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First-line comprehensive care III: update on immune system lab tests for fibromyalgia-chronic fatigue-metabolic syndrome continuum of treatment-resistant pain and fatigue; Optimum clinical management improves outcomes and reduces risks and treatment complications as supported by new data.

This report is an update of a previous contribution to the Townsend Letter. With the benefit of five more years of data, the hypothesis offered in that article is now more strongly supported. (1) New information suggests this approach is highly cost- and outcome-effective, due to the use of more precise predictive and personalized tests.

Fibromyalgia (FM) is a "medical mystery syndrome," characterized by disabling, treatment-resistant pain localized in tender ("trigger") points. (2) The classic definition requires that 11 or more of 17 specific points show significant tenderness. (3) Concurrent substantial fatigue is common. (4) Chronic fatigue immune dysfunction syndrome (CFIDS) is also a "medical mystery syndrome," characterized by disabling fatigue that persists for more than six months. (5) Concurrent substantial trigger point pain and tenderness is common. (6)

Both FM and CFIDS are generally recognized as immune dysfunction syndromes. (7) This article focuses on the integrated, comprehensive management of the causes of autoimmune and immune dysfunction syndromes, which make these conditions of particular interest. (8) This first-line comprehensive care approach to the causes, rather than the consequences, of FM and CFIDS has been studied in a successful, community-based, randomized, controlled trial (CBRCT). (7)

Metabolic syndrome (syndrome X, insulin resistance) is an increasingly common condition. (9) A prodrome of accelerated cardiovascular risks, the dramatic increase in incidence and prevalence portends substantially more chronic disease over the next several decades, as the momentum from today's people with metabolic syndrome express the heart attacks, strokes, small and large vessel diseases, and impaired quality of life that are the legacy of metabolic syndrome. (10) Fortunately, with proper proactive prevention, the nutritional deficits and xenotoxin detoxification can be accomplished with associated sustained remissions. (11)

It is striking that a functional, integrative approach to the science and practice finds remarkable overlap, concurrence, and inter-relationships between these apparently disparate conditions. Such is the difference between looking at symptomatic results rather than the upstream, molecular causes of ill health.

Documenting Successful Outcomes in Fibromyalgia, Chronic Fatigue, Metabolic Syndrome: Relationship to Restoring Homeostasis, Tolerance, Insulin Resistance, and Healthy Cell Acid/Alkaline Balance (pH)

A group of treatment-resistant, multiple-treatment-failure people with fibromyalgia, many of whom had concurrent CFIDS, was recruited for study. This group was selected, in part, based on the participants' expectation of failure due to their prior experiences with unsuccessful therapies. This was done to minimize extraneous variables.

What has been called the placebo effect--more accurately, an important aspect of the human healing response--is one such variable. (12) Selecting people with multiple, prior-treatment failures and an expectation of failure in this trial was part of the design to minimize the "placebo effect." Further, the trial was carried out for a full six months, longer than the so-called placebo effect usually lasts. Successful sustained remission in this group is encouraging for the general application of this comprehensive approach to causes of FM and/or CFIDS. While details of this approach have been published in the peer-reviewed literature, (7) an updated synthesis is presented here. This successful model is reported for the general reader in Fibromyalgia: My Journey to Wellness by Claire Musickant. (13)

This article focuses on what we have learned that would be of general use to integrative, comprehensive-care physicians and those seeking fundamental treatment for resistant, persistent muscle pain (fibromyalgia), fatigue (CFIDS) with or without prominent insulin resistance, impaired cellular energetics, and detoxification. Depending on the group, best-efforts application of the protocol described here resulted in 75%-90% substantial-to-complete sustained remissions. With over ten years of follow-up studies confirming sustained remissions, we are confident that these approaches, taken together, can achieve lasting results when consistently applied. (14)

The number of Americans who suffer from FM and CFIDS are estimated to range from five million (15) to 20 million. (16) Over one in ten Scandinavian women in the prime of life qualify for these diagnoses, according to recent careful surveys. (17) More careful studies find substantially larger numbers of people with these conditions. (18) Clearly, too many people suffer from these "treatment-resistant" syndromes. Although the pain and/or fatigue usually do not respond to symptom-suppressive treatments, a comprehensive approach to the causes yields better clinical and more cost-effective solutions. (7,10) While a precipitating trauma or distress can often be found, this event is often the "last straw that breaks" an already hospitable, predisposed host. (19)

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Healthy Homeostasis and Immune System Tolerance Can Be Restored.

