Chronic Fatigue: Mitochondria and the Other 4 Causes

Intro:

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Dr. Ruscio, DC:

Hi everyone. Today I spoke with Dr. Jennifer Tufenkian and she did a great job of outlining how important mitochondria are in chronic fatigue syndrome and those who also have this annoying and chronic post exertional or post-exercise malaise or fatigue. Now, we had recently discussed this with Ari Whitten and what Jenny brought to the table that I really appreciated was a simple one week trial protocol that can help you determine if mitochondria are the reason for this non-responsive fatigue plus or minus post exertional fatigue. Now, it’s also important for me to mention and clarify that we discuss this within the greater context of it’s not all about the mitochondria. And I express how I had not found much favor with mitochondrial support because as I became more adept at using diet, lifestyle, gut health therapeutics, and potentially referring for limbic retraining, doing work on mold, there was not a lot of room for improvement with other therapies.

Dr. Ruscio, DC:

But as myself and we at the clinic are becoming more and more honed with these tools, there is this cohort, this small subset of people, who still seem to have some lingering, either fatigue or post-exertional malaise that can wipe them out for a day or days. And I’m starting to see now how and where mitochondrial support should be used. So it’s not something that you use right out of the gate. It does have a time and a place. And thankfully, at least from Jenny’s experience, a one week protocol can be sufficient to at least give you the binary of improving yes or no. So this was a really interesting conversation. And regarding Jenny or Dr. Jenny, she is a naturopathic physician and a functional medicine educator. She has been treating chronic illness for two decades and she herself suffered from chronic fatigue syndrome and did a deep dive to try to help herself. And she has found her way to a framework, very similar to what we use in the clinic, as part of how she first helped herself and now she’s helping many, many others.

Dr. Ruscio, DC:

She is a, again, a licensed naturopathic physician. Her training and residency was performed at National University of Medicine. And she also spent time there as an adjunct faculty and owned her own practice. Also, she has a BA in political sociology from Evergreen State College. So we will go here to the show in just a second. Quick reminder, if you have not yet left a review for the podcast, please do that. [It] really helps us reach more people. And okay, with that we will now go to the conversation with [Dr] Jenny.

Dr. Ruscio, DC:

Hey everyone. Welcome back to Dr. Ruscio, DC Radio. This is Dr. Michael Ruscio, DC today here with Dr. Jennifer Tufenkian and we will be discussing this concept of chronic fatigue syndrome, long COVID goes by a few different names, but we’re going to focus on, I suppose said simply, you have found yourself tired all the time, maybe having some pain, [and] can’t figure out why. And we’ll unpack what you should be thinking about, questions you should be asking yourself or your doctor, therapies that you can use, forms of evaluation to help you have normal energy, and just get to that level of wellbeing that’s not encumbered by this chronic fatigue. Or maybe if it’s COVID (long haul) and what we can do again to better understand and to help. So Jenny, welcome to this show. Excited to have this conversation.

Dr. Jennifer Tufenkian:

Thank you. I am very excited to be here. Thank you for having me.

Dr. Ruscio, DC:

Yeah, definitely. This is a condition I think that some clinicians, well, pretty much every clinician, is likely seeing a subset of people who don’t fully respond and they have this lingering, whether it be fatigue or pain or maybe both or something vaguely similar to this. Maybe it’s post exertional malaise, where they just can’t handle exercise and if they go over this very specific threshold, they take days or weeks to recover. And of course it’s always something I think any clinician is trying to better understand. So definitely curious to really unpack what you’re seeing clinically. Where do you start thinking about this? Maybe to provide a heuristic or a framework for the patients and the clinicians listening to this conversation?

Dr. Jennifer Tufenkian:

Sure, absolutely. So I take a step back from looking for what is the one thing that is causing this in people who are struggling with chronic fatigue. And I take a step back and I say, this is a multifactorial process. As in, there’s going to be more than one thing. When I had chronic fatigue and when I first had it years ago, everybody was always looking for what’s the one thing that’s causing chronic fatigue. And I think that we can really do better as clinicians and we can get through this better as people who are struggling with this when we take a step back and we look. What are the root causes that are affecting the fatigue in the patient in front of you, if you’re a physician, or in you.

Dr. Jennifer Tufenkian:

And I look at: there are four health foundations and five root causes. And people will have 1, 2, 3, or all five of the root causes that are affecting their fatigue. And/or they will have a few of the core health foundations that really need to be addressed that will massively move the condition for that patient.

Dr. Ruscio, DC:

I love this framework. This is one of the things that, of course, conventional medicine doesn’t tend to do super well. They’re very rigorous and accurate, oftentimes, in the diagnostic criteria. So we can say it’s this disease versus that disease or this subset of a disease. And that is clearly helpful and has a time and a place, but it tends to also lead to, well, here’s the two or three drugs. And maybe you get a doctor who’s a little bit more well versed and they’ll think about things like sleep or stress, but there’s not usually this real depth of “we’re going to look at a framework of causality,” or just make sure that, as we see in the clinic as one example, all the time you’ll see pain and brain fog and fatigue coming from someone’s gut. So that’s just one thing that there’s not necessarily a drug for, this gut-induced subset of chronic fatigue syndrome. And so, yeah, I just really love that approach.

