[00:00] Organifi Gold/Kion’s Complete Joint Formula
[04:52] About Dr. Sarah Myhill
[06:38] Thyroid, Adrenal & Mitochondrial Function
[15:31] Testing Mitochondrial Function
[21:09] Myalgic Encephalitis Vs. Chronic Fatigue Syndrome
[23:30] Why Dr. Myhill Uses a Fat Biopsy to Test for Detoxification
[26:30] Dr. Myhill’s Infatuation with Vitamin C and How She Uses it to Treat Chronic Fatigue
[34:08] TruNiagen/ Zip Recruiter
[37:08] Chronic Fatigue & Gut Fermentation
[46:43] What Are Allergic Muscles?
[51:46] Live Cultures & Acid Alkali Balance
[54:00] Dr. Myhill’s Recipe for Linseed-Paleo-Ketogenic Bread
[1:00:14] End of the Podcast
Ben: Hey, it’s Ben Greenfield, still coming to you from Estonia. Estonia is actually where I’m based, I’m working out of Estonia, and I don’t get it when people say based, where you’re based out of, I’m located in, living in, my home is in Northern Europe right now. I’m living this nomadic lifestyle, my children are going to a little summer school over here called Mind Valley University. I’m going to it too, actually. I’m attending classes, I’m teaching some classes. It’s very interesting, so check it out, Mind Valley U. Just google it. Anyways though, in addition to that, I’m of course, still coming at you with today’s podcast, a really good one on chronic fatigue with my friend, Dr. Sarah Myhill, and should you wonder if I wound up making the bread that we talk about in today’s show, I did and it’s really tasty. It’s ketogenic, it’s really good for the gut, amazing.
So anyways, the podcast today is brought to you by my friends over at Organifi. Organifi is spelled with an “I”, and not only do they make green juice and red juice, but they make my favorite gold juice. Gold juice is a blend of turmeric with smooth coconut milk and cinnamon, ginger, lemon balm. They even put relaxing mushroom extracts in there to make you this warm relaxation beverage, It’s like golden milk that you get at a coffee shop, but with all the high fructose corn syrup all the other crap they put into it at the coffee shop, and you can make yourself at home, no driving. Also, no cleanup, no blending, no juicing, no chopping turmeric to pieces because they put it all in there. It tastes fresh, it’s healthy, and it’s organic. It’s called Organifi Gold, I highly recommend you grab that along with anything else they get over at Organifi, including their red juice and their green juice. Get yourself a three pack, treat yourself. It’s Organifi with an I, BenGreenfieldFitness.com/Organifi, and you use the discount code mentioned there to get 20% off your order. Use the code mentioned at BenGreenfieldFitness.com/Organifi.
This podcast is also brought to you by the Complete Joint Formula that assists with reparation from workout based injuries or just workout based inflammation, anytime anything is sore on your body. I’ve had people use this stuff to bounce back from surgery, to get their bodies ready for surgery, to shut down a lot of the joint pain that happens as you age. It’s a blend of collagen and then what’s called Flex Pro which has everything from boswellia for killing pain in joints to ginger which you probably know is a really healthy anti-inflammatory, turmeric, white willow bark which is the natural form of salicylic acid that you find in aspirin. It’s got a nice bio-organic mineral blend of 20 different minerals in there, and then enzymes. Enzymes are amazing, proteolytic enzymes specifically as catalysts for enhancing the body’s natural ability to break down inflammatory by-products. So you get all of this, but you get all of it in one bottle. It’s called Kion Flex, and you get a 10% discount. You go to getkion.com, getK-I-O-N.com. That’s where you’ll find all the supplements that I personally design, formulate and make available to you, and the 10% discount code is “Ben Flex 10”. “Ben Flex 10” over at getK-I-O-N.com.
In this episode of The Ben Greenfield Fitness Show:
“So many people are chronically sleep deprived because of Western lifestyle, so that’s what we do. The average sleep that people get is about seven and a half hours whereas our requirement is probably more like eight-and-a-half or nine hours of sleep.” “What I had to do was to give people the information and the tools of the trade, as I call it, so that they can cure themselves. Why? Because it’s not going to come from doctors. Why? Because doctors have become puppets of big pharma, and they are just.”
Ben: Hey folks, it’s Ben Greenfield, and this month, I read two of the better books I’ve read lately on functional medicine and chronic fatigue. And a dozen of concept that not many people are talking about these days, and frankly the information in it blew my mind, and I wanted to share with you, not only these books, but also the physician who wrote them, Dr Sarah Myhill, and she’s a British doctor. She runs a clinic over in Wales, United Kingdom, and it’s very hard for me to say that without adopting my accent, how do you like that, huh? And she’s got like 920 plus web pages and six million visits and just tons of info on there, specifically about Chronic Fatigue and something called, and I actually am going to want to clear this up with you, Dr. Myhill, you call it Encephalitis, I believe, Myalgic Encephalitis, M.E., so you talk about that in the book as well. I wasn’t too familiar with that, but apparently it’s a big deal when it comes to chronic fatigue. So these two books were “Diagnosis and Treatment of Chronic Fatigue Syndrome” and also “Sustainable Medicine” is the other book, and in that, she takes an even deeper dive into basically addressing a lot of the root causes of disease in a way that again, is a lot different than any books that I’ve read lately on these topics. So Dr, Myhill, welcome to the show.
Dr. Myhill: Thank you for inviting me, Ben.
Ben: I know, I have so many questions. I know our time is limited, I feel like I got to talk fast, so my apologies to the listeners if I don’t say much, and I let Dr. Myhill do a lot of the talking. Now the first thing I just want to ask you before we dive into this whole concept of myalgic encephalitis and chronic fatigue syndrome. It’s just your overall philosophy of medicine, I think it’s intriguing. Can you describe what your overall philosophy of medicine actually is?
Dr. Myhill: The important point about medicine is it’s all about identifying the underlying mechanisms that’s resulting in disease. Because if you do that, it has obvious implications for management. So much modern conventional medicine has been usurped by the drug companies who use drugs to suppress symptoms. Now in the short term, the patient feels better because the symptoms has gone away, and that might be high blood pressure or low mood or pain or whatever. But we have symptoms for very good reasons, symptoms protect us from ourselves, and without the symptoms of fatigue or the symptoms of pain, then we would succumb very rapidly. So much medicine, the diagnosis has been muddied because the mechanisms are not being identified, and diagnoses are being muddled with clinical pictures. So, for example, you talked about chronic fatigue syndrome and a myalgic encephalitis. Many people think, well that’s the same thing.
