The Methylation Cycle by Dr. Sarah Myhill www.drmyhill.co.uk Chronic Fatigue Syndrome is a symptom, not a diagnosis, and the name of the game is to identify the underlying causes. In fatigue syndromes we don't see macro-pathology, we see micro-pathology - that is to say the problems are bio-chemical and occur at the molecular level. There are several cycles, which I now know to be centrally important in causing fatigue. All these cycles interlink with each other like Olympic rings and getting one cycle going will drive another. The important cycles which I know to be major players include blood sugar wobbles, allergy problems, sleep cycles, mitochondrial function, anti-oxidant status, the NO/OONO cycle, thyroid and adrenal hormones cycles and de-toxification. I am greatly indebted to Rich van Konynenburg for updating me on a new player which interlinks with many of the above, namely the methylation cycle. The Methylation Cycle Rich van Konynenburg's idea is that ineffective methylation is a major cause of fatigue. There are many possible reasons but those that he's identified for which methylation is essential to are: 1. To produce vital molecules such as Co Q-10 and carnitine. 2. To switch on DNA and switch off DNA. This is achieved by activating and deactivating genes by methylation. This is essential for gene expression and protein synthesis. Proteins of course make up the hormones, neurotransmitters, enzymes, immune factors and are fundamental to good health. When viruses attack our bodies, they take over our own DNA in order to replicate themselves. If we can't switch DNA/RNA replication off then we will become more susceptible to viral infection. 3. To produce myelin for the brain and nervous system. 4. To determine the rate of synthesis of glutathione which is essential for detoxification. 5. To determine the rate of synthesis of glutathione which is an essential anti-oxidant as glutathione-peroxidase. Furthermore oxidative stress blocks glutathione synthesis - yet another vicious cycle! 6. To control sulphur metabolism of the body, not just glutathione but also cysteine, taurine and sulphate. This is an important process for detoxification. 7. As part of folic acid metabolism. This also switches on synthesis of new DNA and RNA. 8. For normal immune function. The methylation cycle is essential for cell mediated immune function and blockages here will mean that infections will not be adequately dealt with. I know this clinically because many patients tell me that once they get on to their B12 injections (an essential co-factor for methylation) this seems to protect them from getting infections. The overall effect here is that if the methylation cycle doesn't work, the immune system mal-functions, the detoxification system mal-functions, our ability to heal and repair is reduced and the anti-oxidant system mal-functions. The Bio-chemistry (you can ignore this bit if you like because it's not essential to know but it's interesting). There are four cornerstones to the methylation cycle and on each cornerstone sit four molecules namely homocysteine, methionine, S-adenosylmethionine (SAMe) and S-adenosylhomocysteine. Each of these cycles leads into the next one by means of enzymes. The important co-factors that allow this to happen are the B vitamins such as folic acid, vitamin B12 and vitamin B6. In converting from S-adenosyl homocysteine into homocysteine, a methyl group is given up and this can be used to stick on to other molecules - hence the name, the methylation cycle. However, there is a particular bio-chemical glitch here. In order for the methylation cycle to work these B vitamins have to be in their activated form, namely methylcobalamin, folinic acid and pyridoxyl-5-phosphate. In order to get cobalamin into methylcobalamin, the methylation cycle has to be working. So if this cycle has crashed completely, the body can't make methyl cobalamin in order to get it up and running again. Since this cycle is so fundamental to other biochemical cycles, including trans-sulphuration and folate metabolism, it can't change the vitamin B6, folic acid and cobalamin into the active forms necessary for the methylation cycles to work. This means that in order to get this cycle up and running initially we have to prime the pump with the activated vitamins, but hopefully once the methylation cycle is up and running, it can function on the vitamins in their normal states. Testing for how well the methylation works We don't have a simple test to see how