Welcome to the VP Life Podcast, the show
where we bring you actionable health
advice from leading minds.
I'm your host, Rob.
My guest today is Alex Manos, a
functional medicine provider who
specializes in working with individuals
with chronic fatigue syndrome.
Expect to learn the history of chronic
fatigue syndrome, also known as malleGic
and cephalomyelitis we can say that three
times for OST the triggers and root
causes of chronic fatigue syndrome and
actionable steps you can start taking
today to reclaim your life.
Now, on to the
conversation with Alex Manos.
Good morning, Alex.
It's great to have you join us today.
It's going to be quite the episode, I
think, and the timing for our discussion
today is actually pretty ideal.
As it wraps up the last few podcasts I've
done on mitochondrial dysfunction,
cellular metabolism, NCAS,
environmental toxins, etc.
Anyway, you're at the start of our
conversation today, but before we sort of
dive into CFS and how individuals should
start thinking about the condition and
how they can manage it themselves, would
you mind just introducing yourself and
how you ended up in this sort of
functional nutrition space?
Yeah, well, thank you
for having me on, Robert.
It's been taking us a
while, but we're here.
So yeah, I guess my story, keeping it
short, is I had a long history of IBS,
ultimately, as a child and teenage.
I eventually got diagnosed
when I was 18 from the GP.
And as anyone who's been diagnosed knows,
I got given some peppermint oil capsules
and was told that I'm just going to have
to figure out a way to
manage it ultimately.
And it really did peak when I was 18.
So in regards to the severity,
there were times when I was in a fetal
position holding my stomach just with
crippling abdominal pain.
And I had some of the common symptoms
that will come with it.
I was napping for up to
two hours in the afternoon.
I was at boarding school, so everyone
else was out playing sports.
And I was kind of just in my beds,
hunking down, trying to
get through to dinner.
Brain fog, I had
terrible skin growing up.
So there was a lot of
other things kind of at play.
But I think the root of many of those
were the fact that I had quite
significant digestive
imbalances, ultimately.
So the gut issues and the inflammation
from that also meant that I had a lot of
musculoskeletal issues as a teenager.
So from 15, 16 onwards, I was just
getting injury after injury.
So I see a lot of physiotherapists,
osteopaths, massage therapists.
And I think that a mixture of just my gut
issues and seeing these professionals
meant that I just started to get a real
interest in the human body.
And then fast forward to after
university, I read a
book by Patrick Holford.
Well, most of his books, but I read his
gut's book, did it to the letter, did it
alongside some gut focused hypnotherapy.
And within two weeks, every single
symptom that I was suffering with
completely disappeared.
And it just blew my mind.
And not just sort of digestive symptoms.
I would put my head down on the pillow,
fall asleep, and I would
wake up eight hours later.
I'm not sure I'd ever done
that in my life before then.
Backaches from a rugby
tackle completely disappeared.
So there was like a total reset.
And from then on, I guess I haven't
really looked back in
trying to learn more about it.
So I went and studied at the
Institute of Optimum Nutrition.
I went then and got my master's in
personalized nutrition.
I studied with the Institute for
Functional Medicine.
And I've kind of branched
out a little bit since then.
So I've done a diploma in
transformational life coaching.
I've trained in transformational breath.
And I was in the first cohort of the
Synthesis Institute Psychedelic
Practitioner Training Program as well.
So I've kind of tried to add a few more
strings to my bow to help people because
especially with these sorts of
conditions, they're
complex, they're multifactorial.
And I think the more therapies, for want
of a better word, that you can apply, the
better our chances of
success are ultimately.
Yeah, no, that's quite the story.
And I know you also are involved in a
company called HealthPath, I believe.
Yes.
Can you tell us a little more about that?
Excuse me.
Yeah.
One of the co-founders of HealthPath and
HealthPath Pro, and HealthPath is
ultimately a platform whereby the public
can get access to some of these sort of
functional advanced tests.
So we have a gut microbiome test.
We have a SIBO breath test.
We did have a slide record still test.
The lab just stopped running that one.
And we have some food
sensitivity testing as well.
And then essentially, our customers will
complete a couple of symptom surveys.
One of them sort of more closed-ended
questions, one of them sort of more
open-ended questions.
So we get the context of what's going on
with their health, why
they've done the test.
And I've got a team of nutritional
therapists that are looking at those
symptom profiles, looking at the test
results, and then creating some health
plans on the back of kind of that
subjective and objective data.
So we get a lot of people with IBS, IBD,
autoimmune conditions, fibromyalgia,
chronic fatigue syndrome, and also just
people interested in sort of their
microbiome, ultimately, doing the testing
to see how much is the gut and the gut
microbiome potentially contributing to
what's going on for them.
So yeah, that's kind of the high level.
Now, the CEO is
actually an old client of mine.
So it's a little bit
like Al from XL Coffee.
He was an old client of mine.
He's the people that got really
passionate about health, ultimately, and
helping others achieve health.
And so Richard Naimi is sort of the true
founder of HealthPath, ultimately, who
had a lot of health issues and functional
medicine really helped him and get his
life back on track, ultimately, and
wanted to kind of pass that forward.
Yeah, no, I think it's an amazing
platform you've built.
And something that's definitely going to
be useful for anyone listening today is
they sort of, as we talk about this
concept of CFS and how people can start
working through it to an extent
themselves, but then having something
like that platform like that on the back
end of that way, they maybe don't
necessarily want to or can afford to see
a GP or a functional therapist who
charges four to 600 pounds an hour.
I think that's an incredible service.
And just is, yeah, it really does fill a
much needed gap in the market.
Yeah, I know, Al's an interesting one.
I'm still trying to
get him onto the podcast.
And I was quite distraught to see the
other day that they're
about to run out of coffee.
So I've got to, I made a very quick order
while there was still some there.
But anyway,
all right, CFS, I suppose we
might as well jump into it.
This isn't a question, ironically, not
that I've actually
asked in the podcast before.
But how would you define CFS, sort of
this this concept of milder,
conservative, milder as it's also known?
Yes, from a clinician's perspective,
obviously, there's some interesting
history there, if
you're familiar with that.
But yeah, yeah, it's interesting, I think
that there are different definitions by
different organizations, which doesn't
help the process in some ways.
But I guess, you know, the textbook
features are going to be someone that is
experiencing debilitating fatigue for a
period of six months or more, that isn't
improved by sleep, and that is
exacerbated by physical exertion.
And some of those organizations will
incorporate additional symptoms.
I think there's an American organization
that talks about either brain fog,
or, oh, I forget now, but one other
symptom, one of those has to be included
within the criteria to receive the
diagnosis, which seems a
little bit odd, ultimately.
But yes, I think, you know, six months or
longer of debilitating fatigue that's
impacting day to day quality of life,
that isn't improved by rest or sleep, and
that is exacerbated by physical exertion,
a kind of, I guess, the markers in there
in the consensus amongst all of these
different organizations.
Yeah, that's a fairly sort
of simple way of advocating.
And I think we're
definitely aligned there.
I think I mentioned this to Gillian
Crowther last week, when we were talking
about the cell danger response, which I
know we'll touch on a little later.
But I think the one silver lining, maybe
you could call it, of the pandemic and
long COVID is that I brought this idea of
sort of recalcitrant, recalcitrant, or
persistent viral fatigue into the
spotlight, which I think is a good thing
as, yeah, well, it is.
And while sadly, I don't think we're much
closer to really a sort of a one pill
solution, I do think at least from a
social standpoint that it's broken down
some of the stigma around
the condition maybe because,
well, and I think that's a win for a lot
of people because they don't, you know,
when you sort of are going
through these conditions,
well, as you know, you often get sort of
told that it's just in your head and it's
just, it's not real.
I think there's definitely some roots
there going back to Gulf War Syndrome,
which I think just looking into the
history of the condition is quite
interesting because everything you've
just mentioned is what soldiers from that
era came back with, with these mystery
illnesses of extreme
fatigue, aching joints.
And yeah, I think it's just sort of
building on that and it's providing just
more awareness of the fact that this is a
real condition and it's not just this
sort of psychosomatic
state that people just happen to fall
into and then never get out of.
But yeah, that's my
tangent for the day done.
I'll try and keep it at least somewhat on
track going forwards.
No, no, I agree.
And I think, you know, some of the
comments that people can receive with
chronic fatigue syndrome just perpetuate
the whole situation.
You know, oh, you look fine, you look
healthy, what's wrong
with you kind of thing.
Like it's it's sort of a silent disease
in that way that people can look
perfectly well and yet be bed bound
because of the severity of their fatigue
and other symptoms they're experiencing.
So it is incredibly challenging.
And I think, you know, it's it's made
worse with those sorts of belief systems
or comments that we can receive.
So, yes, I would agree with
you on all of that, Robert.
Yeah, no, I think it just at the end of
the day, having someone who's just
willing to acknowledge that you have an
actual issue will move the
needle as much as anything else.
Yeah.
Anyway, so sort of to dig into it.
I have a few ideas and of course, I
suppose this speaks to my framework and
understanding of the condition.
But I reckon if we start talking about
the potential triggers of CFS and then
start to look downstream at the sort of
more immunological cellular and then sort
of the hormonal endocrine systems that
are affected, that that
should cover most of it.
Of course, we'll cover the gut in there,
too, which at least from a functional
medicine standpoint is really the
starting point for a lot of this.
From there, I think it would be pretty
cool if we put together a basic framework
of sorts that the listener can then
utilize at least as a starting point if
they're trying to troubleshoot these
issues themselves and at which point if
they do struggle, obviously reaching out
to HealthPath or a company like that, I
think is a great option.
Yeah, does that sound fair enough?
Have I missed anything there?
Would you sort of agree with that?
Yeah, I think exploring all of that is
going to be really helpful and there are
different lenses that we can
take to look at that as well.
So I think there's some really
interesting concepts that we
can kind of cover within that.
Yeah, awesome.
OK, let's dive into the triggers.
Now, of course, before I get into my list
of which I have a few and I'd like to
discuss those with you, I'd like to sort
of get your perspective.
As the audience knows, my background is
in Biochem and working through some of
these issues myself and have helped a few
customers through work.
But most of what I do is
definitely theory-based.
I don't have that level of clinical or
practical experience that you necessarily
do or that you do have.
So what do you generally see as being the
most sort of obvious triggers, mold, etc?
Yeah, so I'm going to potentially
contradict myself here, but I'm going to
try and explain why I'm
going to contradict myself.
So if we think about potential triggers
of CFSME, you know, we're going to be
thinking about microbial.
So this could be bacterial, viral,
parasitic or fungal.
We could be thinking
about things like trauma.
