Dr Sarah Myhill: Why We Get Sick and How to Stay Well

Are you constantly suffering from indigestion, heartburn, bloating, feeling full, and lots of other digestive problems? If so, you may have a fermenting gut, and this episode is for you. In this episode, I spoke to Dr Sarah Myhill. She is a British doctor running her own specialist M.E. clinic in Knighton, Wales, UK. Her website is an extensive resource of articles and information based on her treatment of patients, it runs to 920 web pages and has had over six million individual visits.

In our conversation, we explore mitochondria - what it is and how important its function to our body, mitochondrial dysfunction. the ketogenic diet, chronic fatigue syndrome, fermenting gut, and so much more.


Health Podcast Highlights

Dr Sarah Myhill: Why We Get Sick and How to Stay Well Introduction 

Well, today we’re going to explore why we get sick. Why does disease even happen? Why do things go wrong? It’s interesting because, well, it’s something we fundamentally should be aware of. In order to solve the problem, it often helps to know what that problem is. And it’s interesting to consider how medical practitioners or many, many medical practitioners approach health care. 

They approach it with a degree of scepticism, which is important, but also curiosity. And it’s interesting to consider when that curiosity actually starts or at which point in medical education the curiosity starts.

For many, and I know I was guilty of this when I was in studying Dentistry, a five-year degree. In the first two years were basic subjects like anatomy, physiology, histology, the study of cells, microbiology, and biochemistry. And to be honest, I couldn’t wait to get over those subjects. I was just so pleased I passed them and I could forget about them and move on to the real stuff of what real practitioners did, and we started to study pathology, and then also pharmacology, and we also studied as dentists how to fix problems in the mouth.

So and for medical practitioners, the study of pathology, the study of disease and pharmacology, how to manage that disease is for many where the real medicine starts, and that is where their curiosity continues through their professional life. 

However, I would argue that it’s actually and this is something I have learnt over the last 20 or 30 years that actually going back and studying those basic sciences is really important because they give us a clue as to why somebody might experience a disease, why somebody might be unwell because ultimately it’s an imbalance in the physiology and the workings on a cellular level, and how biochemistry interacts with your health. And that really is why we get sick.

Well, my guest today is going to give us a really wonderful, holistic perspective on this. And it is just a real eye-opener for me, as I hope it will be for you as well. My guest is Dr Sarah Myhill. She is a British doctor running her own specialist clinic in Knighton, Wales, in the United Kingdom. Her focus is on myalgic encephalitis, which many will know also as chronic fatigue. There is a subtle distinction between the two, but they’re very closely linked.

Her website is an incredible resource. It has articles and information based on her treatment of patients, and it runs to over 900 web pages and has received over six million individual visits. Sarah’s view is that myalgic encephalitis and chronic fatigue is characterised by a cellular metabolic mitochondrial dysfunction and has published several studies.

She’s treated in excess of 10 000 sufferers over her, well, it’s actually a 40-year career, and in today’s episode, we dive into Mitochondria 101. You’ll love her description of its mitochondrial, not hypochondria or mitochondria, not hypochondria. Anyway, she explains her philosophy of medicine, and it is a wonderful discussion. I hope you enjoy this conversation I had with Dr Sarah Myhill.

Podcast Transcript

Dr Ron Ehrlich: [00:00:00] I’d like to acknowledge that I am recording this podcast on the traditional lands of the Gadigal people of the Eora nation and pay my respects to their elders past, present, and emerging.

Hello, and welcome to Unstress, my name is Dr Ron Ehrlich. Well, today we’re going to explore why we get sick. Why does disease even happen? Why do things go wrong? It’s interesting because, well, it’s something we fundamentally should be aware of. In order to solve the problem, it often helps to know what that problem is. And it’s interesting to consider how medical practitioners or many, many medical practitioners approach health care. 

They approach it with a degree of scepticism, which is important, but also curiosity. And it’s interesting to consider when that curiosity actually starts or at which point in medical education the curiosity starts.

Dr Ron Ehrlich: [00:01:01] For many, and I know I was guilty of this when I was in studying Dentistry, a five-year degree. In the first two years were basic subjects like anatomy, physiology, histology, the study of cells, microbiology, and biochemistry. And to be honest, I couldn’t wait to get over those subjects. I was just so pleased I passed them and I could forget about them and move on to the real stuff of what real practitioners did, and we started to study pathology, and then also pharmacology, and we also studied as dentists how to fix problems in the mouth.

So and for medical practitioners, the study of pathology, the study of disease and pharmacology, how to manage that disease is for many where the real medicine starts, and that is where their curiosity continues through their professional life. 

However, I would argue that it’s actually and this is something I have learnt over the last 20 or 30 years that actually going back and studying those basic sciences is really important because they give us a clue as to why somebody might experience a disease, why somebody might be unwell because ultimately it’s an imbalance in the physiology and the workings on a cellular level, and how biochemistry interacts with your health. And that really is why we get sick.

Dr Ron Ehrlich: [00:02:35] Well, my guest today is going to give us a really wonderful, holistic perspective on this. And it is just a real eye-opener for me, as I hope it will be for you as well. My guest is Dr Sarah Myhill. She is a British doctor running her own specialist clinic in Knighton, Wales, in the United Kingdom. Her focus is on myalgic encephalitis, which many will know also as chronic fatigue. There is a subtle distinction between the two, but they’re very closely linked. 

Her website is an incredible resource. It has articles and information based on her treatment of patients, and it runs to over 900 web pages and has received over six million individual visits. Sarah’s view is that myalgic encephalitis and chronic fatigue is characterised by a cellular metabolic mitochondrial dysfunction and has published several studies.

Dr Ron Ehrlich: [00:03:42] She’s treated in excess of 10 000 sufferers over her, well, it’s actually a 40-year career, and in today’s episode, we dive into Mitochondria 101. You’ll love her description of its mitochondrial, not hypochondria or mitochondria, not hypochondria. Anyway, she explains her philosophy of medicine, and it is a wonderful discussion. I hope you enjoy this conversation I had with Dr Sarah Myhill. Welcome to the show, Sarah.

Dr Sarah Myhill: [00:04:16] Thank you for inviting me, Ron.

