In this concluding article of our series on Chronic Fatigue Syndrome (CFS) and Myalgic Encephalomyelitis (ME), we look at a recently published paper “Chronic Fatigue Syndrome and Mitochondrial Dysfunction” by Prof. Norman Booth (Oxford University), Dr. John McLaren Howard and Dr. Sarah Myhill. The paper was published in the January 2009 edition of the International Journal of Clinical and Experimental Medicine.
Of all the CFS/ME therapies I researched, treating mitochondrial failure makes the most sense to me. Of course, this is just my opinion and I am not suggesting that it is the definitive answer to CFS/ME, but it certainly all adds up. As my friend Greg (a CFS/ME sufferer) said: ?? I’m sure you’re aware, for every different potential cause for CFS/ME there is a potential treatment all of which can seem to make perfect sense for the purposes of explaining the value of the treatment. The parties, who advocate their belief as to CFS’s causes and invariably the treatment of it, cannot all be correct, and much doubt still remains…
Power supply shuts down
Dr. Myhill explains in her report that the central problem of CFS/ME is mitochondrial failure resulting in poor production of ATP.
ATP is the currency of energy in the body and the mitochondria is the powerhouse of each cell in our bodies, which produces ATP. If the production of ATP is impaired then all cellular processes will slow down resulting in all bodily functions slowing down. If production levels of ATP are abnormal then this could be a result of magnesium deficiency, of low levels of Co-enzyme Q10, low levels of vitamin B3 (NAD) or of acetyl L-carnitine.
CFS and the root of fatigue
CFS/ME, according to Dr. Myhill, is therefore a symptom of mitochondrial failure and every cell in the body can be affected.
In a normal person ATP (3 phosphates) is converted into ADP (2 phosphates) with the release of energy. ADP passes into the mitochondria where it is made back into ATP in a “recycling” process. This simple yet vital process takes about 10 seconds.
However, when the mitochondria get damaged after a prolonged stressful event like some kind of prolonged stress or trauma or oxidative stress caused by free radicals, it starts to malfunction. This is the case with CFS/ME sufferers.
The conversion process from ATP to ADP and back to ATP looks different in a CFS/ME sufferer. ATP is converted faster into ADP than what it can be recycled back in to ATP. This causes an ADP build-up and the excess is shunted into AMP (1 phosphate). This creates a metabolic disaster because AMP cannot be recycled and is lost in urine.
If ATP levels drop because of AMP leakage, the body needs to make brand new ATP. This can be made very quickly from a sugar, D-ribose and is normally a quick-fix for the body to cope with a sudden loss of energy (ATP). D-ribose unfortunately is produced very slowly from glucose (1 ??4 days) and there lies the root of delayed fatigue after excursion – a symptom most CFS/ME sufferers have.
This explains why CFS/ME sufferers are “chronically tired”. Energy is literally lost in the form of AMP and the conversion process from D-ribose to ATP no longer is a coping mechanism, but a survival mechanism which is being exhausted.
CFS and the cause of muscle pain
With the shortage of ATP the body also tries to cope by producing small amounts of “new” ATP directly from glucose by converting it into lactic acid which means that CFS/ME sufferers readily switch to anaerobic metabolism.
Voila! Another can of worms opens: Lactic acid quickly builds up in the muscles causing pain, heaviness, aching and soreness and secondly the metabolism of glucose and D-ribose is also in a complete mess…
The result: Chronic muscle pain and fatigue, recovery takes days, and if this vicious cycle persists, it can take weeks or even months and eventually you are going nowhere fast.
Because this “broken” process happens on a cellular level it has a knock-on effect through the entire body resulting into related CFS/ME symptoms such as digestive disorders, brain fog, glandular problems, joint pain and headaches to mention a few. This knock-on effect becomes part of the vicious cycle and I am sure you can see where I am going with this…
Treat your Mitos
In light of her findings, Dr. Myhill and her team has devised a comprehensive treatment plan for CFS/ME sufferers with which they’ve had a reasonable amount of success. It starts with a simple test (designed by Dr. John McLaren Howard) called the ATP profiles test which tests mitochondrial function. This test is also combined with measuring the levels of Coenzyme Q10, SODase (antioxidant), Glutathione Peroxidase (important enzyme protect against oxidative damage), vitamin B3 and L-carnitine, which are all essential in energy production.
The treatment programme itself consists of three phases:
1. Pace: Pacing the use of energy levels at a lower level than what it is produced and supplied by the mitochondria.
2. Feed the mitochondria: supplying the raw materials necessary for the mitochondria to heal themselves and work efficiently. Supplementing with Coenzyme Q10 (essential for energy production), l- carnitine, and D- ribose.
3. Address underlying causes for mitochondrial damage: This is important to prevent ongoing damage to the mitochondria and it involves:
- Pacing activities to avoid undue stress on the mitochondria
- Getting enough sleep, allowing the mitochondria to repair
4. Excellent nutrition:
- Taking a range of micronutrient supplements
- Stabilising blood sugar levels
- Identifying allergies to food by detoxifying to unload heavy metals, pesticides, drugs and social poisons such as tobacco and alcohol – all of which poison the mitochondria. And in addition, addressing secondary damage caused by mitochondrial failure such as immune disturbances resulting in allergies and autoimmunity, poor digestive function, hormone gland failure, slow liver detoxification.
When you look at the findings and the approach of Dr. Myhill one cannot help but wonder how cognitive behaviour therapy, graded exercise and anti-depressants ever came in to the picture of treating CFS/ME sufferers, let alone cold water therapy…
With a complex illness such as CFS/ME, the debate will always be ongoing and debate (in my opinion) is good as long as it isn ??t ridiculous and as long as leads to a better insight. In speaking with many CFS/ME sufferers and seeing how they struggle bravely to cope with their lives I sincerely hope that there will one day be an answer and a cure. But I am afraid to say, ONE cure is perhaps very ambitious.
Even if the final answer to CFS/ME lies within the damaged mitochondria, the repercussions and effects of mitochondrial dysfunction will still be as individual as the person suffering from it. If CFS/ME showed me anything, then it is that in spite of our biological similarities we are all very unique in our reaction to our circumstances, environments and treatments and in that also lies some of the answer in the search for curing CFS/ME.
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Chronic Fatigue Syndrome and Mitochondrial Dysfunctionby Dr. Sarah Myhill et all, published online, 16.01.09, drmyhill.co.uk
Diagnosing and Treating Chronic Fatigue Syndrome by Dr. Sarah Myhill, published 26.01.09, drmyhill.co.uk