Ben: That’s how you pronounce it, myalgic encephalitis?
Dr. Myhill: Yes, myalgic encephalitis, but the point is that the symptom of chronic fatigue arises when energy delivery mechanisms are impaired. Myalgic encephalitis arises when you’ve got the symptoms of poor energy delivery mechanisms, plus symptoms of inflammation. And what causes inflammation? Chronic infection, chronic allergy or autoimmunity. So by using that very simple paradigm, we can break down the various aspects of fatigue syndromes or any or whatever. Now as you probably gathered, my special interest is in chronic fatigue syndrome and M.E., and that’s why I’ve written a book about it. And always when I speak to my patients, I have to speak in terms that are understandable and immediately grasped by them because I’m asking my patients to do difficult things, but if they can understand the intellectually imperative as to why they have to do these different things, then guess what? Their joy will get on and do it, so in thinking about energy delivery mechanisms, an analogy which I use all along and is very opposite is the car analogy, so if you think the body is a car and fumigates in that car represents our dot and myalgic function. If you can’t fuel the body with energy, or rather energy giving fuels, then of course, you’re going to be fatigued. My special area of interest, and I’ve published three scientific papers now in this area, has to do with mitochondria. Now mitochondria are the engines of our car.
Ben: Yeah, we’ve talked about those a lot before in the podcast. I interviewed Dr. Mercola, I’ve interviewed a lot of folks who’ve talked about like the metabolic theory of cancer, how to enhance mitochondrial health, but that’s got a pretty good correlation to addressing chronic fatigue syndrome, as well?
Dr. Myhill: Absolutely, and at the first paper we published in The Journal of Clinical Experimental Medicine in 2009 showed that those patients with worse levels of energy were most fatigued, have the worst mitochondrial function and vice versa. And there’s a very, very clear cut relationship between the two, so for me, that was a very exciting moment because up until then the whole world, or the medical world, have been saying our chronic fatigue syndrome, it’s all psychiatric, and here, we had a clear, physical, measurable, physiological abnormality that directly correlated with fatigue levels. So that was a first in the world. So the mitochondrial muscle, and actually mitochondria, we now know are implicated in almost any disease process you care to mention. Cancer, as you already mentioned, dementia, diabetes. Susceptibility to infection, mitochondrial are implicated.
Ben: Just pain in general, like muscle pain. I had a guy at my house yesterday who hurt his back, and I did put him on a pulse electromagnetic field therapy bed, had him do infrared sauna, did like a little bit of hyperbaric and implemented a bunch of tools to enhance mitochondrial health, and within two hours, he felt like a million bucks. Like all of his pain was gone, and it wasn’t just blood flow to that area, it was also the fact that he just felt amazing because that was a first time in a long time his mitochondria had been optimized.
Dr. Myhill: Well, you know, that makes perfect sense to me. It’s biologically plausible, and I mean with every diagnosis, you make hypothesis, you push the test, and if the patient responds as they should, then you can say well, we got the diagnosis right, and you just cited the perfect example of just that. So mitochondria acts essential, and then we have to look at the control of mitochondria. In particular, the numbers of mitochondria in the body, and that the called to the size of your engine and then how fast does the mitochondria get, and that is a function, combined function of adrenal and thyroid function, and I think of the thyroid glands as the accelerator pedal of your car and the adrenal glands as the gear box of your car. Now if you look at things from an evolutionary perspective, I always think to myself if in doubt, ask nature what happens in the past. From an evolutionary perspective, all living creatures have to match energy requirements with energy delivery because if there’s a mismatch, that’s a potential disaster. So, for example, if I’m walking through the jungle and a saber-tooth kindly jumps out at me, I need massive energy delivery, so I can run the fastest mile I’ve ever run in my life because I didn’t get gobbled up by that tiger.
On the flip side of things, if I’m a primitive man and I have a long cold winter ahead of me, I have to economize on spending energy because the food is scarce, and if I burn too much energy unnecessarily, I simply won’t survive the winter. So getting the adrenal and the thyroid function right to match energy, requirements with energy delivery is a really important part of recovery for these people.
Ben: So mitochondrial, thyroid and adrenals?
Dr. Myhill: Yes, and that also ties in with diet. Now you’re probably aware of the work of Dr. Ryan who talks about his metabolic monitoring of the body, but the point is that the sum total of the fuel supply, like your diet and the gut function, the mitochondria I.V. engine, the thyroid and adrenal function is reflected by your core temperature. So if any one of those things isn’t working well, then you’re going to run cold, and if we can assume people got the dart right, and believe me I could speak all night of that diet and their gut functionis good, i.e. they are getting the goodness from that, and then mitochondrial function is okay, I’ve now done all nearly a thousand mitochondrial function tests, and I now am fairly confident that I can correct mitochondrial function reliably well, that means that what’s left is the adrenal and the thyroid function, and that level, essentially, the thyroid controls it all. Call it your basal temperature, your core temperature, and the adrenal gland controls fluctuations. So if you’re running very cold all the time, that’s typical hypothyroidism, and if your core temperature is fluctuating very much, then that is typical of poor adrenal function, and the point about using core temperatures is you don’t need a doctor to get in the way to do this. People can do it themselves, they can measure their core temperature accurately with a good thermometer, plot it, look at the chart and that gives them a pretty good idea whether it was a thyroid problem or an adrenal problem or a combination of the two.
Ben: How do you test mitochondrial function?
Dr. Myhill: Well I’m very lucky because I have accurate laboratories, run by John McLaren Howard. Now he is the most brilliant biochemist that has ever existed in my view. My view is he should get the Nobel Prize for biochemistry because he takes cutting edge research by chemical tools and gives them clinical application. Now I’ve been working with John since the late 1980s, and throughout the 1990s, when he was working a bio lab in London, and in the late 1990s, I asked him specifically to see if he could find the test for mitochondrial function, to see how well they worked in a petri dish, and initially he looks at the various prescriptive enzymes to see if there’s any correlation closed or no correlation whatsoever. So what I really want to know about is ATP. As you know, ATP is the energy molecule. It’s the currency of energy in the body. With a monocle of ATP, you can form any task in your body. You can contract the muscle, conductor and then let them make comment or whatever. So I said to John, I want to test how efficient the ATP is made and how efficiently it’s used by the cell and the whole cycling process. Because as you know, ATP is very efficiently recycled, it’s produced in the mitochondria, it’s exported into the cell where it’s used to do a job of work, whatever that job of work may be, and then ADP then gets taken care of back into mitochondria by transferred protein and re-synthesized, and that is an incredibly efficient process. In fact, if you weighed all the ATP all the body creates over the course of 24 hours, it will be about 70 kilograms. You would exceed my body weight. So ATP is an essential molecule.