Dr Ron Ehrlich: [00:04:18] It’s a pleasure, it’s a pleasure. Ever since we first met at the conference that we did last year, The Global Conference for ACNEM, the Australasian College of Nutritional and Environmental Medicine, I was so looking forward to having you on my podcast and sharing you with my listeners. Look, we’ve been in practise and I know we both have been in practise for quite a few years now. Let’s say over 30 almost, you know, well, let’s say 40 years, you know, how do you reflect on medical, the modern medical approach to health and disease?

Dr Sarah Myhill’s reflection on the modern medical approach of health and disease

Dr Sarah Myhill: [00:04:55] Well, the shameful thing is during that those 40 years, it has not evolved one jolt. Modern conventional medicine is still in the dark ages. Why? Because they are still not looking for disease causation. They ask they continue to treat depression as if it is a deficiency of SSRI. They continue to treat the arterial problems as if it’s a deficiency in statins. Now, it is intellectually shocking what is happening in the conventional world. And it’s doctors, like you and me, who are asking the real questions “Why?” Because modern medicine models up clinical pictures and diagnoses, so, for example, it will tell you that Parkinson’s disease is a diagnosis, it’s not. 

Parkinson’s disease is a clinical picture that might be could be caused by drug side effects. It might be Lyme disease. It might be a prion disorder. It might be an Altera sclerotic disorder. So that’s what you and I are trying to do. That’s what the real doctors are doing, the naturopathic physicians, the medical doctors, you know, the functional medicine, those. 

We’re asking the question “Why?” Because that gives us the true diagnosis. Because if you can identify the underlying mechanisms by which symptoms and disease arise, then that has obvious implications for management. Is this personal? Because they’re deficient, because they’re toxic, because they’re allergic, because they’ve got a chronic infection. If you can answer those questions, then you can start to deal, and treat them properly from first principles with logical scientific medicine. And that’s what we are all about.

Dr Ron Ehrlich: [00:06:33] Mm-Hmm. It’s so interesting, Sarah, to hear you say from first principles because we all moved through our degrees in the undergraduate part about the early years were all about anatomy, physiology, histology, biochemistry. And for most practitioners, we just couldn’t wait to finish that so we could get all that, all that crap out of the way. And then we could start studying pathology. 

And most importantly, how pharmacology and how to fix that, how to manage these things. Isn’t it interesting that we just ignore the why, but we’ve gone straight to how to manage?

Dr Sarah Myhill: [00:07:12] Exactly, exactly. I mean, the story I always tell is biochemistry, which was the biggest in a bullock in undergraduate medicine, and when it was an exam you had to get through and you know, you’d what you’ve stayed up all night on black coffee and chocolate biscuits, mugging it all up, regurgitate all this stuff about mitochondria, which you thought was a load of rubbish on the exam paper, and then you’d forgotten it by the afternoon and hoped you’d pass. But the fact of the matter is, you know, mitochondria special area of interest. Mitochondria are involved in every single disease pathology you care to mention. 

Mitochondria 101 

Dr Ron Ehrlich: [00:07:49] Well, you’ve mentioned mitochondria and I think I agree with you there, but I wondered if we might just go to Mitochondria 101. Like, tell us about mitochondria.

Dr Sarah Myhill: [00:08:00] Okay. Well, mitochondria exist in every living cell in nature. So you look at your window and you see grass, trees, hedges, sheep, cattle. Every single living cell in nature has mitochondria within them, and they power the cell because, without power, that cell is dead. You turn the power off and you’re milky dead. 

So mitochondria are a common biological unit that delivers energy to cells’ efficiency. And if you haven’t got mitochondria or the mitochondria go slow, then that cell will go slow. So the cell goes slower than that organ goes slow. The organs go slow you’re slipping to organ failure, and therefore they’re implicating dementia, heart disease, cancer, diabetes, you name it, mitochondria involved. They are the energy providers, and you look at any system in the world and it doesn’t matter if it’s a factory or a car or any system. If you haven’t got energy, it’s not going to work. So they are very, very important players in the whole of medicine.

Dr Ron Ehrlich: [00:09:01] Now, we were talking about our wonderful courses in biochemistry when we were studying and one of the things we remember or I remember from it and I, of course, have been following it more closely, is to get from one point to another point, it needed certain things to be added to make that process occur…

Dr Sarah Myhill: [00:09:24] …and that was energy.

Dr Ron Ehrlich: [00:09:26] And all you got from that was energy, but you needed those cofactors, which are?

Dr Sarah Myhill: [00:09:32] Well, mitochondria can go slow for lots of reasons. And there’s a whole bunch of cofactors. I mean, you know, we have kind of got used to the modern medical paradigm. One symptom, one drug, and away you go. And it ain’t like that. It’s much more complicated than that. 

And the way I explain it to patients is, you know, if you consider that the body is a language, then all the A B C D E F G, which is essential to write those sentences, those paragraphs, those books, that literature, you know, without any one of those, then it’s not going to work. 

So you might not use the word the letter X very often, but without X, you don’t going to be very sexy. It’s going to be a boring old book, and it’s exactly the same with the human body. You need A to Z for it to function normally, and we call those vitamins and lots of other things as well. 

Dr Sarah Myhill: [00:10:23] So the starting point to treat absolutely all pathology is you’ve got to provide the body with all those raw materials, and that’s all about diet and food and cooking. And don’t laugh now, I probably spend more time talking about diet and food and cooking and meals than all other subjects put together, because if you get that right, the body can heal and repair itself. 

It wants to heal and repair itself. It’s been healing and repairing itself for hundreds of millions of years. And OK, we can talk about a few substances and that will speed things up or deal with rate-limiting steps but food and diet are essential for mitochondria function and for normal biochemistry.

Dr Ron Ehrlich: [00:11:03] I love that metaphor, that metaphor of the alphabet, I’m going to use that, Sarah. I will credit you with it, but I’m going to use that again.

Dr Sarah Myhill: [00:11:12] You don’t need to credit it. I put lots of ideas out there, and if people help themselves to them, that’s great. I don’t require them to be credited.

Dr Ron Ehrlich: [00:11:21] But it is. It is true. It is a wonderful metaphor to use that without our alphabet, our language is meaningless and without all of the micronutrients, micronutrients and cofactors, our bodies are, well, not meaningless, but they’d become diseased.

