Dr. Sarah Myhill 0:00

Doesn't matter who's listening to this, you might have chronic fatigue syndrome and you might not but the bottom line is if you sort out your diet and get a really good diet and the gut function, then you are going to live to a high level for many years yet to come. You'll greatly improve your longevity.

Claudia von Boeselager 0:16

Are you ready to boost your longevity and unlock peak performance? Welcome to The Longevity and Lifestyle Podcast. I'm your host Claudia von Boeselager, longevity and peak performance coach. Each week we'll explore groundbreaking science unravel longevity secrets share strategies to grow younger and stay up to date with world-class health and peak performance pioneers. Everything you need to live longer, live better, and reach your fullest potential ready to defy aging, optimize health, and promote peak performance visit llinsider.com for more.

My guest today is Dr. Sarah Myhill. Dr. Myhill is a distinguished naturopathic physician with an incredible career spanning over four decades. Throughout her career she has made significant contributions to healthcare, serving as a general practitioner and working in private practices. Dr. Myhill’s commitment to advancing medical knowledge led her to specialize in neuropathic medicine with a remarkable body of work that includes six published books and a reputation as an international lecturer. She has solidified her status as a leading expert in the field of chronic fatigue syndrome, which I've had and will butcher will discuss as well, and myalgic and I'm gonna get this name a little bit mixed up, and encephalomyelitis, I should probably be able to pronounce it better, and so much more. So we're gonna dig into it today. So I'd love to welcome you on. Dr. Sarah. So it's such a pleasure to have you with us on the longevity Lifestyle Podcast.

Dr. Sarah Myhill 1:52
That's very fine Claudia. You make me sound quite good. So I'm going to try and live up to that, haven't I?

Claudia von Boeselager 01:58
Sure. I first came across your work as I was mentioned by Dr. Molly Maloof, who's been on the podcast a few times as well, where she mentioned your expertise around chronic fatigue syndrome. And so I've had this and I know that some traditional Western doctors are like, well, this is a diagnosis or not. So for people listening, we all have stress, right? So what is exactly chronic fatigue syndrome? Can you expand on that? And then what are modalities people can offer?

Dr. Sarah Myhill 2:31

The key thing about chronic fatigue syndrome is to not think of it as a diagnosis. It's a clinical picture. And it's a clinical picture, which has many causes. And when you ascertain those courses, then that gives you the diagnosis. So chronic fatigue syndrome is the clinical picture of poor energy delivery mechanisms. So that immediately invites the question, how does the body generate energy? Where does that come from? And the analogy that I like to use that I get most of my patients get is the car analogy. So if your car is to go, you've got to have the right fuel in the tank, and that's all about data and gut function. And then you've got to have oxygen coming to our mind our engines for the engines to work. And then you have the engine of the car and the body. Those are our mitochondria. And every living cell, pretty much every living cell in the whole of nature. Without mitochondria, they are dead. So it's a universal engine that applies to all living cells. Then you need the control mechanisms, you need the thyroid accelerator pedal, and the adrenal gearbox and the adrenal allows us to gear up to NDC requirements. So obviously, as we're trotting around in the day, sometimes we have to spend a lot of energy if we're running away from a predator, sometimes you're not spending much energy because you're hibernating at night. It's very important to match energy delivery to energy expenditure because otherwise up will be wasted and the evolution is a disaster. So, chronic fatigue syndrome is similar to me, the me is chronic fatigue syndrome plus inflammation. Inflammation occurs when the immune system is activated and busy, and the immune system can be activated and busy for good reasons, it’s fighting an infection, or for bad reasons, ie allergy or autoimmunity. But if the immune system is busy, first of all, you get lots of symptoms of inflammation, and inflammation is redness, heat, pain, swelling, and loss of function for things not working. But also when the immune system is busy. It takes up a huge amount of energy. Your immune system is our standing army. And as I call it, it kicks a hole in the energy bucket. So you know we spent we can there's we've got less energy that's available to us to spend in a day. So that's the overall kind of strategy for explaining you know, how it all works and how we put it together. And of course, when the patient comes to see me, the first question we have to ask is, Does this person have chronic fatigue syndrome, that is, again is a clinical picture and the clinical picture of chronic fatigue is, well, let me explain that we all have a bucket of energy to spend in the day, we've got so much energy available to us, and we can spend it physically we can spend it emotionally or, or mentally or whatever. Now, if you spend more energy than you have in your bucket, then you will die, you will die because there's no energy for the brain, there's no energy for the heart, you know, and so on. And so you know, we have this bucket of energy, but this spending gets close to our total amount of energy, and then the body and the brain give us symptoms. And those symptoms have been deeply unpleasant and nasty. If they're not as deeply unpleasant as last year, we will carry on pushing through every input, and then we drop that, and that's undesirable. So these symptoms are very unpleasant. So we all know the symptoms of fatigue, physical fatigue, stamina, muscle weakness, haven't got the strength to do things. Now, we may all think I feel tired. Now, we may all feel tired at the end of the day. But the difference between normal fatigue and pathological fatigue is how you are the next morning, you should know if I should be normally fatigued at the end of today, I'd have a good night's sleep nice to wake up tomorrow morning feeling as right as rain. But if you wake up the next day, and you are ill, you have to rest up for a few days for energy levels to be restored. That is pathological fatigue. Now, even athletes who suffer from this is called overtraining. The key to all athletes is to have a good trainer who knows where that sweet spot is, we have the offer amount of training that gets you to the peak fitness, but not so much that your fitness declines. So this is universal throughout. But if you have pathological fatigue, then that means you're overdoing it. So the first thing that people must do is paste their activities carefully. Paste them so that they're not overdoing things the next day, because failing to do that, you are working very inefficiently. So physical fatigue is there we have mental fatigue, and mood fatigue, it's foggy brain, difficulty organizing things can't problem solve, can't multitask. Many of the patients who come to see me say I think I'm going demented. I've got an early dementia. And they're right, the pathophysiology of dementia is the same. It's all about poor energy delivery mechanisms. And again, we can reverse dementia by all the interventions we're going to be talking about today. And then you have poor energy delivery mechanisms to the heart. If the heart doesn't beat strongly as a pump, then blood pressure will fall and so it's typical for these patients often have very low blood pressure and blood pressure much below 100 over 60, which I would consider pathologically low.

