Spoonie Radio Ep 14: Dr. Jonathan Kerr

In Ep 14, Dr. Kerr describes his recent mitochondrial findings in functional diseases, ways to protect mitochondria, what ME/CFS patients can learn from Weston Price, and the complex pathogenesis of the illness.

FULL TEXT TRANSCRIPT:

Dr. Craig:     Thanks for listening to another episode of Spoonie Radio. I'm your host Dr. Courtney Craig. My guest today is Dr. Dr. Kerr Kerr. Dr. Kerr is joining us today from the Universidad Del Rosario in Bogota, Colombia. He has published extensively on gene expression, infections and inflammation in ME/CFS patients. His prior work has also focused on gene profiling and why post-viral fatigue persists in some subsets of ME/CFS patients. Welcome to the show Dr. Kerr.

Dr. Kerr:      Thank you very much for having me.

Dr. Craig:     So after kind of a brief hiatus from publishing and you also relocated from the UK over to Columbia, I know that your group published a new paper just this year in the Journal Mitochondrion. You found a prevalence of two mitochondrial DNA mutations. Now this isn't a classical CFS paper, although you mentioned CFS, you also mentioned fibromyalgia and some other things. So you called these functional diseases, these mutations are found in functional diseases. So if you can kind of start and tell us what did you mean when you describe functional diseases.

Dr. Kerr:      Well functional is an arbitrary term. It includes certain symptoms which are common to multiple diseases. These symptoms would include pain, nausea, fatigue for example low energy, poor sleep. And basically the idea for this study was not mine. It was Richard Boles who visited from UCLA in Los Angeles and he has a long history in this area. Previously he found that these mutations in the mitochondrial DNA were found in certain syndromes like migraine, cyclic vomiting syndrome, and nonspecific abdominal pain. He wanted to look further to see whether chronic fatigue syndrome patients also exhibited these mutations. We found that they occurred in chronic fatigue syndrome with roughly the same frequency that they occurred in other functional syndromes.

Dr. Craig:     Now are you confident with these results? A lot of mutations we see are just common in the overall population. Is this data strong enough to suggest that this is significant? What do you think the significance of this finding is?

Dr. Kerr:      Well I think it is very interesting. I think it would need to be repeated. The biggest drawback with this study was that we looked only at Haplogroup H mitochondrial, Haplogroup H patients. So this is roughly 30 to 50% of cases and there are many more different mitochondrial Haplogroups and the equivalent mutations in those have not been identified so it is a very complex area. But we do have is a very interesting result which fits with other of these diseases. There were seven diseases looked at in total, chronic fatigue and six others and it's just a very interesting phenomenon given the fact that mitochondrial abnormalities are known to play a role in chronic fatigue syndrome. Even with mitochondrial disease you get abnormalities in the mitochondrial anatomy which has also been documented in chronic fatigue syndrome so it is very interesting.

Your specialty is the diets, the mitochondrial protective diets and these are also known to be beneficial in chronic fatigue syndrome and certain supplements such as coenzyme Q10 and riboflavin which is vitamin B2 are known to improve symptoms in chronic fatigue syndrome. So the different pieces of the puzzle do fit together quite well.

Dr. Craig:     Right. But it's too soon to maybe say: could this be a potential biomarker one day to define these groups of people that may be susceptible to develop functional diseases?

Dr. Kerr:      Possibly one day. The difficulty is the different haplogroups. If this was just a regular somatic snp--single nucleotide polymorphism mutation--then this would not have the same complexity but the fact is that there are all these different haplogroups of mitochondrial DNA which complicate the situation enormously.

Dr. Craig:     Maybe listeners aren't aware of mitochondrial; DNA differs from nuclear DNA in that it is much more vulnerable to mutation. It lacks protective molecules and it doesn't have the same DNA repair mechanisms as nuclear DNA, so mitochondrial DNA mutations are quite common. Which raises the question then, a lot of patients have viral triggers so what's the connection between these chronic viruses? I know you studied quite extensively, parvovirus B-19, how is there a link there with the viral infections in mitochondria?

Dr. Kerr:      Well, the answer is I don't know but for sure…

Dr. Craig:     Neither do I. Right? We are uncertain.

