1

5 Steps to RegainingYour Health!

by Jon D. Kaiser, M.D.

Fibro& Fatigue

A Healing Program

for

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To my patients,

who make it possible for me to fulfill my life’s purpose.

_______________________

Copyright © 2019 by Jon D. Kaiser, M.D.

You have my permission to share this E-book (in unaltered form)

with anyone whom you think it may benefit.

Dr. Jon Kaiser is available for in-person and telemedicine consultations.

Information on scheduling a consultation can be obtained

by visiting his website at:

JonKaiser.com

_______________________

The information in this book is based on the accumulated knowledge

of over 30 years of research and experience by the author. It is not

intended to diagnose, treat, cure or prevent any disease or be a

substitute for informed medical advice. Please consult a doctor with

any questions or concerns you may have regarding your health.

book design by Ray Lobato, raydesign.com

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Healing Program Summary

Nutrition• Stay well hydrated

• Eat 3-4 small to moderate meals per day, avoid snacking be-

tween them, and do not eat anything substantial for 2 hours

before going to bed

• Eat a natural and minimally processed diet:

Treatment phase: Paleo or Modified Paleo Diet

Maintenance phase: Mediterranean Diet

Micronutrients & Botanicals • Optimally support the mitochondria with key antioxidants

• Optimally support the gut with probiotics and digestive enzymes

• Optimally support the neuroendocrine system with adaptogenic

herbs

Hormones • Thyroid (T3 & T4) – test and optimize levels

• Testosterone – test and optimize levels

• Cortisol – test and optimize levels

• DHEA – test and optimize levels

Medications • Adequate pain control

• Sufficient mental alertness

• Deep restorative sleep

Mind-Body Techniques • Strategic pacing

• Healing time

• Loving yourself

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Introduction ................................................4

Nutrition......................................................8

Micronutrients & Botanicals.....................20

Medications ...............................................33

Hormones ..................................................43

Mind-Body Techniques..............................52

Conclusion .................................................59

Healing Program Summary ......................60

Biography ..................................................61

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Introduction

Throughout this book I will use the term Fibro & Fatigue to refer

to the properly diagnosed conditions of fibromyalgia and chronic

fatigue syndrome. These conditions have specific diagnostic criteria

and should be assessed by an experienced physician.

Hello. My name is Dr. Jon Kaiser. I have been treating people with

chronic medical conditions for over 30 years utilizing a combination of

natural and conventional medicine. The majority of the conditions I’ve

treated include fibromyalgia, chronic fatigue syndrome, HIV/AIDS and

neurodegenerative disorders. By following this comprehensive healing

program, most of my patients have stabilized, improved and restored

themselves back to excellent health. For many years I personally

experienced chronic fatigue syndrome and chronic pain before I was

able to completely recover utilizing the program I will describe to

you below.

My philosophy has always been to make maximal use of natural heal-

ing methods (i.e. diet, supplements, exercise, yoga, etc.) before pre-

scribing pharmaceutical medications. However, being on the front

lines of the AIDS epidemic for over 2 decades taught me to value

everything in my toolbox, including prescription drugs. The most im-

portant thing about prescription drugs is to use them skillfully and in

the lowest possible dosages.

One thing I can definitely state is true:

The best possible health outcomes result from

skillfully combining natural and standard medical

therapies into a comprehensive healing program.

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Conventional medicine is not equipped to properly treat complex,

multisystem conditions. What is needed is a holistic approach, one

that supports all the systems of your body. This approach is termed

“functional medicine”. Functional medicine addresses the underlying

causes of disease, using a systems-oriented approach. It is an approach

that has great advantages when treating a patient with a chronic,

degenerative medical condition.

I have divided this booklet into 5 sections:

• Nutrition

• Micronutrients & Botanicals

• Hormones

• Medications

• Mind-Body Techniques

My goal is to empower you so you can put in place a strong founda-

tion for your healing program. Your healing program needs to focus

on stimulating your body’s innate healing capabilities so the root

cause(s) of your condition can be addressed and repaired. Some of

these root causes may include chronic inflammation, hormone

imbalances and mitochondrial dysfunction.

In order to best understand the recommendations in this book, it is

crucial that you understand the role played by the mitochondria, the

powerhouses of your cells. Every cell of your body (except mature red

blood cells) contains 500-1500 mitochondria that occupy 30-40% of

the cell’s volume. They burn the fuel we eat, namely carbohydrates

and fats, and turn it into chemical energy that helps every cell of your

body perform work and operate properly. If your mitochondria

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become unhealthy, your cells will no longer function properly and will

begin to break down. This state of energy overload damages your cells

via an excessive release of free radicals (toxic byproducts of energy

metabolism), ultimately leading to chronic inflammation and a vicious

cycle of tissue damage, chronic pain and chronic fatigue.

Mitochondria have their own genes. While the genes in the nucleus

of the cell are protected by a membrane and shielded from damage

by protective proteins, mitochondrial genes float freely within the

mitochondrial matrix and are completely unprotected. When oxidative

stress in the mitochondria rises above a certain threshold, toxic free

radicals can damage mitochondrial genes leading to the occurrence

of mutations. A progressive buildup of these mitochondrial gene

mutations leads to a less healthy mitochondrial population and, ulti-

mately, a shortfall in energy production throughout your entire body.

As I will describe below, a key component of the Fibro & Fatigue

healing program includes putting in place a micronutrient supplement

program designed to optimally support your mitochondria’s ability

to repair themselves and return to generating optimal energy. The

specific micronutrients comprising this supplement program have

been identified and tested over my 30 years of clinical experience.

They are not prescribed to correct dietary deficiencies but to deliver

therapeutic dosages of key nutrient molecules known to decrease

oxidative stress and support mitochondrial function in all of your cells.

In her book on treating chronic fatigue syndrome, my colleague

Dr. Sarah Myhill states, “Putting together a healing program is a little

bit like building a house – there is no point in putting in the windows

until the foundation and walls are in place. Many patients come to me

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after having tried thyroid hormone, nutritional supplements or similar,

but unless the appropriate diet, sleep, pacing and micronutrients are

in place and correct, they may not see any benefit.”

Dr. Myhill and I share very similar treatment philosophies. All of the

pieces of your healing program need to be put in place skillfully and

in the right combination. Dr. Myhill and I also strongly agree on the

importance of supporting the mitochondria when it comes to treating

and overcoming both fibromyalgia and chronic fatigue syndrome.

I am very confident that, by following this program to the best of your

ability, you will improve how you feel. Take a couple of steps today.

Improve your diet and start on the right nutritional supplements. Get

your key hormone levels checked, pace yourself better, and work to

lower your stress level. Put in place as many pieces to the program as

possible. Once you begin to improve, you will be further motivated to

continue implementing your Fibro & Fatigue healing program. Better

health is in your future!

Keep Hope Alive!

Jon D. Kaiser, MDClinical Faculty, Dept. of MedicineUniversity of California Medical School, San FranciscoChief Medical OfficerK-PAX Pharmaceuticals

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Chapter 1 - Nutrition

“Let thy food be thy medicine

and they medicine be thy food.”

- Hippocrates

Eating is something you do several times a day. Everything you put in

your mouth contributes to how you feel and whether your healing

program is moving in the right direction - or not. Your dietary choices

form the foundation of your healing program.

There is no shortage of controversy when it comes to what constitutes

a healthy diet. There is also no single “best” diet for a human being.

In fact, some people respond in metabolically diverse ways to the

exact same food. However, I would like to present some basic dietary

principles that I have found strongly support the healing of patients

with Fibro & Fatigue.

Principle #1 – Stay well hydrated.

Begin drinking clean, filtered water the moment you awaken (at least

8 ounces) and continue drinking it throughout the day. Try to consume

at least 1.5-2 liters of water per day. Carry around a water bottle that’s

made from non-BPA plastic. It is also important to consume salt every

day. This will help you retain the water you drink and keep your blood

pressure at an optimal level. Most people with Fibro & Fatigue have

low blood pressure. This can contribute to your feeling dizzy, foggy

and tired. Check your blood pressure regularly (at about the same

time of day) and aim for the following targets:

• 110 – 120 systolic

• 70 – 80 diastolic

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Principle #2 – Eat 3-4 small to moderate meals per day, avoid

snacking between them, and do not eat anything substantial

for 2 hours before going to bed.

Every time you eat something your body needs to focus on digesting

and processing what it has just eaten. This is hard work that requires

energy. That means there is less energy for your brain and muscles to

function. Makes sense, right?

At each meal, chew slowly and eat only what you require to satisfy

your hunger for the next several hours. Do not eat past the point of

feeling satisfied and content. Over-eating will stress your gut’s

digestive and energy-generating capacities and could precipitate

an energy crash that may last several hours or days.

Allow your body to have 3-4 hour breaks between eating.

