Professor Pall's book, which provides detailed information on his disease theory that he has been talking and writing about for several years, covers his proposed explanation for the internal mechanisms of many multisystem illnesses - chronic fatigue syndrome (CFS), multiple chemical sensitivity (MCS), fibromyalgia (FM), post traumatic stress disorder (PTSD), and Gulf War syndrome (GWS). He says the mechanism common to these illnesses, and many others, is a vicious cycle of internal neural injury that releases nitric oxide that is poorly detoxified by the body. That in turn causes another toxic oxidation product, peroxynitrite, to build up.
Each chapter starts with a one- or two-paragraph "Take Home Lessons" overview of what the chapter will cover.
The first chapter gives an overview of the NO/ONOO (nitric oxide/peroxynitrite) cycle and its possible application to all these illnesses. Another chapter offers an extensive presentation of the biochemical pathways involved, and their properties. He goes on to explain how the NO/ONOO cycle can generate the symptoms that are seen by people with these multisystem illnesses, and discusses the ramifications of this model for potential refinements in medical nomenclature. The model also suggests therapies that may relieve the NO/ONOO cycle.
Separate chapters cover CFS, MCS, FM, PTSD, and GWS in detail, and discuss how the NO/ONOO cycle applies to them.
The chapter on MCS is lengthy, since this condition has some of the most puzzling symptoms. Pall discusses several features of MCS that have been known for a long time, but whose mechanisms has remained puzzling (e.g., far higher sensitivity than the general population, and large variations among individuals in symptoms) and discusses aspects of the NO/ONOO cycle that appear to explain them.
The book devotes a chapter to various stressors - which are substances expected to aggravate the NO/ONOO cycle - and their possible treatments, along with a few social implications. The common stressors - such as pesticides, petrochemical-based fragrances, and building chemicals - are discussed in some detail.
Therapies covered in detail include either avoiding exacerbation of the NO/ONOO cycle, or diminishing it, both of which are familiar approaches to those with MCS.
He discusses antioxidant therapies in detail, addressing both the limitations of current practice, and implications for comprehensive therapies. Among the familiar antioxidants discussed are vitamin C, CoenzymeQ10 (or ubiquinol), selenium, various carotenoids, various flavonoids, carnitine, acetyl carnitine, hydroxocobalamin (vitamin B12), folic acid, pyridoxine (vitamin B6), glutathione, alpha-lipoic acid, magnesium, and several other minerals.
Pall says one important stressor of the NO/ONOO cycle is thimerosal, the mercury-containing preservative that used to be present in many vaccines. Critics of the Centers for Disease Control and Prevention (CDC), such as Robert F. Kennedy Jr., author of the lengthy 2005 article "Deadly Immunity," have said that the agency accepted as long ago as 2000 that thimerosal causes serious health problems such as autism.
The agency still doesn't publicly acknowledge that connection, but it appears that the extensive criticism of thimerosal in vaccines has led to the elimination of this material in many vaccines, according to the Institute for Vaccine Safety, an organization affiliated with the Johns Hopkins Bloomberg School of Public Health (http://www.vaccinesafety.edu/thi-table.htm). However, some vaccines, such as many of those for influenza and tetanus, still contain thimerosal. And some of the vaccines that don't are likely to be more expensive, and may have to be specially ordered.
Pall mentions several environmental medicine physicians around the country who are using variations of therapies suggested by his theory, and discusses their protocols, and how their treatments fit with the NO/ONOO cycle. Dr. Grace Ziem is included. An older version of her protocol is on the RMEHA website (http://bcn.boulder.co.us/health/rmeha/rmehzdoc.htm). Contact her for an update. In general, these physicians report seeing significant improvements in their patients. However, a number of patients have reported significant problems with tolerating at least portions of the prescribed therapies.
One chapter goes into considerable discussion about "What about those who say it's all in your head?" Summaries from several psychiatric specialists are cited, and their shortcomings are discussed in detail. The chapter ends up with the question: "What is the future of psychogenesis for multisystem illnesses?" The author's answer: "I believe there is none."
Pall also discusses the implications and possible applications of the NO/ONOO cycle for other health conditions, such as Alzheimer's disease, amyotrophic lateral sclerosis, autism, chronic whiplash associated disorder, multiple sclerosis, overtraining syndrome, Parkinson's disease, postherpetic syndrome, postradiation syndrome, silicone implant associated syndrome, Sudek's atrophy, and tinnitus.
This book, though not always written in a rigorous way, gives a detailed framework to support people with multisystem illnesses, and hopefully will encourage development of further medical support for these people. It should be on the bookshelf of everyone with a multisystem illness.