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1
5 Steps to RegainingYour Health!
by Jon D. Kaiser, M.D.
Fibro& Fatigue
A Healing Program
for
2
To my patients,
who make it possible for me to fulfill my life’s purpose.
_______________________
Copyright © 2019 by Jon D. Kaiser, M.D.
You have my permission to share this E-book (in unaltered form)
with anyone whom you think it may benefit.
Dr. Jon Kaiser is available for in-person and telemedicine consultations.
Information on scheduling a consultation can be obtained
by visiting his website at:
JonKaiser.com
_______________________
The information in this book is based on the accumulated knowledge
of over 30 years of research and experience by the author. It is not
intended to diagnose, treat, cure or prevent any disease or be a
substitute for informed medical advice. Please consult a doctor with
any questions or concerns you may have regarding your health.
book design by Ray Lobato, raydesign.com
60
Healing Program Summary
Nutrition• Stay well hydrated
• Eat 3-4 small to moderate meals per day, avoid snacking be-
tween them, and do not eat anything substantial for 2 hours
before going to bed
• Eat a natural and minimally processed diet:
Treatment phase: Paleo or Modified Paleo Diet
Maintenance phase: Mediterranean Diet
Micronutrients & Botanicals • Optimally support the mitochondria with key antioxidants
• Optimally support the gut with probiotics and digestive enzymes
• Optimally support the neuroendocrine system with adaptogenic
herbs
Hormones • Thyroid (T3 & T4) – test and optimize levels
• Testosterone – test and optimize levels
• Cortisol – test and optimize levels
• DHEA – test and optimize levels
Medications • Adequate pain control
• Sufficient mental alertness
• Deep restorative sleep
Mind-Body Techniques • Strategic pacing
• Healing time
• Loving yourself
3
Introduction ................................................4
Nutrition......................................................8
Micronutrients & Botanicals.....................20
Medications ...............................................33
Hormones ..................................................43
Mind-Body Techniques..............................52
Conclusion .................................................59
Healing Program Summary ......................60
Biography ..................................................61
4
Introduction
Throughout this book I will use the term Fibro & Fatigue to refer
to the properly diagnosed conditions of fibromyalgia and chronic
fatigue syndrome. These conditions have specific diagnostic criteria
and should be assessed by an experienced physician.
Hello. My name is Dr. Jon Kaiser. I have been treating people with
chronic medical conditions for over 30 years utilizing a combination of
natural and conventional medicine. The majority of the conditions I’ve
treated include fibromyalgia, chronic fatigue syndrome, HIV/AIDS and
neurodegenerative disorders. By following this comprehensive healing
program, most of my patients have stabilized, improved and restored
themselves back to excellent health. For many years I personally
experienced chronic fatigue syndrome and chronic pain before I was
able to completely recover utilizing the program I will describe to
you below.
My philosophy has always been to make maximal use of natural heal-
ing methods (i.e. diet, supplements, exercise, yoga, etc.) before pre-
scribing pharmaceutical medications. However, being on the front
lines of the AIDS epidemic for over 2 decades taught me to value
everything in my toolbox, including prescription drugs. The most im-
portant thing about prescription drugs is to use them skillfully and in
the lowest possible dosages.
One thing I can definitely state is true:
The best possible health outcomes result from
skillfully combining natural and standard medical
therapies into a comprehensive healing program.
5
Conventional medicine is not equipped to properly treat complex,
multisystem conditions. What is needed is a holistic approach, one
that supports all the systems of your body. This approach is termed
“functional medicine”. Functional medicine addresses the underlying
causes of disease, using a systems-oriented approach. It is an approach
that has great advantages when treating a patient with a chronic,
degenerative medical condition.
I have divided this booklet into 5 sections:
• Nutrition
• Micronutrients & Botanicals
• Hormones
• Medications
• Mind-Body Techniques
My goal is to empower you so you can put in place a strong founda-
tion for your healing program. Your healing program needs to focus
on stimulating your body’s innate healing capabilities so the root
cause(s) of your condition can be addressed and repaired. Some of
these root causes may include chronic inflammation, hormone
imbalances and mitochondrial dysfunction.
In order to best understand the recommendations in this book, it is
crucial that you understand the role played by the mitochondria, the
powerhouses of your cells. Every cell of your body (except mature red
blood cells) contains 500-1500 mitochondria that occupy 30-40% of
the cell’s volume. They burn the fuel we eat, namely carbohydrates
and fats, and turn it into chemical energy that helps every cell of your
body perform work and operate properly. If your mitochondria
6
become unhealthy, your cells will no longer function properly and will
begin to break down. This state of energy overload damages your cells
via an excessive release of free radicals (toxic byproducts of energy
metabolism), ultimately leading to chronic inflammation and a vicious
cycle of tissue damage, chronic pain and chronic fatigue.
Mitochondria have their own genes. While the genes in the nucleus
of the cell are protected by a membrane and shielded from damage
by protective proteins, mitochondrial genes float freely within the
mitochondrial matrix and are completely unprotected. When oxidative
stress in the mitochondria rises above a certain threshold, toxic free
radicals can damage mitochondrial genes leading to the occurrence
of mutations. A progressive buildup of these mitochondrial gene
mutations leads to a less healthy mitochondrial population and, ulti-
mately, a shortfall in energy production throughout your entire body.
As I will describe below, a key component of the Fibro & Fatigue
healing program includes putting in place a micronutrient supplement
program designed to optimally support your mitochondria’s ability
to repair themselves and return to generating optimal energy. The
specific micronutrients comprising this supplement program have
been identified and tested over my 30 years of clinical experience.
They are not prescribed to correct dietary deficiencies but to deliver
therapeutic dosages of key nutrient molecules known to decrease
oxidative stress and support mitochondrial function in all of your cells.
In her book on treating chronic fatigue syndrome, my colleague
Dr. Sarah Myhill states, “Putting together a healing program is a little
bit like building a house – there is no point in putting in the windows
until the foundation and walls are in place. Many patients come to me
7
after having tried thyroid hormone, nutritional supplements or similar,
but unless the appropriate diet, sleep, pacing and micronutrients are
in place and correct, they may not see any benefit.”
Dr. Myhill and I share very similar treatment philosophies. All of the
pieces of your healing program need to be put in place skillfully and
in the right combination. Dr. Myhill and I also strongly agree on the
importance of supporting the mitochondria when it comes to treating
and overcoming both fibromyalgia and chronic fatigue syndrome.
I am very confident that, by following this program to the best of your
ability, you will improve how you feel. Take a couple of steps today.
Improve your diet and start on the right nutritional supplements. Get
your key hormone levels checked, pace yourself better, and work to
lower your stress level. Put in place as many pieces to the program as
possible. Once you begin to improve, you will be further motivated to
continue implementing your Fibro & Fatigue healing program. Better
health is in your future!
Keep Hope Alive!
Jon D. Kaiser, MDClinical Faculty, Dept. of MedicineUniversity of California Medical School, San FranciscoChief Medical OfficerK-PAX Pharmaceuticals
8
Chapter 1 - Nutrition
“Let thy food be thy medicine
and they medicine be thy food.”
- Hippocrates
Eating is something you do several times a day. Everything you put in
your mouth contributes to how you feel and whether your healing
program is moving in the right direction - or not. Your dietary choices
form the foundation of your healing program.
There is no shortage of controversy when it comes to what constitutes
a healthy diet. There is also no single “best” diet for a human being.
In fact, some people respond in metabolically diverse ways to the
exact same food. However, I would like to present some basic dietary
principles that I have found strongly support the healing of patients
with Fibro & Fatigue.
Principle #1 – Stay well hydrated.
Begin drinking clean, filtered water the moment you awaken (at least
8 ounces) and continue drinking it throughout the day. Try to consume
at least 1.5-2 liters of water per day. Carry around a water bottle that’s
made from non-BPA plastic. It is also important to consume salt every
day. This will help you retain the water you drink and keep your blood
pressure at an optimal level. Most people with Fibro & Fatigue have
low blood pressure. This can contribute to your feeling dizzy, foggy
and tired. Check your blood pressure regularly (at about the same
time of day) and aim for the following targets:
• 110 – 120 systolic
• 70 – 80 diastolic
9
Principle #2 – Eat 3-4 small to moderate meals per day, avoid
snacking between them, and do not eat anything substantial
for 2 hours before going to bed.
Every time you eat something your body needs to focus on digesting
and processing what it has just eaten. This is hard work that requires
energy. That means there is less energy for your brain and muscles to
function. Makes sense, right?
At each meal, chew slowly and eat only what you require to satisfy
your hunger for the next several hours. Do not eat past the point of
feeling satisfied and content. Over-eating will stress your gut’s
digestive and energy-generating capacities and could precipitate
an energy crash that may last several hours or days.
Allow your body to have 3-4 hour breaks between eating.
