Waking Up the Nation, One Reader at a Time FREE ......Therapy in enhancing mito-chondrial function, reducing fatigue and improving mood and cognition. Introduction Mitochondrial dys-function,

Vol. 7, Issue 10 Investigating Lyme Disease & Chronic Illnesses in the USA October 2012

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Waking Up the Nation,One Reader at a Time...

Mitochondrial Dysfunction and Disease:Loss of Mitochondrial Function in Chronic Diseases

and its Reversal with Lipid Replacement Therapyby Prof. Garth L.Nicolson, Ph.D.*Department of MolecularPathology, The Institute forMolecular Medicine,Huntington Beach, CA email:[email protected]

*The author has nofinancial interest in theproducts discussed inthis contribution

AbstractLoss of function in

mitochondria, the key cellorganelle responsible for cel-lular energy production, canresult in cell death, excessfatigue and other symptomsthat are common problemsin almost every chronic dis-ease. These include: neu-rodegenerative diseases, dia-betes and metabolic syn-drome, cardiovascular dis-eases, autoimmune diseases,neurobehavioral and psychi-atric diseases, musculoskele-tal and gastrointestinal dis-eases, fatiguing illnesses,cancer and chronic infec-tions, among others. At themolecular level reduction inmitochondrial functionoccurs when there is loss ofmitochondrial maintenance,resulting in reduced efficien-cy of the electron transportchain. Lipid ReplacementTherapy using an all-naturalnutritional supplement mix-ture containing membranephospholipids, mitochondri-al cofactors and other ingre-dients can be used to repairmitochondrial damage,improve mitochondrial func-tion and increase the effi-ciency of the electron trans-port chain. Recent clinicaltrials have shown the bene-fits of Lipid ReplacementTherapy in enhancing mito-chondrial function, reducingfatigue and improving moodand cognition.

IntroductionMitochondrial dys-

function, characterized byloss of efficiency in the elec-

tron transport chain in mito-chondria, the chieforganelles inside cells thatproduce high-energy mole-cules such as ATP, is a char-acteristic of aging and essen-tially all chronic diseases.1-4

The disease list includes:neurodegenerative diseases,such as Alzheimer's disease,Parkinson's disease,Huntington's disease, amy-otrophic lateral sclerosis,and Friedriech ataxia; 1, 2, 4, 5

cardiovascular diseases,such as atherosclerosis andother heart and vascularconditions;6, 7 diabetes andmetabolic syndrome;8-10

autoimmune diseases, suchas multiple sclerosis, sys-temic lupus erythematosusand type 1 diabetes;11-13 neu-robehavioral and psychiatricdiseases, such as autismspectrum disorders, schizo-phrenia, bipolar and mooddisorders;14-16 gastrointesti-nal disorders;17, 18 fatiguingillnesses, such as chronicfatigue syndrome and GulfWar illnesses;19-21 muscu-loskeletal diseases, such asfibromyalgia and skeletalmuscle hypertrophy/atro-phy;22, 23 cancer;24, 25 andchronic infections.26, 27

The ability to producehigh-energy molecules likeATP in mitochondria isdirectly related to the abilityof the electron transportchain to pump protonsacross the inner mitochondr-ial membrane, creating atransmembrane proton andelectrochemical gradient thatdrives ADP phosphorylationto ATP.28, 29 A byproduct ofthis process is the produc-tion of Reactive OxygenSpecies (ROS), highly reac-tive free radicals that areproduced as a consequenceof oxidative phosphorylationand can damage mitochon-drial lipids, proteins andDNA by oxidation.30-32

However, there are mecha-nisms to control the excessproduction of ROS, and oneof these is to produce a con-

trol leak of protons backacross the inner mitochondr-ial membrane by inducinguncoupling proteins thatallow protons to flow backacross the proton gradient.29

In the absence of controlledproton leakage, excess oxy-gen consumption and result-ing ROS production candamage mitochondrial mem-brane lipids, such as the veryROS-sensitive inner mito-chondrial membrane cardi-olipin. Oxidative damage ofinner mitochondrial mem-brane cardiolipin and othermembrane phospholipidscan cause increased protonand ion leakage back acrossthe inner membrane andpartial loss of the electro-chemical gradient-thuscausing mitochondrial dys-function,33 which is seen asincreased ROS generationand reduced ATP productionwhile still consuming oxy-gen.

Mitochondrial Function,Fatigue and NaturalSupplements

In humans mitochon-drial function is related tofatigue. Fatigue is consid-ered a multidimensionalsensation that is perceived tobe a loss of overall energyand an inability to performeven simple tasks withoutexertion. At the cellularlevel fatigue is thought to berelated to loss of mitochon-drial function and produc-tion of ATP.34, 35 Chronicfatigue or intractable fatiguelasting more than 6 monthsthat is not reversed by sleepis the most common com-plaint of patients seekinggeneral medical care.36, 37

Chronic fatigue is also animportant secondary condi-tion in many clinical diag-noses, often precedingpatients' primary diag-noses.38 Chronic fatigue hasbeen directly related to lossof mitochondrial function39

and production of ATP.40

Although natural sup-

plements have been used toreduce fatigue, few are con-sidered effective. 41, 42

However, Lipid ReplacementTherapy (LRT) or the use offood-derived molecules forthe natural replacement ofdamaged, mainly oxidized,membrane lipids in mito-chondria and other cellularorganelles has proved veryeffective at reducingfatigue.25, 35, 39, 41, 43 To somedegree, antioxidant supple-ments can reduce ROS andprevent some mitochondrialoxidation, but antioxidantsalone cannot repair the dam-age already done to cells,and in particular, to theirmitochondrial membranes.41,

43-45

Lipid ReplacementTherapy and Fatigue

LRT plus antioxidantshave been effective in thetreatment of certain clinicalconditions, such as chronicfatigue.39, 41, 43, 46, LRT resultsin the actual replacement ofdamaged cellular phospho-lipids with undamaged(unoxidized) phospholipidsto ensure proper function of

cellular membranes.Combined with antioxidants,LTR prevents oxidative dam-age to cellular structures andfunctions and is useful in thetreatment of various clinicalconditions.25, 35, 39, 41, 43 LRT canrepair mitochondrial mem-branes, increase mitochon-drial function, and decreasefatigue in chronic fatiguesyndrome, fibromyalgia syn-drome, and other conditions,including aging (Table 1).When mitochondrial func-tion was followed in parallelwith fatigue in a controlledcrossover clinical trial, therewas a close correspondencebetween loss of fatigue andgains in mitochondrial func-tion.39

Lipid ReplacementTherapy with MembranePhospholipids, CoQ10,and NADH

A new LRT formula-tion of membrane phospho-lipids (polyunsaturatedphosphatidylcholine, phos-phatidylglycerol, phos-phatidylserine, phos

“Mito” ... cont’d pg 5

Subjects/patients n AverageAge Time on LRT

Piper Fatigue Scale(PFS)

fatigue reduction (%)Reference

Chronic fatigue 34 50.3 8 weeks 40.5** Ellithorpe et al.46

Aging, chronic fatigue 20 68.9 12 weeks 35.5* Agadjanyan et al..39

Chronic fatigue syn-drome (and/or fibromyalgia syndrome)

15 44.8 8 weeks 43.1* Nicolson & Ellithorpe43

Aging, fatigue 67 57.3 1 week 36.8* Nicolson et al.47

Chronic illnesses 58 55.0 8 weeks 30.7* Nicolson et al.48

3Modified from Nicolson and Settineri35 **p < 0.0001, *p < 0.001 compared to without LRT

Table 1. Dietary LRT Supplementation Reduces Fatigue Scores in Chronically Ill Patientsa

Professor Garth L. Nicolson, PhD.

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FEATURE

A Word on Detoxification

by Dr. Rashid A. Buttar,D.O.

www.MedicalRewind.com

Congratulations! Iapplaud you for getting thisfar and making such anenormous commitment toyourself and your loved onesto take back control of yourown health. Embrace the 9Steps I speak about in mybook "The 9 Steps to Keepthe Doctor Away" and yourlife will never again be thesame. You've been given aroad map to optimumhealth, regardless of yourcurrent health status. It's mysincere desire for you to livethe life you deserve, onethat's filled with vitality andhappiness. Every single per-son can have this, but itwon't be served on a silverplatter for you!

Do these 9 Stepsalways work? In a word,"Yes" . . . they always work!They are not based on theoryor even merely my experi-ence. Rather, they are basedon natural law-theimmutable laws by which theCreator designed the humanbody and all its self-healingsystems. Depending on yourcurrent state of health beforeembarking on the 9 Steps, itmay take you longer thanothers. You may even needthe intervention of a compe-tent and experienced physi-cian who can help you get tothis point until you no longerneed them. In fact, that'salways been my primary goalwhen I treat someone: to getthem to a point where theirown innate healing mecha-nisms become functionalagain and they no longerneed me.