That will certainly be
a contributory factor.
We can be thinking
about environmental toxins.
So mold and mycotoxins, I do think is
quite a common contributory factor.
And I try and use that term contributory
factor because I think
that it's rarely one thing.
And I'm going to expand on
that in a second as well.
But we've also got, you know, potentially
heavy metals like mercury, toxicity,
lead, cadmium that can be
contributing here as well.
We have obviously there is the gut
component, whether that could be related
to the microbial part or whether that's
related to just intestinal permeability
for whatever reason, that intestinal
permeability is there.
Intestinal permeability
being this idea of leaky gut.
AKA leaky gut.
Yes, thank you.
And then also we can think and again,
this could blend with the
microbial, but oral health.
This is kind of one of the
new frontiers in the research.
Ultimately, what we're understanding
about the oral microbiome and our oral
health and how this impacts
on systemic health as well.
And then there can be again, as a
contributory factor, I don't think it
would ever probably really be
considered a trigger as such.
But food, you know, food allergies, food
sensitivities, food intolerances could
potentially be contributing to a reduced
ability of the cell to produce energy,
which is fundamentally
what we're talking about here.
Now, there are two things I want to add
to this, which is if the cell has reduced
capacity to produce energy, then none of
these things really work anyway.
So you've got suddenly this
bi-directional relationship whereby we
understand the importance of
mitochondrial health and energy
production in maintaining an intact gut
lining and in
maintaining a healthy microbiome.
And therefore,
actually, which even came first?
Was it a reduction in capacity to produce
energy that led to dysbiosis or
imbalances within the gut
microbiome and leaky guts?
Or was it the imbalances in the gut
microbiome and leaky gut for whatever
reason that may be that then led to
reduced capacity of the
cell to produce energy?
So it's really important, I think, to
take that sort of functional medicine
systems biology approach where
understanding that most of these things
we're talking about are all
bi-directional relationships.
And while that can sounds a little bit
daunting and confusing and like, oh,
great, what do I do with that then?
I think it can also be quite empowering
because it means that we can take this
sort of multi-pronged approach to
supporting the bodily systems, knowing
that we're having actually multiple
benefits and impacts at the same time.
And just the other thing, because I said
there were two things I wanted to touch
on, was the concept of allostatic load,
you know, the accumulative wear and tear
on the cell from just life, you know, and
our exposome, which is basically our
entire life experience and exposures,
everything we've breathed, everything
we've thought,
everything we've eaten, etc.
So what we know in the research and what
gets discussed a lot is, you know, we
basically are going to be experiencing a
cumulative wear and
tear at a cellular level.
And we may hit a threshold whereby we
don't have the psycho-emotional
physiological resources to maintain
homeostasis, to maintain
equilibrium, to maintain health.
And there is going to be a collapse in
our health, in our physiology, in those
interconnected bodily systems that is
going to manifest for some maybe as CFS
ME, but for others maybe
as an autoimmune condition.
And obviously there's been a discussion
anyway around the
interconnection there as well.
So it is very complex, I think.
And I'm really, as I think a lot of
people are moving away from this idea of
trying to find the root cause, because
what I think might look like the root
cause when you map out someone's timeline
is really just the final
straw that broke the camel's back.
You've got everything that happened
before that, which is why that trigger
was the trigger in the first place.
So I think this is where sometimes we've
got it wrong, whereby someone, let's just
say, gets glandular fever.
So we think about the Epstein-Barr virus
and we go, "Oh, EBV was your trigger, and
therefore we just need like an antiviral
protocol or a viral protocol,
and you'll be back on track."
When actually the only reason why the
virus became problematic was because
often, in my experience, working with a
teenager in school, they're often the
academic and the athlete, and they've got
pressure to get into the
university, et cetera, et cetera.
There's just an accumulative strain on
the systems and it's meant that they've
hit their threshold.
So I think it's really important when
we're thinking about someone's timeline,
basically their life story, we're trying
to understand where are these stresses
and strains, where have they come from?
Has it been through courses of
antibiotics or has it been through family
dynamics or were they bullied or what was
their diet like or did they live in a
water-damaged property?
What infections, what
diagnoses have they received?
And then you can start to get a little
bit more of, I think, a helpful model in
regards to this individual, "This is
their story, this is their experience,"
and then we get a sense of where we might
want to go to support them.
Yeah, no, I think that just points to the
need for a personalised approach.
It really does.
I think there's just so much chicken and
egg when dealing with a condition like
this, as you sort of alluded to earlier.
I do like the fact that you brought up
the concept of an elastatic load.
I don't know if you're familiar with Dr. Eric Balc Harvage? Yeah, I think that's a very important point, too, that is to keep the sense of
the mischievousness of energy production.
And that's consequently, it starts to
downregulate itself to the point where it
is able to find its own equilibrium again
in a reduced state of energy production.
So it's trying to find that lowest common
denominator where it's essentially still
functional, although at a
point, I think that's, I like that lens,
looking through it as the fact that
there's not something wrong, it's just
the fact that the cell and the body oil
in the specific sense, the area in which
is an issue has become downregulated.
And yeah, I like that lens, I like
looking through that standpoint.
Alex, you mentioned heavy metals earlier,
and I'd like to ask a
quick follow up question there.
I think everyone and their aunt generally
test positive for heavy metals.
I don't know if you see that in clinical
practice a lot, but from some of the
research I've done, I've noted that when
there is a lot of inflammation in the
body, for whatever reason, that you're
going to then have an inability for the
body to properly detox, you're going to
have impaired lymph activity, you're
going to have compromised maybe bowel
flow or hepatic liver function.
And then subsequently, you're then going
to end up with an accumulation of these
environmental toxins.
Now I know that there's a lot of
bioenvironmental toxins,
heavy metals, molds, etc.
Now I know there's a lot of talk about
this, this at the moment, it's quite
invoke, I think, talking about the fact
that if you drink water out of any
plastic bottle, you're going to be dead
and five seconds flat.
But do you think that these are necessary
and just plain devil's advocate, by the
way, because I fully subscribe to the
model that these
environmental toxins are an issue.
But do you think that there
are a trigger in their own right?
Or are they just a downstream consequence
of the body not necessarily being in a
position to effectively
get rid of these chemicals?
I would say both, dependent on the
individual, ultimately.
So my thinking around this, certainly
with heavy metals, if we think of heavy
metals, because it's slightly different,
you could say in some ways from a micro
toxins, for example, but heavy metals,
the two primary mechanisms by which they
cause havoc on our cells is
inflammation, oxidative stress.
And therefore, the question becomes, you
know, why can some of us be walking down
the high street feeling relatively well,
asymptomatic, and have positive heavy
metal tests or micro toxin tests.
And you know, I think you've always got
to put the environmental toxin within the
context of someone's
capacity to deal with it, basically.
So what is someone's
antioxidant status like?
What is someone's immune resilience like,
meaning what kind of anti inflammatory
sort of approach or
benefit can they take?
So I don't think again, it's ever just
the micro toxin or just the heavy metal.
It is a why is this accumulated as you
were sort of alluding to?
And secondly, have you lost capacity to
manage that's going back to the
allostatic load and this idea that the
body's maintaining
equilibrium as long as it can do.
And therefore, there's going to be a
certain amount of heavy metal or micro
toxin mold, it can accumulate and
maintain homeostasis.
And that level that it can accumulate is
going to be based on your anesthetic
load, your nutrient status, your bio
flow, everything, your overall health and
your overall physiological function.
So again, it's got to just be put within
the context of the body and the person
and how they're able to handle that
ultimately, what's their overall
resilience like within this?
Because it's true, you know, inflammation
will absolutely down regulate various
liver enzymes that detoxify some of these
things, but also chronic stress will down
regulate detoxification because you're
distributing your resources according to
the state of that nervous system.
So if you've got someone who is in some
state of fight or flight, let's just say
they have an aura ring and you know,
their HRV is down in
the 20s all the time.
That is someone who isn't in a state to
heal, you know, they are in a mobilized
state whereby at a cellular level, they
are in a state of stress, they are
unsafe, there's danger
somewhere that is being detected.
And therefore, resources are being
distributed to fight or flight or freeze.
And again, you are going to get an
accumulation of environmental toxins, you
are going to get compromised digestive
health, you're going to get compromised
gut lining health, because those things
just aren't important
to that point in time.
So I think there are some real
foundational pieces that have to be
considered before even sort of thinking
about what's the appropriate protocol for
this person, based on any of that kind of
functional testing that you might have
done, because, you know, they might have
SIBO, a good chunk of
people with CFS do have SIBO.
But is that because of the
state of their nervous system?
And actually, if you support them in that
side of things, then
the SIBO just disappears.
So yeah, it's just another key
consideration,
ultimately, within all of this.
So yes, you like going back to your
question a little bit there, Robert, if
someone's got a positive
environmental toxin test,
and I don't have I don't know if there's
like an obvious answer here or black and
white answer, there never really is.
But if you were able to improve their
nutrient status, if you were able to
reduce the oxidative stress, if you were
able to reduce the inflammation in kind
of independent of that toxic burden, to
some degree, you
would be able to do that.
Would that person get noticeable
improvement in symptoms, but still have a
chunk of that trigger or
environmental toxin left?
And I believe, yes, you
know, that's quite possible.
So do we need to get do we need to detox
totally and get like a
negative test result?
Or actually, do we just need
to get them feeling better?
You know, and that's where you know, you
never really want to be treating the test
results or the page.
Yeah, no, I couldn't
have said a bit of myself.
And yeah, I think it really does speak to
the importance of looking at a client's
symptoms, or what patient's symptoms or
an individual symptoms and sort of
acknowledging those as maybe the
benchmark of health.
I think a lot of practitioners, at least
in my experience, maybe not a lot, but
maybe neuro practitioners tend to sort of
get caught up with the
number that's on the page.
And I think that can sometimes be to the
detriment of the individual in question.
Definitely.
Yeah, just sort of,
I sort of I'd like to
move on in a second.
But for the listener,
we've discussed a lot of triggers,
everything from some sort of the some
from, yeah, viral infections, to
bacterial infections, things like tick
bites, to potential molds and mycotoxins.
For those listening who maybe are just
sort of trying to figure this out
themselves to start with, how do you how
would you advise them to start when there
isn't necessarily an obvious
sign of or beginning or trigger?
Obviously, if you have something
potentially like Lyme disease, there's
going to be a bullseye rash in all
likelihood, that's a pretty good
indicator of where the issue sort of
starts has started off.
But for individuals who just sort of
slowly enter this sort of malaise of
dysfunction, how do you normally sort of
work through that process when there
obviously is a lot going on, but there's
sort of, yeah, like, as I said, and sorry
for being verbose, no sort of clear
signal, as it were, as to what's maybe
initiated the problem?
