- DIET: Increase intake of whole grains, fresh vegetables, and fruits, low-to-moderate fat sources of protein such as skinless chicken, fish, and beans. Limit dairy and red meats. Choose organic vegetables and chicken. Avoid or severely limit alcohol, sugar, and caffeine.
- VITAMINS/MINERALS: Multivitamin/mineral supplements that mustinclude Vitamins A, D, E, K, C, the B-vitamins, calcium, iron, iodine, magnesium, copper, zinc, manganese, potassium, chromium, and selenium. Include digestive enzymes such as papain and bromelain. May include NAC (n-acetylcysteine, a precursor to glutathione, an antioxidant enzyme that may inhibit HIV.)
- WESTERN ANTIBIOTIC HERBS: Echinchea, Goldenseal, Myrhh, Garlic
- CHINESE HERBS: Astragulus (immune enhancer, tonic); Schizandra (tonic); Ganoderma (immune enhancer, stress reducer, tonic, and sedative); Atractylodes (immune enhancer, diuretic, tonic); Glycyrrhiza (licorice root -- antimicrobial, antiviral), among others.
- HORMONES: Natural hormones DHEA and testosterone to build immunity, energy and muscle mass. These and other synthetic hormones are administered as needed.
- DIGESTIVE HEALTH TREATMENTS: Herbs including black walnut, berberine, grapefruit seed extract, wormwood. Acidophyllus to maintain a healthy gut. Mainstream antiparasitic drugs.
- EXERCISE: One-half hour of enjoyable exercise per day that causes sweating (which signals removal of waste products and possible inhibition of viral replication.)
- STRESS REDUCTION: Deep relaxation practice two times per day for 15-20 minutes. Rest, emotional healing, social support, support groups, prayer and spiritual development.
These elements underscore Kaiser's belief that it's not enough to rely on antiviral artillery in a goose-stepping war against HIV. Military metaphors may have their place in healing, but Western medicine's "hit it with all you've got" strategy is too narrowly focused to outfox HIV, the wiliest virus that scientists have ever encountered. Healing this disease, says Kaiser, requires an equal emphasis on vanquishing a viral enemy and strengthening the body's natural defenses.
The Key: "Dynamic Equilibrium"
Microbiologists have recently shown that exposure to HIV initiates a long, drawn-out power struggle between invader and host. Over the course of many years, what appears to be a quiet truce in an otherwise healthy person is anything but. Immune "soldier" cells in the body are constantly fighting to stay ahead of HIV as it reproduces itself. According to Kaiser, HIV-positive people can outmaneuver the virus by strengthening their immune defenses with diet, supplements, herbs, exercise, and mind-body medicine."The virus produces up to a billion particles a day, and the body loses and replaces up to a million T-cells a day," explains Kaiser. "One can easily imagine the enormous drain on our resources. Therefore, it's up to the individual to take great measures to support their immune systems in that fight. That includes getting enough protein and nutrients while conserving energy and reducing stress. These efforts enable patients to achieve what I call a 'dynamic equilibrium.' That's when the immune system keeps pace with HIV, preventing active infection and keeping the viral load, as we call it, at low or modest levels."
Where do antiviral drugs fit into this picture? A new class of these drugs, called protease inhibitors, are now being combined in multi-drug regimens that drastically reduce the amount of virus in the bloodstream ("Viral load" is the technical term, and it can now be measured with precision.) In some patients, the virus can no longer be detected in the blood after several months of this therapy. Given these findings, why doesn't Kaiser view multi-drug treatments as the absolute best way to "keep pace" with the virus?
Kaiser's answer is nothing short of adamant. Each antiviral drug, he insists, carries the risk of severe side effects, including nerve system damage, diarrhea, anemia, and liver inflammation. These effects can become cumulative over time, exhausting the immune system and risking liver failure. And there's still no proof that any of these drugs completely vanquish HIV, which may continue to "hide out" in lymph nodes and other sites in the body. Most importantly, in its infinite cleverness HIV can gradually become resistant to most antiviral drugs, including the prodigious protease inhibitors.
"Every time you add a new drug you start the clock ticking on resistance," says Kaiser, whose watchword when it comes to antiviral drugs is prudence. "If you use too many drugs too quickly, you run the risk of having a patient who develops multi-drug resistant HIV. I have already seen such patients."
Like a crafty baseball manager who saves his best relief pitcher for the late innings of important games, Kaiser waits until just the right moment to use the most powerful drugs, especially the protease inhibitors. "I view protease inhibitors as an ace in your pocket," he explains. "If you can keep winning hands without using them, you just keep winning hands. That way you don't waste them."
Looking for Deeper Answers
Part of Kaiser's success appears to lie in his unremitting belief in the body's own healing powers. His approach can be traced to his early background in philosophy, which led him to question the basic assumptions conveyed in his medical school training."I was always asking questions about why the body was breaking down," says Kaiser, recalling his initial exposure to theories of disease. "They were always termed 'good questions,' but nobody had any answers. For almost all the diseases, the solutions were either to cut it out, or kill it with drugs. To me, that wasn't sufficient. I believed that if you understood why the body had broken in the first place, you could get to the root of the problem and reverse it. I was looking for deeper answers."
