Thanks so much Cort for your pertinent questions, and Rich, thanks a lot for your so detailed and comprehensive replies!
I look forward to read Dr. Howard's response to Vermeulen paper, if this finally happens!
Rich, let me take the advantage to ask you something, a bit off-topic:
As I have told you a few times in the past, it seems incredible to me that a theory so well designed and built (GD-MCB theory), that is able to incorporate almost everything --even the new discoveries!--, from a Hg poisoning to a retrovirus infection in order to explain CFS, is not giving the expected results when brought to practice...On paper it is utterly brilliant, so, what occurs in practice?
Which are in your opinion the most feasible "pitfalls" where the body is not able to recover and repair on its own, as it should do in theory?
From your scientific and very knowledgeable perspective on CFS, do you think we can be missing some essential things to decipher the CFS puzzle, or could it be more a matter of finding the right order for the known pieces?
Thanks in advance and best wishes,
Sergio
Hi, Sergio.
Thank you for your kind comments. With regard to why treatment based on this hypothesis does not bring all PWCs to full recovery, let me start with what I wrote last July. which you probably already read:
"About two-thirds of the people report that the treatment gives them significant benefit, but only a few have been brought to what seems like full recovery from it.
"About a third of the people have reported either that they could not tolerate the treatments, or that they have not experienced any benefit from them.
"Among those who have not been able to tolerate the treatments, it appears that excitotoxicity has been one of the main problems. This leads to insomnia, anxiety, hypersensitivity of the senses, and a constantly "wired" feeling.
"In recent months I have been trying to understand how to improve this situation, and I want to share some more thoughts on that.
"First, for the people who can tolerate the treatments but do not experience benefits from them, I suspect that the likely causes are that the methylation cycle and related pathways do not have all the nutrients they need to come back up to normal operation. These include amino acids (especially methionine, serine, glycine, glutamine, and cysteine), vitamins (especially the other B vitamins and vitamin C), and certain minerals (especially zinc, copper, magnesium, manganese, selenium and molybdenum). These deficiencies could be at least partly caused by dysfunction of the digestive system, and I think that there is a lot of potential in working to fix the gut problems. I think the biofilm treatments and Dr. de Meirleir's most recent gut work are things we should pay attention to here. I think the KPU or HPU that Dr. Klinghardt has emphasized comes in here, too, in some cases, depleting zinc, B6 and other nutrients.
"For people who experience severe excitotoxicity and thus cannot tolerate the treatments, I suspect that this is caused by a temporary further depletion of glutathione as more of the homocysteine is converted back to methionine, and less is available for making cysteine and glutathione.
"I recently read Dr. Amy's article on excitotoxicity in the publications section of her website. She has some interesting ideas there, and I think that her discussion of the metabolism of glutamate in the brain shows where the main cause of excitotoxicity on this type of treatment lies. Normally, glutamate is secreted by neurons into their synapse with other neurons, serving as an excitatory neurotransmitter. The astrocytes are then supposed to import the glutamate, convert it to glutamine, and send it back to the neurons to be converted to glutamate and to be used again as a neurotransmitter. But this importation and conversion requires energy in the form of ATP, and I think that's where the problem arises. If glutathione becomes more depleted, the mitochondria of the astrocytes will be less able to produce ATP at normal rates, because of the oxidative stress that will arise, partially blocking the Krebs cycle and the respiratory chain. So I think there is a good basis for suspecting that the temporary glutathione depletion that occurs when this treatment is used is what is responsible for the rise in excitotoxicity.
"If this is true, then it would seem that boosting glutathione while doing the methylation cycle treatments would help this situation. There are lots of ways to try to do this. I know that some people have been nebulizing glutathione, and some have been using liposomal forms of glutathione. There are other ways as well. For people who can tolerate glutathione boosting, this may help to calm the excitotoxicity when doing methylation cycle treatments.
"For people who have experienced some benefits, but have then plateaued and have not had much improvement for a long time, I suspect that the problem is that there are factors that are preventing glutathione from coming up, or are preventing the methylation cycle from coming up, or both. So far, the people in this situation who have repeated the methylation pathways panel offered by Health Diagnostics and Research Institute (formerly Vitamin Diagnostics) have reported that their results on this panel have still not normalized. That's why I suspect that something is preventing recovery of this part of the metabolism in these people.