Yeah, it's a good question, especially
when there isn't sort of
an obvious trigger as such.
I think you know, you always want to be,
you always want to be
thinking about that timeline.
So one of the analogies I use is, you
know, we're trying to get to the first or
first few dominoes that fell over and
pick those back up to have any chance of
obviously dealing with the rest.
So when we think of like cellular energy
production, there are some real
foundational things that
would need to be ruled out.
And again, I think one of the challenges
we have with kind of CFS me is, is the
breadth of debilitation, if that's the
right word, like some people are still
working, but are struggling with their
chronic fatigue syndrome, some people are
totally bed bound and can
barely hold a conversation.
And they're all put under the same
umbrella
fundamentally, which is just crazy.
And I think that's why there's, there's a
lot of friction and a lot of heat in some
of these kind of conversations, because
actually, who are we talking about?
These are two very
different types of people.
But you know, if we think of, if we try
and maybe go through the entire spectrum,
we're thinking, okay,
what's your nutrient status?
Because for some people, it could be, you
know, like an iron deficiency anemia, or
a B12 deficiency that's actually
contributing to that fatigue.
So at the early stages, there are some
really basic things that obviously have
to be really ruled out.
We will do want to be
thinking around gut health.
So then we start thinking about how many
courses of antibiotics have you had?
And what's your diet been like over
different stages of life?
Ultimately, what's your
alcohol intake been like?
What's your sort of drug sort
of intake or usage been like?
I think adverse childhood events is a
really big one as well.
So that has to be considered.
And, you know, understandably, the public
often don't understand there can be a
connection between those first few years
of life and why you ended up with a
disease when you were 40, for example,
but we see in the research partly related
to this idea of allostatic lows, that
there's a real connection there.
So I do think going back to day one, if
not earlier, is actually a really
important way to sort of move forward to
ensure we're not missing
any pieces of the puzzle.
You know, questions around have you lived
in a property that's had any visible
mold, or just a historical water leak?
Or do you feel better when you're out of
your property on
holiday or visiting a friend?
Or have you noticed sort of symptoms
coming on when
entering certain properties?
Just to get a sense of if there is
anything there from a sort of mold
mycotoxin sort of perspective, what's
their oral health like?
Do they have any amalgam fillings that we
just need to be a
little bit mindful about?
And these sorts of things.
So I think it's just it's a mixture of
understanding someone's actual just
journey, and the key events within it,
and then asking specific questions that
are the best we can do to get a sense of
do we need to go further with this
inquiry, which might be then a mycotoxin
test or whatever it may be.
You know, have you been
knowingly bitten by a tick?
Or, you know, did you have a dog?
Have you lived in the countryside?
These sorts of things can
all be considered as well.
I've had a couple of clients just spring
to mind who, you know, moved into a
property that was rural, and it was
surrounded by fields, and they were just
aware of the tractors spraying stuff all
over the crops that
they were surrounded by.
And you just start thinking, okay, there
could very much be an environmental
exposure there, that has been
contributing to why they're
now feeling the way they do.
So even little things like that, that if
you don't ask the question, you might
never know that they live surrounded by
fields that are sprayed with all sorts of
different pesticides, herbicides,
fungicides throughout the year.
So yes, I think a mixture of questioning
and just plotting someone's timeline.
You know, what was
the first 10 years like?
What were your teenage years like?
What happened in your 20s?
And then, you know, asking the specific
questions just to try and
rule in or rule out any of that.
Did you have glandular fever,
etc.
So I think, you know, that's the that's
the only way to go about it really.
And then I do find the HRV monitoring in
some people can be really helpful in
others is feels really unhelpful and can
be just frustrating sometimes.
Yeah, that was actually going to be my
next question was about HRV.
I've always sort of looked at it as more
of a performance metric because when you
have somebody who is definitely in a
state of disease or unwellness, was a
better word, their HRV is going to be
tanged almost regardless.
At least that's been my experience.
Again, not a clinician.
So I don't necessarily have that hands on
understanding of the technology.
But do you think it is, I mean, evidently
to do, but how do you utilize it from
that standpoint, if you
sort of get what I mean?
Is it a tool that you find is able to
provide sort of that longitudinal data
that is consistently objectively useful?
Or does it just become a bit sort of
almost background or shifts?
It's a bit like some of these new tests
that are looking at DNA methylation that
show that you have a high level of
information there before you're going to
either die tomorrow or
in a thousand years' time.
They don't necessarily provide a
quantitative standpoint
of actually what's wrong.
Maybe some of the new
true age diagnostic tests do.
And I'm sorry, I'm just being a verbose
again, but they just provide this sort of
this blanket statement, i.e. you are
inflamed, you have a terrible score.
Do you find that to be
this similar with HRV?
I think I honestly have found it helpful
in certain individuals and that's not
based on the individual, but more just
like the context, what I mean there.
So just to give examples,
I find one of two things.
Either it's really low, you know, it can
be in the tens, twenties, low thirties,
or it's really high and symptomatically
lifestyle that person looks, feels like
actually they're in more of like a
freeze, functional freeze type states.
And in both those situations, I think it
can be helpful in the sense that if
you've got someone with really low HRV,
then you know, we're being informed that
that person is in, people
call it different things.
I've heard it as being
called sort of a mobilized state.
They're in that kind of fight or flight,
they're putting resources to sort of
fight or flight and survival ultimately.
So they're not detoxing, they're not
digesting as well as
they could be, etc, etc.
That is someone who most likely will not
respond to antimicrobials as well as
someone who's got better HRV.
They're more likely to have a Herxheimer
type reaction and therefore you might not
even go there to begin
with, with that person.
You might work on some of the metabolic
aspects of things and look to get that
heart rate variability up a little bit
before going in with antimicrobials to
avoid just a Herxheimer
die-off type situation.
So it can be helpful because it can to
some degree inform when is the right time
to do the intervention that
you are thinking of doing.
And at the under end of the spectrum, if
you've got someone the way you're
thinking that actually it looks like
they're in more of a freeze state, then
that is someone who is almost guaranteed
to have, they're going to have to feel
worse before they feel better because
they're going to have
to move out of a freeze.
And with that comes immobilization that
might manifest as you
know, anxiety, for example.
And you know, I just heard I have a
friend slash colleague who I really
admire, Marek Doyle, who, who would, who
shared a kind of a anecdotal story
whereby he was warning someone, this was
sort of the situation they're in, the
plan they put into place led to some
anxiety come up and the client thought
they were having a
negative reaction to the protocol.
But Marek monitoring HRV as he does with
all of his clients saw that
actually HRV was improving.
This was someone coming out
of kind of a freeze state.
And therefore, the reaction they were
having, it was something that they were
going to have to navigate through.
Ultimately, it was like it was a good
thing, ultimately, because they were
coming out of this state.
And that's the only
way it's going to work.
And you wouldn't have known that if you
weren't tracking heart rate variability
at that point in time, you might have
just agreed with them always
sounds like a die off reaction.
Yeah, let's back off
some of these supplements.
So it can help inform you in
regards to the interventions.
Is it working?
Is it not?
Is it the right time?
Is it not?
So I think it can have real
value from that perspective.
And then if you are able to obviously get
improvement month on month, it's just
obviously incredibly motivating and
inspiring for the clients because they've
got this objective biomarker that things
are starting to move underneath the hood.
And I've certainly had clients whereby it
looks like HRV starting to track in the
right way, but symptomatically, they
haven't yet noticed improvements.
So again, it gives them a positive
reinforcement that this stuff is working
under the hood, things are
going in the right direction.
You just haven't been able to experience
that on a symptom level yet.
But we know that what we're doing is
having a positive impact on physiology
because HRV is starting to trend upwards.
So sometimes it can be helpful.
And then the reasons I think when
sometimes it doesn't work is primarily
when it just, you know, it's stuck and
it's not trending upwards.
And then it just
becomes really frustrating.
And every morning you're looking at your
data going, "Oh, I'm still just where I
am and nothing's working."
And then you start to get that negative
reinforcement that something's broken or
I'm not able to get well and actually it
becomes a real negative
thing.
Yeah, I mean, that can be a helpful
metric in and of itself.
Exactly.
Yeah, if you can put it within the right
context, if you have the right
relationship with the data, it's still a
positive thing, ultimately.
Yeah, I'd agree with that.
Yeah, no, I think you just got to look at
as data at the end of the
day, a bit like SleepScore.
Just, "Okay, this is my SleepScore.
And then don't let that sort of influence
you because it's going to have that sort
of placebo-no-cebo effect if you sort of
then sort of feed into it."
Just, yeah, I suppose that's actually a
good time to maybe talk about the
trigger that maybe, and for those
listening, I've put that into air quotes,
that most people don't think about and
something you've already talked more
alluded to a few times.
And that's this thing about autonomic
nervous system dysregulation.
Yeah, call it what you will, maybe
adverse childhood events, a sort of a
heightened limbic system response, a
hypothalamic response.
But yeah, I think a lot of people don't
necessarily think that stress is
potentially a major trigger or a trigger
in itself for CFS or
ME or any fatigue state.
This is something sort of I get quite
passionate about because I just love the
neurobiology behind it, how high levels
of stress can sort of influence, yeah,
the release of your transcription factors
in the cytokines, which then feed down
into this vicious circle of driving
central nervous system fatigue,
upregulating stress hormones and around
and around you going.
Could you sort of carry that statement
forward and discuss why, yeah, it's
potentially such an issue?
I can try, yeah.
So I guess, you know, I kind of do see it
as foundational ultimately.
And I think the easiest way to think
about it is if that autonomic nervous
system is dysregulated, you know, that is
kind of the conductor.
It's dictating to some degree where your
resources are being distributed.
And if you're not
distributing your resources to,
you know, as we've already sort of
discussed to certain bodily systems or
pathways, whether that's the guts,
whether it's digestion, whether it's
detoxification, whether it's distributing
blood flow to the gut lining to maintain
an intact gut lining, then you're going
to ultimately end up with these
downstream consequences that sometimes
people confuse with the
trigger, like leaky guts.
You know, if you're not getting enough
blood flow to the cells that line the
guts, then you're not able to repair the
guts and you will
have chronic leaky guts.
So a lot of the things that I think we
sort of diagnose, so to speak, are often
downstream of the initial imbalance, if
we just call it that,
I guess, ultimately.
So I do think sort of autonomic nervous
system, dysregulation, limbic sort of
dysfunction are common, you know, and
again, thinking about this just from our
modern way of living and the environment
that so many of us are in, you can take
that in so many different ways, noise
pollution, air pollution,
sort of EMFs and going
down that sort of rabbit hole.