If you fall into thiscategory of having a majormedical condition or havinga condition that has yourdoctor baffled to the pointthey're trying one medica-tion after another, desper-ately trying to get you somerelief-then this last chapterwill be the most importantone for you. I would stronglyurge you to review the ThreeFoundations again, especial-ly the first one, detoxifica-tion. I urge you to make thecommitment to pursue theproper methods of detoxifi-cation indicated for yourcondition. I also stronglysuggest that you begin yourjourney back to health by,first and foremost, under-standing the necessity forproper detoxification. If youdon't achieve effective detox-ification, you will neverregain what you hope to beable to regain.

If anyone's storyyou've read or heard has

ever resonated with you, or ifyou recognize some of theirsituations, it's in your bestinterest to find a doctor whounderstands the seven toxic-ities. If your story is nothinglike the ones you read orheard except that you couldrelate to the frustration orhopelessness in cases whereall treatments attemptedsimply failed, or if your storyis just that none of the spe-cialists can figure out what'swrong with you, then youespecially need to see a doc-tor who understands theseven toxicities.

No matter what youmay be dealing with, be itheavy metals, persistentorganic pollutants, or one ofthe other forms of body bur-den I've mentioned, thereare specific detoxificationmethods to address eachindividual concern. By rid-ding your body of theseroadblocks, you can makethe journey back to health-toa place that's not just a mereexistence but one where youthrive and grow and actuallylive your life again. If you'regoing to such great lengthsto reclaim your God-givenstate of natural health,you need all the advantageson your side.

The only thing thatcan derail your progress is ifyour body is not properlydetoxified. I cannot overem-phasize the monumentalimportance of detoxificationin any healing process.Unless the toxic burden islifted from your body, yourbody will not be able tomend itself effectively. That'swhy many people who makea sincere commitment toreclaim their health finallyquit, discouraged and bewil-dered after failing to see theresults they expected. Thereason they fail is becausethey either never knew therewas a hidden componentsabotaging them every stepof the way or they didn'tknow how to effectivelyeliminate that sabotagingcomponent. Their body was-n't able to divert resources togetting better and healingbecause it was too busy try-ing to simply survive, contin-uously spending all itsresources putting out theinternal fires of inflamma-tion and oxidation.

There are two routesthat you can pursue to deter-mine an effective course ofaction for your particular sit-uation. First, review thevideos on toxicity atwww.factsontoxicity.com.Next, get familiar with the 3Foundations, 9 Steps and 7Toxicities I teach in mybook. It’s hard finding theright doctor within a reason-able distance who has spe-cial training to help youregain your God-given rightto live a happy and healthylife. You can go towww.abcmt.org as onesource to choose a certifiedphysician to help you beginyour journey back to recov-ery.

You can also find alisting of physicians whohave been personally trainedby me at www.centersforad-vancedmedicine.com I'll justmention here that I person-ally handpicked this select

list of doctors. They were notable to buy their position onthis list, and they wereselected not only on thebasis of their medical abilitybut also on their attitudetoward healing. Obviously, Ican't guarantee they'll beable to help you, but what Ican guarantee is that theyare exceptional doctors andthey will do everything theycan to help you get better.

A Word on thePhilosophy of Healing

Make sure that youare comfortable with thephysician you choose to helpyou in your journey to recov-ery and maintain open linesof communication withthem. Never compromise onwho your doctor is because agood doctor is as rare of acommodity as a goodmechanic. When you findone and you "connect" withhim or her, you know you'reon your way to regainingyour health.

Never take anyone'sword for anything, especiallywhen it comes to yourhealth. That goes for me aswell. Just because I wrote ithere, don't take my wordblindly. Do your ownresearch and search for thetruth. It will become veryevident to you as long as youkeep your mind and yourheart open and receptive.There are far too many doc-tors, health regulators,politicians, health systems,insurance companies andpharmaceutical corporationswho are willing to compro-mise your well-being fortheir personal profit.Hopefully, you didn't need tohear this from me and youwere already aware of thisintuitively. However, whatyou may not recognize-yetthis is essential in order foryou to fully recover-is thatyou must take responsibility.You are ultimately responsi-ble for your own health.

To blame a book, doc-tor or TV show for advicethat may not be accurate foryou is just an excuse to shiftresponsibility to someoneelse. By doing so, you areessentially giving your poweraway to someone else. Whenit comes to your own health,don't blindly believe every-thing you read or see on TV.In fact, don't believe most ofit. Always challenge thesource of the informationand trust your instinctswhen it comes to the validityof the message being pre-sented. Never be afraid toquestion a doctor. Evenme! If a doctor is offendedthat you questioned them,here's a little advice: Find adifferent doctor! As physi-cians, we may be wearing thewhite lab coat and carryingthe big title, but you are theexpert when it comes to yourown body. Only you knowhow your body reacts andfeels "inside."

The most sophisticat-ed piece of machinery Godcreated was the body you'reliving in right now. Humanbeings have yet to createanything that comes evenclose to the intelligence andresiliency of the very bodythey inhabit. When it comes

to sheer efficiency, even themost complex computer sys-tems fade in comparison.Part of the marvel of thismachine we call our body ishow it was designed to reactin certain scenarios. We'vecome to call the study ofthese reactions and process-es "physiology." Take time tosit quietly and listen to whatyour body is telling you.Listen to your physiologyand let it tell you. Deepdown, your body knows whatit needs and is speaking toyou all the time. Never sec-ond-guess it, and always fol-low your intuition, especiallywhen it comes to asking thequestions you need to haveanswered. Never hesitate toask and always listen for theanswer.

Getting Out of the Way

When the mostsophisticated biologicalorganism gives us a messagethat something harmfulneeds to be moved outimmediately, does it makessense to block the process?In our arrogance of goingagainst the natural design ofthe human body, we claim tobe more intelligent than theOne who created it, and inresponse, we suffer from theconsequences of our med-dling. More accurately, thepatient suffers the conse-quences. In a situationwhere the symptom wouldlast only three to four daysbefore the body "self cor-rects," we arrest the processof correction, forcing thebody to keep the toxinsinside where they do moredamage over a longer periodof time.

Let's look at an exam-ple using a very commonproblem that physicians tryto deal with to illustrate thispoint. Let's use a case ofdiarrhea, for instance.Typically speaking, diarrheais a natural response to somesort of gastrointestinal irrita-tion. It could be an infectionfrom a bacteria or a virus, orit could be because some-thing you consumed was notfit to be consumed or goingbad. Generally, diarrhea isself-limiting, meaning that itwill go away by itself andusually lasts just two to fourdays. In certain conditions,diarrhea can last for fargreater periods if there is aserious underlying issue, butthis isn't typical.

In the vast majority ofcases, the culprit is a virus orbacteria (food poisoning)and the diarrhea is thebody's natural detoxifyingresponse to expel it as quick-ly as possible. In fact, that'show God designed our sys-tems, with a feedback mech-anism built in. If you touchsomething hot, you immedi-ately pull your hand back.Similarly, when you ingestsomething that is detrimen-tal to the body, it willrespond with vomiting ordiarrhea or both to get rid ofthe offending substance youingested. Still, doctors justlove to prescribe medicinesto stop the diarrhea. Why?By doing so, a condition thatwould have lasted a few daysnow takes seven to ten daysto resolve.

One of the editorsreviewing my manuscriptcommented that the expla-nation I just presented didn'taddress why doctors pre-scribe the medication thatcauses the condition to lastlonger. In the interest ofclarity, allow me to explain.Doctors don't prescribe tomake it (diarrhea, in thisexample) last longer.Doctors are trained to pre-scribe, and that makes thecondition being treated lastlonger.

The Warnings

It's this type ofapproach in medicine thathas gained favor in the lastfifty years and has come tobe known as "symptom man-agement." Masking symp-toms with medication is adangerous trend that hasgone on for far too long. Ifyou keep turning up theradio so you don't hear theknocking in your car engine,the motor will eventuallyburn up completely. Outsideof emergency care for brokenbones and trauma, modernmedicine has made an artform out of getting in theway of the infinitely intelli-gent processes of the humanbody-to disastrous effect.

Having said that,however, and in defense ofdoctors, I have to say thatthat's all we've been taughtto do-how to "block" things.That's why we (doctors) use"beta blockers" and "calciumchannel blockers" and so on.In fact, the mechanism ofpractically every drug is toblock something from hap-pening. That's mostly whatmedicine has become today,getting in the way of thebody and preventing it fromdoing its own work.Common sense dictates thatwe should allow the "badstuff " to get out. Who'dwant to carry around a back-pack full of liquidy, smelly,festering stool for the nextseven days?

Yet, that's exactlywhat tens of thousands ofpeople are doing every daywhen they are unnecessarilyprescribed medication fordiarrhea. This holds true forevery message your bodygives you, whether it's aheartburn, headache, rash,swelling, allergies or any-thing else. An outward mani-festation is always a signal tolook deeper and find thecause. To cover up the symp-tom with a drug is likeremoving the fuse from thewarning indicator on thedashboard of your car.

