptoms. None of these constitute a diagnosis since a diagnosis implies a cause. I suspect this is why food allergy has been greatly overlooked as a diagnosis and so the stoneage diet that I recommend to all my patients with CFS may well be an important part of management. The commonest allergens are grains, dairy, yeast and sugar.

The clues from the history that suggest allergies may be a problem are:
• A long history of various and changing problems dating from childhood – A history of tonsillitis as a child is typical of allergy to dairy products. Indeed, a colleague of mine considered it medical negligence to remove a child’s tonsils without first trying a dairy-free diet!
• A shopping list of symptoms - in one study, over 50% of unexplained symptoms were caused by food allergy.
• A particular liking to a food – oddly sufferers often get addicted to the foods which cause them most problems. This is akin to a nicotine or alcohol addiction!
• Irritable bowel syndrome- often caused by wheat allergy. 
• Bloating is often induced by wheat, sugar and alcohol and this could also point to yeast allergy. I say this partly because alcohol contains yeast and partly because sugar is often fermented in the gut by yeast and one ends up reacting allergically to endogenous yeast in the gut.
• Rashes and other obvious allergic problems such as asthma or eczema

There aren’t any reliable tests for food allergies and people simply have to do the stoneage diet.

I think that many of Carlos’s symptoms such as his sleep apnoea, vasovagal syncope, headaches, sacroielitis and alternating constipation and diarrhoea could certainly be explained by food allergy. Irritable Bowel Syndrome is not a diagnosis but just a description of gut symptoms which are often caused by food allergy and/or gut dysbiosis. The natural progression of allergy in a patient is for the incitant to remain the same but the target organ to change, which is why we see so many different pathologies throughout a lifetime. I think it is highly likely that for Carlos to do a good stoneage diet is going to be a very important part of getting well. Combined with this I suggest he also try high dose “do it yourself” probiotics and the present flavour of the month is Kefir, which can be easily grown and is very cheap because one sachet can last a lifetime.

Muscle Aching and Pain
I suspect one major overlooked feature of allergy is the allergic muscles. I know this directly from my own experience – in my case dairy products cause acute low back pain. I have to say I’m not sure I would have believed this possible unless I had experienced it myself! Symptoms of muscle stiffness and pain together with tremors and twitching is also typical of magnesium deficiency. The reason for this is that calcium is necessary to contract muscles and magnesium necessary to relax them. Relaxation is an energy-requiring magnesium dependent process, if magnesium is absent then muscle fibres effectively get sticky which means when they are stretched they tear and this results in muscle damage. This explains the symptoms of stiffness and pain and would partly explain the very high cell free DNA that Carlos has (see below).

Yeast/Candida problem.
Respectable doctors nowadays don’t like to call this candida because it has never really been proven that candida is the offending bug. We prefer to call it ‘fungal-type gut dysbiosis’ which may cause problems because a patient is allergic to yeast (and Carlos obviously has allergy problems) or it may cause problems because yeasts ferment food in the gut to produce alcohol, wind and gas which result in bloating. Yeasts interfere with both the absorption of micronutrients and the normal processes of digestion creating leaky gut, which can switch on food allergies. Different people require different levels of treatment to control this problem. The first line of approach is a low carbohydrate diet since this reduces sugars on which yeasts ferment. The second approach is high-dose probiotics and some people also need herbal antifungals and some people systemic prescription antifungals to get on top of their yeast problem. 

Poor digestion
Carlos may well be a poor digester of foods – indeed he has already identified lactose intolerance. His urinary organic acids show high levels of arabinose which is suggestive of a yeast overgrowth of the gut – yeasts often get into the gut where there is hypochlorhydria.

Mineral deficiency
Carlos’s symptoms of mitral valve reflux and poor diastolic function is suggestive of magnesium deficiency and indeed this is confirmed in the tests below. Essentially one needs calcium to contract muscles and magnesium to relax them. Poor diastolic function means the heart muscles do not relax properly in order to allow the chambers to fill with blood. Carlos’s symptoms of kidney stones could indicate vitamin D deficiency – it is vitamin D that makes sure that calcium is deposited in bone. Indeed Carlos has low vitamin D at 25.2umol/L – the best source of vitamin D is sunshine but failing that I recommend he take 2,000i.u. daily of vitamin D.

I note Carlos has generally low levels of minerals from the hair analysis but his level of superoxide dismutase is good suggesting adequate mineral status here.

For further information see my website for information on PROBIOTICS and KEFIR, GUT DYSBIOSIS, HYPOCHLORHYDRIA and COMPREHENSIVE DIGESTIVE STOOL ANALYSIS.

Hypochlorhydria
This is an extremely common problem in which insufficient acid is secreted by the stomach for the efficient digestion of proteins. It can have many clinical symptoms including symptoms of GORD (gastro-oesophageal reflux disease) and hyperacidity (I know this sounds rather counter-intuitive but the pyloric sphincter is pH sensitive and unless a certain acidity is achieved then the stomach fails to empty), a tendency to allergies (protein foods are poorly digested and present as large, antigenically interesting molecules, which have a tendency to switch on allergies), failure to sterilise gut contents (this results in bacterial and yeast overgrowth so that food is fermented instead of being digested resulting in wind, gas and bloating and poor absorption of divalent and trivalent cations leading to micronutrient mineral deficiencies). 

