Treatment Suggestions
March 3, 2000


As a physician and scientist, I have long been torn between wanting to
recommend therapy for GWS and anthrax vaccine-associated illnesses, and
the remarkable lack of scientific data to support any treatment
protocols.  As many know, the only two treatment trials of GWS currently

in progress are for mycoplasma (doxycycline treatment alone if positive
forensic PCR) and cognitive behavioural therapy.  No trials for anthrax
vaccine illness exist.  No case definition exists.  No good data on
incidence and prevalence exist.

As a clinician, I treat many patients with chronic fatigue syndrome,
fibromyalgia, multiple chemical sensitivity, and a few with Gulf War
Ilnesses.  As Garth Nicholson and others have shown, these are strongly
overlapping syndromes.  I suspect that they are due to a variety of
incitants, but that there is great commonality in terms of
pathophysiology.  I believe that much anthrax vaccine-induced illness
fits in the above categories, although some aspects may not.  I have
said before that I believe one major mediator of the varying symptoms is

lack of ATP (cellular energy) production.

This probably impairs function of all tissues with high energy
requirements, particularly brain, other nerve tissues, heart, muscle and

liver.  Frequently there is inadequate endocrine function which may
involve one or many hormones.  Functional thyroid and adrenal
deficiencies are seen, as well as sex hormone deficits. ATP pumps
maintain the transmembrane electrochemical gradients of sodium,
potassium, magnesium and calcium, and it is suspected that inability to
maintain these gradients, and resultant loss of electrolytes, contribute

to symptoms.

What do these observations mean in terms of treatment?

Treatment is symptomatic, not curative, as I and others in the field do
not know the primary event(s) leading to illness and whether it (they)
can be cured.

However, various therapies can ameliorate many of the effects patients
experience.  Megavitamins and minerals, many of which are cofactors for
reactions producing high energy compounds like ATP, can help push these
reactions forward.  Specific nutrients and supplements may functions as
antioxidants, as transport substances (acetyl carnitine moving fatty
acids into mitochondria), or may assist with detoxification of noxious
metabolic byproducts.  Judicious use of small doses of hormones may be
beneficial.  Eating a careful diet that doesn't tax the body's sytems
and provides adequate nutrients is important (sufficient protein,
limiting sugar in patients who have hypoglycemic symptoms, and eating
healthy fats/avoiding trans fatty acids and excess saturated fats). The
goal is to maximize whatever can be maximized in terms of metabolism,
for patients who are starved for metabolic energy.

Jeff Bland PhD in 1997 provided the following list of nutrients for
neurological/cardiovascular disorders:

CoQ10
N acetyl carnitine
N acetyl cysteine
glutathione
Vit E succinate
lipoic acid
Vit. B12
Vit. B 6
folate
betaine
creatine
Magnesium
Zinc
Copper
Selenium
Molybdenum
Ginkgo biloba
DHA/EPA (omega 3 fatty acids)

To his list, I would suggest that Megamultivitamins with minerals avoid
taking so many separate things.  Malic acid, NADH, sAME and Vit C are
useful.  I often prescribe electrolytes: Mg, K, Ca, and even Na.  B12
and DHEA deficiencies should be checked by a clinical lab, and
supplemented if low.  Hormone levels in the low normal range may lead me

to a therapeutic trial of low dose hormone supplementation, to see if
the patient benefits.  Hormones I often use include thyroid,
fludrocortisone, pregnenolone, DHEA.  Other doctors use oxytocin and
small doses of cortisol, in the range of 5 mg. per day.  Plus other sex
hormones.  Dose ranges for these substances vary widely, and often can
only be determined using trial and error. Some doctors use individual
amino acid supplements, or medical food products with defined vitamin,
electrolyte, antioxidant and amino acid content. Many have benefitted
from antibiotics when they test positive for mycoplasma or other
microorganisms.

The sleep disturbance that is usually part of the illness should be
treated, because patients feel much better when they receive adequate
sleep.  There are many approaches to use, and most doctors are familiar
with them.

The treatment of pain is difficult.  It generally is "out of proportion"

to any pathology doctors can find, and does not respond well to usual
painkillers.  It is a result of fibromyalgia, a "pain amplification
syndrome" in which minor trauma to a body area results in excruciating
pain, and patients often wake with any movement in the night, due to the

pain.  Often supplementation with substances above lessens the pain,
especially folate 2.4 mg/day and magnesium malate.  Applying capsaicin
cream to a painful area several times daily helps, by reducing the
inappropriate neurotransmission of pain signals to the brain.

The increased sensitivity to noxious odors and other products which may
accompany these illnesses should be treated first with avoidance.
Treatment with electrolyte solutions, bicarbonate buffers and vitamin C
is reported to rapidly benefit exacerbations.

Increased symptoms of allergy benefit from OTC or prescription
antihistamines.

Tricyclic antidepressants, calcium blockers, and other pharmaceuticals
have a role in selected patients.

Some doctors are now experimenting with increased oxygen intake, either
normobaric or hyperbaric.

Authors who have contributed to the understanding of patients and other
clinicians include Daniel Wallace MD (fibromyalgia) and Jacob Teitelbaum

MD (chronic fatigue syndrome).  Each has written books directed at
patients.

I regret that I cannot treat patients at a distance, but this is
something I absolutely cannot do, for reasons of patient safety.  I
believe that the suggestions above will be useful to sufferers and their

physicians alike.  I am hopeful that research to better understand the
illnesses and begin clinical trials of treatment protocols will soon
eventuate.

Meryl Nass