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The Marshall Protocol for Treating Chronic Fatigue Syndrome and Fibromyalgia: Hopeful Results Emerging

November 22, 2006

Note: A number of patients with CFS, FM, and other chronic illnesses such as lupus and Lyme disease are reporting success with the experimental Marshall Protocol, originally developed for relieving the symptoms of patients with the "Th1" inflammatory disease sarcoidosis. (See the Marshall Protocol message board at http://www.marshallprotocol.com, and "A Journey Towards Complete Recovery from Chronic Fatigue Syndrome" at http://www.immunesupport.com/library/showarticle.cfm/id/6569

Following is an exclusive interview conducted in July 2004 with Trevor Marshall, PhD, who devised the highly demanding and still-controversial protocol, which must be administered under the care of a physician. He explains why he believes it may work for certain CFS and FM patients, and others. (See disclaimer at end of article.)

Question: Please introduce yourself by giving some background on your medical training and practice.

Trevor Marshall, PhD: I graduated Bachelor of Engineering (w/w statistics) from the University of Adelaide in 1974. I spent a year in Papua New Guinea teaching at the University of Technology in Lae, and then spent 6 years teaching at Curtin University in Western Australia. During that tenure I received my Masters Degree and commenced my PhD Research at the University of Western Australia, in Biomedical Engineering. It was an exciting time. Another UWA student, Dr. Barry Marshall (no relation) had just discovered that the bacterium Helicobacter Pylori was the cause of stomach ulcers, and the teaching hospital where we did our clinical research ("Sir Charles Gairdner") was full of "new ideas." My mentors were convinced that we needed to develop a totally different approach to medicine.

I researched Infertility and Cryptochidism with Ted Keough and Diabetes in Tim Welborn's group. Ted found a way to treat infertility by pulsatile infusion of a hormone called GnRH, and resolved Cryptorchidism without surgery, using pulsatile infusions of the hormone LHRH. Tim's group explored the continuous infusion of insulin in Diabetes.

After moving to the USA in 1982 I took some time off to study with Mike Albisser's group at the Hospital for Sick Children in Toronto. "Sick Kids" was a world leader in diabetes research at the time, and our research team included MDs and PhDs from all over the world. It was an amazing experience, and my doctoral thesis, "Mathematical Modeling of the Insulin Glucose Homeostasis in Healthy and Diabetic Individuals", was accepted in 1985.

Soon after that, I came to the realization that sunlight was a factor in immune disease, but it took many years for all the elements of the Th1 immune reaction to gel together in my mind. Late in 1999 I noticed that a new class of drugs, "Angiotensin Receptor Blockers' (ARBs), were affecting the psyche of Sarcoidosis patients. Since I knew that ARBs should not have any such effect I commenced a full-time sabbatical in early 2001 to try and figure out exactly what was happening. The result of that research was a pathogenesis for sarcoidosis, published in 2002. Since then we have conducted an Internet-based study of ARB and antibiotic therapy in sarcoidosis, and are now exploring how our success can be generalized to all the Th1 immune diseases. The Autoimmunity Research Foundation is acting as a focus for our current efforts (http://autoimmunityresearch.org).

Question: A number of patients with Chronic Fatigue Syndrome (CFS), Fibromyalgia (FM), and other chronic illnesses report they're finding success following your sarcoidosis treatment protocol. Could you explain what CFS, FM, and sarcoidosis patients might have in common that could explain this?

Trevor Marshall, PhD: Sarcoidosis is a Th1 inflammatory disease which can damage the lungs, heart, eyes, brain, liver, kidneys and soul. Patients are still being told it has no known cause and no known cure.

Tiny "pleomorphic" bacteria have been photographed living within the cells of the immune system of sarcoidosis patients. Emil and Barbara Wirostko produced stunning electron microscope photographs of immune phagocytes each containing hundreds of tiny bacterial forms, around 0.01 to 0.025 microns in diameter, living in colonies within the very cells (phagocytes) which are supposed to kill these bacterial parasites. One of the Wirostko photographs can be found at http://www.autoimmunityresearch.org/wirostko-fig3.jpg It is important to understand that these bacteria are "coccoid" (round, and very, very small), 10 to 100 times smaller than the shapes these same pleomorphic bacteria will take when they enter the bloodstream.