Between his first and second years of medical school at the University of Texas, Kaiser got a job managing a health food store. He became a voracious reader of books about natural medicine, and essentially taught himself naturopathy and herbal medicine. "It became clear to me that getting away from nature had helped to cause the breakdown, and geting back to nature would be instrumental in correcting so many of those root causes." He began to envision integrated treatments that could achieve new levels of success in the treatment of cancer, heat disease, diabetes, and other chronic ailments of our time.
After medical school, Kaiser went to the Kaiser Foundation Hospital in San Fransisco, where he spent two years as an ER doctor and trained in internal and family medicine. It was the early 1980s, when the first AIDS cases were being reported -- many of them in the Bay Area. As it became clear that AIDS was a rampaging infectious disease with no cure, Kaiser saw an opportunity to contribute by developing an integrated program for immune empowerment. "There I was in San Francisco when the AIDS epidemic was starting to peak," recalls Kaiser. "I saw it as an interesting intersection of preparedness, opportunity, and destiny."
In those days, AIDS was virtually untreatable. Kaiser's awareness of this crisis, coupled with his dissatisfaction with mainstream medicine, led him to a fateful decision. "You come to a personal crossroads, where you say, 'It's now or never.' So I opened my own clinical practice with just one patient. To supplement my income, I continued to moonlight in emergency rooms."
During the past decade, Kaiser's clinic has grown into a one-of-a-kind Wellness Center where people with HIV and AIDS get the kind of care that addresses their biological, nutritional, psychological, and spiritual needs. The recent move to join forces with the Conant Medical Group has strengthened his ties to mainstream AIDS doctors, some of whom have come to appreciate Kaiser's contribution. Considering the severity of their conditions, the atmosphere at the Wellness Center, where HIV patients and others with immune dysfunction come for integrated care, is decidedly upbeat.
"When I speak to the new patients, they say that this program is exactly what they've been searching for," comments Pramela Reddi, the clinic administrator at the Wellness Center. "They've been looking for a physician who has all the requisite medical knowledge, but who also knows diet, supplements, and herbs, a doctor who believes in massage and acupuncture. Also, Dr. Kaiser has a frank and open relationship with his patients. They feel they are getting all of their needs met."
To ensure that his patients get their needs met, Kaiser has a physician assistant on staff, Martin Kramer, who can always be reached to respond to patients' day-to-day symptoms or concerns. Some patients come to the Wellness Center after unpleasant or even traumatic experiences with other doctors. "Many of them have had such bad experiences with Western medicine that they are skeptical of everything you do," comments Kramer. But once positive changes occur, the skepticism is quickly replaced by commitment. "I wish I had before-and-after pictures of these patients," says Kramer, former head of a free clinic for HIV patients in Haight-Ashbury. "The difference is unmistakable, and you see it in their energy levels, their appearance, and how they feel about themselves."
Mind, Body, Spirit, and HIV
A patient of Dr. Kaiser's for nine years, Michael Stokes's commitment to his program has been unshakeable. When he started in 1988, it was not the details of integrative therapy that cemented his choice as much as Kaiser's aura of acceptance and conviction. "I liked his voice and his energy," says Stokes. "Meeting him was like walking into a room where you feel calm and at peace with whatever goes on there." The program's emphasis on natural therapies also made sense to him. "I was exhilarated by the fact that this doctor was doing something that fit so perfectly with my life."Stokes, 46, was in the midst of a personal upheaval when he first came to Kaiser. Not only had he lost his job and split with his lover, an HIV test informed him that he'd also lost his health. The discipline of Kaiser's program helped Michael put the pieces of his life back together. He began participating in a small psychological support group for HIV patients led by Kaiser, a group that continues to meet to this day. And he began the regimen of natural therapies that remains his daily touchstone. But Michael has made exceptional efforts to commit himself to the emotional and spiritual aspects of Kaiser's healing program.
Without fail, Michael meditates twice a day for a half-hour. He spends time writing down affirmations, statements about his care for his body and spirit that have meaning for him. And he has followed one of Kaiser's most unorthodox prescriptions: writing letters to the HIV virus. "For me, it has been a process of befriending the virus, because I know that it's something I will probably have to live with for the rest of my life," says Michael. "The virus came into my world and put me on the path that got my life in order. I was actually searching for that before I was HIV-positive."
According to Kaiser, writing such letters enables a person to work through troubling thoughts and feelings about their condition. "You can look at what's going on between you and HIV as a relationship," says Kaiser. "If you uncover a great deal of fear and negativity, writing letters can help you to evolve the relationship into a more positive one." This technique, which he only recommends to patients who feel they will benefit, is rooted in Kaiser's concept of a healing psychological attitude toward HIV.