This means very little snacking, even if the snack consists of healthy
food. Think about it. When your body is in “digest mode” there is less
energy available for your brain and muscles. Fibro & Fatigue are
conditions of low energy. When you eat a meal, you should focus on
consuming your food and allowing your gut to release the enzymes
and hormones necessary to digest the meal properly. It is important to
let your gut rest for several hours after eating a meal so your
body can metabolize your food as fuel and provide you with adequate
energy to use for work, exercise, household chores, etc. If you are
constantly snacking, your body doesn’t know whether it should be in
“digest mode” (directing blood flow to your gut and releasing insulin)
or “work mode” (directing blood flow to your brain and muscles and
releasing glucagon). By allowing your gut to rest between meals, you
allow your body to have more energy for other activities.
10
After you eat a meal there is a transfer of blood flow, metabolic
resources and energy toward your gastrointestinal tract (stomach,
intestines and liver). If you get up and start moving too quickly, your
body won’t know where to concentrate your blood flow and energy.
Should it focus on properly digesting your food or should it focus on
moving and thinking?
It helps not to confuse your body. After you have consumed your last
bite of food, stay where you are for at least 10 minutes (preferably
more) before you get up and start moving. This will allow the shift in
blood flow and metabolic resources to gain momentum and promote
improved digestion, which over time will lead to a healthier gut. A
healthier gut promotes a healthier body.
Finally, when you sleep your digestive function slows down signifi-
cantly. If you have eaten a large meal prior to going to bed (less than
2 hours before), this food will sit undigested and ferment, leading
to the growth of unhealthy bacteria. Try to avoid eating anything
substantial for at least 2 hours prior to going to sleep.
Principle #3 – Your diet needs to be natural and
minimally processed.
The dietary guidelines I recommend for a Fibro & Fatigue recovery
program can be thought of as falling within the boundaries of a Paleo
/ Mediterranean / Anti-inflammatory Diet.
11
The Paleo Diet
A Paleo diet is a dietary plan based on eating foods similar to what
might have been eaten during the Paleolithic era, which dates from
approximately 2.5 million to 10,000 years ago. This diet is also referred
to as a “stone age” or “cave man” diet. It discourages the use of foods
that became available after the onset of farming.
In essence, it is a diet high in protein, fiber and nutrients that typically
includes lean meats, fish, fruits, vegetables, nuts and seeds — foods
that in the past could be obtained by hunting and gathering. You can
also eat eggs and olive oil on the Paleo diet.
A Paleo diet limits dairy products, legumes and grains—foods that
became common after farming began. This means that the Paleo diet
is completely gluten-free. You also can’t eat any processed foods on
this diet. Processed foods can be thought of as any food that has gone
through a factory. This includes cakes, cookies, crackers, chips, granola,
pizza and breakfast cereals. None of the foods I just mentioned
are good for your health if you are suffering from Fibro &
Fatigue symptoms.
I’d like to try to explain why flour products are to be completely
avoided for the first several months of your healing program.
Consuming flour and sugar promotes fermentation. After many
decades of consuming cakes, cookies, crackers, bread, chips, granola,
pizza and breakfast cereals, the bacteria in your gut (the gut
microbiome) have become highly adept at fermenting these nutrients.
Fermentation of sugar and grain leads to the release of alcohols,
ketones and other fermentation byproducts that promote gas,
12
bloating, fatigue, brain fog and chronic inflammation. Completely
eliminating sugar and flour products for the first six months of this
program will improve the quality of your gut microbiome and help
eliminate the above-mentioned symptoms.
The Paleo diet is excellent for reducing inflammation,
improving gut health, clearing up skin conditions and
promoting weight loss. These are all good things to accomplish
if you are trying to recover from Fibro & Fatigue.
Foods to eat on the Paleo diet include:
• Fruits
• Vegetables
• Nuts and seeds (minimally processed nut butters are fine)
• Oils from olives and nuts
• Lean meats, especially organic, grass-fed and
free-range animals
• Fish, especially those rich in omega-3 fatty acids, such as salmon,
mackerel and tuna
Foods to avoid on the Paleo diet include:
• Grains, such as wheat, oats, corn and barley
• Legumes, such as beans, lentils, peanuts and peas
• Dairy products
• Refined sugar
• Processed foods
• Artificial sweeteners
• Refined vegetable oils, such as canola
The Paleo diet is very strict however, in my opinion, it is the
best anti-inflammatory diet to follow if your health is seriously
compromised and you need to make rapid progress. It may not be
right for everyone, but it can at least provide a goal to aspire to, one
that might be adjusted based on your individual needs. The next diet I
will describe is called the “Modified” Paleo diet. This modified version
allows you to include some non-Paleo foods that are still healthy for
you to consume.
While following the Paleo diet might on the surface appear difficult,
there are plenty of delicious recipes easily available on the internet.
Either Google ‘favorite Paleo recipes’ or visit cookinglight.com.
Paleo Diet Examples:
13
Paleo breakfast (fruit and nuts)
Paleo dinner (beef and vegetablestopped with kale)
14
The Modified Paleo Diet
The Modified Paleo diet has some healthful additions such as peas,
lentils, beans, tofu, seitan, barley, quinoa and millet. I developed this
version of the Paleo diet so that:
1. It is not so strict and difficult to follow.
2. It includes some very nutritious grains that are often well tolerated
(barley, quinoa and millet).
3. It includes beans, tofu and seitan so that you can consume less meat
which is good for you and good for the planet, not to mention
good for the animals.
Foods to eat on the Modified Paleo diet include:
• Fruits
• Vegetables
• Nuts and seeds (minimally processed nut butters are fine)
• Oils from olives and nuts
• Lean meats, especially organic, grass-fed and free-range animals
• Fish, especially those rich in omega-3 fatty acids, such as salmon,
mackerel and tuna
• Tofu and other soy products
• Seitan (high protein wheat gluten; do not use if you are gluten
intolerant)
• Legumes such as peas, lentils, peanuts and beans
• Whole grains such as rice, barley, oats, quinoa and millet (no
flour products)
Foods to avoid on the Modified Paleo diet include:
• Refined sugar
• Processed foods
15
• Dairy products
• Artificial sweeteners
• Refined vegetable oils, such as canola
• Cakes, pies, cookies, ice cream and desserts
• Corn, wheat and flour products
The Mediterranean Diet
The Paleo (or Modified Paleo) diet is the best diet to follow for
the initial “treatment phase” of your healing program. Once
your symptoms have improved significantly, you can follow
the Mediterranean diet for the “maintenance phase” of your
healing program.
Interest in the Mediterranean diet began in the 1960s with the
observation that heart disease caused fewer deaths in Mediterranean
countries, such as Greece and Italy, than in the United States and
northern Europe.
The primary difference between the Paleo diet and the Mediterranean
diet is that the Mediterranean diet allows for the moderate
consumption of dairy products, whole grains and legumes.
These foods will likely be more efficiently digested once your health
has improved.
Foods to eat on the Mediterranean diet include (italics indicate foods
also allowed on the Paleo diet):
• Fruits
• Vegetables
• Nuts and seeds (minimally processed nut butters are fine)
16
• Oils from olives and nuts
• Lean meats, especially organic, grass-fed and free-range animals
• Fish, especially those rich in omega-3 fatty acids, such as salmon,
mackerel and tuna
• Legumes such as peas, lentils, peanuts and beans
• Moderate intake of dairy products such as yogurt and cheese
• Moderate intake of rice, quinoa, barley, oats, corn and wheat
Foods to avoid on the Mediterranean diet include:
• Refined sugar
• Processed foods
• Artificial sweeteners
• Refined vegetable oils, such as canola
• Cakes, pies, cookies, ice cream and desserts
Principle #4 – Use your diet to produce a positive effect on your
physiology
My advice is this: Give yourself 1 month to work up to eating a strict
Paleo (or Modified Paleo) diet, then stay on it for 6 months. It will
break your body’s addiction to simple sugars and carbohydrates. This is
an absolute necessity if you are to fully recover your health. Eating a
Anti-inflammatory and Healing Potential ➝ ➝ ➝
StandardAmerican
Diet(SAD)
The Mediterranean
Diet
The PaleoDiet
17
really healthy diet will also help the other components of this pro-
gram work more effectively. Then, see how much of an improvement
you feel. A Paleo diet will help improve your physiology and
strengthen your gut bacteria, and it may even positively change your
life, especially when combined with the other aspects of this program.
Making significant changes to your diet is of even higher importance
if you have significant gastrointestinal symptoms (e.g., irritable bowel
syndrome or leaky gut symptoms) or if you are carrying a few extra
pounds. Do not underestimate the power of your food choices to
exert a powerful effect on your health and healing!
Principle #5 – Miscellaneous Guidelines
Coffee — It’s perfectly fine to have one cup of coffee per day. It’s also
OK to use a little cream and sugar. Avoid iced, blended and sweetened
coffee drinks. A combination of caffeine, sugar, dairy and ice is toxic to
your gut, liver and pancreas.
Tea — All teas are fine. Use raw, unfiltered honey as a sweetener.