This means very little snacking, even if the snack consists of healthy

food. Think about it. When your body is in “digest mode” there is less

energy available for your brain and muscles. Fibro & Fatigue are

conditions of low energy. When you eat a meal, you should focus on

consuming your food and allowing your gut to release the enzymes

and hormones necessary to digest the meal properly. It is important to

let your gut rest for several hours after eating a meal so your

body can metabolize your food as fuel and provide you with adequate

energy to use for work, exercise, household chores, etc. If you are

constantly snacking, your body doesn’t know whether it should be in

“digest mode” (directing blood flow to your gut and releasing insulin)

or “work mode” (directing blood flow to your brain and muscles and

releasing glucagon). By allowing your gut to rest between meals, you

allow your body to have more energy for other activities.

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After you eat a meal there is a transfer of blood flow, metabolic

resources and energy toward your gastrointestinal tract (stomach,

intestines and liver). If you get up and start moving too quickly, your

body won’t know where to concentrate your blood flow and energy.

Should it focus on properly digesting your food or should it focus on

moving and thinking?

It helps not to confuse your body. After you have consumed your last

bite of food, stay where you are for at least 10 minutes (preferably

more) before you get up and start moving. This will allow the shift in

blood flow and metabolic resources to gain momentum and promote

improved digestion, which over time will lead to a healthier gut. A

healthier gut promotes a healthier body.

Finally, when you sleep your digestive function slows down signifi-

cantly. If you have eaten a large meal prior to going to bed (less than

2 hours before), this food will sit undigested and ferment, leading

to the growth of unhealthy bacteria. Try to avoid eating anything

substantial for at least 2 hours prior to going to sleep.

Principle #3 – Your diet needs to be natural and

minimally processed.

The dietary guidelines I recommend for a Fibro & Fatigue recovery

program can be thought of as falling within the boundaries of a Paleo

/ Mediterranean / Anti-inflammatory Diet.

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The Paleo Diet

A Paleo diet is a dietary plan based on eating foods similar to what

might have been eaten during the Paleolithic era, which dates from

approximately 2.5 million to 10,000 years ago. This diet is also referred

to as a “stone age” or “cave man” diet. It discourages the use of foods

that became available after the onset of farming.

In essence, it is a diet high in protein, fiber and nutrients that typically

includes lean meats, fish, fruits, vegetables, nuts and seeds — foods

that in the past could be obtained by hunting and gathering. You can

also eat eggs and olive oil on the Paleo diet.

A Paleo diet limits dairy products, legumes and grains—foods that

became common after farming began. This means that the Paleo diet

is completely gluten-free. You also can’t eat any processed foods on

this diet. Processed foods can be thought of as any food that has gone

through a factory. This includes cakes, cookies, crackers, chips, granola,

pizza and breakfast cereals. None of the foods I just mentioned

are good for your health if you are suffering from Fibro &

Fatigue symptoms.

I’d like to try to explain why flour products are to be completely

avoided for the first several months of your healing program.

Consuming flour and sugar promotes fermentation. After many

decades of consuming cakes, cookies, crackers, bread, chips, granola,

pizza and breakfast cereals, the bacteria in your gut (the gut

microbiome) have become highly adept at fermenting these nutrients.

Fermentation of sugar and grain leads to the release of alcohols,

ketones and other fermentation byproducts that promote gas,

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bloating, fatigue, brain fog and chronic inflammation. Completely

eliminating sugar and flour products for the first six months of this

program will improve the quality of your gut microbiome and help

eliminate the above-mentioned symptoms.

The Paleo diet is excellent for reducing inflammation,

improving gut health, clearing up skin conditions and

promoting weight loss. These are all good things to accomplish

if you are trying to recover from Fibro & Fatigue.

Foods to eat on the Paleo diet include:

• Fruits

• Vegetables

• Nuts and seeds (minimally processed nut butters are fine)

• Oils from olives and nuts

• Lean meats, especially organic, grass-fed and

free-range animals

• Fish, especially those rich in omega-3 fatty acids, such as salmon,

mackerel and tuna

Foods to avoid on the Paleo diet include:

• Grains, such as wheat, oats, corn and barley

• Legumes, such as beans, lentils, peanuts and peas

• Dairy products

• Refined sugar

• Processed foods

• Artificial sweeteners

• Refined vegetable oils, such as canola

The Paleo diet is very strict however, in my opinion, it is the

best anti-inflammatory diet to follow if your health is seriously

compromised and you need to make rapid progress. It may not be

right for everyone, but it can at least provide a goal to aspire to, one

that might be adjusted based on your individual needs. The next diet I

will describe is called the “Modified” Paleo diet. This modified version

allows you to include some non-Paleo foods that are still healthy for

you to consume.

While following the Paleo diet might on the surface appear difficult,

there are plenty of delicious recipes easily available on the internet.

Either Google ‘favorite Paleo recipes’ or visit cookinglight.com.

Paleo Diet Examples:

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Paleo breakfast (fruit and nuts)

Paleo dinner (beef and vegetablestopped with kale)

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The Modified Paleo Diet

The Modified Paleo diet has some healthful additions such as peas,

lentils, beans, tofu, seitan, barley, quinoa and millet. I developed this

version of the Paleo diet so that:

1. It is not so strict and difficult to follow.

2. It includes some very nutritious grains that are often well tolerated

(barley, quinoa and millet).

3. It includes beans, tofu and seitan so that you can consume less meat

which is good for you and good for the planet, not to mention

good for the animals.

Foods to eat on the Modified Paleo diet include:

• Fruits

• Vegetables

• Nuts and seeds (minimally processed nut butters are fine)

• Oils from olives and nuts

• Lean meats, especially organic, grass-fed and free-range animals

• Fish, especially those rich in omega-3 fatty acids, such as salmon,

mackerel and tuna

• Tofu and other soy products

• Seitan (high protein wheat gluten; do not use if you are gluten

intolerant)

• Legumes such as peas, lentils, peanuts and beans

• Whole grains such as rice, barley, oats, quinoa and millet (no

flour products)

Foods to avoid on the Modified Paleo diet include:

• Refined sugar

• Processed foods

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• Dairy products

• Artificial sweeteners

• Refined vegetable oils, such as canola

• Cakes, pies, cookies, ice cream and desserts

• Corn, wheat and flour products

The Mediterranean Diet

The Paleo (or Modified Paleo) diet is the best diet to follow for

the initial “treatment phase” of your healing program. Once

your symptoms have improved significantly, you can follow

the Mediterranean diet for the “maintenance phase” of your

healing program.

Interest in the Mediterranean diet began in the 1960s with the

observation that heart disease caused fewer deaths in Mediterranean

countries, such as Greece and Italy, than in the United States and

northern Europe.

The primary difference between the Paleo diet and the Mediterranean

diet is that the Mediterranean diet allows for the moderate

consumption of dairy products, whole grains and legumes.

These foods will likely be more efficiently digested once your health

has improved.

Foods to eat on the Mediterranean diet include (italics indicate foods

also allowed on the Paleo diet):

• Fruits

• Vegetables

• Nuts and seeds (minimally processed nut butters are fine)

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• Oils from olives and nuts

• Lean meats, especially organic, grass-fed and free-range animals

• Fish, especially those rich in omega-3 fatty acids, such as salmon,

mackerel and tuna

• Legumes such as peas, lentils, peanuts and beans

• Moderate intake of dairy products such as yogurt and cheese

• Moderate intake of rice, quinoa, barley, oats, corn and wheat

Foods to avoid on the Mediterranean diet include:

• Refined sugar

• Processed foods

• Artificial sweeteners

• Refined vegetable oils, such as canola

• Cakes, pies, cookies, ice cream and desserts

Principle #4 – Use your diet to produce a positive effect on your

physiology

My advice is this: Give yourself 1 month to work up to eating a strict

Paleo (or Modified Paleo) diet, then stay on it for 6 months. It will

break your body’s addiction to simple sugars and carbohydrates. This is

an absolute necessity if you are to fully recover your health. Eating a

Anti-inflammatory and Healing Potential ➝ ➝ ➝

StandardAmerican

Diet(SAD)

The Mediterranean

Diet

The PaleoDiet

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really healthy diet will also help the other components of this pro-

gram work more effectively. Then, see how much of an improvement

you feel. A Paleo diet will help improve your physiology and

strengthen your gut bacteria, and it may even positively change your

life, especially when combined with the other aspects of this program.

Making significant changes to your diet is of even higher importance

if you have significant gastrointestinal symptoms (e.g., irritable bowel

syndrome or leaky gut symptoms) or if you are carrying a few extra

pounds. Do not underestimate the power of your food choices to

exert a powerful effect on your health and healing!

Principle #5 – Miscellaneous Guidelines

Coffee — It’s perfectly fine to have one cup of coffee per day. It’s also

OK to use a little cream and sugar. Avoid iced, blended and sweetened

coffee drinks. A combination of caffeine, sugar, dairy and ice is toxic to

your gut, liver and pancreas.

Tea — All teas are fine. Use raw, unfiltered honey as a sweetener.