We found that you can measure a hormone (in the blood) resulting from the Th1 inflammation produced by these tiny bacteria, and that it is elevated in Sarcoidosis patients. It is also often elevated in CFS patients, indicating that the inflammation of CFS is often very similar to that of Sarcoidosis.

Question: Some researchers (including Garth Nicolson, PhD at The Institute for Molecular Medicine in Huntington Beach, California) and physicians believe that multiple co-infections including bacterial and mycoplasmal infections, play a key role in the onset and pathology of CFS and FM. To what extent are bacterial and mycoplasmal infections involved in sarcoidosis, and do you believe your methods for treating those infections in sarcoidosis apply to CFS and FM patients?

Trevor Marshall, PhD: Multiple co-infections of antibiotic-resistant bacteria can act in unison because many of the species have evolved a similar technique for evading the immune system.

These bacteria live in the cytoplasm of phagocyte cells, and directly stimulate a protein called NuclearFactor-kappaB to cause the continuous release of inflammatory chemicals, a Th1 cytokine cascade. This is the source of the inflammation driving the CFS symptoms.

Where our work diverges from that of Dr. Nicolson is the manner in which we control the hormones Angiotensin II and 1,25-dihydroxyvitamin-D so as to weaken the defense mechanism of these tiny bacteria, and allow the immune system itself to start to recognize and kill them. We then use common (oral) antibiotics, at a very low dosage, to help the immune system deal with the parasites. It is the immune system which kills these tiny resistant microbes, helped along by low-dose antibiotics.

Question: What is your treatment protocol for bacterial and mycoplasmal infections?

Trevor Marshall, PhD: Our treatment protocol is split into two phases. The first phase lasts for about three months and is focused on getting the bacterial load down to a point where the endotoxins are no longer life-threatening. Then, in phase 2, we use additional (low-dose) antibiotics, making it almost impossible for the resistant bacteria to evade the immune system.

Phase 1 is available online at http://SarcInfo.com/phase1.pdf

We focus on blocking genetic protein transcription, the process whereby the tiny bacteria use the bacterial 30S and 50S Ribosomal Nucleic Acid subunits to produce the proteins they need to hide from the immune system. In phase 2 we block multiple pathways for 50S RNA synthesis, which allows the immune system to recognize (and kill) even the strains which have evolved a resistance to standard antibiotics.

Question: How do you go about improving immune function in your patients, what is your protocol for that objective which could cross over from sarcoidosis to CFS and FM patients?

Trevor Marshall, PhD: The two hormones critical to this inflammatory process are Angiotensin II and the seco-steroid 1,25-dihydroxyvitamin-D.

Blockade of Angiotensin II weakens these bacteria to the point where they can be more easily killed, and reducing the 1,25-D makes it harder for the bacteria to slip in and out of the cells they have infected.

We use the Angiotensin Receptor Blocker "Olmesartan Medoxomil" (Benicar/Olmetec/Votum), dosed approximately every 6 hours, to blockade the Angiotensin II receptors in the inflamed tissue.

The seco-steroid 1,25-D is the active hormone resulting from sunlight on our skin, and the Vitamin D we ingest. Both these sources of 1,25-D have to be attenuated if these bacteria are to be killed.

Question: Are you currently treating any patients with CFS and/or FM, or have you in the past? If so, what is your strategy for treating these patients?

Trevor Marshall, PhD: I am a researcher with a PhD, not an MD, and I cannot treat patients directly. I help their physicians understand the disease process, so that those physicians can work with the patients to cure the disease. We are also working with several LLMDs (Lyme literate Medical Doctors).

I, and my colleagues, have published a number of papers describing all the elements of our discoveries, and, during 2002, we set up a clinical trial at the Internet site http://www.SarcInfo.com so that we could track the progress of the first patients using our protocol.