Chocolate — Not allowed on the Paleo or Modified Paleo diet. On the
Mediterranean diet, one to two small squares (no more) of dark
chocolate every couple of days is fine.
Dairy products — Ideally, dairy products are to be completely avoided.
Adult mammals no longer have the need for, or the ability to properly
digest, large amounts of dairy products. Think of all of the milk,
butter, cheese, pizza, yogurt, ice cream and other dairy products in our
society’s diet. It’s way more than necessary. Many functional medicine
physicians believe that an excess of dairy products contributes to many
18
chronic health problems including heartburn, irritable bowel
syndrome, obesity, etc. That said, a moderate intake of high-quality
yogurt and sheep or goat cheese, consumed on an intermittent basis,
should not impede your healing progress.
Pasta — Not allowed on the Paleo or Modified Paleo diet; allowed on
the Mediterranean diet. A surprisingly good substitute for pasta is
spaghetti squash or zucchini noodles (zoodles).
Nuts — Nuts contain a significant amount of protein. However,
they also contain a significant amount of fat. Therefore, they are
somewhat difficult to digest in large quantities. Consuming a couple
of handfuls of nuts per day is healthful. Some nuts, such as pecans,
cashews and macadamia nuts, contain more fat than others and may
be harder to digest.
Organic food — Consuming organic foods is ideal since many
pesticides have a direct toxic effect on the mitochondria. When you
are not well, your body does not need the added stress of dealing
with toxic chemicals. Organic produce has also consistently been
found to contain 20–30% more antioxidant compounds than
conventional produce. However, it is impossible to expect most people
to consume a 100% organic diet. The most important foods to eat
organically are: 1) fresh produce, especially items that are consumed
whole (grapes, apples, berries, etc.) and 2) meats (this will help you to
avoid both pesticides and hormones).
Alcohol — Alcohol is toxic to your nervous system. While the
Mediterranean diet allows for one glass of red wine per day, this
amount is not especially helpful to your healing program.
19
One glass of wine or beer two to three times per week may be fine,
but anything more than this will impede your progress. Obviously this
guideline needs to be individualized to your health situation.
A strong nervous system can tolerate alcohol better than a weaker
nervous system.
Artificial sweeteners — These have been linked to weight gain,
diabetes, headaches and allergies. Not recommended at all.
Food allergies — There are at least two kinds of reactions to foods.
One is an acute (immediate) allergic reaction, such as the kind that
sends children who are allergic to peanuts to the emergency room
with life-threatening symptoms (hives, difficulty breathing, etc.). A
second type of reaction is more of a sensitivity whose symptoms can
be delayed by a few hours to a day or two. The symptoms of this kind
of reaction are more subtle and can include increased fatigue, brain
fog, abdominal pain, bloating and diarrhea. The most common foods
that can cause a delayed sensitivity reaction are cow’s milk and cheese,
wheat (gluten), corn, soy, eggs and nuts. The Paleo or Modified Paleo
diet will eliminate all of these foods except soy, eggs and nuts. If you
think you are allergic to soy, eggs or nuts, avoid the offending food
for at least 6 months and then try introducing it again in small
amounts. By following a strict Paleo or Modified Paleo diet, and
improving the health of your gut, you can completely eliminate many
delayed food sensitivities.
20
Chapter 2 - Micronutrients & Botanicals
Twenty years ago, I identified a key combination of micronutrients
that helps eliminate the symptoms of abnormal mitochondrial
function. This combination includes:
• Alpha lipoic acid
• N-acetyl-cysteine
• Acetyl-L-carnitine
• Coenzyme Q-10
These four micronutrients are not commonly found in most
multivitamins. If they are in your daily multivitamin, they are almost
certainly not present at the dosages neccesary to exert a therapeutic
effect on improving your mitochondrial function. Consuming all four
of these micronutrients will allow you to achieve the most beneficial
effect when supporting the mitochondria.
I’d like to explain how I identified this key mitochondrial support
formula. Twenty years ago, I was caring for several hundred patients
with HIV/AIDS. The majority of these patients needed to take the first
generation of antiviral medications, which had numerous side effects.
Many of these side effects were caused by mitochondrial toxicity. In
other words, while these drugs were inhibiting HIV replication, they
were also poisoning my patients’ mitochondria.
This mitochondrial toxicity caused severe side effects including nerve
damage, fatigue, dementia and immune dysfunction. After several
years of testing and refinement with multiple nutrient combinations,
it became clear to me that one specific formula of micronutrients and
21
antioxidants was able to reverse these side effects. This formula
restored normal functioning to the majority of my patients’ immune
and nervous systems. In response to taking it, their overall health also
clearly improved.
Since beginning to prescribe this combination of mitochondrial
support nutrients to my patients with Fibro & Fatigue, I’ve found that
the majority of them have also been able to stabilize, improve and, in
many cases, regain normal health and functioning.
As a physician, it is very important to me that any nutritional formula I
prescribe to a patient is of the highest quality so that it can effectively
accomplish its goal.
The ability of a nutritional supplement to accomplish its goal depends
on:
• The quality of the raw materials used
• The quality of the manufacturing process
• The ingredients and dosages of the specific formula
After many years of medical practice, I became frustrated with the
lack of consistent quality found in many consumer-grade nutritional
supplements. You’ve probably heard reports on how a large
percentage of nutritional supplements found in health food stores,
when tested by an independent laboratory, have been shown to
contain between 0% and 200% of the amount stated on the label.
If a patient trusts me enough to follow the nutritional supplement
guidelines I recommend, I want to make absolutely sure that the
products he or she takes are of high enough quality to work
as intended.
22
This is the reason why I started K-PAX Pharmaceuticals in 2006.
I wanted my patients to have access to the highest quality, pharmaceu-
tical-grade nutritional supplements possible. I also wanted a company
that would produce the exact formulas I had identified as effective.
Furthermore, I wanted a company with the ability to perform high
quality clinical trials to investigate how these formulas might improve
the lives of patients with diseases linked to mitochondrial dysfunction.
K-PAX Pharmaceuticals has accomplished all of these goals.
When it comes to prescribing micronutrients and botanicals as part of
a treatment program for Fibro & Fatigue, I have three basic goals:
• Optimally Support the Mitochondria
• Optimally Support the Gut
• Optimally Support the Neuroendocrine System
Optimally Support the Mitochondria
Mitochondrial dysfunction is a mechanism that can explain the range
of symptoms experienced by patients with Fibro & Fatigue. In 2010,
a study of 20 patients with fibromyalgia compared to 10 healthy
controls demonstrated that patients with fibromyalgia had: 1) reduced
levels of coenzyme Q-10, 2) decreased mitochondrial membrane
potential and 3) increased levels of lipid peroxidation, a marker of
elevated levels of oxidative stress. Decreased numbers of mitochondria
in each cell were also observed in the fibromyalgia patients.
In patients with chronic fatigue syndrome, electron micrographs of
muscle biopsies have shown that their mitochondria are frequently in
23
a state of degeneration. Furthermore, evidence of elevated oxidative
stress has also been detected in muscle biopsies from patients with
chronic fatigue syndrome.
Generally speaking, if an individual experiences a prolonged period of
long-term stress, inadequate intake of micronutrients and/or exposure
to environmental toxins, the presence of free radicals inside the
mitochondria can rise to unhealthy levels. This exposes the mitochon-
dria’s genes, proteins and membranes to toxic levels of oxidative stress
which can cause progressive damage. Over time, the cell’s energy-gen-
erating capacity declines and the cell dies, eventually leading to a
state of chronic inflammation.
When this situation occurs in individuals with a genetic susceptibility
to mitochondria-related disorders (e.g., fibromyalgia, chronic fatigue
syndrome, Alzheimer’s disease, Parkinson’s disease), symptoms begin
to occur. When early symptoms such as fatigue, headaches and flu-like
symptoms are not properly addressed, they can progress to a full-
blown diagnosis of fibromyalgia or chronic fatigue syndrome.
The two major goals of a mitochondrial support supplement
program are to decrease oxidative stress in the mitochondria,
thereby preventing any further damage from occurring,
and to encourage the restoration of normal mitochondrial
functioning. The reversal of a long-standing process of mitochondrial
decline does not happen easily. It requires a unique combination of
antioxidants and micronutrients administered at the proper dosages.
Because of my unusual experience of caring for hundreds of HIV/AIDS
patients with mitochondrial toxicity in the early days of the epidemic,
I was able to identify, study and refine two micronutrient formulas
that I believe accomplish this goal.
24
K-PAX Pharmaceuticals produces these formulas to my exact
specifications. The raw materials they use are of the highest quality,
and the quality of the manufacturing process is extemely high. All the
micronutrients needed for your daily multivitamin are combined into
the two formulas below:
• K-PAX Immune is a complete multivitamin containing opti-
mal dosages of highly potent antioxidants, including alpha
lipoic acid, acetyl-L-carnitine, N-acetyl-cysteine and coenzyme
Q-10, to recharge your body’s energy-generating capacity at
the cellular level. K-PAX Immune has been clinically tested
for over 10 years and shown to support liver, immune and
nervous system functioning.