Sure, you don't seethe symptom anymorebecause the fuse was takenout. We're now lulled intoour false sense of securitybecause the flashing light onthe dashboard is no longerflashing and annoying us.But it was that very symp-tom you covered up(removed) that was trying towarn you that your engine isabout to blow. And if youignore the symptom or coverit up, your engine will blow.The body knows what it

“Detox” ... cont’d pg 4

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needs to do. The problem ismost of us keep hitting theoverride switch of our body'ssignaling systems, and whenthat's not sufficient, we go toa doctor and have them over-ride the system with strongerover riders meant to blockeven more reactions.

The bottom line isthat "killing" the messenger(symptom) with a drug isnever the smartest or bestcourse of action. In fact, it'sthe worst possible option youcan choose. Listen to yourbody!

Embrace the signalsit's providing. Don't suppressthe message by covering itup. And run from any doctorwho simply wants to flip youa prescription and push youout the door. You deservebetter. And if you want to gethealthier and stay healthier,you must demand better.

Good Medicine Is YourChoice

There are many doc-tors practicing in multiplespecialties with long titles. Itdoesn't matter if the doctor istrained in cardiology, neurol-ogy, rheumatology, gynecolo-gy, oncology or anything else.There are really only twospecialties in medicine-meth-ods that work with the bodyand methods that workagainst it. Patients continueto leave conventional medi-cine in droves for treatmentsthat work with their bodies,treatments that bring realhealing. This philosophy hasbeen called a lot of thingsover the years, from alterna-tive medicine to integrativemedicine, from holistic med-icine to natural medicine. Isimply choose to call itGoodMedicine or moreappropriately, AdvancedMedicine.

It's true that on therare occasion (very rare), Imay opt to use a drug, butit's always prescribed for aspecific limited period oftime. Regardless of what Iuse or how I treat a person, itwill always be with theunderstanding of physiologyand the intervention thatworks with the innate intelli-gence of the patient's body.

Many people thinkthat when they becomehealthy, they'll be happy.However, it's the other wayaround. Happy, joyous peo-ple are quite often thehealthiest. Your attitude hasfar more to do with yourhealth than you may evenrealize. The good news foryou is that your state of mindis completely within yourown control and you havefull power to change it how-ever you see fit.

I once read that hap-piness is governed by the "3Cs of Life": compromises,choices and consequences.Most people continuouslycompromise their entirelives, only to find that thechoices they could havemade would have preventedthem from having to face theconsequences of those com-promises. Be brave when itcomes to your health. Makethe bold choice. It may notbe the easiest thing to do atthe time, but remember, theuniverse always gives a

reward equal to or greaterthan in proportion to the risktaken.

Take the risk to behappy-really happy! Yes, it isa choice to find the good inyour day and focus on it allday. We've all seen a personwho has had a life plaguedwith one misfortune afteranother and yet greets every-one with a smile. How dothey do it?

It's no secret. Theyjust choose to be happy. Ahappier person has a happierbiochemistry and a happierbiochemistry means happiercells, which create a healthierbody. Thismay be over-simplifyingthings, butyou get thepoint.

There'sa saying thatgoes, "Whatyou think ofme is none ofmy business."Wiser wordswere neverspoken.People canthink whatthey wantabout you.They caneven say what they wantabout you. It happens to meall the time! But just becausesomeone says it, it doesn'tmake it true. Only you knowyour truth. Nothing has thepower to change that. Itreminds me of a line fromanother children's movie:"No matter how the windhowls and screams, themountain will never bend toit." Once you're anchored inyour truth, no one can evermake you feel any specificway without your permis-sion. When you allow some-one to hurt or upset you, it'snot their fault. You just vio-lated your own truth. Takeyour power back and remem-ber who you really are. Howyou feel is all about you andup to you.

Empowerment OftenBegins in Your Body

One of the added rea-sons why I emphasize detoxi-fication so often is becauseby rediscovering and learn-ing to honor the healingpower of our bodies, webecome aware of somethingvery profound and miracu-lous within ourselves. Mostof us have been raised and(unfortunately) indoctrinatedin a way that we've neverbeen conscious of our body'sremarkable power to healitself. To be honest, whatmakes the biggest differencefor my patients is this aware-ness-that their body is doingthe healing. I'm actuallynothing more than a glorifiedtrash removal expert, a "san-itation engineer" of the phys-iology, removing toxicitiesfrom the body. The real heal-ing is that my work simplyhelps them to detoxify;their body's own healingintelligence kicks in and thenthe miracles take place. Itreally isn't me at all-and thisrevelation frees them fromdepending on me or anyother authority for the rest oftheir lives. If there's one

insight you take from thisbook, I hope it's that yourbody is a miracle, and it canheal itself from virtually any-thing. Sure, you may need toassist it by removing toxinsor feeding it the right nutri-ents, but with the rightpieces in place, your bodywill do the healing. Nothingelse is necessary-not me, notany drug, not any supple-ment. Of course, it's onething to know this and it'sanother thing to experienceit in your own actual life.

That, my friend, iswhat will change everythingfor you. I promise! Because

once youhave thisunder-standingandinsight,no onecan takethat awayfrom you.Not now,not ever.I men-tioned amomentago thattrueempower-ment canbegin in

your body. What did I meanby that? Well, it's simple:Health is the most basic needwe have on this planet. Wetake it for granted when it'sthere, but when our health isthreatened-as in the case of aterminal illness-it suddenlybecomes our number onepriority.

If people feel thattheir health lies outside theirhands whether the causes aregenetic, environmental oranything else-then they mustrely on an authority for thesolution. This effectivelyremoves their own powerand places it into the handsof others. Instead, what I'msuggesting and promoting-this awareness of your body'sown healing intelligence-serves to empower you in aprofound way. Once youhave this awareness,you don't need anyone oranything. You can never besold a drug, a supplement oranything else that your bodydoesn't truly need to healitself.

What's more, there'sno substitute for the confi-dence that comes fromknowing that you have theability to heal yourself. Youno longer have to fear thesame health challengeseveryone else does, and youwill naturally make betterchoices because you funda-mentally understand thatyou are the one who deter-mines what happens withinyour own body. Everything-your weight, your appear-ance, your energy levels-it allcomes down to your aware-ness and your choices. Thisis the root of your power,and reclaiming your health isoften the best first step. Youcan begin reclaiming yourhealth immediately by imple-menting these 9 Steps.

When it comes tohealing, consistency is thename of the game. Keepingin a consistently positiveframe of mind as you gothrough these 9 Steps on a

daily basis is what's going toget you to your goal. Mostpeople see significantimprovement within the firstthree to six weeks.Invariably, however, after acertain time, they usually feelso good that they slowly startto slip, thinking they don'tneed to live by the 9 Stepsany longer, and they begin torevert to the choices that ledto their disorder, conditionor lack of health in the firstplace. When these problemsbegin to resurface and thepatient comes back to me, Ialways ask why they stoppedpracticing the 9 Steps. I'vebeen amazed at the reply Imost often get back. "Istopped doing the 9 Stepsbecause I got better."

Remember, the 9Steps are not a "symptommanagement" form of medi-cine. In fact, the 9 Steps arenot any type of medicine.They are a lifestyle! They area philosophy that is onlyworth something if youchoose to live by it. Can youdo this? Of course you can.Anyone can! The question is,"Will you do this?" That's thequestion that only you cananswer. As long as you keepon keeping on with the 9Steps, you'll continue toenjoy the benefits of vibrantgood health. And as you do,let no excuse get in your way.Put yourself first andremember the followingpearls I have accumulatedover the years:

1. Express your lovefor those you care about on aregular basis. And express itto them. It's not sufficient totell others how much youlove your children or yourwife. Tell your children andyour wife or other lovedones. Show them.

2. Live in a state ofgratitude. If you can't thinkof what you have to be grate-ful for, think of all the peoplewho are homeless, hungry,missing an arm or a leg or allalone . . . and suddenly you'llhave much to be gratefulabout.

3. Show me somethingyou think you desperatelyneed, and I'll show you hun-dreds of others who get alongperfectly well without it.

4. Accept that somedays you will be the pigeon,and on other days you'll bethe statue. Remember how-ever that regardless ofwhether you are the pigeonor the statue, everything thathappens has a specific pur-pose. Nothing occurs ran-domly. Regardless of whatyou choose to believe, this isfact.

5. Remember thatwhen you think someone elsehas an attitude problem, itmay actually be you who hasa perception problem. Lookto yourself and see how youcan improve. Those aroundyou will automaticallychange as you do.