well the methylation cycle works. What we can do is measure levels of homocysteine and SAMe. If these were raised this would show a blockage in one part of the pathway. Indeed, a raised homocysteine we know to be a major risk factor for arterial disease, almost certainly because this represents blockages in the methylation cycle. However, one could have a normal homocysteine and normal SAMe but blockages elsewhere in the system, which would still impair the ability to methylate. So there is no simple test. How do we go about treating this? Rich van Konynenburg has identified a package of micronutrients specifically to support the methylation cycle. He recommends the activated form of vitamins. These are more expensive than the basic forms, but I think that the idea here is that they are necessary in the short term to get the cycle working and in the longer term they can be dropped off. In addition to the basic three B vitamins Rich van Konynenburg has one or two other additions which you may also like to choose to use, but my initial suggestions would be as follows. The Methylation Cycle - which supplements to take to support This is the package of supplements to support the methylation cycle. It needs to be taken in addition to everything else! But the package will change with time because as the methylation cycle starts to work again, it will start to stand on its own feet. Everyone's package will be a bit different depending on how poorly their cycle is working. One day we will have the biochemical tests to tailor make each package for each person, but until then I suggest the following regime: For two months a daily dose of * Hydroxycobalamin 5,000mcgms daily ("shot O B12") * Methylcobalamin 1mg sublingually * Methyltetrahydrofolate 800mg (ActiFolate) * Pyridoxal 5 phosphate 50mgs twice daily * Glutathione 250mgs daily * Phosphatidyl Serine 200mgs one daily (BioCare) If you are better - fine! If you are worse - it may be the abreaction. If you are unchanged, swap the sublingual B12 for injected B12 ie: * Daily subcutaneous injections methylcobalamin 1/2ml (this is a bit more expensive than cyanocobalamin). I would prefer people to start with this regime but I know many do not fancy the idea of injections - actually I am a wimp too, but they are easy and almost painless. * Methyltetrahydrofolate 800mg (ActiFolate) * Pyridoxal 5 phosphate 50mgs twice daily * Glutathione 250mgs daily * Phosphatidyl Serine 200mgs one daily (BioCare) * Lecithin (phosphatidyl choline) and Phosphatidyl Ethanolamine. If you are better - fine! If you are worse - it may be the abreaction. If you are unchanged add in: * Tri-methylglycine (also known as betaine hydrochloride, also used to increase stomach acid so take at meal times and be mindful that it may cause symptoms of acidity - see information on hypochlorhydria). * S-adenosyl methionine (SAMe) directly as a supplement 400mgs daily Once you are better Then the regime can be relaxed. Once you are a good methylator, methyl B12, ActiFolate and glutathione could be tailed off. Injections could be swapped for oral supplements. However, do this slowly - some people need a small supplement long term in order to stay well. 1. Methyltetrahydrofolate 800mg (ActiFolate). 2. Hydroxycobalamin 5000mcgms sublingually (Shot-0-B12), together with Methylcobalamin 1000mcgms sublingually. It may be necessary for some people to have B12 by injection to get the best effect (easy to self inject 1/2ml daily, initially as methylcobalamin then switch to the less expensive cyanocobalamin) 3. Pyridoxyl-5-phosphate 50mgs (this is present in the BioCare multivitamin) 4. Phosphatidyl Serine 200mgs one daily (BioCare) These should be taken in addition to my basic package of supplements, namely multivitamins, Myhill Magic Minerals, essential fatty acids, vitamins C and D - these are the supplements I like all people to take on a regular basis. Problems with starting this package of treatment Rich van Konynenburg has been in contact with patient and support groups and about 60 so far have gone through this regime. He seems to see two categories of effect - firstly sometimes a quite rapid and profound improvement in some of the common symptoms, or secondly symptoms worsening or new symptoms arise because in getting the methylation cycle going one suddenly starts to get detox and die off symptoms. The reason for this is that when the methylation cycle was not working the body was unable to detox properly and unable to produce cell mediated immune