Using the Neural Protocol


Much recent research has documented specific biochemical changes in patients who have hypersensitivity to chemicals, often causing respiratory and other symptoms. The biochemical process that causes this is a vicious cycle occurring in the brain known as neural sensitization. Basically, there is increased nitric oxide production by various mechanisms. This excess nitric oxide then produces increased peroxynitrite, a very tissue-damaging free radical. Peroxynitrite leads to tissue damage and the formation of other free radicals in many tissues of the body, including increased inflammation in the respiratory tract, gastrointestinal and genital urinary tract, lining of blood vessels, conjunctiva and skin.


Excess peroxynitrite is then converted into even more nitric oxide, unless the body has adequate substances to reduce peroxynitrite and substances to prevent this conversion to even more nitric oxide. The body uses an enzyme called SOD (super oxide dismutase) to prevent excess peroxynitrite from forming even more excess nitric oxide. SOD requires adequate amounts of the minerals zinc, copper and manganese.


This vicious cycle summarized above is described in more detail with scientific references, documenting that the cycle exists and the effectiveness of substances to control it. With this knowledge, there is a scientific basis for a neural protocol to dramatically reduce these body exacerbations from low dose chemical exposures.


Because there is no barrier ("blood brain barrier") between the nose and the brain, substances breathed in the nose can readily enter the brain as well as the lungs and the rest of the body. The neural protocol is designed to correct/treat this vicious biochemical cycle at its source. Left untreated, these changes lead to increased respiratory inflammation, with symptoms such as nasal congestion, sinus congestion and pain, hoarseness, coughing, chest tightness etc. These symptoms in response to low levels of chemical irritants are called reactive airway disease. It is a form of neurogenic inflammation caused by the biochemical cycle above.


Unfortunately, neurogenic inflammation also affects the gastrointestinal tract, leading to increased permeability to larger food particles and the development of food intolerance. Symptoms resembling acid reflux also occur, and are not due to increased acid but rather increased inflammation. Increased genital urinary inflammation can cause pain in the genital area. When there is pain on passing urine, infection should be ruled out.


Increased inflammation of blood vessel linings also occurs. This makes it harder to supply oxygen to vital organs such as the brain, heart etc. It also reduces blood flow to other organs, including but not limited to the skin, fingers and toes. Increased inflammation of the conjunctiva by this mechanism leads to a sense of "burning" in the eyes. Increased inflammation of the skin can also lead to symptoms of "burning", rashes etc.


Because the above-described inflammation involves so many body areas, affected persons often feel achy and fatigued. These are symptoms that accompany excess inflammation. This excess inflammation often lowers/depletes the body proteins and minerals, impairs immunity (reduced secretory IgA), adrenal disturbances, hormonal disturbances, and many other changes. These changes have been discussed in more detail in my papers of August 2001 and October 2003. I feel that a major factor producing those body changes is neural sensitization from chemical injury. It has been my experience with patients that the neural protocol used over time results in a dramatic reduction of this inflammation and thus a major reduction both in reactivity to chemicals as well as greatly reduced aching, fatigue and other body changes significantly caused by the inflammation of neural sensitization.


Using the Neural Protocol

The neural protocol includes glutathione by nebulizer, hydroxycobalamin and substances that can be taken by mouth.

A. Using Nebulized Glutathione

The more severe the inflammation, the more diluted the glutathione needs to be at the beginning. About half of patients with significant hypersensitivity/ reactive airway disease (and/or migraines) can begin with glutathione at 60 mg per milliliter. A milliliter is the same as a cubic centimeter. More severely affected patients will need to dilute the glutathione with normal saline. First try the nebulizer with only normal saline. This will tell you if the tubing and nebulizer are okay. If you experience difficulty, you may need tubing with less chemical off gassing. This can be obtained from various sources, including but not limited to Living Source (254-776-4878), Key Pharmacy (800-878-1322) and other sources. If you are extremely sensitive, you can begin the glutathione as low as one drop in a milliliter of normal saline. If you have no irritation, work the concentration up as tolerated. If you reach a concentration that increases the irritation, that concentration is too much for your stage of healing. Dilute it further and work up more gradually. Remember that some is better than none.


After you are easily able to utilize 60 mg per milliliter and have been on this concentration for months, you can gradually further increase the concentration. As you do this, if you are using the rest of the protocol, you will note that your chemical reactions are declining, and your aching should decrease, energy increase, and other symptoms get better.


See Section B for adding hydroxycobalamine to your nebulizer.


You can also use the same concentration of glutathione you are using for nebulizer in a nasal spray bottle that you can use at the time of exposure and/or with reactions. This helps the glutathione enter the brain more rapidly, where it is more quickly available to reduce the biochemical disturbance called neural sensitization. For eye burning, this concentration can be used as an eye drop: take from the nebulizer bottle, not the nasal spray container.