6. On the keyboard oflife, always keep one fingeron the escape key. Choosenot to suffer from stress.There is nothing wrong with"healthy" conflict, like argu-ing which ball team is goingto win the game or a spirited

“Detox” ... cont’d pg 8

“Detox” ...cont’d from pg 2

I once read thathappiness is

governed by the "3 Cs of Life":compromises,

choices and consequences.



phatidylinositol, and othermembrane phospholipids),CoQ10 plus microencapsu-lated NADH and other nutri-ents has been developed.This formulation suppressedintractable fatigue inpatients with a variety ofdiagnoses during a two-month trial.48 The 58 partic-ipants in this study hadmoderate to severeintractable fatigue for anaverage >17 years and hadbeen to an average of >15practitioners without resolu-tion of their fatigue. Thesesubjects included 30 patientswith chronic fatigue syn-drome, 17 with chronic Lymedisease; 16 with other fatigu-ing illnesses, includingfibromyalgia syndrome andGulf War illness; 4 withautoimmune disease, includ-ing rheumatoid arthritis; 2with cancer; and 2 with dia-betes. These patients hadtried unsuccessfully manydrugs and supplements(average >35) to reduce theirfatigue.48

Participants in thetrial of chronic illnesspatients took the combina-tion supplement ATP Fuel®(membrane phospholipids,CoQ10, NADH and otheringredients) for 8 weeks, andfatigue was scored using thePiper Fatigue Scale (PFS).38

The PFS is a validatedinstrument that measuresfour dimensions of subjec-tive fatigue: behavioral/severity, affective/ meaning,sensory, and cognitive/mood.38 These were used tocalculate the foursubscale/dimensional scoresand the total fatigue scores.48

In this study on 58 long-term chronic illness patientswith intractable fatigue theinitial PFS mean total fatigue

score ± SD was 7.51 ± 0.29,and after 8 weeks of supple-ment this improved to 5.21 ±0.28, or a 30.7% reductionin fatigue. The meandecrease in fatigue scoreswas significant by t-test (p <0.0001) and Wilcoxonsigned-rank (p < 0.0001)analyses.48

The PFS fatiguescores can be further dissect-ed into four subcategories.38

These include:Behavior/Severity subcate-gory, which deals with com-pleting tasks, socializing,engaging in sexual activityand other activities, andintensity or degree offatigue; Affective/Meaningsubcategory, which deter-mines fatigue/tiredness ispleasant/unpleasant,whether the patient is agree-able/disagreeable, protec-tive/destructive, or feels nor-mal/abnormal; Sensory sub-category, which determineswhether the patient isstrong/weak, awake/sleepy,refreshed/ tired, or ener-getic/unenergetic; andCognitive/Mood subcatego-ry, which assesses whether apatient feels relaxed/tense,exhilarated/depressed,able/unable to concentrate,remember, and think clear-ly). All of these subcategoriesshowed significant reduc-tions by the end of the 8-week trial (p < 0.0001), indi-cating that there were signif-icant improvements in allsubcategories of fatigue.48

For example, there was a30.7% reduction (p <0.0001) in severity/behaviorof fatigue, indicating thatthere was a significantreduction in the intensity offatigue, and a significantincrease in the ability tocomplete tasks, socialize,

and engage in sexual andother activities. Also, therewas a 28.0% improvement(p < 0.0001) in mood andcognitive ability, such as theability to concentrate,remember, and thinkclearly.48

Regression Analysis ofFatigue Data

To determine if thetrends in fatigue reductionover time during the trial onthe combination supplement(membrane phospholipids,CoQ10, NADH and otheringredients) were consistent,occurred with a high degreeof confidence, and could pre-dict further reductions infatigue, we conductedregression analyses of thedata.48 The regression analy-sis of overall fatigue and ineach of the subcategories offatigue indicated significantand consistent downwardtrends in the fatigue data,suggesting that furtherreductions in fatigue wouldhave been likely if the trialhad been continued. Theregression R2 values for thevarious subgroups were:behavior/severity, 0.956;affective meaning, 0.960;sensory, 0.950; and cogni-tive/mood, 0.980.

Regression analysis ofthe overall fatigue yielded aR2 = 0.960. This indicatedthat there was a high level ofconfidence and reproducibil-ity in the downward trendsin all fatigue data. The com-bination supplement ATPFuel® was also safe, andthere were no safety issuesthat came up during thetrial.48

In previous trialsusing LRT the most severelyfatigued subjects showed thegreatest reductions in fatigue

scores.39, 43, 46 For example,subjects with initial overallfatigue scores indicatingsevere fatigue (above 8 inthe PFS scale) showedgreater reductions in fatiguescores on day 60 (35.3%improvement in overallfatigue) than subjects withlower scores (moderatefatigue, initial PFS score 4-8,25% improvement).

Examination ofscores from patients withchronic fatigue syndrome,Lyme disease, or other diag-nosis categories did notreveal major differences inoverall fatigue or its reduc-tion by the combination sup-plement that were depend-ent on diagnosis.48

Effects of CoQ10 andNADH Without LRT

Some but not all pre-vious clinical studies onCoQ10 or NADH reportedsome positive effects onfatigue. However, in thesestudies only a subset ofpatients responded or theresponse was for a limitedtime.49, 50 In a study onchronic fatigue syndromepatients 8 of 26 (30.7%)responded to microencapsu-lated NADH compared with2 of 26 (8%) on placebo (p <0.05).49 These results werenot considered significant byothers.50 The use of oralNADH compared to psycho-logical/ nutritional therapyfor 31 chronic fatigue syn-drome patients revealed thatNADH alone reduced fatigueonly in the first 4 months ofa 12 month trial.51 After thefirst 4 months, symptomscores were similar in theNADH andpsychological/nutritionalarms of the trial. OralNADH given for two months

to chronic fatigue syndromepatients resulted in adecrease in anxiety and max-imum heart rate after astress test, but little or nodifference was found in thefunctional impact of fatigue,quality of life, sleep quality,exercise capacity, or func-tional reserve.52

Cofactor CoQ10 is animportant antioxidant andan essential component inthe mitochondrial respirato-ry chain as well as a mole-cule involved in gene regula-tion.53 CoQ10 has been usedas a dietary supplement in avariety of chronic illnessesand age-related conditions.53,

54 In the combination supple-ment used by us (ATPFuel®) CoQ10 was used toimprove energy transductionand combat oxidativestress.54

SummaryWe used a combina-

tion oral supplement con-taining a mixture of mem-brane phospholipids, CoQ10,and microencapsulatedNADH to significantlyreduce intractable fatigue inpatients with chronic fatiguesyndrome, fibromyalgia syn-drome, Gulf War illness,chronic Lyme disease, andother conditions. Thesepatients had been sympto-matic for an average of over17 years, had been seen bymultiple practitioners (>15),and had used many othersupplements and drugs(>35) without apparentreductions in their fatigue.The combination supple-ment was a safe and effectivemethod to significantlyreduce fatigue in patientswith intractable chronicfatigue.48

phaaphaa

Footnotes:1. Reddy PH. Mitochondrial medicine for aging and neurodegenerative dis-eases. Nueormolec Med 2008; 10(4):291-315.2. Swerdlow RH. Brain aging, Alzheimer's disease and mitochondria.Biochim Biophys Acta 2011; 1812(12):1630-1639. 3. Green DR, Galluzzi L, Kroemer G. Mitochondria and the autophagy-inflammation-cell death axis in organismal aging. Science 2011;333(6046):1109-1112.4. Reddy PH, Reddy TP. Mitochondria as a therapeutic target for agingand neurodegenerative diseases. Curr Alzheimer Res 2011; 8(4):393-409.5. Karbowski M, Neutzner A. Neurodegeneration as a consequence offailed mitochondrial maintenance. Acta Neuropathol 2012; 123:157-171.6. Victor VM, Apostolova N, Herance R, Hernandez-Mijares A, Rocha M.Oxidative stress and mitochondrial dysfunction in atherosclerosis: mito-chondria-targeted antioxidants as potential therapy. Curr Med Chem 2009;16:4654-4667.7. Limongelli G, Msarone D, D'Alessandro R, Elliott PM. Mitochondrial dis-eases and the heart: an overview of molecular basis, diagnosis, treatmentand clinical course. Future Cardiol 2012; 8(1):2-18.8. Ma ZA, Zhao Z, Turk J. Mitochondrial dysfunction and -cell failure intype 2 diabetes mellitus. Exp Diabetes Res 2012; 1-11 doi10.1155/2012/703538.9. Joseph A-M, Joanisse DR, Baillot RG, Hood DA. Mitochondrial dysregu-lation in the pathogenesis of diabetes: potential for mitochondrial biogene-sis-mediated interventions. Exp Diabetes Res 2012; 1-16. doi10.1155/2012/642038.10. Nicolson GL. Metabolic syndrome and mitochondrial function: molecu-lar replacement and antioxidant supplements to prevent membrane oxida-tion and restore mitochondrial function. J Cell Biochem 2007; 100(6):1352-1369.11. Ghafourifar P, Mousavizadeh K, Parihar MS, Nazarewicz RR, PariharA, Zenebe WJ. Mitochondria in multiple sclerosis. Front Biosci 2008;13(1):3116-3126.12. Mao P, Reddy PH. Is multiple sclerosis a mitochondrial disease?Biochim Biophys Acta 2010; 1802(1):66-79.13. Fernandez D, Perl A. Metabolic control of T cell activation and death inSLE. Autoimmun Rev 2009; 8(3):184-189.14. Maiese K, Morhan SD, Chong ZZ. Oxidative stress biology and cellinjury during type 1 and type 2 diabetes mellitus. Curr Neurovasc Res2007; 4(1):63-71.12. Rossignol DA, Frye RE. Mitochondrial dysfunction in autism spectrumdisorders: a systematic review and meta-analysis. Mol Psychiatry 2012;17(3):290-314.13. Palmieri L, Peerscio AM. Mitochondrial dysfunction in autism spectrumdisorders: cause or effect? Biochim Biophys Acta 2010; 1797(7):1130-1137.14. Prince JA, Harro J, Blennow K, Gottfries CG, Putamen OL.Mitochondrial energy metabolism is highly correlated to emotional andintellectual impairment in schizophrenics. Neuropsychopharmacol 2000;22:284-292.15. Marazziti D, Baroni S, Piccheti M, Landi P, Silvestri S, Vatteroni E,Dell'Osso MC. Psychiatric disorders and mitochondrial dysfunctions. EurRev Med Pharmacol Sci 2012; 16(2):270-275.16. Konradi C, Eaton M, MacDonald ML, Walsh J, Benes FM, Heckers S.Molecular evidence for mitochondrial dysfunction in bipolar disorder. ArchGen Psychiatry 2004; 61:300-308.17. Chitkara DK, Nurko S, Shoffner JM, Buie T, Flores A. Abnormalities ingastrointestinal motility are associated with diseases of oxidative phospho-rylation in children. Am J Gastroenterol 2003; 98(4):871-877.18. Di Donato S. Multisystem manifestations of mitochondrial disorders. JNeurol 2009; 256(5):693-710.19. Norheim KB, Jonsson G, Omdal R. Biological mechanisms of chronicfatigue. Rheumatology 2011; 50(6):1009-1018.