Dr. Kerr:      But it's likely that there are multiple hits involved in generation of a syndromes such as chronic fatigue syndrome. So maybe it's recognized there is a minor genetic component and also there will be lifestyle and the amount of stress that you are under and in addition, what infections you have encountered and what state of stress you are under, when you encounter them. And I think a very big factor which has become recognized recently is the diet that a person is consuming day-to-day. You can make yourself prone to a very inflammatory state by eating the wrong diet, and you can reduce your inflammation and thereby control infections and offset any genetic problems that you may have by eating in the right way.

Dr. Craig:     Yeah, absolutely. I mean that's certainly my forte.

Dr. Kerr:      Absolutely. There are so many problems with the standard as you say American diet, and the standard global diet.

Dr. Craig:     Yeah, it is global now isn't it?

Dr. Kerr:      Yes it is. We all eat the same rubbish basically and too much sugar, too much carbohydrates, too much genetically modified food and too much animals that are fed the wrong food, it's not their natural food such as the genetically modified grains used to feed cows and pigs, for example.

Dr. Craig:     Right and I think the research is a little sparse here but all of these things I think have the potential to promote mitochondrial dysfunction through perhaps mutation of some of the mitochondrial DNA.

Recent study has shown that CFS patients have elevated lactate both in muscle and also in cerebrospinal fluid,which I think is very suggestive of mitochondrial dysfunction in that mitochondria are not effectively utilizing carbohydrates and instead they undergo glycolysis and the waste product of that is lactate. So this is all the more room for a dietary intervention.

Dr. Kerr:      Absolutely, yes indeed.

Dr. Craig:     And then in a recent article that you did on Phoenix Rising, you brought up Dr. Weston Price. So how does that all fit in? Dr. Weston Price and his history, his dietary theories, and mitochondria?

Dr. Kerr:      Well yes. Weston Price was an interesting guy. He was a dentist from Canada who worked near Chicago and he was horrified at the prevalence of dental caries in his patients. And he hypothesized very intelligently that this was linked with consumption of a modern processed food diet particularly sugar and bread. This was in 1938 and when he did his studies, it was obvious to him then that the diet of the region had changed dramatically in the subsequent 40 or 50 years. And so he tried to find evidence for this, traveled the world, he visited different tribes and he found that people who ate an old-fashioned diet--meaning a diet without processed food, grains, and sugar--they had much better dental health than the people who had gone to the cities and were eating bread and sugar among other things of course.

He also found very interesting, that the old-fashioned diet was associated with a very high resistance to developing tuberculosis. He also found that the old-fashioned diet without processed food in pregnant mothers, was associated with much better formation of the hard palate and the teeth and the face. Peoples whose mothers' who ate processed food more often developed cleft palate more than did mothers eating an old-fashioned diet.

He did lots of studies in this way and there were lots of documentary picture of the people on the old-fashioned diet and on the modern processed food diet. So it's really quite a compelling work which really provides a lot of evidence that the processed foods are bad thing for health in multiple ways. And it actually makes good sense. It makes you wonder why dentists and dental education doesn't say don't eat sugar because in my opinion it should.

Dr. Craig:     Yeah and again I think it hones right in on the mitochondria. The mitochondria have to handle all of this food source that we put in. And when we constantly throw carbohydrate at it, we create oxidative stress, we completely stress the mitochondria and have the potential then to set off these mitochondrial DNA mutations or these predispositions that these patients might have.

Dr. Kerr:      Absolutely and in addition to that, sugar itself is a toxin. Especially in its refined form. It's basically an inflammatory molecule which creates an inflammatory state in the body and most people who eat sugar they eat it every day and so this inflammatory state continues for as long as they continue eating the sugar.

Dr. Craig:     Right, it creates a vicious cycle of chronic inflammation systemically and cellular inflammation which damages all these key mitochondria.

Dr. Kerr:      Absolutely. And it's very interesting that recently there is several very high profile studies which re-examine the proposed role, the presumptive role, of saturated fat in coronary artery disease. These studies find no relation between the consumption between saturated fat and atherosclerosis whatsoever. It's more and more thought that sugar may be the culprit.