Claudia von Boeselager 7:56
My mother falls under that category and she has dementia now.

Dr. Sarah Myhill 8:00
Okay, okay, well, we could talk about that too. But, of course, if the blood pressure drops, then cardiac output will fall. So the heart compensates by beating a bit faster. So it's quite common to see with people who are very severely fatigued, low blood pressure and a mild tachycardia at rest, then, but that becomes a real problem when people stand up, because normally, my very sick patients, you know, horizontal, they're lying down, because it's much easier, circulate blood around the body on the flat as I call it. Now, when you stand up, you have to circulate blood uphill and downhill. And that takes energy. The heart has to increase its output by about 20%. Now, if you've got a very poor energy-liberated heart, you haven't got the energy to do that. So when you stand up, you have the part that has to be even faster to maintain cardiac output, those two become unsustainable, and you fall over. This is called Postural Orthostatic Tachycardia Syndrome. And it's almost universal in people who've got severe fatigue. So those are the signs of the clinical picture with that clinical picture. Yep, you've got a chronic fatigue syndrome. And we need to look at energy delivery mechanisms. So

Claudia von Boeselager 9:15
I want to dive into the energy delivery mechanisms as well. But I think for I don't know what percentage of the population you look at in this terms, but how much is it sort of mental from over undue stress or lack of sleep? How many cases would you say potentially?

Dr. Sarah Myhill 9:32
Well, well, that can certainly be a triggering factor. I mean, the people who are severely mentally fatigued, simply don't have the energy delivery mechanisms to function well. And that's why their brain is going slow. That's why they can't problem-solve. That's why they can't multitask. So that's a symptom of, but I think you're talking about precipitating factors. What causes this disease in the first place? Yes, for many, if they're just chronically burning the candle at both ends And they're sleep-deprived. They're skipping meals, they're not eating well, they're using addictions to keep going people who have a high intake of caffeine or alcohol or sugar, which is, of course, a serious addiction, or using drugs to keep going in it that's symptomatic that their energy delivery mechanisms are falling, or failing rather. And of course, so and mental stress will do that, won't it because it'll stop you from sleeping. If you're if your brain is constantly thinking about work and commitments and family, then, you know, that is kicking a hole in the empty bucket. So yes, it's very common to see people with teachers, sometimes there can be a slow build-up of chronic fatigue as a result of these cumulative lifetime stresses. And then often you get the last straw that breaks the camel's back, that might be a Christmas, you have to prepare for a flu-like infection, getting COVID Having a COVID vaccine, you know, some acute event that then tipped you over the top into a full-blown chronic fatigue syndrome. So yeah, there are many precipitating factors. I mean, I've, I've even seen somebody had a chronic fatigue triggered by a head injury. He was unconscious for about three days. And when he came around, he just didn't have his usual entity. So there are many potential triggers. But regardless of the triggers, the workup is the same. We start with energy delivery mechanisms, and just say the car analogy is very helpful. And again, it's so important to do these in the right order. And getting well is like building a house. And what do you do? What's the first thing you do? You put down the foundation stones, don't you? The foundation stones with this is the diet and the diet is in my view, non-negotiable. If you don't get the diet or on the way to the data, the data is rice, you can then don't bother with the rest, because you're going to struggle with it. Is that

Claudia von Boeselager 11:47
A firm statement with that as well, and I think it's so important. And I think people listening might be like, Oh, my diet, okay, or I do you know, the as best as I can. So how will some people know they're doing the right diets? And, for people around the world, this could be different. Right? So how would you define that?

