From Dr. Stratton: Homocystine levels are elevated with B12 and folate deficiency, but can be reduced by folate alone. On the other hand, serum methyl malonate levels are elevated in B12 deficiency and are not changed by folate. Therefore, serum methyl malonate levels are the best indicator of B12 deficiency.
Dr. Stratton now recommends a combination of B12, B6, and folate - (see abstract). Cellular
replication requires one carbon metabolism. Killing Cpn involves cellular repair and regrowth. Any cellular repair thus is going to require these vitamins. When combined with NAC, these vitamins are
very important for mental function.
J Nutr Health Aging 2002;6(1):39-42
Folate, vitamin B12 and vitamin B6 and one carbon metabolism.
JM USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA. firstname.lastname@example.org
The vitamins folic acid, B12 and B6 and B2 are the source of coenzymes which participate in one carbon metabolism. In this metabolism, a carbon unit from serine or glycine is transferred to tetrahydrofolate (THF) to form methylene-THF. This is either used as such for the synthesis of thymidine, which is incorporated into DNA, oxidized to formyl-THF which is used for the synthesis of purines, which are building blocks of RNA and DNA, or it is reduced to methyl-THF which used to methylate homocysteine to form methionine, a reaction which is catalyzed by a B12-containing methyltransferase. Much of the methionine which is formed is converted to S-adenosylmethionine (SAM), a universal donor of methyl groups, including DNA, RNA, hormones, neurotransmitters, membrane lipids, proteins and others. Because of these functions, interest in recent years has been growing particularly in the area of aging and the possibility that certain diseases that afflict the aging population, loss of cognitive function, Alzheimer's disease, cardiovascular disease, cancer and others, may be in part explained by inadequate intake or inadequate status of these vitamins. Homocysteine, a product of methionine metabolism as well as a precursor of methionine synthesis, was shown recently to be a risk factor for cardiovascular disease, stroke and thrombosis when its concentration in plasma is slightly elevated. There are now data which show association between elevated plasma homocysteine levels and loss of neurocognitive function and Alzheimer's disease. These associations could be due to a neurotoxic effect of homocysteine or to decreased availability of SAM which results in hypomethylation in the brain tissue. Hypomethylation is also thought to exacerbate depressive tendency in people, and for (colorectal) cancer DNA hypomethylation is thought to be the link between the observed relationship between inadequate folate status and cancer. There are many factors that contribute to the fact that the status of these vitamins in the elderly is inadequate. These factors are in part physiological such as the achlorhydria , which affects vitamin B12 absorption and in part socioeconomic and habitual. We need more studies to confirm that these vitamins have important functions in the etiology of these diseases. We also need to establish if these diseases can be prevented or diminished by proper nutrition starting at a younger age.
The following is not suggested as an exclusive or recommended source, only as an example of the recommended dose and type of supplement used by Dr. Stratton.
Cpn exploits a variety of mechanisms to thwart our immune system. There is one mechanism that is particularly important and can be countered by over the counter supplements. Cpn targets niacin metabolism. In doing so it leads to impaired T-cell function, low melatonin, low serotonin, low tryptophan, low niacin all of which can present as depression, fatigue and insomnia, all familiar symptoms in Chronic Fatigue, Fibromyalgia and a host of Cpn related disorders.
Niacin therapy has been used safely for the treatment of hypercholesterolemia for decades, just the same, niacin levels should be increased slowly to minimize flushing and liver enzymes should be monitored. Expect some endotoxin release (as organisms die) as niacin is increased. Endotoxin release will lower nitric oxide levels temporarily and lead to cold hands and feet and possibly increased muscle aches in the initial stages of niacin treatment. You have to build up gradually on niacin as ingestion causes a flush like a hot flash. This reaction abates as you get used to the increased levels, and you can increase (UP TO???) the dose as tolerance develops.
Eventually time-released niacin can be used after niacin tolerance is established, but this form of niacin can be harder on the liver. Just be careful and make sure your doctor is monitoring liver enzymes and CBC every month or so until tolerance is well established. Unfortunately Niacinamide, ("No Flush Niacin") does not appear to be as effective.
Adding herbs that increase nitric oxide synthase (NOS) activity can also be helpful and can lead to improved immune function and warmer extremities. Garlic, ginseng, & ashwagandha all increase the activity of NOS and may be synergistic in combination with niacin. Increasing nitric oxide usually decreases FM related muscle pain and anxiety. One of the following articles supports the use of niacin for chronic headache (Mayo Clinic article) and another links infection with Cpn to disruption of niacin metabolism and immune evasion.Make sure that you are taking a good multivitamin daily when doing battle with Cpn. Nutritional demands are increased significantly by increased exposure to the endotoxin that is released from dying organisms. Biochemicals made by the the body to fight Cpn are made at the expense of tryptophan, niacin, melatonin, and serotonin all of which also are needed to fight Cpn in other ways. Supplementation with niacin and melatonin should make life more difficult for Cpn.
