AIDS TREATMENT NEWS Issue #309, December 18, 1998
John S. James

We believe that so-called alternative or complementary approaches will become more important over the next two or three years, for several reasons, but especially to help the mainstream therapies work better. Doctors are now beginning to see more clinical consequences of viral load which can no longer be controlled because some patients have "used up" all the available drugs, and new antiretrovirals are not being developed rapidly enough for many of these patients. Therefore it is very important to extend the effective life of the antiretroviral therapies for as long as possible, to avoid exhausting one's options too quickly.

One example of such a strategy is Dr. Kaiser's "elimination of cofactors checklist", which is referred to repeatedly in his new book. The eight cofactors listed are: Herpes infections; Intestinal parasites; Unhealthy intestinal environment; Low protein intake; Inadequate antioxidant vitamins; Hormonal imbalances; Substance abuse; and Emotional distress. For most patients who may need to change antiretrovirals, instead of rushing to switch, Dr. Kaiser will check these potential cofactors and treat if necessary, then re-test viral load, etc., to evaluate whether an immediate change of antiretrovirals is still required. Also, some patients who have not yet started antiretrovirals may be able to wait, instead of immediately beginning what may be a lifetime commitment to a difficult medical regimen.

If it works, this approach to improving health by controlling possible cofactors may be like having another antiretroviral drug available--a drug with few or no side effects, no interactions with other drugs, and no viral resistance. But how confident can we be that treating these cofactors really has any effect on HIV?

Many of these potential cofactors listed (such as herpes infection, intestinal parasites, and of course malnutrition) have been suspected for years of contributing to HIV disease progression. But definitive trials are expensive, so we do not have data as good as that for FDA-approved drugs, which are developed at the cost of hundreds of millions of dollars each (and priced accordingly). Since the medical community has become accustomed to this level of data, potential treatments which do not have it are unlikely to become part of the standard of care, and may get little or no attention in a patient's treatment--especially in this age of HMOs and cost-cutting medicine.

One way to approach uncertainty is to compare the costs of being wrong with the benefits of being right. Most of the respected "alternative" medical approaches have relatively little risk or expense (unless they are used to replace standard medical attention, in which case the health risk can be severe). Our impression is that such approaches--based on some laboratory evidence, biological rationale, and clinical experience--work well for some people. It is hard to rule out the possibility that seemingly good results are only coincidence or placebo effect--but we doubt that all the success can be explained this way. And placebo effect is unlikely to account for measurable changes such as viral load or CD4 count improvement.

Below we mention a few of the many ideas in Dr. Kaiser's new book that may be useful. There is little certainty, but much room for exploration to find what does or does not work for oneself.

HEALING HIV: HOW TO REBUILD YOUR IMMUNE SYSTEM

This book's introduction describes its focus:

"I define a comprehensive approach as one which adds a program of *aggressive natural therapies and emotional healing techniques* to the standard medical treatment of an illness or condition [italics in original]. An aggressive natural therapies program includes a combination of diet therapy, vitamins, herbs, exercise, and stress reduction. Emotional healing encompasses a proactive program of psychological healing techniques that ideally include a spiritually oriented practice (prayer, meditation, yoga, etc.), combined with a significant level of social support." [from the Introduction]

The book has many specific practical suggestions. And readers will appreciate the effort that has gone into making them easy to understand and apply:

* The section on getting enough protein includes easy-to-use tables, showing grams per serving of about two dozen high- protein foods; it also has a protein powder comparison chart, which includes a column on cost per gram of eight well-known commercial products. Dr. Kaiser recommends at least .6 grams of protein per pound of body weight for a person with HIV-- for example, someone weighing 175 pounds should get at least 105 grams per day. These charts are notably easy to use, unlike some nutrition charts which are complex and confusing.

* The vitamins and minerals section is similarly straightforward. Dr. Kaiser recommends a 9-pill vitamin and mineral regimen, taken twice a day with breakfast and with dinner. He does not recommend particular brands, but lists about a dozen ingredients and the amounts that should be included. He also warns about certain vitamins and minerals which can be dangerous in overdose. He gives an approximate cost of this regimen, $75 per month.

* On diet, Dr. Kaiser lists the following general principles (which are then described in more depth):

- "Increase your consumption of whole grains...

- Increase your consumption of vegetables (fresh, steamed, stir-fried, or juiced)...

- Increase your consumption of fresh fruit...

- Increase your consumption of natural soups, teas, and warm beverages...

- Eat a nutritious breakfast every day...

- Eat plenty of onions, garlic, and ginger.

- The best oils to use are high-quality canola, olive, and sesame.

- Eat locally grown, seasonal foods--organic if possible.

- Make sure that your diet provides you with abundant protein...

- Limit your dairy consumption to approximately 10% of your total diet...

- Avoid sugar, alcohol, and caffeine.