John of Accurate Laboratories came up with a test that measured those various parameters. It measured how efficiently mitochondria made ATP, how well ATP is transported from the mitochondria into the cell where it’s needed, how efficiently ATP gives up its energy from ADP, and that’s a magnesium depended process and then how well that molecule of ADP is taken back into the mitochondria by a translator protein to be recycled. Now as you can well imagine, if any one of those steps goes slow, then energy delivery mechanisms are going to be impaired, i.e., you can’t generate the ATP necessary for that cell. Now as I mentioned earlier, John has now done nearly a thousand tests for my patients, and that’s give me a pretty good handle on what’s going on and why. So even if you cannot get the test, I now know the regimens that have to be put in place to improve mitochondrial function, and broadly speaking, mitochondria can go slow because they’re lacking a raw material and the commonest right limiting steps. They are commonest deficiencies I see are low levels of Vitamin-B3, cynamide, low levels of Co-Q10, of acetyl-L-carnitine, or magnesium and the raw material to make ATP which is D-Ribose.
So those five supplements are incredibly helpful to improve the mitochondrial dysfunction, or mitochondria maybe going slow because they’re blocked by something, something is getting the way. Something is inhibiting the enzymes that create ATP, or something is stuck onto translocate protein which stops ATP getting from the mitochondria to the cell or from the cell back to the mitochondria. And there are lots of tests of toxicity that can be done, Genova did a urine test, and of course, I’m very lucky at Acumen because I could get a translocator proteins studies or that is done or whatever. The problem for Acumen is that at the moment, it’s the only lab that’s doing the biochemistry, and John simply can’t take on any more new doctors sending him tests. But there are other labs that are starting to develop these testers. One in Germany is starting to develop this test, so hopefully, it will become more widely available, but even without the test, there are other nutritional tests that can be done and other tests of toxicity that impact directly on mitochondria and now done so many follow-up tests for patients. I know that these regimens are effective.
Ben: Interesting, okay so this mitochondrial test that you like to perform your testing for ATP, for NAD, super-oxide dismutase, carnitine, DNA, glutathione and Coenzyme Q10.
Dr. Myhill: Yup all those things, and they’re all impact on mitochondrial dysfunction, and you can get those tests at other laboratories, and that would be very helpful with anybody with the fatigue syndrome.
Ben: Okay I’ll try and hunt a test down for those who are listening who are in the States. You can find the other one from Dr. Myhill’s website, but I’ll take show notes and put everything along with the books we’re talking about over at bengreenfieldfitness.com/myhill. That’s bengreenfieldfitness.com/M-Y-H-I-L-L.
So I want to ask you a little bit about in addition to this mitochondrial test, what you would do if someone were to come to you with chronic fatigue-like symptoms, but before I do, ’cause I promised I would, what’s the difference between this myalgic encephalitis and chronic fatigue syndrome?
Dr. Myhill: Okay, chronic fatigue syndrome arises when the energy delivery mechanisms are poor, so anybody who is hypothyroid or having full adrenal function, have poor mitochondrial function, that metabolic syndrome or whatever would be fatigued, and they would simply suffer from the symptoms of all energy delivery. Now with M.E., we have all of the symptoms of chronic fatigue syndrome plus we have inflammation symptoms. Now inflammation is characterized by heat, pain, redness, swelling, loss of function, and inflammation can be driven by chronic infection, chronic allergy or autoimmunity, i.e. the immune system is not functioning perfectly or the immune system is functioning in a way that caused it. The immune system is activated and is causing those symptoms.
Now we often see the two because very often people’s chronic fatigue syndrome or M.E. is triggered by an acute infection like Epstein-Barr infection. That comes up as a very common trigger, like Lyme disease, Babesier, Bartonella, mycoplasma, and we’re seeing epidemics of these new infections. Why? Because modern diets are becoming increasingly deficient in micronutrients, so our bodies are no longer healthy and we have been increasingly poisoned by toxins from the polluted world, and those toxins have the potential to inhibit mitochondria, dysregulate the immune system, and so on. You know with time, the clinical pictures are getting more confusing because if I have a patient who is not taking micronutrient supplements, and they will be deficient, simply because modern Western diets are deficient. If I have a patient who’s not on any sort of detox regimen, they will be poisoned. I have never done a fat biopsy, for example, and found a normal result, i.e., with no toxins.
Ben: A fat biopsy?
Dr. Myhill: Yes, that’s a test. It’s a very helpful test, very easy to do because you just stick a needle in the fat of patient and pull the needle out, and the amount of fat or oil contained within the core of the needle is sufficient to do an analysis.
Ben: An analysis of what?
Dr. Myhill: Well to look for fat-soluble pollutants and the bulk of organic compounds and pesticides. Neatly, organic chlorines, organic phosphate and down. Again, this is an Acumen only test, but Genova, I noticed, offered a urine test which gives one an idea of one’s toxic load of pollutants, persistent organic pollutants they’re called or popped. And again, I’ve seen a few of those tests, I’ve never seen a normal result. We are all carrying a toxic load, whether we like it or not. So you can be the very best you can to eat healthily, to eat organically, to avoid toxic, but we’re inevitably contaminated with some toxins, and all we can do is keep the load as low as reasonably possible and mitigate any toxicity with good micronutrient status, i.e., take good multivitamin, take some minerals, take some good essential fatty acids.
Ben: So I come to you for chronic fatigue, I’m tired all the time, and I feel worn out. Maybe I have inflammation too, so I’ve got this myalgic encephalitis, and you test my mitochondrial function, you test my level of toxins. What else are you going to do?