All of this is having some kind of impact
on our physiology at an unconscious or
sometimes conscious level.
So, you know, living by a really busy,
noisy road, that is a
stressor on your physiology.
You know, there's research around that.
So my master's dissertation was on
cortisol resistance and
chronic fatigue syndrome.
So again, like you already alluded to a
little bit, Robert, this idea of if you
are constantly producing excessive levels
of cortisol for whatever reason, some
kind of stressor, let's just say, the
receptors on your cells to cortisol can
desensitize, can become resistant, like
we think of insulin
resistance and type 2 diabetes.
And although everyone will know of
cortisol as the stress hormone, as many
of us also know, it is a potent
anti-inflammatory
immune modulating hormone.
And therefore, if you end up with
cortisol resistance, you are not getting
that anti-inflammatory immune modulating
property that we need
and want from cortisol.
And this can sometimes manifest in low
cortisol in salivary testing, where
people go, "Oh, I've got adrenal fatigue.
I need to kind of support my adrenals."
Actually, that is again, often thought to
be an adaptive response.
Your bodily has deliberately lowered your
free cortisol to free up immune resources
to deal with something that you're
struggling to deal with,
an infection, for example.
So I really do, in my heart, believe that
the body very rarely,
if ever, makes a mistake
and that everything we're seeing in test
results, or nearly everything, is a
deliberate act by the body, by the cell,
because it has far more wisdom and
intelligence than we do.
And then we're trying to figure out
what's going on ultimately.
So the question is, why
would the body do that?
Why would the body deliberately do what
we're seeing with free cortisol that we
just went through, for example?
And it's the same with this idea that CFS
is a sort of hibernation reduced
metabolic state as a way to
preserve life, ultimately.
It just comes at a huge
cost in many other ways.
So the body has deliberately done that.
And what we need to try and do is
obviously understand the accumulative
wear and tear and the
biggest fish in the pond that's Dr.
Neil Nathan sometimes calls it.
What are those that if we can act upon
and if we can sort of deal with, so to
speak, then the body has enough resources
to deal with the other stuff that might
be accumulating the
wear and the tear as well.
So there's going to be a tipping point
whereby healing spontaneously happens
once we've dealt with the excess that we
referred to earlier, when we've hit that
threshold, where the body no longer has
the resources to cope with the strain
that is being placed on the system.
And this is where we also have to be
thinking about our emotional well-being.
You know, there's a condition called
alexithymia, which is kind of this
reduced ability to identify, label,
experience our emotions.
And one of the theories is that if you
have a reduced ability to kind of
recognize and identify and label how you
are emotionally feeling, there's kind of
like, there's another stressor
ultimately, because you're not going to
be able to act accordingly.
You're not going to be able to respond to
what is actually happening
in your internal landscape.
And that's been associated with some of
these conditions,
certainly IBS and fibromyalgia.
I'm pretty sure chronic
fatigue syndrome as well.
It would totally make
sense that it would be.
So, you know, I also think that actually
some of the most powerful therapies can
sometimes be journaling, for example, but
not just necessarily journaling without
any prompts, but, you know, again,
looking at the research and looking at
the sort of questions or statements that
are being used to prompt people to go
deep with their journaling practice.
You know, being in the breathwork space a
little bit, there are, you know, these
stories of people going into a conscious
connected breathwork ceremony where
they're lying down, eyes closed, music
playing, breathing through the mouth for
60 minutes, often having some sort of
quite profound experience.
That could be an emotional release or
that could be something psychological.
But I know of people who have had chronic
fatigue syndrome, who have had
significant improvement in symptoms after
going through something like a conscious
connected breath experience.
So, you know, there is that mind body
element to this as well, which I think is
a really valid route to explore.
Yeah, it's definitely,
I keep on going forward
and backward on that one.
I must admit having sort of worked
through programs like the Gupta program
myself, and maybe not necessarily having
seen the results I was after.
I do wonder if I do think it works.
I just, I'm not, I don't necessarily
believe that it's maybe a
modality that works off the bat.
I still think you have to get that
supportive, the supportive basis in first
before you can sort of maybe start before
you start to deal with the sort of the
mind body aspect of it.
I'm not denouncing it at all.
I just think that you have to have that
baseline support and to allow the body to
then slowly start at
least at a cellular level.
And I suppose this gets more into the
cell dangerous response stuff that we'll
talk about in a bit.
After that sort of CDR1, CDR2 state and
then back into a position where maybe,
yeah, you can then leverage these more
broadly speaking, yeah,
psychosomatic approaches.
Would you agree with that?
Yeah, I think it's all of these things
are quite frankly a bit hit and miss.
And we don't necessarily have a logical
explanation as to why it worked for this
person and didn't for this person.
And it could be all sorts of different
little components at the end of the day.
But I do like what you say, Robert,
because, partly because, you know, we're
at a space, I think, where people are
really pushing their
bias, you know, their thing.
And we're at a point where I'm seeing
more like somatic practitioners, like
dissing functional medicine, because, oh,
I had a client come to me and they spend
thousands on tests and supplements and
they didn't get better and
they did my program and did.
But it's like, that's
true the other way as well.
Like it's not, one isn't better.
And like a multi pronged approach is
always going to give you the most
likelihood of success.
But I think, you know, there's got to be
those foundations in place, as you say.
And again, keeping it really basic, this
won't be relevant to a lot of people.
But if there are some nutrient
deficiencies where the cell actually just
doesn't have the raw ingredients it needs
to create energy, no amount of journaling
or breath work or anything is going to
touch it, because that's just a pure
physiological, biochemistry, biological,
whatever root cause that
needs to be addressed as that.
Now, there are those cases, and I imagine
the more we go down the spectrum of
severity of kind of chronic fatigue
syndrome and the more multi prongs it
comes, I think the more likely is that
there are some ACEs, that there are
environmental toxins at play that are,
that is disposed of intestinal
permeability, because there's been a
greater collapse in physiology and
homeostasis, ultimately.
So yeah, I think again, it comes back to
where is that person
within their journey?
What have they explored, but also just
how severe is their condition?
Yeah, no, I really like the way you put
that because oftentimes you're, you're
going to onto social media, and you'll be
struggling with one of
these sorts of issues.
And again, just to reuse the same analogy
from earlier, everybody in the pen there
on will have the solution.
And it's oftentimes just a
fairly narrow viewpoint on this.
Okay, so I'm just going to go through
this detox program, which may be great.
I'm not saying it isn't, but and there's
there often a lot of claims that it's
that will solve your problem, or you've
just got mast cell activation syndrome,
and all you've got to do is take
quesitin, crumblin, low histamine diet,
and Bob's your your be heal.
And I think, I think these clinicians or
sometimes just people who've worked
through themselves, and who are then
selling a solution, they really mean
well, they really want help.
But I think, and I'm not necessarily
pointing to them and saying that they're
doing anything wrong.
But I think people have just got to be
aware that that that that as you've
highlighted, excuse me, a multi pronged
approach is is definitely,
well, it just makes sense, you're sort of
the more approaches you have, the more
likely you are to hit the target.
And I think if you sort of go in with the
mentality that this one thing is going
to, to be your answer, that you're going
to be disappointed and ultimately, well,
not ultimately, but potentially end up
sort of back on the back foot in a sort
of state of, well, where is me, life's
I'm just been destined to be miserable
forever sort of thing.
Cool.
I'd love to carry on
this discussion all day.
There is a receptor sensitivity part sort
of really sort of litify
under me and what I wanted.
And we think, yeah, I think if we were to
sort of then discuss things like cytokine
insensitivity, that would be something
else to, well, another
rabbit hole to go down.
I think if one could figure out how to
stop various receptors from becoming
insensitive to any
input, be it a hormone drug,
whatever, you'd probably
be a billionaire overnight.
But anyway,
I reckon it's probably a good time to
move on and maybe talk about some of
these downstream issues that arise from
these triggers that
we've really been discussing.
But first, I'd just like to the audience
to understand that there is almost orders
of operations to how the body enters into
the sort of aloe static
state, the state of dysfunction.
Now, I want to keep this very high level
and I'd love your feedbacks.
And if I miss anything,
please feel free to correct me.
But the way I see this is that there will
be a trigger and I want to find another
word now because that
one's driving me nuts.
But that will ultimately drive some level
of inflammation within the body and
that's going to be mediated most of the
time by the immune system.
A good example of this would be, say you
have mold as your primary trigger,
obviously speaking to the audience here,
and that could then be driving high
levels of incast of the sort of histamine
controlled
immunological response in the body.
And then consequently downstream of that
inflammation, you then end up at least
according to Naviocerri, a rubber doctor,
rubber Naviocerri, this sort of, this, as
we alluded to earlier, this
state where the mitochondria become
dysfunctional, the cell
danger response, as it were.
And then downstream of that, again,
you're going to end up
with hormonal dysregulation,
which is where I think some people tend
to sort of miss the mark a bit and they
end up going straight to HRT because on
paper they have a low testosterone or
estrogen or whatever when all the results
are, all the issues are upstream of that
and that the hormones are just a
consequence of this sort
of dysfunctional physiology.
I know that again was very high level and
that I miss out a lot of nuance there.
But again, just from the sort of order
operation standpoint, do you think that
sort of sums up how the body sort of
enters into this state of dysfunction or
anything or did I get it wrong entirely?
No, I think that sums up nicely
ultimately and easy to understand.
Like, I think, as you said, it's really
important to stress like the biggest
trigger or the final trigger.
So if you just think of an individual
cell, you know, you've got all of these
different stimuli ultimately, and the
cell can maintain its
health for only so long.
So going back to this threshold, then you
get exposed to mold or whatever it may
be, and yeah, then
there's just this collapse.
So I think you summarize that sort of
dominant sequence nicely.
Cool.
I'm glad I got something right today.
I might actually put in for pay rise.
All right.
So I reckon the next logical step would
be to maybe discuss some of these
downstream issues of the
trigger in a little more detail.
And now I know we could go, there are
obviously there are
dozens, hundreds of them.
But if we were to just touch on the main
ones, I think that would be helpful.
And talk about things like mast cell
activation syndrome, and then maybe dive
in a little deeper into the CDR side of
things, the mitochondrial dysfunction,
would just be helpful to people.
As I think that these are generally
issues that affect more people than not
when it comes to these states.
And then again, maybe to talk about the
vagus nerve in a little more detail, just
to carry on that conversation we had
earlier from a, from an autonomic
dysregulation standpoint.
Are there any more there that you would
like to maybe hide for
people listening in or?