Dr. Sarah Myhill 12:04
Well, well, you know, the first point is everybody thinks they're eating a healthy diet. And, and they rationalize it to them to themselves. But whenever there's a difficult question like this, I always go back to first principles. And those first principles are about evolutionary biology. You know, how would the primitive woman eat, you know, what was her diet? And the answer is, she wasn't eating as much food as we were. Many people are currently overeating. It was largely based on fiber, high fiber, high fat, yes, and protein, she would have carbohydrates, but only once a year, with where we have a windfall when we have a windfall of fruit a windfall of root vegetables of grains of pulses of nuts and seeds. They're the high carbohydrate foods, which are such a problem for many. And yes, you'd have had a windfall of those in the autumn. And the thing about carbohydrates, especially sugars, and especially processed foods is they're very addictive. And what that means is when we start eating them, we can't stop eating them. And addiction for primitive women was very desirable. She would get addicted to her fruits and her nuts and she'd eat lots of them, as many as she could get, and she would get fat. And being fat is a survival value for the winter. It's insulation and of course, it's a fuel source. But at the start of the art the end of the autumn, she stopped eating those foods because you have no choice you ran out of them, and went into hibernation mode hibernating with the odd excursion to try and hunt or kill a deer or whatever, whatever. So essentially add darkness, as I call it, Paleo ketogenic so ketogenic, low in sugars and carbohydrates, rich in fiber, and fat, and not high in protein, it's a normal protein diet. It needs to be paleo, because the two modern groups of foods that have come in recently other dairy products and the gluten grains, from an evolutionary perspective, are very recent. They're a few 1000 years old, which is the blink of an eye. And many people haven't evolved a gut function or an immune function that can deal with those foods. So dairy allergy and allergy to gluten grains are very common. So that's the essence of the Paleo ketogenic diet. And in parallel with that, we have to sort out the upper fermenting guts. Now, to explain what the upper fermenting gut is, I'll take you through a quick whizz through normal gut function. Now the gas is achieved between the mouth and the anus. It's about 30 feet long, and we've got about 20 to 23 feet of small intestine, a big bunch of upper gut, from the esophagus, stomach duodenal Judoon, a small intestine about 20 footers, that which should be near sterile. There should be virtually no microbes they should be almost sterile. And then the last bit of the gut lasts about five feet of the gut, the large colon. That's where the microbiome is. And the microbiome is comprised of kilograms of bacteria yeast and viruses that are fermenting fast. labor and some resistant starch to do much good for the body synthesize vitamins and minerals, programs, the immune system makes neurotransmitters, and so on. But I'm talking about the upper gut the first 20 feet, that should be near sterile. Now, the problem with modern diets that are high in sugars and carbohydrates, is you overwhelm the ability of the aggregate to digest them. And foods start to ferment instead. And these microbes which ferment our evolutionary incorrect if you like, they're foreigners, and that causes all sorts of problems. First of all, if you've got a fermenting up a gut, these microbes live in the lining of the stomach, which makes for a leaky gut. And if you've got a leaky gut, you can't concentrate acid in the stomach. Acid in the stomach is such an important part of correct digestion. Because we need acid to absorb minerals, we need acid to break down proteins. We need acid to sterilize the upper gut because about 90% of infections will come in through the gut. And even those microbes that we inhale, get stuck on sticky mucus in the nose and choked in the throat, coughed up and swallowed, and they also end up should end up in an acid bath, and in that acid Graphtec, there killed. So it's a very important defense against infection. And another problem when we find few met from it is if you ferment, if you've got us there, and they ferment sugars, you will produce alcohol. This is called the auto-brewery syndrome, and we produce significant amounts of alcohol, which have to be dealt with by the liver. If you gave me half a glass of wine for breakfast, then I can tell you work wouldn't get done that morning. And, so it's not just alcohol that can be fermented. sugars and carbohydrates are fermented to D lactate to hydrogen sulfide, to ammoniacal compounds to all sorts of nasties which give you a foggy brain. And so often people tell me that as they do that PK Dart, and they clean up their upper guts, their foggy brain is much improved. Not surprisingly, it's so we're not drinking half a glass of wine every time we eat something. And there's another really important issue here as well because it has to do with energy. Now I'm jumping sideways for a second, but don't, don't panic, I won't do it. At rest, the brain, although it weighs 2% of body weight consumes about 20% of all the energy generated in the body. The heart consumes about 70% of all the energy generated in the body, but the liver can consume up to 27% of all the energy generated in the body. Because it's using a huge amount of energy to detox all these nasties. And not just products, they are fermenting up, people are eating processed foods with lots of chemicals and additives and flavors. And goodness knows what, those who aren't on prescription medication who take addictions, all require detoxing the liver. So a massive amount of energy goes there. So there's another point here, of course, because of these microbes in Africa, they are also hungry for vitamins and minerals. So you know, people want the easy way out, they want to change their diet is on Texas supplements and all will be well. But it's not like that. If you feed supplements to somebody's got an upper fermenting gut, then they will just ferment harder, and the microbes will say, Oh, yum, yum, yum has nice B vitamins isn't nice KCC. And I could do some of that. And they do and they reproduce faster. And they produce more toxins as a result. And one final problem is the alpha fermenting gap. So I'm going to tangent is my favorite subject as you can probably get these microbes, although we are taught in medical school that yes, they're in the gut, there they remain. We now know that's not true. We now know microbes get very easily from the gut into the bloodstream. Now, if these are friendly micros from the large bowel that the immune system has been looking at for, you know, hundreds of 1000s of years, no problem, the Muses result, they're safe, and they just can't get in there yet in a year, we just get rid of them. But if they are unfamiliar microbes, then the immune system can be alerted to them. And this will switch on inflammation wherever these microbes end up. So we know in the gut these drive inflammatory bowel diseases like Crohn's disease and ulcerative colitis. We know in the joints they drive inflammatory arthritic cities like rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and all these nasty arthritic knees, in the muscles, they drive polymyalgia and fibromyalgia. In the brain, they drive psychosis in the lungs, they drive asthma, dee da, they drive a whole heap of other pathology. So the interesting thing about this approach to treating chronic fatigue syndrome is it is also the approach to treating all Western pathology. So it doesn't matter who's listening to this and you might have chronic fatigue syndrome and you might not, but the bottom line is we should all be doing this. Because if you sort out your diet and get a really good diet and the gut function, then you are going to live to us high level you know, for many years yet to come your great improve your longevity. So other mentees got how do we treat it? Well, first of all, stop feeding it stop feeding it stop feeding it sugars and carbohydrates. So that's why we want a low-carbohydrate diet. And then in addition to that, there are two very useful tools that I love to use. And that's ID and vitamin C. Now, in both ID and vitamin C, contact kills all microbes. So they're very helpful to clean up, yeah, fermenting. They're also extremely safe. They're also very cheap. And they do lots of other good jobs too. They help strip out heavy metals to improve our antioxidant status, you know, their essentials, the immune function to killing microbes. They are my two favorite and most important tools.

Claudia von Boeselager 20:46
So which item would you recommend which vitamin C?

Dr. Sarah Myhill 20:49
The key about vitamins is don't take them at the same time, because one's a reducing agent yells an oxidizing agent, one's electron donor one's electron safe, they knock each other out. So separate them. Some people prefer to take it in the morning and vitamin C throughout the day, or vice versa. It doesn't matter. But I use Google's ID in 15%. It's as cheap as chips. We sell it for about six pounds for a bottle that will last you a long time. And I like to take three drops of RD either at night or first thing in the morning, children a bit less maybe. And that contact kills all microbes. And then vitamin C I just use ascorbic acid because it's inexpensive. Ascorbic acid is good for my PBS. Now I do have to tell you it's a joke to explain what PBS is. So forgive me but this derives from a newspaper article I read 20 odd years ago now about a merchant bank that wanted to target its wealthiest customers. So it was a very wealthy bank with lots of wealthy customers set prepared a letter that then went down to the mail merge department so it could be personalized so it goes to law this or sir that or Mr. This or Mr. That. Unfortunately, the scruff in the mail merge button department forgot to press the Mail Merge button. And so all these wealthy people received a letter that opened up dear rich bastard. So people who come to you who are wealthier are described as Arby's rich bastards. But most of my patients are PVS, their poor pastures, they can't afford many interventions because they can't work. So the interventions I'm looking for have got to be affordable, they've got to be doable, they've got to be accessible to all they've got to be very cheap, and visma cnidarian ticks all those boxes, and ascorbic acid is the cheapest form of vitamin C. And it's also the best because it is an acid, you can take it with food and that helps to digest and is acidic. I did digest food by acidifying the upper stomach,

Claudia von Boeselager 22:49
and just is it absorbing acid or ascorbic?