Also [a message board was created] called "MarshallProtocol" (http://www.marshallprotocol.com), and CFS and FM patients have used the information from that site to work with their physicians to implement the protocol... It seems the protocol is working just as well for these CFS and FM sufferers as it did for the sarcoidosis patients, most of whom have progressed to "cure" over the last two years.

Question: In one of your recent research articles, you discuss "Lessons from Lyme Disease." Many chronic Lyme patients experience symptoms very similar to CFS and FM, and in fact, it is not unusual for someone with Lyme disease to be mis-diagnosed with CFS or FM. Could you discuss this issue, and talk a bit about how you diagnose and treat patients with Lyme and other spirochetal diseases?

Trevor Marshall, PhD: Whether the inflammation (which gives rise to the CFS and/or FM symptoms) is caused by Borrelia, Bartonella, Chlamydia, or any other bacterium with the ability to change into these tiny pleomorphic shapes (also called "L-forms," "Cell Wall Deficient," "Cystic," "Mycoplasma"), the inflammation needs to be treated the same way. The microbes seem to be resistant to standard antibiotics, even IV antibiotics, and have to be killed by our immune system itself. We have defined what is necessary to achieve that.

Diagnosis can often be done from bloodwork assay. If the level of 1,25-dihydroxyvitamin D in the blood is elevated (above 38-45pg/ml), or the 25-hydroxyvitamin-D depressed (below 20 ng/ml) then it is pretty certain that a Th1 process is in play (note: all blood must be frozen during transit to the labs for these tests to be accurate).

Sometimes it is quicker and cheaper to apply the angiotensin blockade as a "therapeutic probe." If there are profound psychic and systemic effects from using Benicar, a drug which usually only changes the blood pressure, then that is a pretty good indication of the presence of Th1 inflammation, and an indication it is worth starting on our protocol.

Question: For those patients out there struggling with dubious diagnoses, do you recommend any specific laboratory tests to determine what infections they might have?

Trevor Marshall, PhD: Unfortunately today's laboratory tests are of little use until the immune system starts to recognize these intracellular invaders. Hundreds of these tiny bacteria can live inside a single cell. They are too small to be seen with conventional optical microscopes. The host cells live for a relatively long time. There is little apoptosis (cell death), so very few bacteria are released into the bloodstream, and they are hard to detect with lab equipment.

Because they live in stable symbiosis with our immune system, there are no antibodies created. The bacteria live within the cells in stable colonies which cannot be attacked by the body's normal defenses. Lab tests will not find antibodies to these bacteria.

PCR (polymerase chain reaction testing) is capable of sensing the occasional cell apoptosis, but the resulting low DNA concentrations would be regarded as insignificant by most labs.

The biochemical symbiosis is so delicate that it is virtually impossible to culture these bacteria outside the body. Just as the bacteria causing Leprosy (mycobacterium leprae) and the bacteria causing Syphilis (treponema pallidum) are nearly impossible to culture, I expect it is unlikely we will be able to culture these Th1 pleomorphs until we fully understand the biochemistry needed to sustain them. No lab has been able culture these bacteria up to this point in time (with the possible exception of Lida Mattman's research at Wayne State University).

So I guess the next task for us is to start working with labs to help devise tests which can produce a reliable diagnosis.

Question: Do you have any parting advice for CFS and FM patients seeking appropriate, effective treatment?

Trevor Marshall, PhD: I would just say don't take "no" for an answer. For the last 100 years sarcoidosis patients have been told that there is no known cause and no known cure for their disease (much the same prognosis being given to CFS and FM patients). The diagnosis of chronic sarcoidosis is regarded by pulmonologists as irreversible, they know their patient is dying, and that it is just a matter of time.

Yet the sarcoidosis folks who have been helping us develop our protocol, are becoming healthy again. Not just 10 percent, or 25 percent, but close to 100 percent are recovering their lives and their families. They have variously reported regaining cognitive focus, stamina, and stable gait, and resolving chronic pain, paresthesias and visual disturbances. Some have been able to discard wheelchairs, braces and supplementary oxygen.