Immune system responses can usually be reset to tolerance and delayed hypersensitivity reactions systematically lost by following this comprehensive care approach. Homeostasis and tolerance restoration depend upon identifying an individual's immune burden, i.e., those items recognized by comprehensive functional immune system tests as inducing a delayed immune response. This involves the following:

1. Substitution for delayed allergens to the extent possible so that immune system attention can be focused on repair rather than preoccupied with defense burdens induced by reactive foreign invaders. Functional lymphocyte response assays such as LRA by ELISA/ACT and MELISA are the current state of the art of comprehensive delayed hypersensitivity / delayed allergy tests.

2. Eating an "akaline way" energizing and detoxifying diet so that cell metabolic systems are restored to their efficient, resilient states The Alkaline Way is described in detail in "Summary and Conclusions" below.

3. Sufficient supplementation to correct cumulative deficits, while meeting current metabolic demands, so that free radical damage is quenched, and antioxidant networks protect and activate cell enzyme catalysts

4. Practice of healing actions to engage the human healing responses so that immunohormonal control systems are restored to resilient, sustainable good health, and well-being

How a Comprehensive Protocol for Managing FM, CFIDS, Metabolic Syndrome, Impaired Cell Energetics, and Detoxification Works in Clinical Practice

1. A functional, comprehensive, ex vivo assessment of all delayed allergy mechanisms addresses the basic burden on immune defense and repair systems. The more attention to defensive reaction from delayed allergies, the less ability the immune system has to devote to necessary repair. Cumulative deferral of repair results in increased permeability in tissues that have the greatest wear-and-tear: those that are distressed. Cumulative repair deficits are clinically known as inflammation. Fundamentally, we can understand inflammation as incomplete or blocked repair.

Based on outcome results detailed below, it is clear that careful "best efforts" to substitute for reactive items is sufficient using LRA by ELISA/ACT tests (Figure 1) to determine reactivities. It appears that there is a threshold for each individual below which the body can neutralize foreign substances (probably based on dendritic, phagocytic cells), without depending upon or burdening lymphocyte responses with defense reactions that reduce repair competences. Thus, while it is important to identify and substitute as many of the reactive substances as feasible, perfect substitution is not necessary to achieve effective clinical results.

LRA by ELISA/ACT tests are unique in that they measure all delayed allergy pathways. This lymphocyte response assay (LRA) is functional. This means immune memory lymphocytes (both B and T cells) respond to potential reactants under laboratory controls. So, for example, beneficial, protective, neutralizing IgG antibodies are not detected, while harmful, reactive, complement activating IgG antibodies are detected. This is in contrast to serum ELISA IgG tests that detect the presence of antibody but do not assess the antibody function--helpful or harmful. The LRA by ELISA/ACT tests are comprehensive, in that B-cell-mediated antibodies, immune complexes, and T-cell-mediated reactions are all measured. Further, the LRA tests are ex vivo in that the cells react just as they do in the body yet under direct laboratory observation.

2. Restoration of digestive competence means redressing maldigestion, (A) dysbiosis, (B) and enteropathy. (C) This creates the following results:

a. Eating foods that can be digested more completely without triggering focal or systemic immune responses This typically includes 80% (by volume eaten) of alkaline-forming foods that are intrinsically easy on digestion while providing bulk and essential nutrients in contrast to acid-forming foods that provide dense calories but low nutrient density. The accompanying chart, "Food and Chemical Effects on Acid/Alkaline Body Chemical Balance" (Figure 2), is useful in implementing The Alkaline Way in practice and at home. The preferred alkaline-forming foods are on the left side; the acid-forming foods are on the right side.

b. Eating in ways that enhance the degradation of food to healthy building blocks

These building blocks include aminoacids, di- and tri-peptides, sugars, glycerides, and fatty acids.

c. Replenishing a healthy microflora A full range of healthy probiotics are needed, along with dietary or supplemental prebiotics as described above. This means replenishment with 20-40 Bn organisms daily for two months to restore healthy probiotic balance, followed by 10-20 Bn organisms daily for health maintenance. Ten helpful probiotic strains have been independently shown beneficial for humans. All are recommended in state of the art probiotic formulas, typically with 5 Bn freeze-dried (lyophilized; alive) organisms per capsule.

d. Stimulating repair of intestinal capacity and rebuilding an areas of focal atrophy (enteropathy) This means providing energy for repair from I-glutamine (best recycled with the benefit of PAK). This also means enhancing efficient removal of environmental toxins, from toxic minerals to hormone mimic biocides to solvent residues.

The advantage of recycled glutamine is that physiologic amounts (1.5-6 gm/day) are recycled ten times per molecule so that clinical benefit is equivalent to 15-60 gm of free l-glutamine to restore intestinal energetics and enhance recovery from atrophic intestinal enteropathy.

