By Nelson Vergel
Jon D. Kaiser, M.D., has been a leader in promoting the integration of natural immune system support with state of the art standard medical therapies for HIV. He is also the author of Healing HIV: How to rebuild your immune system (1999 HealthFirst Press). All of Dr. Kaiser’s current treatment guidelines and current research activities can be followed at www.jonkaiser.com.
I felt compelled to ask Dr. Jon Kaiser to give us his input on micronutrient use for the management of mitochondrial toxicity. Differing with Dr. Walker from Germany, Dr. Kaiser in San Francisco has positive experience with the use of simple micronutrients available over the counter in the US.
NV: Thank you Dr. Kaiser for taking the time to answer these questions. Could you tell us about your protocol for mitochondrial toxicity? What supplements are you using and at what dose? What variables are you looking at?
JK: Nelson, first let me commend you on the questions you submitted. They are both probing and insightful. It is my belief that mitochondrial toxicity is a severe problem which potentially affects every HIV(+) patient taking a reverse transcriptase inhibitor (RTI) (i.e. D4T, AZT, DDI, abacavir, etc.).
As is commonly known, the mitochondria are the power plants inside every cell that produce the energy required for healthful functioning. The RTI class of medications significantly blocks a mitochondrial enzyme whose sole purpose is to assist the mitochondria in producing the building blocks necessary to produce this energy.
As this enzyme is poisoned, the ability of the mitochondria to break down the toxic waste products of normal energy metabolism diminishes. These toxic waste products are known as “free radicals” and they contain highly charged oxygen atoms which are poisonous to the cells. As this process progresses over time, the level of free radicals increases to dangerous levels.
NV: Is there anything that can be done to prevent or reverse the buildup of these toxic free radicals in the mitochondria?
JK: The level of vitamins and antioxidants we consume as part of a normal diet are only adequate for detoxifying free radicals in a system that is not under stress. Once you add HIV infection, plus the use of RTI antiviral drugs, to a person’s system, the level of toxic free radicals rises dramatically and begins to cause system-wide toxicity which can ultimately lead to neuropathy, pancreatitis, liver problems, fat atrophy, lactic acidosis, amongst others.
I have been testing different combinations of antioxidants for the past several years in an attempt to identify which ones most effectively reduce the incidence of mitochondrial toxicity. Fortunately, I believe I have found a combination that, not only reduces antiviral medication side effects, but also provides the immune system with enhanced levels of energy and vitality.
This combination of antioxidants includes high doses of NAC, alpha lipoic acid, and acetyl L-carnitine, supported by a base of B-complex, vitamin C, Calcium, Magnesium, Zinc, and Selenium. After experimenting with different formulas, I have been so pleased with the beneficial effects of the current formula that my previous recommendation to include coenzyme Q-10 in the program has been dropped without any apparent loss of benefit. Leaving out coenzyme Q-10 has however allowed the overall cost of the formula to be reduced.
The exact formula that I have been using with my patients during the past three years for preventing mitochondrial toxicity with excellent results can be viewed on my website at www.jonkaiser.com. The dosage is based on a person’s weight. HIV(+) patients who weigh greater than 145 lbs. should take twice the dosage of HIV(+) patients who weigh less than 145 lbs. I have found this weight cutoff to work the best.
It is my opinion that HIV(+) patients taking this formula of nutrients experience far fewer medications side effects including peripheral neuropathy, fat atrophy, pancreatitis, liver inflammation, etc. Furthermore, I often observe a CD4 count boost of approximately 15-20 percent within a few months after beginning this formula.
NV: In your opinion, can micronutrients possibly prevent neuropathy for someone starting “D” drugs?
JK: In my opinion, there is no doubt that the right combination of quality antioxidants can block this mitochondrial toxicity process. My opinion is based on the past three years of reviewing the latest research combined with my clinical experience in over 500 patients following my protocol.
NV: Is there a difference between vitamin brands and manufacturing standards?
JK: Without a doubt. As I began the process of manufacturing my formula for a clinical study, I learned a great deal about how vitamin supplements are produced. In essence, vitamin supplements can be produced cheaply, using inferior raw materials, mixing them with wax so they can be pressed into less expensive tablets that don’t break down easily in the gut, or they can be produced to extremely high quality, pharmaceutical-grade standards that use the highest quality raw materials possible.
NV: In addition, the antioxidants I mentioned above (NAC, alpha lipoic acid, and acetyl L-carnitine) are extremely sensitive to heat, light, and most importantly, exposure to air. Antioxidants react vigorously with oxygen. Therefore, if they are not protected from the air and kept in cold long term storage, they will degrade over time.
JK: I guarantee that the manufacturing of my formula by IHC Vitamins applies these pharmaceutical-grade standards to every batch. They use the highest quality raw materials, are mixed into quick dissolving capsules, are sealed into single dose convenient packets and are kept in cold storage until shipment. I have direct oversight of the quality control process and every batch is tested for potency by a nationally accredited reference laboratory.
These are the same nutrient packets currently being tested in my research studies. To view the study protocol visit www.jonkaiser.com and click on the research button.
NV: What is the monthly cost of your mitochondrial toxicity prevention formula?