Dr Sarah Myhill: [00:11:39] Yeah, they start to go slow. And I mean, if you slow up brain conduction by a certain percent, some comparable figures, you’ve got dementia. So and you can explain much of dementia simply in terms of poor energy delivery mechanisms. I’m sure you’re aware of the work of Dale Bredesen, Neurologist, California. He can reverse dementia by correcting the mitochondrial dysfunction through diet — ketogenic diet is the starting point.

So yes, the important thing to recognise is that the tools that we are using are incredibly powerful. They’re much better than drugs. Okay, it’s harder work. They don’t work overnight. But you’re, we, you and I are affecting cures. That is a very different from what the conventional doctors are doing who are managing problems may be controlling symptoms, may be postponing pathology, but the overall progression is downhill.

Dr Sarah Myhill: [00:12:34] Let’s look at heart failure, for example. Heart failure. If you have been diagnosed with heart failure by conventional doctor, the prognosis is awful. 50% dead in two years. If you treat heart failure with nutritional medicine, you will cure those patients. 

And I have any number of patients diagnosed with heart failure off their drugs, on their nutritional supplements. Five, 10, 15, 20 years down the line, doing very nicely. Thank you very much. Why? Because we cured them. And that’s what proper medicine should be all about. 

Dr Ron Ehrlich: [00:13:09] Yes, well, tell us a little bit more about what goes wrong. Before we dive in, you’ve mentioned Bredesen and I’d love to have him on as a guest as well because he does some phenomenal work. Maybe you could give us a little bit of an insight there as a preview, but what can go wrong with mitochondria? What are some of the things that cause mitochondrial dysfunction?

What causes mitochondrial dysfunction?

Dr Sarah Myhill: [00:13:29] OK. Mitochondria can go wrong for any number of reasons. The first thing is you’ve got to have the right fuel in the tank. Now, the problem with Western diets is it’s based on carbohydrate, it’s sugar. And okay, mitochondria can use sugar as a fuel, but it’s very damaging to them. Lots of free radicals, premature ageing. So the starting point is you got to have the right fuel, and that’s ketones and that comes from fat and from eating fibre. 

Secondly, they’ve got to have the raw materials to work, and we have nasty bits of biochemistry like oxidative phosphorylation and Krebs citric acid cycle and respiratory enzymes. But essentially, they’re nasty names that describe the processes by which we generate energy or the mitochondria generate energy, and they need certain things like they need coenzyme Q10, which is a very important electron donor and accept with the mitochondria. 

They need magnesium, which I think of as the spark plug of our engines. Without magnesium, you can’t make ATP and you can’t get energy from ATP. We need Acetyl-L-carnitine, which I think was the nozzle up at the fuel pipe that gets on acetate roots from this cell cycle into the mitochondria, where they can be used as a fuel. They need Vitamin B3. Vitamin B3 is essential to make NAD and NADH. Again important intermediaries.

Dr Sarah Myhill: [00:14:50] So if you haven’t got those cokes, you know those wheels, those bits of micro machinery within mitochondria, then they can’t work. Then the mitochondria got to be free from toxic stress. If you poison with something, then they will go slow. And I kind of woke up to this in the 1990s when I started seeing farmers locally with what was described then as shaped it flu. 

But they were using organic phosphate chemicals to dip their sheep to get rid of the mites and the ticks and the parasites that were living on the sheep’s wool. And it works very well to kill the sheep, the ticks, but it also kills the human beings as well, because organophosphates inhibit oxidative phosphorylation for very obvious biochemical reasons.

Dr Sarah Myhill: [00:15:36] Another group of people who also poisoned by organophosphates were the Gulf War veterans. The Gulf War was the most toxic, poisonous war that’s ever been fought in human history, and organic phosphates were widely used as chemical weapons, and they’re also used in the desert to control sandflies, and those poor soldiers in the frontline were saturated with them. 

They’re using organophosphates for example, they sprayed any prisoners with organophosphates to get rid of body lice, for example. So they were poisoned. So again, organophosphates inhibit oxidative phosphorylation.

Dr Sarah Myhill: [00:16:09] But guess what? It’s not just organophosphates. Yeah, so many chemicals will interfere. Heavy metals, mercury, aluminium, lead, arsenic will interfere, volatile organic compounds. In fact, I often do tests of toxicity on my patients, which might be if that helps. I have yet to find a normal result. A normal result is no chemicals. We all carry a body burden of chemicals, which might be organic chlorine, polybrominated biphenyls, toluene substances, benzene substance we’ve all got them. 

And that’s because we live in such a polluted world and very simple techniques for getting rid of those… Heating regimes get rid of them reliably well. Saunas, if you’ve got your fit enough to run an exercise and shower even better. Hot baths, reception soap, absolutely brilliant. So anything we can do to keep that toxic load as low as possible is going to be highly desirable.

Dr Sarah Myhill: [00:17:04] And then, of course, mitochondria, they are just the engines. But for engines to work, we need a thyroid accelerator pedal and an adrenal gearbox because it’s very important to match energy delivery to energy demand. Now the point being is if we waste energy, if we pissed it up the wall, as my father would say, you know, if we waste energy, then that’s wasting precious resources, and that means we ain’t going to survive the winter. 

So it’s really important to very carefully match the energy we need to hunt, you know, to dig the garden, to acquire food with energy delivery and energy waste it is inefficiency. And that’s where the adrenal glands in the thyroid glands are very finely tuned to make sure we have just the right amount of energy to it for the job we need and no more than a no less than. You’ve got to be able to do that job. We got to be able to hunt, but we don’t want to be wasting.

Dr Sarah Myhill: [00:18:00] Of course, in a world of plenty, people don’t notice that because the biggest constraint for primitive man would have been food supply. Now we have an abundant food supply. So people aren’t cognisant of this idea, but it is absolute vital, evolutionary imperative. And broadly speaking, the thyroid gland, as I call it, base loads that tells you what your average speed of your mitochondria is. And guess what? I want my mitochondria be going at 50 miles now, not 15 miles an hour.

And then the adrenal gland adjusts energy delivery from second, second minute to minute from day to day. And so for sabertooth tiger jumps out at me, my adrenaline levels will soar and I will run the fastest mile I’ve ever run in my life. 

