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Archive for the ‘Antivirals’ Category

I must preface this blog entry with another apology for my lack of writings in recent months. The fact of the matter is that using the computer causes me cognitive impairment, headaches and a next-day migraine. If the frequency of my blog entries was graphed against the state of my ME, a direct correlation would be found- That is, if I blog often, I am feeling slightly healthier than if I don’t blog for a period.

                                                                                                                                                                                                                                        Dexedrine

An Olson et al. study (found here http://www.ncbi.nlm.nih.gov/pubmed/12515836) resulted in dexamphetamine improving the fatigue severity scale scores in 9 out of 10 CFS patients while only 4 out of 10 patients in the placebo group experienced improved fatigue severity scores. Dexedrine may improve; cognitive problems, decrease fatigue and increase energy. It may also increase certain neurotransmitters that may be low in some ME patients. Dr. Teitelbaum is an advocate of Dexedrine believing it may increase energy and blood pressure. Dr. Goldstein believes that one third of CFS patients will benefit by taking stimulants (he recommends amphetamine salts.)

                                                                                                                                                                                                                                                               There are risks associated with taking Dexedrine such as the risk of addiction if used for extended periods of time. Some of the potential side effects listed are also off-putting. Dr. Goldstein warns that if certain neurotransmitters are too low in patients, stimulants may increase CFS symptoms.

                                                                                                                                                                                                                                                                   My experience in taking Dexedrine was quite short lived. After a night of interrupted sleep, I took ¼ of a 5mg tablet (in the morning.) My cognitive abilities were noticeably improved throughout the day and I was more alert than normal- After an interrupted sleep, I am typically very sleepy during the day however the Dexedrine remedied this problem. Every day I meditate for 1 hour and on the day I took the Dexedrine, my meditation was far more focused, easier and effective than normal. The downside of the Dexedrine hit me at approximately 5pm when I experienced a crash. I speculated that the Dexedrine was wearing off when I crashed as it has a very short half-life. I have not taken Dexedrine since due to the potential crash it may cause.

                                                                                                                                                                                                                                  Azithromycin

Azithromycin is an antibiotic with immunomodulatory and antiviral properties. The macrolide antibiotic family (of which Azithromycin belongs) is effective against a broad range of bacteria-many of which have been linked to ME. Azithromycin is able to cross the blood brain barrier with some ease and it hence has the potential to fight CNS infections. It also has anti-inflammatory properties. Dr. De Meirleir and Dr. Nicholson are both advocates of Azithromycin, using it quite frequently with some success. A Vermeulen et al. study (found here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1562448/) discerned that 58 out of the 99 CFS patients studied had a decrease of symptoms while taking Azithromycin. The antibiotic was most effective in patients with low levels of Acetylcarnitine. It should be noted that none of the patients in the study reached remission status as a result of this treatment. Azithromycin may exacerbate liver function impairment and can be fairly expensive.

                                                                                                                                                                                                                                                                   My experience with Azithromycin is ongoing as I have been taking it for the past 3 weeks and will continue to take it for the next 3 weeks. To date, I haven’t noticed any effects.

                                                                                                                                                                                                                                   Testosterone

I will attempt to keep this Testosterone summary short. As a male, with borderline low testosterone, I applied testosterone cream daily for approximately 1 month and had HCG injections weekly for 4 weeks. Over this period, I experienced frequent crashes and an exacerbation of many symptoms. It was arguably the worst month of my ME. I also lost my appetite (probably due to the HCG injections.) The blood test showed that after 1 month of testosterone treatments, my testosterone was moderately lower than when I began the testosterone treatments. My doctor speculated that my body had ceased to create endogenous testosterone due to the exogenous testosterone applied to it. I’m not feeling well enough at present to detail the potential positives and negatives of testosterone (it can replicate viruses including XMRV-whatever that is) however I have ceased the treatment and am now back to baseline (how I was feeling before trialling the testosterone.)

                                                                                                                                                                                                                                      Conclusion

Ideally, I would like to write in detail regarding each treatment however due to my current health status, this is not possible. I have a handful of other treatments that I will commence over the coming months and I will blog about any effect these treatments have on my ME.

 

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                                                                                                                                                                                                                                       What is Nexavir?