3. A healthy, alkaline biochemical balance is important for all these functions. A good clinical assessment of sufficiency of buffering or of net acid excess (NAE) is attained from measurement of first morning urine pH. (20) Human cells are optimized around a narrow pH range. (21) Even small (hundredths of a pH unit) shifts to the acid or alkaline sides that are uncompensated induce substantial loss (typically, a functional loss of 20%-90%) of cell efficiency in energy production, protein synthesis, essential transport, and overall metabolic competence. (22,23)

Compensated metabolic acidosis both disposes to and amplifies the effects of insulin resistance and metabolic syndrome. Correcting metabolic acidosis, as monitored by first morning urine pH measurement, is an important clinical tool on verifying successful outcomes through clinically useful, non-invasive tests.

Saliva is a useful tool in people with healthy gingiva. (24) If gingiva are not healthy, the serous fluid exudate makes saliva pH no longer representative of NAE. (25) Clinically, first morning urine pH is the more reliable specimen for determining NAE. (26)

4. Practice of healthy habits to engage the human healing response While it typically takes regular practice for 40-60 days, helpful actions that take but a few minutes each can amplify and potentiate the benefits received from the other elements of this comprehensive care approach.

From relaxation response to active meditation, from stretching exercises to therapeutic touch, adjunctive techniques that intrinsically reduce distress and enhance the healing response are integrated organically into this approach.

All Supplements Are Not Created Equal: Bioavailability and Functionality Matter

Most supplements contain ingredients that are less than fully bioavailable. Indeed, only ten percent to 20% of the nutrients in most professional brands are actually bioavailable, even in a healthy person. (27) This is because of manufacturing procedures or ingredients that are not fully available and/or because the transporters needed for uptake are not included.

In addition, we suggest supplements that have been analyzed by third-party, post-production, independent, and, where possible, by clinical bioassays to assure full potency. Further, most labels are not full disclosure. This means hidden ingredients are commonly present. These undisclosed ingredients may interfere with uptake or provoke adverse reactions. We suggest full disclosure as a better approach to professional supplementation.

Which Supplements Are Needed Based on Lab Tests in FM, CFIDS, and Metabolic Syndrome X?

Scientific studies repeatedly conclude that certain nutrient deficiencies are strongly implicated in FM and/or CFIDS. These include the following:

1. Magnesium deficiency, often complicated by magnesium uptake block (28)

2. Choline citrate is helpful in correcting acetylcholine deficits as well as energizing and alkalinizing the cell. In addition, choline citrate combines with magnesium to enhance uptake and bypass its usual energy-intensive uptake route. (29) The pathway that creates energy requires magnesium to work efficiently. When the immune system is compromised by factors such as stress or illness, and when diet, toxins, or immune reactions cause excess cellular acidity (metabolic acidosis), magnesium demand increases, yet uptake is often impaired. Having pioneered this approach, we are gratified by the results when magnesium is safely and effectively delivered in active forms to cells and organs hungry for that buffering and enzyme-activating magnesium.

3. Glutamine deficit is common. (30) Glutamine is an important energy source in metabolically active and rapidly dividing cells. Enough I-glutamine to be clinically effective (15-60 grams/day) can lead to I-glutamate build up as an excitoneurotoxin. (31) Glutamate is one of glutamine's metabolic products. A unique formulation of I-glutamine and PAK (pyridoxyl-alpha-ketoglutrate) recycles the I-glutamine, so 1.5 grams of I-glutamine with 0.5 grams of PAK gives the functional effect of 15 grams of free glutamine, due to an average recycling of ten times for each glutamine molecule. (D)

4. Rapid consumption of ascorbate in cells of FM and CFIDS people is common. We recommend individualized calibration of ascorbate need (E) to achieve beneficial cellular ascorbate levels (concentrations).

5. Flavanoid (as quercetin dihydrate, the safer, more effective flavanoid) and flavanol (low molecular weight, soluble OPC) are effective, when combined, in stimulating tissue repair, reducing pain from inflammation, and local swelling. (F)

6. Nutritional and toxic mineral status can be determined using the d-penicillamine protocol to determine both nutritional and toxic mineral cellular status. (G)

7. Essential fatty acid deficits of omega 3 fatty acids including EPA, GLA, DHA, and CLA are common in people with FM. These are available in a single formulation. (H)

8. Comprehensive, fundamental supplementation of enzyme-activating antioxidants, minerals, cardiobeneficial mixed natural tocopherols, tocotrienols, and selenomethionine, along with energizing and alkalinizing Krebs' four DCAs (malate, succinate, fumarate, and citrate) is recommended. (I)