The Sinus Technique: If you have sinus pain (over eyebrows, behind eyes and/or upper cheeks) you can try the following to get more glutathione to enter the sinuses:


* Breath in with your left hand pinching the nostrils (nose openings) closed.


* Hold your breath a few seconds. The glutathione will now shoot out into the room. To prevent this, put your right hand over the area of leakage to stop flow into the room. You will feel pressure build up, puffing your cheeks out, and glutathione will be pushed up into the sinuses.


* Breathe out through your nose. This can also be used for people with earaches with exposure but breathe out when you feel ear pressure from glutathione.


* This technique will cover ALL the respiratory tract: nose, sinuses, throat, larynx, bronchi and lungs.


B. Hydroxycobalamin

Hydroxycobalamin is the form of cobalamin (vitamin B12) which is effective as a scavenger for nitric oxide, the substance that acts to start the vicious cycle of neural sensitization. This can be used as needed for reactions as well as building body levels up to adequate. As long as reactions are occurring, body levels in the brain are not adequate.


Nebulizer Use Fastest, Best:

* Add to glutathione just prior to nebulizing (most rapid and effective). Do not store mixed with glutathione. Compound it up to 5 mg hydroxycobalamine daily.

* Portable for reactions - nasal spray.

* Sublingual

* By injection.

With nebulizer use, first add glutathione concentration known to be tolerated. Then add hydroxycobalamine liquid, mix well, nebulize.


Nebulizer Selection:


The AeronebGo is a hard (polycarbonate) minimal off gassing nebulizer. It has no detectable sound or vibration, is small, comes with small battery pack for travel if desired, and delivers a higher percent of the substance. Contact http://www.evomedical.com/ or Key Pharmacy 800-878-1322 http://keynutritionrx.com/. for low cost price.


Hydroxycobalamine is not well absorbed when taken by mouth through the stomach.


If you have reactions, you may wish to try nasal hydroxycobalamin at the time of exposure or with beginning of increased symptoms from a reaction/ exposure. Many individuals can use 500 micrograms per spray, with one spray in each nostril at the beginning of exposure/reaction and then repeating about every 15 minutes until symptoms clear. You may wish to blow your nose first to allow better absorption. Using the nasal spray allows the substance to go directly to the brain where the vicious biochemical cycle is occurring. For some persons, this concentration is too high. If you have any increased symptoms at this level, dilute the nasal spray. The nasal hydroxycobalamin may also be used several times daily or more if this helps reduce symptoms.


If using self-injection (needle/syringe) it is important that you receive proper instruction technique. After instruction you should be observed by a qualified nurse or medical provider who watches you perform all the steps correctly at least twice in a row (two sequential injections). When your health care provider feels confident that you are able to do proper self injections, he or she can provide you with the proper prescription. Lower gauge needles have minimal discomfort: 22 gauge. Another needle may be helpful for withdrawing the hydroxycobalamin from the container. A 20-22 gauge is often used for this. To sterilize the container of hydroxycobalamin and your skin, many patients tolerate Zephirin wipes better then isopropanol. A container for needles and syringes for proper disposal is important and should be used by persons using injection technique.


To determine if you are deficient or low, testing through SpectraCell Laboratory? is helpful.


Hydroxycobalamin is a remarkably nontoxic substance. Levels of a thousand times higher than used in the neural protocol are used to treat cyanide poisoning. As long as you have chemical reactions with symptoms of the respiratory tract, it is likely that you need more hydroxycobalamin than the level currently in your body.



C. Substances By Mouth

These are best taken with a meal with food in the stomach.


1. Ascorbic acid is best used in a buffered form. To test whether your body level is adequate, you can use Perque C strips (800-806-8671). Simply dip the blue strip in your urine, collected in a cup or other container. If the strip turns white, you have adequate body protection with vitamin C.


2. Vitamin E should be taken in the form of natural mixed tocopherols. It is the gamma tocopherol that is most effective against peroxynitrite. Persons with high sensitivity/inflammation often need 200 I.U. daily gamma tocopherol. Alpha tocopherol alone can lower gamma levels and dl is synthetic and not effective.


3. Selenium is helpful to maintain glutathione in its active form. Your body level of selenium will depend in part on your diet and where you live. If your soil where your food is grown is selenium deficient, you are more likely to be selenium deficient: 200 micrograms daily is often needed.


4. Coenzyme Q10 is an antioxidant for your energy metabolism. Many chemically injured patients have difficulty digesting fat. Since Coenzyme Q10 is a fat-soluble substance, a form that is broken down into very small particles known as "micellized" can provide better absorption.