During the 1940s, a product called Kutapressin was licensed to treat acne, cold sores, herpes viruses and other inflammatory viruses. In 1983, Kutapressin was trialled on ME/CFS patients. A company called Schwarz Pharma produced Kutapressin until several years ago when this product was discontinued.  A separate company called Nexco Pharma recently reintroduced this same product with a virtually identical composition to Kutapressin under the brand name ‘Nexavir.’ The terms Kutapressin and Nexavir will be used interchangeably in this article.

                                                                                                                                                                                                                                    Nexavir is a porcine liver extract that is the residual product from the process of vitamin B12 extraction. It is composed of peptides and amino acids.

 

                                                                                                                                                                                                                                   Nexavir Studies

Nexavir has been around for almost 70 years however few studies have been performed on it. I will examine the Nexavir studies relevant to ME/CFS. The first such study was a 1996 study titled ‘Potential in vitro activity of Kutapressin against Epstein-Barr virus.’ The abstract of this study can be found here: http://www.ncbi.nlm.nih.gov/pubmed/8797033 This study determined that Kutapressin can inhibit Epstein-Barr virus in vitro.

                                                                                                                                                                                                                                            The second study to assess the efficacy of Kutapressin was published in 1994 and titled ‘Antiviral activity in vitro of Kutapressin against human herpesvirus-6.’ The abstract of this study can be found here: http://www.ncbi.nlm.nih.gov/pubmed/7893985 This study concluded that Kutapressin has potent and previously unexpected antiviral effects. HHV-6 replication was inhibited in vitro by greater than 90%.

                                                                                                                                                                                                                                                A study was published in the 1990 spring CFIDS Chronicle titled ‘The Treatment of CFIDS with Kutapressin.’ This study can be found here: http://www.me-cvs.nl/index.php?pageid=3423&printlink=true&highlight=cfs This study was not peer reviewed and didn’t contain a control group or placebo treatment. Inclusion in this study required patients to fulfil the Holmes et al. criteria with symptoms present for at least four months. Many secondary tests were performed on this cohort to exclude CFS-related conditions. A large portion of those included in this study (59%) had abnormal EBV-EA IgG titer levels. 80% of this study cohort had CFS for greater than 1 year while 18% of the cohort had CFS for a duration exceeding 6 years.

                                                                                                                                                                                                                                           2ml of Kutapressin was administered daily for ten days followed by three times a week. Out of the 270 study participants, 96% of those receiving more than 40 injections reached remission or near remission status (with few residual symptoms.) 71% of patients receiving 11-40 injections reached remission or near remission status (with few residual symptoms.) This positive correlation of number of injections to treatment efficacy was realised post hoc by the study authors hence not all participants had more than 40 injections. High EBV-EA IgG titer levels were the main biomarker indicating a success of Kutapressin treatment, although patients with normal EBV-EA IgG levels also improved with Kutapressin.

                                                                                                                                                                                                                                            The final study that I will examine is titled ‘Subjective Reduction in Symptoms of Chronic Fatigue Syndrome Following Long-Term Treatment with a Porcine Liver Extract: A Phase 1 Trial.’ Some details of this study can be found here: http://www.ncf-net.org/library/kutreat.html This 1994 study was led by the same two study authors as the previously mentioned 1990 study. Consequentially, the same Holmes criteria were used to select participants and a greater than four months CFS duration was a prerequisite for patient inclusion. There was no control group or placebo treatment in this study. The 130 CFS patients in this study were administered 2ml injections of Kutapressin daily for 25 days, then every second day for 50 days followed by three times a week for 105 days. In total, the participants had 95 injections over a period of 180 days. Of the 180 CFS patients, following Kutapressin treatment 43% reached remission status while 42% reached near remission status (with few residual symptoms.) The authors concluded that Kutapressin subjectively decreased the clinical symptoms of the majority of CFS patients.

 

Nexavir’s Possible Mechanisms of Action on ME/CFS Patients

Nexavir may improve ME/CFS symptoms because it:

  • Inhibits EBV
  • Inhibit HHV-6
  • Is anti-inflammatory
  • Is antiviral
  • Is an immunomodulator (Nexavir may help shift the immune system away from Th2 dominance.)
  • Enhances blood flow in the brain (as measured by a SPECT scan.) This increased rate of blood flow may be a consequence of the Bradykinin effect which involves dilation of the blood vessels.