9. Many fibromyalgia patients suffer concurrently from the following:

a. Poor digestion, for which probiotics, preferably nine freeze-dried active strains (J)

b. Yeast infections, indicating impaired host immune defenses (for which the LRA by ELISA/ACT tests are helpful) Along with long transit time, yeast infections allow digestive remnants to ferment and feed yeasts in the colon, for which the ascorbate calibration protocol--along with the ionized magnesium and choline citrate protocol--facilitate magnesium uptake necessary for benefit in people with a blocked calcium-magnesium ATPase enzyme.

c. Nausea, indicating impaired detoxification, for which either nutritional support of liver phase 1 and phase 2 detoxification (K) and/or neuroimmune detoxification (L) is recommended.

10. We have recently observed the direct link between adrenal fatigue (cortisol/DHEA dysrhythm) and glucose/insulin energy regulation. (32) In sum, hormone and glucose/insulin ratios are both improved following rehabilitative supplementation of adrenal function after just six weeks of therapy. While most hormone studies have required six months or more to show benefits, this comprehensive supplement improved adrenal stress indices (ASI) after just a brief, six-week intervention. Striking is the improvement in glucose/insulin energetics concurrent with improved HPA axis (cortisol/DHEA) function (Figures 3 and 4).

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It is worthwhile to recognize that each person has a specific set of conditions and requires nutrients at dosages suitable for their individual utilization rates. The information above provides functional, state-of-the-art methods for determining individual needs. This makes it possible for people to take control more actively of their health. This can prevent FM and/or CFIDS from taking over their life by getting to and resolving the causes rather than reacting to the symptomatic consequences of their suffering.

Clinical Example of This Approach in Practice

A 44-year-old married woman was diagnosed with FM by a rheumatologist five years prior to her presentation. Her rheumatologist recommended Elavil. Elavil slightly reduced the pain perception and improved her sleep, but made her excessively drowsy (perhaps due to its anti-histaminic, immune-blocking side effects). The patient also used massage therapy, which provided temporary relief from the pain. Exercise therapy, as walking, when she felt well enough, benefited her.

Upon initial examination by her referring physician, the patient noted constant and often unbearable pain in her upper back and lesser pain in her foot, along with chronic stiffness throughout her body. The chronic pain was associated with emotional lability and acquired depression. She described herself in the following ways:

1. "Totally fatigued and weak"

2. "Pushing myself all the time"

3. Sleep is restless and consists mostly of dozing through the night.

The above symptoms are commonly associated with FM. Other health concerns included the following:

1. Chronic constipation since childhood She regularly used fibers, stool softeners, and laxatives

2. Constant itch on her knees, elbows, and, often, on her scalp

3. Odor sensitivities to smoke and perfume (this heightens other symptoms)

4. Poor memory and difficulty concentrating

5. Premature menopause at age 36 (on HRT for seven-plus years)

The patient also reported delayed allergies or hypersensitivity to dust, metal from jewelry, chemicals, and scents such as flowers, exhaust, smoke, mowed grass, and perfumes.

Her first morning urine pH was acidic (=5.5). This suggested net acid excess (NAE) and is an independent risk factor for treatment resistance.

An ENT exam was ordered. This showed signs and symptoms of moderate allergic rhinitis. An IgE allergy work-up (RAST test) showed reaction to five of the 18 items tested. These items included dust mites, house dust, dust, milk, and egg whites. Injection immunotherapy for inhalants was started.

The patient was then referred to Dr. Susan Brown, PhD, CCN for a nutritional evaluation. The evaluation revealed food cravings, probable delayed food and chemical sensitivities (in addition to the immediate reactions identified by the RAST test), as well as signs and symptoms of nutrient inadequacy of ascorbate, retinol, B complex, essential fatty acids (EFA), dietary fiber, and the minerals calcium, magnesium, zinc, and chromium. The patient took the LRA by ELISA/ACT tests and was advised by her physician to begin implementing the test results' treatment guide.

Food substitutions were made for all reactive items, both delayed and immediate. Chemicals to which lymphocytes were reactive include DBCP, potassium bromate, selenium sulfide, and halogenated biocide (cholinesterase inhibitors). The patient implemented a whole-food, alkaline way diet high in vegetables and fruits, lentils and pulses, seeds, nuts, and sprouts. Nutritional supplementation based on the LRA by ELISA/ACT health appraisal included vitamins, minerals, flavanoids, I-glutamine / PAK, (M) and EFA. (N) In addition, the patient did breathing exercises approximately once a week. She reported use of the salt-and-soda, relaxing, detoxifying bath three times a week for the first month and once a week for the next four months. She practiced food-combining about half the time.