Chocolate — Not allowed on the Paleo or Modified Paleo diet. On the

Mediterranean diet, one to two small squares (no more) of dark

chocolate every couple of days is fine.

Dairy products — Ideally, dairy products are to be completely avoided.

Adult mammals no longer have the need for, or the ability to properly

digest, large amounts of dairy products. Think of all of the milk,

butter, cheese, pizza, yogurt, ice cream and other dairy products in our

society’s diet. It’s way more than necessary. Many functional medicine

physicians believe that an excess of dairy products contributes to many

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chronic health problems including heartburn, irritable bowel

syndrome, obesity, etc. That said, a moderate intake of high-quality

yogurt and sheep or goat cheese, consumed on an intermittent basis,

should not impede your healing progress.

Pasta — Not allowed on the Paleo or Modified Paleo diet; allowed on

the Mediterranean diet. A surprisingly good substitute for pasta is

spaghetti squash or zucchini noodles (zoodles).

Nuts — Nuts contain a significant amount of protein. However,

they also contain a significant amount of fat. Therefore, they are

somewhat difficult to digest in large quantities. Consuming a couple

of handfuls of nuts per day is healthful. Some nuts, such as pecans,

cashews and macadamia nuts, contain more fat than others and may

be harder to digest.

Organic food — Consuming organic foods is ideal since many

pesticides have a direct toxic effect on the mitochondria. When you

are not well, your body does not need the added stress of dealing

with toxic chemicals. Organic produce has also consistently been

found to contain 20–30% more antioxidant compounds than

conventional produce. However, it is impossible to expect most people

to consume a 100% organic diet. The most important foods to eat

organically are: 1) fresh produce, especially items that are consumed

whole (grapes, apples, berries, etc.) and 2) meats (this will help you to

avoid both pesticides and hormones).

Alcohol — Alcohol is toxic to your nervous system. While the

Mediterranean diet allows for one glass of red wine per day, this

amount is not especially helpful to your healing program.

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One glass of wine or beer two to three times per week may be fine,

but anything more than this will impede your progress. Obviously this

guideline needs to be individualized to your health situation.

A strong nervous system can tolerate alcohol better than a weaker

nervous system.

Artificial sweeteners — These have been linked to weight gain,

diabetes, headaches and allergies. Not recommended at all.

Food allergies — There are at least two kinds of reactions to foods.

One is an acute (immediate) allergic reaction, such as the kind that

sends children who are allergic to peanuts to the emergency room

with life-threatening symptoms (hives, difficulty breathing, etc.). A

second type of reaction is more of a sensitivity whose symptoms can

be delayed by a few hours to a day or two. The symptoms of this kind

of reaction are more subtle and can include increased fatigue, brain

fog, abdominal pain, bloating and diarrhea. The most common foods

that can cause a delayed sensitivity reaction are cow’s milk and cheese,

wheat (gluten), corn, soy, eggs and nuts. The Paleo or Modified Paleo

diet will eliminate all of these foods except soy, eggs and nuts. If you

think you are allergic to soy, eggs or nuts, avoid the offending food

for at least 6 months and then try introducing it again in small

amounts. By following a strict Paleo or Modified Paleo diet, and

improving the health of your gut, you can completely eliminate many

delayed food sensitivities.

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Chapter 2 - Micronutrients & Botanicals

Twenty years ago, I identified a key combination of micronutrients

that helps eliminate the symptoms of abnormal mitochondrial

function. This combination includes:

• Alpha lipoic acid

• N-acetyl-cysteine

• Acetyl-L-carnitine

• Coenzyme Q-10

These four micronutrients are not commonly found in most

multivitamins. If they are in your daily multivitamin, they are almost

certainly not present at the dosages neccesary to exert a therapeutic

effect on improving your mitochondrial function. Consuming all four

of these micronutrients will allow you to achieve the most beneficial

effect when supporting the mitochondria.

I’d like to explain how I identified this key mitochondrial support

formula. Twenty years ago, I was caring for several hundred patients

with HIV/AIDS. The majority of these patients needed to take the first

generation of antiviral medications, which had numerous side effects.

Many of these side effects were caused by mitochondrial toxicity. In

other words, while these drugs were inhibiting HIV replication, they

were also poisoning my patients’ mitochondria.

This mitochondrial toxicity caused severe side effects including nerve

damage, fatigue, dementia and immune dysfunction. After several

years of testing and refinement with multiple nutrient combinations,

it became clear to me that one specific formula of micronutrients and

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antioxidants was able to reverse these side effects. This formula

restored normal functioning to the majority of my patients’ immune

and nervous systems. In response to taking it, their overall health also

clearly improved.

Since beginning to prescribe this combination of mitochondrial

support nutrients to my patients with Fibro & Fatigue, I’ve found that

the majority of them have also been able to stabilize, improve and, in

many cases, regain normal health and functioning.

As a physician, it is very important to me that any nutritional formula I

prescribe to a patient is of the highest quality so that it can effectively

accomplish its goal.

The ability of a nutritional supplement to accomplish its goal depends

on:

• The quality of the raw materials used

• The quality of the manufacturing process

• The ingredients and dosages of the specific formula

After many years of medical practice, I became frustrated with the

lack of consistent quality found in many consumer-grade nutritional

supplements. You’ve probably heard reports on how a large

percentage of nutritional supplements found in health food stores,

when tested by an independent laboratory, have been shown to

contain between 0% and 200% of the amount stated on the label.

If a patient trusts me enough to follow the nutritional supplement

guidelines I recommend, I want to make absolutely sure that the

products he or she takes are of high enough quality to work

as intended.

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This is the reason why I started K-PAX Pharmaceuticals in 2006.

I wanted my patients to have access to the highest quality, pharmaceu-

tical-grade nutritional supplements possible. I also wanted a company

that would produce the exact formulas I had identified as effective.

Furthermore, I wanted a company with the ability to perform high

quality clinical trials to investigate how these formulas might improve

the lives of patients with diseases linked to mitochondrial dysfunction.

K-PAX Pharmaceuticals has accomplished all of these goals.

When it comes to prescribing micronutrients and botanicals as part of

a treatment program for Fibro & Fatigue, I have three basic goals:

• Optimally Support the Mitochondria

• Optimally Support the Gut

• Optimally Support the Neuroendocrine System

Optimally Support the Mitochondria

Mitochondrial dysfunction is a mechanism that can explain the range

of symptoms experienced by patients with Fibro & Fatigue. In 2010,

a study of 20 patients with fibromyalgia compared to 10 healthy

controls demonstrated that patients with fibromyalgia had: 1) reduced

levels of coenzyme Q-10, 2) decreased mitochondrial membrane

potential and 3) increased levels of lipid peroxidation, a marker of

elevated levels of oxidative stress. Decreased numbers of mitochondria

in each cell were also observed in the fibromyalgia patients.

In patients with chronic fatigue syndrome, electron micrographs of

muscle biopsies have shown that their mitochondria are frequently in

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a state of degeneration. Furthermore, evidence of elevated oxidative

stress has also been detected in muscle biopsies from patients with

chronic fatigue syndrome.

Generally speaking, if an individual experiences a prolonged period of

long-term stress, inadequate intake of micronutrients and/or exposure

to environmental toxins, the presence of free radicals inside the

mitochondria can rise to unhealthy levels. This exposes the mitochon-

dria’s genes, proteins and membranes to toxic levels of oxidative stress

which can cause progressive damage. Over time, the cell’s energy-gen-

erating capacity declines and the cell dies, eventually leading to a

state of chronic inflammation.

When this situation occurs in individuals with a genetic susceptibility

to mitochondria-related disorders (e.g., fibromyalgia, chronic fatigue

syndrome, Alzheimer’s disease, Parkinson’s disease), symptoms begin

to occur. When early symptoms such as fatigue, headaches and flu-like

symptoms are not properly addressed, they can progress to a full-

blown diagnosis of fibromyalgia or chronic fatigue syndrome.

The two major goals of a mitochondrial support supplement

program are to decrease oxidative stress in the mitochondria,

thereby preventing any further damage from occurring,

and to encourage the restoration of normal mitochondrial

functioning. The reversal of a long-standing process of mitochondrial

decline does not happen easily. It requires a unique combination of

antioxidants and micronutrients administered at the proper dosages.

Because of my unusual experience of caring for hundreds of HIV/AIDS

patients with mitochondrial toxicity in the early days of the epidemic,

I was able to identify, study and refine two micronutrient formulas

that I believe accomplish this goal.

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K-PAX Pharmaceuticals produces these formulas to my exact

specifications. The raw materials they use are of the highest quality,

and the quality of the manufacturing process is extemely high. All the

micronutrients needed for your daily multivitamin are combined into

the two formulas below:

• K-PAX Immune is a complete multivitamin containing opti-

mal dosages of highly potent antioxidants, including alpha

lipoic acid, acetyl-L-carnitine, N-acetyl-cysteine and coenzyme

Q-10, to recharge your body’s energy-generating capacity at

the cellular level. K-PAX Immune has been clinically tested

for over 10 years and shown to support liver, immune and

nervous system functioning.