 

 

Side Effects

Nexavir has been used to treat a variety of conditions for almost 70 years and is widely regarded as safe. Some physicians that are reluctant to prescribe antivirals such as Valtrex and Famvir due to possible side effects instead prescribe Nexavir as a safer alternative.  

                                                                                                                                                                                                                                            The 1990 study titled ‘The Treatment of CFIDS with Kutapressin’ contained 270 CFS patients and involved the administration of 8,900 injections of Kutapressin. This study only noted one adverse reaction to Kutapressin in which the patient believed that they had new symptoms and observed a deterioration of functioning immediately following injections.

                                                                                                                                                                                                                                            The 1994 study titled ‘Subjective Reduction in Symptoms of Chronic Fatigue Syndrome Following Long-Term Treatment with a Porcine Liver Extract: A Phase 1 Trial’ also examined the side effects of Kutapressin injections. Out of the 130 CFS patients, only 21 had minor side effects. Out of the 21 patients experiencing mild side effects, 16 reached a remission or near remission of their CFS.

                                                                                                                                                                                                                                        Nexavir is contraindicated in those with an intolerance or hypersensitivity to liver or pork products. Nexavir contains tyramine and therefore cannot be used by patients taking MAO inhibitors. The tyramine may also cause migraines in a small portion of patients. Nexavir also contains phenol which may cause an allergic reaction in some users. Like with all injections; rashes, swelling, pain and stinging may occur at the injection site. Anecdotal reports online indicate that many users of Nexavir experience bruising at the injection site and therefore must vary the specific injection location.

  

ME/CFS specialists’ opinions on Nexavir

I will now present what an eclectic range of ME/CFS specialists’ thoughts are regarding Nexavir as an ME/CFS treatment. I have attempted to gather the most up-to-date viewpoints of these specialists however due to the perpetually evolving nature of ME/CFS treatments, some of these opinions may now be outdated.

                                                                                                                                                                                                                                              Dr. De Meirleir

Dr. De Meirleir performed a study involving the administration of Nexavir or a placebo to ME/CFS patients. 63% of those ME/CFS patients in the treatment group responded to Nexavir while only 17% of those ME/CFS patients in the placebo group responded. Dr. De Meirleir finds that approximately 50% of his patients are pain free after 2-3 months of Nexavir injections. His patients generally experience a normalisation of sleep within 3 days of commencing Nexavir. Approximately 70% of Dr. De Meirleir’s patients experience a 20+ point increase (based on the Karnovsky scale) as a consequence of taking Nexavir

 

Dr. Cheney

Dr Cheney formerly recommended Kutapressin as a treatment for ME/CFS. He stated that it is analogous to a weaker form of Ampligen. In the past Dr Cheney used Kutapressin/Nexavir injections however at some staged preferred using the gel form of Nexavir. He has also stated that his patients generally experience a 20-80% improvement as a consequence of taking Nexavir gel and secondary treatments.  ‘ECHO terrain maps’ now mainly influence Dr Cheney’s ME/CFS protocol and he has consequentially stopped prescribing Nexavir. He now uses his own mix of five cell signalling factors instead of Nexavir. These are; porcine brain, bison liver, bison heart, bison kidney and bison pancreas.

 

                                                                                                                                                                                                                                               Dr. Enlander

Dr. Enlander used Kutapressin for approximately 12 years until Schwarz Pharma ceased producing it. He then originally tried Nexavir on his patients however due to the preservatives within Nexavir, he trialled his patients on Hepapressin. Hepapressin is similar to Nexavir however it is an Argentinean bovine liver extract, as opposed to porcine liver extract. Dr. Enlander recommends that his patients take other substances in tandem with Hepapressin to increase its effectiveness. 67% of his patients have shown an improvement as a consequence of weekly Hepapressin injections in combination with other treatments. Recently, Dr. Enlander commenced a study alongside Dr. De Meirleir that examined alternative ways to administer Nexavir/Hepapressin.