Dr. Sarah Myhill 22:53
It doesn't matter. I call it ascorbic. I pronounced the C I think there should precede it

Claudia von Boeselager 23:00
Same thing I just wanted to be sure of our show notes here for everyone listening.

Dr. Sarah Myhill 23:04
Okay. So now hopefully we've got the right fuel in the tank tracks for our mitochondria, ie ketones, and we get ketones from fat and we can get ketones from the fiber. When fiber is fermented in the microbiome, we produce short-chain fatty acids which have ketone bodies. And then we have to have oxygen right? Now, this is I think, quite a common problem but often overlooked. Now, for your engine to go for your mitochondria, it's got to have oxygen. And the way these works is, obviously we breathe in air that contains oxygen, and oxygen hops on hemoglobin in the red blood cells. It circulates in the body, and it gets near mitochondria in the capillaries, and then oxygen hops off and goes to the mitochondria. But the question we have to ask is, how does oxygen know to hop on in the lungs and hop off in the mitochondria? Because guess what he was the other way around it. I mean absolute disaster, wouldn't it? And the answer has to do with carbon dioxide and acidity. Now, obviously, mitochondria are burning oxygen to produce carbon dioxide. That's the waste product that comes up so it has to be carried away in the bloodstream. And it dissolves in the bloodstream as a weak carbonic acid. So when blood comes in contact with mitochondria, there's carbon dioxide, there's acidity there, and as the acidity changes, oxygen hops off to the mitochondria. In the lungs, the opposite is true in the lungs, we're exhaling carbon dioxide, we're washing it out. As we wash it out from the blood, the blood becomes more alkaline, and in an alkaline environment, oxygen hops from the lungs onto the hemoglobin. Now, the reason this is important to understand is because some people breathe too much they hyperventilate and if you hyperventilate, you wash out all your carbon dioxide and you make the blood too alkaline. And if the blood is to alkali, then oxygen cannot go from hemoglobin to the cells. Now these people, when they do their oxygen saturations, there can be 100% saturation, oh yes, I've got lots of oxygen in the bloodstream. But that's oxygen in the bloodstream, that is not oxygen in the cells going to the mitochondria. So, to diagnose if we have a hyperventilation problem, we can do this through breathing exercises. Now, I'm very happy to send my chapter on oxygen around if you're, if your listeners would like to read this in detail. But there are three important points to breathing. First of all, always breathe through your nose. Many people have mouth breathers, which is not good news for other reasons as well. But breathe your nose because that increases what we call the dead space, ie the amount of air that is re-inhaled after exhalation. The second thing is to breathe with your diaphragm because that improves, circulate circulation of the blood. But it's an important part of normal respiration. Many people panic and breathe with their chests. And third thing is to breathe more slowly and slow the breathing down. And it should be fairly easy to get to three breaths per minute. So you breathe in for maybe five seconds and out for about 15 seconds, and then repeat. And by doing that you are retaining carbon dioxide and resetting the Scripture center in the brain. Now, anybody who's running their life on adrenaline, on caffeine, on addictions, stimulates the respiratory center and they hyperventilate. This is a stress response. But when you hyperventilate, as I say you impair oxygen delivery, and you will make yourself more fatigued. So it's a difficult concept to get your head around. But guess what the treatment for it is free, it doesn't cost anything at all. Anybody can do these exercises perfectly. My PBS, when you're lying down just before you go to sleep when you wake up in the morning, that's the time to do them just to reset the whole system and maybe combine it with a meditation or listening to a storybook or, or something relaxing. So that now we've got to the point where we have got good fuel in the tank, you've got oxygen coming to our mitochondria. And then we looked at the mitochondrial engines. Now, mitochondria. I mean, when I learned about mitochondria in medical school, it was the source of something. And this was the 1970s, I'm ashamed to say is the 1970s. It's so sad that you marked up the night before and chocolate biscuits and black coffee and regurgitated your recently acquired knowledge on the exam paper and hoped you'd done enough to pass. And the reason that we treated mitochondria as such a disdainful man is because when I was at medical school, they had no clinical application whatsoever. Mitochondria and not once mentioned by pathologists, whatever that authority may be. And now we know they are involved in all pathologists. There is no pathology that doesn't involve mitochondria from aging, cancer, dementia, heart disease, diabetes, arthritis, you name imvolve it. Mitochondria is centrally important to all. So the fact is, we should all be paying attention to our mitochondria. Now, why can they go slow? Well, they can go slow because they don't have the raw materials to function. And we know that from Well, lots of work. There's a wonderful book called The Sinatra Solution, written by cardiologist, Stephen Sinatra, who started as a conventional cardiologist with the drugs the surgery with the pacemakers, and all that and ended up just doing nutritional medicine because those drug interventions might maintain or control the heart, but it doesn't reverse authority. And Stephen Sinatra established what he calls his Awesome Foursome, I will add one to that, which is magnesium 300 milligrams daily and vitamin D 10,000 IU for its absorption Coenzyme Q 10, at least 100 milligrams a day. Acetyl l carnitine. Maybe one gram a day, vitamin B 315 100 milligrams a day, and D ribose, which is the raw material to make ATP. So those are the five key rate-limiting steps that come up time and time and time again if your mitochondria are going slow. And then, of course, mitochondria can go slow because they're blocked by something. So there are any number of somethings that can block them. And we thank John McLaren Howard, who really should be awarded the Nobel Prize for Medicine for his work with mitochondria. He developed tests so he could look at what was inhibiting mitochondrial function either by what's inhibiting oxidative phosphorylation which is the biochemical name for energy making, or that was blocking translocator protein, which is how the energy molecule ATP gets from mitochondria into the cell where it's needed to do a job of work. By doing this stuff As he established the common things with common now the number one thing that blocks mitochondria is lactic acid. Now lactic acid is what happens when we don't pace our activity well. This is another reason why pacing is so important because you're producing lactic acid all the time, and your mitochondria getting slower and slower and slow. The second he found was products of the upper fermenting gut, Mel on the aldehyde, D lactate ammoniacal compounds, and so on. So, well guess what, we've done that too, haven't we because we source data off of fermenting gas. And then we've got heavy metals, toxic metals. Now they weren't, they had to. To get rid of those we need nutritional supplements glutathione minerals, or chelating ratios, which can now be done at home. The second group will be pesticides, volatile organic compounds, so glyphosate, synthetic pyrethroids, organic lines, all these nasty chemicals can get stuck on many volatile organic compounds. Now these can be got rid of by heating regimes. And this is my favorite, another favorite intervention because we can hopefully most of us can afford to do a heating regime, my favorite Epsom salt baths. Because that's about last again multitasks most people have got a bath and hopefully hot water. Epsom salts are very cheap, but your favorite for foreigners. Epsom salts are magnesium sulfate mined out of the ground by the tongue. And in the UK, we can get a 20-kilogram bag delivered for about 30 pounds, which will give you 40 Detox Epsom salt baths. And my experience is because we've done tests of toxicity before and after, roughly speaking 40 at 50 bars will have your total load of toxins. Now if you never get down to zero, you can but you can have the dose at 50 and Harvard is another 50 in half the dose another 50 until you get the level so low that the body can cope.