Dr. Jennifer Tufenkian:

Right? Yeah. And I think that the I too really love the diagnostic skills of conventional medicine and we benefit from that brilliance and that reductionist thinking. We all benefit from that, yet when you have a complex chronic condition, it’s been tragic to see how that thinking just excludes all these people from really feeling validated in their experience of having this chronic disease, of having chronic fatigue, of having chronic pain, of having brain fog, because it doesn’t fit into the neat little diagnostic box. And there’s not a test for chronic fatigue. There’s not even agreed upon series of symptoms internationally for it. And so a lot of people get dismissed, because, again, it doesn’t fit in the system. And I’m saying, okay, maybe the system needs to change so that we can really understand what’s happening with people and get them to a higher level of health.

Dr. Ruscio, DC:

Right. And especially when you slap on a label like “myalgic encephalomyelitis,” it sounds like, “Ooh, this seems like something that may need a special treatment, a special drug, a special diagnosis.” But a lot of the people who have been labeled as that will likely improve from treatments that aren’t necessarily sanctioned underneath that condition. So even even more reason for us to think broadly. And also, I think we’re both on the same page. I don’t know this for a fact, but just getting to know you here I’m assuming that you’re not against a certain medication, but you’re looking at that as more ofa palliative support rather than something that’s the furthest upstream that we might be able to intervene.

Dr. Jennifer Tufenkian:

I see it as a bridge. That’s usually a bridge. I mean, absolutely, if there’s a medication that’s going to support somebody, I’m a hundred percent down for that if that’s the best option for them. Whether it’s what their body resonates with the most or whether it’s the best financial option for them, totally, but it’s a bridge for sure. Because really the ideal goal is to get the body back into balance.

Dr. Ruscio, DC:

Now coming to the diagnostic criteria for a moment, I’ve never found it to be incredibly informative. Again, because I am more thinking on the level of what is it that’s driving this individual’s symptoms and there’s a level at which, at least for me in my perspective, knowing more about the diagnosis does not tell me anymore about the treatment. In fact, I would argue it’s antithetical to being better at treatment because now you’re occupying more of your bandwidth toward checking all the boxes and not necessarily thinking about, “well, what am I going to do to help this person?” So for me, getting into the nitty gritty of, well, does this person technically have or not have chronic fatigue syndrome, has been less interesting, less helpful. But do you think there’s anything here that is important to keep in mind for delineating someone with chronic fatigue?

Dr. Jennifer Tufenkian:

You can’t see me because we’re not doing video, but I’m totally smiling as you’re saying this because I a thousand percent relate to that. There’s a lot of nitpicking about “is this chronic figure or is that,” and I don’t feel like it serves a lot. I think the only benefit of it…the benefits actually a two-edged sword. I think the benefit is for people who have been struggling with mystery illness, it can be helpful at times to feel validated, to have a label put on their thing and to be acknowledged like, yes, you do have this thing. But then that’s a double-edged sword, right? Because then people can take it as a badge of honor and it’s easy to get stuck in a victim stance of like, “oh, well I have chronic fatigue or I have ME or I have fibromyalgia,” and they can get stuck in that identity. Which I think can block healing on some level for some people. And so I think it’s one of those things that I’m aware of the importance of on one level, but I don’t want to get too attached with a name because my goal is to get people living their fullest most vital life they can.

Dr. Ruscio, DC:

Yeah. Fully agreed. And especially when it comes to…There’s a certain, I guess you would say, personality type that will really wrap their hands around and grip a diagnosis, which is why I progressively try to use terms that are not pathological in their framing. For that very reason that ties in with limbic, which is I know something we’ll probably touch on.

Dr. Jennifer Tufenkian:

Exactly. I was just going to say that’s totally a limbic brain thing, absolutely. Love that. Yeah.

Dr. Ruscio, DC:

Tell us about the, you said multifactorial, you said five. I’m not sure if you meant five literallyor five is a starting point, but tell us about what you’re looking at in terms of what underlies this chronic fatigue.

Dr. Jennifer Tufenkian:

Sure. So when I say there are four health foundations and five root causes, I see the four health foundations as being what are essential for every single person to experience better health. So whether somebody’s in really great health and they just want to go to the next level or somebody is sick or want to avoid illness, it’s all the same. It’s the health foundations. And these won’t be strange to you or your listeners. I’ve talked with many other holistic practitioners and we all seem to have our own little system. So mine is digestion/detoxification is one, and movement and breath is another one, and rhythm and sleep is another one, and then mindset and spirit. And I see those as being the pillars of all good health. And any treatment you’re doing, any medication is going to work better if somebody is looking at those.

Dr. Jennifer Tufenkian:

And I find it helpful to think about this as a practitioner. Because when a patient comes to me with a whole host of complaints and conditions and things that are going on and I can see the 20 things that they could do to get better, but I know that that’s too much and too overwhelming on day one, right? That’s the mistake we all make when we’re our first year out. 20 years into this, I can see that it’s a lot easier if I can say, “let’s just focus on this one foundation. This is the one foundation that’s going to be the most important, it’s your sleep or it’s your digestion, detoxification,” whatever it is. And that can be really helpful for the patient and the practitioner to simplify what can feel really overwhelming in the first couple of visits.

Dr. Jennifer Tufenkian:

And I have to say, I’m actually, because of the experience of the pandemic and seeing how much people suffered from disconnection, I’m actually feeling like I’m shifting that model to adding a fifth pillar that permeates all of them. And I call it connection. And it’s connection to others because we’re social animals. And it’s also connection to ourselves. And it’s also a connection to our full being, our highest self on all levels. But I’m sort of playing with that model.