So, possible symptoms of hypochlorhydria would be:
• Gastro-oesophageal reflux disease and hyperacidity
• Poor digestion of foods with recognisable foods appearing in faeces
• Diarrhoea, malabsorption, irritable bowel and fermentation of foods
• A tendency to allergies
• A tendency to micronutrient deficiencies
• A tendency to get gut infections since acid is normally required to sterilise the contents of the stomach – indeed, I suspect this is part of the mechanism by which CFS sufferers are susceptible to gut viruses like Epstein-Barr.

The treatment is to acidify stomach contents. A traditional remedy is of course cider vinegar but many people will not tolerate the yeast contained in this. Ascorbic acid has a beneficial effect as indeed does betaine hydrochloride 1 – 4 capsules taken with meals depending on the size of the meal.

Carlos’s symptoms are highly suggestive of hypochlorhydria. We now have a test for hypochlorhydria which is to measure salivary vascular endothelial growth factor. It is very common to see hypochlorhydria with allergies and if this test is required then it’s easily arranged. 

Carbohydrate intolerance and hypoglycaemia
There are two common ways in which diet can cause fatigue – firstly allergies and secondly carbohydrate intolerance. The carbohydrate intolerance is often a symptom of sugar addiction. Addiction and allergy are closely allied and indeed people get allergic to their addictions and addicted to their allergens. 

The clues from the history that suggest this may be a problem are:
• A need for carbohydrate foods
• Missing a meal results in feeling awful – having to snack or graze on foods regularly through the day
• Feeling at one’s worst on waking
• Tendency to gain weight easily (this results from high insulin levels)
• Disturbed sleep / waking in the middle of the night and unable to drop off again – this is because the person is woken by low blood sugar and the adrenalin reaction that accompanies it.
• Anxiety and mood swings.

Because carbohydrates are so addictive, any change in diet should be done gradually – if this is done too quickly symptoms may get much worse. However for many this is an essential and possibly the most important part of treatment. We can test for hypoglycaemic tendency by measuring levels of short chain fatty acids first thing in the morning before breakfast has been taken. This is a blood test and can be arranged on request.

Parasites
Carlos has been tested positive and attempted to eradicate both blastocystis hominis and endolimax nana.

Sleep problems
It is a sine qua non that poor sleep will result in chronic fatigue. The average sleep requirement is for 9 hours sleep between 9.30pm and 6.30am – more in winter, less in summer and the most restorative hours of sleep come before midnight when melatonin is produced. Sleep doesn’t creep up on us during the course of the evening, it comes in waves and there is a sleep wave roughly every 90 minutes. So I would like Carlos to catch the relative sleep wave and use whatever herbs or medications necessary to help him achieve this. If combined with a sleep dream, this produces a Pavlovian conditioned reflex and this prevents problems of tachyphylaxis and dependency. See SLEEP section in my CFS book.

Thyroid Problems
Hypothyroidism is both a clinical and a biochemical diagnosis and can certainly present with fatigue. Anybody suffering CFS could well be hypothyroid! So I would very much like to see the results of a recent or new free T4, free T3 and TSH. 

The clues from the history that suggest this may be a problem are:
• A gradual descent into fatigue often attributed to ageing
• Feeling cold, cold hands and feet, low basal body temperature
• Slow pulse and inability to get fit (relative to current ability), shortness of breath
• Dry hair, skin, loss of hair, loss of eyebrows
• Headache
• Other members of the family also affected by thyroid problems.

Adrenal stress problems
If one thinks of oneself as a car, the mitochondria represent the engine of that car, the thyroid gland the accelerator pedal and the adrenal gland is the gearbox. It allows one to move up into fourth gear or fifth gear when one is stressed and this allows individuals to achieve extraordinary feats! However it is not sustainable long term. If there is unremitting stress (and this may be financial, physical, mental, emotional, nutritional, infectious stress or whatever) then the adrenal glands fail, output of stress hormones falls dramatically and effectively one is left stuck in first gear. With prolonged rest the adrenal glands do eventually recover but in the interim adrenal supplements can be helpful. Adrenal tests show that Carlos has low cortisol and high DHEA levels.

Depression
There is a clear clinical difference between fatigue and depression. In depression there is no volition, but often when people are made to do things they feel better as a result. In fatigue the desire is there but the patient does not have the energy to undertake the task, and indeed, quickly discovers that if they do push themselves to do something it makes them feel very much worse. This is an important difference to make clinically and failure to do so has resulted in many wrong diagnoses. It is not unusual for patients to become frustrated by their inability to do things and, indeed, are possibly secondarily depressed because nobody is addressing the root cause of their problems. There is a difference between depression and being “pissed off”! This can usually be discerned from careful history taking. However this has major implications for choice of medication. This is because the stimulating antidepressants such as the SSRIs increase the desire to do things but do very little for the performance and thereby increase the frustration factor. The important point is that SSRIs may be making some patients with fatigue worse. 

Actually my preference is to use the tricyclic antidepressants at night in order to improve the quality of sleep and the length of sleep and this may have a very beneficial effect on the fatigue. If there is secondary depression then this may help address that side as well but at worst one can do little harm with low dose tricyclics. Most patients with fatigue syndromes are intolerant of normal doses of medication and should a tricyclic be tried then it needs to be in much smaller doses than generally considered to be therapeutic. For example with amitriptyline I usually start patients off on 5 to 10 mg at night and it is unusual for them to tolerate more than 25mg. And with Trimiprimine (Surmontil) I suggest 10mgs at night because sometimes this also has a beneficial effect on muscle pain. Having said all that a few patients are improved by small doses of SSRI and I suspect this is because SSRIs also have mild anti-inflammatory actions and downgrade the nitric oxide/peroxynitrite pro-inflammatory cycle and, if relevant, Carlos may feel he would like to discuss these options with you.