On the back of that adrenaline mimics minute cortisol allows the adrenal glands to gear up and deal with stress and a longer term basis maybe DHA allows the adrenal glands to gear up and the mitochondria to run faster, for example, dealing with chronic and acute infection.

Dr Sarah Myhill: [00:19:00] So the control mechanisms are vital. And once you get all those players in place, you will optimise your energy so you will lift your full potential. You will improve your quality of life and you will improve your quality of life because you get that rule in place and you will resist all pathology, heart disease, cancer, degenerative conditions, Parkinson’s and so 

So of course, what I would love everybody to do and but life ain’t like this, as you know, I would like everybody to start looking after their mitochondria straight away. Diet supplements, detox regime sort out the adrenal glands and infectious disease will then become a thing of the past. Degenerative disease will become a thing of the past, and we will all live to our full potential. And guess what? I’m enjoying life. That’s what I want to do. And I think if I want to do it, I’m quite sure my patients do too.

Dr Ron Ehrlich: [00:19:53] Well, it’s interesting you draw your alertness to this important regulatory mechanism of thyroid and adrenals working together. I’ve often heard it described as the thyroid is where we’re idling along going along. But when we need to put our foot on the accelerator, the adrenals kick in. But thyroid disease, underactive overactive is, well, I hate to use the word pandemic, but anyway, it is at a very high level.

Thyroid disease

Dr Sarah Myhill: [00:20:22] Correct. Correct. And when we say thyroid disease, you know, 99 times out of 100, we’re talking about an underactive… And that is absolutely key to getting people well. But the key point to remember here is that the thyroid gland manifests through its effects on mitochondria. So you’ve got to fix the mitochondria first to get the full benefit from the thyroid gland.

Dr Sarah Myhill: [00:20:46] Now, let me say, some people don’t just get hypothyroidism as a single entity, and you fix that and you’re away. But I’m really thinking about patients with chronic fatigue syndrome. And if you just knock on thyroid, then the thyroid will beat up mitochondria that are not in a fit state to respond. And you’ve got to feed the mitochondria right with the ketogenic diet. 

You got to feed the mitochondria right with the raw materials to allow them to start to work, and you’ve got to stop poisoning them. And then your mitochondria are in a fit state. They can, they have the potential to run. And then and only then can you apply the authority accelerator pedal and gradually increase the pressure.

Dr Sarah Myhill: [00:21:24] Now the shameful, disgraceful, awful thing about this is that endocrinologists don’t know this, and the endocrinologist… I have, I have a league table of arrogance of consultants and that is spearheaded by the endocrinologists who think that they can diagnose the whole of our disease by doing a blood test. And it’s worse than that. 

Often they only look at one aspect of that blood test, which is the TSH. And, of course, euthanizing patients with chronic fatigue syndrome. Many of them do not have primary hypothyroidism. They have secondary hypothyroidism because the pituitary gland is down. And so the TSH is normal. 

So these poor, fatigued patients trot along to the endocrinologists asking all the right questions. I think I’m hypothyroid, the endocrinologist say, “Oh no, the TSH is fine. Go away.” And they are left helpless, you know, with no assistance whatsoever.

Dr Sarah Myhill: [00:22:22] So one of the things I tell my patients very early on is there’s only one person that’s going to get you well and that’s you. I can give you the rules of the game and the tools of the trade, but you’ve got to actually walk the path and get yourself better. And guess what? There’s nobody better incentivised to get yourself well than yourself.

Dr Ron Ehrlich: [00:22:43] Hmm.

Dr Sarah Myhill: [00:22:43] So the point about thought is, yes, you can fix it yourself with the help of glandulars. Now, when hypothyroidism myxedema was first described, the 1920s, the 1930s, the only tool they had to treat it was the dried pig thyroid gland. It was called armour thyroid. And guess what? It was the best. And in the 1930s, all those endocrinologists treating their patients used to listen to them. 

They used to hear what they had to say, you know, how are you feeling? What are your energy levels like? What’s yours? How’s the sleep? And let’s look at your pulse rate. What’s your core temperature? What’s your blood pressure? And they would adjust the dose of thyroid, according to clinical picture. And that’s what we should be doing today. That is the best sort of medicine.

Dr Sarah Myhill: [00:23:33] So we start our patients today on dried pig thyroid gland. You can also use dried cow thyroid gland. It comes under lots of names armour thyroid, natural thyroid, thyroid-s, natural desiccated thyroid, metavive, you know there are lots of preparations on the market, but they’re all fundamentally the same thing. 

They’re dried animal glands and they have active hormones in them, and they are the best treatment for treating the underactive thyroid. The key to using them is we have to start with very low doses and increase very slowly. And the reason for that is that thyroid hormones aren’t just responsible for how fast mitochondria go, they’re also partly responsible for the number of mitochondria.

 From an energy perspective, that’s the difference between having a little engine with not many mitochondria and a big engine with lots of them. And guess what? You know, I won’t be driving around in a Rolls-Royce […] so start with modest doses of thyroid, glandular or natural desiccated and build up very gradually. 

And most people end up needing about between one and two grains of natural thyroid, which is equivalent to 60 mg or 120 mg of desiccated thyroid or whatever. They come in in various doses, but do go slowly with that and monitor that. How do you feel? What’s my pulse rate? What’s my blood pressure?

Dr Sarah Myhill: [00:24:59] Of course, now we have all these apps so we can monitor ourselves properly and responsibly, you know, at home and sort it out. If you’ve got a therapist to help you, well, that’s even better. But it works brilliantly well and underactive thyroid is fantastically common. You may be aware of the work of Dr. Kenneth Blanchard, consultant endocrinologist in America. He reckons that about 40% of Westerners are hypothyroid. Now that’s in the normal population.

In the chronic fatigue m.e population. You can double that. Now, of course, the temptation for anybody listening, thinking, I’ve got confused all this rush out and get some of these things and, you know, feel better tomorrow. It ain’t like that. You’ve got to do the whole shooting that you’ve got to put the mitochondria in a fit state to respond.

And that is a ketogenic diet, preferred fuel, mitochondria ketones, a mitochondria package of supplements. Stop the detox regimes, and then you will start to get a good response to the thyroid and the adrenal extracts.

Dr Sarah Myhill: [00:26:00] So one of the things, you know, I realise now, and of course, this is 40 years into 40 years of doing it wrong, 40 years of many blind avenues and patients who have been willing guinea pigs is nothing. Not only do we now know what the regimes are, we now know they’ve got to be done in a certain order. 