Dr. Myhill: Well I probably will start off testing you because there is much that can be done to improve fatigue, before we even think about doing any tests. The starting point for the treatment of almost absolutely everything, so it doesn’t matter somebody comes to me with chronic fatigue syndrome or dementia or heart disease or cancer, whatever. The starting point for treating everybody is the same, and that is to try to mimic our evolutionary past, i.e. do a Paleo, ketogenic diet. Improve the micronutrient content of our food by taking supplements, so that it’s compatible with what primitive man would have eaten, to ensure good quality sleep, and so many people are chronically sleep deprived because of Western lifestyles. That’s what we do. The average sleep that people get in Western worlds is about seven-and-a-half hours, whereas our requirement is probably more like eight-and-a-half or nine hours of sleep. So sleep is simple, an activity getting the right amount of this activity. Now the people with chronic fatigue syndrome, they dare not exercise because it makes them ill, and in fact, that is what defines that condition, and I would give them the basic package of nutritional supplements, a good multivitamin, a good multi-mineral and some essential fatty acids and a dose of vitamin C. Vitamin C is another area where I am getting so interested in. It’s such an important and helpful intervention.
Ben: You mean orally or via IV?
Dr. Myhill: No, take it by mouth. When I first started, of course, I thought I could cure the world as everybody does when they first start up in medicine, and then I rapidly realized no, that wasn’t going to happen. What I had to do was to give people the information and tools of the trade, as I call it, so they can cure themselves. Why? Because it’s not going to come from doctors. Why? Because doctors have become puppets of big pharma, and they have just become peddlers of drugs. Our word Doctor, it comes from the Greek, it means “to teach”, and my job is to teach people with the tools of the trade that are available, and believe me, they are available to cure themselves to heal themselves, and vitamin C is an incredibly important tool. Now there’s a really interesting evolutionary story here because fruit bats, guinea pigs and human beings, they can’t make their own vitamin C.
Ben: Wait, human beings and those two animals you just mention, the fruit bat and the guinea pig can’t make their own vitamin C?
Dr. Myhill: Correct, all other animals can make their own vitamin C, and what’s so interesting is that during any sort of illness, those other animals hugely ramp up their vitamin C production in order to deal with disease. Humans can’t do that, so if you, and I’m sure you’re aware of the work of Linus Pauling, who’s the only guy to have won two Nobel Prizes at single-handed, he was only beaten to a third Nobel Prize by Watson Crick who discovered the Double Helix, but he was a clever guy, and he devoted the latter stages of his life to research into vitamin C. And the bottom line is we should be taking at least five grams of vitamin C that is five thousand milligrams of vitamin C, on a daily basis, just for optimum health.
Ben: Not all at once though? That gives you diaper pants to do it all at once, right?
Dr. Myhill: Well that would be unusual.
Ben: Really, to get loose bowels from five grams would be unusual?
Dr. Myhill: Spread through the day, you’d be unusual to get.
Ben: Oh yeah, spread through the day. From what I understand, you could absorb like one-and-a-half grams or so at a time.
Dr. Myhill: Well vitamin C is such interesting stuff because if you have a systemic illness, then your bowel tolerance of vitamin C increases hugely, so the normal dose should be five grams spread through the day, and the worst people do is they put their daily dose in a bottle of water and drink it steadily through the day, and that is ideal for optimum health, but at the first sign of any infection or any illness, you greatly ramp up you’re intake of vitamin C. Why? Because that’s what all other animals do, when any other animal has any sort of illness, they greatly ramp up their body’s own production of vitamin C. Because it is a vital defense against disease. And what’s so interesting about, it’s the other animals can make vitamin C from sugar. In fact, it’s a full enzyme step to make vitamin C from sugar.
Humans lack one of those enzymes which is why we can’t make it ourselves, but I suspect this gives us an insight into the mechanism by which vitamin C works because, obviously, sugar is a fuel for bacteria. If sugar levels are low or bacterial numbers are increasing, if you saturate the body with vitamin C, they will try to use vitamin C as a fuel instead. Vitamin C doesn’t work as a fuel and it ends up the killing the organism, and the mechanism is exactly the same for killing cancer, and I’m sure you’re aware of work where there’s lots of work showing the benefits vitamin C and the treatment for cancer, and the treatment for cancer would be exactly the same as treatment of any infection, i.e. starve out the tumor cells with a ketogenic diet, very low carbohydrate diet, and then kill them with vitamin C. In fact just yesterday, I had a lovely lady come to visit me. She was diagnosed with an inoperable malignant esophageal cancer last August and told me she had a few months to live, and she has done a ketogenic diet and she is taking vitamin C to bowel tolerance, and she is now swallowing her food fine and feeling really well.
Ben: What kind of vitamin C, is it like a specific form?
Dr. Myhill: No, just ascorbic acid which is the cheapest and the best, works fine.
Dr. Myhill: I mean lots of people take liposome or vitamin C on the grounds that it’s supposed to be absorbed better, but I got in touch with the company that makes liposome or vitamin C and asked for the science on which that was based. Where are the trials that show that liposome or vitamin C is better absorbed, and they can only come up with the study that involved two patients or two people? One took ordinary vitamin C to bowel tolerance, the other took liposome vitamin C to bowel tolerance, and the blood level of the liposome vitamin C was marginally higher than the person that just took ordinary vitamin C. So I said well, you got to be joking. You can’t make a general prediction on the basis of a study involving two subjects, at which point they can’t afford communication with me.
So I don’t think liposome vitamin C, an ordinary Vitamin-C which is ascorbic acid works perfectly well, and there is lots and lots and lots of very good science showing that to be the case, like Robert Cathcart. Robert worked by at Frederick Clare, and in fact, there was a lovely study published recently by Dr, Paul Merrick who is a consultant in infectious diseases, and he specializes in treating septicemia. Now septicemia is blood poisoning, its real bad news, and even in intensive care with the best antibiotics, the best supporting treatment and higher oxygen zone, the mortality is about 40%. Now Merrick found that when he added intravenous vitamin C in his regimen, he reduced the mortality to less than 1%. No side effects, no complications, it’s a highly effective treatment. It’s extremely safe.
Ben: Is there a best time of the day to take it?
Dr. Myhill: I don’t think so, you just take it throughout, to spread it through the day. I mean that’s what the body would normally do we were able to make vitamin C. You know all other mammals made vitamin C regularly throughout the day, from sugar and at the sign of any first symptom of any disease or infection will really ramp it up. So my view is little and often throughout the day is mimicking nature.
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Ben: Got it, you also talk about magnesium quite a bit in the book, in addition of vitamin C. You’re a real fan of magnesium in your practice, is that correct?