A report on the patient three years later revealed the following:

1. Back pain is 95% better. She now wakes up refreshed and largely without stiffness without sleep medication.

2. Overall health is (self-rated) at 90% better.

3. Now the "wind is at my back, not in my face."

4. Occasional use of anti-histamines if exposed to large amounts of chemicals, problem foods, dust, or auto exhaust

5. Optimism and more stable emotions

6. Chronic constipation has been totally corrected. She reports daily, regular bowel movements.

7. Constant itch on knees, elbows and (at times) scalp is totally corrected if she avoids reactive foods.

8. More tolerant of odors, especially in public places

9. Memory and ability to concentrate are substantially improved.

Summary and Conclusions

While conventional care continues to struggle with the lack of response based on symptom-reactive care, we suggest an outcome-supported, comprehensive-care approach to the causes that is considered first-line by many clinicians and researchers.

The elements that weave together in this approach are as follows:

1. Functional, comprehensive, ex vivo determination of delayed hypersensitivities ("delayed allergies"), using LRA by ELISA/ACT tests and treatment guide Substitution for reactive items reduces the burden on immune defense and repair systems. This relief allows a shift from defense reactivity to repair induction to take place in the immune system.

2. An alkalinizing, detoxifying, energizing diet, known as "the alkaline way," featuring non-reactive fruits and vegetables, lentils and pulses, seeds, sprouts, and herbs as 80% of the volume of what is consumed The remaining 20% can be chosen electively among the acid-forming higher fat and protein foods. This is consistent with Thomas Jefferson's maxim: "Let meat be the condiment rather than staple of your diet choices." Figure 2 shows the metabolic effects of specific foods on body chemistry. (O)

3. Sufficient supplementation to correct cumulative essential nutrient deficits while meeting the higher demand of repair systems

4. Healing actions that engage the human healing responses or mind-body or psychobiology, whichever term is preferred

5. The collective benefits to immune system and hormonal system functions have been reviewed. A comprehensive, integrative approach is found of value as reported above with an emphasis on the tests that can be used predictively.

This approach has shown itself effective in evoking sustained remissions over ten plus years in 87% of those who are willing to put their best efforts into applying this comprehensive-care, first-line approach. As wisdom says, "perseverance furthers" to success, especially when prudently applied to an evidence-based, comprehensive-care, first-line approach. (33)

Dr. Jaffe is Senior Fellow of the Health Studies Collegium Research Foundation. He is developer of the LRA by ELISA/ACT tests and plans, the d-penicillamine nutritional and toxic mineral assessment protocol, the ascorbate calibration protocol, dose-response platelet aggregation, the occult blood method not interfered with by ascorbate reducing substances, among others. He serves as director of ELISA/ACT Biotechnologies and PERQUE nutritive supplements. Dr. Jaffe is recipient of the International Scientist of the Year 2003, awarded by the International Biographical Commission of Cambridge, England, to recognize his contributions to Biochemistry, Clinical Medicine, and Immunomics. He was recently elected as a Fellow of the National Academy of Clinical Biochemistry. He also maintains Fellow status in the American Society for Clinical Pathology, American College of Nutrition, and American College for Allergy, Asthma, and Immunology. He is a certified clinical nutritionist (CCN).

Resources

1. LRA by ELISA/ACT[TM] tests are available from ELISA/ACT Biotechnologies, 2 Pidgeon Hill, #410, Sterling, VA 20165; 1-800-553-5472; Fax: 1-703-450-2981; Email: clientservices@ELISAACT.com

2. The Health Studies Collegium Alkaline Way[TM] Guide is available from 2 Pidgeon Hill, #410, Sterling, VA 20165; 1-800-328-7372; Fax: 1-703-450-2998

3. PERQUE[TM] Supplements are available from PERQUE; 14 Pidgeon Hill, #180, Sterling, VA 20165; 1-800-525-7372; Fax: 1-703-450-2995; Email: clientservices@PERQUE.com; Website: www.PERQUE.org

4. Claire Musickant's, Fibromyalgia: My Journey to Wellness (2nd edition) is available from CEM Publishing, Milwaukee, WI or from a variety of online book distributors.

Notes

1. Jaffe R. Clinical importance of delayed immune reactions to antigens and haptens detected by functional Lymphocyte Response Assays (LRA by ELISA/ACT tests) in primary management of chronic disease--Part 2. Townsend Letter. 2004: 246: 68-73.