And in the early days, I give people a shopping list of things to do. But there’s this supplement and this is glandular and there’s this detox regime. And guess what? They cherry-pick the easy things. And guess what? The most difficult thing is doing the ketogenic diet, but it’s also the most important. 

And actually, what I skipped over, forgive me, is there’s another really, really important reason for doing the ketogenic diet. And that is because if you have spent decades fuelling your body with sugars and carbohydrates, so you know, muesli and toast for breakfast, biscuits and crisp mid-morning, sandwiches at lunchtime, cake for the afternoon, pasta and all that and that sort of stuff. If you spent decades eating like that, then you will have enough of fermenting gut. 

Fermenting gut

Dr Sarah Myhill: [00:27:10] Now, as you and I know, the upper gut be sterile, it should be an acidic digesting gut, the business of digesting meat and fat. But if you’ve got a fermenting gut, it means that the microbes have moved in, that bacteria have moved in, the fungi have moved in and every time you eat sugar, a carbohydrate, they are busy fermenting away. What does that give us symptoms of? Indigestion, heartburn, reflux, bloating, burping, feeling full and lots of digestive symptoms.

Now, if your upper gut is full of bacteria and fungi, when you start taking vitamins and minerals, the bacteria and the fungi say, “Yum yum! Thank you very much.” That is, you know, that’s nectar. You’re just feeding the bugs, you know, so you’re mild absorb they’re not going to go to where they’re needed, which is in your body to the mitochondria.

Dr Sarah Myhill: [00:28:01] So first, to be able to manage to be able to absorb all those expensive substances, you’ve got to get rid of your fermenting gut. And there’s another problem here. You know, what do these microbes ferment produce? Well, they ferment to produce nasty toxins. It’s called the auto-brewery syndrome. And when as those microbes ferment, you get horrible things like alcohol, de lactate, hydrosulphite ammonites or compounds. And they all poison those mitochondria. 

So it’s a real double whammy. It’s, you know, you can’t get the nutrients in, and your poison the whole system at the same time. And then on top of that, you’ve got bacterial and toxin, you’ve got fungal mycotoxins. And we all know those poisoned mitochondria and the liver and everything else like nothing else.

Dr Sarah Myhill: [00:28:48] And then there’s another major major problem, and I think this is a massively overlooked driver of pathology. You know, you and I Ron, we are taught at medical school that yes, the gut is full of bacteria and there they stay. We now know that’s not true. We now know those microbes very easily get from the gut into the bloodstream. It’s called bacterial translocation. It’s a well-recognised phenomenon. 

One example of that, if you brush your teeth and you take a blood sample two minutes later, you find dental bacteria in your bloodstream. That’s why people with heart disease, they’re given antibiotics before any dental procedure because they don’t want those bacteria to infect the heart valves. So if you’ve got this tsunami of bacteria pouring into the bloodstream all the time, that presents a real problem for the immune system. Because bacteria are potentially foreign invaders, its potential septicaemia and whatever those microbes end up in the body will drive inflammation. 

So if they end up in the blood vessels, you could get polyarteritis nodosa. If they get into the muscles, you can get polymyalgia rheumatica. In blood vessels, temporal arteritis. If they get into again the muscles, fibromyalgia. The skin, chronic urticaria. The joints, arthritis. So many arthritis we now know driven by bacteria.

Dr Sarah Myhill: [00:30:15] In fact, when I was at the Middlesex Hospital Medical School in the 1970s, we had a consultant there called Dr Alan Ebringer, a rheumatologist. He demonstrated that ankylosing spondylitis is driven by microbes in the gut called Klebsiella. And if you are a particular tissue type, which is HLA-B27 positive that the immune system looks exactly like Klebsiella. 

So the bacterium make antibodies against Klebsiella, which cross-react with ligaments in the spine and you get inflammation there and guess how Ebringer was treating his patients? With a low carbohydrate diet. He’s got some curing their ankylosing spondylitis.

Small Intestines Bacterial Overgrowth (SIBO) explained

Dr Ron Ehrlich: [00:30:58] With this bacterial overgrowth, I mean, it’s referred to, if I’m not mistaken, SIBO (Small Intestinal Bacterial Overgrowth)?

Dr Sarah Myhill: [00:31:06] Yes, but that’s too narrow a term.

Dr Ron Ehrlich: [00:31:08] Okay.

Dr Sarah Myhill: [00:31:09] Upper fermenting gut is a much better term because it doesn’t infer in an organism and an upper fermenting gut will embrace SIBO. The problem with calling it SIBO is the gastroenterologists do a test for SIBO and say, “Oh, negative.” you know, and thereby therefore people say, “Well, I haven’t got enough of fermenting gut so I can continue with my wicked ways.” 

But you know, the upper fermenting gut embraces parasites, embraces fungi, it embraces bacteria, which might be aerobic bacteria, and it might be an anaerobic bacteria. But the treatment of all those things, it the starting point for treatment anyway is the same. 

First of all, you starve them out with a ketogenic diet, which is high in fat and high in fibre. That’s what you fill the body with. And then you kill them. And you start off killing them with Vitamin C.

Vitamin C

Dr Sarah Myhill: [00:31:57] Now, Vitamin C is one of my favourite multitasking tools. Humans need at least five grams daily. That’s 5000 milligrams a day. Put it in your bottled water. Put in your glass. Drinking little enough through the day. Why do we need so much? Because that’s what the rest of the animal kingdom get. All other animals, pretty much all animals, humans, fruit bats and guinea pigs, all other mammals like dogs, the horses, the cattle, sheep likes out there. They can all make their own Vitamin C, and they make it in a quiver of about five grams a day. 

And more importantly, when they have infectious stress or toxic stress, they can massively increase the amount of Vitamin C they make to deal with that. And we should do the same. We should copy nature.

Dr Sarah Myhill: [00:32:44] So baseload with five grams of Vitamin C, and that keeps your upper gut clean and tidy because it contact kills all microbes. In fact, I wrote a book about this called The Infection Game, about the whole of the immune system and how we deal with microbes. And as I was doing that, aside I wonder if Vitamin C has been ever used to treat helicobacter pylori. Now, helicobacter pylori, like you, Australians, you know, you discovered it. Barry Marshall discovered helicobacter pylori in Melbourne.