"So what is it? I think the major suspects are things known to deplete glutathione. These include mold toxins, Borrelia bacteria (Lyme disease), and heavy metals, such as mercury. We don't know yet about how important XMRV is in CFS, but this may also be a possibility.
"If these factors are indeed holding down glutathione, then I suspect that they will need to be dealt with directly before the methylation cycle treatments will be successful in restoring the methylation cycle and the folate and glutathione levels.
"I have just heard from Lisa (slayadragon) that when she and another person have dealt with other issues, including mold toxins, they have then found that the methylation treatments have been much more effective in helping them to detox. Again, I think this suggests that other impediments to raising glutathione may need to be dealt with first.
"Along this same line, the women who were treated in the study that Dr. Neil Nathan and I carried out had already been treated for a variety of other issues before starting the methylation treatments. These issues included mold illness, Lyme disease, and heavy metal toxicity.
"In addition, the people who have reported essentially complete recovery from these treatments have also reported that they did a number of other treatments beforehand, some of them being antiviral treatments.
"So I think there are bits and pieces of evidence that support this line of thinking.
"One other thing that occurs to me is that this may be a major difference between CFS in adults and autism in children. The children with autism are of course much younger, in general. This being the case, they have had much less time to accumulate toxins and infections than have the adults. They also don't have amalgam fillings in their baby teeth. The really young ones have probably not had as much possible exposure to tick bites as the adults. The point is that the adults (especially those who have been ill with CFS for many years) may have many more impediments to the success of these treatments than the young children with autism, and they may need more additional treatments to address them specifically."
I think that the only thing I can think of to add is that perhaps the GD-MCB hypothesis does not extend far enough in time to describe everything that goes on in a person's body after they have developed the partial methylation cycle block, glutathione depletion, B12 hijacking, and draining of folate metabolites. I do think that this combination is the decisive thing in the development of CFS, but perhaps I should put more emphasis on what happens after that. For a person who has had CFS for an extended time, during which their defenses against oxidative stress, buildup of toxins, and infection with a variety of pathogens are deficient because of this combination, unfortunately a great deal more could happen. I am speculating here, because you have asked me what the pitfalls may be that the body might not be able to recover from on its own.
Oxidative stress over time might produce accumulating damage to the mitochondria, much as is seen in normal ageing, but on a faster timescale. I have suggested to Dr. Cheney that one of the beneficial effects of stem cell therapy might be that the person is infused with cells that have "young" mitochondria. Normally, new mitochondria are formed from the previous ones, and if there is damage to the mitochondrial DNA, the new ones will also have this damage.
Buildup of toxins over time might reach levels that are sufficiently high that the detox system itself is impaired, so that it cannot work down the backlog of toxins on its own. It is known that toxins can block enzymes, and the detox system depends on many enzymes to do its job. In this situation, additional measures to support detox, such as chelation, may be the answer.
Buildup of pathogens may become great enough that even if the immune system is operating completely normally, it will not be able to conquer the pathogens by itself. Pathogens have ways of frustrating the immune system so that they can survive. In this situation, the answer may be to add antimicrobials, i.e. antibiotics, antivirals, and/or antifungals. And now with the prospect of retroviruses being involved in CFS, perhaps antiretrovirals or things like GcMAF and Nexavir, as Dr. de Meirleir is using, will be needed.
I think it's possible that there could also be combined effects of oxidative stress, toxins and pathogens, so that they interact to produce more problems than each could by itself. I note that Amy Yasko has suggested that pathogens and metal toxins interact with each other.
As you can see, all I can do is speculate about this at this point, and the answer may well be different for different PWCs, depending on what has accumulated in their bodies. I note that in the study that Dr. Nathan and I did on the methylation treatment, he added some additional individualized treatments after the initial uniform treatment for 6 months, which were based on testing for heavy metals, mold illness, and Lyme disease, and in a couple of cases the results were very good. So I think it may be that all PWCs share a common core pathogenesis initially, but then each individual may accumulate different toxins or pathogens, depending on what they are exposed to, after the vicious circle involving the partial methylation cycle block has been established.
Again, I'm speculating here, based on the little evidence I have available. Maybe you have some thoughts on this.
I still believe that the GD-MCB hypothesis is essentially valid, as far as it goes, but I may not have carried it far enough.
Best regards,
Rich