Dr. Jennifer Tufenkian:

But in terms of the five root causes, I actually do literally mean five root causes. This came out of my experience of being very, very sick with this twice. And the second time I was 17 years into my medical practice. And I really couldn’t just lie in bed for a few months without taking my family down into bankruptcy, literally. And I did a lot of research. Like I couldn’t sleep because I was in severe pain and I just stayed up at night and I researched and I ended up having this experience where my clinic got flooded with patients. And I began to see that there were multiple root causes and they had specific patterns and there were certain questions I could ask people in clinic to begin to lead down my differential diagnosis as to which root cause was affecting them.

Dr. Jennifer Tufenkian:

And so there are five root causes. And I’m seeing those also in long COVID, with patients who have long COVID or long hauler syndrome.

Dr. Ruscio, DC:

Yeah. Let’s go into those.

Dr. Jennifer Tufenkian:

Sure. So one is chronic viral infection. So, sort of a no duh, you have long COVID. But a lot of people have chronic viral infections going on. Another one can be mitochondrial dysfunction. Another one can be toxic overload. And another one can be [a] limbic or emotional sort of trauma piece. And another one is what I would call an imbalance in what we call the “hormone triangle”. So the ovary, testes, or an adrenal or HPA access, and thyroid. So that whole system. And I call that the gateway root cause because that’s like the stress. We’re all under so much stress, that’s the gateway root cause that often makes people really susceptible to reactivate the chronic infection that they have or to make it so that they’re not detoxifying as well and their toxic overload becomes so much.

Dr. Ruscio, DC:

Well, you make a lot of great points. Coming back to the COVID for a moment. This is something that Leonard Winestock, who’s a conventional gastroenterologist. He’s published a lot of great research. I really respect his opinion and his perspective on most things but we did get into this back and forth on his perspective regarding long haul COVID and mast cell activation syndrome. And I think we were maybe seeing the same problem, but looking at it from different vantage points where, and I’m not saying one is right or wrong, but the vantages as I’ll paint them would be Leonard might be seeing a higher predilection toward mass cell-like symptoms in those who have long COVID. And he may have even cited biopsy data that correlates a higher density of mass cell.

Dr. Ruscio, DC:

I mean, this is true. And I think helpful and interesting, but somewhat reductionistic finding. Whereas the way I’ve been framing it is, well, maybe we’re just seeing that people who are most amenable to being sedentary, being inside, having less connection, presumably eating out more, and therefore seeing metabolic arrangement go up to a degree or gut health regress to a degree from eating out. And so you could say that in a grouping of the population who are exposed to those variables, those with a different, let’s say, density of mass cells will develop long haul COVID, but it doesn’t necessarily tell us the best way to remedy that. And so that’s where I think we have a similar perspective on how we frame things.

Dr. Ruscio, DC:

Which is okay, just like maybe another cohort, if we all went to to Mars and Elon Musk got his way, maybe there are some people there with a certain genetic variation that makes them have bone loss at an accelerated rate. And the key I think, would be trying to change the environment or have the environment be one that’s befiting to the individual. And not necessarily say, “well, what drug most targets the mass cells,” even though I think that’s something that’s a good idea for end phase. But if you use the end phase medications without getting the foundations in place, you usually don’t have the response that you would like. And we see this at the clinic, people who’ve gone to see very well regarded MCAS specialisst and obtained some relief, which is great, but came away feeling like, “I just don’t feel like I’ve really gotten to the cause of this. I don’t feel like I’m feeling as healthy as I should.”

Dr. Jennifer Tufenkian:

Yeah. A hundred percent. Yeah. So I’m totally about looking at the root cause and I’m, I just have been seeing a lot more mass cell activation even before COVID 19 hit the scene. Right. I don’t know about you, but I remember when I was way back in clinic in the nineties, it was really unusual to see somebody with the mass cell activation disorder. I remember somebody who did come into the student clinic I was in, who had it. And she was up at OHSU and spent a lot of time with specialists and we’re trying to figure out what’s going on with her. And now it’s very, very common. We all see it all the time. And I think so I think it could be a chicken and egg question for sure.

Dr. Jennifer Tufenkian:

But addressing the root cause of mass cell activation is key. And it’s not, as you say, just treating with a drug for the end use. I think that there’s a lot of really interesting…Stanley Yannick did some really great research papers looking at brain inflammation and brain fog and the relationship of high histamine levels and how with leaky gut, you also have leaky brain and you’re getting this chronic inflammatory cycle going on in the brain. And the thing is that when the brain is inflamed, it doesn’t shut off in the same way that say, when you sprain your ankle and you have a shutdown system. It doesn’t shut off. It keeps going unless you stop that cycle in a different way. And this is part of this high histamine situation that we’re seeing. And I really think that’s the root of a lot of the brain fog that we’re seeing with people with long haulers and people with chronic fatigue syndrome is partly due to this. And I think addressing mass cell reactivation from its root, looking at the gut, and using the host of natural remedies that we have to stabilize mass cells and to get that inflammation down is […] a really great way to go

Dr. Ruscio, DC:

Yeah. A hundred percent. And as someone who was histamine intolerant, brain fog, midday fatigue, those are some of the most chief symptoms that I grappled with. And the framework that you outline is where I found most of the relief to the symptoms that I have. So fully with you there.