I think the histamine
piece is, is really big.
I think it's been really big for a long
time, but we're only now just starting to
really appreciate how big it is.
And COVID has definitely sort
of been a player within that.
But you know, histamine and its
contribution from an IBS, CFS, and
obviously going through sort of MCAS type
stuff, like it's,
it's really significant.
And I think it is definitely
underdiagnosed, misdiagnosed, missed by a
lot of practitioners, including myself
over the years, obviously.
Because partly it can manifest in so many
different ways for different people.
So in mast cells,
we have an abundance of mast cells that
infiltrate the gut lining.
So in people with IBS, they often have an
accumulation of mast cells along the
lining of the gut, which is then
obviously contributing to some of the
symptoms they might be experiencing.
And mast cells can be triggered to
release their content, which includes
histamine, but hundreds of other
mediators, obviously, as well.
Many are pro-inflammatory.
Mycotoxins, heavy metals have been shown
to sort of trigger mast cells.
Now that's not mast cell.
I think I'm right in saying from the
paper, it wasn't mast cell degranulation,
which we often hear about.
It was just literally the mast cell being
triggered to release
contents from the cell.
And this can contribute to, you know,
your classic symptoms, sneezing,
reactivity, hay fever type stuff.
But it could be purely digestive related.
It could be cognitive.
A brain fog will be a
really common scenario there.
It can be related to the
monthly cycle in females.
It can be related to
blood pressure regulation.
It can be migraines and headaches.
Blood pressure?
There is a mechanism around certainly the
cardiovascular system
being influenced as well.
Would that have to do with
nitric oxide potentially?
Yes, that would make sense.
Yeah, at least if nothing else, then I
imagine nitric oxide at play.
I'm not sure what the mechanisms are
there off the top of my head.
But yeah, I mean, almost most bodily
systems can be
influenced at the end of the day.
Now with IBS, you know, there are studies
where they've given an over-the-counter
antihistamine and a subset of people get
total improvement in their
gastrointestinal symptoms.
So that kind of shows you the role that
it can play within IBS.
And with histamine, obviously you've got
exogenous consumption
from high histamine foods.
You've got potential production from gut
bacteria that can produce histamine.
And then you've got mast cell and
basophils that can produce histamine and
they both kind of store
it within the cytoplasm.
So you've got endogenous and exogenous
exposures ultimately.
And then various environmental toxins,
like we've mentioned, can trigger the
mast cell to release that
histamine that it contains.
And we've all got,
remotely familiar with histamines,
probably heard about the
whole histamine buckets.
You know, again, we've got a
threshold that we can handle.
And then when that threshold has
exceeded, we're going to be
symptomatic fundamentally.
And there are two primary ways that we
deal with histamine.
Sort of the dietary
source, we have the DAO enzyme.
So you can supplement DAO to help you
tolerate dietary histamine ultimately.
And for some people, it works wonders and
it diversifies the diet
again and they're happy as Larry.
For others, it doesn't work.
And that's just because their issue
wasn't a DAO issue, most likely.
So again, it's just one of the things
that can be at play there.
Diamine oxidase being the enzyme that
brings down histamine.
Yes, correct.
Yeah.
And that's primarily
dietary or exogenous histamine.
Now you could have a bacterial overgrowth
that is driving histamine if those
bacteria are histamine producers.
And then we have to go down more of a,
let's just call it a microbiome
modulating sort of protocol to deal with
the overgrowth or at least understand the
cause of the overgrowth.
And then you've got the environmental
triggers of actual mast cells triggering
histamine release and
releasing it from that perspective.
And then there's also the HNMT.
I was just going to ask.
And I never, I can't
remember what it stands for.
HNMT.
But that's dealing with kind of more
endogenous histamine.
Now both of those enzymes, DAO and HNMT,
as they all require,
they have co-factors.
So there is copper and
B6 among others for DAO.
And I think there's zinc
and B6 for HNMT among others.
So nutrient deficiencies will contribute
to kind of your histamine bucket, your
histamine threshold and how much you're
dealing with there as well.
Now DAO can be deteriorated with any
damage to the gut lining because that's
its primary place of origin, so to speak.
So when you do have intestinal
permeability, AKA leaky guts or gut
information, it's very likely that DAO
has been compromised as well.
And then MCAS is kind of further down the
spectrum again of severity ultimately.
So you have histamine intolerance, which
is often more of a DAO dietary thing,
moving down to MCAS, where now you've got
a multi-system, multi-factorial condition
that can be
incredibly complex ultimately.
But we still want to be thinking about
what is the trigger.
And that could be the things that we have
been talking about, infections, toxins,
trauma, and these sorts of things.
Yeah, no, that was beautifully put.
Thank you.
And it just it really sort of highlights
the fact that these mast cell issues,
these histamine issues are a symptom of a
bigger issue than not the issue in
themselves, which again, I think is what
where a lot of people sort of scrolling
through social media sort of tend to sort
of maybe make a mistake, they sort of see
their issue as a histamine issue.
The histamine is a symptom of something
else that's going on.
And just by maybe just taking your
chromoly and quercetin or whatever, you
aren't actually, maybe you're controlling
some of the symptoms, but you're not
actually dealing with the picture.
It's definitely a very sort of, I don't
want to say reductionist because that has
a lot of negative connotations.
But I think, yeah, it's just sort of
cherry picking one specific
pathway or one specific issue.
And then sort of saying, okay, right,
that's my issue and then
sort of ignoring the rest.
The enzyme that you were thinking about,
by the way, was histamine
N-methyltransferase, I believe.
Thank you.
I could be wrong.
I've been going through my genetics a
little bit, trying to sort of remember
some of what I learnt in
uni, which was a long time ago.
But anyway, but yeah, I think histamine,
it definitely is an issue for a lot of
people, especially as you alluded to, it
can be triggered by so many things.
And people who are trying to maybe do the
right thing by detoxing are oftentimes
going to sort of run into this issue of
excess histamine release.
People getting into a sauna for too long,
because that's great maybe for helping to
liberate some heavy metals, that's great.
But heat is going to drive up histamine
release or a woman who sort of maybe jump
onto HRT because they think that this is
their solution and then all of a sudden
they're taking more estrogen and that's
going to sort of drive
up histamine release.
So yeah, it really is an
issue for so many people.
And the fact that yeah, it's, and I think
that's again where COVID is a bit of a
silver lining, because it's just brought
this to the forefront, especially when
you start looking through the lens,
through the lens of long COVID.
Now I'm sure we could
discuss that all day.
And
yeah, I had a lovely podcast with Dr.
Tina Moore, I'm sure
you're familiar with.
Yes.
For anyone who is listening who wants to
dive down the histamine rabbit hole, I
highly encourage you to listen to that
podcast that we did or
any podcast that she's done.
She's done a number of
podcasts recently, including Dr.
John something.
Yeah, that escaped me out.
We'll link it in the show notes, but
she's an excellent source thereof.
Let's discuss the mitochondrial piece.
CDO, again, we've done a deep dive into
this, but from a high level, I think it's
important to know why mitochondria sort
of break and then maybe we'll discuss
what we can do about it a little later on
in the episode when we start to put
together this
framework for folks to follow.
But from your vantage point anyway, how
do you see
mitochondrial dysfunction occurring?
And then where do you see this idea of
the cell danger response fitting in?
So on mitochondria, I read recently, the
canaries in the coal mine
from a cellular perspective.
So as many of us as your listeners would
have probably heard, they're an ancient
bacteria that sort of co-evolved with an
archaea, I think it was, wasn't it?
Millions and millions of years ago.
So this is why there's the antibiotic
piece with mitochondria.
But mitochondria are not just the
powerhouses of the cell
that often we hear them being.
They are that, but they are so much more.
I mean, they regulate calcium sort of
regulation and they have many other roles
in including relation to the production
of steroid hormones,
cholesterol, among other things as well.
But mitochondrial dysfunction, you know,
the textbook thing is the manifestation
is most likely going to be among other
things, fatigue because of their role,
obviously, in energy production.
But mitochondria can be damaged.
We can develop mitochondrial dysfunction
because of nutrient deficiencies, because
of dysbiosis and leaky gut, you know,
these lipopolysaccharides or endotoxins
can have an impact on mitochondrial
function, apparently.
Butrate, you know, a metabolite, healthy,
good, important metabolite from some of
our gut bacteria
supports mitochondrial function.
We've got xenobiotics and various
environmental chemicals that can inhibit
mitochondrial function.
What else have we got that impacts
mitochondrial function?
I mean, all of the typical things,
inflammation, mycotoxins, they're all
going to be impacting it ultimately.
So again, mitochondrial dysfunction,
there's this kind of camp that think
mitochondrial dysfunction is, you know,
the cure, you know, the cause of
everything and therefore the cure.
Because if you can get healthy
mitochondria, you can get a healthy cell.
And if you have a healthy
cell, you have a healthy organ.
If you have a healthy
organ, you have a healthy system.
If you have a healthy system,
you have a healthy organism.
But as you kind of said, Robert, you
know, mitochondrial dysfunction is
downstream of these sorts of things.
And therefore, we still have to
constantly ask the why until we feel
we've actually got to the answer,
ultimately, like what is the most
upstream thing we can get to?
And that is the thing that
we probably need to focus on.
So is it nutrients?
It could be the guts from a
mitochondrial perspective.
Is it some kind of
environmental chemical or toxin?
Is it trauma?
There's a study that was looking at
adverse childhood events.
And, you know, it's been a long time
since I read it, but the takeaway was
ultimately that it can contribute to
reduced ATP
production within mitochondria.
So one of the sort of almost mechanisms
between early childhood trauma and
diseases later in life could be related
to mitochondria dysfunction.
And essentially, that person just being
less resilient as a result on
a physical level, so to speak.
And then obviously, mitochondria
dysfunction, you would have thought, will
manifest in certain organs first the most
energy dependent organs.
So hearts, liver, kidneys, gut lining.
And we've already mentioned how
mitochondria have a big role to play
within maintaining a healthy gut
microbiome and a healthy gut lining.
So again, are you is the glutamine and
zinc carnosine really going to fix the
leaky gut if there's some mitochondrial
dysfunction, which is
actually upstream of that?
So yeah, I think mitochondria are really
important piece of the puzzle, but it's
just important that we don't do what you
were saying, Robert, which is, you know,
along the lines of take your quercetin
and think that you've kind
of dealt with it ultimately.
So don't take your CoQ10 or whatever it
may be and think that
you've dealt with it.
And within the cell danger response, you
know, one of the many changes that
happens is the cell membrane
obviously becomes more rigid.
