Summary of talk presented by Dr. Chitra Bhakta on “Adrenal Fatigue, Correction of Genetic Methylation Pathways, and Protocol for Decreasing Inflammation in Lyme, Autism and Chronic Illness” by Rich Van Konynenburg Dr. Chitra Bhakta, M.D., Director of Orange County Integrative Medical Center in Tustin, California, presented a talk on the above topics on Saturday afternoon, September 12, 2009, in Conference Room F in the lower level of the Presbyterian Intercommunity Hospital in Whittier, CA. The talk was sponsored by the Southern California Lyme Support group, coordinated by Earis Coram. I heard about it from Al Melillo, who also attended, together with about 30 other people. Dr. Bhakta is from India, where she received her medical training. She did her residency at the Los Angeles County Hospital. Her specialty is family medicine. It was clear to me from her talk and discussions afterward that Dr. Bhakta puts the best interests of her patients first, and that she continues to search for new developments that will enhance their treatment. The protocols she uses today combine contributions from several front-line researchers. A few years ago, she was treating a number of autism patients, and she had become familiar with and used the Defeat Autism Now! (DAN!) approach for treating autism. This was effective for many of the cases, but some of the kids she was treating never got better. She attended the Lyme-Induced-Autism conference and then tested these nonresponding patients for Lyme disease, finding that they all had either Lyme disease or its coinfections. This is how she became involved in treating Lyme disease. She then trained with Dr. Charles Ray Jones (age 82!) in Connecticut. He is the foremost pediatrician treating Lyme disease. She integrated the DAN! and ILADS (International Lyme and Associated Diseases Society) approaches to treatment into her treatment protocols, but felt that antibiotics were being used too much to treat Lyme disease. She developed an approach that treats several aspects first, and then uses antibiotics later, if necessary. She decided to start her treatment with the gut, as is done by others in autism. She has been treating the methylation cycle for about ten years, based on the research of Drs. S. Jill James and Richard Deth. She became aware of the later work of Amy Yasko, Ph.D., N.D., who applied the science of nutrigenomics, which had come from the University of California at Davis, to the treatment of autism. She believes that this approach has merit, but she found Dr. Yasko’s treatment to be very complicated. She reported that she found my work (involving the Glutathione Depletion—Methylation Cycle Block (GD-MCB) hypothesis for chronic fatigue syndrome (CFS) and the Simplified Treatment Approach based on it) on the internet. She noted that I had applied the methylation cycle related biochemistry to CFS and had been able to explain many of the features of CFS on this basis. She also noted that I had “streamlined” the Yasko treatment approach, making it easier to use. She displayed a large chart showing the methylation cycle and associated pathways that had been developed by Dr. Yasko, and explained the relationships between the methylation and folate cycles and the transsulfuration pathway, including glutathione. She explained that Dr. James and coworkers had found that genetic “weaknesses” can block several sites in this part of the metabolism. In addition, environmental factors, such as thimerosol in vaccines, can contribute to this as well. A block in the methylation cycle will cause decreases in plasma methionine and the ratio of S-adenosylmethionine to S-adenosylhomocysteine (SAMe/SAH). It will also lower the ratio of reduced to oxidized glutathione (GSH/GSSG). She went on to describe the GD-MCB hypothesis for CFS in detail. A discussion of this hypothesis can be found on the internet at http://aboutmecfs.org/Rsrch/GSHMethylation.aspx She noted that according to this hypothesis CFS is caused by a combination of genetic predisposition and stressors, except in the epidemics or clusters, where the genetic factor is less important because of the action of a virulent pathogen. She suggested that polymorphisms in the enzymes CYP2D6 and COMT may be associated with fibromyalgia, and a polymorphism in NAT2 may be associated with multiple chemical sensitivity. She also reported that Borrelia burgdorferi bacteria have been found to deplete glutathione in their host, and noted that I had suggested that this may provide a link between Lyme disease and CFS. She reviewed some of the polymorphisms to which Dr. Yasko has drawn attention, including AHCY-1, BHMT-08, CBS C699T, COMT V158M, MTR A2756G, and MTRR A66G. She discussed the work of Dr. Ritchie Shoemaker on Lyme and other biotoxin diseases, noting his FACT test for visual contrast sensitivity, HLA DR DQ typing, and other tests. She said that she prefers using the K-PAX multivitamin. She reported success in raising the glutathione levels in two autistic patients using OSR#1 at a dosage of 300 mg per day, in whom it had not been possible to raise glutathione levels before. She discussed KPU or the “mauve factor” as originally discovered by the late Dr. Abram Hoffer and coworkers. This was originally found in the urine of schizophrenia patients. It results from an inborn genetic error in the pyrrole metabolism, which is used to make hemoglobin. Dr. Dietrich Klinghardt has found that this is present in 80% of his Lyme patients, and it causes a depletion of zinc and vitamin B6. Dr. Bhakta recommended getting the $59 test for KPU from www.kryptopyrrole.com. She described Dr. Klinghardt’s KPU treatment, which is available on his website. She also discussed his metal detox protocol. Dr. Bhakta said that she prefers to use the Metagenics formulas for detox, i.e. the Ultraclear Renew for fibromyalgia, and the Ultraclear Plus pH for CFS. Dr. Bhakta also discussed the Neuroscience approach to testing and treating the neuroendocrineimmune issues. She talked about the stages of adrenal fatigue and noted that correction of this condition must be done centrally, because neurotransmitters are involved. She discussed inflammation and noted that there are many chronic inflammatory conditions, which involve inflammatory cytokines. She discussed new research pertaining to the cholinergic anti-inflammatory pathway, and noted that acetylcholine has been found to be important for lowering the levels of inflammatory cytokines and stopping inflammation. She discussed a new treatment called Avipaxin, produced by Neuroscience. Avipaxin contains both a cholinesterase inhibitor to inhibit the breakdown of acetylcholine, as well as supplements to feed the formation of new acetylcholine. In starting her treatment with the gut, she recommends three tests: food allergies, stool analysis, and an organic acids test. She emphasized that the human body is complex, and it is necessary to address several aspects of these illnesses in order to treat it successfully. She pointed out the importance of eating organic food, locally grown and seasonal. She recommended eating 5 or 6 small meals per day, like a diabetic diet. For food allergies, she recommends a rotation diet, switching foods each week. She recommended taking Juice Plus to get the nutrients from vegetables and fruits. For omega-3 fatty acids, she recommended EPA-Select. She emphasized that it’s important to raise the EPA intake, but not DHA. She favors starting with one new supplement at a time, to see what the response is, before adding others. In response to a question, she recommended that vegetables be cooked at first, until the gut is able to handle raw vegetables. At that point, salads are very beneficial. For protein, she recommended Alaskan wild salmon and organic meats, such as bison meat. She favors removing amalgams, so that they do not continue to introduce mercury into the body. She emphasized that in treating these disorders, it is necessary to use a synergistic approach. I was of course gratified to learn that Dr. Bhakta had found the Glutathione Depletion—Methylation Cycle Block hypothesis and the Simplified Treatment Approach based on it to be helpful in treating her patients. She has found treatment of the methylation cycle issue to be an important part of her overall treatment protocol, but it must be emphasized that it is not the whole thing. Her treatment also includes several other aspects of these disorders as well.