In addition to detoxing, you also give yourself a nice dose of magnesium and a nice dose of sulfate. And that again further helps in many ways. So we have that so we Detox our mitochondria. And then of course they can be blocked by by virus proteins by bacterial or extra toxin by fungal mycotoxins. So sometimes you can get a clue from those tests that you know that there's a chronic infection there or that the moment those tests aren't available, so don't everybody come rushing to me say can we have the tests because we can't get them. But those are how mitochondria can be blocked and inhibited. And then, of course, we have to have the control mechanisms. For the control mechanisms, we need the authority accelerator pedal and the adrenal gearbox. Now, of the two, I probably cure 10 times more people through sorting out their third than their adrenal glands. So let's, let's talk let's look at the thyroid. Now, of course, if the thyroid gland is underactive, you will get all the symptoms of poor energy delivery mechanisms that we've talked about. Doctors will tell if you're hypothyroidism underactive, simply by looking at the blood test, and that can be very misleading because many doctors only look at the thyroid stimulating hormone, which will only pick up primary hyperthyroidism that will miss secondary hypothyroidism due to the pituitary gland. And that's the commonest form of fatigue syndromes. They will miss the diagnosis because the reference range is set too low. So my reference range for a T is about 22. I've been 12 to 22. Professors for Anthony Toft, who wrote the BMA guide to treat the underactive thyroid in his book, says, that some people don't feel well until they're free T four is running at 30 Peak moles per liter. So the reference ranges are often wrong. So the point here is it's not just biochemical diagnosis, we don't just look at the blood tests and say yes or no. We also look at the clinical picture. What can we see and the useful symptoms and signs, first of all, are the pulse feel your pulse at rest, and if your pulse at rest is much below 70 beats per minute, certainly in the 50s. And probably in the 60s, I think underactive thyroid. Another name for the underactive thyroid is mixed edema, or you tend to retain fluid. So puffy eyes, crease marks on the face and you wake up a big tongue if you look at the size of your tongue. If you've got tooth marks alongside your tongue, that can point to fluid retention. Through detention, the risk causes carpal tunnel syndrome which presents with numbness and tingling in those fingers and half of the ring finger the little finger is spare so if you wake in the night with tingling there think underactive thyroid and, and temperature low temperature if your core temperature on waking in the morning is Slow, think handbrake started the day with the vocal cords that can cause croaky voice. So it sounds like you've been smoking for 20 years, but you're eight or you can lose your singing voice. So people say, Oh, I can no longer hit my top notes. So those are all clues. There's that authority issue and say often adrenal issue goes in parallel with that. So by correcting all these factors, you can greatly improve energy delivery mechanisms, and some people, that's all they have to do that, that that that nails it, but some people have as I call it, a whole in the energy bucket. And you alluded to stress and so on, and yes, that would put like, as I describe it, an emotional hole in the empty bucket. But the big common problem is the immunological hole in the energy bucket, the immune system is activated, and that is using energy. Now, it can be activated for reasons of allergy. And actually, this is how I got interested in the whole chronic fatigue syndrome air in the first place, because when I was working in the 1980s, I discovered that my daughter and I were both very dairy allergic and, and that not only the cutting out the dairy products, cure her intractable colic as a baby, but it also cured my chronic snotty nose and chesty, wheeze. And I felt much better for that. So I knew allergy was a big player. And you know that that was nowhere in the medical textbooks then and it's nowhere in the medical textbooks. Now, very few doctors will even mention allergies, but this is a very real issue. So as you do dairy products, allergies to gluten grains are common. And so what you have to do well, you have to avoid them. And of course, that's the start of the Paleo ketogenic diet. Some people have lots of other allergies, and they know what their allergies are. And there are desensitization techniques that we can use, but we won't go into those today. But that's for the allergy side of things. And then we have autoimmunity and autoimmunity is very easy to switch on, and it's very difficult to switch off. So, you know, avoidance is the name of the game and I think that the number one thing that switched on autoimmunity today, vaccines, not my words, but the words of Professor Yehuda Shoenfeld, consultant immunologist who works out of Israel flies all over the world as an expert witness talking about vaccines and autoimmunity. So, don't vaccinate. And if you have any doubts about the efficacy of vaccination, because it's never been tested, vaccination has never been tested, placebo-controlled, double-blind. If you have any doubts, then you need to read a book called Dissolving Illusions, which is about the history of vaccines. And what we find through reading that book is that it wasn't vaccines that stopped infectious disease. It was good hygiene. You know, having people living in clean conditions with clean water, a good sewage system, clean foods, and therefore having a good immune system. I mean, I could give anybody typhoid fever, like if anybody Koror if I put them in filthy conditions and fed them filthy food, and we know that every wherever there's a war zone, a war event, people end up in these conditions, and guess what infectious diseases sore, so it's not vaccines, it's all about good health and good hygiene. That's what protects us from disease vaccines are almost irrelevant. So again, autoimmunity and autoimmunity are also switched on when we're in an inflamed state. The most pro-inflammatory thing you can do to your body is eat sugar and carbohydrates, and the most anti-inflammatory thing you can do is get into ketosis. Ketones alone have a marked anti-inflammatory effect. So I'm not gonna talk about chronic infection, because, I mean, do you see what I mean? I've been waffling on purely due to you asking me questions before you fall asleep with boredom.