• K-PAX Energy is designed to improve your energy and
mental alertness. In addition to supporting healthy
mitochondrial function, K-PAX Energy contains a small
amount of caffeine (similar to that contained in 1/3 cup of
coffee) that acts as a catalyst to enhance its effect on mental
alertness. The balancing nutrients in K-PAX Energy give it
excellent tolerability.
Optimally support your mitochondria by implementing the following
program:
25
Since K-PAX Energy includes a small amount of caffeine, you should
avoid consuming any additional caffeine-containing products (except
maybe a little coffee or tea). These include but are not limited to Red
Bull, Monster, Rockstar, 5-hour Energy, etc.
If you don’t take K-PAX Energy for any reason, you should increase
the dosage of K-PAX Immune to 3-4 tablets twice daily so you get the
correct amount of the key mitochondrial support nutrients.
The goal of this program is to help repair your mitochondria and
restore their ability to robustly generate energy. A complete list of
the nutrients and dosages contained in these two formulas can be
reviewed at the K-PAX Energy Support Program.
Optimally Support the Gut
The gastrointestinal tract is a finely balanced ecosystem with over 500
different strains of bacteria competing for space and nutrients. When
a healthy balance exists, few gastrointestinal symptoms are present.
However, the natural balance of gut microorganisms (gut microbiome)
can be upset by chronic stress, poor diet, alcohol consumption, and
many common medications (such as antibiotics, oral contraceptives,
etc.).
The K-PAX Energy Support Program
With Breakfast With Lunch (before 3pm)
K-PAX Immune: 2 tablets K-PAX Immune: 2 tablets
K-PAX Energy: 1-2 tablets K-PAX Energy: 1-2 tablets
26
The success of your Fibro & Fatigue healing program depends on
restoring a healthy gut microbiome. We live in a symbiotic relationship
with these organisms. In return for a warm, dark and nutrient–rich
environment, they help us to digest our food, absorb nutrients and
eliminate harmful toxins. They have evolved with us for millions of
years and play an important, beneficial role in maintaining our health.
It is helpful to think of the gut microbiome as your private inner
garden. This analogy is accurate since bacteria are actually plants. Your
inner garden can be beautiful and healthy, or overgrown with weeds,
bugs and mold. It can also be of intermediate health with many
strong, beautiful plants, accompanied by some unwanted weeds.
When your inner garden is healthy and vital, it helps your body
remain balanced and strong. When it is weak and overgrown with
unhealthy organisms, your immune system becomes overactive and
stressed, and a chronic inflammatory state begins to take root. An
unhealthy microbiome can contribute to symptoms of fatigue, brain
fog, insomnia, bloating, abdominal pain, diarrhea and constipation.
The most important factor for reestablishing a healthy microbiome is
to follow the dietary guidelines described in Chapter 1. There are also
several nutritional supplements that can significantly support a
healthy gastrointestinal tract. Furthermore, your physician or other
healthcare professional can order a comprehensive stool analysis.
A properly performed comprehensive stool analysis checks for the
presence of intestinal parasites and other unhealthy organisms
(such as Candida albicans) that can contribute to an unhealthy
gut microbiome.
27
Intestinal Revitalization
Supplementing your gut microbiome with healthy probiotic organisms
is like planting your garden with a fresh crop of healthy plants.
Because probiotics are living organisms, there are many challenges as-
sociated with manufacturing and distributing probiotic supplements.
While there are hundreds of probiotic supplements on the market,
many are of low potency and require constant refrigeration.
After 30 years of medical practice, I have identified a two probiotic
supplements that, in my clinical experience, work extremely well
together to rebuild and restore a healthy gut microbiome:
K-PAX Super Probiotics is a unique probiotic formula designed to
deliver a therapeutic amount of active organisms known to promote a
healthy gastrointestinal environment, protect intestinal integrity
and boost immune function. It contains highly potent amounts of
Lactobacillus acidophilus and Bifidobacterium organisms (20 billion
organisms per capsule). It also contains Saccharomyces boulardii, an
extensively researched microorganism known to help support immune
defenses and gut health by helping to eliminate unhealthy bacteria.
K-PAX Super Probiotics does not require refrigeration.
Microbiome Mega-Spore Biotic is a new, advanced probiotic that
can help reinvigorate your gut. Microbiome Mega-Spore Biotic
contains spore-forming strains of bacillus organisms that are highly
resistant to stomach acid. Because they are acid-resistant, bacillus
spores deliver a much higher concentration of live organisms to the
small intestine, where they are most needed. Bacillus strains have also
been shown to support immune function by producing vitamins and
other potent antioxidants. Microbiome Mega-Spore Biotic also does
not require refrigeration.
28
Revitalize your gut microbiome with K-PAX Super Probiotics & Micro-
biome Mega-Spore Biotic by implementing the following program:
Digestive Enzymes
Millions of Americans take antacid drugs to treat heartburn, bloating,
ulcers and other gastrointestinal problems. These drugs are available
both over-the-counter and by prescription. The two most commonly
prescribed classes of antacid drugs are called H2 blockers and proton
pump inhibiters (PPIs). The versions of these drugs that are available
over-the-counter include Prevacid, Prilosec, Nexium, Zantac
and Tagamet.
Television commercials for antacid drugs promote their use so you
can eat foods that you normally would not tolerate or digest properly,
including pizza, ice cream and cold cut sandwiches. This makes no
sense! It’s important to listen to your body and not tell it to shut up
when it’s trying to communicate that it can’t tolerate certain foods.
What most people don’t realize is that many of these drugs (PPIs in
particular) have been linked to a variety of health problems, including
serious kidney damage, bone fractures, dementia and, most recently,
an increased risk of death from all causes. For example, when patients
taking H2 blockers were compared with those taking PPIs for between
Intestinal Revitalization Program
First month: 2 capsules of each twice daily
Next 6 months: 1 capsule of each twice daily
Maintenance: 1 capsule of each once daily
29
1 and 2 years, researchers at Washington University School of Medi-
cine in St. Louis found that those taking PPIs had a 50% increased risk
of dying over the next 5 years. This study was published in the British
Medical Journal in July 2017. Many people believe PPIs (Prevacid,
Prilosec and Nexium) are safe because they are readily available, but
there are real risks to taking these drugs, particularly for long periods
of time.
Instead of taking a PPI and decreasing the amount of acid released in
your stomach, thereby “making it more difficult” for your body to
digest your meal, I highly recommend making the dietary changes
recommended in Chapter 1. If you still have any symptoms of gas,
bloating or indigestion, I recommend taking a high-quality digestive
enzyme supplement that will “make it easier” for your body to digest
your meal. The following digestive enzyme product is high-quality,
safe and effective at improving digestion using plant-based enzymes:
Integrative Therapeutics Similase Lipo.
A healthy gut usually eliminates waste between one and three times
per day. An ideal bowel movement is well formed and tubular, similar
in shape to a corn cob. If you struggle with having regular bowel
movements, you may need to provide your gut additional fiber. While
it is ideal to achieve this goal through diet modification, you may
want to try a fiber supplement and/or stool softener. The following
fiber supplement is comprised of a 50/50 balance of soluble and
insoluble fiber derived from organic psyllium seeds, fig powder, rice
bran, apple pectin and prune powder: K-PAX Regular One.
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Optimally Support the Neuroendocrine System
The first step to optimally supporting the neuroendocrine system is to
restore its mitochondrial health. This is best accomplished by following
the mitochondrial support protocol described earlier in this chapter.
However, there is a class of herbal products (botanicals) called “adap-
togens” that can provide additional support to the functioning of
your neuroendocrine system. Some adaptogens, like ashwagandha,
are frequently used in Ayurvedic medicine, while others, like ginseng,
astragalus and rhodiola, have been used for centuries in Asia
and Europe.
Many researchers think adaptogens work by helping the body’s auto-
nomic nervous system return to its normal, healthy, relaxed state.
These compounds can help the body sustain itself during times of
stress and recover more quickly after the stressful situation has passed.
Individuals with Fibro & Fatigue who take adaptogenic herbs may
want to consider rotating several adaptogenic products to see which
ones work best on their symptoms.
31
Additional Supplements to Consider
Curcumin
Since inflammation contributes to the symptoms of Fibro & Fatigue, a
natural anti-inflammatory agent that is safe and effective can play a
positive role. Curcumin, the most active ingredient found in the spice
turmeric, has recently gained attention for its antioxidant and anti-in-
flammatory properties. While turmeric has been used for thousands of
years as a component of curry powder, curcumin is the compound
within turmeric that has been shown to exhibit the greatest health
benefits and comprises the active compound used in most supplement
products. Numerous studies have shown that curcumin is able to block
inflammation in rheumatoid arthritis and osteoarthritis, and also
reduce nervous system inflammation.