2. Rau CL, Russell IJ. Is fibromyalgia a distinct clinical syndrome? Curr Rev Pain. 2000; 4(4): 287-294.

3. Wolfe F, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia: Report of the Multicenter Criteria Committee. Arthritis Rheumatism. 1990; 33:160-172.

4. Jaffe RM, Deuster PA. Poster #37. Clinical Immunology Society Annual Meeting, 1996 May 31-June 3; New Orleans, LA.

5. Holmes GP, Kaplan JE, Gantz NM, et.al. Chronic fatigue syndrome: a working case definition. Annals of Internal Medicine. 1988; 108:387-389.

6. Buchwald D, Garrity D, Archives of Internal Medicine. 1994;154(18):2049-2053.

7. Mullington JM, Hinze-Selch D, Pollmacher T. Mediators of inflammation and their interaction with sleep: relevance for chronic fatigue syndrome and related conditions. Ann N Y Acad Sci. 2001;933:201-210.

8. Deuster PA, Jaffe RM. A novel treatment for fibromyalgia improves clinical outcomes in a community-based study. J Musculo Pain. 1998; 6: 133-149.

9. Meigs JB, et al. Hyperinsulinemia, hyperglycemia, and impaired homeostasis. JAMA. 2000; 283: 221-228.

10. Rosmond R, Dallman MF, Bjorntorp P. Stress-related cortisol secretion in men: relationships with abdominal obesity and endocrine, metabolic and hemodynamic abnormalities. J Clin Endocrinol Metab. 1998; 83(6):1853-1859.

11. Jaffe R, Mani J, DeVane J and Mani H. Tolerance loss in Diabetics: Association with foreign antigen exposure. Diabetic Medicine. 2006; 23:924-5.

12. Science and wellness: the new medicine. Annals American Public Health Assoc. 1977; 104: 4080.

13. Musickant C. Fibromyalgia, My journey to wellness. CEM Pub. 2001.

14. Jaffe RM. Comprehensive care of fibromyalgia and chronic fatigue immune dysfunction syndrome (CFIDS) seminar. Health Studies Collegium. 11 Nov 2003, McLean, Va.

15. Aaron LA, Buchwald D. Chronic diffuse musculoskeletal pain, fibromyalgia and comorbid unexplained clinical conditions. Best Pract Res Clin Rheumatol. 2003 Aug; 17(4): 563-574.

16. Neumann L, Buskila D. Epidemiology of fibromyalgia. Curr Pain Headache Rep. 2003; 7(5): 362-368.

17. Peres MF. Fibromyalgia, fatigue, and headache disorders. Curr Neurol Neurosci Rep. 2003; 3(2): 97-103.

18. Gran JT. The epidemiology of chronic generalized musculoskeletal pain. Best Pract Res Clin Rheumatol. 2003; 17(4): 547-561.

19. Goldenberg DL. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. 1997; 9(2): 135-143.

20. Bell J, Whiting SJ. personal communication via Dr. Susan Brown, 12 October 2000.

21. Guyton AC, Hall JE. Textbook of Medical Physiology. 10th edition. WB Saunders;2000.

22. Lemann J Jr, Bushinsky DA, Hamm LL. Bone buffering of acid and base in humans. Am I Physiol Renal Physiol. 2003 Nov;285(5):F811-32.

23. Lehninger AL. Bioenergetics: The Molecular Basis of Biological Energy Transformations. 3rd Edition. New York: Addison-Wesley Pub; 1978.

24. Navazesh M, Denny P, Sobel S. Saliva: a fountain of opportunity. Tex Dent I. 2003;120(5):424-432.

25. Bertzbach K. Immunopathology and peridontal diseases. A review and an attempt at site determination. Dtsch Zahnarztl Z. 1975;30(7):426-430.

26. First morning urine pH assessment, HSC protocol 112, Health Studies Collegium, Sterling, VA.

27. Greger JL. Dietary supplement use: consumer characteristics and interests. J Nutr. 2001;131(4 Suppl):1339S-1343S.

28. Seelig MS. Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome. J Am Coll Nutr. 1993;12(4):442-458.

29. Facilitation of magnesium uptake by choline citrate. HSC protocol 113, Health Studies Collegium, Sterling, VA

30. Larson AA, Giovengo SL, Russell IJ, Michalek JE. Changes in the concentrations of amino acids in the cerebrospinal fluid that correlate with pain in patients with fibromyalgia: implications for nitric oxide pathways. Pain. 2000;87(2):201-211.

31. Waagepetersen HS, Sonnewald U, Schousboe A. Compartmentation of glutamine, glutamate, and GABA metabolism in neurons and astrocytes: functional implications. Neuroscientist. 2003;9(5):398-403.