"It is not the antibacterial therapy" that is helping these patients, say 'the experts,' "it is just spontaneous remission." Well, personally, I don't care what they call it, most of us will take this antibiotic-induced "spontaneous remission" any day, as long as it gives us back our health, our lives and our families. Don't take "no" for an answer.

_______

Disclaimer: The content of this article reflects the views of Professor Trevor Marshall, PhD. ProHealth/ImmuneSupport.com does not endorse this or any other specific protocol as a treatment or cure for CFS or FM.

Note: This information has not been evaluated by the FDA, and is not meant to diagnose, treat, cure, or prevent any disease. It is very important that you never make any change in your health support plan without the careful review and approval of your professional healthcare team.




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Snake Oil Sales Man strike again!
Posted by: TheSephardic
Nov 22, 2006
Every independent poll that I've seen on this protocol has had the same results: Disaster! Has 50% of people getting worst on it versus 28% getting better. Oddly, most of those reporting getting claimed that they went to FULL REMISSION, yet I cannot find a single post on that group saying that - this cause me to suspect that those results were salted. If you look at the Marshall Board, you will find Aussie Barb -- whose been on the protocol for a long long time (likely the longest of any CFIDS patient) and her posts indicate that she is not in remission, and quite frankly, continues year after year in religious-like hope that it will. What is odd is the total absence of any articles in recognized medical journals after many years? There seem to be many MD's trying it on their patients --- surely, at least one of them would want to share such a wonderful breakthru! Or, are these MD's prescribing to just get quiet from demanding patients and they are not seeing the results with their patients?
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Marshall Protocol is suspect
Posted by: dafo
Nov 29, 2006
I agree with TheSephardic whose comment was written here on 11-22-06. I have sarcoidosis and when I was first diagnosed, I initially got into the Marshall Protocol (MP), reading everything and trying like crazy to find a doctor. They continued to send me lists of doctors whom, I discovered, would NOT use the MP. One doctor's office requested to be taken off the list because they were tired of the calls, and although I told them about it, the name remained. When the list of doctors to contact is long, it makes this treatment look more impressive, doesn't it? Another doctor I actually went to twice, and paid $125 out-of-pocket for each visit, told me he had used the protocol in the past although he could not tell me the names of the drugs used in the later phases! When I questioned him about it, he said his "patients got better on Phase I alone." He clearly had no clue about the MP, but he remains on the MP list of doctors. Consider this: Why in the world would anybody want to start this program without knowing what drugs it entails?? Why do they keep them "secret?" People should not blindly take ANY drugs without looking up the side effects first, but the folks at the MP won't tell you what they are. It's not as if you can self-medicate because they are prescription drugs. I, too, have not found any independent validation of the protocol and, in fact, found it is listed as one of the worst. I also agree with TheSephardic about Aussie Barb, and others. On the site she admits to not following the protocol 100% (she eats forbidden foods like bacon), and then backpeddles when called on it. She is good at admonishing others in her tone, but why isn't she cured by now if she's been following the plan? Some of the administrators and Trevor Marshall himself occasionally appear to be hostile, angry, or condescending to members. Look up info on their site about why there have been no clinical trials if this protocol really works, and you won't get a straight answer. Really. Think about it: why wouldn't someone who really believes in this MP want scientific PROOF via clinical trials?
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The Marshall Protocol for Treating Chronic Fatigue Syndrome and Fibromyalgia: Hopeful Results Emergi
Posted by: marystuff
Dec 5, 2007
The report is from November 2006 and the interview from 2004. Anything currently available? My wife was on the MP, and it was working wonders, until she had to get off it last December for some unrelated complications. We are eager to get back on the protocol and would like to hear from others about their experieces. The Marshall protocol site is wealthy with comments and experiences.
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Beware of Marshall Protocol claims
Posted by: fabwheelie
Jan 26, 2008