Dr. Ruscio, DC:

Let me ask you one question, just coming back to your foundations model with sleep. We’ve been sniffing out more apnea cases at the clinic, and this is something that it’s a little bit early for me to say because as you can imagine, it takes quite a bit of time to really see a number of patients with different presentations and get a handle on, okay, the historical findings might flag at a mild, moderate, severe level that correlates with the home sleep test finding of a mild, moderate, severe level, and you see enough patients and you do therapy, you have a varying level of compliance with the therapy, you have a varying amount of other things going on…

Dr. Ruscio, DC:

So it takes at least I think, six months to start getting a read. Little early for me to say, but encouraged from what we are seeing thus far in people having untreated apneas, that can be one component to this. Of course it would be secondary to just getting the basics of healthy sleep down. But once thoses are out of the way, then the health of the airway definitely is important to make sure is not overlooked. Are you seeing any relationship or in the research, any relationship between apnea, chronic fatigue, long haul COVID?

Dr. Jennifer Tufenkian:

I think that I’m with you in terms of apnea is one of those things that I’m seeing more of and truthfully it’s an economic thing, right? Because it used to be, what, thousands of dollars for somebody to go in and get a sleep study done 10 years ago? And now we can do the home studies for less. So it’s easier to have more patients do home studies that can afford it. And therefore I’m seeing more in the clinic. I mean, I think that’s just the…I don’t know what your experience is, but I think that’s my experience. And I see it more and I do, definitely. It’s one of the things you need to rule out. I think, to be fully honest, I think I downplayed sleep apnea years ago, a long time ago in clinic around people who had chronic fatigue.

Dr. Jennifer Tufenkian:

And I only thought that people who really had massive snoring events and were gasping in the nighttime had apnea. And now I think there’s a lot of sleep apnea that is undiagnosed, especially in women. And interestingly enough, I don’t know if you read the book “Breathe”, but I didn’t realize this, but we’re changing due to our eating habits over centuries. Our whole facial structure is changing and making us more vulnerable to sleep apnea and osteoporosis also can make it so that you’re more vulnerable to sleep apnea. So there’s a lot of women, I think, who just maybe snore a little bit and have a low level sleep apnea. And I think it’s really important to get that looked at and then to get it addressed. When you say treating, are you doing CPAP machines or do you have other protocols?

Dr. Ruscio, DC:

There’s actuallya wonderful array of therapies that range through cell phone apps or breathing resistance devices that cost respectively $5 or $55, all the way up through mandibular advancement or E stem. So we’ve been uncovering a bunch of these as we’ve been following the research literature. And that’s what’s so exciting about it is there’s these other options that are much more palatable.

Dr. Jennifer Tufenkian:

Yeah. I love that. And that excites me too. And I love looking at those. And when you start looking at, so to loop back to the vagus nerve and vagal tone, and how do we improve a tone and does that help? And what if we are practicing breathing in a different way in the daytime, does that impact how we sleep/breathe at nighttime? And there’s a lot that we can uncover and look at here.

Dr. Ruscio, DC:

Coming over to viral infections for a moment. This is something that it’s been a challenge for me. And let me frame this in the sense that I’m very appreciative of the field, it literally diverted my path to where, who knows where I would’ve been if I didn’t find the ameba that was causing massive problems in my gut while being silent in terms of its gastrointestinal manifestations. It was killing me slowly regarding cognition, mood, sleep. So very grateful. But I’ve also noticed that there’s all this diagnostic conjecture and viral testing is one area that there’s just so much inconsistency in terms of, let’s say Epstein barr as one example. You’ll read three different research papers and they have three different criteria for how they’re identifying someone as positive for EBV. So what viruses do you think are relevant? What testing are you using? How reliable do you think the testing is?

Dr. Jennifer Tufenkian:

Okay. So the way that I talk about viral testing…Totally agree with you. The way I talk about viral testing is, frankly, we dropped out of doing a lot of research on viruses for the last century and we’re picking it up now, obviously, which is great. So I think our viral testing is not that awesome. And what I always say is it’s a bit like reading tea leaves and there’s a lot of art to listening to the patient and so that you can identify what the patient is saying, and then look at the labs as well, and make a…It’s definitely still in the art of medicine is what I would say. What I say about viral testing and viruses is there are many, many viruses out there that we don’t even have names of yet. I mean, there are things out there that aren’t even necessarily named. And then of those that have names, we have tests for just a few of the ones that actually of the viruses that have names. We have tests for only a few of those. And those that we have excellent tests for are zero. And the one that we have the best test for is EBV in terms of testing for latent chronic viral infection.

Dr. Jennifer Tufenkian:

And so I think that we are still in really not exactly the dark ages, but close, early industrial stage in terms of how it is that we look at viruses. And for a number of reasons, one is that they hang out in the mitochondria often. Often they’re in there in a latent infection. And it’s really hard to test because how are you going to get in there without affecting, without killing the cell? I mean, it’s just a very tricky thing to test. And I think now really brilliant people are beginning to figure out different ways of looking at that. And I really expect in the next 5-10 years, we’re going to have a lot more better understanding of how to do this. But for right now I think it is challenging.

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Dr. Ruscio, DC:

How often are you finding that direct antivirals are needed as compared to maybe more of a supporting the person? This is like the germ terrain theory. How often do you find direct antivirals, as compared to let’s say terrain support, is key or crucial.

Dr. Jennifer Tufenkian:

I a hundred percent do both. I don’t think you can have one without the other. If you just treat with antivirals it’s going to come back. If you just treat with antivirals and you don’t do the dossier, you don’t teach the patient to understand what are their triggers and how it can easily come back, it’s going to come back. And so you’ve got to do the terrain and you’ve got to have the patient understand the importance of that. And for them to understand when they’re vulnerable for a reinfection to come back.