32. Jaffe R, Mani J. Improved cortisol/DHEA rhythm and glucose/insulin function after brief (six-week) supplementation with an adaptogenic, trophorestorative supplement. In preparation.

33. Jaffe RM, First line comprehensive care: clinical value of functional Lymphocyte Response Assays (LRA by ELISA/ACT tests) in chronic disease primary management: Part 1 Townsend Letter. 2003; 245: 72-77; Part II (Jan 2004).

Endnotes

A. Incomplete digestion, leaving large digestive remnants that can be recognized by the body is foreign and, hence, immune reactive and burdensome if not trapped in the gut-associated lymphoid tissue (GALT).

B. Loss of healthy microflora and hospitality to pathogenic organisms

C. Atrophy of intestinal wall surface area and diminished healthy intestinal immune defense mucins and secretory IgA antibodies among other functional losses

D. For information about PERQUE EnduraGuard (I-glutamine recycling with PAK), contact clientservices@PERQUE.com or call client services at 1-800-525-7372 or 1-703-450-2990 or fax 1-703-450-2995.

E. Based on the ascorbate calibration protocol, available by fax or email without charge from PERQUE client services at 1-800-525-7372 or 1-703-450-2990.

F. Information about PERQUE Pain Guard, known as "nature's NSAID," is available from clientservices@PERQUE.com or by calling client services at 1-800-525-7372 or 1-703-450-2990.

G. The d-penicillamine protocol is available by fax or email without charge from PERQUE client services at 1-800-525-7372 or 1-703-450-2990.

H. Information about PERQUE Triple EFA Guard, known as "complete EFAs," is available from clientservices@PERQUE.com or by calling client services at 1-800-525-7372 or 1-703-450-2990.

I. Information about PERQUE2 Life Guard, a comprehensive 40-nutrient life support, is available from clientservices@PERQUE.com or by calling client services at 1-800-525-7372 or 1-703-450-2990.

J. Information about PERQUE DigestaGuard Forte, ten freeze-dried, active probiotic strains (5 Bn viable organisms per capsule), is available from clientservices@PERQUE.com or by calling client services at 1-800-525-7372 or 1-703-450-2990.

K. Information about PERQUE LivaGuard, comprehensive phase 1 and phase 2 liver detoxification support, is available from clientservices@PERQUE.com or by calling client services at 1-800-525-7372 or 1-703-450-2990.

L. Information about PERQUE Detox IN Guard, comprehensive neuroimmune phase 1 and phase 2 detoxification support, is available from clientservices@PERQUE.com or by calling client services at 1-800-525-7372 or 1-703-450-2990.

M. For information about PERQUE EnduraGuard (I-glutamine recycling with PAK), contact clientservices@PERQUE.com or call client services at 1-800-525-7372 or 1-703-450-2990 or fax 1-703-450-2995.

N. Information about PERQUE Triple EFA Guard, known as "complete EFAs", is available from clientservices@PERQUE.com or by calling client services at 1-800-525-7372 or 1-703-450-2990.

O. The metabolic effects of foods on body chemistry is available by email from clientservices@ELISAACT.com or by calling 1-800-553-5472 or by fax:1-703-450-2981.

by Russell Jaffe, MD

Fibromyalgia (FM), chronic fatigue immune dysfunction syndrome (CFIDS), and metabolic syndrome (diabetes risk): definition, incidence, and prevalence
Figure 2: Food & Chemical Effects on Acid/Alkaline Body Chemical
Balance[TM]