Dr Ron Ehrlich: [00:33:15] Well, now, hang on Sarah, just for our listeners that may not be aware, peptic ulcers in the stomach were used to be treated in one way, but then it realised that it was actually a bacterial overgrowth.

Dr Sarah Myhill: [00:33:27] Voila! It’s another example of the upper fermenting gut. The upper fermented includes Helicobacter pylori. So I asked the question because Helicobacter pylori is a difficult microbe to get rid of. You know, it’s two or three weeks of antibiotics and proton pump inhibitors need, and then it’s only 90% success. So I ask myself the question, “Does Vitamin C get rid of Helicobacter pylori?” 

And I found a pollee study where they had asked that very same question, and they treated their patients with just five grams of Vitamin C daily for a month. If you’d asked me that, I said, Well, that’s a waste of time. It’s not a big enough dose of vitamin C. You still eat your normal carbohydrate diet. The chance of getting rid of H. Pylori might be so very small.

Dr Sarah Myhill: [00:34:11] Even with that regime, 30% of patients cleared they healed from Helicobacter pylori. So you have the ketogenic diet that you’re going to make that even more powerful and then you stick with the ketogenic diet for life because that’s the evolutionary correct diet. 

And you’re going to slowly starve those Helicobacter pylori out over the weeks months and probably get rid now. That study has not been done. And I would love to do it. But you know, I don’t have the wherewithal to do it. But it illustrates the point. Vitamin C is a great way of cleaning up the upper gut, and you’ve got to get rid of the upper fermenting gut to start to hear your mitochondria.

Ketosis explained

Dr Ron Ehrlich: [00:34:45] Does the body just once you’re in ketosis, that’s the fuel. I mean, if things change in a 24 hour period, your body could switch a little bit to the… it moves between the two fuel sources constantly, doesn’t it?

Dr Sarah Myhill: [00:35:01] Yes, and that’s called metabolic flexibility. And guess what? In the in this month of September and I’m a gardener, I’ve got plums in the garden at the moment. I’ve got raspberries, I’ve got blueberries and I love them and I eat them. And I’m not in ketosis all the time and sometimes I slip up. But that doesn’t matter because within a few hours I’m back in ketosis again. 

And that metabolic flexibility, the ability to move from one fuel source to another is very helpful. So long as most of the time you’re in ketosis, that will do very nicely. Thank you very much.

Dr Ron Ehrlich: [00:35:32] But it still comes down on a daily basis when people get started on this to reducing your carbohydrate intake, doesn’t it?

Dr Sarah Myhill: [00:35:40] Yes. Because most people are not in ketosis. Most people, you know, we have, our children at school at all is the risible food pyramid. When we should be based in is it lots of pastoral grains and it’s rubbish?

Dr Ron Ehrlich: [00:35:54] Well, it’s a wonderful economic model, just not a very good health model.

Dr Sarah Myhill: [00:35:57] That’s where it’s driven by, you know, it’s the old story. Follow the money. You know, if you, you know, grow a ton of potatoes and you convert that into crisp, you can make 10000 quid. You know that cheap, easy fuels. Now, it’s not such a problem when you’ve got a population that’s physically active and burning it off. 

If I had an athlete that I was training for sprinting, then I would want them for that sprint probably to be running on sugar because it is rocket fuel in the short term. It’s just so damaging in the longer term. But if we’re very physically active, so we were carb loading and burning off in the day. I mean, when we moved, when I moved up to Weston in 1990, we inherited an old boy born in the 1920s, and he could remember cutting hay by hand. And that was during the 1930s.

And he said the daily ration was ten pints of cider throughout the day. And he said, We never got drunk. We never got pissed because we were so physically active, you know, so it was hard to walk for hours and hours a day, cutting and cutting and cutting, and they needed that alcohol and they needed that sugar to fuel them and fuel them it did, and it hydrates them as well. 

But of course, we just not sufficiently physically active to deal with all the sugar and carbohydrates. We’re pouring into our systems now, and I’m certainly not that physically active. Okay, I love to exercise, but what am I going to do? I won’t be sitting in front of my computer. I’m going to be seeing patients, you know, I’m not running around doing so.

The food we should be eating

Dr Ron Ehrlich: [00:37:27] What are some foods that we should be eating that will promote that for us, given we may not be exercising enough?

Dr Sarah Myhill: [00:37:35] Okay, when it came apparent to me that the ketogenic diet was central, the first thing I realised I had to do was to find a bread substitute. Because bread is such a universal thing you can eat at any time and covering I got up early every morning for about six months and experimented with different grains and listen, and I put together a recipe for paleo ketogenic bread, which is based on linseed. 

And the joy of linseed is it’s 2% carbohydrates, 26% fibre. So A) that fibre prevents you getting constipated; B) that fibre is happily fermented in the large bowel by the frenzy microbes to produce short-chain fatty acids, which are another form of ketones. So linseed is a fabulous, you know, food if you want a bread substitute and from linseed in the cookbooks, there are recipes for pastry you can make to keto pizza if you want to and so on. 

So, that’s a great start. And then don’t be afraid of fat. So many people are terrified of eating fat, and we have this and the rise of all hypotheses is the high-fat diet causes high cholesterol that causes arterial disease. Rubbish, rubbish, rubbish.

Dr Ron Ehrlich: [00:38:42] A very, very popular theme on our programme. You’re in good company here so don’t worry.

Dr Sarah Myhill: [00:38:47] OK, so the point is you five things that there’s a fatty. So my normal breakfast would be a couple of boiled eggs, keto bread. Because I’m so allergic to dairy. I have butter, which is not, which is dairy-free, but butter would be fantastic. A fantastic fuel. And the point is, with that fibre, with that fat on board, and in ketosis, you don’t get hungry. I mean, I, you know, if I’m physically in the guard working all day, I never, I don’t bother to eat because I forget I’m busy in the garden working.

If I’m sitting at my desk and have a snack at lunchtime, which might be the egg and cheese, it might be a big salad. It might be last night’s leftovers evening meal is usually meat. I’m very lucky. I’ve got my own pigs, so there’s lots of fat on that meat. 