Dr. Jennifer Tufenkian:

And then I also find antivirals are amazing. Really super helpful. […] But I also find a combination. It’s not just one thing. Like I use botanicals, I use aminos, I use homeopathics, I use pharmaceuticals, and I’m really looking for the combination that works best for the patient or having the patient figure out what’s best for them. And I do find that we’re a lot more effective if we do a couple of things. It’s like, if you just do Valcyclovir, that can be helpful, but it’s just one note in a symphony. And I find whenever you’re killing critters—like I’m sure you found this when you were attacking your ameba—that critters do better if you’re hitting them with multiple things at once and you keep them guessing so they really don’t have a chance to stay active.

Dr. Ruscio, DC:

Sure. Yeah. Yeah. And this is why with our antimicrobial protocol, I’ve leaned in the direction of using multi ingredient formulas, and then using a couple different ones rather than just a high dose of burberine or what have you.

Dr. Jennifer Tufenkian:

Right. Exactly. It’s the symphony thing, right? Totally. Or rotating days works really well too. I don’t do that so much with chronic viral infections, but I do it a lot with gut bugs. I find rotating, it’s like one day it’s garlic, another day it’s Burberus, another day it’s some essential oils or something like that. And I find that works really well for people to get rid of some of those hard ones to get rid of.

Dr. Ruscio, DC:

Some of the treatments for the viruses, some of the natural antivirals are also antimicrobial, antihistamine. So that’s another thing that I’ve ruminated on in that the response rate, in my experience, to antivirals was not high. It was much higher to things like GI directed antimicrobial therapy. The signal of response from gut therapies was 5X probably of antiviral therapy. But I was also wondering [if] part of the response I was seeing in that smaller grouping who responded to the antivirals, maybe it’s because of the Reshi or the Quercetin or the Monolaurin having either mass cell stabilizing or antihistamine effect or the antimicrobial component of that. What are your thoughts there?

Dr. Jennifer Tufenkian:

Yeah, I think that’s really interesting. So when you say antiviral component, you’re talking about nutraceuticals, you’re not talking about pharmaceutical, correct?

Dr. Ruscio, DC:

Correct. Yes.

Dr. Jennifer Tufenkian:

Yeah, no, I think that that is very likely one of the things that’s going on. And it’s frankly why I like prefer using botanicals when I can, because they are doing so many things at once. And some of those you can be really intentional about, and some of them may be accidental, like you’re talking about. Going after the virus, but look, maybe we’re actually lowering the histamine at the same time.

Dr. Ruscio, DC:

Sure, sure. Right. Well, I’m with you. And this is one of the nice things about natural medicines, and I believe this framework comes from Chinese medicine, but they say the better drugs have more actions and the weaker drugs have more narrowed actions. And I think conventional medicine looks at things in the opposite light.

Dr. Jennifer Tufenkian:

Isn’t that brilliant?

Dr. Ruscio, DC:

It’s not to say one is right or wrong, but especially with how we’re intervening upstream with agents that don’t have much, if any, side effects in most cases. And having that broad action seems like we were wherever we want to start. And then yeah, if you have a drug that has a side effect, then you would probably want to limit the side effect to the most narrow scope as possible and therefore having the most narrow acting drug.

Dr. Jennifer Tufenkian:

Right, right. Absolutely.

Dr. Ruscio, DC:

With mitochondria we recently had on the podcast, […] Ari Whitten.

Dr. Jennifer Tufenkian:

Oh, great. Yeah.

Dr. Ruscio, DC:

Who really, really appreciate his work and always have a great time chatting with him. And he did a good job of helping me better understand this cell danger response as pertains to mitochondria. And his framework was twofold, which I think is very in alignment with how we are looking at things, which is direct mitochondira support on the one hand, but also intervening upstream to prevent whatever’s causing the cell danger response. Is that how you’re approaching this also?

Dr. Jennifer Tufenkian:

Yes, absolutely. Yes. Yeah. It’s such a…The cell danger response is fascinating and I love how it ties in with the limbic brain as well. It just, it’s very interesting. It makes so much sense of what I see clinically and I love when those theories match up with what we’re seeing in the clinic.

Dr. Ruscio, DC:

Are there any agents for mitochondrial support that you’re finding particularly helpful?

Dr. Jennifer Tufenkian:

So depends on what’s going on with the mitochondria for that patient. What I usually do when I’m working with patients with mitochondria and I’m trying to decide is this a mitochondrial issue or not, is I do a trial of a high dose of D-Ribose. I do a D-Ribose trial along with some Reservatol, some Coq 10, maybe some glycolic acid, and it’s just for a week. And we do the 5g TID D-Ribose. And I see if it makes a difference. If it’s going to make a difference, they’re going to know within a day or two. Or by the end of that week they’re going to be at clinic at five o’clock knocking on the door saying, “I need some more D-Ribose to get through the weekend, please.”

Dr. Jennifer Tufenkian:

And I had this incredible experience doing this on myself when I was trialing on myself many years ago. And that’s great. That that’s how you definitely know that your mitochondria are one of the things that’s really challenged. And you can use D-Ribose as a bridge while you’re doing the deeper healing and getting rid of the viruses that are maybe sabotaging your mitochondria or working on your limbic brain or whatever the other root causes are that are impacting your mitochondria at that time.

Dr. Jennifer Tufenkian:

Now, if that doesn’t work, what does that mean? So does that mean that it’s not the mitochondria? Or does it mean something else? And that’s where you need to go to the next step and say, okay, well, I still think from history, from the patient’s history, meaning that they have post-exertional malais, if I see somebody’s post- exertional malaise, that’s mitochondrial dysfunction. It takes 72 hours for the ATP to reset in an ideal condition situation. Most people aren’t saying, “yeah, I’m exhausted for one day or three days.” So that’s a real clinical sign for me that it’s a mitochondrial issue.