20. Nicolson GL, Berns P, Nasralla M, Haier J, Nicolson NL, Nass M. GulfWar Illnesses: chemical, radiological and biological exposures resulting inchronic fatiguing illnesses can be identified and treated. J Chronic FatigueSyndr 2003; 11(1):135-154.21. Myhill S, Booth NE, McLaren-Howard J. Chronic fatigue syndromeand mitochondrial dysfunction. Intern J Clin Exp Med 2009; 2(1):1-16.22. Cordero MD, de Miguel M, Carmona-Lopez I, Bonal P, Campa F,Moreno-Fernandez AM. Oxidative stress and mitochondrial dysfunction infibromyalgia. Neuro Endocrinol Lett 2010; 31(2):169-173.23. Rabinovich RA, Vilaro J. Structural and functional changes of peripher-al muscles in chronic obstructive pulmonary disease patients. Curr OpinPulm Med 2010; 16(2):123-133.24. Sotgia F, Martinez-Outschoorn UE, Lisanti MP. Mitochondrial oxidativestress drives tumor progression and metastasis: should we use antioxi-dants as a key component of cancer treatment and prevention? BMC Med2011; 9:62-67.25. Nicolson GL. Lipid replacement therapy: a nutraceutical approach forreducing cancer-associated fatigue and the adverse effects of cancer ther-apy while restoring mitochondrial function. Cancer Metastasis Rev 2010;29(3):543-552.26. Gabridge MG. Metabolic consequences of Mycoplasma pneumoniaeinfection. Isr J Med Sci 1987; 23:574-579.27. Ashida H, Mimuro H, Ogawa M, Kobayashi T, Sanada T, Kim M,Sasakawa C. Cell death and infection: a double-edged sword for host andpathogen survival. J Cell Biol 2011; 195(6):932-942.28. Rich PR, Marechal A. The mitochondrial respiratory chain. EssaysBiochem 2010; 47:1-23.29. Divakaruni AS, Brand MD. The regulation and physiology of mitochon-drial proton leak. Physiology 2011; 26:192-205.30. Richter C, Par JW, Ames B. Normal oxidative damage to mitochondri-al and nuclear DNA is extensive. Proc Nat Acad Sci USA 1998; 85:6465-6467.31. Wei YH, Lee HC. Oxidative stress, mitochondrial DNA mutation andimpairment of antioxidant enzymes in aging. Exp Biol Med 2002; 227:671-682.32. Spector AA, Yorek MA. Membrane Lipid composition and cellular func-tion. J Lipid Res 1985; 26:101-105.33. Chicco AJ, Sparagna GC. Role of cardiolipin alterations in mitochondr-ial dysfunction and disease. Am J Physiol Cell Physiol 2007; 292:C33-C44.34. Duchen MR, Szabadkai G. Roles of mitochondria in human disease.Essays Biochem 2010; 47:115-137.35. Nicolson GL, Settineri R. Lipid Replacement Therapy: a functional foodapproach with new formulations for reducing cellular oxidative damage,cancer-associated fatigue and the adverse effects of cancer therapy. FunctFoods Health Dis 2011; 1(4):135-160.36. Kroenke K, Wood DR, Mangelsdorff AD, et al. Chronic fatigue in pri-mary care. Prevalence, patient characteristics, and outcome. JAMA 1988;260:929-934.37. Morrison JD. Fatigue as a presenting complaint in family practice. JFamily Pract 1980; 10:795-801.38. Piper BF, Dribble SL, Dodd MJ, et al. The revised Piper Fatigue Scale:psychometric evaluation in women with breast cancer. Oncol NursingForum 1998; 25:667-684.39. Agadjanyan M, Vasilevko V, Ghochikyan A, Berns P, Kesslak P,Settineri R, Nicolson GL. Nutritional supplement (NTFactor) restores mito-chondrial function and reduces moderately severe fatigue in aged sub-jects. J Chronic Fatigue Syndr 2003; 11(3):23-36.40. Myhill, S., Booth, N.E. and McLaren-Howard, J. Chronic fatigue syn-drome and mitochondrial dysfunction. Int. J. Clin. Exp. Med 2009; 2:1-16.41. Nicolson GL. Lipid replacement as an adjunct to therapy for chronicfatigue, anti-aging and restoration of mitochondrial function. J AmNutraceutical Assoc 2003; 6(3):22-28.

42. Chambers D, Bagnall A-M, Hempel S, Forbes C. Interventions for thetreatment, management and rehabilitation of patients with chronic fatiguesyndrome/myalgic encepthalomyelitis: an updated systematic review. JRoyal Soc Med 2006; 99:506-520.43. Nicolson GL, Ellithorpe RR. Lipid replacement and antioxidant nutri-tional therapy for restoring mitochondrial function and reducing fatigue inchronic fatigue syndrome and other fatiguing illnesses. J Chronic FatigueSyndr 2006; 13(1):57-68.44. Green K, Brand MD, Murphy MP. Prevention of mitochondrial oxidativedamage as a therapeutic strategy in diabetes. Diabetes 2004; 54(Suppl1):S110-S118.45. Jomova K, Vondrakova D, Lawson M, Valko M. Metals, oxidative stressand neurodegenerative disorders. Mol Cell Biochem 2010; 345:91-104.46. Ellithorpe RR, Settineri R, Nicolson GL. Reduction of fatigue by use ofa dietary supplement containing glycophospholipids. J Am NutraceuticalAssoc 2003; 6(1):23-28.47. Nicolson GL, Ellithorpe RR, Ayson-Mitchell C, Jacques B, Settineri R.Lipid Replacement Therapy with a glycophospholipid-antioxidant-vitaminformulation significantly reduces fatigue within one week. J AmNutraceutical Assoc 2010; 13(1):11-15.48. Nicolson GL, Settineri R, Ellithorpe E. Lipid Replacement Therapy witha glycophospholipid formulation with NADH and CoQ10 significantlyreduces fatigue in intractable chronic fatiguing illnesses and chronic Lymedisease. Intern J Clin Med 2012; 3(3):163-170.49. Forsyth LM, Preuss HG, MacDowell AL, et al. Therapeutic effects oforal NADH on the symptoms of patients with chronic fatigue syndrome.Ann Allergy Asthma Immunol 1999; 82:185-191.50. Colquhoun D, Senn S. Is NADH effective in the treatment of chronicfatigue syndrome? Ann Allergy Asthma Immunol 2000; 84:639-640.51. Santaella ML, Font I, Disdier OM. Comparison of oral nicotinamideadenine dinucleotide (NADH) versus conventional therapy for chronicfatigue syndrome. Puerto Rico Health Sci J 2004; 23(2):89-93.52. Alegre J, Rosés JM, Javierre C, et al. Nicotinamide adenine dinu-cleotide (NADH) in patients with chronic fatigue syndrome. Rev ClinEspaña 2010; 210(6):284-288.53. Littarru GP, Tiano L. Clinical aspects of coenzyme Q10: an update.Nutr 2010; 26:250-254.54. Orsucci D, Filosto M, Siciliano G, et al. Electron transfer mediators andother metabolites and cofactors in the treatment of mitochondrial dysfunc-tion. Nutr Rev 2009; 67:427-438.