responses to get rid of chronic infections. Once the methylation cycle is up and running, suddenly the body can swing into action with respect to detox and cell mediated immune responses and this can make the person much worse. The reasons for this are fairly obvious - as soon as one starts to detox one mobilises chemicals and toxins into the blood stream, this makes people ill. Secondly remember that it is not viruses and chronic infections that make one ill, it is the immune reason against them. Cell medicated immune responses make you feel sick! So it is really important to go into this regime gently, be mindful that it may make things worse initially but see this as a good sign. Rich tells me that the following symptoms of CFS have been reported to have been corrected and so I have taken his list and repeated it at length so you can see the sort of things to expect. PWC means People With Chronic fatigue. "The following symptoms of CFS have been reported to have been corrected by various PWCs on this treatment. Note that these are gathered from reports from many PWCs, so that not all have been reported by a single person. 1. Improvement in sleep (though a few have reported increased difficulty in sleeping initially). 2. Ending of the need for and intolerance of continued thyroid hormone supplementation. 3. Termination of excessive urination and night-time urination. 4. Restoration of normal body temperature from lower values. 5. Restoration of normal blood pressure from lower values. 6. Initiation of attack by immune system on longstanding infections. 7. Increased energy and ability to carry on higher levels of activity without post-exertional fatigue or malaise. Termination of "crashing." 8. Lifting of brain fog, increase in cognitive ability, return of memory. 9. Relief from hypoglycaemia symptoms. 10. Improvement in alcohol tolerance 11. Decrease in pain (though some have experienced increases in pain temporarily, as well as increased headaches, presumably as a result of detoxing). 12. Notice of and remarking by friends and therapists on improvements in the PWC's condition. 13. Necessity to adjust relationship with spouse, because not as much caregiving is needed. Need to work out more balanced responsibilities in relationship in view of improved health and improved desire and ability to be assertive. 14. Return of ability to read and retain what has been read. 15. Return of ability to take a shower standing up. 16. Return of ability to sit up for long times. 17. Return of ability to drive for long distances. 18. Improved tolerance for heat. 19. Feeling unusually calm. 20. Feeling "more normal and part of the world." 21. Ability to stop steroid hormone support without experiencing problems from doing it. 22. Lowered sensation of being under stress. 23. Loss of excess weight. The following reported symptoms, also gathered from various PWCs trying this simplified treatment approach, are those that I suspect result from die-off and detox: 1. Headaches, "heavy head," "heavy-feeling headaches" 2. Alternated periods of mental "fuzziness" and greater mental clarity. 3. Feeling "muggy-headed" or "blah" or sick in the morning. 4. Transient malaise, flu-like symptoms. 5. Transiently increased fatigue, waxing and waning fatigue, feeling more tired and sluggish, weakness. 6. Dizziness. 7. Irritability. 8. Sensation of "brain firing: bing, bong, bing, bong," "brain moving very fast". 9. Depression, feeling overwhelmed, strong emotions. 10. Greater need for "healing naps." 11. Swollen or painful lymph nodes. 12. Mild fevers 13. Runny nose, low grade "sniffles," sneezing, coughing. 14. Sore throat. 15. Rashes. 16. Itching. 17. Increased perspiration, unusual smelling perspiration. 18. "Metallic" taste in mouth. 19. Transient nausea, "sick to stomach" 20. Abdominal cramping/pain. 21. Increased bowel movements. 22. Diarrhoea, loose stools, urgency. 23. Unusual colour of stools, e.g. green. 24. Temporarily increased urination 25. Transiently increased thirst. 26. Clear urine. 27. Unusual smelling urine 28. Transient increased muscle pain. What to do if you're not getting better If you are still struggling then there must be another cause of fatigue that has not been addressed. Remember, fatigue is just a symptom! There are many parallels between chronic fatigue syndrome and autism and many of these ideas have already been used in the treatment of autistic children with excellent results. This work has been pioneered by Dr Amy Yasko N.D., Ph.D. in America.