Dr. Craig:     Yeah, I absolutely believe that and we actually now have governing bodies making changes there, at least here in the US. The USDA is finally slowly coming to their senses in regard to the fear of fat and I look forward to these changes going globally because again going back to the mitochondria, mitochondria definitely prefer to burn fat as fuel. It is much less demanding of cofactors of vitamins and nutrients and it's just less oxidative stress when you have a higher fat diet and less carbohydrates, less sugar.

Dr. Kerr:      Yes indeed, absolutely.

Dr. Craig:     So getting back to your recent paper, the subtitle of this paper is really quite comical. So your paper is subtitled – Are We Describing Different Parts Of An Energy Depleted Elephant? So how did you group try to address that question with the energy depleted elephant?

Dr. Kerr:      This is the idea of Richard Boles who works at UCLA and we have a nice picture there of an elephant. Basically it's supposed to be a metaphor basically a very large animal with different diseases affecting different parts of the body and being attended to by different doctors who don't talk to each other.

Dr. Craig:     And we see that a lot in CFS. It's a multi-system illness. We have gastrointestinal problems so you go see a gastroenterologist. You have neurological problems so you go see a neurologist…you go to see a rheumatologist, you go for immune specialist…but as a clinician are we creating major problem? Are we not seeing the whole picture of the patient?

Dr. Kerr:      Well I think the structure of the modern medicine as you just describe it. If we have one problem we go to one doctor, a different problem to a different doctor. It's useful in one respect and it is basically the most useful in terms of surgery. But in terms of understanding pathogenesis and solving complex problems like chronic fatigue syndrome, it's quite unhelpful.

I know in my own experience in medical school we would go to a rheumatology classes to learn about rheumatological diseases and then we would learn that 30% of patients with rheumatoid arthritis also have atherosclerosis. That seems like an interesting part of rheumatoid arthritis. It was very little known in the day I was in medical school so basically these exceptions always have to be remembered.

But basically every disease, every medical disease is a whole body event. And what's very interesting I think about these chronic diseases is the prodromes of them. Patients who develop rheumatoid arthritis or some other rheumatic diseases, frequently have a prodrome lasting years in which they have a virus infection and it smolders on and they get feverish and they have chills and it lasts for many months and only after a long period of time do they develop joint pain and that's the time at which they go see a rheumatologist and he begins the process of giving them different ant-rheumatism drugs. But basically the pathogenesis of the disease is not understood because that prodrome is not understood and that is what triggers the whole thing.

So I think modern medicine is very helpful in some ways but quite unhelpful in others and this is what this energy dependent elephant is supposed to illustrate.

Dr. Craig:     Right and here I practice under a functional medicine model, I don't know if it is a popular term in the UK or in Colombia but…

Dr. Kerr:      Yes it is. It's a rarely used the term but in this case I think very helpful.

Dr. Craig:     Right, right. You have to look for the whole picture of the patients and appreciate disease as systemic & then look for underlying root causes. The more I am learning and the more I am working with the patients, I keep coming back to mitochondrial dysfunction.

We were talking earlier about mitochondrial dysfunction, the link between that and autoimmunity and I think we are going to see more and more of this coming out and clinicians are going to be forced to kind of think a little a bit differently in order to treat these kinds of patients, these difficult cases.

Dr. Kerr:      Absolutely. And I think one of the biggest areas that modern medicine has is the whole issue of diet. I mean it's been said, I can't remember by whom but: "let medicine be that food and food that medicine" and I think that's a wonderful quote and it is true because it's possible to make ourselves sick with the wrong diet.

Dr. Craig:     Now I know a lot of patients and a lot of listeners of the show do try to eat this unprocessed natural diet and they have different approaches to it. What do you think is going on… You do everything right as far as it goes, they have a perfect diet and they still don't make any budge in their energy meters, no improvement whatsoever, despite this Weston Price-type diet.

Dr. Kerr:      Well there are so many factors in the pathogenesis of any chronic disease and that includes chronic fatigue syndrome so I think there would be psychological stress. I mean, everybody suffers from that. I do myself and I have to rationalize to myself to calm down about certain things and let certain things go because they are not that important etc., etc. So that's something we all struggle with.

And then there is our genetics, our personal relationships – are they supportive, are they not? There is just so many factors and that includes diet and lifestyle – do we drink a lot of coffee? This is something very prevalent in today's society but it's not a helpful thing. So it's a multi-factorial illness and I think there are many avenues to explore even if a person is taking a perfect diet and they still lack energy.