So the cell membrane, I always remember
one of my lecturers and the masters kind
of really emphasizing the cell membrane.
It is the brain of the cell.
The cell membrane is so important for
cellular function,
and this becomes rigid.
So less good stuff gets in, less bad
stuff gets out, and it's going into that
sort of hibernation or
locked down state to survive.
And that's where I guess, you know,
things like your phospholipid replacement
therapy type protocols have some value
and some people respond well to.
So yeah, I'll pause there.
No, again, that was that was perfect.
Thank you very much.
And again, it just sort of points to the
fact that just dealing with the basics,
which I know we'll touch on a bit getting
in your essential nutrients, it is so
important and almost taking this sort of
orthomolecular approach, maybe as a first
stop is probably for the most part the
best place to start for a lot of people.
However, we'll get to that in a bit.
I'd love it if we could also just quickly
sort of backtrack slightly and then talk
a little more about the nervous system
again, but this time from the standpoint
of the vagus nerve, because I think, I
mean, this is quite a trigger, but it's
also oftentimes a downstream result of a
lot of this dysfunction.
And there's a lot of chicken and egg
going on with the vagus nerve, and the
more the vagus nerve gets more
dysregulation that happens
with regards to the vagus nerve,
the more oftentimes an individual is
going to end up in a sort of
sympathetically dominant state, which
actually is going to sort of then trigger
that some of at least,
yeah, some of the CDR type stuff, some of
this mitochondrial dysfunction as well,
just by way of increasing the release of
catecholamines, all
these stress hormones.
Now, there's a lot to be said about the
vagus nerve, especially around polyvagal
theory, which I believe I'm right in
saying it, you're fairly well-read and
definitely more so than I am.
Can we have a quick discussion about that
and where that fits into the picture?
Yeah, it's been a while since I've talked
about this, so feel free
to jump in and help me here.
But, you know, the vagus nerve obviously,
in Latin, I think it's wandering, so most
people can picture like the roots of a
tree, you've got branches of this nerve
innovating all the
different organs in the body.
And the polyvagal theory put really
simply is this idea that there is a
hierarchy to the vagus nerve.
And we have, let's think about this, we
have the ventral vagal and the dorsal
vagal, which are parts of this kind of
hierarchy, ultimately.
And I think the ventral vagal, correct me
if I'm wrong here, Robert, but the
ventral vagal is kind of the social
safety component of this, and the dorsal
vagal is kind of the shutdown ultimately.
And we can definitely see people who have
gone down into this kind of shutdown
vagus nerve response.
You know, you could almost think about it
as the freeze or this
hibernation type state, ultimately.
And the key theme with the pole polyvagal
theory from my perspective, again,
keeping this quite high level is the
theme around safety.
If we don't feel safe, we can see a shift
in vagus nerve, and that's obviously
going to manifest from a behavioral
perspective, but also
from a cellular perspective.
And there's this really, I think,
sensitive sort of topic around, you know,
a lot of people struggling with chronic
complex illnesses retreat for various
reasons, both just because of the
debilitating nature of the symptoms, but
also because sometimes the comments they
receive from friends or family, you look
fine, these sorts of things.
And, you know, they feel, you know, gut
stuff bloated, who wants to go out and
have fun and socialize when you feel
really bloated, for example.
So there's lots of
different things that come into it.
The problem is, we all know now know the
importance of our social
lives in regards to healing.
So there's this kind of really sensitive
conversation sometimes that has to be had
around balancing the retreat, which
totally makes sense and is understandable
with actually engaging in life as a way
to support the healing process as well.
And that's where I think, you know, the
polyvagal theory can be really helpful
with this theme around safety and
understanding where
someone is at within it.
I know people that specialize in this
will even talk about, dependent on where
you are within that hierarchy, that will
very much influence the most appropriate
form of exercise for you, for example.
So it can be very helpful
on a clinical level as well.
So, yes, that's kind of
what comes to mind immediately.
That's perfect.
Thank you.
And again, it just sort of really works
to complete that picture of everything
that we've discussed up until now.
And again, just to sort of hop on about
this again, I really encourage the
audience to sort of look at their
emotional health when it comes to sort of
starting to try and work your way through
these sorts of issues
because it really cannot be,
and what's the word, it can't be sort of
downplayed as to its importance, how
important the nervous system is in
regulating the wrist, the body, in
regulating how cells communicate.
Yeah, and just to touch on that, you
know, maybe branched with that is the
whole concept of psychoneuroimmunology,
you know, the mind, the nervous system
and the immune system.
These are deeply interconnected systems.
So we absolutely have to be thinking
about our psyche when we're thinking
about the states of our nervous system
and our immune system.
And we all know the immune system is so
interconnected with everything that we're
kind of talking about here.
So if you wanted like the science,
polyvagal theory, yes, but also this
psycho neuroimmunology is
a really fascinating area.
So, you know, it's little practices,
giving yourself 10 minutes a day, find
yourself a little grounding exercise that
could just be coming to the breath and
doing some diaphragmatic breathing, feel
your feet on the floor, feel your
buttocks on the chair, kind of get
grounded, get censored as much as you
can, and do a little bit of journaling,
find some prompts, even if it's using
chat GPT, to ask for
some journaling prompts.
Like there's lots of ways that we could
go about that now, but I think it's so
helpful because, you know, it's going to
be arguably, I think for a lot of us, you
know, the safest environment.
We're on our own, we're journaling, no
one's going to read it, hear
it, we can burn it afterwards.
And that can be quite a therapeutic sort
of ritual to do as well, where you're
literally kind of releasing that back
into sort of the atmosphere ultimately.
But I think those little habits where
there's a bit of self-inquiry can be
incredibly helpful to help us understand
ourselves, which is part of I think the
healing process ultimately.
Yeah, no, it definitely is.
And I love the fact that you touched on
the psychoneuroimmunology.
Dr.
Leo Primrook is an absolute wizard.
And I've got a friend who's going through
his course at the moment, and she's
shared her notes with me.
I won't mention her in case she gets,
somebody's listening.
But yeah, no, I've been going through
some of the coursework.
And it's, yeah, no, it's everything that
you've just described.
He really sort of gets
this properly nailed down.
And anyone who really, really wants to
deep dive into this side of it, you
definitely have a look at
his, what he posts online.
Alex, I reckon we've got
the basics covered there.
I mean, we've only just scratched the tip
of the iceberg when it
comes to all the potential
immunological side of things, not to
mention the cut side of things, etc.
But for the sake of time and your sanity,
I'd love to sort of maybe pivot towards
talking about how people can really start
to deal with these sorts of issues, at
least at a high level.
And I'd love it if we could sort of
create just again, broadly speaking, a
framework that people
can start to follow.
Again, I know we could go in many
directions with this.
And we can't get that granular because,
as you've alluded to, I mean, there's
something like the gut, for example, I
mean, you can have, there's three
different types of SIBO, for example,
each of which could have
10 different inventions.
So, yeah, I know we can't help anyone,
everyone with this sort of framework, but
just a way to sort of view it, which I
think would be helpful.
And then maybe if time allows, we can
start talking about some more esoteric
ideas like H-Bot and LDN, etc.
I think obviously the best place to start
off with here would be with obviously the
boring, the lifestyle, the diet piece.
And then maybe we can sort of pivot into
helping people maybe
identify their trigger.
I think we've already done that to some
extent, but maybe we can
touch on that again too.
And then different strategies to help
maybe start to reduce that toxic load to
support the adrenals.
I know that's a bit hidden-ness.
And then, yeah, to support the nervous
system, we've discussed that a lot.
And I think some
strategies there would be useful.
And then finally, things like just basic
hormonal and mitochondrial support.
Again, I think we've, yeah, and this will
come through obviously in our
conversation, but I just want to point
out to the audience that really you do
want to sort of follow a framework in
this respect, because just going back to
our conversation earlier about
mitochondrial dysfunction,
chances are if you have any sort of
lingering fatigue, there's going to be an
element of
mitochondrial dysfunction to it.
However, if you suddenly start taking
mitochondrial support, supplements,
nutrients, co-cutin, carnitine, all these
sorts of particular, these electron
donors for the most part, you can
sometimes make things worse.
One of the byproducts of, as you know,
Alex, energy production, oxidative
phosphorylation is the production of
reaction of oxygen species, ROS, at the
end of that particular cycle.
And if you're going to feed the body
large amounts of these electron donors
and antioxidants, well, they are
secondary antioxidants, some of them, you
can actually make matters worse.
So yeah, there really, again, is an order
of operations to this where, so I think
having this system in place would be, for
those listening, quite beneficial.
So again, unless I missed anything, and
please feel free to correct me on
anything that I've said that's wrong,
which is probably quite high,
I think we should jump into the lifestyle
and the diet piece, which
is a good place to start.
Broadly speaking, where would you have
someone start with regards to this?
Yeah, so I guess from a dietary
perspective, like if I had to, if I had
to give like a generic comment around it,
it would essentially be moving people
towards a paleo style framework, I think,
you know, moderate, moderate high
protein, moderate high
fat, low carb framework.
And I think a lot of
people will benefit from that.
I wouldn't go all the way to keto,
obviously, because that can be, again,
that can go wrong, especially when
there's mitochondrial
dysfunction at play.
So we'd want carbs in there, but
certainly a paleo style framework is
probably the easiest, quickest way of
describing what is going to be
beneficial, I think, for
more, the majority of people.
Now, ideally, you know, in season, whole
food, I actually don't think it without
the context of an individual, it needs to
be over complicated.
So whole food diets, nutrient dense, lots
of polyphenols, lots of color, this idea
of eat the rainbow a day if you can.
Now, oftentimes, people are going to have
personal reactions to foods.
And the caveat here is I do think, you
know, there's a moderate percentage of
people that could have a
bit of a histamine issue.
So, you know, FYI, you might need to go
more to a low histamine diet
within that framework as well.
So it can start to sound much more
complicated and have more nuance to it.
Once we know about the individual and
their unique sensitivities.
But yes, I do think, you know, a high
protein, high fat sort of breakfast for
many people works well.
And then really thinking about in season
and whole food, and I'm not sure it needs
to be more complicated without specific
knowledge of the individual, ultimately.
Certainly in fibromyalgia, there are
studies and I think a meta analysis that
basically concluded every single diet
that has been trialed has
been beneficial for some.
So whether that's paleo Mediterranean,
low FODMAP, low histamine, vegan, you
know, there are people that benefit it.
So that I find quite interesting as well.
Now, fibromyalgia, obviously a different
entity, but there is an overlap there.
So it's something that I think, although
I sit here as, you know, a nutritional
therapist, primarily nutrition for me is
actually one of the smaller pieces that
we probably need to like
investigate and acquire around.