"You should not be at war with HIV for the rest of your life," comments Kaiser. "If you are, you'll lose a great deal of time and energy. I think it's important to view HIV as a teacher or a catalyst, a positive stimulus for growth and change. But if HIV starts behaving aggressively, I also think its important to show it that you mean business. You'd like to be in harmony with it, but if it doesn't respond appropriately you need to show it strength."
By emphasizing stress management -- meditation, visualization, affirmation, prayer, and group support -- Kaiser helps his patients live harmoniously with HIV. (Research in the field of psychoneuroimmunology suggests that mind-body techniques can indeed buttress the immune system.) At the same time, he holds his antiviral firepower in reserve for times when the virus "behaves aggressively." Some patients never need the antiviral armamentarium. Michaeal Stokes, for one, has remained completely symptom-free for the past nine years without antiviral drugs. Michael says that he's learned to live in balance with HIV, and as a result his whole life has moved into balance, with a new profession, a solid support system, and a sense of joy in his daily activities.
Immune Power for Everyone
To what extent does Kaiser's "immune power" program apply to people with other immune-associated diseases, or those who simply want to strengthen their resistance? Kaiser also treats people with cancer, chronic fatigue, and autoimmune disorders. With certain key exceptions, the program he recommends is the same.For non-HIV patients, Kaiser says, there is no need for anti-viral drugs or antiviral botanicals such as Glycyrrhiza (licorice root). But for everyone with weakened or imbalanced immunity, Kaiser recommends "a high potency multi-vitamin, extra vitamin C, coenzyme Q10, and perhaps acidophylllus. You would take herbs in a preventive fashion. You'd make sure to get a lot of garlic, which is an antimicrobial. You would take echinacea [an established immune builder] and chamomile to calm your nerves. You would exercise regularly, and practice stress reduction continually. You would consider DHEA or other hormones when your system is depleted, though not if you are generally healthy. Finally, you would begin to view your life as a spiritual journey, in which the roadblocks gave you reasons to learn and grow."
Kaiser's believes these guidelines apply not only to people with immune-associated diseases, but also to people beset by low-level symptoms of immune impairment -- constant colds, nagging infections, chronic exhaustion. [See BOX 1, "A Checklist for the Immune Compromised.") Distilling those approaches to apply to everyone, we have identified eight key steps to immune empowerment. [See BOX 2, "Eight Steps to Immune Empowerment."]
In applying these components, an important caveat should be kept in mind. For years, we've been regaled by the media to "boost," "stimulate," or "jump start" our immune systems. Dr. Kaiser's work teaches us that in many instances, boosting immunity is exactly what's not needed.
In fact, Jon Kaiser generally avoids stimulating his HIV patients' immune systems. Why? Both immunizations and infections, to name two examples, stimulate the immune system but can be a disaster for people with AIDS. "Once the immune system is stimulated, HIV-infected macrophages divide, multiply, and activate their DNA," he explained. "They begin making even more HIV virus."
For these reasons and others, Kaiser stresses immune power and balance, not boosting. People with autoimmune diseases (e.g., rheumatoid arthritis, multiple sclerosis, and lupus) experience disabling symptoms because their immune cells mistakenly attack their own tissues. They need some parts of their immune system suppressed, not stimulated. A common misapprehension about patients with chronic fatigue syndrome (CFS) is that their immune systems are weak and need boosting. The truth is more complex: People with CFS have overstimulated immune systems that eventually begin to flag. Their symptoms are often caused by too much immune activity.
Kaiser embraces a principle reminiscent of the tonics of herbal medicine, whose actions differ in the body depending upon the energetic needs of the host. For instance, the Chinese herb astragulus is an immune enhancer, but it is also a tonic, which means it will be used by the body as needed. Most Western pharmaceuticals are designed as technologic magic bullets. By contrast, tonics subtly interact with our body's cells and substances, increasing the efficiency of our healing systems in a proportional fashion.
By this definition, mind-body-spirit practices are also tonics, increasing the strength and tone of our systems rather than mechanically "boosting" them. When used properly, psychotherapy, support groups, meditation, biofeedback yoga, or bodywork are health-promoting choices that safeguard our sense of meaning and purpose.
Jon Kaiser believes that complementary medicine will eventually triumph over HIV and disorders of the immune system. He is certain that combining the best of both worlds will ease suffering and lengthen lives. But he also argues that it will save billions of healthcare dollars by lessening the current reliance on shockingly expensive drugs and acute medical care. Toward that end, Kaiser is now pursuing funds and a research associate to compare the long-term progress of his HIV patients with those who receive standard care. He knows that a published study will provide the kind of evidence that may finally alert the barons of healthcare to the cost-effcetiveness of his approach.
In the interim, Kaiser spreads the word through his book and the free HIV Health Fairs and workshops he leads throughout the country. But the resistance to his work appears to be rooted in the fundamental philosophic difference between his approach and that of mainstream AIDS doctors. I asked him to define that difference. "Many physicians have little faith in the body's ability to heal, and that is why they promote reliance on drugs," responded Kaiser. "I have every faith in the body's ability to heal, and everything I do is designed to promote that ability."
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