• K-PAX Energy is designed to improve your energy and

mental alertness. In addition to supporting healthy

mitochondrial function, K-PAX Energy contains a small

amount of caffeine (similar to that contained in 1/3 cup of

coffee) that acts as a catalyst to enhance its effect on mental

alertness. The balancing nutrients in K-PAX Energy give it

excellent tolerability.

Optimally support your mitochondria by implementing the following

program:

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Since K-PAX Energy includes a small amount of caffeine, you should

avoid consuming any additional caffeine-containing products (except

maybe a little coffee or tea). These include but are not limited to Red

Bull, Monster, Rockstar, 5-hour Energy, etc.

If you don’t take K-PAX Energy for any reason, you should increase

the dosage of K-PAX Immune to 3-4 tablets twice daily so you get the

correct amount of the key mitochondrial support nutrients.

The goal of this program is to help repair your mitochondria and

restore their ability to robustly generate energy. A complete list of

the nutrients and dosages contained in these two formulas can be

reviewed at the K-PAX Energy Support Program.

Optimally Support the Gut

The gastrointestinal tract is a finely balanced ecosystem with over 500

different strains of bacteria competing for space and nutrients. When

a healthy balance exists, few gastrointestinal symptoms are present.

However, the natural balance of gut microorganisms (gut microbiome)

can be upset by chronic stress, poor diet, alcohol consumption, and

many common medications (such as antibiotics, oral contraceptives,

etc.).

The K-PAX Energy Support Program

With Breakfast With Lunch (before 3pm)

K-PAX Immune: 2 tablets K-PAX Immune: 2 tablets

K-PAX Energy: 1-2 tablets K-PAX Energy: 1-2 tablets

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The success of your Fibro & Fatigue healing program depends on

restoring a healthy gut microbiome. We live in a symbiotic relationship

with these organisms. In return for a warm, dark and nutrient–rich

environment, they help us to digest our food, absorb nutrients and

eliminate harmful toxins. They have evolved with us for millions of

years and play an important, beneficial role in maintaining our health.

It is helpful to think of the gut microbiome as your private inner

garden. This analogy is accurate since bacteria are actually plants. Your

inner garden can be beautiful and healthy, or overgrown with weeds,

bugs and mold. It can also be of intermediate health with many

strong, beautiful plants, accompanied by some unwanted weeds.

When your inner garden is healthy and vital, it helps your body

remain balanced and strong. When it is weak and overgrown with

unhealthy organisms, your immune system becomes overactive and

stressed, and a chronic inflammatory state begins to take root. An

unhealthy microbiome can contribute to symptoms of fatigue, brain

fog, insomnia, bloating, abdominal pain, diarrhea and constipation.

The most important factor for reestablishing a healthy microbiome is

to follow the dietary guidelines described in Chapter 1. There are also

several nutritional supplements that can significantly support a

healthy gastrointestinal tract. Furthermore, your physician or other

healthcare professional can order a comprehensive stool analysis.

A properly performed comprehensive stool analysis checks for the

presence of intestinal parasites and other unhealthy organisms

(such as Candida albicans) that can contribute to an unhealthy

gut microbiome.

27

Intestinal Revitalization

Supplementing your gut microbiome with healthy probiotic organisms

is like planting your garden with a fresh crop of healthy plants.

Because probiotics are living organisms, there are many challenges as-

sociated with manufacturing and distributing probiotic supplements.

While there are hundreds of probiotic supplements on the market,

many are of low potency and require constant refrigeration.

After 30 years of medical practice, I have identified a two probiotic

supplements that, in my clinical experience, work extremely well

together to rebuild and restore a healthy gut microbiome:

K-PAX Super Probiotics is a unique probiotic formula designed to

deliver a therapeutic amount of active organisms known to promote a

healthy gastrointestinal environment, protect intestinal integrity

and boost immune function. It contains highly potent amounts of

Lactobacillus acidophilus and Bifidobacterium organisms (20 billion

organisms per capsule). It also contains Saccharomyces boulardii, an

extensively researched microorganism known to help support immune

defenses and gut health by helping to eliminate unhealthy bacteria.

K-PAX Super Probiotics does not require refrigeration.

Microbiome Mega-Spore Biotic is a new, advanced probiotic that

can help reinvigorate your gut. Microbiome Mega-Spore Biotic

contains spore-forming strains of bacillus organisms that are highly

resistant to stomach acid. Because they are acid-resistant, bacillus

spores deliver a much higher concentration of live organisms to the

small intestine, where they are most needed. Bacillus strains have also

been shown to support immune function by producing vitamins and

other potent antioxidants. Microbiome Mega-Spore Biotic also does

not require refrigeration.

28

Revitalize your gut microbiome with K-PAX Super Probiotics & Micro-

biome Mega-Spore Biotic by implementing the following program:

Digestive Enzymes

Millions of Americans take antacid drugs to treat heartburn, bloating,

ulcers and other gastrointestinal problems. These drugs are available

both over-the-counter and by prescription. The two most commonly

prescribed classes of antacid drugs are called H2 blockers and proton

pump inhibiters (PPIs). The versions of these drugs that are available

over-the-counter include Prevacid, Prilosec, Nexium, Zantac

and Tagamet.

Television commercials for antacid drugs promote their use so you

can eat foods that you normally would not tolerate or digest properly,

including pizza, ice cream and cold cut sandwiches. This makes no

sense! It’s important to listen to your body and not tell it to shut up

when it’s trying to communicate that it can’t tolerate certain foods.

What most people don’t realize is that many of these drugs (PPIs in

particular) have been linked to a variety of health problems, including

serious kidney damage, bone fractures, dementia and, most recently,

an increased risk of death from all causes. For example, when patients

taking H2 blockers were compared with those taking PPIs for between

Intestinal Revitalization Program

First month: 2 capsules of each twice daily

Next 6 months: 1 capsule of each twice daily

Maintenance: 1 capsule of each once daily

29

1 and 2 years, researchers at Washington University School of Medi-

cine in St. Louis found that those taking PPIs had a 50% increased risk

of dying over the next 5 years. This study was published in the British

Medical Journal in July 2017. Many people believe PPIs (Prevacid,

Prilosec and Nexium) are safe because they are readily available, but

there are real risks to taking these drugs, particularly for long periods

of time.

Instead of taking a PPI and decreasing the amount of acid released in

your stomach, thereby “making it more difficult” for your body to

digest your meal, I highly recommend making the dietary changes

recommended in Chapter 1. If you still have any symptoms of gas,

bloating or indigestion, I recommend taking a high-quality digestive

enzyme supplement that will “make it easier” for your body to digest

your meal. The following digestive enzyme product is high-quality,

safe and effective at improving digestion using plant-based enzymes:

Integrative Therapeutics Similase Lipo.

A healthy gut usually eliminates waste between one and three times

per day. An ideal bowel movement is well formed and tubular, similar

in shape to a corn cob. If you struggle with having regular bowel

movements, you may need to provide your gut additional fiber. While

it is ideal to achieve this goal through diet modification, you may

want to try a fiber supplement and/or stool softener. The following

fiber supplement is comprised of a 50/50 balance of soluble and

insoluble fiber derived from organic psyllium seeds, fig powder, rice

bran, apple pectin and prune powder: K-PAX Regular One.

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Optimally Support the Neuroendocrine System

The first step to optimally supporting the neuroendocrine system is to

restore its mitochondrial health. This is best accomplished by following

the mitochondrial support protocol described earlier in this chapter.

However, there is a class of herbal products (botanicals) called “adap-

togens” that can provide additional support to the functioning of

your neuroendocrine system. Some adaptogens, like ashwagandha,

are frequently used in Ayurvedic medicine, while others, like ginseng,

astragalus and rhodiola, have been used for centuries in Asia

and Europe.

Many researchers think adaptogens work by helping the body’s auto-

nomic nervous system return to its normal, healthy, relaxed state.

These compounds can help the body sustain itself during times of

stress and recover more quickly after the stressful situation has passed.

Individuals with Fibro & Fatigue who take adaptogenic herbs may

want to consider rotating several adaptogenic products to see which

ones work best on their symptoms.

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Additional Supplements to Consider

Curcumin

Since inflammation contributes to the symptoms of Fibro & Fatigue, a

natural anti-inflammatory agent that is safe and effective can play a

positive role. Curcumin, the most active ingredient found in the spice

turmeric, has recently gained attention for its antioxidant and anti-in-

flammatory properties. While turmeric has been used for thousands of

years as a component of curry powder, curcumin is the compound

within turmeric that has been shown to exhibit the greatest health

benefits and comprises the active compound used in most supplement

products. Numerous studies have shown that curcumin is able to block

inflammation in rheumatoid arthritis and osteoarthritis, and also

reduce nervous system inflammation.