 

Dr Teitelbaum

Dr. Teitelbaum has noticed a dramatic improvement in some of his CFS patients as a consequence of taking Nexavir regularly. He has found that those patients who took Nexavir three times a week didn’t gain much benefit as daily injections are a necessity. Dr. Teitelbaum has also observed that some of his patients’ CFS symptoms returned after discontinuing Nexavir.

 

Dr. Lapp

Dr. Lapp provided almost every ME/CFS patient that made an appointment with him, the opportunity to try Kutapressin. He has labelled it as a “wonderful alternative.” Dr. Lapp has stated that Nexavir was handmade for CFS patients with the main arguments against taking it being the cost and the necessary frequency of the ‘painful’ injections.  

 

 Combining Nexavir with Other Treatments

Many specialists combine Nexavir with other treatments to either increase the efficacy of Nexavir itself or through the means of multiple treatments increasing the chances of a successful treatment.

  • Dr. De Meirleir often uses Nexavir in combination with vitamin B12 injections. He recommends 10mgs of B12 (either methylcobalamin or hydroxocobalamin) be administered twice a week.
  • Dr. Enlander combines Hepapressin injections with injectable; magnesium sulphate, folic acid, B12, calphosan, glutathione and trace elements.  
  • Dr. Cheney (who no longer recommends Nexavir) formerly found combining Nexavir gel with Hawthorn leaf and flower an effective treatment.
  • Some anecdotal reports indicate that combining Nexavir with other, more traditional prescription antivirals may increase the efficacy of Nexavir or one of the other antivirals.

 

How to take Nexavir?

Nexavir is to be administered by either subcutaneous or intramuscular injection. Different ME/CFS specialists have various protocols regarding dosage and frequency of Nexavir injection however the most commonly recommended dosage is 2ml administered daily. Some patients may experience a herxheimer type reaction on a 2ml starting dose hence it may be wise to work up to a 2ml dose. Dr Cheney (when he prescribed Nexavir) recommended that the dose be varied between 1 and 4 cc a day. Nexavir should be taken for at least 6 months to determine whether it may be an effective treatment.

 

Other Details

A prescription is required to purchase the injectable form of Nexavir. The only company that manufactures Nexavir is a Texan company called Nexco Pharma. A Texas pharmacy called Village Compounding produces Nexavir compounded as a transdermal gel. A prescription is also required for this Nexavir gel. Nexavir should not be confused with ‘Nexavar,’ a drug that treats certain cancers.

 

Negatives of taking Nexavir

The main negative of taking Nexavir is the cost. At 2ml a day (the standard dose), Nexavir will cost approximately US$450 a month. As the minimum recommended treatment period of Nexavir is 6 months (barring side effects), the total cost of a Nexavir trial is approximately US $2,700. This is not including the cost of shipping, syringes or needles.  Some insurance companies may partially cover the cost of Nexavir.

                                                                                                                                                                                                                                  Another negative of taking Nexavir involves the cumbersome daily injections. These have been described by some Nexavir uses as “painful.” The final potential negative of using Nexavir as an ME/CFS treatment involves the possible side effects (mentioned in an earlier section.) While the likelihood of experiencing these side effects seems to be minimal, the possibility exists.

 

My Nexavir Protocol

I will begin Nexavir injections in the coming week. I will start at a 2ml daily dose and keep this dose static for 1-2 months. Depending on whether Nexavir has any effect on my ME/CFS symptoms, I may then begin to pulse the Nexavir dose. I may also attempt to combine Nexavir with other treatments to increase its efficacy. I will update this blog to detail any effects Nexavir has on my illness.

 

Conclusion

Nexavir/Kutapressin boast some of the most successful study results of CFS treatments. Although the heterogeneity of CFS  makes transposing CFS study results often problematic. The efficacy of Nexavir in tandem with the low possibility of side effects makes Nexavir (or one of its related derivatives) one of the primary ME/CFS treatments utilised by a multitude of specialists.

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Oxymatrine

On the 29th of October 2009 I began taking oxymatrine tablets. My preferred brand of oxymatrine was Equilibrant which also contains various immune modulators. Doctor Chia began producing the Equilibrant form of oxymatrine after becoming concerned with the purity of some of the other brands. I was unable to acquire the Equilibrant brand hence I ordered the White Tiger brand.