And if it's whole food in season,
nutrient dense, you're kind of ticking
the big boxes without then personalizing
it to the individual needs.
Yeah, that was perfect.
Just a quick question regarding the
elimination side of things.
And I know that might be getting slightly
into the weeds, but I think for a lot of
people that is quite doable, if you are
indeed still getting a lot of flare ups
when you're just following this very sort
of, yeah, this elemental paleo approach.
I often sort of suggest that for a short
period of time, that people really do
have sort of a lot of food restrictions
or a lot of flare ups that they take the
easiest approach and if they're open to
it, maybe follow something like a
carnivore diet for a short period of
time, and then sort of reverse engineer
it and then slowly reintroduce foods that
they can handle that aren't necessarily
triggering the
reactions that they're having.
And I suppose I really recommend that
because a carnivore diet is basically the
ultimate elimination diet and it takes
care of FOBMAPs, takes care of histamine
as long as obviously your meat's not
sitting in the fridge for three weeks.
And it takes care of a lot.
So you can then start to reintroduce
things like dairy and see if this
actually is an issue for you or not.
I mean, obviously there are multiple
things in dairy that could be triggering.
Do you think utilizing something like
that, if following a whole foods approach
doesn't work as an option?
The way that I've said it for a while is
I think the sort of the extremity is the
word I'm looking for, if that is a word,
extremity of the diet needs to correlate.
Well, one way to look at this is the
extremity of the diet needs to correlate
with the extremity of the symptoms.
So if someone is really struggling and
they're saying, "Alex, I'm just reacting
to everything ultimately,"
then that would be the only time to start
considering it, I think.
And again, it's a tricky one because
there are some people that can have
life-changing
experiences going on carnivore.
And there are people that have never been
right since going on carnivore or have
been worse since going on carnivore.
So I think it's really important to
appreciate whenever you're doing an
extreme intervention, you have higher
risks attached to it.
And if you're already fragile on a
physiological level, I sometimes wonder
whether actually you are more susceptible
to having a negative reaction to an
extreme intervention.
So it's something that I'm open to.
And obviously all of these things, the
client is the one deciding
how they want to proceed.
So if symptoms are severe enough, then it
could be something that you trial.
And maybe it's a trial for a week before
you start reintroducing things.
It doesn't have to be a long time when
you're doing something that extreme.
And in the research, although they don't
go as far as talking about carnivore,
what they do talk about with elimination
diets is the two
different ways of going about it.
And your personality can dictate which
one's most appropriate for you.
And this is common sense.
You can take one food out
at a time and do it that way.
Or you can go and do...
They have different names for these, but
a 12 food elimination diet or a six food
elimination diet or a
three food elimination diet.
And so you can go all the way and that
you say with
carnivore, come back from there.
And that's just a personal preference
type thing that's going to be based
probably on how much someone is suffering
at the end of the day.
Yeah, those are great words.
And I think another great resource while
you're talking, I just sprung to mind and
I should have mentioned earlier was the
autoimmune paleo diet, I
believe by Mickey Trescott.
I think that's a bit of an
original text in this space.
And that's probably also a good starting
point for a lot of people to follow if
they find that they are reacting to the
sort of traditional paleo,
maybe lower carb approach.
And yeah, as you said, I think that's a
great place to start and that it
shouldn't really be over
complicated unnecessarily.
That's perfect.
Okay, so beyond dietary interventions,
we've got the basic movement, sunlight,
sleep.
Now, obviously, I think anyone who is in
the space and is listening to these sorts
of podcasts trying to find resolution is,
it is likely familiar with the importance
of grounding, of getting outdoors, of
getting natural sunlight to help restore
the circadian rhythm.
Sleep, I think is something that people,
that sounds intuitive and people would,
they understand that
they need to get more of it.
But I think there are a few nuances there
that people really need
to dig into a little more.
And maybe that sounds a bit prescriptive,
it wasn't meant to be.
But I think that when you think about
sleep, you've got to also think about
what makes sleep
healthy, what makes sleep good.
And in that respect, things like healthy
airways, being able to breathe nasally
properly at night is important, as well
as making sure that your sleep
environment is on point.
I think those are two things that people,
yeah, folks listening should be aware of.
And in that regard, I think that the use
of nasal strips can help from a
congestion standpoint.
Definitely just open up those airways and
allow some more sympathetic,
parasympathetic
activity to occur during sleep.
I think that's an easy, sort of easily
accessible tool for
most people to utilize.
And then also making sure that your sleep
environment is on point.
So maybe turning off the Wi-Fi router,
making sure that it is as little out in
the room as possible.
I think those are both easy strategies
that people can utilize to ensure that
they're getting the best possible sleep.
Would you add anything into that?
And what do you think of the
Wi-Fi piece, the EMF piece?
Nothing that I'd really add, apart from
just acknowledging that inflammation or
microbiome, histamine, these things
impact sleep quality.
So I think a lot of the time with these
sorts of individuals dealing with MCAS,
CFS, et cetera, their poor sleep is
often, again, a symptom downstream.
And there's things that are interrupting
that sleep quality and that sleep cycle.
And histamine can be so neurostimulatory.
I mean, I've had terrible
histamine issues in the past.
And one of the primary symptoms was
insomnia, basically.
And it was this weird state of the mind
being so switched on, but
physically feeling very tired.
So it can be really problematic.
But yes, the foundations
still have to be in place.
You still need the sleep hygiene.
You still want to be thinking about your
breathing patterns and
these sorts of things.
But if you're still struggling, it's not
because you need to do more around the
sleep hygiene in your environment.
It's that there's
something else, obviously, at play.
And then your other parts of this was?
Yeah, we talked about sunlight exposure
and the movement ground
movements.
So yeah, movement is
going to be very personal.
And I know this is a bit of a heated
topic within the
space for obvious reasons.
But I think it's a
matter of doing what you can.
And I do think it's about understanding
to the best of your
ability what your capacity is.
And sometimes you might overheat that.
And then there's going to be a little bit
of a flare or relapse.
But I really like the idea of there's got
to be something no matter what, almost no
matter what, there's got to be something
even if that's getting yourself a can of
baked beans and doing a bicep curl in
bed, because there's
the intention behind it.
And there's the mindset behind it, which
I think is actually really important and
powerful in its own right.
So I have an old client who
always comes to mind to you.
She just started with one repetition of
five different exercises.
And it was either with a dumb, small,
tiny dumbbells that she bought, it was a
bodyweight squat, for example, one
bodyweight squat a day.
And that went to two,
and then it went to three.
And she just very slowly built it up.
Because there's this fine balance, I
think, between like, when you do nothing,
and you're getting more and more D
conditions, then it starts to obviously
compound your overall
health state ultimately.
So we want to try and maintain whatever
we can, if not improve upon it.
And I think that's such
an important piece of this.
But again, without knowing where someone
is within the spectrum, you know, it's
hard to be able to give any specificity.
Yeah, just with regard to that, and thank
you for bringing it
up, I do glean over it.
What do you think about,
I don't want to use the term exercise
mimetics, but technologies like PEMF, to
maybe support that process to maybe help
from an oxygenation
standpoint within the body?
Yeah, it's not something I've looked into
a huge amount, I must
say, but I do know that Dr.
Terry Walls did some of this stuff with
her kind of journey
with multiple sclerosis.
So yeah, that came to mind.
And obviously, she has some incredible
results with everything that
she did, and there was a lot.
But yeah, I think there is value for
people that are really struggling to, you
know, to move into exercise because of
the nature of their health.
Yeah, no, it's, it's definitely a big
one, especially where there is that sort
of post-exertional malaise that happens
that sort of post those issues with
recovering from exercise when people
really are struggling.
But yeah, it is important just from a
sort of an ability to keep those
mitochondria taking over to help with
lymphatic flow, lymphatic flow, etc.
Okay, so I think the next sort of logical
sort of step in this would be to sort of
talk about the gut, and we could probably
tie in detoxification that in that, in
that as well, just
from a time perspective.
But how do you generally approach that?
So yeah, it's a good question.
It's an important point, because
obviously another foundational piece
that, you know, is one of the first
things that we need to be considering is
a daily bowel movement.
You know, people need to be pooping at
least once a day, it should be easy to
pass, well-formed, sausage-like,
shouldn't be any pain.
And that's, you know,
becoming rarer and rarer, ultimately.
But from a detox perspective, but also as
the best biomarker of your gut health, an
easy to pass, well-formed stool is, you
know, that's the goal, that's what we're
all looking for for
gut health, ultimately.
So I would worry less about those one,
two, three bacteria in your stool test
that are out of the reference range and
focus much more on, do
you have any bloating?
Do you have much flatulence?
And how is your bowel movement?
If those are all good, then,
you know, that's good enough.
And then you can move on to the next
piece of the puzzle, ultimately.
But yeah, with chronic fatigue syndrome,
ME, we definitely do need to sometimes be
thinking about SIBO.
We do need to be thinking about
overgrowth infections within
the large intestine as well.
And an interesting one with SIBO or EMO,
as it's now called intestinal methanogen
overgrowth, rather
than kind of methane SIBO,
is there is a little bit of research that
discusses this being an
adaptive response again.
So exogenous methane, given by IV, has
been shown to have anti-inflammatory
antioxidant properties.
So there's this kind of working theory,
which is actually, if you're, if you're
methanobrevibacter or methanogens are
producing more methane, could that be an
adaptive response because methane has
anti-inflammatory antioxidant properties,
and actually your redox is really poor
and you need those things.
There's also some research that is now
showing us that our own cells have the
capacity to produce methane, and all
cells have the
capacity to produce methane.
And therefore, what we're seeing on a
breath test for SIBO, when methane is
elevated, the research at the moment says
the majority is probably from methanogens
in your gut, but a subset, it could
absolutely be coming from mitochondria,
cellular production.
And therefore, is there this kind of
adaptive response and the collateral
damage for some people is constipation,
but not everyone with positive methane
tests is constipated either, which kind
of again shows you just the
gray nature of the human body.
So yes, you know, you've got these things
that have to be considered.
Now, you're going to
suspect SIBO if there is bloating.
If you don't have any bloating, you just
don't have SIBO in my opinion, and
there's no point doing the test.
And if you did the test for some reason,
and you didn't have any bloating, and the
test was positive, I would argue that's a
false positive test, because the whole
premise of SIBO is excess gas production.
And therefore, you kind of have to have
bloating and excessive flatulence or
belching, because that's the main route
that that gas is going to
come out of you ultimately.
So that's kind of an easy one to
consider, you know, do I need to go down
the SIBO rabbit hole at all?