Yes, sometimes I have chips, but in my view of chips are a little bit of potato and cooked with lots and lots, lots of fat. And they’re divine. They’re crunchy, they’re crispy, they’re tasty and hugely satisfying. And my pudding will be berries with coconut milk, which is again very low in carbohydrates.

Dr Sarah Myhill: [00:39:50] So I have an incredibly varied diet, it’s very satisfying. I never get hungry. I never run out of fuel. I don’t wake up in the night. You know, the commonest cause of disturbed sleep is hypoglycaemia, because if you’re running on carbs, your blood sugar is up, down, up, down, every time your blood goes up, you are insane. Every time a blood sugar comes down, you pour out adrenalin. What’s adrenalin do in the middle of the night? It wakes you up.

Saunas and detoxification

Dr Ron Ehrlich: [00:40:14] Hmm. Now we’ve talked, we’ve touched on it. I’m sure there’s many more areas of nutrition we could explore. But you’ve also mentioned getting rid of toxins. And apart from making responsible decisions, informed decisions, which is a really powerful tool to have. You also mentioned sodas and carbs. How often should one do that?

Dr Sarah Myhill: [00:40:38] Well, I collected lots of data to ask the question: “How effective are these regimes? Do like fat biopsies like blood tests?” And what I find is that roughly speaking, 50 heating regimes will halve your toxic load. So well, I mean, as important as the heating regime is the washing up afterwards.

Dr Sarah Myhill: [00:41:00] I’ll tell you a really interesting, lovely story about a family who came to see me in the early nineties or late 1980s. Their house, the whole house have been sprayed for cockroaches or fleas or something. And what they use organophosphates. The whole family were poisoned. The whole family got sick with the chronic fatigue syndrome. 

So they all wanted to be tested because money was no object, which was very nice. Tested, they all had high doses, high levels, organophosphate in their blood and in their fat. So I said, Well, you’ve got to do these heating regimes. So they decided to go off on holiday and they went off to a spa town in Eastern Europe called the Nubia’s, and there they had three weeks of saunaing hot tubs, massage showers. 

You know, all that stuff that they’ve been doing in Europe for years is just standard mainstream medicine for three weeks. And then they came back and they said off the office, they said, “Oh, can you retest us?” I said, “No, no, no.” Clever me. I said “It’s far too early. You know your rules.” You know what they said, “No, we’ve got lots of money. We want to be tested.” Do you know what? They’ve got rid of their organic phosphates. With three weeks, OK, now it’s every day and it’s very posh. And they had lovely food as well. But they had got rid of their load and I found that. 

And actually, by the time they’d been in the hot tub and then they’d been showering and then they’d been sunbathing because always, it doesn’t matter what technique you use, it doesn’t matter. We use sunshine, we use hot water, we use steam. You know, the point is as if you get hot toxins littering the subcutaneous fat immobilised onto the lipid layer of the surface of the skin, and then you wash them off in the shower. And so they just mobilised, mobilised, washed off, washed off and got rid.

Dr Sarah Myhill: [00:42:43] So I think we should all because we live in a toxic world, we should all be doing one heating regime a week, whether it’s a hot bath, sunshine, if you can, if you can exercise and get fit and run and get fit and sweat. The key thing is to shower afterwards in order to maintain the status quo.

And then if you are poisoned, then you do that more often. And at the same time, of course, you’ve got to stop loading up with this stuff. There’s no point putting toxins out. If you poison yourself with cosmetics next, smelly cleaning agents, you know, spray drift that they are the major and dental amalgam in all these poisons that we are using all the time, which we think are okay and they’re not. 

So clean up your environment. Do the detox regime. You will never get rid of every last toxin, but that doesn’t matter because the body can cope quite well with a low toxic load. We have the enzyme systems in place to deal with that. It’s when we get overwhelmed with prescription drugs, addictions, poisoning the environment, air fresheners. That’s when the whole thing starts to break down.

Dr Ron Ehrlich: [00:43:49] And that’s showering is enough just to get under a shower and let the water runoff. Or should we be scrubbing? What should we be doing there?

Dr Sarah Myhill: [00:43:56] Well, the toxins come out into the fat, so you want to be the soap, want to be safe, wash that literally off the skin if afterwards, and this is what I do. I love coconut oil. When I finish my shower, I actually put on coconut oil because I love the smell of it. I love the feeling. I got some lovely. It’s cheap as chips. It’s the body, identical fat. And so again, that helps replace the good of the dirty fatty washed off with the clean fats. And I think that’s a great way to detox.

How do we test for mitochondrial dysfunction

Dr Ron Ehrlich: [00:44:29] Hmm. And with the mitochondria, how do I mean, do we just take… How do we test for mitochondrial dysfunction? Although it sounds like almost everybody’s mitochondria is not working optimally in our modern world. But how do we test for it? 

Dr Sarah Myhill: [00:44:45] Well, there are various ways you can look. I mean, I work for many years with a wonderful laboratory by a lab in London, and then that was run by Dr. John McCarron Howard, and he developed a test called ATP Studies, which is the most complete test of mitochondria function that’s available. But the trouble is to do that test, you have to be a biochemical genius. You have to be a laboratory wizard and you need lots of raw materials. 

And unfortunately, Brexit and COVID has put paid to that. But there are very often tests that you can do, like the organic acid test, which looks at cofactors and Krebs citric acid cycle. Easy tests to do on a urine sample. You can get an awful lot of clues from that about what the mitochondria are doing. But the fact of the matter is I rarely do these tests, and the reason I rarely do them is because the patients that I’m dealing with haven’t got any money because they can’t work because they have no energy. 

And there’s no point doing tests when I know what the result is going to be. So I tend to save tests from the moment at which we get stuck and we really don’t know what’s going on. Because when these mitochondria function tests became available, we published many what we published many of our results and the first results we published was 71 patients who done the basic workup. The diet. You know what I thought was the right sufferer decision, the 19 in the 90s, and we got stuck.

Dr Sarah Myhill: [00:46:13] And at that point, I made that mitochondrial function because we had the test. And what was so fascinating is those were the worst level of energy, had the worse mitochondrial function and vice versa. And this test, this study was done blind because I saw the patients and we agreed what their clinical energy school was. We sent the blood to the lab to be tested. 

