A.T.P. (Original source of this written material has been acknowledged)

[Guest guest]

Myhill's CFS is Low Output Heart Failure Secondary to Mitochondrial

Failure

June 2006

I think this is one of the most important handouts I have ever produced in

terms of my understanding of CFS and what to do in order to recover! So

please read this very carefully and several times over because for many

sufferers it contains the keys to unlock their illness!

Introduction - What is Chronic Fatigue Syndrome

We are made up of lots of different cells - heart, blood, muscle nerve cells

etc. All these cells are different because they all have a different job of

work to do. To do this job of work requires energy. Bu the way in which

energy is supplied is the same for every cell in the body. Indeed, all

animals share this same system. The mitochondria in my dog, my cat and my

horse are exactly the same as mine. Mitochondria are a common biological

unit across the animal kingdom. Energy is supplied to cells by mitochondria

which I think of as little engines which power every cell in the body.

Chronic fatigue syndrome is the symptom caused by mitochondrial failure. The

job of mitochondria is to supply energy in the form of ATP (adenosine

triphosphate). This is the universal currency of energy. It can be used for

all sorts of biochemical jobs from muscle contraction to hormone production.

When mitochondria fail, this results in poor supply of ATP, so cells go slow

because they do not have the energy supply to function at a normal speed.

This means that all bodily functions go slow.

Indeed, this is the biological basis of poor stamina. One can only go at the

rate at which mitochondria can produce ATP. If mitochondria go slow, stamina

is poor.

Chronic fatigue syndrome therefore is a symptom of mitochondrial failure and

every cell in the body can be affected.

Biochemical processes involved in producing energy

The following cycle illustrates what happens inside each cell:

ATP (3 phosphates) is converted to ADP (2 phosphates) with the release of

energy for work. ADP passes into the mitochondria where ATP is remade by

oxidative phosphorylation (i.e. a phosphate group is stuck on). ATP recycles

approximately every 10 seconds in a healthy person - if this goes slow, then

the cell goes slow and so the person goes slow and clinically has poor

stamina, i.e. CFS.

Problems arise when the system is stressed. If the CFS sufferer spends

energy faster than the mitochondria can supply it, (and actually most CFS

sufferers are doing this most of the time!) ATP is converted to ADP faster

than it can be recycled. This means there is a build up of ADP. Some ADP is

inevitably shunted into adenosine monophosphate (AMP -1 phosphate). But this

creates a real problem, indeed a metabolic disaster, because AMP, largely

speaking, cannot be recycled and is lost in urine.

If ATP levels drop as a result of leakage of AMP, the body then has to make

brand new ATP. ATP can be made very quickly from a sugar D-ribose, but

D-ribose is only slowly made from glucose (via the pentose phosphate shunt

for those clever biochemists out there!). This takes anything from one to

four days. So this is the biological basis for delayed fatigue.

However, there is another problem when a person tries to push him/herself.

If the body is very short of ATP, it can make a very small amount of ATP

directly from glucose by converting it into lactic acid. This is exactly

what many CFS sufferers do and indeed, we know that CFS sufferers readily

switch into anaerobic metabolism. However, this results in two serious

problems - lactic acid quickly builds up, especially in muscles, to cause

pain, heaviness, aching and soreness ( " lactic acid burn " ), secondly, no

glucose is available in order to make D-ribose! So new ATP cannot be easily

made when you are really run down. Recovery takes days!These processes

constitute the biological basis of treatment for CFS.

Treatment package for failing mitochondria

PACE - do not use up energy faster than your mitos can supply it.

FEED THE MITOCHONDRIA - supply the raw materials necessary for the

mitochondria to heal themselves and work efficiently, namely D-ribose,

Co-enzyme Q10, acetyl-L-carnitine, NAD and magnesium

ADDRESS THE UNDERLYING CAUSES as to why your mitochondria have been damaged.

This must also be put in place to prevent ongoing damage to mitos. In order

of importance this involves:

Improving anti-oxidant status (energy production processes produce free

radicals which, if not mopped up, further damage mitochondria)

Getting excellent sleep so mitos can repair

Identifying and removing substances that inhibit mitochondrial function:

heavy metals, pesticides, drugs, social poisons, VOC

high carbohydrate diet

allergies to foods, chemicals, inhalants, micro-organisms

Detoxifying to unload heavy metals, pesticides, drugs, social poisons

(alcohol, tobacco etc) and volatile organic compounds, all of which poison

mitos.

ADDRESS THE SECONDARY DAMAGE caused by mitochondrial failure such as immune

disturbances resulting in allergies and autoimmunity, poor digestive

function, hormone gland failure, slow liver detoxification and

hyperventilation.

And now for a bit of good news! You will have read that AMP cannot be

recycled. Actually, AMP can be recycled, but it happens very slowly. For

practical purposes for patients who are very fatigued, this recycling is so

slow that it is clinically insignificant. Interestingly, the enzyme which

facilitates this recycling ( " cyclic AMP " ) is activated by caffeine! So the

perfect pick-me-up for CFS sufferers could be a real black organic coffee

with a teaspoon of D-ribose!

CFS is Heart Failure Secondary to Mitochondrial Malfunction

Two papers have come to my notice recently which make great sense of both my

clinical observations and also the idea that CFS is a symptom of

mitochondrial failure. The two symptoms I am looking for in CFS to make the

diagnosis is firstly very poor stamina and secondly delayed fatigue. I think

I can now explain these in terms of what is going on inside cells and the

effects on major organs of the body (primarily the heart). More importantly,

there are major implications for a test for CFS and of course management and

recovery.

If mitochondria (the little batteries found inside every cell in the body)

do not work properly, then the energy supply to every cell in the body will

be impaired. This includes the heart. Many of the symptoms of CFS could be

explained by heart failure because the heart muscle cannot work properly.

Cardiologists and other doctors are used to dealing with heart failure due

to poor blood supply to the heart itself. In CFS the heart failure is caused

by poor muscle function and therefore strictly speaking is a cardiomyopathy.

This means the function of the heart will be very abnormal, but traditional

tests of heart failure, such as ECG, ECHOs, angiograms etc, will be normal.

Thanks to work by Dr Arnold Peckerman

www.cfids-cab.org/cfs-inform/Coicfs/peckerman.etal.03.pdf

we now know that cardiac output in CFS patients is impaired. Furthermore,

the level of impairment correlates very closely to the level of disability

in patients. Dr Peckerman was asked by the US National Institutes of Health

to develop a test for CFS in order to help them to judge the level of

disability in patients claiming Social Security patients. Peckerman is a

cardiologist and on the basis that CFS presents with low blood pressure, low

blood volume and perfusion defects, he surmised CFS patients were in heart

failure. To test this he came up with Q scores

Much more