- Avoid raw foods such as clams, oysters, marinated (uncooked) fish, sushi, very rare meats, and "runny" eggs. These can contain infectious bacteria and intestinal parasites.

- Combine and balance foods properly. Do not eat vegetables and fruits at the same time... Rest for at least 10 minutes after each meal..."

These principles are followed by lists of dozens of foods, in five groupings from most to least recommended.

* Dr. Kaiser strongly recommends avoiding processed sugar (due to published studies which found immune-suppressive effects), caffeine, and alcohol. But in order to formulate a program people can live with, the dietary recommendations allow a small amount of all of these, such as a cup of strong coffee a few times per week, or a small amount of processed sugar one to three times a week.

* On diet as elsewhere, Dr. Kaiser shows a rare sensitivity to the steps actually involved in getting started. "Allow yourself to begin incorporating some of the changes that I have outlined in this chapter [the diet and nutrition information] on a daily basis. Start small. Eat breakfast every day. Begin avoiding caffeine, sugar, and alcohol. Drink plenty of water. Buy some herb teas and find a favorite. These are some easy, healthful changes to begin with. Next, eat more fruits and vegetables. Make sure your protein intake is varied and substantial. Eat less junk food. All of these will help, and after a few weeks of combining these changes together into a program of healthful eating, you will begin to feel the difference..."

There are many other parts of Dr. Kaiser's program--some widely used by HIV physicians, and some not:

* Checking testosterone levels, and supplementing if they are abnormally low;

* Checking DHEA levels--and comparing them with optimal young-adult averages (not age-adjusted averages) to decide if supplementation is appropriate;

* What to look for in BIA results (bioelectrical impedance analysis, a measure of body cell mass and early warning of wasting syndrome)--and specific exercise, nutrition, and medical programs to correct deficiencies.

* Using certain nutritional supplements which may help prevent peripheral neuropathy (especially calcium, magnesium, and vitamin B6, in correct doses), when on an antiretroviral regimen which may cause this effect;

* Using natural therapies to treat certain gastrointestinal or other side effects which may occur with antiretroviral regimens, in an effort to prolong the use of that regimen for the patient and not use up new treatment options any faster than necessary.

* A chapter on six causes of fatigue, and their treatment;

* How to develop an effective exercise program--and the importance of avoiding too much exercise as well as too little. (The first advice is to "find exercise activities that you enjoy.")

* Discussion of extensive stool tests from specialized labs, which look not only for parasites and bacteria which are clearly recognized as pathogenic, but also for certain others on which medical consensus has not yet developed as to whether they are harmful or not. Some of the labs will test intestinal bacteria not only for sensitivity to antibiotics, but also for sensitivity to certain herbal treatments which might be used to assist in their eradication.

* A protocol for prevention and natural treatment of sinus infections.

* Many suggestions on stress reduction, and emotional and spiritual healing.

* A resource section, including HIV-positive cookbooks, AIDS hotlines, buyers clubs, and dozens of Web sites.

The book also has: over 20 case histories (sometimes of patients who are difficult to treat, due to poor CD4 and viral load numbers, and intolerance or apparent resistance to many antiretrovirals); outcomes comparisons of patients treated in Dr. Kaiser's program, vs. others who received mainstream HIV treatment without the natural-therapy component; information about certain major herbs from both Western and Chinese medical traditions (although Dr. Kaiser usually refers patients to herbalists experienced with HIV for specific prescriptions); a discussion of approved and experimental antiretrovirals; and an appendix explaining common laboratory tests.

A major area where HEALING HIV: HOW TO REBUILD YOUR IMMUNE SYSTEM does not offer much help is how to find an HIV- experienced physician in your area who is open to working with you on some of these approaches. While many of the suggestions can be applied on one's own, others require medical supervision, especially for patients with serious health problems.

Our other suggestion for improving this book would be to establish a Web site for new articles on treatment changes as they occur. (These updates could then also become the basis of more-frequent new editions of the printed book, which would then start with new updates on the Web.) A major obstacle to using natural treatments in HIV has been the lack of authoritative, comprehensive, and easy-to-use protocols which remain readily available and up to date. HEALING HIV: HOW TO REBUILD YOUR IMMUNE SYSTEM is a major contribution to making this treatment approach more accessible.

HEALING HIV: HOW TO REBUILD YOUR IMMUNE SYSTEM, by Jon D. Kaiser, M.D., 392 pages including index, $19.95, is published by HealthFirst Press, Mill Valley, California, 1999. Despite the 1999 publication date, some copies are now in stores in San Francisco. Copies can also be ordered by calling 888-432- 5448.

[Note: Dr. Kaiser does have a Web site, http://www.jonkaiser.com, which may include updated treatment information in the future.

Also, Dr. Kaiser is beginning a nationwide referral list of physicians who are supportive of his treatment philosophy. For more information, send a self-addressed stamped envelope to: HealthFirst Press, 775 E. Blithedale, Suite #367, Mill Valley, CA 94941.]
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