About the AuthorProfessor Garth L. Nicolson is the President, Chief Scientific Officer andResearch Professor at the Institute for Molecular Medicine in HuntingtonBeach, California. He is also a Conjoint Professor at the University ofNewcastle (Australia). He was formally the David Bruton Jr. Chair inCancer Research and Professor and Chairman of the Department ofTumor Biology at the University of Texas M. D. Anderson Cancer Center inHouston, and he was Professor of Internal Medicine and Professor ofPathology and Laboratory Medicine at the University of Texas MedicalSchool at Houston. He was also Professor of Comparative Pathology atTexas A & M University. Professor Nicolson has published over 600 med-ical and scientific papers, including editing 19 books, and he has servedon the Editorial Boards of 30 medical and scientific journals and was aSenior Editor of four of these. Professor Nicolson has won many awards,such as the Burroughs Wellcome Medal of the Royal Society of Medicine(United Kingdom), Stephen Paget Award of the Metastasis ResearchSociety, the U. S. National Cancer Institute Outstanding InvestigatorAward, and the Innovative Medicine Award of Canada. He is also aColonel (Honorary) of the U. S. Army Special Forces and a U. S. NavySEAL (Honorary) for his work on Armed Forces and veterans' illnesses.

“Mito” ... cont’d from pg 1


FAITH FACTOR

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When You Wrestle With the Question of “Why Me?”

by Harriet L. BishopPast President of TexasLyme Disease Association,2006 to 2012

When plagued withan endless chronic illnessthat lays you low undiag-nosed for many years, it'squite natural for a person toponder "Why me? What isthe purpose in this pain?"Me, who lived a healthyactive outdoor lifestyle,stayed faithful, tried to eat ina healthful manner and triedto love my seemingly unlov-able neighbor - why has thishappened to me?

As I pondered thisquestion myself it was notwith a whine in a self-pityframe of mind, but in a curi-ous exploration of facts and Itruly wanted an answer. Ihad been married nearly 25years, had five wonderfulchildren in school, and now Ilived on a beautiful workingcattle ranch in sandy soil

where I could indulge mylove of gardening whilemaintaining my steady jobas a medical social worker. The unending escalatingpain that made each daymore difficult than the lasthad taken its toll, and Icould barely sit in my well-padded office chair longenough to record the dailyclinic interviews.

And then the youngerseemingly unlovable neigh-bor woman with the devilisheyes invaded my family andover a period of fiveanguished years took overmy place in the household,my place in the kitchen, andin my weak husband's heart.I asked advice from my wiseand precious father-in-lawbut he too could see no easyway out, and he just shookhis head sadly.

"How could this hap-pen? Why me?" I prayed toGod hoping for an answer.And I did get an answer butnot one I wanted to hear."So you will gain the courageyou've lacked to take theaction you need to take toremove your children froman emotionally unhealthyatmosphere" came thebooming response to myplea.

It took two more longyears for the divorce I soughtto be contested, withunthinkable threats from theother side causing timedelays and increasing theattorney fees every day.

My unceasing prayersto God for help wereanswered once again whenan unlikely visit from a firstcousin, recently retired butskilled in corporate negotia-tion, resulted in him rentinga small house nearby fornearly a year, long enough toconsult with both sides tobring an end to the costlystalemate.

The happy day camewhen my friends gathered tohelp move my belongings tomy new place, a ranch of myown, closer to town with alarger, lovelier split levelhome high on a hill over-looking our 40 acres of graz-ing pasture. There was spaceenough for all the children,and of course a big barn fortheir horses and ponies -dogs, cats, hamsters, and ababy goat to raise. And therewas a chicken coop forRocky and Priscilla, myfaithful Plymouth Rock egglayers.

The older three chil-dren were in college by then,and the teens were busy withtheir activities and after-school jobs. Money wastight, but we made it withmy huge garden, peach trees,the chickens and my salary.Thank goodness for collegeloans! I co-signed loans forthousands of dollars, know-ing they would grow up to beresponsible individuals whowould work to pay backevery dollar borrowed. But after a few years when

time had eased some of theemotional pain of rejection, Icould no longer deny that Iwas lonely for loving com-panionship. My daily prayersand hit or miss Bible readingled me to once again searchthose crinkly pages for ananswer to "Why me?"

That answer struckme like a lightning bolt in apassage that said in effect,"So you will seek Me and getthe help you need when youask for it. And then you willtell others of the comfort youhave gained from your faithin Me." Simple as that.Ah-ha! At last I know why Ihave been through the slingsand arrows and the fiery fur-nace. I must tell others thatwhen I prayed for courage, itcame to me. When I prayedfor patience, it came to me.When I prayed for help, along-lost cousin arrived. Andwhen I prayed for lovingcompanionship, my WhiteKnight, the real love of mylife, appeared wearing Levisand cowboy boots to oursquare dancing classes. We"graduated" together, andhave been married now for31 idyllic years. The chronicillness has abated after diag-nosis and treatment forLyme disease and five co-infections.

We enjoy the love of15 grandchildren and 7great-grandchildren whobring us the truly great joysof life. We are indeedblessed!

So when theinevitable "Why me?" creepsinto your thinking, as dailyphysical pain causesanguish, seek your ownanswer in the pages of theGreatest Book Ever Written.

phapha

TEXAS LYME FACTS

•Lyme disease has sur-passed AIDS as one of thefastest growing infectiousepidemics in our nation,with a cost to society in

the billions of dollars.

•Lyme disease is the mostcommon vector-borne dis-

ease in the state.

•Lyme disease is endemicin Texas and physicians

need to be familiar with it.

•In Texas, there are 11public health regions.

Patients with Lyme dis-ease reside in every public

health region in Texas.

•Borrelia burgdorferi, theagent of Lyme disease, has

been detected in Texasticks.

•Epidemiological evidencesuggests Amblyomma

americanum, the "LoneStar" tick, is the vector of

Lyme disease in Texas.

For More Info:www.TxLDA.org


CASE STUDIES

More Case Studies from IDSA Doctor Treating Chronic Lyme Disease

by Burton A. Waisbren,M.D.

Patient First Seen:September 13, 2007

This twenty-four-year-old, single, charming,ambitious young womangave the following history:She sustained a tick bite withrash in Wisconsin at ageseven. She developed severehives after this and then gen-eralized arthritis. A diagno-sis of rheumatoid arthritiswas made, but there wasnever any serologic evidenceof this disease.

At age thirteen, shedeveloped hair loss, chronicfatigue, and concentrationissues ("brain fog"), all ofwhich had continued until Isaw her on August 10, 2008.On physical examination,she had definite ataxia andabsent abdominal reflexes. She brought in a question-naire that she had found onthe Internet which had con-vinced her that she hadchronic Lyme disease, andthat is why she sought meout.

After an examination,I shared with her mythoughts that:

1. Something indeed waswrong.

2. My differential diagnosiswas between multiple sclero-sis (which as the reader ofthese case reports will know,I had found in chronic Lymedisease) and chronic Lymedisease. (essay 11)

3. Chronic Lyme disease.

I felt that there wasenough possibility that shehad chronic Lyme diseasethat on a clinical basis, Iadvised that we should starttreatment with oral doxycy-cline (100 mg twice a day),Ceftin (500 mg twice a - 10 day), and Flagyl (500mg) once daily for six weeks.

Her laboratory workshowed borderline antibod-ies against Borrelia but noevidence of other tick-relateddiseases. Her lumbar punc-ture revealed high globulin,and antibodies againstmyelin were positive. This isthe ninth patient in whomdemyelination was suspectedin this series.

When seen in sixweeks, the improvement wasnot convincing, perhapsbecause of her intolerance toCeftin, which we added atthree weeks.

On August 21, 2008,

she lost her job and insur-ance and moved to Indiana,so I sent the following letter: To her Insurance Provider ata Medical Center:

This will introduce(Patient’s Name), date ofbirth November 8, 1994. Iam trying to decide whethershe has early MS or demyeli-nation due to chronic Lymedisease. There was enough ofa response to oral doxycy-cline, Ceftin, and Flagyl thatI have suggested a four-weekcourse (eight weeks ifresponds) to IV Rocephin (4grams a day) along with oralerythromycin and Flagylthrough a PIC line on anoutpatient basis.

I have enclosed thepertinent data from herchart, and since she hasmoved, I suggested a "freshstart" at an academic institu-tion.

Please send me yourevaluation and plan. In myclinical evaluations, I decid-ed that something is wrongand that we are not dealingwith a "somatic disease." Sheand I would deeply appreci-ate careful consideration ofthis case.

