A Look at Dr. Jon Kaiser's Complementary Approach to HIV/AIDS
Eight years ago, a San Francisco internist made public a breakthrough program for the reversal of heart disease. In a landmark study, Dean Ornish, MD, proved that intensive changes in lifestyle -- diet, exercise, and mind-body healing -- could literally reopen the blocked arteries of patients who had suffered heart attacks. Ornish's findings represented a stunning challenge to the prevailing medical approach to heart disease. Cardiologists would no longer have to rely exclusively upon drugs, balloons, and open-heart surgery to either burrow or bypass blockages that threaten the lives of people with heart disease.
As it happens, Ornish's arguments have yet to win the hearts of most conventional cardiologists. But he has made more significant inroads into mainstream medicine than perhaps any other practitioner of scientifically-based alternative healing. His books have occupied best-seller lists throughout the 1990s. His alternative program is the first of its kind to be covered by a major insurance company. Ornish's approach is a model for how breakthroughs in natural medicine may be integrated into the mainstream to benefit thousands of suffering patients. Yet no other leading figure in alternative medicine has made a similarly compelling contribution to the fight against a life-threatening disease.
That may soon change. Another San Francisco internist appears en route to a similar kind of breakthrough, but this time the challenge is the most vexing infectious disease of our time -- AIDS. The internist is Jon Kaiser, MD, and like Ornish he does not reject mainstream treatments. Rather, he offers a new program that radically shifts the emphasis away from drugs toward natural therapies that raise the patients' own healing capacities to heretofore unimagined levels. Dr. Kaiser's work represents not only a potential leap forward in the fight against AIDS, if offers a new approach to immune empowerment for anyone -- sick or well -- whose immune system may be vulnerable.
Dr. Kaiser's brand of AIDS medicine can only be called complementary, since he uses natural therapies -- including nutrition, supplements, herbs, natural hormones, and mind-body techniques -- in conjunction with mainstream diagnosis and treatment. But his work embodies the famous passage in the Hippocratic Oath, "first do no harm," as natural therapies take precedence over potentially toxic drugs in his therapeutic schema.
What appears to set Kaiser apart from most alternative AIDS healers is that his approach is both more systematic and nuanced. He embraces natural medicines as primary therapies, but he does use antiviral drugs, when needed, in an exquisitely judicious fashion. The payoff has also set Kaiser apart from his colleagues in AIDS medicine: data compiled from his case files reveal an astonishing degree of clinical success.
As of March, 1994, Dr. Kaiser had for seven years tracked the progress of 300 of his HIV and AIDS patients. Only 20 of them had died. And Kaiser believes that improvements in both natural and mainstream AIDS therapies are yielding even better results today. "At this point, paitents in my practice whose disease is progressing are the rare exceptions," says Kaiser. "It is clear now that many of my patients are reversing damage caused by HIV and actually rebuilding their immune systems."
Dr. Kaiser's work is gaining ground, not only because he has a following among patients in San Francisco or those who've have read his book, Immune Power (St. Martin's Press, 1993). It is also drawing attention from leading lights in complementary medicine, including Dean Ornish himself, who has personally encouraged Kaiser in the development of his clinical programs and research endeavors. "Jon Kaiser is doing important work in examining the roles of diet, nutrition, and psychosocial support in the treatment of HIV-positive patients," says Ornish.
Back from the Brink
One of those patients is Kenneth, a high-strung, 41-year old manager at a telephone company office in New England, Two years ago, Kenneth began losing weight at a frightening clip. He suspected that the cause was HIV, but did not want to dwell on the possibility and kept up his heavy work schedule. Six months and 40 pounds later, Kenneth was alone at home when he collapsed. He barely found the strength to call his family and finally confide, "I'm falling apart."
Kenneth's doctor told him the bad news: His rapid weight loss, known as "wasting," was the result of an opportunistic AIDS infection. His doctor prescribed an antiviral agent to combat the infection, as well as AZT, then the most commonly prescribed anti-HIV drug. But his doctor still pronounced his prognosis very poor. "There was no way I was expected to recover from that," recalls Kenneth. "My family and I had my plot picked out."
The drugs did not stop Kenneth's decline. He was losing hope as precipitously as he continued to lose weight. The first glimmer of optimism came when his pharmacist mentioned the name Jon Kaiser, describing him as a San Francisco doctor who combined mainstream and alternative therapies. Kenneth called Kaiser and made an appointment for a month later. By the time of his appointment, 70 pounds had been shed from Kenneth's 6-foot frame. He barely made it from the airport to Kaiser's clinic.