Absorption of curcumin is very limited due to its low solubility, poor

stability and rapid elimination. In essence, it is difficult to consume

enough curcumin for it to exert a bioactive effect. Integrative

Therapeutic’s Theracurmin uses a novel preparation that dramatically

increases absorption by reducing the size of curcumin particles by over

100 times. This reduced particle size results in a more stable formula

with significantly higher bioavailability. Integrative Therapeutics

Theracurmin.

Magnesium

Magnesium is extremely important to many functions in the body.

In addition to supporting healthy bone formation, magnesium is

necessary for the mitochondria to turn the sugar and fat we eat into

chemical energy molecules known as ATP (adenosine triphosphate).

32

Low levels of ATP are commonly found in people with Fibro & Fatigue,

and it is believed that this plays an important role in many of their

symptoms. Adequate magnesium also exerts a calming effect on the

nervous system and is necessary for proper muscle functioning.

While the recommended daily amount of magnesium is 400 mg, this

dosage does not adequately treat Fibro & Fatigue symptoms. Malic

acid is a form of magnesium that is often used to treat fibromyalgia

pain. This supplement is commonly taken at a dosage of 600–1200 mg

twice daily. Magnesium is often best absorbed when taken with food.

Other common forms of magnesium, such as citrate, chloride and

aspartate, are also well absorbed. Soaking in a bath containing 1–2

cups of Epsom salt (magnesium sulfate) can also have a soothing,

pain-relieving effect on muscles and nerves. A very informative

website with all the information you ever wanted to know about

taking a magnesium supplement for fibromyalgia symptoms can be

found here.

33

Chapter 3 - Medications

Physicians specializing in the treatment of Fibro & Fatigue should use

pharmaceutical medications in a way that ensures their patients

achieve the following three goals:

1. Adequate Pain Control

2. Sufficient Mental Alertness

3. Deep Restorative Sleep

Adequate Pain Control

There are many medications that can be used to manage pain.

The goal should always be to use the lowest dosage possible of the

fewest medications necessary to achieve the desired result. Since I

can’t possibly provide an exhaustive description of all the available

pain medications, and since every pain management program needs

to be individualized, I would like to make you aware of several

different categories of pain medications that you and your physician

might consider using.

Narcotics (codeine, hydrocodone, tramadol, oxycodone, dihy-

dromorphine, etc.)

Narcotics are highly addictive and can cause many problematic side

effects including fatigue, mental confusion, dizziness, nausea and

constipation. Therefore, they should be used as a last resort at the

lowest possible dosage. With that said, their occasional use may

sometimes be the only option to break your pain cycle so I do not

completely rule them out. The bottom line is that narcotics are best

avoided if possible.

34

Anti-inflammatories (aspirin, ibuprofen, naproxen, piroxicam,

sulindac, etc.)

Chronic inflammation is one of the driving forces underlying the

fibromyalgia disease process. Chronic inflammation damages nerves,

promotes pain and drains your energy. Taking a daily anti-inflamma-

tory medication can be an important addition to your Fibro & Fatigue

pain management program.

An effective anti-inflammatory medication can also lessen the need to

take other stronger, more problematic pain meds such as narcotics.

I have directly observed the benefits of including a daily anti-inflam-

matory medication as part of the treatment program for hundreds of

patients with Fibro & Fatigue. Anti-inflammatories can enable you to

be more functional and to lessen, or completely avoid, the “crashes”

that often follow exercise or other periods of exertion.

As with all medications, it is my goal to prescribe the lowest possible

dosage of the safest medication. Since aspirin and ibuprofen are often

not strong enough to control pain in fibromyalgia, I have discovered

that prescribing piroxicam 10–20 mg (or a similar anti-inflammatory)

on a daily basis can help diminish overall pain symptoms.

As with all medications, anti-inflammatories can cause side effects.

These include heartburn, stomach ulcers, tinnitus and decreased

kidney function. They should always be taken with food and at least

8 ounces of fluids.

35

Anticonvulsants (gabapentin, pregabalin, levetiracetam, etc.)

Anticonvulsant medications work by slowing down nerve impulses in

both the brain and peripheral nervous system. They have traditionally

been used to treat neuropathic pain and seizures.

Pregabalin (Lyrica) is one of the three medications approved by the US

Food and Drug Administration (FDA) to treat fibromyalgia. It is an

anticonvulsant that is also prescribed to treat nerve pain in people

with diabetes (neuropathy), herpes zoster (shingles) and spinal cord

injuries, and it is used in epilepsy to treat partial seizures.

Side effects of anticonvulsants can include headaches, dizziness,

sleepiness, confusion, memory problems, dry mouth and weight gain.

Serious side effects may include angioedema, leg swelling and an

increased suicide risk.

As you can see, many side effects associated with anticonvulsants

resemble Fibro & Fatigue symptoms (dizziness, sleepiness, confusion,

memory problems, etc.). This highlights a very important principle—try

to avoid becoming overmedicated! The treatment toolbox for many

conventional doctors contains only pharmaceutical medications.

We were taught in medical school to treat the symptoms of a disease

and that “there is a drug to address each and every symptom a patient

describes.” Implementing this philosophy often contributes to patients

with multiple symptoms accumulating a large number of medications.

Combining the appropriate use of medications with a strong natural

therapies program is the best way I know of to lessen your overall

need for medications, as well as to help them achieve their desired

effects at a lower dosage and with fewer side effects.

36

Antidepressants (fluoxetine, duloxetine, sertraline, tricyclics,

etc.)

The three drugs approved by the FDA to treat fibromyalgia are

pregabalin (Lyrica), duloxetine (Cymbalta) and milnacipran (Savella).

While pregabalin is an anticonvulsant, duloxetine and milnacipran are

antidepressants. These medications are used to treat Fibro & Fatigue

symptoms of pain, fatigue and insomnia, and they are generally used

at lower dosages than for the treatment of depression. Using antide-

pressants in this way, at lower than normal dosages, can be helpful

and should be tried if necessary. Otherwise, standard antidepressants

should be reserved to treat symptoms of depression.

Medical cannabis (different strains and dosing formulations)

Many states have now legalized the use of medical cannabis to treat a

variety of disease symptoms, including epilepsy, anxiety, nausea and

chronic pain, among others. Some people describe the relief they

receive from using medical cannabis as miraculous.

Since medical cannabis is a completely natural substance, I believe its

use is generally safer than the use of many synthetic chemical

medicines. However, as with all medicines, the quality and dosage of

what you consume can make a big difference.

First, let’s cover a few basic concepts. Medical cannabis comes in many

different varieties (strains). In general, the “indica” strain is more

calming, with muscle-relaxant properties, while the “sativa” strain is

more stimulating to the brain. There are also many “hybrid” strains

that are basically genetic blends of the two strains. Your local cannabis

37

dispensary is often the best source of information on which strains are

best used to treat specific symptoms such as pain, nausea, anxiety,

insomnia or fatigue.

The next concept to consider is the mode of administration. Smoking

medical cannabis has a shorter duration of action than consuming

what are called “edibles.” The effects of smoked cannabis usually last

between 1–2 hours while the effects of eaten cannabis usually last

between 3–5 hours. The onset of action of smoked cannabis also

occurs much more quickly (1–3 minutes) compared to the onset of

action when consuming an edible (20–40 minutes). Therefore,

smoking medical cannabis is often a more preferable mode of admin-

istration because its effects are immediate and more controllable.

It is reasonable to be concerned about the health effects of smoking

any substance. First, my review of the medical literature has not un-

covered any evidence that smoking medical cannabis in moderation

causes any increase in the incidence of emphysema or cancer. This is in

contrast to smoking tobacco, which is a highly toxic plant that defi-

nitely increases the risk of developing both of these conditions. Also,

when the cannabis is smoked using a high-quality vaporizer such as a

volcano vaporizer, the active ingredients of the cannabis plant are

heated and released into the water vapor that you inhale. Nothing is

“burned.” Using this method of cannabis consumption exposes your

lungs to far fewer harmful chemicals than if cannabis is smoked in a

joint or a pipe. Finally, I do not recommend using a “vape pen” since

these have recently been associated with harmful effects most likely

linked to substances added when the cannabis plant is refined into

an oil.

Is it essential that you use medical cannabis? No. However, if consum-

ing a small amount of medical cannabis on a daily basis allows you to

38

feel better, have less pain and avoid using one or more pharmaceutical

medications, you may want to consider it as an option. In that case, I

recommend using a volcano vaporizer.

Sufficient Mental Alertness

Many people with Fibro & Fatigue experience symptoms of decreased

alertness, poor concentration and memory issues. These symptoms

are often collectively termed “brain fog” and they can be very

debilitating.

For many years I strongly recommended against taking stimulant med-

ications in order to help treat these symptoms. At the time,

I believed that the use of any stimulant medication in people with

Fibro & Fatigue would further deplete an already exhausted system.

Then, out of necessity, I treated a number of patients who were so

disabled by their fatigue and brain fog that I believed a trial of a

stimulant medication was their only hope to have enough energy to

properly care for themselves and to occasionally get out of the house.