Absorption of curcumin is very limited due to its low solubility, poor
stability and rapid elimination. In essence, it is difficult to consume
enough curcumin for it to exert a bioactive effect. Integrative
Therapeutic’s Theracurmin uses a novel preparation that dramatically
increases absorption by reducing the size of curcumin particles by over
100 times. This reduced particle size results in a more stable formula
with significantly higher bioavailability. Integrative Therapeutics
Theracurmin.
Magnesium
Magnesium is extremely important to many functions in the body.
In addition to supporting healthy bone formation, magnesium is
necessary for the mitochondria to turn the sugar and fat we eat into
chemical energy molecules known as ATP (adenosine triphosphate).
32
Low levels of ATP are commonly found in people with Fibro & Fatigue,
and it is believed that this plays an important role in many of their
symptoms. Adequate magnesium also exerts a calming effect on the
nervous system and is necessary for proper muscle functioning.
While the recommended daily amount of magnesium is 400 mg, this
dosage does not adequately treat Fibro & Fatigue symptoms. Malic
acid is a form of magnesium that is often used to treat fibromyalgia
pain. This supplement is commonly taken at a dosage of 600–1200 mg
twice daily. Magnesium is often best absorbed when taken with food.
Other common forms of magnesium, such as citrate, chloride and
aspartate, are also well absorbed. Soaking in a bath containing 1–2
cups of Epsom salt (magnesium sulfate) can also have a soothing,
pain-relieving effect on muscles and nerves. A very informative
website with all the information you ever wanted to know about
taking a magnesium supplement for fibromyalgia symptoms can be
found here.
33
Chapter 3 - Medications
Physicians specializing in the treatment of Fibro & Fatigue should use
pharmaceutical medications in a way that ensures their patients
achieve the following three goals:
1. Adequate Pain Control
2. Sufficient Mental Alertness
3. Deep Restorative Sleep
Adequate Pain Control
There are many medications that can be used to manage pain.
The goal should always be to use the lowest dosage possible of the
fewest medications necessary to achieve the desired result. Since I
can’t possibly provide an exhaustive description of all the available
pain medications, and since every pain management program needs
to be individualized, I would like to make you aware of several
different categories of pain medications that you and your physician
might consider using.
Narcotics (codeine, hydrocodone, tramadol, oxycodone, dihy-
dromorphine, etc.)
Narcotics are highly addictive and can cause many problematic side
effects including fatigue, mental confusion, dizziness, nausea and
constipation. Therefore, they should be used as a last resort at the
lowest possible dosage. With that said, their occasional use may
sometimes be the only option to break your pain cycle so I do not
completely rule them out. The bottom line is that narcotics are best
avoided if possible.
34
Anti-inflammatories (aspirin, ibuprofen, naproxen, piroxicam,
sulindac, etc.)
Chronic inflammation is one of the driving forces underlying the
fibromyalgia disease process. Chronic inflammation damages nerves,
promotes pain and drains your energy. Taking a daily anti-inflamma-
tory medication can be an important addition to your Fibro & Fatigue
pain management program.
An effective anti-inflammatory medication can also lessen the need to
take other stronger, more problematic pain meds such as narcotics.
I have directly observed the benefits of including a daily anti-inflam-
matory medication as part of the treatment program for hundreds of
patients with Fibro & Fatigue. Anti-inflammatories can enable you to
be more functional and to lessen, or completely avoid, the “crashes”
that often follow exercise or other periods of exertion.
As with all medications, it is my goal to prescribe the lowest possible
dosage of the safest medication. Since aspirin and ibuprofen are often
not strong enough to control pain in fibromyalgia, I have discovered
that prescribing piroxicam 10–20 mg (or a similar anti-inflammatory)
on a daily basis can help diminish overall pain symptoms.
As with all medications, anti-inflammatories can cause side effects.
These include heartburn, stomach ulcers, tinnitus and decreased
kidney function. They should always be taken with food and at least
8 ounces of fluids.
35
Anticonvulsants (gabapentin, pregabalin, levetiracetam, etc.)
Anticonvulsant medications work by slowing down nerve impulses in
both the brain and peripheral nervous system. They have traditionally
been used to treat neuropathic pain and seizures.
Pregabalin (Lyrica) is one of the three medications approved by the US
Food and Drug Administration (FDA) to treat fibromyalgia. It is an
anticonvulsant that is also prescribed to treat nerve pain in people
with diabetes (neuropathy), herpes zoster (shingles) and spinal cord
injuries, and it is used in epilepsy to treat partial seizures.
Side effects of anticonvulsants can include headaches, dizziness,
sleepiness, confusion, memory problems, dry mouth and weight gain.
Serious side effects may include angioedema, leg swelling and an
increased suicide risk.
As you can see, many side effects associated with anticonvulsants
resemble Fibro & Fatigue symptoms (dizziness, sleepiness, confusion,
memory problems, etc.). This highlights a very important principle—try
to avoid becoming overmedicated! The treatment toolbox for many
conventional doctors contains only pharmaceutical medications.
We were taught in medical school to treat the symptoms of a disease
and that “there is a drug to address each and every symptom a patient
describes.” Implementing this philosophy often contributes to patients
with multiple symptoms accumulating a large number of medications.
Combining the appropriate use of medications with a strong natural
therapies program is the best way I know of to lessen your overall
need for medications, as well as to help them achieve their desired
effects at a lower dosage and with fewer side effects.
36
Antidepressants (fluoxetine, duloxetine, sertraline, tricyclics,
etc.)
The three drugs approved by the FDA to treat fibromyalgia are
pregabalin (Lyrica), duloxetine (Cymbalta) and milnacipran (Savella).
While pregabalin is an anticonvulsant, duloxetine and milnacipran are
antidepressants. These medications are used to treat Fibro & Fatigue
symptoms of pain, fatigue and insomnia, and they are generally used
at lower dosages than for the treatment of depression. Using antide-
pressants in this way, at lower than normal dosages, can be helpful
and should be tried if necessary. Otherwise, standard antidepressants
should be reserved to treat symptoms of depression.
Medical cannabis (different strains and dosing formulations)
Many states have now legalized the use of medical cannabis to treat a
variety of disease symptoms, including epilepsy, anxiety, nausea and
chronic pain, among others. Some people describe the relief they
receive from using medical cannabis as miraculous.
Since medical cannabis is a completely natural substance, I believe its
use is generally safer than the use of many synthetic chemical
medicines. However, as with all medicines, the quality and dosage of
what you consume can make a big difference.
First, let’s cover a few basic concepts. Medical cannabis comes in many
different varieties (strains). In general, the “indica” strain is more
calming, with muscle-relaxant properties, while the “sativa” strain is
more stimulating to the brain. There are also many “hybrid” strains
that are basically genetic blends of the two strains. Your local cannabis
37
dispensary is often the best source of information on which strains are
best used to treat specific symptoms such as pain, nausea, anxiety,
insomnia or fatigue.
The next concept to consider is the mode of administration. Smoking
medical cannabis has a shorter duration of action than consuming
what are called “edibles.” The effects of smoked cannabis usually last
between 1–2 hours while the effects of eaten cannabis usually last
between 3–5 hours. The onset of action of smoked cannabis also
occurs much more quickly (1–3 minutes) compared to the onset of
action when consuming an edible (20–40 minutes). Therefore,
smoking medical cannabis is often a more preferable mode of admin-
istration because its effects are immediate and more controllable.
It is reasonable to be concerned about the health effects of smoking
any substance. First, my review of the medical literature has not un-
covered any evidence that smoking medical cannabis in moderation
causes any increase in the incidence of emphysema or cancer. This is in
contrast to smoking tobacco, which is a highly toxic plant that defi-
nitely increases the risk of developing both of these conditions. Also,
when the cannabis is smoked using a high-quality vaporizer such as a
volcano vaporizer, the active ingredients of the cannabis plant are
heated and released into the water vapor that you inhale. Nothing is
“burned.” Using this method of cannabis consumption exposes your
lungs to far fewer harmful chemicals than if cannabis is smoked in a
joint or a pipe. Finally, I do not recommend using a “vape pen” since
these have recently been associated with harmful effects most likely
linked to substances added when the cannabis plant is refined into
an oil.
Is it essential that you use medical cannabis? No. However, if consum-
ing a small amount of medical cannabis on a daily basis allows you to
38
feel better, have less pain and avoid using one or more pharmaceutical
medications, you may want to consider it as an option. In that case, I
recommend using a volcano vaporizer.
Sufficient Mental Alertness
Many people with Fibro & Fatigue experience symptoms of decreased
alertness, poor concentration and memory issues. These symptoms
are often collectively termed “brain fog” and they can be very
debilitating.
For many years I strongly recommended against taking stimulant med-
ications in order to help treat these symptoms. At the time,
I believed that the use of any stimulant medication in people with
Fibro & Fatigue would further deplete an already exhausted system.