Dr. Myhill: That is correct, now magnesium efficiency is pandemic. Again I don’t think I’ve ever seen the normal red cell magnesium in somebody who’s not taking magnesium supplements. I know lots of reasons for this, but a major reason for this is vitamin D deficiency. Again, as I’m sure you’re aware, vitamin D deficiency is pandemic, and we need vitamin D in order to be able to absorb magnesium from the gut, that’s the first problem. The second problem is that people are told to have lots of dairy products because they’re good for them, but again dairy products are not evolutionary correct foods. Dairy products are meant for young mammals. When young mammals are young, they’re very small, they have to grow very quickly, and dairy products are ideal for the fast growing young mammal, but they are not good for mature adults, and one of the reasons for that has to do with the ratio of calcium and magnesium. We have ten parts of calcium to one part of magnesium in dairy products, but our physiological requirements possibly two to one, probably more like one to one. Now calcium and magnesium compete for absorption, so if you take a lot of calcium, you block magnesium absorption, so you induce a magnesium deficiency. My guess is those two factors are the main reason why magnesium deficiency is so common, but again, there’s another little quirk here with my chronic fatigue syndrome patients because magnesium is essential to the mitochondrial function. Without magnesium, you can’t make ATP and you can’t release energy from ATP. But magnesium has to get inside cells, and for the magnesium to get inside cells is moving against the concentration gradient. I need energy to do that, so you end up with a terribly vicious cycle where you can’t get magnesium into cells because you haven’t got the energy to do it, but you need magnesium inside cells in order to generate energy.
Now in that event, I do have some patients who benefits hugely from injected magnesium. Why? Because I think what happens when you inject magnesium, if you have a window of time, a brief window of time where you spike magnesium in the bloodstream, you reduce the concentration gradient. You make it much easier to get magnesium into the cells and mitochondria, and you kick-start the mitochondrial engine, and having kick-started, you got it spinning. It’s now creating more energy and therefore has the energy to drag more magnesium into the cell and into the mitochondria.
Ben: This is so interesting, so magnesium intravenously, vitamin C, at like five grams a day, and you also talk about in the book the link between the fermenting gut and chronic fatigue. I didn’t realize there was such a big link between gut fermentation and chronic fatigue. Can you get into that?
Dr. Myhill: Yeah, it’s a very, very big problem, and again, the idea here is let’s go back to nature, or the basics. Now humans have a gut which is almost unique in the mammal world because we can deal with so many different foods. We can eat meat, we can eat vegetables. If I give my horses meat, it’s not good for them. If I give my dog lots of carbohydrates, that’s no good for her. And the reason is because we have dual purpose gut. Now the upper gut should be a sterile, digesting gut in order to allow us to deal with meat and fat, and the lower gut, either colon, is a fermenting gut, and that allows us to ferment vegetable fiber where we can get more fuel and more goodness from that. The problem is if we eat a high carbohydrate diet, and the shameful thing is we had 35 years of very poor nutritional advice which says we should be eating lots of sugars and carbohydrates. If we do that, then we risk overwhelming our ability to sterilize the upper gut and to break down these foods. And of course, with our modern culture snacking, so eating all the time, the upper gut is never really free from carbohydrates or free from sugars. And the result of that is the bacteria and the yeast move in.
Now bacteria and yeast are incredible microorganisms. If they can find a food, you will find some bacteria and yeast, and in fact, you’ll find bacteria and yeast throughout the whole world. There are even bacteria specific to clouds because there’s something in the cloud that those bacteria want to ferment. So all our body services, the whole body is colonized by bacteria, and it’s a simple numbers game. We have to keep them at a low level. Now if we eat a lot of carbohydrates, we overwhelm our ability to deal with those, and instead of having a sterile digesting upper gut, we have a fermenting upper gut. Now that is really bad news because those bacteria or yeast in the upper gut cause low grade inflammation on the lining of the gut, and that means we have leaky gut, and if we have a leak out, then got contents can get from the gut into the bloodstream where they cause immunological havoc. Now when I was at medical school, I was taught yes, we have some bacteria, we have yeast in the gut, and there they stay. We now know that is not true. Bacteria and yeast gets into the bloodstream very easily.
Ben: Do they just cross the gut barrier?
Dr. Myhill: Correct, and if the gut is leaky, and that’s what happens when there is inflammation, then they get across even more easily. And once in the bloodstream, they will activate the immune system, and if they get stuck in any part of the body, they would activate the immune system there because there’s a threat of infection, and I think that a great many modern pathologies such as arthritis and muscle stiffness and connective tissue pain is allergy to microbes from the fermenting gut. We’re seeing epidemics of interstitial cyctitis which is a bladder and irritating bladder condition where, no the tests don’t show there’s any infection, but there’s low-grade bacterial or yeast presence with inflammation, and the inflammation in the bladder causes all the symptoms of cystitis, with frequency, pain, urgency of micturition. I suspect chronic urticaria is driven by allergy to ferment microbes from the fermenting gut. Intrinsic asthma, the same.
We know that Crohn’s disease and [44:10] ______ and bowel diseases are associated with abnormal gut microbiome, and there’s some lovely work done by a Japanese researcher called Nishi Hara, and what he has shown is if you’ve got fermenting gut, you’ve got fermenting bread, i.e., you have microbes in the brain which have the potential to ferment out neurotransmitters in the brain. Now if you are fermenting noradrenaline and adrenaline and transmitting in the brain into amphetamine, into LSD-like substances, that would be the basis of psychosis. Now obviously, lots more work is needed on this, but it is a biologically plausible mechanism, and guess what? We know from the work of people like Carl Saphier and Abram Hoffer, that’s the treatment for any psychosis is a ketogenic diet. A very good treatment for any epilepsy is a ketogenic diet.
Ben: Is that just because there’s no carbohydrates to be fermented?
Dr. Myhill: Correct, there’s no carbohydrate to be fermented. You starve out those microbes in the brain that are fermenting brain neurotransmitters and causing psychosis, and you settle the whole problem down, and my guess is that the benefits of keto gut could be made even more profound by adding vitamin C because that helps the little wretches as well. So that jewel approach, the ketogenic diet combined with vitamin C, and anybody can do this, it’s not an expensive treatment. It would be a great thing that any brain pathology, that anybody with the brain fatigue syndrome, that anybody with dementia. In fact you’re probably aware of the work of Dale Bredesen who is a neurologist from California, and he took 10 patients with quite a lot of Dementia, and 9 out of 10 of those patients, he was able to reverse the dementia, simply with the ketogenic diet and various solved things like correcting the thyroid, correcting the adrenals, ensuring good quality sleep and so on. Now if that had been a drug that have that effect, my word, it would have been headline news in every newspaper in the world. But guess what? It’s just the boring old diet with a bit of vitamin C, and nobody’s going to make any money doing that. So guess what, it doesn’t get the headlines.