Best wishes to all of those who striving to be a bad host to Cpn. The last two articles document the effects of nitric oxide and melatonin on Cpn.
I spoke with a rheumatologist in California, Dr. Michael Powell, who is cautiously using a combination of antibiotics in conjunction with standard therapeutics for the treatment of nanobacterium (including Cpn) in patients suffering from FM, CFS and autoimmune disorders. His results with this treatment program have been encouraging. He faxed me some examples of patient feedback forms, excerpts from which you can see below. Recovery is not instantaneous, but tends to occur over a 6 to 12 month period. The graphs of subjective improvement are drawn from visual analogue scores compiled during each visit. When summarized in this manner these data give a time-lapsed impression of the response to treatment.
One of the interesting things he mentioned was in relation to negative patient serology for Cpn when other clinical signs lead him to suspect some involvement. Serologic assays for IgG, IgM and IgA are sent to confirm infection prior to treatment. He would like to see a positive serology in patients before engaging them in a combination antibiotic protocol, but recognizes that patients may not have antibody reactions. This may be due to the ability of intracellular organisms like Cpn to evade a humoral response (antibody production), immunoglobulin depletion, or other factors. In these cases, when there is a high index of suspicion for the infection without a humoral response, he tests the spouse of the partner for Cpn. He sees the "non-symptomatic" partner as a good indicator of Cpn in the patient, given the infectious nature of Cpn. Thus far, most spouses are positive when an ill family member is non-reactive.
In our discussion Dr. Powell pointed out the many similarities between TB and Cpn. Both organisms can evade our immune system. Both organisms can be carried from the lungs, the original site of infection, and infect other tissues. Both require prolonged treatment with multiple drugs to eradicate the infection. Both are sensitive to stress levels. Optimal therapy is being evaluated at various research centers and new medications for Cpn are on the horizon (see activbiotics.com).
INH and supplements for endotoxins-
Dr. Powell finds most patients improve on a standard combination antibiotic protocol for Cpn. Rheumatologist have apparently been using doxycycline for many years with success for inflammatory arthritis but there is evidence that using doyxcycline in combination with rifampin is even more effective. Some patients plateau after about 8 months of treatment he has found variations in the treatment protocol have made a difference. One protocol he uses involves the use of NAC 600 mg twice daily, INH 300 mg once daily before breakfast, and metronidazole 500 mg twice daily pulsed with 5 days on and two weeks off. It is essential to start each agent separately and gradually increase the dose over weeks or months as tolerated. The use of Vitamin C 500 - 1000 mg four times daily (the half life of vitamin C is 30 minutes and little remains after 3 hours) to offset the release of toxins during therapy. B6 is important to control INH related peripheral neuropathy. Monthly laboratory evaluation of AST, ALT, Cr, and CBC are recommended for all who engage in this protocol. It is not uncommon for liver enzymes to show a mild elevation during the initial stages of treatment. Antibiotic therapy should be temporarily discontinued during periods of toxicity, should it arise. He emphasized the importance of insuring that yeast and fungal infections do not overgrow during protracted antibiotic use. He recommends the use of acidophillus, nystatin, diflucan, oregano oil, and/or grapefruit seed extract as needed to prevent secondary opportunistic infection during treatment.
Covering for the possibility of yeast and fungal overgrowth during antibiotic therapy is essential. If diarrhea develops, stool must be evaluated for antibiotic associated diarrhea (C. difficile). This is not a simple protocol and it is best if it is guided by an experienced clinician who is familiar with the medications and methods of minimizing toxicity related to killing the nanobacterium.
A link to Dr. Powells clinic may be found on our links page. Dr. Powell does do telephone consultations by arrangement and may be a resource for those who have had difficulty finding a Cpn knowledgeable doctor in their area. He requires an initial visit with a physical examination before initiating therapy (lab work can be performed prior to the initial visit to facilitate diagnosis and treatment), and monthly laboratory testing with monthly phone consults are then the norm. Treatment of related hormone imbalances in the thyroid system and nutritional support, temporary antidepressant support as needed, and sleeping medications are useful adjuncts to the antibiotic protocol. It is necessary for patients to have a primary care physician to monitor health matters that are unrelated to FM, CFS and autoimmune disease.
This page is almost a separate research page, but this time focused on supplements, or natural substances which work along with the protocols or with the diseases primarily addressed on this site.
Watch for it to grow as new links and info are added! Have a link to research or information that applies to the topic of this page? Post it as a forum topic or email mrhodes40(me) or Jim and we'll add it if it fits.
Melatonin with comments threadQuinolinic acid is an excitotoxin that induces oxidative damage. Melatonin prevented this damage.