Claudia von Boeselager 38:51
This is brilliant. But I just want to touch on the ketogenic diet, I think I mean, two things I'd like to touch on. One was before when you mentioned low carbohydrates, you could just expand on that a little bit as well because obviously, there are different versions of it. And then secondly, obviously, the ketogenic diet has had its sort of Renaissance however, there are some that say, and I've had phases of doing the ketogenic diet myself, but that it's, you know, not sustainable, or it's good to kind of flip in and out, particularly for women as well, it can be a bit tricky as well. So could you expand a little bit more on both of those as well?

Dr. Sarah Myhill
Okay, well, a ketogenic diet is not a no-carbohydrate diet. It's a low-carbohydrate diet. And because the point is, sugar is such dangerous stuff for the body that if sugar levels go high, then the body will always burn that first to get it out of the way. So sugar isn't essential isn't essential for detoxing. It's the central for the raw material to make ATP. It's essential to make DNA and RNA so it isn't essential for the body. But the problem is if you just eat processed foods and sugars, you get addicted to them and you overeat. So it's not no Car bits low carb. And the way to test is to get yourself a breath meter. Now the one I'm using at the moment is called ACE track. It's very, it's very good. It's very reliable. And you know, I'm in ketosis. Well 99% of the time, but I do eat apples. I do eat fix. I do enjoy the dark chocolate. Sometimes you know oatcakes, but I'm in ketosis all the time.

Claudia von Boeselager 40:24
And how open process are you like between two and four mallomars?

Dr. Sarah Myhill 40:30
Well, this is parts per million. Sometimes I'm as low as 20 parts per million, as high as 100 parts per million, it just depends. So you know, I don't eat breakfast, I eat all my food within a six-hour window of time. So if I go for walks in the morning, by the time I come back, I might be praying at 90-100. But in the morning, sometimes when I wake up, it might be those 20 or 25. But it doesn't matter the actual what the actual score is, because as I said, the body will always get rid of sugar first because sugar is so dangerous. If the blood sugar rises, it'll burn that off as fuel. So it means if you're in ketosis, then we can infer your blood sugar is going to be level and stable. So it's a very good way of monitoring to make sure that you are there. Now some people struggle to get into ketosis because you need extra nutrients. And the three that come up time and time and time again, are thymine. And there's a product called Ben for timing, which is lipid soluble form and you need one gram, a ruthenium, unique chromium for good, good glucose burning. And I suggest, if you're deficient, take two milligrams a day for say, a couple of months and then a maintenance dose of maybe 200 micrograms a day. And the third one is carnitine. Al carnitine. You need carnitine. To fat burn efficiently, maybe a gram a day. So those are three supplements. But despite that some people still struggle with keto ketosis, and that is often a symptom of the underactive thyroid. Because to fat burn, we need thyroid hormones. We know that somebody who's thyrotoxic goes into overdrive fat-burning mode, and they just burn off all their fat. So so we need thyroid hormones, the fat but if you haven't got the thyroid hormones, then you fat burn with adrenaline instead, because you can fat burn with adrenaline. But if you're running high levels of adrenaline, that is very uncomfortable. It stops you from sleeping. You get that wired, tired but wired feeling and very often people say Oh, I can go ketosis for a week or so. But then I feel terrible. I can't sleep. They often have an underactive thyroid, it's called ketogenic hypoglycemia. It's a dreadful name, but it is a condition that exists. So if you have any problems getting into ketosis, think about those things.

Claudia von Boeselager 42:53
So the supplements and then we've had a specialist on who is Hashimoto’s specialist speaking about the thyroid as well. The amount of people who have hypothyroidism is a large number as well. So if somebody who is hypo or has a tendency to have hypothyroidism, myself included, what would you recommend to be able to be in that optimal state of the Paleo ketogenic diet?

