developed by Martin Pall, PhD

Treatment protocol for patients with chronic fatigue, fibromyalgia, chemical injury—especially when accompanied by upper/lower reactive airways—and post-traumatic stress disorder (PTSD) based on a cycle of elevated nitric oxide (NO) and other elements that occurs from various traumas or stress events (physical and/or emotional).

Summary of Neural Protocol:
Glutathione By Nebulizer, Hydroxycobalamine, and a potent mix of vitamins, minerals and antioxidants including Vitamins C and E, Selenium, Coenzyme Q-10, Alpha lipoic acid, Zinc, Copper, Manganese, Magnesium, Betaine (methyl donor), folic acid, Ginkgo biloba extract, Silymarin (milk thistle extract), Bilberry extract, Cranberry extract, and a mix of Carotenoids.

Dr. Grace Ziem currently recommends two years of full neural protocol or until no longer reactive. Then maintenance antioxidants are needed lifelong. With more environmental controls, less will be needed: with poor environmental controls, the protocol alone cannot correct the problem.

Below is a more detailed summary of the protocol.

A New Theory of Causation of Chronic Illness
by Mary Woodard, MS, LCSP

Dr. Martin Pall, PhD of the Molecular Biosciences department at Washington State University has proposed a new comprehensive theory to explain the cause and ongoing effects of the chronic health problems of CFS, MCS, FM and PSTD (Post Traumatic Stress Disorder).

His work is explained in numerous articles on his website. He has written also written a book about this theory titled: Explaining “Unexplained Illnesses”.

For each condition there is an initiating event causing extreme stress to the body—a chemical exposure, a viral or bacterial infection, a traumatic physical accident or stress, an emotional stress, or any combination of these. The initiating stress event causes chemical changes in the body via the formation of nitric oxide, which through a process of ongoing oxidative stress creates a vicious cycle involving elevated levels of nitric oxide, peroxynitrite, NMDA and other factors of the cycle, which in turn creates havoc in the various systems of the body. Dr Pall calls the cycle the NO/ONOO cycle which mimics the human response to the cycle “No!, Oh no!”

Dr Pall studied the treatment protocols of five well known physicians working with these chronic conditions, analyzing the effects of each agent in terms of the NO/ONOO cycle, in down-regulating the cycle, reducing the elevated levels of elements of the cycle, or of scavenging the elements in the cycle. He worked most closely with Dr. Grace Ziem who has been using many agents of the protocol since 2004 with notable success. He feels that no one supplemental agent makes a large difference and that to use a variety of agents is most effective.

Dr. Ziem emphasizes the need for continued environmental controls to reduce chemical exposures. In light of Dr Pall’s theory, this could be broadened to include the need to avoid any and all stressors.

The protocol described below—which is a collaboration with Dr. Ziem—is described in Dr. Pall’s book and numerous articles he has written. Emphasis is on antioxidants to down-regulate the NO/ONOO cycle and scavengers of the elements of the cycle. Comments are mine based on Dr. Pall’s comments and other sources.

• Nebulized, inhaled reduced glutathione
  A major scavenger, is short lived in the body, is produced in the body by 3 precursor amino acids: 1) cysteine (or N-acetyl cysteine); 2) glutamic acid (or glutamine); 3) glycine (DMG or betaine HCl)

• Nebulized, inhaled hydroxocobalamin (or shots or sublingual vit B12)
  A major NO scavenger

• Mixed natural tocopherols, including gamma tocopherol
  Antioxidant, gamma especially is a scavenger of oxidation products

• Buffered vitamin C
  Antioxidant, boosts immune function, chelator

• Magnesium
  Lowers NMDA acivity, is always deficient with liver stress, reduces pain

• Four different flavonoid sources: gingko biloba, cranberry extract, silymarin, bilberry (blueberry)
  Flavonoids are antioxidants, immune enhancing, anti-inflammatory. Others have used citrus bioflavanoids, blue green algae, noni, grapeseed extract, olive leaf extract.

• Selenium
  Antioxidant, enhances vitamin E activity, scavenges peroxynitrite

• Coenzyme Q10
  Antioxidant, chelator, scavenges peroxynitrite

• Folic acid
  Reduces nitric oxide

• Vitamin B6 (as pyridoxyl phosphate)
  Reduces excitotoxicity

• Riboflavin 5′-phosphate (FMN)
  Needed to regenerate reduced glutathione

• Carotenoids including lycopene, lutein and beta carotene
  Scavenge peroxynitrite

• Alpha Lipoic acid
  Antioxidant, regenerates reduced glutathione

• Zinc (modest dose) and Manganese (low dose)
  Detox copper, levels elevate with stress

• Betaine (trimethylglycine)
  Precursor to glutathione, reduces excitotoxicity and NMDA

• Taurine
  Antioxidant amino acid, lowers excitotoxicity and NMDA

Nutricology carries a line of Dr. Pall’s supplements to assist in the downregulation of the NO/ONOO cycle, no Rx required:

CoQ-Gamma E with Tocotrienols & Carotenoids 60 softgels #55930
A unique formulation containing high levels of coenzyme Q10, carotenoids, gamma-tocopherol, and gamma-tocotrienol as part of an antioxidant protocol. $51.50

FlaviNOx™ 90 capsules #55780
A state-of-the-art combination of herbal extracts with standardized bioflavonoids, providing broad spectrum antioxidant protection. $36.25

MVM-A Antioxidant Protocol 180 capsules #55940
Multiple vitamin and mineral formula with additional nutrients featuring acetyl-L-carnitine for antioxidant support. Developed by Martin Pall, Ph.D. and NutriCology. $24.95

NAC Enhanced Antioxidant Formula 90 tablets #55960
Enhanced antioxidant formula containing amino acids, nucleic acid, and lipoic acid that acts as a powerful antioxidant and supports glutathione production. Developed by Martin Pall, Ph.D. and NutriCology. $21.95

Super EPA Fish Oil Concentrate 60 Softgels #51250
Eicosapentaenoic acid (EPA) is a rich source of long-chain omega-3 fatty acids and is present in high quantities in cold water fish. Oils prepared from such fish as cod, mackerel, salmon, and shark are also rich in docosahexaenoic acid (DHA), an omega-3 fatty acid. Both of these fatty acids are important for maintaining the fluidity and function of cell membranes, particularly in the retina and the brain. Super EPA is prepared from molecularly distilled fish oils. Each batch is tested to insure purity and the absence of heavy metals and other contaminants. $20.00

Alternately, you can order a compounded capsule from Key Pharmacy (800.878.1322) in Washington State but they do require an Rx. You can order a nebulizer and both the liquid glutathione and B-12 from them as well.

source(s): The Tenth Paradigm (Martin Pall PhD’s website), Rocky Mountain Environmental Health Association, ChemicalInjury.net (Dr. Grace Ziem’s website), Pall Protocol on About.com, Mary Woodard, MS, LCSP of Topaz Wellness Center