Since these were my patients, they were also following the other

aspects of this healing program, including supporting their mitochon-

dria with the proper antioxidant micronutrients. My experience with

this cautious use of stimulants was dramatically positive. I had several

patients come back to my office almost in tears at how the addition of

a low-dose stimulant drug completely changed their lives for the

better. Their fatigue, alertness and mental clarity all improved. And

surprisingly, their pain symptoms also improved because, with more

mental energy, they now had a higher pain threshold. Quite a number

of my patients have experienced a continuous, sustained improvement

in their health lasting many years by adding a low dosage of a

stimulant medication to their program.

39

A Moment of Discovery

What I observed in these initial few patients led me to a very

important insight. By adding a low dosage of a stimulant drug

to a program that already included potent mitochondrial support,

my patients could experience a very positive improvement in their

symptoms without further depleting their system. As long as their

mitochondria were properly supported, gentle stimulation to their

nervous system acted as a catalyst for restoring normal brain and

nervous system function. This was a very positive discovery that has

helped me enable many of my patients with Fibro & Fatigue to regain

the ability to live normal lives.

It is still important not to overstimulate the nervous system. The use of

a low dosage of a stimulant medication MUST be combined with the

other aspects of this program, including properly supporting the

mitochondria. However, I believe that, with proper supervision of a

physician, many patients with Fibro & Fatigue can improve their

health and functionality in a meaningful way using this approach.

Here are two stimulant medications and their dosages that I have had

good results using in patients with Fibro & Fatigue:

Methylphenidate (Ritalin) (short-acting; about 3–4 hours)

2.5–5 mg — taken once or twice daily with breakfast and/or lunch

(before 3pm)

Modafinil (Provigil) (long-acting; about 8–12 hours)

25–50 mg — taken once daily with breakfast

(Modafinil is only available as a 100-mg pill, so you will need to use a

pill cutter to cut it into a half or quarter pill.)

40

If you have any of the following medical conditions, stimulant

medications should never be used:

• Diabetes mellitus

• Uncontrolled high blood pressure

• History of cardiovascular disease (including angina, heart attack,

arrhythmia or stroke)

• History of seizures

• Chronic liver disease

• Chronic kidney disease

• Psychiatric disorders, including delirium, psychosis, schizophre-

nia, bipolar disorder, anorexia nervosa or generalized anxiety

disorder

Always consult with a physician before starting any new medication.

Finally, if you are taking a prescription stimulant drug, you should

avoid consuming any caffeine-containing products (except maybe a lit-

tle coffee or tea). These include but are not limited to Red Bull,

Monster, Rockstar, 5-hour Energy, etc.

If you are taking the K-PAX Energy Support Program, and then begin

taking a prescription stimulant, you should discontinue taking K-PAX

Energy and switch to taking K-PAX Immune at a dosage of 3–4 tablets

twice daily. This allows you to avoid caffeine but to continue getting

the proper dosage of mitochondrial support nutrients.

Deep Restorative Sleep

The amount of sleep needed varies from person to person. However,

poor sleep quality has been linked to several health problems,

including depression, poor immune function, anxiety, weight gain,

41

muscle pain, irritable bowel syndrome, fatigue and headaches.

Usually a person passes through four stages of sleep: Stage 1, 2, 3,

and REM (rapid eye movement) sleep. Stage 3 is also known as deep

non-REM sleep. Brain waves during Stage 3 sleep are called delta

waves due to their slow speed and large amplitude. Of all of the sleep

stages, Stage 3 is the most restorative. During Stage 3 sleep the brain,

muscles, adrenal glands and immune system are all restored.

People with Fibro & Fatigue have been shown to spend less time in

Stage 3 sleep than healthy individuals. It is best to improve your sleep

quality through natural means; however, the most important goal is

that you re-establish a proper sleep cycle. This may require the use of

a low dosage of a sleep-promoting medication.

Natural sleep hygiene tips:

• Put yourself on a bedtime schedule. Go to sleep and wake up at

the same time each day.

• Create a bedtime routine to unwind from the day such as

reading a book, listening to a meditation tape or taking a

warm bath.

• Eliminate bright lights, computers and TV’s from your bedroom.

• Do not work on your computer for at least an hour before

going to bed.

• Avoid lying in bed tossing and turning. Consider getting up and

doing a light activity, such as reading, until you’re tired again.

• Replace your pillows if you’ve had them for over a year and

have trouble getting comfortable.

• Melatonin 5-10 mg 30 minutes prior to going to bed may be

helpful for promoting sleep.

42

Sleep medication tips:

• Avoid using more than one medication. If you use medical

cannabis to promote sleep, don’t add a pharmaceutical

medication.

• Take the lowest possible dosage to achieve your goal.

• Many of my patients have been able to achieve deep,

restorative sleep using one of the following medications taken

before bed:

■ mirtazapine (Remeron) 7.5-15 mg

■ trazadone 25-50 mg

■ amitriptyline 25-50 mg

■ gabapentin 400-600 mg

■ clonazepam 0.25-0.50 mg

43

Chapter 4 - Hormones

This chapter is very important, but it is also detailed and a lot

to absorb. You may want to read it when you are fresh and

have ample alertness and concentration.

The word hormone is derived from the Greek word “to excite”.

While hormones are released in very small amounts, they can have

wide-ranging and powerful effects. For the purposes of this book,

I will briefly discuss several hormones that play an important role in

determining your energy level and overall health. They are:

• Thyroid hormones

• Testosterone

• Cortisol

• Dehydroepiandrosterone (DHEA)

If the levels of any of these hormones are low, they can be supple-

mented in a safe and prudent manner. One of these hormones – DHEA

– is available over-the-counter while the others require a prescription.

Properly managing these hormones can play a significant role in

supporting your recovery from Fibro & Fatigue. Since these hormones

have powerful effects, it’s best if they are supplemented under the

supervision of a healthcare practitioner utilizing periodic blood and/or

saliva testing.

In general, the optimal hormone blood level for maintaining your

peak health will usually be in the upper half of the laboratory’s

“normal range”. This level is most effective at supporting your body’s

overall health, while still remaining within safe parameters.

44

Again, hormone supplementation should always be supervised and

managed by an experienced healthcare professional utilizing regular

laboratory testing.

Thyroid

The thyroid gland releases hormones to control your metabolic rate -

the rate at which your body uses energy. Thyroid hormone can affect

your heart rate, blood pressure, muscle strength, energy level and

mental alertness. The thyroid gland uses iodine from the food you eat

to make its two main hormones:

• Triiodothyronine (T3)

• Thyroxine (T4)

T4 has only a slight effect on metabolism. The majority of it is

converted into T3, which is the active hormone that stimulates

metabolism. About 80% of this conversion takes place in the liver and

kidneys, while 20% of it takes place within the thyroid gland itself.

T3 and T4 have the same exact structure except that T3 contains three

iodine molecules while T4 contains four iodine molecules. Up to 99%

of thyroid hormones circulating in the bloodstream are bound to

transport proteins, such as thyroxine-binding globulin (TBG) or

albumen. Only a very small fraction is free (unbound) and biologically

active; hence, when assessing thyroid hormone levels, it is of better

diagnostic value to measure the level of free thyroid hormones (free

T3 and free T4).

45

While there are many opinions as to how to interpret thyroid tests

and supplement these hormones, I’d like to make one point clear:

the most important thyroid test to measure, and to maintain in the

optimal range, is called the TSH (thyroid-stimulating hormone). TSH is

actually produced in the pituitary gland at the base of the skull. It is

known as a “feedback hormone,” which means that if the pituitary

gland detects that your metabolic rate and level of thyroid hormones

is low, it releases additional TSH to stimulate the thyroid gland to

produce more thyroid hormone. Therefore, when your thyroid

hormone levels become too low, your TSH level rises.

Since most testing laboratories define the “normal range” as the

average level found in the general population, it is my opinion that

when measuring most hormone levels, the optimal range for

maintaining peak health is in the upper half of the laboratory’s “

normal range”. However, when it comes to monitoring your TSH level,

I advise that you maintain your TSH level in the 0.5 – 1.5 mU/L range.

This is a much more narrow range than the 0.5 – 4.5 mU/L “normal

range” reported by most testing laboratories and will insure that your

thyroid hormone level is providing your muscles, brain and

immune system with the optimal amount of energy.

Testosterone

Testosterone is the hormone often associated with the masculinizing

changes that occur in male adolescents. In addition to supporting

muscle mass, it has several other effects which include maintaining

healthy energy, mood and cognitive function. Women also produce

testosterone, though only about 10% of that produced by men.

46

Keeping your testosterone level in the optimal range is also important

for preventing fatigue, depression and a decreased libido.