Dr. Sarah Myhill 43:17
Well, I've written a book about this. And I've been very naughty. I've called it the underactive thyroid, do it yourself because your doctor won't. And the shameful thing is, that is the state because doctors do not treat the underactive thyroid well, and as a result the diagnosis is missed, or worse, or worse, people are undertreated. And you're right. Kenneth Blanchard, who is an American physician, and who only did write this once he retired, recommends that at least 20% of Westerners have an underactive thyroid. Amongst my fatigue syndrome patients, I bet it's about half have an underactive thyroid and can benefit from thyroid support. So yes, this is common. And the key point to remember is that yes, you need blood tests, you need blood tests, just to make sure that you are not overactive because the last thing you want to do is used thyroid hormones and somebody who is overactive. And also to see if there's biochemical scope for a trial of thyroid because we all have our personal reference range, which is not the same thing as the population reference range. So the population my population reference ranges a T for about 12 to 22. But some people will be normal running 12 or 14, and some will be normal running at 2829. So having got the blood test to show that there's scope for a trial, we then ask ourselves is the clinical picture right? So we then go to the symptoms of certain signs that suggest the thyroid is underactive, or one important one I forgot, has to do with our diurnal rhythm, because the way that we stay awake by day and we go asleep by night, obviously liked it. Tami's that, but as light fades then the levels of melatonin, which is the sleep hormone build up at night, and melatonin levels as they build up, they stimulate the pituitary gland to produce thyroid stimulating hormone TSH spikes at midnight. Now, TSH trots around the body to the thyroid gland and gives it to Kitces can't make some thyroid hormones. And the first one the thyroid gland makes is T four. And that spikes to about four o'clock in the morning, T four is fairly inactive, which slowly converted to the active T three and that spikes at five o'clock in the morning, T three then trucks around to the adrenal gland and kicks it. So we should wake up naturally at six or seven o'clock in the morning. Okay, so if any part of that goes wrong, then the Holden rhythm slips, and people become owls. Many of my fatigue center patients can't get off to sleep till midnight or one o'clock in the morning, I can't get out of bed till 910 11 o'clock in the morning. That's another clue that you've got an underactive thyroid. So we look at the clinical picture. And we think, yup, the clinical picture fits you know, I've got many of those symptoms. The blood test shows there's biochemical scope for a trial of thermoformers. So let's try them. Thankfully, anybody can buy those over the counter online. These are thyroid gland healers, and thyroid gland views are in the book, there's a list of all the supplies throughout the world. If you Google around, you can find them. And essentially, these are animal thyroid glands that have been dried and encapsulated. And thyroid hormones are extremely stable. So it's a very good product and the doses and the Mad thyroid hormones in there are very standard. And what we do then is we start with a very tiny dose of thyroid glandular, I suggest 50 milligrams of thyroid glandular and we increase the dose by 50 milligrams every week. Until we get up to the level that sorts things out. Now level that sorts things out is going to be different for people. So bigger people need more than little people. But you know, I tomorrow have an underactive thyroid, and I reckon I need about 90 milligrams of thyroid glandular to be well, in old money. This used to be measured in grains because the original one was arm authority you'd use to get it in grains. And one grain of arm authority is equivalent to 60 milligrams of thyroid glandular, that's pork 30 or 65 milligrams of bovine thyroid. So just to give you an they're pretty similar. So I'm taking the equivalent of about one and a half grains of aromatherapy daily. And I need that to be well and to be sharp, but everybody's different. So the point is, you can sort it out yourself. But the key is to start low, and go slow. Check your path, check your temperature, how do I feel? How am I functioning, and you work it out yourself? And there's a key point here. Because there's nobody who's going to be better motivated to do it than yourself. Nobody is better on hand to assess the same sorts of data than yourself, and you are in the driving seat. So what I am doing is teaching my patients to become their doctors. You know, I'm empowering given per se, you can do it. They come back to me, and I suggest this, and I suggest that, but it's much better if patients learn that they have to be the ones in charge. They have to be the ones you know, taking control of their health, because there's there's none, there's no blame game. There's then no oh, I'm going to see you because you gave me the wrong advice game, you know, and it's and we're intelligent people talking to intelligent people. And that's how it should be.

Claudia von Boeselager 48:34
Empowerment of health as well. So sorry, I interrupted you. When you were on to the next mechanism. And I'm trying to report where we left off.

Dr. Sarah Myhill 48:43
Absolutely. Chronic infection. And this is very likely to be a problem when there's an obvious infectious trigger to that fatigue syndrome. So the one that comes up time and time again again is Epstein-Barr Virus. And very common history is the dairy allergic child, who goes through life with recurrent tonsillitis and recurrent sore throats. And then they get Epstein Barr Virus or mono as the Americans call it. And then they flip into chronic fatigue syndrome or me. That's a very common sequence. We're seeing epidemics that moment of Lyme disease. And it is I mean, although we talked about Lyme disease and ticks, it is biologically plausible Lyme disease could be passed by any biting insect. A colleague of mine had a picnic in Hyde Park in London. Right in the South. She came home a few days later, she had she found a bullseye rash. And she tested herself in the laboratory and she picked up Lyme disease so anybody could get it. It's almost impossible to avoid that think Lyme if there's, any history of illness following a bite, mycoplasma, a very common cause of pneumonia often calls walking pneumonia because it's not sufficient to get somebody into the hospital, but chronic chest infections, think mycoplasma infections, fungal infections from aspergillosis we women who've got chronic vaginal thrush and some think fungi. So there are any number of microbes that can get in there. And of course, now COVID in particular spike protein, which gives a similar immunological reaction as to getting code infection that the VAT the vaccine, we're now finding it is very dangerous and very good at switching on post, Emmys, and long COVID. So, one of the problems is, if you've got one infection, like Epstein Barr Virus, then the immune system is going to be slightly suppressed, and you're more likely to get other infections. And so what we find is that these people, they don't just have an infection, they have a cocktail in front of infections. And there's no point just giving the antibiotics for Lyme because that will make your use problem worse. So no point just giving the antivirals because that may allow something else to flourish. So these days, I'm increasingly saying we need general measures to reduce the total infectious load as much as we possibly can, and then hope the immune system can do the rest. And there are we do have some very good techniques for doing that. Now, of course, just improving energy delivery mechanisms, as we talked about, will give the immune system the energy to do the rest to fight. But there are at the moment, there are two approaches that I'm using. One is I learned about quite recently called vicinal. Now this is medicine all but spelt with a V vicinal. It's a combination of nine herbs nine has been an honor about like Chinese skullcap, cook, Yeoman. Luton, Spurgeon, and a whole range of herbs can't remember them all. Which have multiple antiviral, antimicrobial, antifungal, anti-inflammatory healing repair effects. And I think that's going to be very useful. But for my PBS especially, I'm getting very interested in methylene, blue methylene is very inexpensive. So you know, three months of treatment will cost you about 20 or 25. It's very cheap. It's very safe. It also multitasks. It's also your friend's mitochondria. It's a very important donor and acceptor of electrons. And it has broad, widespread antimicrobial effects against viruses, it gets bacteria, it gets COVID, it's even antifungal. The waste take methylene blue is we slowly builds up to about two milligrams per kilogram of body weight. And I can send you my instruction sheet on how to prepare it. So it's very simple. What I do advise is to make up the methylene blue and when I say blue, it is blue, it's blue, like my shirt is blue, and it gets blue everywhere and up blue. So the key to that is before you drink it as some ascorbic acid, about two or three grams for ascorbic acid, so your cover methylene blue, stare it in leave it for a couple of hours, and the scope ik acid converts it to meth to leucomethylene blue, it renders it colorless. So that means you can drink it without staining your teeth and your dentures and your tongue and everything else bright blue. It's enough to frighten the horse isn't it and then slowly build up to two milligrams per kilogram a day. And in parallel with that, use D M S O, which breaks down biofilm and then activates it all with light. If you're lucky enough to live in a country, lots of sunshine get sunbathing, failing that far, near-infrared light, works well. And you can have a little belt that you can put on that shines light through the body. And the light activates methylene blue and makes it work just as well. This is called photodynamic therapy. And guess what, it's inexpensive and very doable. So that's, that's how I'm treating chronic infection and I've had some good results too. So this is hugely encouraging.

