October 1999

"We have an exciting new treatment modality, and based on your blood pH of
7.47 you are a candidate. We've been seeing alkaline blood pH's for years
and dismissed them because I was taught to dismiss them. I was taught that
if you see an alkaline blood there's only one cause - it's psychogenic
hyperventilation. The anxiety of the pain of the needle stick causes the
patient to over breathe. The problem with that idea is that almost
everybody we see has alkaline blood. So something more fundamental is going
on."

"Now this is what we think is going on. Citrate elevation is really big in
this disease. Did we get an organic acids test on you last time? Almost
everyone's is elevated. Even if it's not, other things are suggestive of
citric elevation within the cell. (He finds my test from April 1998.) Ah,
you had the variant of it in 1998. Citrate is not elevated, but your
2-oxo-glutaric is low. When you see this, usually the citrate is actually
elevated. Citrate is very probably elevated in the cells, but it's just not
showing yet in the urine." (My test from October 1999 showed significantly
elevated citrate.)

"The primary cause of citrate elevation is glutathione deficiency. Citrate
is converted to 2-oxo-glutaric by an enzyme that is glutathione-dependent.
So if glutathione is down, citrate will go up. And 2-oxo-glutaric will go
down. That's in the citric acid cycle - an energy producing cycle."

"The best treatment I know of for glutathione deficiency is (undenatured)
whey protein. (Immunocal or IMUPlus) But it doesn't work in some people and
I don't know why. But if it works it always affects the citrate level.

"The next thing that happens is if citrate goes up inside the cell, 2/3 DPG
goes down. 2/3 DPG controls oxygen transfer off the hemoglobin molecule. So
if this goes down, oxygen transfer is compromised. There can be plenty of
oxygen in the blood, but it can't get into the cells. Then you get tissue
hypoxic. Hyponemia (sp?) means fatigue, and ? doesn't work. The next thing
that happens is that without oxygen you switch over to anaerobic
metabolism, and that produces tissue acidosis. And that produces pain. The
acidosis is peculiar because you're not generating a lot of carbon dioxide,
you're generating a lot of organic acids, which concentrate inside the cell."

"The next thing you do, like any good body does, is it compensates for the
tissue acidosis by developing a blood alkalosis. The blood alkalosis is
unusual in that the venus pH is generally greater than 7.4 and the urine pH
is typically below 6.0. Now when you see this together, it's never
psychogenic. It's a metabolic problem. It's a compensatory, respiratory,
and renal alkalosis."

"Now the next thing that happens is unbelievable! And it's really, really
bad for you. The blood alkalosis as a primary problem will further lower
2/3DPG and you end up in a vicious cycle."

"Secondly, every blood vessel in your body constricts. So you get vessel
constriction and poor perfusion on that basis. Acidosis of the blood
dilates the vessels. Alkalosis constricts them. So the worst possible
situation is no oxygen transfer to the cells, no blood flow, no nutrient
flow, and no removal of toxins. So the organic acids keep building up even
more. And finally you get blood volume contraction. And the blood volume
disappears, and without blood volume you can't stand up, and you may even
faint. This explains David Bell's finding of volume contraction."

"The real problem here is there's no oxygenation - it all follows from
that, which follows from the low 2/3 DPG, which follows from the raised
citrate that can't convert, which follows from the low glutathione.
Obviously, if you want a powerful treatment intervention, you'd use (an
undenatured) whey protein and hope it addresses the glutathione deficiency.
Because if you don't, you get elevated citrate, lowered 2/3DPG, tissue
hypoxia, tissue acidosis, blood alkalosis, which in turn creates a vicious
cycle, vessel constriction and poor perfusion, and blood volume contraction."

"There's another thing you can do - treat the blood alkalosis. Immediately.
And you will interrupt the cycle, stopping the lowering of 2/3DPG, tissue
hypoxia, tissue acidosis, blood alkalosis, vessel constriction, poor
perfusion and blood volume contraction. And it instantly works! It's mask
oxygen."

"Now you need to use a partial rebreathing mask, with a bag on the end. The
reservoir bag lets you rebreathe your expired air. Now if you rebreathe
your expired air you instantly correct the alkalosis, and oxygen will pour
off the hemoglobin and every vessel will dilate, and you'll start perfusing
your brain and tissues, and bringing out the toxins and bringing in the
nutrients. You get a huge benefit. Just an hour of breathing this will buy
you half a day of doing better. And bringing in oxygen will kill the yeast
in your body. Lack of oxygen breeds yeast."

"All you're doing is breathing oxygen once or twice a day, for about an
hour. (I ask if we're breathing in both oxygen and carbon dioxide with the
rebreather.) Yes, which is what makes it work. If you're just breathing
oxygen, so what? You just add more oxygen to the hemoglobin but it doesn't
go anywhere. It just keeps the oxygen bound to the hemoglobin. You must get
the oxygen off the hemoglobin. You must drop the blood alkalosis down.
There's no better way than rebreathing your carbon dioxide. But if that's
all you did, you'd run out of oxygen. You need both the carbon dioxide and
the oxygen. Works much better."

"If you put the nasal prongs on, you just get oxygen. If you use just the
mask with a high flow rate you get oxygen. If you get the rebreather, ahhh,
you get the carbon dioxide."

"I got a big boost of confidence when I went to (the Fatigue Conference in
June in) London, and a serologist got up and said 'Ladies and gentlemen,
I'm here to tell you that CFIDS patients are alkaloidic and they do really
well if you teach them to breath correctly.' And he refers all his patients
to breathing experts, particularly Teresa Hale, founder of the Hale Clinic
in London. (I believe she's written a book called Breathing Free) What
she's saying is pretty much what I'm saying. There's a lot of people
walking around who are over breathing, and breathing alkaline. When you are
over breathing there's no oxygen transport. And when you under breathe you
get significant transport and perfusion."

"We see this problem every day. Blood pH above 7.4, you're impaired. Above
7.5 and you're real impaired. You're 7.47! Above 7.5 there's almost no
oxygen transport at all."

"If you'd like to try this I'll write out a prescription. A partial
rebreather mask set at 35 to 40% FIO2 (Fraction of Inspired Oxygen),
meaning a flow rate of about 10 liters per minute. Use it for an hour a
day, one to three times a day. (One sixty minute session, two thirty
minutes sessions, three twenty sessions.) Call any medical supply company
and tell them you have a prescription. They'll bring everything out and set
it up. Do not breathe heavily - breath normally. An hour a day is about
$100 per month. Two hours a day is $200 a month. You can modulate your
breathing according to what you can afford. Breath at least 20 minutes, but
no more than one hour (at a time?)."

"Do you have headaches? (I say yes.) If we write this for headaches,
insurance may pay for it."