Then, out of necessity, I treated a number of patients who were so
disabled by their fatigue and brain fog that I believed a trial of a
stimulant medication was their only hope to have enough energy to
properly care for themselves and to occasionally get out of the house.
Since these were my patients, they were also following the other
aspects of this healing program, including supporting their mitochon-
dria with the proper antioxidant micronutrients. My experience with
this cautious use of stimulants was dramatically positive. I had several
patients come back to my office almost in tears at how the addition of
a low-dose stimulant drug completely changed their lives for the
better. Their fatigue, alertness and mental clarity all improved. And
surprisingly, their pain symptoms also improved because, with more
mental energy, they now had a higher pain threshold. Quite a number
of my patients have experienced a continuous, sustained improvement
in their health lasting many years by adding a low dosage of a
stimulant medication to their program.
39
A Moment of Discovery
What I observed in these initial few patients led me to a very
important insight. By adding a low dosage of a stimulant drug
to a program that already included potent mitochondrial support,
my patients could experience a very positive improvement in their
symptoms without further depleting their system. As long as their
mitochondria were properly supported, gentle stimulation to their
nervous system acted as a catalyst for restoring normal brain and
nervous system function. This was a very positive discovery that has
helped me enable many of my patients with Fibro & Fatigue to regain
the ability to live normal lives.
It is still important not to overstimulate the nervous system. The use of
a low dosage of a stimulant medication MUST be combined with the
other aspects of this program, including properly supporting the
mitochondria. However, I believe that, with proper supervision of a
physician, many patients with Fibro & Fatigue can improve their
health and functionality in a meaningful way using this approach.
Here are two stimulant medications and their dosages that I have had
good results using in patients with Fibro & Fatigue:
Methylphenidate (Ritalin) (short-acting; about 3–4 hours)
2.5–5 mg — taken once or twice daily with breakfast and/or lunch
(before 3pm)
Modafinil (Provigil) (long-acting; about 8–12 hours)
25–50 mg — taken once daily with breakfast
(Modafinil is only available as a 100-mg pill, so you will need to use a
pill cutter to cut it into a half or quarter pill.)
40
If you have any of the following medical conditions, stimulant
medications should never be used:
• Diabetes mellitus
• Uncontrolled high blood pressure
• History of cardiovascular disease (including angina, heart attack,
arrhythmia or stroke)
• History of seizures
• Chronic liver disease
• Chronic kidney disease
• Psychiatric disorders, including delirium, psychosis, schizophre-
nia, bipolar disorder, anorexia nervosa or generalized anxiety
disorder
Always consult with a physician before starting any new medication.
Finally, if you are taking a prescription stimulant drug, you should
avoid consuming any caffeine-containing products (except maybe a lit-
tle coffee or tea). These include but are not limited to Red Bull,
Monster, Rockstar, 5-hour Energy, etc.
If you are taking the K-PAX Energy Support Program, and then begin
taking a prescription stimulant, you should discontinue taking K-PAX
Energy and switch to taking K-PAX Immune at a dosage of 3–4 tablets
twice daily. This allows you to avoid caffeine but to continue getting
the proper dosage of mitochondrial support nutrients.
Deep Restorative Sleep
The amount of sleep needed varies from person to person. However,
poor sleep quality has been linked to several health problems,
including depression, poor immune function, anxiety, weight gain,
41
muscle pain, irritable bowel syndrome, fatigue and headaches.
Usually a person passes through four stages of sleep: Stage 1, 2, 3,
and REM (rapid eye movement) sleep. Stage 3 is also known as deep
non-REM sleep. Brain waves during Stage 3 sleep are called delta
waves due to their slow speed and large amplitude. Of all of the sleep
stages, Stage 3 is the most restorative. During Stage 3 sleep the brain,
muscles, adrenal glands and immune system are all restored.
People with Fibro & Fatigue have been shown to spend less time in
Stage 3 sleep than healthy individuals. It is best to improve your sleep
quality through natural means; however, the most important goal is
that you re-establish a proper sleep cycle. This may require the use of
a low dosage of a sleep-promoting medication.
Natural sleep hygiene tips:
• Put yourself on a bedtime schedule. Go to sleep and wake up at
the same time each day.
• Create a bedtime routine to unwind from the day such as
reading a book, listening to a meditation tape or taking a
warm bath.
• Eliminate bright lights, computers and TV’s from your bedroom.
• Do not work on your computer for at least an hour before
going to bed.
• Avoid lying in bed tossing and turning. Consider getting up and
doing a light activity, such as reading, until you’re tired again.
• Replace your pillows if you’ve had them for over a year and
have trouble getting comfortable.
• Melatonin 5-10 mg 30 minutes prior to going to bed may be
helpful for promoting sleep.
42
Sleep medication tips:
• Avoid using more than one medication. If you use medical
cannabis to promote sleep, don’t add a pharmaceutical
medication.
• Take the lowest possible dosage to achieve your goal.
• Many of my patients have been able to achieve deep,
restorative sleep using one of the following medications taken
before bed:
■ mirtazapine (Remeron) 7.5-15 mg
■ trazadone 25-50 mg
■ amitriptyline 25-50 mg
■ gabapentin 400-600 mg
■ clonazepam 0.25-0.50 mg
43
Chapter 4 - Hormones
This chapter is very important, but it is also detailed and a lot
to absorb. You may want to read it when you are fresh and
have ample alertness and concentration.
The word hormone is derived from the Greek word “to excite”.
While hormones are released in very small amounts, they can have
wide-ranging and powerful effects. For the purposes of this book,
I will briefly discuss several hormones that play an important role in
determining your energy level and overall health. They are:
• Thyroid hormones
• Testosterone
• Cortisol
• Dehydroepiandrosterone (DHEA)
If the levels of any of these hormones are low, they can be supple-
mented in a safe and prudent manner. One of these hormones – DHEA
– is available over-the-counter while the others require a prescription.
Properly managing these hormones can play a significant role in
supporting your recovery from Fibro & Fatigue. Since these hormones
have powerful effects, it’s best if they are supplemented under the
supervision of a healthcare practitioner utilizing periodic blood and/or
saliva testing.
In general, the optimal hormone blood level for maintaining your
peak health will usually be in the upper half of the laboratory’s
“normal range”. This level is most effective at supporting your body’s
overall health, while still remaining within safe parameters.
44
Again, hormone supplementation should always be supervised and
managed by an experienced healthcare professional utilizing regular
laboratory testing.
Thyroid
The thyroid gland releases hormones to control your metabolic rate -
the rate at which your body uses energy. Thyroid hormone can affect
your heart rate, blood pressure, muscle strength, energy level and
mental alertness. The thyroid gland uses iodine from the food you eat
to make its two main hormones:
• Triiodothyronine (T3)
• Thyroxine (T4)
T4 has only a slight effect on metabolism. The majority of it is
converted into T3, which is the active hormone that stimulates
metabolism. About 80% of this conversion takes place in the liver and
kidneys, while 20% of it takes place within the thyroid gland itself.
T3 and T4 have the same exact structure except that T3 contains three
iodine molecules while T4 contains four iodine molecules. Up to 99%
of thyroid hormones circulating in the bloodstream are bound to
transport proteins, such as thyroxine-binding globulin (TBG) or
albumen. Only a very small fraction is free (unbound) and biologically
active; hence, when assessing thyroid hormone levels, it is of better
diagnostic value to measure the level of free thyroid hormones (free
T3 and free T4).
45
While there are many opinions as to how to interpret thyroid tests
and supplement these hormones, I’d like to make one point clear:
the most important thyroid test to measure, and to maintain in the
optimal range, is called the TSH (thyroid-stimulating hormone). TSH is
actually produced in the pituitary gland at the base of the skull. It is
known as a “feedback hormone,” which means that if the pituitary
gland detects that your metabolic rate and level of thyroid hormones
is low, it releases additional TSH to stimulate the thyroid gland to
produce more thyroid hormone. Therefore, when your thyroid
hormone levels become too low, your TSH level rises.
Since most testing laboratories define the “normal range” as the
average level found in the general population, it is my opinion that
when measuring most hormone levels, the optimal range for
maintaining peak health is in the upper half of the laboratory’s “
normal range”. However, when it comes to monitoring your TSH level,
I advise that you maintain your TSH level in the 0.5 – 1.5 mU/L range.
This is a much more narrow range than the 0.5 – 4.5 mU/L “normal
range” reported by most testing laboratories and will insure that your
thyroid hormone level is providing your muscles, brain and
immune system with the optimal amount of energy.
Testosterone
Testosterone is the hormone often associated with the masculinizing
changes that occur in male adolescents. In addition to supporting
muscle mass, it has several other effects which include maintaining
healthy energy, mood and cognitive function. Women also produce
testosterone, though only about 10% of that produced by men.
46
Keeping your testosterone level in the optimal range is also important
for preventing fatigue, depression and a decreased libido.