Monitoring the total testosterone level is sufficient, since testing the

free testosterone level is much more expensive and only necessary in

difficult-to-assess situations. In men, the optimal range for the total

testosterone level is 500–1000 ng/dl. In women, the optimal range for

the total testosterone level is 50–100 ng/dl. Maintaining your testos-

terone level within these parameters will help insure that your muscle

mass, energy level, libido and brain function are well supported.

Testosterone levels should always be checked at the same time of day

(preferably in the morning).

When dosed properly, topical testosterone creams are usually effective

at maintaining your total testosterone level in the proper range.

They can be obtained with a prescription from most compounding

pharmacies. Maintaining a healthy testosterone level is an often

overlooked component of a Fibro & Fatigue treatment program,

especially in women.

The side effects of testosterone supplementation usually occur only if

the blood level rises too high. In women, this can manifest as an acne

outbreak or the occurrence of hair growth on the face. These effects

occur rarely as long as supplementation is properly managed. In men,

enlargement of the prostate and hair loss are possible side effects.

Men who have a previous history of prostate cancer and women who

have a previous history of breast cancer should never supplement

testosterone (or DHEA).

47

Adrenal Gland Hormones: Cortisol & DHEA

The adrenal glands produce several hormones that help protect the

body from stress. While adrenaline (epinephrine) helps protect the

body from immediately stressful events, such as getting out of the way

of a car that is about to hit you, other adrenal gland hormones,

including cortisol and DHEA, help protect your body from medium

and long-term stress.

Cortisol and DHEA levels are known to rise when the body is faced

with the initial phase of an illness. However, as an illness or long-term

stress persists over time, adrenal gland production of these important

hormones frequently declines. As the protective effects of cortisol and

DHEA are lost, a chronic inflammatory state can develop. This chronic

inflammatory state is like a smoldering fire whose effects can weaken

the body over time.

The longer a person suffers from a chronic illness, the lower cortisol

and DHEA levels can go. Sometimes they decrease to virtually

undetectable levels. Proper supplementation of cortisol and DHEA

can help improve many of the symptoms of Fibro & Fatigue including

fatigue, brain fog, muscle loss and depression.

Cortisol

Cortisol is one of your body’s most important stress hormones.

While the adrenal glands release adrenaline to deal with immediately

stressful situations (fight or flight situations), they release cortisol in

response to medium-term stressful situations (stressful life events or

an acute illness). Cortisol has the following effects:

48

• It is anti-inflammatory

• It increases blood sugar

• It mobilizes the metabolism of carbohydrates, fats and protein

Cortisol can be thought of as a catabolic or “resource-mobilizing”

hormone. It raises your blood pressure and blood sugar while

temporarily suppressing immune function. The prescription drug

prednisone is essentially a super-charged version of cortisol. After the

stressful situation or illness has passed, your cortisol level should

gradually return to normal. If your stress level remains high, the ability

of the adrenal glands to continue producing both cortisol and DHEA

can begin to falter. This state is often referred to as “adrenal fatigue.”

A low cortisol level can contribute to the following symptoms:

• Anxiety

• Depression

• Headaches

• Insomnia

• Chronic pain

• Weight gain

• Poor digestion

• Low blood pressure

• Chronic inflammation

Many of these symptoms are common in people with Fibro & Fatigue

yet conventional medical doctors frequently do not check cortisol

levels in their patients. It’s important to understand that the release of

cortisol is also linked to your circadian rhythm so the vast majority of

this hormone is released in the morning (6-8am). Your cortisol level

then gradually declines throughout the day.

49

In extreme cases, too little cortisol production may be due to a

problem in the pituitary gland. This condition is known as Addison’s

disease, which is believed to be an autoimmune condition. If a

diagnosis of Addison's disease is suspected, it is very important to

pursue an assessment by an endocrinologist.

The most accurate way to check your cortisol level is with an adrenal

stress profile test. This test monitors your cortisol level over a 24-hour

period by measuring it in saliva samples. A healthy cortisol level is

highest in the first sample (7am) and then gradually declines. An

example of an adrenal stress profile test can be viewed here.

Cortisol is a hormone that can be supplemented in pill form and

managed by an experienced physician.

DHEA

An optimal DHEA level is important for the body to maintain its

health in response to long-term periods of illness and stress. It is also

necessary for healthy aging. DHEA helps support a strong immune

system, normal cognitive function and a healthy muscle mass.

DHEA production is most abundant when people are in their twenties

and thirties. Its production thereafter declines at about 10% per year.

Associated with this decline is an increased incidence of degenerative

diseases including heart disease, diabetes, cancer and neurodegenera-

tive disorders such as Alzheimer’s and Parkinson’s diseases. Is this

merely a coincidence? Many physicians and researchers think not.

A low DHEA level can contribute to the following symptoms:

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• Anxiety

• Depression

• Headaches

• Insomnia

• Weight loss

• Low immune function

• Chronic inflammation

There are two forms of DHEA in the body. DHEA is the active form,

while DHEA–Sulfate is the storage form. While both can be measured

with a blood test, measuring DHEA–Sulfate is the best way to assess

the proper level of this important hormone. The optimal range for

DHEA–Sulfate for people with Fibro & Fatigue is between 300 – 500

ug/dl (for men) and 100 – 200 ug/dl (for women). Do not go by the

normal range provided by the laboratory for this hormone. This range

is usually adjusted for age, which is not what you want. The goal is to

restore a youthful level of DHEA, similar to the amount you had when

you were at the peak of health. It is best to use the same laboratory

when tracking DHEA–Sulfate values. This insures the greatest level

of consistency.

Salivary DHEA levels are measured as part of an adrenal stress profile

test, but I also prefer to follow DHEA-Sulfate blood tests. In my

experience, it is the most effective way to measure this hormone.

For the treatment of Fibro & Fatigue, the usual DHEA dosage I

prescribe is 5-10 mg per day for women, while the most common

dosage range I prescribe in men is 10-50 mg per day. I recommend

tracking hormone levels quarterly to start, and then once or twice per

year after a stable level has been achieved.

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Important: Women who have had breast cancer (or are at high risk)

and men who have had prostate cancer (or are at high risk) should

completely avoid taking DHEA supplements since it is possible that this

hormone can stimulate the growth of these tissues.

Conclusion

When it comes to managing hormones, the key word is “balance”.

As I stated earlier in this chapter, small amounts of hormones can

have wide-ranging and potent effects. An experienced healthcare

practitioner should always supervise any hormone supplementation

with regular monitoring. A physician skilled in functional medicine can

be an excellent resource to assist you in balancing your hormones.

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Chapter 5 - Mind-Body Techniques

“Healing does not come out of little bottles,

it comes from within.”

- Jon D. Kaiser, M.D.

Every thought you have generates neurotransmitters and hormones

that can significantly affect your health. Some thoughts can have

positive, healthful effects, such as those that may lead you to meditate

or exercise regularly. Other thoughts can have detrimental effects,

such as worrying about things you can’t control or routinely

overcommitting yourself.

A chronically high stress level leads to the release of excessive

quantities of the hormones adrenaline and cortisol. This does not

positively contribute to your health. The release of these hormones

over time can weaken you immune system, promote a chronic inflam-

matory state, degrade your health and impede your ability to heal.

Conversely, feelings of gratitude, love and joy can have a very positive

effect on your physical body by promoting the release of endorphins,

serotonin and dopamine in your brain. These neurochemicals are well

known to decrease inflammation and stimulate the healing process.

My goal in this chapter is to provide you with some basic, but ex-

tremely important, techniques that you can start applying immedi-

ately. These techniques can help harness and focus your body’s healing

abilities. They will also enable all the components of your healing

program to work together to achieve their maximum potential.

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The three techniques I’d like to discuss in this section are:

1. Strategic Pacing

2. Healing Time

3. Loving Yourself

Strategic Pacing

Fibromyalgia and chronic fatigue syndrome are fundamentally

disorders of insufficient cellular energy production. Therefore, if you

push your body too hard and exceed its energy-generating capacity, it

will present you with symptoms that are designed to slow you down.

These include dizziness, fatigue, brain fog and pain. It’s important to

understand that your body always has the last word—it can pull the

rug out from under you whenever it needs for you to rest.

People who’ve recovered from Fibro & Fatigue frequently state that

scaling back their activities and stress level, at least temporarily, made

a very positive contribution to their recovery. A useful analogy is to

treat the amount of energy you have each day as “your energy bank

account.” Over expending energy to the point where your energy

account becomes overdrawn can precipitate a variety of symptoms

often referred to as “energy crashes.” Becoming skillful at pacing

yourself can ensure that you have an adequate supply of energy

available for when you really need it!

Doesn’t it make sense to get ahead of these symptoms by putting in

place a program of strategic pacing and prescribed rest? It certainly

does! Listed below are pacing techniques that patients with Fibro &

Fatigue regularly associate with their recovery. These techniques have

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played an invaluable role in helping many of my patients successfully

rebuild their health.