Ben: So a ketogenic diet, addressing gut fermentation, vitamin, magnesium, testing a lot of ATP and mitochondrial function issues, all that seems to make sense. Another thing that you mention in the book is something about allergic muscles. You’re talking about fibromyalgia and allergic muscles, and somebody who works on a lot of athletes get muscle pain and stuff like that. I’m curious I hadn’t heard that term around before. Can you talk about allergic muscles and what those are?
Dr. Myhill: Well that’s a term that I made up to try to explain the mechanism of what goes wrong, and do you know what I get? Probably more emails and questions about allergic muscles than any other subject, but I think what happens is that when we damage our cells and we have a fall or a bruise or whatever, whenever we damage our cells, we get bruising. Now when this bruising, blood comes in direct contact with connective tissue. Of course, that’s not supposed to happen. Blood is meant to be contained within the blood vessel. So there is potential at the moment of bruising, so that connective tissue, wherever that may be, it might be in your back, it might be in your foot, it might be in your shoulders. There is potential for that tissue to sensitize or become allergic to whatever is in the bloodstream at the time. Now that might be a food antigen, and guess what? We know that food antigens from the gut easily get into the bloodstream. We could find milk protein and wheat protein in the bloodstream or it might be a microbe from the fermenting gut. Now what that means is that after the bruising has settled down and healing and repair has taken place, but you’re left with sensitization of that tissue.
So if subsequently, that tissue comes in contact with a tiny bit of milk protein or a tiny bit of wheat protein or a tiny bit of microbe, it will react with inflammation. Now there’s one lovely example of this, bunions. Now bunions are a painful arthritis of the first joint of the big toe, and I now have three patients whose bunions have completely resolved just doing a dairy-free diet. I think what happens is that that joint is a very prominent joint, and if your foot gets crushed, because I know in my case, a horse treads on it or you drop something on your foot, that is the joint that gets crushed because it’s the biggest one. And when it gets crushed, there’s bleeding, there’s damage, there’s bruising, and that joint has sensitized. And then subsequently when the person eats that offending food, you get inflammation there. Because very often, you get people who got bunions. They’ve only got on one foot, they haven’t got on the other side. You ask yourself well, it’s not a systemic issue then. There must be a local problem, local to that joint, but the same can occur with muscles. So if you tear a muscle, guess what? You’re going to get bruising and potential to that muscle to sensitize to whatever’s in the bloodstream at the time. The calmest food that does it are the dairy products, and the point here is that when that person subsequently consumes dairy products, they get muscle spasm. Now muscle spasm is incredibly painful. I don’t if know if you ever had cramps, but it’s absolutely an agony.
Ben: I used to get horrible, horrible cramps in water polo, which is horrible because you’re in the water, and you basically have to use your arms to get yourself to the edge before you sink because both your calves typically from the eggbeater kick got these horrible cramps and spasms. So yeah, definitely.
Dr. Myhill: Absolutely, and some people must drowned when they get there in the pool, but the interesting about the allergic muscles is the pain, some in all of that, extreme is a bit agonizing, and then as soon as the muscle goes uptight, that patient is as right as ray. So anybody watching would think well, they’re right to calm alright. One moment, they’re screaming in agony, the next moment, they’re as right as ray, and I’ve now had so many patients who have got rid of their allergic muscles, got rid of their screaming agony, simply by doing a Paleo-ketogenic diet, i.e. cut out the major allergens, grains, dairy, yeast, and reduce the load of fermenting microbes in the gut because you’re starving them out with a low carbohydrate diet.
Ben: Interesting. Okay, so this idea with low carbohydrate diet fermentation actually links directly to allergic muscles then. And by cleaning up the diet, when it comes to the fibromyalgia that often accompanies chronic fatigue, a lot of these things address that, too.
Dr. Myhill: That’s absolutely right, in fact if you sat in with me, well for a day I thought you might be my patient, you think I lead a really boring life because I’m talking about diet and gut function all the time. So much so that I’ve end up writing another couple of books, one diabetes which is why we tend to eat high carbohydrate diets, and the second the Paleo-ketogenic cookbook which tells you how to go about eating a low carbohydrate diet. The difficulties that anticipate and sort of foods to eat to get around that.
Ben: Now this is probably kind of related to the fermenting gut issue, but at the end of your book, you go out of your way to include this recipe that you apparently make yourself and use quite a bit for live cultures. Can you go into that and what that actually is and you wouldn’t just take probiotics?
Dr. Myhill: Okay, the point about taking probiotics is if you got a good gut function, they are unlikely to colonize the gut. They should be killed by stomach acid, so it really is a numbers game, and if you’re going to take probiotics, you’ve got to take enough of them in order to be able to impact on the gut, and the most effective way to do that is to grow live cultures, and guess what? It’s also very inexpensive, so I usually start off with kefir because that’s very easy to grow and grow really well on a range of substrates. I personally like to grate on coconut milk, some people like to grate on soy milk, and you can grate on almond milk or whatever. But there’s another microbe called Lactobacillus rhamnosus, and that has been shown in at least two well-conducted trials to be effective in switching of allergies. So I suspect it is the microbe that induces oral tolerance to foods. So if I got somebody who is allergic to a food, then I always ask them to grow that Lactobacillus rhamnosus on kefir or up a big one, on soy milk or on coconut milk. That reduces the sensitivity to that food in the gut, it’s a very good where switching off allergies.
Ben: So you use the milk, you got to purchase the culture, then just grow the culture on top of the milk medium?
Dr. Myhill: Correct, and guess what? It’s very cheap because you only have to buy one culture, and that last you for years and years and years and years. Okay, sometimes you might make a mistake on whole and have to guess about it and have to start again, but again, it’s a very inexpensive treatment, and these patients are really sick. Often can’t afford expensive probiotics or the fickle micro-bacteria therapy or whatever, but they will can easily grow fermented foods.
Ben: Cool, this is actually a recipe I want to try. Maybe I’ll have my kids try it because they do it like a food podcast, and sometimes when I have a recipe that I want to try, I just have them do a podcast about it, so maybe they’ll make me some live cultures tonight.