If you don't have bloating, probably not.
If you do have bloating, do you need to
go down the SIBO rabbit hole?
Maybe to some degree, but and I say that
because there are people that go down the
SIBO rabbit hole and stay down the rabbit
hole for two years trying to kill, kill,
kill, kill, kill the sober growth, when
actually it could be nervous system
dysregulation as an actual root cause to
why they've got SIBO.
Or actually they need to do much more
around motility and transit through the
stomach and small intestine.
And they just have an
undiagnosed upper GI condition maybe.
So yeah, the guts are really, really
complex one, but there's definitely a
strong connection between
the guts and energy production.
Partly obviously common sense, we digest
and absorb our nutrients there.
And therefore, if you're not doing that
very well, you're not getting those
nutrients to the
mitochondria to produce your energy.
So it is kind of the bread and butter
from a nutrient status perspective.
And then you've got 70 ish percent of
your immune system in the gut.
And therefore, when we think of immune
modulation and inflammation, we were
thinking partly about gut health and the
role that that's playing in
managing your inflammatory loads.
You've got neurotransmitters that
influencing things, you've got the gut
brain access that is going to be
massively involved in
some of these things.
So it's definitely a foundational piece.
The million dollar question is how much
is the gut driving other stuff?
And how much is that other
stuff driving the gut stuff?
Yeah, I was going to ask what your
thoughts are on the idea that everybody
who is ill has some
sort of GI dysfunction.
I think there's real truth to that.
And that's why a
multi-pronged approach is needed.
And again, it's not going into the whole
black and white either or debate.
It's like, well, we want to support the
gut, but we don't want to throw the
kitchen sink in the guts.
And we want to support the other stuff,
potentially simultaneously in some shape
or form, because that's how we're going
to be able to shift that physiological
state back into a
healthier equilibrium, as it were.
So it's kind of, again, multiple inputs
to nudge physiology back
to where it needs to be.
And there are two ways of doing that.
I guess one would be doing something more
gut focused and doing that, but doing it
for let's just say six, eight weeks, and
then moving on to the next phase of your
plan or taking more of a multi-pronged
approach where you're doing a bit of gut
and a bit of whatever else it might be
liver or mitochondria,
et cetera, et cetera.
So I don't think
there's a right or a wrong.
It's just, it's building the most logical
rationale for the protocol.
Yeah, that was very well put.
Just a quick question.
What are your thoughts on single dose,
the use of high single, excuse me, the
use of single nutrients and high doses,
things like thiamine.
Have you found those to be effective,
especially from a gut perspective?
Yeah, it's actually something I've only
just started sort of doing clinically.
I had Elliot Oberton on the podcast, so
I've become more and more aware of he's
doing amazing stuff, kind of getting that
information out there.
So yeah, and you look at some of the,
just the comments on his YouTube page and
all these sorts of things.
And there are lots of people that have
had wonderful improvements and healings
through doing this for gut health or
fibro and other conditions as well.
So it's definitely a legitimate option.
I think the thing that's, if I mean,
totally honest, that's kind of held me
back with it is there's no
way of knowing when to do it.
So it feels a bit like we're just going
to try this thing because we don't really
know what else to do.
It isn't like we can go and do a test.
It's like, oh, you are a
really good candidate for this.
It's almost like, well, we've tried these
things, they haven't worked.
Should we give this a go?
And there's not
necessarily anything wrong with that.
But obviously, it doesn't, it just feels
a bit like, as a practitioner trying to
be a bit more precise about things,
you know, you can just go and get some B1
and try it out and see kind of thing.
But that's the only way that we can
really do it at the end of the day.
Yeah, again, that was a great answer.
And Tony, you mentioned your podcast,
because I interviewed Elliot on the back
end of that one actually.
So it was, yeah, I like to think that if
somebody's going to trials Hido Simon for
a GI issue, it's probably the other point
that they should take into consideration
is the nervous system standpoint, the
nervous system piece.
I think if there is some level of
autonomic nervous system dysregulation, I
think Simon can be a needle mover.
I know we've found that with regards to
recommending Benfertiamine to customers
who have a lot of, I don't want to use
the word trauma, but emotional
dysregulation, when they sort of hit that
sort of north of a gram of Benfertiamine,
it doesn't happen all the time.
But just now and again, I will find that
someone sort of writes back and they'll
say, you know what, I've taken
Benfertiamine at the suggested doses and
all of a sudden, the anxiety sort of
dropped off the map and the
bowel issues have improved.
But yeah, as you've alluded to, well, not
alluded to, said, it's really hard to
sort of from a diagnostic standpoint,
sort of, okay, well, we're going to try
this intervention because data, it's
still sort of yet to be elucidated, I
think, when that intervention is maybe
best placed in a protocol.
I think, yeah, it's looking to start to
wrap up, but I think it would be great if
we could sort of also talk about the
detoxification side of things.
Are you one who feels that active
detoxification strategies are a good
idea, or do you sort of work off the
premise that if someone is struggling
with some sort of, yeah, fibro, ME, CFS,
that they should get the basics in place
and then work off the assumption that the
detox processes in the body,
glucuronidation, sulfation, etc., will
then start to naturally and come back
online and improve and the body will then
start to detox
whatever's in the badder fault.
Yeah, I think more the latter,
ultimately, like it's not that we
wouldn't do any sort of direct detox
support, but I certainly wouldn't be
putting any kind of
extensive detox protocol together.
You know, we start with elimination, so
hydration, pooing daily, we think about
the microbiome, we think about adequate
fiber intake, and we think
about it from that perspective.
And you know, there are studies showing
that as you increase fiber intake, there
is an increase in excretion of certain
heavy metals, for example.
So there is that kind of
binding capacity there.
And detox, you know, there's even a
paper, I can't remember who wrote it now,
but I mean, they basically said detox is
lifestyle, you know, it's not a protocol,
so it's a lifestyle.
So your movements, your breathing, your
hydration, your diet, if you can get
access to a sauna, wonderful.
Can you do some sort of lymphatic work,
whether that's dry
brushing or seeing a therapist?
You know, yes, there are key nutrients.
So most of them, ultimately, are really
important at some phase within
detoxification, your B vitamins, all of
the antioxidants, amino
acids are all important.
And then that takes us back to gut
health, just from a
digestive capacity perspective.
We've got to think
about the biliary system.
So I do use bitters a lot
with kind of the exceptions.
What I said at the beginning, by the way,
it's kind of, if I'm working with like a
mold client, like glutathione, it's the
bread and butter of kind of
detoxing some of this stuff.
So I use liposomal
glutathione a lot with clients.
I need to send you some of Dr.
Andrew Campbell's research
on glutathione and gliotoxin.
He's on the impression
that if you increase,
that if you provide glutathione, when
there's a high gliotoxin alone, you can
actually sort of impair that
immunological mismatch, so sort of from
M1 to M2 macrophage movement within the
brain and actually
increase neural inflammation.
Just his research.
I'll send you some research there.
But yeah, just an aside.
Yeah.
So yeah, we'd be supporting that.
And I think the biliary system is a
really, I think it's a really common area
that people need some support around.
So, you know, thinking of bitters, for
example, as ways to support that,
phosphatidylcholine is kind of trending
at the moment, I
think, ultimately as well.
But yeah, I do think really kind of
working on those foundations, getting the
nervous system in a more regulated state,
all of those things are
going to improve detox capacity.
And then it's a matter of, you know,
patients, ultimately.
So that's kind of definitely more the
approach that I would
take, I think, from it.
Okay, perfect.
And then last question for the day.
The hormonal thyroid
adrenal side of things.
Where do you stand on that?
Do you think that those sorts of
interventions are useful off the bat?
And by adrenal, I'm talking specifically
about things like adaptogenic herbs, etc.
Or do you just get the basic sort of
nutrients into place, your
B6s, B5s, magnesium, etc.
I think the basics always
need to be the priority.
I do use adaptogens with some clients.
And I think that sometimes
people just really want them.
So it's kind of like, it's providing that
support as well, ultimately.
I want a client at the moment who is just
benefiting from ashil gandha so much.
So she's just like the biggest
cheerleader for ashil
gandha, for example.
So I think they do
absolutely have a place.
You know, there's some interesting
research, ashil gandha
and sleep, for example.
So they can be helpful, I think, right
time, right place, and
something I definitely use.
But again, I think, oftentimes, I really
like the idea that the human body is a
self-organising, self-healing organism
given the right environment.
If we can improve that environment, then
there is that kind of positive snowball
effect that takes place.
So it's really focusing on that
environment, which is kind of, you know,
a lot of what we've
been talking about today.
Obviously, everything from the diets, the
air you breathe, thinking about the
quality of your home in the building, and
whether there's any damp issues, etc.
So yes, you know, and then the
supplements from those sort of
perspectives are of kind
of the cherry on the top.
Yeah, definitely.
And obviously, being a nutritional
therapist, you are not going to sort of
get involved in the
hormonal side directly.
But do you ever find that sort of maybe
suggesting or somebody sees a medical
doctor for hormonal support?
Is that ever effective, as you find?
Yeah, I think sometimes it really can be,
you know, I think it's, it's, I'm not
sure I could tell you when I feel it's
going to be most
valuable or an important step.
But I definitely have had clients over
the years whereby they
found it incredibly helpful.
So yeah, context is always going to
matter there from that perspective.
And again, you know, I think thyroid
adrenal stuff is
downstream of, of other stuff.
And therefore, how good a job have we
done of exploring that and intervening
appropriately on those things.
But that's it, you know, they are
absolutely downstream of other things.
And therefore, that comprehensive
evaluation becomes just so important.
So yeah, you know, it takes us back to
really that functional medicine matrix
and systems biology and understanding how
all of these things are interconnected,
and how all of these things are
bi-directionally interconnected.
Definitely.
I couldn't have thought
of a better place to end.
And with, yeah, thank you
so much to your patients.
Thank you so much to your time.
You've had to put up with
me for the last two hours.
So that's, that's no
mean feat in and of itself.
So thank you.
Alex, where can people find you should
they wish to work with you if they are
struggling with these sorts of issues and
have sort of on the ground?
Yeah, my website is just alexmanos.co.uk.
My Instagram handle that I'm not
massively active on these
days, but is alexandamanos.
And yeah, either of those two are really
the best places to find me.
Yeah.
And for those listening, Alex has a great
podcast slash YouTube channel.
That's definitely worth visiting.
If you are, yeah, if you're interested in
more of what he does, as I mentioned
earlier, I found his podcast with Elliot
there too, and it was
definitely insightful.
So again, thank you for the time, Alex.
And yeah, it was great to chat to you.
Likewise. Thank you,