Sincerely, Burton A.Waisbren, MD, FACP

I called the patient inJuly 2010, and she has notbeen able to find a doctorwho will take her seriously,although I am not sure howhard she has tried. She stillhas her presenting symp-toms. I, of course, feel badly because in my concept of a"perfect world," she wouldhave somehow receivedintravenous therapy with apossible chance of a "cure."Summary: A case that sug-gested Lyme disease andmultiple sclerosis.

Patient First Seen:October 4, 2007

On August 10, 2007, aforty-year-old physical ther-apist was kind enough tosummarize her case for me.It follows, although I omit-ted some of her feelingsregarding her previous care.Her summary is in italics,and my comments in text.

I am a physical ther-apist. I know my body. Iwas healthy and fit untilJune 9, 2007, when Iattended an outdoor partyin Richmond, Illinois. A dayafter the party, I noticed ared, circular rash about thesize of a quarter on mylower right abdomen. Iknew immediately this bitewas different than a typicalbug bite -it was angrierlooking and had a distinctlydefined center. I immediate-ly thought of Lyme disease,but everyone I knew wholived in Richmond, Illinois,and all the medical profes-sionals I knew said "noway." It couldn't be Lymedisease. They had neverheard of it in Richmond orin Illinois for that matter. SoI put it out of my mind.

About four days later,I suddenly felt very sick,faint, and out of it. I hadseveral bouts of diarrhea.

My husband rushed to myside and took me to see theobstetrician who had deliv-ered my second baby fourweeks before. He said thesymptoms were probablynothing or blood poisoning.About the bite, he said hehad also had one on hisarm, probably from a mos-quito. The feeling of being sickremained, so a week later Isaw an internist. He said Iabsolutely did not haveLyme disease because I had-n't seen the tick, and the tickwould have ballooned upwith blood to an enormoussize. He also said that therewas no Lyme disease in ourarea. He did not advisetreatment or studies. Thenthe muscle twitches beganalong with the strangetraveling paresthesias. ThenI noted electric-type cur-rents through my extremi-ties and migrating jointpain. I continued to seek help andsaw two other physicians inmy area. They empiricallyprescribed antibiotics butsaid that the blood tests thatthey had run were negative,so I could not have Lymedisease. My symptoms con-tinued and got worse, andthen a brain fog set in. Icouldn't seem to concen-trate. I felt mentallyweighed down and fuzzy-headed and mentallydepressed and frightened.

I sought anotherinternist who, when myLyme test came back nega-tive, told me I couldn't haveLyme disease and that Ishould discontinue theantibiotics. My symptomsremained. I began wonder-ing if it's not Lyme, thenwhat is it? A pinched nerve,carpal tunnel, fibromyalgia,some progressive neurologi-cal disease? I was research-ing and researching andstill, the only thing thatmade any sense was Lyme.Eventually, and logically,my mind wandered towardsMS. By this point, I haddeveloped a positiveLhermitte's sign. I referredmyself to a chiropractor. Isaw him three times, and hewas stumped. But we diddiscuss the possible justifica-tion for an MRI. So I didn'tappear to be a hypochondri-ac, I referred myself to aneurologist at another oneof Chicago's premier hospi-tals prior to requesting anMRI. This neurologist, Icould tell somewhat reluc-tantly, gave me the referral.The MRI reveals the causeof many of the symptoms-4white lesions, 2 in the brainand 2 in the cord. He thenreferred me for a lumbarpuncture, which came backpositive for antibodies to"something" and 2 oligo-clonal bands. He diagnosedme with, most likely, relaps-ing-remitting MS. My"Lyme tests" were againnegative. My family and Iwere crushed. We discussedbeginning MS drugs. I soonthereafter had my first full-blown neurological event,partially brought on by the

stress of this nightmare- dif-fuse numbness and musclespasms, and ended up in theER, and then in the hospitalfor a night.

The patient continuedher search for help, andmore consideration of thepossibility of her findingsbeing due to Lyme diseaseand, through this website,decided to come to see meabout her problems. Her his-tory, the white lesions on herMRI, the picture of her tickbite that she showed me, herhyperreflexia, paresthesia,ataxia, and absent abdomi-nal reflexes convinced methat she had Lyme diseasemasquerading as multiplesclerosis. An empiric courseof anti-Lyme disease therapywas started through a PICline. It consisted of a six-week course of 4 grams ofintravenous ceftriaxone and500 mg of Flagyl given twicea day by mouth. She contin-ued on oral doxycycline anderythromycin. Blood testsdone at her first visit didcome back suspicious forLyme disease. They weredone by Quest Laboratoriesand confirmed by BowenLaboratories. She also hadantibodies against Bartonellahenselae and Bartonellaquintana, which confirmedexposure to ticks. Fourmonths after the completionof the intravenous ceftriax-one, she describes her situa-tion as follows:

I completed a six-week course of IV antibi-otics, coupled with someoral medications, and amnow in my fourth month oftreatment for chronic Lymedisease. I feel immeasurablybetter. My brain fog hascompletely cleared. I'm nottripping over my words orlosing my train of thoughtanymore. My paresthesiasand muscle twitches are fewand far between. My energylevel is up. All in all, I feelalmost back to normal andmost definitely vindicated.And I'm now on a mission toeducate others about thisoften misdiagnosed andmistreated disease. This is a"silent epidemic," as manylike to call it. Had I listenedto the highly regarded andoverly confident neurologistwho diagnosed me with MS,I would now be much sicker,

getting precisely the wrongtreatment, and headed formore debility.

Comment: Of course,a few anecdotes do notestablish anything, but eachcase of an unusual naturethat presents itself to aninquiring physician shouldnot be ignored. This but-tresses my opinion that casesof an MS-like nature whichappear after tick exposuredeserve an empiric course ofLyme treatment (see essay11).

The patient was con-tacted on September 31,2009. She stopped all antibi-otics by mouth six monthsafter the course of intra-venous ceftriaxone (she hadbeen put on Ceftin, Ketek,and Flagyl). She stoppedbecause of persistent gas-trointestinal symptoms. They finally subsided after shetook probiotics for a month.On September 31, 2009, shefelt well and was workingfull-time. She had some eyecomplaints which we willcheck on by an optic nervepotential test. She has nodiscrete neurologic symp-toms. This case buttressed myopinion that demyelinationassociated with Lyme dis-ease will sometimes respondto treatment for chronicLyme disease (see essay 7).She was followed up by e-mail in June 2011 and feels"entirely well."

Patient First Seen:September 13, 2007

This was a patientwho on a nature hike inDecember, 2006, suffered atick bite.

Chronologic History: January 2007 Attack

of Bell's palsy that respond-ed to one week of oral pred-nisone therapy.

April 2007 She devel-oped blurred vision, general-ized paresthesia, and numb-ness in her lower extremi-ties. She saw a physicianwho suspected multiple scle-rosis. A lumbar puncturewas negative for that disease.A Western blot for Lyme dis-ease showed a positive 41 KGIgG band.

“Case Study” ... pg 8



June 14, 2007 I saw her firston this date. She had goneon outdoor camping trips forthe previous ten years in tickcountry with no recollectionof a tick bite. Physical examshowed only hyperreflexiaand absent abdominalreflexes. Complaints were ofparesthesia, blurring vision,fatigue, and weakness of thelower extremities. I made aclinical diagnosis of Lymedisease (Bell's palsy, pares-thesia, weakness, fatigue,and absent abdominal refl-exes).

Laboratory studiesshowed mild hypothy-roidism, 41 KG IgM Westernblot band, but no evidence ofother tick-caused diseases orantibodies against Borrelia. Imade a clinical diagnosis ofLyme disease and started heron Armour thyroid anddoxycycline (100 mg bymouth three times a day).

July 23, 2007 Therewas some improvement inthe paresthesia and fatigue,but she still felt "sick." Iadded Ceftin (500 mg bymouth three times a day)and Diflucan (200 mg bymouth per day).

September 19, 2007When seen, she was essen-tially asymptomatic.

April 19, 2008 Theimprovement continued, andshe elected to stop all med-ications.

September 10, 2009 Icontacted her husband byphone, and she had justgiven birth to a healthy babyboy. Her pregnancy hadgone well, and she had takenno antibiotics for a year. Shehad continued to take thy-roid medications.

It seems to me thatthis was a classic case ofLyme disease that showeddemyelinating presentationand responded to oral thera-py with doxycycline (seecases 1 and 4 and essay 11).

Patient First Seen:October 10, 2007

This forty-eight-year-old male had been in previ-ously good health until July2007. In June 2007, he hadvisited a deer farm in Illinoiswith a female companion,who developed documentedLyme disease soon after.

The history thepatient gave me was as fol-lows: A month after the visitto a deer farm, he noted hisarm twitching and pain inhis calf muscles. By the endof July 2007, he became"fatigued, forgetful, and irri-table." On August 2, 2007,he started oral doxycycline(100 mg twice a day). He

kept this up, but his symp-toms did not improve, andhe developed blisters on hisfeet. The doctor who wastreating his female compan-ion for Lyme disease startedhim on doxycycline,rifampicin, and Zithromax.Because he had not notedimprovement, he made anappointment to see me onOctober 10, 2007. Hebrought with him a reportfrom IGeneX Laboratorywhich showed a negativeblood test for Borrelia and aWestern blot positive for 34and 39.