Dr. Myhill: Well I thought what you were going to say was my recipe for the Paleo-ketogenic bread which I make from linseed.
Ben: Yeah, fill me in. What’s that recipe?
Dr. Myhill: Well as a safe, a starting point for treating absolutely everything is a Paleo-ketogenic diet, but what people miss more than anything else is bread because it’s very quick, it’s very convenient, it’s very delicious, it’s got great texture. So every morning for about six months, I got up early in order to experiment making a loaf, and to cut a long story short, I’ve made a loaf and the only ingredients are linseed, water and salt, and how to make it is online. I like to send you the link, but it takes five minutes. The point is it looks like a small brown loaf, it cuts like a small brown loaf, it makes great toast, it makes great fried bread, and it makes the Paleo-ketogenic so much easier and doable.
Ben: What is linseed exactly?
Dr. Myhill: Well linseed is a seed, but the key thing about linseed is it’s only two-percent carbohydrate. It’s about 26% fiber, so it’s very good for the gut, so it’s a great substrate for the lower gut, which does need to ferment fiber.
Ben: Is it the same thing as flax seed?
Dr. Myhill: Yes.
Ben: Oh okay, alright we call it flax seed more often over here on this side of the pond. That’s interesting, I did not know that. I’m going to look up that recipe, too. Obviously for those you’re listening in, all of these recipes are in the book, and I’ll link to the book over at bengreenfieldfitness.com/myhill. That’s bengreenfieldfitness.com/M-Y-H-I-L-L.
One other thing that you talk about that is kind of controversial in medicine, and I think you mentioned this in the “Sustainable Medicine” book is the acid alkali balance and why that’s so important to you? And a lot of people argue that your kidneys do just a perfect job themselves maintaining the body’s acid alkali balance, and so it’s not something that should be targeted quite as much. Why is it that you focus on the acid alkali balance and what do you do?
Dr. Myhill: Well I don’t focus that much on it these days, I have to say, simply because when you get the diet right and you get the fermenting gut right, the acid alkali balance looks after itself. So it’s quite useful, I mean very often, people come to me with sets of blunts, and you can work out the acid alkali balance by looking at their electrolytes, by looking at bicarbonate levels in the blood. So you give your point in, but I wouldn’t concentrate a lot of fire on correcting that, simply because, as I say, it sorts itself out once you get people on their Paleo-ketogenic diets, sorting out the fermenting gut, good micronutrients and so on.
Ben: Okay, alright so basically with this whole acid alkali balance thing, are you testing, or are you giving people any form of bicarbonate to adjust their acid alkali levels or anything like that?
Dr. Myhill: Well no, I wouldn’t with bicarbonate as you say because there are two ways of balancing that out. One is via the kidneys and the other is via the lungs, and the body does quite a good job of that. Again testing for it is awkward, it’s not as easy as you might think because all our secretions are slightly acidic, and they’re meant to be slightly acidic. Why? Because acid is a very good defense against disease, against bacteria. So saliva should be slightly acidic, urine should be slightly acidic, even earwax should be slightly acidic. So to really test the acid alkali balance, you’ve got to do blood tests to get a good idea what’s going on, and again, I’m trying to make meds simple so that people don’t have to rely on expensive blood test to sort the cells out, but the same, my experience is the acid alkali balance looks after itself when you get everything else in place.
Ben: There is a host of information we didn’t even delve into, like you talk about everything from how you use infrared to this concept of the pace study that’s kind of controversial study when it comes to chronic fatigue, a whole host of stuff in both these books, at “Sustainable Medicine” and also chronic fatigue, and of course, you address in a lot more detail than we even got a chance to dive into, mitochondria, ATP detoxification, and again, I know a lot of this stuff for those of you listening in, sounds like things I’ve addressed before but never in as much detail and with as much practical experience, specifically for chronic fatigue as Dr. Myhill gets into in these books. One is called “Sustainable Medicine: Whistle-Blowing on 21st-Century Medical Practice” and the other one is “Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis”. I’m going to link to these over at bengreenfieldfitness.com/myhill, and I’m also going to let you know if your linseed Paleo-ketogenic bread and live cultures go over with my family or not, Dr. Myhill. We have to see how tasty those actually are, but I’ll keep you posted. I’m going to make them.
I actually do that, when I find cool things in books, I do make them and try them, and some stick around and some don’t, but this is Paleo-ketogenic bread looks like it could be something to go hand-in-hand with my wife’s current bread which is slow fermented sourdough bread from a non-GMO local wheat, but this looks pretty good too and obviously even better for gut fermentation issues. So anyways though, you’re a wealth of knowledge. Thanks so much for coming on the show and sharing the stuff with us.
Dr. Myhill: My pleasure, do ask me again because I’m sure a bit well there’s lots we haven’t touched upon, I’ll be very happy to help any time in the future.
Ben: Yeah absolutely, I would actually like to have you back. There’s a lot we didn’t get into, so stay tuned, and in the meantime, folks who are listening in, you can go to bengreenfieldfitness.com/myhill. That’s bengreenfieldfitness.com/M-Y-H-I-L-L for the show notes, for Dr. Myhill’s books and much more. Thanks for listening in and have a healthy week.
This month, I read two of the better books I’ve read lately on functional medicine, chronic fatigue and health concepts that it seems not many people are talking about these days. In other words, I folded over a lot of pages in these books! Both were written by the same author: Dr. Sarah Myhill.
Doctor Sarah Myhill is a British doctor running her own specialist ME clinic in Knighton Wales, United Kingdom. Her website is an extensive resource of articles and information based on her treatment of patients and runs to 920 webpages with over 6 million individual visits. Dr. Myhill’s view is that the disease is characterized by a cellular metabolic mitochondrial dysfunction and has published several studies. Dr. Myhill has treated in excess of 10,000 CFS/ME sufferers over her 30-year career.
The first book, “Sustainable Medicine: whistle-blowing on 21st-century medical practice“, is based on the premise that twenty-first-century Western medicine—driven by vested interests—is failing to address the root causes of disease. Symptom-suppressing medication and “polypharmacy” have resulted in an escalation of disease and a system of so-called “health care,” which more closely resembles “disease care.” In this book, author Dr. Sarah Myhill aims to empower people to heal themselves by addressing the underlying causes of their illness. She presents a logical progression from identifying symptoms to understanding the underlying mechanisms, to relevant interventions and tests and tools with which to tackle the root causes. She writes: “It’s all about asking the question ‘why?’”