Dr. Jennifer Tufenkian:

So if I ‘m pretty sure they have mitochondrial problem, but they’re not responding to D-Ribose, then my question is, well, is it because the mitochondria is too gummed up? Is there something in there that’s making it so that it can’t take in the D-Ribose to actually function properly? And so that could be the chronic virus that is literally hijacking the glycolysis pathway in the mitochondria and sucking the energy out of the cell. Or it can be a heavy metal. Very common to have mercury and lead, which are perfectly charged, to get in and just get stuck inside the mitochondria and really mess it up and reduce that inner the glutathione reduction pathway in the mitochondria itself.

Dr. Jennifer Tufenkian:

And so my usual next go to clinically is to do a heavy metal test and just to check and see where are your heavy metals? Because that’s what I’ve seen clinically, is it really pretty common is that somebody has too many heavy metals in them. And if we just do a little bit of detox there, then we can get their mitochondria responding in a lot better way. Unless we really think it’s just the viral piece, which is also really common. Then we’re going a little bit more after that.

Dr. Ruscio, DC:

Now this is great, Because this is one of the things I wanted to cue in on on specifically is this post exertional fatigue and what you’re finding there. So knowing that you’re looking at this as a chiefly or most commonly perhaps mitochondrial problem, and if there’s non-responsiveness to mitochondrial support, you’re looking for toxins. Because this is something that in mold exposure cohorts it seems to be more common. And what I’m trying to figure out now is how do we best sequence or synergize all of the foundational stuff plus the mold therapies. And then when do we want to bring on board the mitochondrial support? Tell us more about this, because I’d really be curious to learn from what you found to be the most efficient here.

Dr. Jennifer Tufenkian:

Yeah, sure. Good question. And I should say that when I talk about toxins as being one of the root causes, mold is pretty high on that list of toxins. And I know some people, again, are like, “well mold is not chronic fatigue,” and I’m like, well, mold causes chronic fatigue. So your question is how to sort of, what do you do first? Is that what you’re asking?

Dr. Ruscio, DC:

Yeah. And let me add in one or two other strokes on this. Because there’s this theoretical situation wherein someone can be colonized with mold…And this is something that Joe Mather and I from from our clinic, we’ve gone back and forth on. And it’s not that we’re not open, it’s just that there’s so many theories that don’t really seem to matter. So we tend to interrogate these things and really play devil’s advocate to each other’s points. I mean the entire clinical team does this, but Joe and I, specifically, have been banding this one back and forth.

Dr. Ruscio, DC:

And so the way that we’re looking at this is if someone cannot reduce the amount of urine microtoxins on their urine tests after a reasonable amount of time, let’s say you get to the four to six month mark of detox therapy and they’re just not really able to get a clear test, that tells us that there’s either ongoing exposure. Or if that’s been fairly well situated, then some type of colonization. And it seems to be in this cohort that, at least from the hazy read that we have, that the post exertional fatigue is more common. And so then you get into this world of itraconazole and antimicrobial therapy to try to combat the colonization, this is where things like nasal antimicrobials along with systemic and orally dosed antimicrobials seems to be helpful. But I want to, with his cohort start coadministering mitochondrial support. And Whitten made a great case for his formula. Which I really like, by the way, his Energenisis formula. So those are the things that are at least going through my mind when I ask this question. So I’ll throw those on the table if they help pinpoint your responses at all.

Dr. Jennifer Tufenkian:

Yeah. So I agree if you’re doing detox on somebody, if you’re working on their mycotoxins and they’re not able to clear, then obviously you have to first make sure that there isn’t an ongoing exposure happening. And then you have to say like, why are they so locked up? And I would say I would start treating the mitochondria right away with somebody who has that exposure. I would start treating mitochondria right away in somebody who is super fatigued because you’re going to give them more oomph to be able to actually do the detox. Right.?

Dr. Ruscio, DC:

Sure. That makes sense.

Dr. Jennifer Tufenkian:

And then I also think that, I mean, it depends on when you’re talking with people who are really fatigued. I can’t remember who this was, but they were talking about, it’s really important to make sure that your patient has enough energy to detoxify. I think sometimes we throw patients too quickly into a detoxification process. Those who are really, really, really exhausted and their vital force is so low that they can’t really release and you need to work on raising that vital force. And so whether that is through going back to the basics and making sure you’re just focusing on gut healing or whether it’s really working on HPA access and really working on that.

Dr. Jennifer Tufenkian:

Or do you need to go to their trauma brain? Is it because they’re so exhausted because their cell danger response is just really flaring and their limbic brain is on fire and there’s no way you can do everything you want, but the body is so strong and saying, “it is not safe for me to be here. I am slowing down this whole thing. I’m just shutting it down. And we’re going into hibernation mode because I can tell you for a thousand reasons it’s not safe and we’re not doing anything.” I don’t care what you throw at that body that is strong. That’s a survival instinct. It’s very strong. It’s going to dominate. So I think sometimes when our therapies or our treatments aren’t working, sometimes you have to jump to another. Like do I need to go back to another system? Do I need to go to another root cause and support that instead? And then often I see the body then like, oh look, we worked in the limbic brain and now the detoxification pathways are working and the body can release. It’s like, literally we see this where the liver detoxification pathways function better once the limbics back in balance.