Most Alkaline More Alkaline Low Alkaline Lowest Alkaline

Baking Soda Spices/Cinnamon * Herbs (most): White Willow
 Valerian Arnica, Bergamot, Bark
 Licorice Echinacea, Slippery Elm
 * Black Cohosh Chrysanthemum, Artemesia Annua
 Agave Ephedra,
 Feverfew,
 Goldenseal,
 Lemongrass,
 Aloe Vera
 Nettle
 Angelica
Sea Salt Sulfite#
Mineral Water * Kambucha * Green or Mu Tea Ginger Tea
 Molasses Rice Syrup * Sucanat
 Soy Sauce Apple Cider Vinegar * Umeboshi
 Vinegar
Umeboshi Plum * Sake * Algae, Blue
 Green
 * Ghee
 (Clarified
 Butter)
 Human Breast
 Milk
 * Quail Egg * Duck Egg
 Oat
 'Grain Coffee'
 * Quinoa
 Wild Rice
 * Amaranth
 Japonica Rice
 Poppy Seed Primrose Oil Avocado Oil
Pumpkin Seed Cashew Sesame Seed Seeds (most)
 Chestnut Cod Liver Oil Coconut Oil
 Pepper Almond Olive/Macadamia
Hydrogenated * Sprout Oil
 Oil# Linseed/Flax Oil
Lentil Kohlrabi Potato/Bell Pepper Brussel Sprout
Brocoflower Parsnip/Taro Mushroom/Fungi Beet
* Seaweed Garlic Cauliflower Chive/Cilantro
Nori/Kombu/ Asparagus Cabbage Celery/Scallion
 Wakame/Higki Kale/Parsley Rutabaga Okra/Cucumber
Onion/Miso Endive/Arugula * Salsify/Ginseng Turnip Greens
* Daikon/Taro Mustand Greens Eggplant Squash
 Root
* Sea Vegetables Jerusalem Pumpkin Artichoke
 (other) Artichoke Collard Greens Lettuce
Dandelion Greens Ginger Root Jicama
* Burdock/Lotus Broccoli
 root
Sweet Potato/Yam
Lime Grapefruit Lemon Orange
Nectarine Canteloupe Pear Apricot
Persimmon Honeydew Avocado Banana
Raspberry Citrus Apple Blueberry
Watermelon Olive Blackberry Pineapple Juice
Tangerine * Dewberry Cherry Raisin, Currant
Pineapple Loganberry Peach Grape
 Mango Papaya Strawberry

Food Category Lowest Acid Low Acid

Spice/Herb Curry Vanilla
 Stevia
Preservative MSG# Benzoate
Beverage Kona Coffee Alcohol
 Black Tea
Sweetener Honey/Maple Syrup
Vinegar Rice Vinegar Balsamic Vinegar
Therapeutic Antihistamines#
Processed Cream/Butter Cow Milk
 Dairy
Cow/Human Yogurt Aged Cheese
Soy Soy Cheese
Goat/Sheep Goat/Sheep Cheese Goat Milk
Egg Chicken Egg
Meat Gelatin/Organs Lamb/Mutton
Game * Venison Bear/Elk/Game
 Meat
Fish/ Fish Mollusks
 Shellfish Shellfish (whole)
Fowl Wild Duck Goose/Turkey
 * Triticale Buckwheat
Grain Millet Wheat
Cereal Kasha * Spelt/Teft/Kamut
Grass Brown Rice Farina/Semolina
 White Rice
 Pumpkin Seed Oil Almond Oil
Nut Grape Seed Oil Sesame Oil
Seed/Sprout Sunflower Oil Safflower Oil
Oil Pine Nut Tapioca
 Canola Oil * Seitan or Tofu
Bean Spinach Split Pea
Vegetable Fava Bean Pinto Bean
 Kidney Bean White Bean
Legume Black-eyed Pea Navy/Red Bean
Pulse String/Wax Bean Aduki Bean
Root Zucchini Lima or Mung Bean
 Chutney Chard
 Rhubarb
Citrus Fruit Coconut Plum
 Guava Prune Tomato
 * Pickled Fruit
 Dry Fruit
Fruit Fig
 Persimmon Juice
 * Cherimoya
 Date

More Acid Most Acid

Nutmeg Pudding/Jam/Jelly
Aspartame Table Salt (NaCL)#
Coffee Beer, 'Soda'
 Yeast/Hops/Malt
Saccharin Sugar/Cocoa
Red Wine Vinegar White/Acetic Vinegar
Psychotropics Antibiotics#
* Casein, Milk, Processed Cheese#
 Protein, Cottage
 Cheese
New Cheese Ice Cream
Soy Milk
Pork/Veal Beef
Bear
* Mussel/Squid Shellfish (Processed)
 * Lobster
Chicken Pheasant
Maize Barley
Barley Groat Processed flour
Corn
Rye
Oat Bran
Pistachio Seed * Cottonseed
Chestnut Oil Oil/Meat#
Lard Hazelnut
Pecan Walnut
Palm Kernel Oil Brazil Nut
 Fried Food#
Green Pea Soybean
Peanut Carob
Snow Pea
Legumes (other)
Carrot
Chickpea/Garbanzo
Cranberry
Pomegranate

* Therapeutic, gourmet, or exotic items
Italicized items are NOT recommended

Note: The items indicated with # are NOT recommended.

Figure 4: Insulin Resistance Improvement in DG After Six Weeks on
Trophorestorative Adrenal Support

Change in Insulin Resistance

 Insulin Resistance
 HOMA Glucose/Insulin ratio

T0 5.7 23.89
T2 4.1 6.25

Note: Table made from bar graph.
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Author:Jaffe, Russell
Publication:Townsend Letter
Geographic Code:1USA
Date:Jan 1, 2008
Words:5435
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