Dosing

The White Tiger brand contains 200mg of oxymatrine per tablet. My dosing structure is flexible based on any reaction to the oxymatrine however at the moment stands at:

100mg each day for 2 weeks. The tablet is to be taken with water before or with meals.

100mg 2x a day for 2 weeks.

200mg at am and 100mg at pm for 2 weeks.

 200mg at am and 200mg at pm for the remaining 6 weeks.

 Note that for the White Tiger brand, it is necessary to break to tablet in half in order to obtain a 100mg dose of oxymatrine.

 The above dosing schedule is preliminary as over half of those taking oxymatrine experience some sort of side effect. This may include headache, fatigue or an increase in severity of some of your current symptoms. If I don’t experience any side effects I will follow the above dosing structure. If I do experience side effects I will adjust the dosing structure accordingly based on the severity of side effects and what dose of oxymatrine the side effects occur at.

I will complete the oxymatrine course after 3 months if I experience no improvement of my current symptoms however if I experience improvement I will extend the dose accordingly.

I must stress that it is imperative to slowly increase the dose. I have so far taken oxymatrine for 5 days and on day 2 I became very dizzy. This lasted for around 4 hours starting about 10minutes after taking a 100mg dose of oxymatrine.

 

Facts about Oxymatrine

Oxymatrine is derived from the Sophora plants. It has been shown to have some degree of antiviral properties. It is often used in treating Hepatits B due to its suggested ability to reduce liver damage and reduce viral load. It has also been suggested that oxymatrine can increase blood flow and in China it is sometimes used as an anti-cancer drug.

 

Study

Doctor Chia is the main advocate of oxymatrine and has done a study on its usefulness. The results of the study are one of the main reasons that I decided to try taking it. The results of Dr Chia’s oxymatrine studies:

52% of those taking it showed some sort of improvement.

2% of those using placebo showed some sort of improvement

52% of those taking oxymatrine showed some improvement in the second trial.
Dr Chia has given to herb to over 350 patients and says that 52% of patients experience some degree of improvement.

 

Enterovirus

The use of oxymatrine is intended for those CFS patients who test positive to enterovirus. It can be quite expensive to determine if you have enterovirus. Some of the blood tests for enterovirus are not considered sensitive enough. Dr Chia often gets stomach biopsies performed to determine the virus in patients.

Positive results on coxsackie b or echovirus antibody tests can also justify trying oxymatrine. I have decided to take oxymatrine without having any of these tests done. I figure that I can spend thousands of dollars getting these tests done and then try oxymatrine or try oxymatrine without getting the tests done. If I am negative for enterovirus, coxsackie b and echovirus, then oxymatrine still may be of use for its antiviral affects.

Dr Chia is very interested in the patient’s onset of CFS. Mine seemed to be a gradual onset with coughing up mucus an isolated symptom for 3 months until fatigue began to set in. This coughing up mucus has continued from the onset to the present and increased in severity to the point of me currently coughing up mucus 700 times plus a day. A common onset of enterovirus is upper respiratory symptoms hence I am interested in taking oxymatrine. I do suspect that the upper respiratory symptoms of enterovirus last only a few weeks based on case studies I have read. The 4 years of my upper respiratory symptoms seems to indicate that maybe my onset isn’t consistent with enterovirus however I am still willing to take oxymatrine.        

 

Warnings

Oxymatrine should not be used in those with autoimmune tendencies or known seizure disorders. There is also a risk or neurological toxicities in those taking oxymatrine. I must stress that if you intend to take oxymatrine, I recommend doing it under medical guidance. It is also very important to increase the dose slowly.

I will continue to update this blog with any affects oxymatrine has on me.
A good source of discussion between those who have already taken oxymatrine can be found at the HHV 6 foundation forums at http://hhv6foundation.proboards.com/index.cgi?board=antiviral&action=display&thread=200&page=1

You need to sign up for the forums in order to view topics such as this one.

 The Phoenix Rising page also has a good amount of information on oxymatrine including an interview with Dr Chia http://aboutmecfs.org/Int/IntChia1.aspx

And some general information about oxymatrine http://aboutmecfs.org/Trt/TrtOxymatrine.aspx

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  •  I have completed a 2 month course of artesunate.
  • I have finished a 2 ½ month course of colloidal silver.
  • I have taken inosine for 2 months.
  • I have taken Proboost (thymic protein A) for 2 ½ months.