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Dr. Ruscio, DC:

So if you’re finding that, let’s say there’s no suspicion of a viral issue, the detox has been ongoing, limbic has been ongoing. So you’re finding that mitochondria, it sounds like, would be something fairly significant to add into this confection of supports.

Dr. Jennifer Tufenkian:

I would think it would be, but I guess I’m having a hard time answering the question because I can think of so many different unique situations. And I guess what I really want to say is, I think it’s definitely something worth thinking about clinically, if that is the best choice and using that. But if that doesn’t feel like it’s making a difference for that patient, then I think it’s time to take a step back and to look at, like I said, one of the other root causes. And the next one that I would be really, really be looking at is that cell danger response, limbic brain connection. And see if that’s going on.

Dr. Ruscio, DC:

By the way, I’m sorry, not to cut you off. But I’m fully with you there. And I guess the reason why I’m skewing my questioning around the mitochondria is because I think out of all these aspects, you’ve laid out, the mitochondrial support is the one I’ve been the most reluctant to use. And it’s probably just because it’s not been something that’s produced a high clinical signal in the past, but that doesn’t mean it rules it out. I think that means I’ve just gotten and we’ve gotten really good at all of these other things. And we very consistently see responses there. And we may just have needed to have the right presentation for which to use the mitochondrial support.

Dr. Jennifer Tufenkian:

Yeah. I think that’s really true. And I’ve sort of heard that from other clinicians. And I think the same thing happened to me, like many, many, many, many, many years ago around mitochondria. And it just didn’t, I don’t think I didn’t really understand it. I didn’t really understand the complexity of the mitochondria and how it functions and what it responds to. And I didn’t understand, we didn’t even have the science back then to really understand how it interrelates with all these other root causes.

Dr. Jennifer Tufenkian:

And now that I understand that I can see how, how central it is to helping people get their energy and vitality back. And again, it’s not that when the treatment doesn’t work for the mitochondria, instead of us going like, “oh, well, mitochondria stuff’s overblown. I don’t know why it works for Ari. It doesn’t work for me.” Instead going, “oh, wait a second. Why isn’t it working this patient? What else is blocking this from working in this patient? Again, is there a virus that’s stuck in there? Or is it the limbic brain that’s turning on the cell danger response? Or is it toxic overload in the cells what’s blocking the mitochondria from responding to this therapy?” Does that make sense? That’s how I think.

Dr. Ruscio, DC:

Fully, fully. Yeah. I’m fully with you. Yeah. And you were saying that a week is an adequate evaluation period. Can you speak to that a little bit more because this is all something I really appreciate and I try to be so on the lookout to prevent us from falling into, “well I know it’s been a month and you’re taking five different mitochondrial supports, but we got to hang in there, stay with it.” I want to have a high bar and it’s like, okay, here’s an evaluation period. It’s going to be a somewhat binary at the end. You’re [either] better [or] you’re not. And no, if you come in and say, “ah, well I think maybe I’m like 5% better.” No, that’s not a response. And we’re going to move on.

Dr. Jennifer Tufenkian:

Totally. Yeah. Yeah. So here, I’ll tell you my story around my experience with D-Ribose. So I read Sarah Myhill’s book, I actually, I just inhaled it. I ordered it from the UK and I inhaled it and read it like three times, like “help me.” This is when I was super exhausted and I was looking for some answer for myself and she’s all into the mitochondria. And it’s where I learned about this D-Ribose challenge. At that time, I was very exhausted. I could work a few hours in the morning and then I had to go lie down for most of the rest of the afternoon. And Datis Kharrazian was coming to Portland and I was super excited and really wanted to go to his workshop for the weekend. But I realized I couldn’t. I couldn’t even if I had a blanket in the back of the room, I was too tired.

Dr. Jennifer Tufenkian:

Like there’s just no way I had enough energy to be anywhere else, except my clinic for a few hours and home. And I was super bummed, like just bummed. So I didn’t sign up for that workshop. Our family came to town that weekend and as did my D-Ribose. [It] arrived in the mail that same weekend. And so I started taking it. Did the 5g TID thing. I started taking it and my extended family wanted to go up to Mount hood and go hiking. And I was feeling a little bit better on the D-Ribose. And I was like, well, I’ll go, but I’ll just take pillows and blankets and my artwork. And I’ll just lie in the car while they hike and I’ll just go in the drive with them. And so that was my plan, but I got up there and I was like, now I feel like hiking.

Dr. Jennifer Tufenkian:

So I’ll hike a little bit. I ended up hiking three or four miles and I was like, oh man, I’m going to be so trash. I’m going to be like in bed for the next 10 days. Like, what was I doing hiking three or four miles? I went to the back of the car. I felt like a drug addict. And I grabbed my D-Ribose and I took an additional dose thinking maybe this will help. And then we ended up staying up super late, trying to get meals and trying to get food, got home at midnight. And I just knew I was done for.

Dr. Ruscio, DC:

Ob boy, yeah. That’s a big day.

Dr. Jennifer Tufenkian:

Right. Went to bed, woke up the next morning and I felt fine. And that was the Sunday of that weekend. That seven days prior I had, there was no way I could even sit in a hotel room with a blanket in the back of the room, lying down on a mattress, let alone hike and stay up until midnight and all of that. And so for me, I had one of those wild experiences of like, that was night and day to the point where, when we traveled to the United Kingdom to visit family a few months later, I made sure I took my D-Ribose. And when I spilled it on the carpet, I was scooping it up and I ate DRI with…

Dr. Ruscio, DC:

So you were that patient showing up at five o’clock, essentially.