And John McCarron Howard did the actual tests? And he worked out. So he measured how well the mitochondria again and the results went to a third party. Professor Norman Booth at Mansfield College, Oxford and he analysed the mitochondrial function test and bought it all together. So although it wasn’t placebo controlled, double blind, it was blinded. You know, I didn’t know what the mitad results were. And John certainly didn’t know what the clinical disability was.

Dr Sarah Myhill: [00:46:59] So the results were astonishing, and that paper was published in 2009, was the first paper that really demonstrated that a central lesion in patients with chronic fatigue and ME was mitochondrial dysfunction, i.e. this is a physical disorder. I wrote a book on the back of it, which I called it Mitochondria, Not Hypochondria, and that went down very well.

Chronic fatigue

Dr Ron Ehrlich: [00:47:22] Well, that does raise. That’s how I love that, too. That does raise another issue, doesn’t it? Where and it’s very frustrating, I think for patients and chronic fatigue was a good example of this is people would present with a set of symptoms and the doctor just didn’t know what was wrong with them. 

So rather than say, I don’t know what’s wrong with you, they would be told there is nothing wrong with you. And therein is a very it rolls off the tongue very easily. But the difference is there was a world of difference between those two statements. Isn’t that I mean… 

Dr Sarah Myhill: [00:48:00] …That dishonest medicine. The first lesson I learnt, in general, practise in 1982 is, never tell a patient to lie, because they’ll source you out very quickly. And what I also then learnt very quickly is my patients didn’t mind me saying, “I don’t know ” what they mind me saying, is…

Dr Ron Ehrlich: [00:48:20] As a practitioner, that is empowering.

Dr Sarah Myhill: [00:48:22] What they did mind me saying is, I don’t care. So I would say, I don’t know, but let’s try this. Let’s try that. That’s why I said earlier, I’ve been down every blind alley. It’s possible to go down and I’ve gone to bed at night, you know, fretting and worrying about the whys and wherefores. 

And now the whole thing is beginning to unravel. But the awful thing about the conventional doctors is not only do they say, “I don’t know, and I don’t care.” They just consign these patients to the psychiatric dustbin. And the treatment of chronic fatigue syndrome in this country has been given over to psychiatrists and the psychiatrist say, “Oh, a bit of cognitive behaviour therapy, a bit of graded exercise, and you will get well.” and worse than that they set up a study called the Pace Study, which was published in 2011, where they took patients and they treated them with great exercise and behaviour therapy.

And they told the world that they had got 61% patients better and cured 22%. We now know that was a big fat lie. And I spent the last decade exposing that lie together with many other academics all over the world, and we now know it is rubbish. And we would have very interesting points at the moment because when that study was published, it became part of a nice guideline.

Dr Sarah Myhill: [00:49:43] So NHS guidelines that, yes, treat chronic fatigue in patients with graded exercise, and that graded exercise remained in the nice guidelines, making patients worse time and time and time again. Until the nice guidelines were reviewed. Now, they should have been published on the 17th of August this year. 

And hours before they’re due to be published, they were paused. We now know why the new nice guidelines had dropped graded exercise therapy because it’s making people patients worse and thereby disgraced the psychiatrists. 

We now know that the psychiatrists are working very hard behind the scenes to try and get graded exercise back on the agenda in order to support their untenable and unsupportable theories. And there’s a big battle going on. There’s a big demonstration in London yesterday outside a night to get rid of great exercise because it’s making patients worse.

Dr Ron Ehrlich: [00:50:44] So nice is just for our listeners in Australia. Nice. N-I-C-E is still, I don’t know what the acronym stands for, but it’s a national, it’s kind of a health guidelines body. NICE. But listen, I want to thank you for joining us today. I can see why I’ve been so looking forward to talking to you. And honestly, I could sit and listen to you for hours on end because I’ve learnt and it’s alerted me to so much. Sarah, thank you. Thank you so much for joining us. 

Dr Sarah Myhill: [00:51:14] Absolute pleasure. And just a little thing I wreckage in. They’re very popular workshops online like this and I’m joined by people from all over the world and we have great fun. I’m maxed out at 20. Anybody can stop because as you know, I love talking. Anybody can stop way ask questions at any point. And we have lots of fun on any subject. It tends to be made that chronic disease, or any. But if you get on my website, anybody can buy a ticket and join me and have a fun day.

Dr Ron Ehrlich: [00:51:44] Well, we almost certainly have links to that and then promote that because it will be, would be a wonderful experience. Sarah, thank you so much for today. 

Dr Sarah Myhill: [00:51:51] My pleasure.

Conclusion

Dr Ron Ehrlich: [00:51:55] Now, there is so much in this episode. I am definitely going back and listening to it again with a pen and paper to record. Well, there’ll be transcripts. So let’s not forget to have a good close look at the transcripts because there is such great information here, which is so fundamentally important to every disease. The body requires something like 50 or 60 different elements in the periodic table. It also requires some essential fatty acids. 

That’s why they called essential because we can’t make them. It also requires some essential vitamins like Vitamin C, which we as primates can’t make and essential amino acids because again, we can’t make those. There are about 20 amino acids that make up proteins and eight of those are referred to as essential because we simply can’t make them.

So these alphabets, these letters of the alphabet that we require to make sense of the book that is your life, that is your health is really critically important. And I just thought it was a great discussion. And we will, of course, have links to Sarah’s website. And if you are interested, I would recommend that you join her on her workshops, that she runs online and attracts an audience from all over the world on a regular basis. And you can see her passion, her knowledge is just so inspiring.

I was so looking forward to talking to Sarah. I first met Sarah when she was a speaker at last year’s global online conference from the Australasian College of Nutritional and Environmental Medicine, and I was just struck by the depth and breadth of her knowledge, her enthusiasm, and her passion, and her ability to communicate all of that. 

So I hope if you haven’t gone onto our website and explored some of the wellness programmes that are out there, we’re working on an online wellness programme. We’re working on a subscription model. We’re curating old episodes to bring a whole new breadth to our podcast. We’ve realised that so many podcasts we’ve done are absolute gems and we’ve actually gone back and curated and commented on some of those. 

So it was really our Unstress Lab podcast, which takes our podcasting to another level. So look into that, look into subscribing and joining us, and there were so many wonderful resources available to you if you do, I hope this finds you well. Until next time. This is Dr Ron Ehrlich. Be well.

 

This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.