I haven’t experienced any notable improvement in CFS symptoms despite being on this ‘cocktail’ of antivirals and immunomodulators for the past 2 months. During the 2 months I experienced what I suspect is a pulsed herxheimer effect. This entailed having a runny nose and a heavy cold that lasted for 2 days and occurred every 10 days (approximately 6 times over the 2 month period.)

I rarely experienced heavy colds prior to starting the antiviral and immunomodulator treatment. I will take note of if I continue to have them after completing the treatment. This will give me some sort of indication regarding whether the colds were spurious or related to the antivirals in the possible form of a herxheimer effect.

I will continue to take the inosine and Proboost until the recommended dosing period is over however have finished the artesunate and colloidal silver

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I have been taking the colloidal silver and ProBoost for 12 days now. On day 4, I noticed quite a severe headache. On day 5 I came down with symptoms similar to a cold, runny nose, yellow mucus. By today (day 12) my cold is starting to dissipate. I am hopeful that the ‘cold’ was caused by the Herxheimer Effect. More information regarding the Herxheimer Effect and its relation to colloidal silver can be found at http://www.silvermedicine.org/herxheimerreaction.html I am very well aware that my headache and cold’s relationship to the Herxheimer Effect could be a spurious similarity.

I was due to start taking the Inosine on the 26th of August however I purposefully delayed taking it due to my cold. I will start taking it on the 31st August 2009 and now will be able to monitor any effects (if any) it has on me. I will begin taking the Artesunate several days later.

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Non prescription anti-virals and immunomodulators that I am currently trying/about to try.

On the 19th of August 2009, I began taking colloidal silver. I take two tablespoons 10 minutes before breakfast, one tablespoon 10 minutes before lunch and one tablespoon 20 minutes before dinner. Rather than swallow the colloidal silver straight away, I leave it under my tongue for 30 seconds, then swish it around my mouth and finally swallow it. This is to hopefully maximise the absorption of it. I will continue taking the colloidal silver for 8 weeks. This is a website that looks at some of the things colloidal silver can supposedly treat

(http://www.diagnose-me.com/treat/T305705.html)

On the 19th of August 2009, I also began taking ProBoost (thymic protein A.) I take it one hour after meals, 3 times a day. Rather than swallowing it, I place it underneath my tongue for 3 minutes and it dissolves. Any that is swallowed becomes useless due to the acidity of the stomach. I will take ProBoost for 12 weeks. ProBoost can be helpful to CFS patients with various infections and is also an immunostimulant.

On the 26th of August 2009, I will begin to take Inosine tablets. Inosine is the active ingredient in Isoprinosine, which is a prescription medication. Isoprinosine can raise natural killer cell levels and hopefully Insosine will do this to me. Inosine is an antiviral and immunostimulant. The dose of Inosine I will be taking varies depending on the day, week and month. I will be taking a dosing structure recommended by Dr Cheney and is found at this website. (http://www.anapsid.org/cnd/drugs/isoprinosine.html)

On the 28th of August 2009, I will begin to take Artesunate. The use of Artesunate in treating CFS is experimental. Despite this, studies have shown that Artesunate is an anti-viral and can reduce herpesvirus levels. The herpesvirus relation to CFS is quite controversial. Some CFS specialists believe the herpesvirus is central to a root cause of CFS however other specialists deny any relation between the two. Personally I believe that a subset of CFS patients are infected with a quasi-herpesvirus.
I will take
First day: 2 capsules twice a day sublingually (by opening the capsules and pouring the contents under my tongue.

Second day to Fifth day: Take 2 capsules once a day, sublingually

For the next 2 or 3 months: Take 1 capsule 2 or 3 times a week

While completing these treatments, I will continue to update on this blog if I experience any effects.

Source:

http://www.chronic-fatigue-syndrome.suite101.com/article.cfm/immunostimulants_in_cfsme_treatment
http://www.ei-resource.org/expert-columns/dr.-jacob-teitelbaums-column/how-to-optimize-your-immune-defense-system-naturally/
http://www.prohealth.com/fibromyalgia/blog/boardDetail.cfm?id=1353234

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