Sustainable Medicine covers a wide range of symptoms including inflammation (infection, allergy, autoimmunity), fatigue, pain, toxic symptoms, deficiency symptoms, and hormonal symptoms. And Dr. Myhill includes a toolbox of treatments for specific illnesses and ailments, as well as a general approach to avoiding and treating all disease. Finally, she offers a series of case histories to show how people have successfully taken control of their health and healed even in the face of the most discouraging symptoms—all without the harmful interventions of 21st-century Western medicine.
The second book, “Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis ” is just as good. In this book, details the practical application of her successful and comprehensive treatment approach for CFS/ME.
Key chapters include:
-The clinical picture of CFS: CFS symptoms list, medical tests for chronic fatigue
-Mitochondria and chronic fatigue syndrome: energy powerhouse, mitochondrial failure, implications for major organs, vital tests
-Treating mitochondrial failure
-Foundations for recovery – the Dr Myhill CFS protocol with tips for CFS help: rest and pacing, vitamins and minerals, Vegepa for CFS, sleep, diet, allergies, digestion, detoxification & antioxidants
-Related health issues: avoiding viral infections, hormonal disturbances in CFS, the contraceptive pill and HRT, oxygen supply, psychological aspects of CFS, the right exercise
-Toxic and viral causes of CFS: chemical poisoning, chronic infections, pain
-Practical CFS help: where to start (rest, nutritional supplements, Vegepa for ME, sleep, stone age diet, treating mitochondrial dysfunction, correcting hormones, detoxing, avoiding infections)
During our discussion, you’ll discover:
-Dr. Myhill’s overall philosophy of medicine…6:45
-How Dr. Myhill tests mitochondrial function, and why she feels it’s so important…15:30
-What is myalgic encephalitis and how is it any different from chronic fatigue syndrome…21:10
-Why Dr. Myhill uses a fat biopsy to test for detoxification…23:30
-Dr. Myhill’s infatuation with Vitamin C and how she uses it to treat chronic fatigue…26:30
-Why Dr. Myhill administers a lot of intravenous magnesium to her patients…33:00
–The fascinating link between the fermenting gut and chronic fatigue…40:15
-What allergic muscles are, and how they are linked to fibromyalgia…51:00
-At the very end of the book, Dr. Myhill has a recipe for live cultures, and why she’s not a fan of probiotics…52:00
-Dr. Myhill’s recipe for linseed-Paleo-ketogenic bread…54:00
-Why Dr. Myhill focuses on the acid-alkali balance…56:00
-And much more!
Sponsors of this Episode:
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Resources from this episode:
How to make a PK bread loaf in five minutes
- Weighing scales, measuring jug, Nutribullet (or similar effective grinding machine – do not attempt to do this with a pestle and mortar – I know – I have tried and failed)
- Cup in which to weigh the linseed
- Mixing bowl
- Wooden spoon
- A 500 grams (or one pound in weight) loaf baking tin
- One teaspoon of sunshine salt (or sea salt)
- Dollop of coconut oil or lard
- Cooking oven that gets to at least 220 degrees
- Paper towels
- Wire rack for cooling
Take 250gms whole linseed.
You could purchase in 250gm packs and that saves weighing it! Use dark or golden linseed grains – the golden grains produce a brown loaf, the dark a black one. Do not use commercially ground linseed – the grinding is not fine enough, also it will have absorbed some water already and this stops it sticking together in the recipe. If you purchase linseed in bulk then you must weigh it really accurately in order to get the proportion of water spot on! No raising agent is required.
Pour half the linseed into the NutriBullet together with one rounded teaspoon of sunshine salt.
Grind into a fine flour.
Use the flat blade to get the finest flour. Grind until the machine starts to groan and sweat with the effort! You need a really fine flour to make a good loaf. This takes about 30 seconds. The finer you can grind the flour the better it sticks together and the better the loaf. I do this in 2 batches or the blades “hollow out” the mix so that half does not circulate and grind fully.
Pour the ground flour into a mixing bowl. Repeat the above with the second half of seeds and add to mixing bowl. Whilst this is grinding, measure the water you need.
Add in exactly 270ml water (not a typo – 270 it is!). Chuck it all in at once, do not dribble it in. Stir it with a wooden spoon. Keep stirring. It will thicken over the course of 30 seconds. Keep stirring until it becomes sticky and holds together in a lump.
The amount of water is critical! When it comes to cooking I am a natural chucker in of ingredients and hope for the best. But in this case – you must measure! Initially, this will look as if you have added far too much water! Keep stirring.
Use your fingers to scoop up a dollop of coconut oil or lard. Use this to grease the baking tin. Your hands will be covered in fat which means you can pick up your sticky dough without it sticking to your hands.
Use your hands to shape the dough until it has a smooth surface. Drop it into the greased baking tin.
Spend about 30 seconds doing this. Do not be tempted to knead or fold the loaf or you introduce layers of fat which stop it sticking to itself. This helps prevents the loaf cracking as it rises and cooks (although I have to say it does not matter two hoots if it does. It just looks more professional if it does not!)
Let it rest for a few minutes, so it fully absorbs all the water and becomes an integral whole.
Rub any excess fat into your skin where it will be absorbed.
There is no need to wash your hands after – the basis for most hand creams is coconut oil or lard. (Yes, lard! It amuses me that rendered animal fat is a major export from our local knacker man to the cosmetic industry).
Put loaf into the hot oven at least 220° for 60 minutes.
Set a timer or you will forget! I always do! I do not think the temperature is too critical – but it must be hot enough to turn the water in the loaf into steam because this is what rises it. I cook on a wood-fired stove and the oven temp is tricky to be precise with. That does not seem to matter so long as it is hot! Indeed, I like the flavour of a slightly scorched crust.
Wipe out the mixing bowl with a paper towel.
This cleaning method is quick and easy. The slightly greasy surface which remains will be ideal for the next loaf. The point here is that fat cannot be fermented by bacteria or yeast and does not need washing off mixing and cooking utensils. My frying pan has not been washed for over 60 years. I know this because my mother never washed it either.
When the timer goes off, take It lasts a week kept like this. Freezes well too.
When the timer goes off, take loaf out of the oven, tip out and allow to cool on a wire rack. Once cool keep in a plastic bag in the fridge. It lasts a week kept like this. Freezes well too. Best used sliced thinly with narrow bladed serrated knife.