JK: As I mentioned above, the recommended dose of my formula is based on a person’s weight and health status. HIV(+) patients who weigh greater than 145 lbs. should take a double-strength packet twice daily while those weighing less than 145 lbs. should take a single-strength packet twice daily.
The current cost to individuals for a month’s supply of single strength packets is $84.95 per month while the cost for a month’s supply of double strength packets is $142.95 per month. In my opinion, this program provides all the micronutrients an HIV(+) person needs to take for optimal immune system support.
Buyers clubs and non-profit organizations can order the vitamins for their members at a substantial discount (30% off) and I am working hard to get the cost down even further as quickly as possible without compromising the high quality standards.
NV: Are you looking at the effect on fat cells under the skin? If not, do you know anyone doing research on supplements that may prevent lipoatrophy?
JK: The proposed mechanism…that fat atrophy in the face and extremities is due to the buildup of reactive oxygen species (free radicals) in the fat cells…is plausible and substantiated by a significant amount of research to date. There may be other factors as well, but the buildup of free radicals in fat tissue will cause apoptosis (cell death) to fat cells as just as effectively as it causes it to other types of cells.
A study which has yet to be done is to give a large group of patients just beginning antiviral therapy high-dose antioxidants, compared to a second group that gets a placebo. They should then be followed for at least 3-5 years with close monitoring. In my opinion, the high-dose antioxidant group will have fewer side effects (including lipoatrophy) and will require less frequent changes to their antiviral therapy due to resistance.
NV: Have you observed any improvements in metabolic parameters, lipids, etc.?
I have yet to see a patient taking my micronutrient formula develop diabetes due to antiviral medications. Cholesterol and triglycerides are another story. Increases in these parameters is most probably not due to a mitochondrial toxicity mechanism.
NV: In your assessment of neuropathy, what tool did you use?
JK: I used a questionnaire called the NILAS, plus a physical exam assessing the effect on light touch, pain, and vibratory sense to measure the degree of peripheral neuropathy present. The NILAS is a linear scale from 0 to 100 that asks three questions and is scored based on the patient’s subjective responses.
NV: Do you think there may be a possibility for BMS to provide supplements that enable people to take D4T and DDI in the long term as part of their product? I remember when adefovir was provided with Carnitine when it was studied for HIV.
JK: Yes, it is the goal toward which I am fervently working. However, high quality research needs to be performed which supports any benefit claims before they will consider this proposal.
NV: . If you had unlimited funds for research, what would you study and why?
JK: That’s easy. First, I would design a large research study that gave patients beginning antiviral medication for the first time either my vitamin packets or a placebo packet to be taken twice daily with food. Then I would follow both groups for as long as possible (at least 3-5 years) and carefully observe the incidence of drug related side effects as well as immunologic parameters such as CD4 cells and how often the patients needed to switch their antiviral regimens due to drug failure. I’m pretty sure the vitamin group would show clear benefits in several areas.
Next, I would do a study in an under-developed area, such as Africa, to test whether a combination of high-dose micronutrients, plus a daily protein supplement, could slow the progression of HIV in patients not taking antiviral medication. The use of this type of nutritional support could stabilize a large percentage of the population until the availability of antiviral medications had increased. My experience leads me to believe that this type of intervention would work very well.
NV: Are there any other natural treatments that you believe make a big difference in the long term health and wellbeing of an HIV(+) individual?
JK: Yes. I check a body composition test (BIA) on my patients every six months and strive to keep their muscle mass in the 40-44 percent range for HIV(+) men and the 30-34 percent range for HIV(+) women. This helps maintain solid energy production by the body and optimally supports the immune system.
While I believe accomplishing this naturally utilizing protein supplements and resistance exercise is optimal, I often prescribe nandrolone, oxandrolone, and occasionally recombinant human growth hormone, if the situation warrants.
I also strongly encourage all HIV(+) individuals to get their free testosterone and DHEA-sulfate levels checked every six months as well. The optimal range for these depends on each individual’s needs, however a general rule of thumb is to keep these hormone levels within the upper half of the normal range. Both these hormones support energy production, mood, libido, and immune function.
By utilizing micronutrients and intelligent hormone supplementation, the immune system can be well supported, ultimately leading to less reliance on drugs and fewer HIV-related illnesses. The E-newsletter archives on my website (www.jonkaiser.com) provides in-depth articles on how to supplement each of these hormones to your greatest advantage (see issues 12/02 through 5/03).
NV: You have been a trendsetter in the HIV medical world. Do you think physicians would embrace the use of micronutrients as a pharmacological intervention for side effect management?
JK: Yes, I do. There would need to be one or two very compelling studies (which I hope to do) that attract other researchers who had an open mind to study the effects of high-dose micronutrients in HIV disease. Once other researchers become involved, I believe there would be a great deal of important data generated that would convince HIV treatment providers that micronutrients can provide real benefits.
Remember, HIV has always been a condition that has been able to break down barriers for patients needing to access new treatments. This is primarily because the scientific community is trying to improve the standard level of care which is presently unable to guarantee our patients long and healthful lives.
Thank you very much for allowing me to share this information with your readership.
NV: And thank you, Doctor.