Dr. Craig:     Now in your paper you mention two kinds of defining characteristics of all of these functional diseases. One is mitochondrial dysfunction, which we discussed already. The other one is autonomic dysfunction. So what is the connection there or is it a chicken or the egg kind of thing?

Dr. Kerr:      Well basically the mutations that we find are the 16519 polymorphism; is in a controlled region involving the mitochondrial DNA replication and the 3010 is in the 16S ribosomal RNA gene.

So the mechanism of their influence on health is not entirely clear but it suggested that there could be some abnormality in bodily function. And for all we know, chronic fatigue syndrome has different autonomic abnormalities that fits quite well with mitochondrial dysfunction because mitochondrial disease tends to involve a lack of energy and autonomic dysfunction so we have both of these in chronic fatigue syndrome. The problem is that it's multifactorial and it is difficult to know what comes first. So it could be that you have a poor diet or a state of inflammation which favors mitochondria polymorphisms, mutations or it could be that we have inherited those polymorphisms which then makes us more likely to handle the modern diet in a way that results in disease.

Dr. Craig:     You have been in this field for a long time now and there is a lot of new research coming out within the past five years or so. Is there anything that has really stuck out with you in the ME/CFS research field that you would like to see more investigation, something that caught your eye as of late?

Dr. Kerr:      Well, I think I would like to see less rubbish psychiatry and I think that's become more and more prevalent. I mean, the theories that they have for why people do not respond to the exercise treatments I think are quite ridiculous and I would like to see less of that.

I would also like to see more research in the mitochondrial area. I think the evidence for a mitochondrial abnormality extends back for a very long time and there are multiple pieces of the jigsaw which have become slowly apparent over the years and it does fit with the clinical presentation of the disease and I think that it is very likely this plays an important role in the pathogenesis of chronic fatigue syndrome.

Dr. Craig:     Yes, that is something I would love to see as well but as we all know research funding for this illness is hard to come by.

Dr. Kerr:      Yes it is.

Dr. Craig:     So is there anything you are working on now that you could speak about?

Dr. Kerr:      Well, we have a project going in Colombia. The situation in Colombia is quite different to that in the developed world.

Here there are a lot of unfortunate people that have to do very bad jobs, dangerous jobs where they are exposed to different toxins or problems or dust or whatever and they have a very poor health as a result of that. One of the studies we have is studying agricultural workers in the country and their exposure to pesticides and from previous studies from the University here. It is being shown that exposure to pesticides can trigger a chronic fatigue syndrome-like disease. And obviously this is known already; studies from England, studies from other parts of the world are showing the same thing. So we have a study going on agricultural workers in different parts of Columbia at the moment but no results as yet.

Dr. Craig:     Interesting. Is that looking particularly at glyphosphate?

Dr. Kerr:      Well there are different cocktails that are used but basically growth of rice and potatoes needs a lot of pesticides and needless to say these are genetically modified rice and potatoes basically foods with negligible nutritional value, they need the most pesticides to grow so different cocktails are used in each. It's very interesting. It's a scandal really that people are exposed to these pesticides in this way without proper protective equipment because that's the way it is here.

Dr. Craig:     Is there any interest in ME/CFS research in South America? Is there any research groups working in that area?

Dr. Kerr:      Well not directly but there are clinics where chronic fatigue syndrome patients are seen and fibromyalgia patients and others from pain clinics and neurological clinics so it is possible to study chronic fatigue syndrome here although it's definitely not as easy as it was in the United Kingdom.

Dr. Craig:     And that's one thing I would say in general about the research, I think it's a little biased and it's mainly looking at Caucasian populations and female populations and it doesn't take into account minorities and how we might have different subsets in different types of people.

Dr. Kerr:      Well absolutely. That's a very good point and as we know it's a heterogeneous disease so one person with chronic fatigue syndrome will have a different spectrum of factors active in the pathogenesis of their disease than with another person and because they are triggered by different viruses, they have different lifestyles, they have different belts, they have different genes so that's a very good point.

Dr. Craig:     Yeah, and that is something you've also done some work on is the gene profiling, trying to figure out these different subsets. Any more insights on that with new information or ways that maybe we can identify these groups?