5. Alpha lipoic acid is a very vital substance: it reactivates glutathione in all body tissues. However, if you have intestinal inflammation, it can be irritating at first (not compounded together with rest of oral Rx). It is often best to begin it separately at 100 mg. Always take it on a full stomach. If you have irritation, reduce the dose to below the irritation level, even if this requires less than 100 mg. Remember: some is better than none. As your inflammation improves you will gradually be able to work up to full dose of 600 mg daily, divided into two or more doses with meals.


6. The enzyme mentioned in the introduction, superoxide dismutase or SOD requires zinc, copper and manganese. These are often absorbed and transported better to cells in patients with significant chemical injury when taken as the picolinate form, for example zinc picolinate. Persons who are very deficient in one or more of these minerals may need higher levels. Be careful about overdosing without testing. Intracellular levels of these minerals can be measured by Metametrix Laboratory (800 221-4620), http://www.metametrix.com/, or Great Smokies Diagnostic Laboratory (GSDL: 800-522-4762). Great Smokies takes Medicare; for other insurers/uninsured, prepayment is much cheaper). Zinc can also be measured by SpectraCell Laboratory (800-227-5227) http://www.spectracell.com/.


7. Magnesium is very important to reduce neural sensitization. Magnesium is often deficient in patients with chemical injury. Symptoms of magnesium deficiency include muscle twitching and muscle cramping, although deficiency can be present without these symptoms. Magnesium deficiency can be tested as intracellular levels through Metametrix Laboratory or Great Smokies Laboratory, or by SpectraCell Laboratory http://www.spectracell.com/ for functional adequacy.


8. Trimethylglycine, also known as betaine, is able to donate methyl groups, important in the neural protocol.


9. Folic acid is also an important substance in the neural protocol. This can be taken in the form of folic acid. Some people cannot convert folic acid to its bioactive form. Others do not convert folic acid efficiently. The bioactive form is 5-methyl tetrahydrofolate. Folic acid should be tested through SpectraCell Laboratory.


10. Riboflavin-5 phosphate, the bioactive form of B2, is essential for reactivating antioxidant, glutathione.


11. There are a number of bioflavonoids that are important in reducing the damage of peroxynitrite. These include ginkgo biloba, silimarin, bilberry, cranberry, and carotenoids like lycopene, beta carotene, lutein, etc. The phosphonylated of silimarin (siliphos) may better repair liver tissue: the liver is a major site of detoxification.


When possible, it is ideal to take the above substances twice daily with meals - food in stomach. This helps to continually interrupt the vicious cycle of neural sensitization.


It is important to remember in lab test interpretation that the lab "normal" levels are based on comparison with the "junk food eating" American public. It is recommended for healing chemical injury that the patient values be brought well above average, i.e., ample, although they need not exceed the upper range of "normal".





Environmental controls to reduce irritants and toxins are the single most important measure in healing neural sensitization and other chemical injury. More information can be obtained about less toxic pest control from Beyond Pesticides (202-543-5450, http://www.beyondpesticides.org/ ) or The Northwest Coalition Against Pesticides (541-344-5044). A good reference for less toxic consumer products is the book Less Toxic Alternatives by Carolyn Gorman (214-361-9515), an experienced health educator. Dr. Ziem has also written a document called The Environmental Control Plan, which can be used together with the above information sources.


Food is another source of pesticide residue and other toxic chemical food additives. Food grown more naturally, without petrochemical or other toxic pesticides (sometimes called "organic") is another way to reduce your body levels of toxic substances.


Chemical exposure increases the risk of developing many medical conditions. In addition to reactive airway disease and toxic encephalopathy, these include migraines, many autoimmune diseases, neurodegenerative diseases, cancer of the brain and lymph system, and leukemia. Conditions which are caused or exacerbated by chemicals include sinus problems, ear inflammation especially in children, allergies, bronchitis and many chronic illnesses. Cardiovascular disease diabetes, adult arthritis, "irritable bowel", and "irritable bladder" are now known to be diseases of chronic inflammation. Chronic inflammation also leads to chronic fatigue, aching, adrenal and other endocrine changes. The free radicals release damage lipid membranes in all body cells, ribosomes (which make protein), mitochondria (which generate energy that is needed for ALL body functions), and genetic DNA. Myelin is a vital lipid coating nerve cells in the brain and body and is damaged by free radicals. Those other changes can be tested for and treated, and are described in more detail in Dr. Ziem's August 2001 paper "Medical Evaluation and Treatment of Patients with Chemical Injury and Sensitivity", Dr. Ziem's October 2003 paper "Endocrine Changes in Patients with Chronic Illness Following Chemical Overexposure" (Chemical Injury Information Network 406-547-2455, http://www.ciin.org/ ) and this website.


F ollow the links below to learn more about RMEHA and Environmental Illness.

Revised '8-Sep-2008,12:38:58'