During the October10, 2007, visit to my office,the physical exam was essen-tially negative for a lupusscreen but was positive forthe Epstein-Barr virus andCMV virus. Lyme studies byQuest showed anti-Lymeantibodies at a titer of 1.10,but negative Western blotstudies (we have seenWestern blot positives disap-pear after therapy). Studiesfor Bartonella were negative.

Even without the oldrecords but with the knowl-edge that his female com-panion had been treated, Ifelt that a course of intra-venous ceftriaxone was indi-cated. The rationale for thiswas explained in detail, andhe agreed to have a course ofintravenous ceftriaxonearranged. His managed-carecarrier agreed, and theychose the "Home InfusionsSolutions" organizationwhich was affiliated withRush Medical College as theagency to give the treatment.

The following pro-gram was ordered and insti-tuted by this agency for fiveweeks:

1. Ceftriaxone- 4,000 mg in100 ml of saline infused bygravity every 24 hours.

2. Lab: weekly CBC, SGPT,and SGOT blood tests; and Cdifficile in stool.

I saw the patientagain on November 12,2007, and he reported thatthe response, at best, wasequivocal. We decided oncontinuing for anothermonth, and this wasordered.

During the third weekof this period, the patientdeveloped a high fever andchills. He was admitted tothe emergency room of RushMedical Center, where theirdiagnosis of acute bacterialsepticemia was confirmed byseveral blood cultures thatrevealed serratia bacteremiathat responded to the antibi-

otic treatment suggested bysensitivity studies. As itturned out, the hospital hadbeen notified at that timethat the heparin preparationwhich they had been using tokeep the pic line open, wascontaminated with serratiabacteria. The patientresponded well to the treat-ment for septicemia, and thefollow-up suggested by theCDC was followed by bloodcultures for several months,which remained negative. Ofcourse, the PIC line throughwhich the antibiotics hadbeen given was removed.

The patient wasunderstandably disturbed,and he notified me that thetreatment had not helped,and that he was seekingother medical help.

I, of course, acceptedthis and told him that hisnext physician might want totreat both his high titers ofviral infections as well asBartonella, the most usualinfection associated withLyme disease that does notrespond to intravenousantibiotics.

Patient 7 First Seen:October 16, 2007

This retired seventy-two-year-old army man wasbit by a tick in July 2008 innorthern Wisconsin. He wasan outdoorsman, and his doghad been successfully treatedfor Lyme disease in the fallof 2007. Two months afterthe tick bite, which was notfollowed by a rash that heremembered, he developedgeneralized joint pain. Hisdoctor, without an involvedworkup, started him onprednisone (20 mg by mouthtwice a day). In spite of this,he continued to have gener-alized joint pain withswollen fingers and ankles.

There was no clinicalresponse to prednisone. Hisson, who was a pharmacist,thought he had Lyme diseaseand referred him to me. Hehad always been in excellenthealth and had for yearsindulged in, what his wifesaid, was a large amount ofalcohol. He had never beenseriously ill during manyyears of military service. Onone physical examination, hedid have tender, swollenankles and wrists and anenlarged liver.

He was reluctant tohave much laboratory workdone and brought in reportsthat showed a negative testfor rheumatoid arthritis andotherwise normal routineblood work. He was onMedicare and said he couldnot afford the IGeneX Lab

studies that I suggested. Hedid consent to antibodystudies for Borrelia, Westernblot studies for Lyme dis-ease, a lupus panel, and anEpstein-Barr screen, whichwas done by Quest. OnlyEpstein-Barr titers wereabnormal. At this point, Ican only say that in my expe-rience this Epstein-Barrvirus may be a cofactor inchronic Lyme disease.

In a conference withthe patient and his wife, Iexplained to them that Ithought there was enough ofa possibility that he hadLyme disease that it wouldbe reasonable to initiate thefollowing plan:

1. Taper his prednisone tozero.

2. Try doxycycline, Ceftin,erythromycin, and Flagyl fora month. If there was not aclinical response, start intra-venous ceftriaxone in highdosages along with empirictreatment for tick-associateddiseases.

He agreed to this planafter talking it over withtheir son, who is a well-trained pharmacist. The patient was seen againon December 4, 2008. Theoral medications had notseemed to be of benefit. Hehad been able to wean him-self from prednisone. Accordingly, I outlined aplan for six weeks of intra-venous ceftriaxone to begiven at home by organiza-tions we have in Milwaukeethat specialize in homeintravenous therapy. Thisorganization had given intra-venous ceftriaxone to severalpatients of mine who Ithought had chronic Lymedisease. Their personnel hadbeen impressed with theresults in a few patients. Iasked the patient to take theplan to his insurer, which hehad in addition to hisMedicare. To my pleasantsurprise, the insurer accept-ed the plan and we were ableto institute it starting inJanuary 2009. Prior to treat-ment, he was essentiallycrippled with generalizedjoint pain, and he started todevelop ataxia.

He then receivedeight weeks of the followingdaily: Initially a PIC line wasinserted at St. Mary'sHospital in Milwaukee. Theirradiology department hadpioneered the PIC-line tech-nique. Then, with me pres-ent and an EpiPen handy, hewas given the initial infusionof ceftriaxone at St. Mary's

Outpatient Department inthe dosage of 6 grams in 50cc of saline. I have repeated-ly found that 6 grams of cef-triaxone is tolerated intra-venously for long periods oftime.

The home infusionteam then went to his homethe next day and taught hiswife how to give the infusionand how to clear the linewith heparin. Infusions weregiven during a one-hourperiod. The home-care nursevisited the patient weekly tocheck on his progress and todraw blood for a basic meta-bolic panel and blood countand to collect a sample forurinalysis. He had orders fora stool for clostridium diffi-cile if he had any diarrhea.The visiting nurse was pres-ent during the first five daysand then weekly. Thepatient's wife kept in touchwith me by phone.

Oral erythromycin (2grams daily) and Flagyl (500mg daily) were taken as well.They were to treat empirical-ly Bartonella and the cysticphase of Borrelia, respective-ly.

I saw the patient inmy office on April 13, 2009.He had tolerated eight weeksof intravenous ceftriaxone ata daily dose of 6 grams with-out any complications givenfor eight weeks. He hadgradually lost all joint painsand stated that he was backto "normal." He was contin-ued on doxycycline (100 mgby mouth twice a day) andFlagyl (500 mg once daily). I last saw him on October 12,2009. He had no complaints.He said he had reduced hisalcohol intake and that hehad become his "active oldself." His Lyme tests wererepeated and for the firsttime showed a positive IgG30 KD band. I had acqui-esced to his wish to stop oralantibiotics in July 2010.

Comment: This caseseems almost too good to betrue, and it may be.However, we ended up witha well man who was com-pletely disabled before thera-py. The okay from his insur-ance carrier without a "peep"almost seems too good to betrue, as well.

phaaphaa

“Case Study” ...cont’d from pg 7

More case studiesfrom Dr. Waisbren canbe read by purchasinghis book Treatment ofChronic Lyme Disase

fromwww.LymeBook.com.

debate about religion or poli-tics. But if the arguing makesyou feel sick, it's no longer ahealthy conflict. Do notengage. Nothing is worthgetting ill about.

7. When you're wor-ried about your own situa-tion, find someone else tohelp; invariably, your sourceof worry will dissipate. Thereis empowerment in helpingothers.

8. Never argue withan idiot. They will always

drag you down to their level,and then proceed to beat youwith experience. Rememberthat the best revenge is liv-ing a good life.

9. When confrontedby a difficult problem, youcan always solve it easily byreducing the problem to aquestion, such as, "Howwould Spider-Man handlethis?"

10. The three thingsthat no human has a monop-oly on are Love, God and

stupidity. So when youencounter someone withmore than their allottedshare of stupidity, say aprayer of gratitude. Becausethey just left more Love andGod for you.

11. Always do theright things in life. You knowwhat they are. Your bodywill resonate to them. Usethe tool you'll be given at theend of this book to alwaysknow what the right answeris when faced with any deci-

sion in life.12. Make it a point to

put a smile on someoneelse's face every day. It willcome back to you magnified.Do this as much as possible.Keep count of how manysmiles you create and try toexceed that number everyday.

Everyone comes tothis Earth with a purpose.Find yours and life will beginto taste sweeter. You didn'tcome here to suffer in order

to learn. Knowledge ispower, and you now have thetools to re- create the healthof your youth or the healthyou've always dreamed youwould like to have. It's all upto you now! Move forwardwith boldness and the uni-verse will smile upon you.It's guaranteed.

phaaphaa

“Detox”... cont’d from pg 4

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