Monitoring the total testosterone level is sufficient, since testing the
free testosterone level is much more expensive and only necessary in
difficult-to-assess situations. In men, the optimal range for the total
testosterone level is 500–1000 ng/dl. In women, the optimal range for
the total testosterone level is 50–100 ng/dl. Maintaining your testos-
terone level within these parameters will help insure that your muscle
mass, energy level, libido and brain function are well supported.
Testosterone levels should always be checked at the same time of day
(preferably in the morning).
When dosed properly, topical testosterone creams are usually effective
at maintaining your total testosterone level in the proper range.
They can be obtained with a prescription from most compounding
pharmacies. Maintaining a healthy testosterone level is an often
overlooked component of a Fibro & Fatigue treatment program,
especially in women.
The side effects of testosterone supplementation usually occur only if
the blood level rises too high. In women, this can manifest as an acne
outbreak or the occurrence of hair growth on the face. These effects
occur rarely as long as supplementation is properly managed. In men,
enlargement of the prostate and hair loss are possible side effects.
Men who have a previous history of prostate cancer and women who
have a previous history of breast cancer should never supplement
testosterone (or DHEA).
47
Adrenal Gland Hormones: Cortisol & DHEA
The adrenal glands produce several hormones that help protect the
body from stress. While adrenaline (epinephrine) helps protect the
body from immediately stressful events, such as getting out of the way
of a car that is about to hit you, other adrenal gland hormones,
including cortisol and DHEA, help protect your body from medium
and long-term stress.
Cortisol and DHEA levels are known to rise when the body is faced
with the initial phase of an illness. However, as an illness or long-term
stress persists over time, adrenal gland production of these important
hormones frequently declines. As the protective effects of cortisol and
DHEA are lost, a chronic inflammatory state can develop. This chronic
inflammatory state is like a smoldering fire whose effects can weaken
the body over time.
The longer a person suffers from a chronic illness, the lower cortisol
and DHEA levels can go. Sometimes they decrease to virtually
undetectable levels. Proper supplementation of cortisol and DHEA
can help improve many of the symptoms of Fibro & Fatigue including
fatigue, brain fog, muscle loss and depression.
Cortisol
Cortisol is one of your body’s most important stress hormones.
While the adrenal glands release adrenaline to deal with immediately
stressful situations (fight or flight situations), they release cortisol in
response to medium-term stressful situations (stressful life events or
an acute illness). Cortisol has the following effects:
48
• It is anti-inflammatory
• It increases blood sugar
• It mobilizes the metabolism of carbohydrates, fats and protein
Cortisol can be thought of as a catabolic or “resource-mobilizing”
hormone. It raises your blood pressure and blood sugar while
temporarily suppressing immune function. The prescription drug
prednisone is essentially a super-charged version of cortisol. After the
stressful situation or illness has passed, your cortisol level should
gradually return to normal. If your stress level remains high, the ability
of the adrenal glands to continue producing both cortisol and DHEA
can begin to falter. This state is often referred to as “adrenal fatigue.”
A low cortisol level can contribute to the following symptoms:
• Anxiety
• Depression
• Headaches
• Insomnia
• Chronic pain
• Weight gain
• Poor digestion
• Low blood pressure
• Chronic inflammation
Many of these symptoms are common in people with Fibro & Fatigue
yet conventional medical doctors frequently do not check cortisol
levels in their patients. It’s important to understand that the release of
cortisol is also linked to your circadian rhythm so the vast majority of
this hormone is released in the morning (6-8am). Your cortisol level
then gradually declines throughout the day.
49
In extreme cases, too little cortisol production may be due to a
problem in the pituitary gland. This condition is known as Addison’s
disease, which is believed to be an autoimmune condition. If a
diagnosis of Addison's disease is suspected, it is very important to
pursue an assessment by an endocrinologist.
The most accurate way to check your cortisol level is with an adrenal
stress profile test. This test monitors your cortisol level over a 24-hour
period by measuring it in saliva samples. A healthy cortisol level is
highest in the first sample (7am) and then gradually declines. An
example of an adrenal stress profile test can be viewed here.
Cortisol is a hormone that can be supplemented in pill form and
managed by an experienced physician.
DHEA
An optimal DHEA level is important for the body to maintain its
health in response to long-term periods of illness and stress. It is also
necessary for healthy aging. DHEA helps support a strong immune
system, normal cognitive function and a healthy muscle mass.
DHEA production is most abundant when people are in their twenties
and thirties. Its production thereafter declines at about 10% per year.
Associated with this decline is an increased incidence of degenerative
diseases including heart disease, diabetes, cancer and neurodegenera-
tive disorders such as Alzheimer’s and Parkinson’s diseases. Is this
merely a coincidence? Many physicians and researchers think not.
A low DHEA level can contribute to the following symptoms:
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• Anxiety
• Depression
• Headaches
• Insomnia
• Weight loss
• Low immune function
• Chronic inflammation
There are two forms of DHEA in the body. DHEA is the active form,
while DHEA–Sulfate is the storage form. While both can be measured
with a blood test, measuring DHEA–Sulfate is the best way to assess
the proper level of this important hormone. The optimal range for
DHEA–Sulfate for people with Fibro & Fatigue is between 300 – 500
ug/dl (for men) and 100 – 200 ug/dl (for women). Do not go by the
normal range provided by the laboratory for this hormone. This range
is usually adjusted for age, which is not what you want. The goal is to
restore a youthful level of DHEA, similar to the amount you had when
you were at the peak of health. It is best to use the same laboratory
when tracking DHEA–Sulfate values. This insures the greatest level
of consistency.
Salivary DHEA levels are measured as part of an adrenal stress profile
test, but I also prefer to follow DHEA-Sulfate blood tests. In my
experience, it is the most effective way to measure this hormone.
For the treatment of Fibro & Fatigue, the usual DHEA dosage I
prescribe is 5-10 mg per day for women, while the most common
dosage range I prescribe in men is 10-50 mg per day. I recommend
tracking hormone levels quarterly to start, and then once or twice per
year after a stable level has been achieved.
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Important: Women who have had breast cancer (or are at high risk)
and men who have had prostate cancer (or are at high risk) should
completely avoid taking DHEA supplements since it is possible that this
hormone can stimulate the growth of these tissues.
Conclusion
When it comes to managing hormones, the key word is “balance”.
As I stated earlier in this chapter, small amounts of hormones can
have wide-ranging and potent effects. An experienced healthcare
practitioner should always supervise any hormone supplementation
with regular monitoring. A physician skilled in functional medicine can
be an excellent resource to assist you in balancing your hormones.
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Chapter 5 - Mind-Body Techniques
“Healing does not come out of little bottles,
it comes from within.”
- Jon D. Kaiser, M.D.
Every thought you have generates neurotransmitters and hormones
that can significantly affect your health. Some thoughts can have
positive, healthful effects, such as those that may lead you to meditate
or exercise regularly. Other thoughts can have detrimental effects,
such as worrying about things you can’t control or routinely
overcommitting yourself.
A chronically high stress level leads to the release of excessive
quantities of the hormones adrenaline and cortisol. This does not
positively contribute to your health. The release of these hormones
over time can weaken you immune system, promote a chronic inflam-
matory state, degrade your health and impede your ability to heal.
Conversely, feelings of gratitude, love and joy can have a very positive
effect on your physical body by promoting the release of endorphins,
serotonin and dopamine in your brain. These neurochemicals are well
known to decrease inflammation and stimulate the healing process.
My goal in this chapter is to provide you with some basic, but ex-
tremely important, techniques that you can start applying immedi-
ately. These techniques can help harness and focus your body’s healing
abilities. They will also enable all the components of your healing
program to work together to achieve their maximum potential.
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The three techniques I’d like to discuss in this section are:
1. Strategic Pacing
2. Healing Time
3. Loving Yourself
Strategic Pacing
Fibromyalgia and chronic fatigue syndrome are fundamentally
disorders of insufficient cellular energy production. Therefore, if you
push your body too hard and exceed its energy-generating capacity, it
will present you with symptoms that are designed to slow you down.
These include dizziness, fatigue, brain fog and pain. It’s important to
understand that your body always has the last word—it can pull the
rug out from under you whenever it needs for you to rest.
People who’ve recovered from Fibro & Fatigue frequently state that
scaling back their activities and stress level, at least temporarily, made
a very positive contribution to their recovery. A useful analogy is to
treat the amount of energy you have each day as “your energy bank
account.” Over expending energy to the point where your energy
account becomes overdrawn can precipitate a variety of symptoms
often referred to as “energy crashes.” Becoming skillful at pacing
yourself can ensure that you have an adequate supply of energy
available for when you really need it!
Doesn’t it make sense to get ahead of these symptoms by putting in
place a program of strategic pacing and prescribed rest? It certainly
does! Listed below are pacing techniques that patients with Fibro &
Fatigue regularly associate with their recovery. These techniques have
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played an invaluable role in helping many of my patients successfully
rebuild their health.