Strategic pacing techniques include:

• Resting often

• Walking more slowly

• Minimizing multitasking

• Not overcommitting yourself

Healing Time

Getting adequate rest is one of the most important ways a person

with Fibro & Fatigue can begin their recovery. Take a period of time

each day to devote to your healing. Try starting with 20 minutes, then

advance to 40 minutes and finally to 1 hour each day. It takes at least

20 minutes just to settle down and approach a peaceful state. Deep

healing occurs most efficiently in the time after a peaceful state has

been attained.

Focus on what you are doing without any distractions such as televi-

sion, music or reading the newspaper. Powering down your phone is

essential. Yes, don’t just mute it—power it down. Trust me, it will start

up again.

You may want to begin by lighting a candle and invoking this prayer:

“May the time I now spend bring peace to my mind,

healing to my body and love to my spirit.”

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During this healing hour it is very important to make sure that you

minimize any disturbances. If anyone you live with asks you what you

are doing, just tell them that you are taking some time for healing

once a day. Then get back to your healing. Do not worry about what

they may say or think—you are doing what’s right for you.

Lie down and allow your body to get comfortable. Just reading about

this exercise is not effective. You need to practice it regularly.

Take a few deep breaths. Allow everything to quiet and to settle.

Allow your thoughts to begin having lots of space between them and

when you are ready, place your hands on any part of your body that

needs healing. If you are attempting to heal emotional symptoms,

such as anxiety or fear, place your hands first on your heart and then

on any part of your body that needs your healing touch. Allow your

body to move into any position it desires. Love yourself—be with

yourself—heal yourself.

Feel your body. Notice any areas of tension, discomfort or pain. Gently,

just begin to notice them. Try to breathe into them. It is important not

to be angry with any part of your body for feeling pain. Pain is one of

your body’s ways of getting your attention. The source of your pain

needs to be explored and investigated. Do not be judgmental.

Acknowledge the pain’s presence. And then, slowly, allow your

awareness to move a little closer to this area, the area where you

feel the pain. As you go, breathe deeply and expand your abdomen

completely.

Deep breathing is very important. Allow your awareness to come as

close to your pain as you feel comfortable and then, just be with it.

Where your awareness goes, your energy flows. Just experience the

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place that exists between pain and no pain, between tension and no

tension. Just sit there, on the boundary of your pain, and be with it for

a little while, as you might spend time being with someone who is ill.

Send it love. As it softens, take one small step closer. Just be with it.

Continue breathing deeply. Nowhere to go, nothing to do, just to be

with yourself and whatever discomfort you may be feeling. Give your

body the attention it’s asking for, the attention it needs to heal.

Give yourself 1 hour every day to focus completely on your healing.

Aren’t you worth 1 hour each day? Isn’t your healing worth 1 hour each

day? You can create the most potent healing environment possible for

yourself during this healing hour.

Of all the recommendations in this book, taking a significant period of

time every day to rest is the single most important, and often the most

difficult, recommendation to follow.

Loving Yourself

“Comes a time, when the blind man takes your hand,

Says, don’t you see?

You’ve got to make it somehow…on the dreams you still believe.

Don’t give it up… you’ve got an empty cup. Only love can fill.

Only love can fill”

- Robert Hunter

Your subconscious plays a very important role in determining your

health. If you can evolve unhelpful beliefs into positive ones, you can

positively alter the chemicals your brain is producing, and the

messages your brain is sending, to every cell of your body.

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No matter how long you’ve been suffering with Fibro & Fatigue, there

is hope! The tips and guidance included in this book can help begin to

steer your health in the right direction. Your body will respond to your

love and attention, but you need to apply the time and effort. Begin

putting all the pieces of your healing program together in a concerted

fashion. Show your body that your healing has now become your

highest priority! Let your body become the recipient of your

unconditional love.

I frequently listen to podcasts by a Buddhist teacher named Tara

Brach. I highly recommend listening to her podcasts. They are funny,

soothing, relaxing, life-affirming and filled with helpful suggestions

that can help you live a life as free from suffering as possible. Here is a

link to one example titled “Cultivating a Kind Attention”.

This next point is very important: your body needs to regain its trust in

you. It needs to trust that you will take really good care of it from this

point forward. It needs to trust that you will not expend more energy

than you have. You show your body love when you give it your

undivided time and attention on a regular basis.

Here are some ways you can show your body love:

• Eat a healthy diet

• Sit quietly in nature for 15 minutes a day

• Listen to a tape of positive affirmations

• Take a relaxing bath with candles and bath oil

• Use your favorite massage oil to massage a part of your body

that’s in pain

• Begin a program of “restorative yoga” (search “restorative

yoga” on YouTube)

• Write a love letter to your body expressing gratitude for all of

the things it does for you

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Chapter 6 — Conclusion

It is best to think of fibromyalgia and chronic fatigue syndrome

as neuro/endocrine/immune disorders. These three systems are

intimately connected. When the brain has thoughts, it produces

neurochemicals that stimulate hormones to be released by the

endocrine system, which in turn modulates the functioning of the

immune system. Your neuro/endocrine/immune system also affects

the amount of inflammation in your body, your energy level and your

general sense of well-being. After many years of poor nutrition,

chronic stress and possible exposure to environmental toxins, these

critical systems can break down, resulting in the occurrence of Fibro &

Fatigue symptoms.

Conventional medicine is not equipped to properly treat

complex, multisystem conditions. What is needed is a holistic

approach, one that supports all the systems of your body. This

approach is termed “functional medicine.” Functional medicine

addresses the underlying causes of disease, using a systems-oriented

approach that engages both the patient and practitioner in a

therapeutic partnership. It is an approach that has great advantages

when addressing the needs of a patient with a chronic, degenerative

medical condition.

I have an important secret to share with you: This exact program

will work to stabilize and potentially reverse the symptoms of ANY

neurodegenerative disorder. This includes mild to moderate

Alzheimer’s and Parkinson’s diseases. This has been my direct

experience in the patients I have treated with these conditions and its

rationale is thoroughly supported in the scientific literature.

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Most progressive neurodegenerative disorders, including Alzheimer’s

and Parkinson’s diseases, affect more than just the nervous system and

have been strongly linked to mitochondrial dysfunction.

You can’t sharp shoot these conditions with a single treatment (i.e.,

drug). You need to assemble a comprehensive program that supports

every system of your body—including the restoration of normal

mitochondrial functioning.

So there it is. With the right motivation you can begin your recovery

today! As the ancient Chinese philosopher Lao Tzu stated, “A journey

of a thousand miles begins with a single step.” Take your first step

today and begin implementing your Fibro & Fatigue healing program.

Improve your diet and start on the right supplements. Get your key

hormone levels checked, pace yourself and begin working to lower

your stress level. Once you begin to feel better, you will be highly

motivated to continue implementing your healing program.

Lastly, find a physician who is willing to work with you as a

partner in your recovery. Unless they have a better plan to suggest,

one that does not rely solely on prescription drugs, they should be

open to assisting you with whatever treatments you are intuitively

drawn to trying. This is your healing journey.

Keep Hope Alive!

Jon D. Kaiser, MDClinical Faculty, Dept. of MedicineUniversity of California Medical School, San FranciscoChief Medical OfficerK-PAX Pharmaceuticals

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Healing Program Summary

Nutrition• Stay well hydrated

• Eat 3-4 small to moderate meals per day, avoid snacking be-

tween them, and do not eat anything substantial for 2 hours

before going to bed

• Eat a natural and minimally processed diet:

Treatment phase: Paleo or Modified Paleo Diet

Maintenance phase: Mediterranean Diet

Micronutrients & Botanicals • Optimally support the mitochondria with key antioxidants

• Optimally support the gut with probiotics and digestive enzymes

• Optimally support the neuroendocrine system with adaptogenic

herbs

Hormones • Thyroid (T3 & T4) – test and optimize levels

• Testosterone – test and optimize levels

• Cortisol – test and optimize levels

• DHEA – test and optimize levels

Medications • Adequate pain control

• Sufficient mental alertness

• Deep restorative sleep

Mind-Body Techniques • Strategic pacing

• Healing time

• Loving yourself

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Biography

Jon D. Kaiser, M.D. has been treating individuals with chronic medical

conditions for over 30 years with a combination of natural and

conventional medicine. The majority of his patients have had

fibromyalgia, chronic fatigue syndrome, HIV/AIDS, Alzheimer’s disease,

Parkinson’s disease, cancer or other difficult-to-treat conditions.

By following a comprehensive healing program, most of Dr. Kaiser’s

patients have stabilized, improved and restored themselves back

to health.

Dr. Kaiser is also a specialist in mitochondrial medicine and has

published several research studies on the link between mitochondrial

dysfunction and degenerative diseases (research studies). He is on the

clinical faculty of the University of California Medical School in San

Francisco and is the author of several books on healing from chronic

medical conditions. In addition to caring for patients, Dr. Kaiser serves

as the Chief Medical Officer of K-PAX Pharmaceuticals.

Dr. Kaiser is available for in-person and telemedicine consultations.

He can be reached by visiting his website at JonKaiser.com.

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