Dr. Jennifer Tufenkian:

I was totally that. And so I started experimenting this with my patients. I’m like, well, I had an amazing experience. And some did and some didn’t. And again, the ones that didn’t, I was like, okay, why not? And that’s when I really discovered this, like, there’s something blocking the mitochondria and the most common thing are heavy metals. And then I’m able to get them to respond to the D-Ribose after that. And that has been my experience. It’s not everybody but it’s worth a trial. And if it works, oh my gosh.

Dr. Jennifer Tufenkian:

If it works, that patient has just gone to this other level where they have more hope and they’re able to do more and they feel more confident and then you’re able to get onto the next thing right. And work on the next piece with them. And it’s pretty exciting when that happens. My experience with just doing mitochondrial supplements from all the varied 10,000 companies that we can buy mitochondrial supplements has not been as dramatic as that. And I also have to be really clear that I do add in other things with the D-Ribose. So, I call it Mito foods. I add in some Reservatol, Alpha-lipoic acid, and Coq 10 along with it. And these are people that we’ve already done health foundations, and they’re already working on their health foundations. I don’t think you can just [start with this]. Yeah. So does that help, does that make sense?

Dr. Ruscio, DC:

That’s very helpful. And you were saying the dose of the D-Ribose, was it five? I forget if it’s dosed in milligrams or grams, but it was five…?

Dr. Jennifer Tufenkian:

Five grams TID. Three times a day.

Dr. Ruscio, DC:

Gotcha. That’s a pretty high dose. Yeah.

Dr. Jennifer Tufenkian:

Yeah. And it’s expensive or it can feel expensive to some. And I would have small pots and big pots of it in my clinic. And I would say take the small pot. You’ll come back for the big pot if you need it.

Dr. Ruscio, DC:

That’s great. And with this synergistic Reservatol, Alpha-lipoic acid, and Coq 10 are [there] standard doses there or?

Dr. Jennifer Tufenkian:

Yeah. Yeah. It’s pretty standard. About a hundred for the Coq10 and Alpha-lipoic acid about the same. Reservatol… Gosh, it depends. There’s so many different respiratory products out there, but sort of standard dose. Yeah.

Dr. Ruscio, DC:

Okay.

Dr. Jennifer Tufenkian:

And that is where I have found it to be helpful. There’s a combination product I have found since then that has a number of those things in it, so that I’m not sending people out with five things. I’m just sending them out with two things and that’s beneficial. So I do think there’s a place for those mitochondrial support products along with the D-Ribose.

Dr. Ruscio, DC:

Yeah. And what’s the product that you’re using for that?

Dr. Jennifer Tufenkian:

It’s one that is called Mito2Max.

Dr. Ruscio, DC:

Mito2max, like Mito…

Dr. Jennifer Tufenkian:

Mito2Max. Yeah. Gotcha.

Dr. Ruscio, DC:

Okay, cool.

Dr. Jennifer Tufenkian:

Yeah, it doesn’t have the Reservatol in it, but it has the other products in it. And I found that to be good enough for the trial. And then if we feel like we’re going to continue supporting, then I add in the Reservatol through another product.

Dr. Ruscio, DC:

Yeah. This is great. Anytime we can test the therapy at a reasonable price at a reasonable amount of time, that’s a huge one. That’s how I feel about the low histamine diet. We recommend a one week trial. At the end of the week it’s either going to be helping or it’s not. And if it’s not, we’re not going to continue to deprive you all those foods.

Dr. Jennifer Tufenkian:

Exactly. It is so easy for all of us to fall into that. Like 50 supplements forever. And like, am I better? I don’t know. […] Which, yeah. And I think that’s the other thing that I really always want to tell people who are struggling with fatigue. A couple things, like one, I always believe there’s hope and we just need to keep knocking on the doors and finding until you find the answer that for your path and what you need. And I also feel like it’s really easy to get stuck in a place where we get stuck under our own glass ceiling. And I always think there’s another level of health for all of us. And it’s just being willing to sort of break through that our own limitations and our belief around it and just be able to go for that. Right?

Dr. Ruscio, DC:

Got to keep reaching. I agree with you.

Dr. Jennifer Tufenkian:

Yeah, exactly.

Dr. Ruscio, DC:

A hundred percent.

Dr. Jennifer Tufenkian:

For sure.

Dr. Ruscio, DC:

Well, Jenny, I feel like we could keep talking here for a while, but I think in respect at your time, anything that you want to lead people with Enlo and will you tell people website or wherever you’d want to point them?

Dr. Jennifer Tufenkian:

Sure. Yeah, absolutely. If people are interested in learning more about my approach to working with people who are dealing with fatigue, check out my website. It’s DrJenniferTufenkian.com. And I have online programs for the general public where I walk you through, how is it that you can address your health foundations? How is it that you can work with your practitioner in terms of discover and covering your root causes? What labs to order, what things to take protocols, all that stuff is in there. And then I also have a program for practitioners where I go through the same process and in the one for practitioners, it’s all in there thick with the research and all of the science behind it, as well as the clinical pearls that I use when I’m in clinic with patients, what is it that I’m listening for? What is it that I tend to see? Where do you start? , where do you go? That’s what I’m really working with with the doctors. So I have those, if, if you’re interested in that and I’m super happy to answer any questions, just please reach out.

Dr. Ruscio, DC:

Awesome, Jenny, great conversation. Thank you so much.

Dr. Jennifer Tufenkian:

Thank you so much for having me. It’s been a real pleasure.

Outro:

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