Dr. Kerr:      I think part of the problem is that chronic fatigue syndrome has been lumped together into what they have tried to make a single disease. It's got a lot of heterogeneity, it's not a single disease and I think this is one of the reasons we have difficulty studying it because propaganda tells us it's a single disease.

And to some extent that's necessary because we need to all get together as researchers and doctors to study the disease but we should also remember that it is heterogeneous and for example there is the group triggered by one set of factors or one infection and then a group triggered by different infection and then another group which is more of a pesticide triggered group and the group's other factors can't be identified. And we do know that antibiotics and antiviral drugs can help but it's all about selecting the patients for the use of the individual drugs.

Dr. Craig:     Right, right antivirals don't work for everybody.

Dr. Kerr:      Exactly, exactly.

Dr. Craig:     Okay. This is obviously further complicated with the diagnostic criteria and the constant battle between how do we diagnose this illness. It makes for a very messy research and the more complicated patient care I think.

Dr. Kerr:      Yes it does, it has muddied the water and quite considerably.

Dr. Craig:     Right, right so instead for many years we are trying to find the virus, hunters looking for this virus that triggers the illness I think maybe instead--and you talk about this in your paper--we need to instead, classify these as not infectious diseases but as mitosomatic diseases.  I love how you coin that in this paper. So what are we talking about when we talk about mitosomatic disease? Instead of maybe infectious or even psychosomatic, which is a terrible word associated with ME/CFS?

Dr. Kerr:      Yes, yes it is. Well mitosomatic will be abnormalities in the mitochondria which result in partial disability of their function resulting somatic symptoms. I think this paper looks at the mitochondrial angle but within an individual, there are multiple factors in pathogenesis and I think they all interact.

I think you mentioned we are always looking for the virus that causes this disease, it's very unlikely and it is my belief that these chronic autoimmune diseases which include CFS because there are autoimmune features of it, are caused by multiple viruses and it's not realistic to expect to find a single virus or a single pathogenic factor that accounts for most because they are all multifactorial, there are multiple viruses and it's rather difficult to talk to people about it sometimes because it's always assumed that there would be a single virus discovered at some time in the future which will then explain all of the causes of one particular disease or another.

Dr. Craig:     Right, right and that's naïve thinking. I don't like to say it that way but a lot of patients would really love to have that answer, one answer, one easy answer and one solution and so far we haven't seen that and I don't think we will because these illnesses are so complex, they are so multifactorial, the solution, the cause is more than one, the solution is also going to be more than one factor.

Dr. Kerr:      Yes indeed and then the patients have had a hard time and it's understandable that they would wish for a breakthrough that will validate their suffering and their disease and make it a legitimate one which is something that CFS patients have to struggle with. But nonetheless I think there are great breakthroughs to be had in accepting the situation as it is working with it as best we can because there are lots of supplements which we take and there are dietary modifications for mitochondrial aspects.

For the virus aspect, if we can identify which virus triggered our chronic fatigue syndrome, which is difficult, but if we can do it we can use a specific treatment. And if we are conscious of ourselves and aware of certain things that make us stressed we can manage stuff better so I think there is multiple ways in which CFS patients could effectively manage their illnesses and it would be a proper management.

Basically there is this illusion that the management of other diseases such as rheumatoid arthritis and multiple sclerosis is much better than the management of chronic fatigue syndrome. Well it is and it isn't. In one way these other diseases have a better image but in another way we don't have cures so it's just juggling of drugs really for a lot of these diseases and they could be managed better in terms of diet, viral infection as well. So I think in some ways the CFS patients are in the same place as these other diseases.

Dr. Craig:     Right. That's a really hopeful message actually to end our interview here, we are about time. So I think there are definitely some solutions the more pieces of the puzzle that we put together. So thank you so much Dr. Kerr for taking time to do this interview today and I look forward to seeing some more work published in the coming months and years.

Dr. Kerr:      My pleasure. Thank you very much for having me Dr. Craig.

Dr. Craig:     Okay that wraps up another episode of Spoonie Radio. If you like the show, be sure to go over on to iTunes I would appreciate it if you would rate and review the show and don't forget to subscribe so you never miss an episode. This is Spoonie Radio signing off.