Strategic pacing techniques include:
• Resting often
• Walking more slowly
• Minimizing multitasking
• Not overcommitting yourself
Healing Time
Getting adequate rest is one of the most important ways a person
with Fibro & Fatigue can begin their recovery. Take a period of time
each day to devote to your healing. Try starting with 20 minutes, then
advance to 40 minutes and finally to 1 hour each day. It takes at least
20 minutes just to settle down and approach a peaceful state. Deep
healing occurs most efficiently in the time after a peaceful state has
been attained.
Focus on what you are doing without any distractions such as televi-
sion, music or reading the newspaper. Powering down your phone is
essential. Yes, don’t just mute it—power it down. Trust me, it will start
up again.
You may want to begin by lighting a candle and invoking this prayer:
“May the time I now spend bring peace to my mind,
healing to my body and love to my spirit.”
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During this healing hour it is very important to make sure that you
minimize any disturbances. If anyone you live with asks you what you
are doing, just tell them that you are taking some time for healing
once a day. Then get back to your healing. Do not worry about what
they may say or think—you are doing what’s right for you.
Lie down and allow your body to get comfortable. Just reading about
this exercise is not effective. You need to practice it regularly.
Take a few deep breaths. Allow everything to quiet and to settle.
Allow your thoughts to begin having lots of space between them and
when you are ready, place your hands on any part of your body that
needs healing. If you are attempting to heal emotional symptoms,
such as anxiety or fear, place your hands first on your heart and then
on any part of your body that needs your healing touch. Allow your
body to move into any position it desires. Love yourself—be with
yourself—heal yourself.
Feel your body. Notice any areas of tension, discomfort or pain. Gently,
just begin to notice them. Try to breathe into them. It is important not
to be angry with any part of your body for feeling pain. Pain is one of
your body’s ways of getting your attention. The source of your pain
needs to be explored and investigated. Do not be judgmental.
Acknowledge the pain’s presence. And then, slowly, allow your
awareness to move a little closer to this area, the area where you
feel the pain. As you go, breathe deeply and expand your abdomen
completely.
Deep breathing is very important. Allow your awareness to come as
close to your pain as you feel comfortable and then, just be with it.
Where your awareness goes, your energy flows. Just experience the
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place that exists between pain and no pain, between tension and no
tension. Just sit there, on the boundary of your pain, and be with it for
a little while, as you might spend time being with someone who is ill.
Send it love. As it softens, take one small step closer. Just be with it.
Continue breathing deeply. Nowhere to go, nothing to do, just to be
with yourself and whatever discomfort you may be feeling. Give your
body the attention it’s asking for, the attention it needs to heal.
Give yourself 1 hour every day to focus completely on your healing.
Aren’t you worth 1 hour each day? Isn’t your healing worth 1 hour each
day? You can create the most potent healing environment possible for
yourself during this healing hour.
Of all the recommendations in this book, taking a significant period of
time every day to rest is the single most important, and often the most
difficult, recommendation to follow.
Loving Yourself
“Comes a time, when the blind man takes your hand,
Says, don’t you see?
You’ve got to make it somehow…on the dreams you still believe.
Don’t give it up… you’ve got an empty cup. Only love can fill.
Only love can fill”
- Robert Hunter
Your subconscious plays a very important role in determining your
health. If you can evolve unhelpful beliefs into positive ones, you can
positively alter the chemicals your brain is producing, and the
messages your brain is sending, to every cell of your body.
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No matter how long you’ve been suffering with Fibro & Fatigue, there
is hope! The tips and guidance included in this book can help begin to
steer your health in the right direction. Your body will respond to your
love and attention, but you need to apply the time and effort. Begin
putting all the pieces of your healing program together in a concerted
fashion. Show your body that your healing has now become your
highest priority! Let your body become the recipient of your
unconditional love.
I frequently listen to podcasts by a Buddhist teacher named Tara
Brach. I highly recommend listening to her podcasts. They are funny,
soothing, relaxing, life-affirming and filled with helpful suggestions
that can help you live a life as free from suffering as possible. Here is a
link to one example titled “Cultivating a Kind Attention”.
This next point is very important: your body needs to regain its trust in
you. It needs to trust that you will take really good care of it from this
point forward. It needs to trust that you will not expend more energy
than you have. You show your body love when you give it your
undivided time and attention on a regular basis.
Here are some ways you can show your body love:
• Eat a healthy diet
• Sit quietly in nature for 15 minutes a day
• Listen to a tape of positive affirmations
• Take a relaxing bath with candles and bath oil
• Use your favorite massage oil to massage a part of your body
that’s in pain
• Begin a program of “restorative yoga” (search “restorative
yoga” on YouTube)
• Write a love letter to your body expressing gratitude for all of
the things it does for you
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Chapter 6 — Conclusion
It is best to think of fibromyalgia and chronic fatigue syndrome
as neuro/endocrine/immune disorders. These three systems are
intimately connected. When the brain has thoughts, it produces
neurochemicals that stimulate hormones to be released by the
endocrine system, which in turn modulates the functioning of the
immune system. Your neuro/endocrine/immune system also affects
the amount of inflammation in your body, your energy level and your
general sense of well-being. After many years of poor nutrition,
chronic stress and possible exposure to environmental toxins, these
critical systems can break down, resulting in the occurrence of Fibro &
Fatigue symptoms.
Conventional medicine is not equipped to properly treat
complex, multisystem conditions. What is needed is a holistic
approach, one that supports all the systems of your body. This
approach is termed “functional medicine.” Functional medicine
addresses the underlying causes of disease, using a systems-oriented
approach that engages both the patient and practitioner in a
therapeutic partnership. It is an approach that has great advantages
when addressing the needs of a patient with a chronic, degenerative
medical condition.
I have an important secret to share with you: This exact program
will work to stabilize and potentially reverse the symptoms of ANY
neurodegenerative disorder. This includes mild to moderate
Alzheimer’s and Parkinson’s diseases. This has been my direct
experience in the patients I have treated with these conditions and its
rationale is thoroughly supported in the scientific literature.
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Most progressive neurodegenerative disorders, including Alzheimer’s
and Parkinson’s diseases, affect more than just the nervous system and
have been strongly linked to mitochondrial dysfunction.
You can’t sharp shoot these conditions with a single treatment (i.e.,
drug). You need to assemble a comprehensive program that supports
every system of your body—including the restoration of normal
mitochondrial functioning.
So there it is. With the right motivation you can begin your recovery
today! As the ancient Chinese philosopher Lao Tzu stated, “A journey
of a thousand miles begins with a single step.” Take your first step
today and begin implementing your Fibro & Fatigue healing program.
Improve your diet and start on the right supplements. Get your key
hormone levels checked, pace yourself and begin working to lower
your stress level. Once you begin to feel better, you will be highly
motivated to continue implementing your healing program.
Lastly, find a physician who is willing to work with you as a
partner in your recovery. Unless they have a better plan to suggest,
one that does not rely solely on prescription drugs, they should be
open to assisting you with whatever treatments you are intuitively
drawn to trying. This is your healing journey.
Keep Hope Alive!
Jon D. Kaiser, MDClinical Faculty, Dept. of MedicineUniversity of California Medical School, San FranciscoChief Medical OfficerK-PAX Pharmaceuticals
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Healing Program Summary
Nutrition• Stay well hydrated
• Eat 3-4 small to moderate meals per day, avoid snacking be-
tween them, and do not eat anything substantial for 2 hours
before going to bed
• Eat a natural and minimally processed diet:
Treatment phase: Paleo or Modified Paleo Diet
Maintenance phase: Mediterranean Diet
Micronutrients & Botanicals • Optimally support the mitochondria with key antioxidants
• Optimally support the gut with probiotics and digestive enzymes
• Optimally support the neuroendocrine system with adaptogenic
herbs
Hormones • Thyroid (T3 & T4) – test and optimize levels
• Testosterone – test and optimize levels
• Cortisol – test and optimize levels
• DHEA – test and optimize levels
Medications • Adequate pain control
• Sufficient mental alertness
• Deep restorative sleep
Mind-Body Techniques • Strategic pacing
• Healing time
• Loving yourself
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Biography
Jon D. Kaiser, M.D. has been treating individuals with chronic medical
conditions for over 30 years with a combination of natural and
conventional medicine. The majority of his patients have had
fibromyalgia, chronic fatigue syndrome, HIV/AIDS, Alzheimer’s disease,
Parkinson’s disease, cancer or other difficult-to-treat conditions.
By following a comprehensive healing program, most of Dr. Kaiser’s
patients have stabilized, improved and restored themselves back
to health.
Dr. Kaiser is also a specialist in mitochondrial medicine and has
published several research studies on the link between mitochondrial
dysfunction and degenerative diseases (research studies). He is on the
clinical faculty of the University of California Medical School in San
Francisco and is the author of several books on healing from chronic
medical conditions. In addition to caring for patients, Dr. Kaiser serves
as the Chief Medical Officer of K-PAX Pharmaceuticals.
Dr. Kaiser is available for in-person and telemedicine consultations.
He can be reached by visiting his website at JonKaiser.com.
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