Kaiser well remembers Kenneth's first visit. "When I first saw him he weighed 150 pounds, had almost no T-cells, was suffering with CMV (cytomegalovirus) related colitis, chronic diarrhea, and wasting. The doctors had given him months to live and he was, as you might imagine, very depressed. One of the first things I did was say, 'Forget about what your doctor has said. Concentrate on the belief that you are going to turn this thing around. You're going to fight your way back and live several years, if not much longer.' "
Kaiser's words not only revived Kenneth's spirits, they were the necessary spur for him to make radical changes. With Kaiser's guidance, he went on a diet of natural foods that included a high intake of protein, vegetables, and grains. Dairy foods, processed foods, and excess oils were scratched from his menu. He began a regimen of vitamin/mineral supplements as well as Western and Chinese herbs for cleansing the bowels and buttressing the immune system. Regular exercise and relaxation techniques became part of his daily routine. Kaiser prescribed hormones such as DHEA and testosterone shots in order to rebuild his muscle mass, improve his immune function, and raise his energy levels. He also prescribed medicines to prevent pneumonia and added modest doses of another antiviral, DDI, to his pharmeceutical regimen.
Kenneth's emotional state was buoyed by Kaiser's no-holds-barred approach. He managed to stick with his demanding regimen, including 100 pills a day and vigilant attention to safeguarding his health and well-being. One month later, he noticed the first clear-cut improvement: his diarrhea was gone. Soon, the scale showed more such evidence as poundage gradually returned. Every month, he consulted by phone with Dr. Kaiser, who for Kenneth was part physician, part holistic guide, and part sideline coach in a spirited fight with the HIV virus. "He was always completely honest with me, encouraging me in strong terms to move back to healthy behavior," says Kenneth. "He's been like a Guardian Angel."
Today, two years later, Kenneth's T-helper cell count has risen from the single digits to near 200. (Normal counts range between 1000 and 1500, though HIV patients with T-helpers over 200 often remain healthy.) His weight is up from 150 to well over 200 -- normal for him. His opportunistic infection and diarrhea have vanished. Against all odds, Kenneth currently has no remaining symptoms of HIV or AIDS.
Kaiser's Program: The Best of All Worlds
Kenneth's story is no isolated anecdote. According to Kaiser, about three-quarters of his patients are continuously symptom-free. Their T-cell counts -- a key index of health for HIV patients -- have either remained stable or increased. And, based on his own careful observations, his patients with full-blown AIDS live longer, are hospitalized less frequently, and have fewer chronic symptoms than similar patients who rely only on conventional medicine. In Immune Power, something of an underground hit, Dr. Kaiser included a comparison of survival rates among his own patients with full-blown AIDS and those who received standard treatments of the late 1980s and early 1990s. After 27 months, 80% of Kaiser's patients had survived, compared to only 50% on conventional medicine, as reported by the Centers for Disease Control.
In the past few years, medical treatments for AIDS and HIV-positive patients have unquestionably improved. But Kaiser still appears to be getting significantly better results than those achieved with today's medical programs. The key is his deft combination of treatments that buttress the body and battle the virus. "When you try to promote healing from life-threatening conditions," said Dr. Kaiser recently, "you can't limit your options. You have to use an integrative mix of natural and standard therapies, and to approach your illness from a spiritual point-of-view."
So powerful is Kaiser's "mix" that he is able to use surprisingly low doses of antiviral drugs, when he uses them at all. The trick has been to administer low doses of such drugs as AZT, 3TC, and protease inhibitors alongside an immune empowerment program that includes dietary change, nutrient supplements, herbs, exercise, and psychospiritual development.
Several years ago, as word spread about Kaiser's results, his caseload became so unwieldy that he decided to join forces with a Dr. Marcus Conant, a specialist with one of the largest AIDS practices in San Francisco. In a unique comingling of mainstream and alternative medicine, Kaiser now heads the Wellness Center within the Conant Medical Group. At the Center, he oversees the natural therapies with the help of an appropriately diversified staff of acupuncturists, bodyworkers, a nutritionist, and a physician assistant, among others.
As with Kenneth, Kaiser treats his patients with precise attention to their individual needs, making decisions based not only on test results, but also on their unique stressors, lifestyle habits, medical history, and support systems. This enables him to knit together a program tailored for each patient, but one that generally includes these elements:
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."
This article was provided by Penguin Books USA, Inc..