Claudia von Boeselager 53:48
This is so phenomenal. I think I want to become your patient information and I think it's so tricky to find someone who has such a depth of knowledge on all the different aspects right I mean, I've lived in nine different countries I've seen medical professionals around the world I look for experts into the podcast speak to many as well but to have that breadth across the spectrum as well as is just phenomenal.

Dr. Sarah Myhill 54:14
Well, I can promise you, I don't know all the answers, but I do know all the good questions.

Claudia von Boeselager 54:19
The quality of life represents the quality of the questions you ask right? So I'm paraphrasing but as we finish up today, I want to ask you if you could live to 150 years old with excellent health, how would you spend it?

Dr. Sarah Myhill 54:36
Oh gosh. Well it first in my garden because I love my garden
Secondly, developing my tribe because I live live with with with a group of friends and others and we have fun riding my horse of course, and going on doing these talks because health is so important and There are, there aren't many good people out there asking good questions. I mean, health has now just been bought out by the drug companies. And if I can get the message across to the people that take charge of your own health, and in my job, as I call it is to give the rules of the game and the tools of trade so everybody can heal themselves. And all the stuff we talked about today, you don't need to buy any drugs. Anybody can do it. You didn't have to be a clever doctor or have gene therapy or something like that, or it's all dead simple stuff. And that simple stuff is done really well. It gets you all the way so I will go on to shouting, you know, just do it. Just do it. Just do it. In fact, on that longevity. One of the members of the tribe has an old boy who lives in the granny flat. And obviously, I feed him a PK diet. He's been here about six years, but in July, we celebrated his 101st birthday. Wow. And he is as sharp as an attack he has no dementia. He goes out walking every day. He has no cancer. He has no it was slightly wobbly, occasionally but otherwise, he's he's fit and well.

Claudia von Boeselager 56:04
Fabulous. So yeah, clearly tried to deal with longevity as well. Do you have a certain protocol? Or where can people find your protocol for the Paleo ketogenic diet?

Dr. Sarah Myhill 56:14
Oh, all my stuff is on my website. So if you go if you just Google my Hill, it comes up and all my books are there. I'm just about to read. Well, the chronic TCM book is about to be reprinted so that we'll have the up-to-date chapters there. But it's ecological medicine as PK one how that's the third book. So there's lots of going at.

Claudia von Boeselager 56:32
Beautiful, what excites you most about the future of health and longevity over the coming years and beyond?

Dr. Sarah Myhill 56:40
Well, gosh, I mean, I suppose what excites me is the prospect that it's all very possible, very doable. But we live in such an awful world at the moment where, you know, health has been taken over by big pharma. People, walking like lambs to the slaughter with respect wretched vaccines and drugs. These days, I'm ashamed to be a doctor. I'm proud to be a naturopathic physician. And it's the naturopathic doctors who are asking the right questions, so I'm not sure I can be very excited about the future. I'm hugely worried about the future. I've got two girls and I want them to have as good a life as I have. Thankfully, they do all the stuff that I do. But there's so much that's not within our control isn't it's within the control of the politics and the pollution by chemicals, pollution by plastics. You know, I think we're going to have to struggle for them to survive as a species.

Claudia von Boeselager 57:34
I guess it's raising awareness as well, and letting people be aware and then make choices based on that to what are alternatives that are healthier and better for them, and then modalities to detox and to get rid of them in the environment? Yeah, correct.

Dr. Sarah Myhill 57:49
But for 999, good people like that, who do all the right things. You only need one psychopath in power to destroy the whole lot.

Claudia von Boeselager 57:57
Which is around the world. We have a few examples. Where can people follow more what you're up to? So your website, as you mentioned.
Dr. Sarah Myhill 58:07
The lovely Craig runs a wet very good Facebook, where I think he's got a few 1000 followers there. Then I run online workshops where anybody can I can talk for a day in this vein, and anybody can ask any question, I run workshops from my home, which is good fun. All weekend. I teach the whole of medicine. We've got one coming up shortly. So yeah, look at the website and you'll find stuff on there.

Claudia von Boeselager 58:30
Beautiful. Do you have a final ask or recommendation or any parting thoughts or message for my audience today?

Dr. Sarah Myhill 58:37
Well, I think I would say just do it yourself. Take control of your health don't rely on doctors who may be misleading you with drugs and other things like that. You know, take control of your health. Work it out for yourself and first principles and just do it and feel the benefits.

Claudia von Boeselager 58:55
Beautiful. Thank you so much for sharing your incredible knowledge with us today. This has been such a pleasure. My pleasure.