Dr Marshall and protocol could be dangerous! Hello, sorry to disappoint anyone who thinks the Marshall protocol has any proper scientific basis but I'm educated with BSc Biological Sciences and MSc Biomedical Sciences and have looked at the Marshall protocol web site as I was researching if it may help my lupus(SLE). My scientific education included studies in pathology and immunology and for people out there who think I'm just a critic of TG Marshall all I can say is I've looked into his arguements and the most current "peer reviewed published research" and I am open minded enough to have sufficient vision to consider any valid arguement for "treatment" which may help my lupus I actually think that this site (http://www.marshallprotocol.com/) is dangerous and misleading. Dr TG Marshall is not a medical doctor and his theories regarding Vitamin D are misinformed (eg what he says about Vitamin D contridicts numerous research which shows that vitamin D supplements can actually help lupus) If he really believes his theories to be true why does he not publish his findings in "proper peer reviewed reputable scientific journals". It is relatively easy to get scientific articles published even if you are contridicting what other people say The MP site says "In order to receive counseling on this study site and be included in the cohort of study subjects, members (or their caregivers) must meet the following criteria...." "Failure to meet these criteria will exclude members from the study at any time and mandate they rely on their doctor alone for information and support." One of these criteria is "-Acceptance of the validity of the Marshall pathogenesis." From the research I've done no one could accept the validity of his pathogenesis because his immuno-pathological explaination has not been scientifically validated, and his theories on vitamin D are actually contridicted by the majority of scientific resarch and "peer reviewed" medical opinion Please do research outside the MP site Please discuss with you GP (and any consultant treating your disorder) before stopping any medication that you are on Please be aware of the risks and symptoms associated with low vitamin D levels
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Molecules don't lie, Doctors do.
Posted by: nat12
May 7, 2008
While the Marshall Protocol is not yet mainstream clinical practice it is based on some very innovative and rigorous molecular modeling. Yes, the role of Vit D is conceived of differently than in clinical medicine but that is because Prof. Marshall has drilled down and investigated the structure and function of the various forms of Vit D (there are several) rather than just blindly plying people with one form of Vit D and make subjective judgments about what is going on inside the body- that’s what clinical medicine does and it’s akin to playing pin the tail on the donkey. No scientist outside the medical field takes that sort of ‘research’ methodology seriously. Vit D will make CFS and other autoimmune patients feel better in the short term (as will steroids) as it is immunosuppressive. But try then going off it, even for a moment, and watch the spectacular relapse! As an analytical chemist, I am delighted to finally see proper molecular modeling and analysis entering into clinical medicine and challenging misguided assumptions that have dominated the clinical field for so long leaving patients with few answers on chronic illness except pain killers, steroids and more illness. I’m pleased that Prof. Marshall is getting more airtime and readers should note that he recently attended a conference at Karolinska institute, presented a seminar on his work at the US FDA and has managed to get published in peer review journals including BioEssays and Theoretical Biology and Medical Modelling, (see http://www.trevormarshall.com/papers.htm). So yes it’s new and different but it’s legit. Times are finally a changin’.
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Marshall Protocol is sound science and a curative therapy.
Posted by: Pro-MP
Sep 14, 2008
How long will it take for all of the "experts" finally understand that it is not low vitamin D that is so dangerous as is high 1,25D? Elevated 1,25D supresses the production of vitamin D{25-D}, resulting in low test levels. More importantly high 1,25D is whats causing all of the other immune problems people with Th-1 pathogens experience.....then the "experts" come in and say "It must be because your 25-D is so low that these problems are occuring," Then they tell them to bring their 25-D levels up....then you end up worse thn before....with high 1.25D and high 25-D. Here is the problem with high 1,25D: it blinds the immune system to the culprits causing the current manifestation of their illness....whether it is chronic fatigue,fibromyalgia,neuropathy etc.. High 1,25 D allows these bacteria,called l-form or cell wall deficienr bacteria to infect and proliferate in the T-cells of the host,resulting in destructive "auto-immune" disease. 25-D is immunosupressive....so taking it shuts down what's left of your immune system....which reduces the symptoms of the disease while giving the bacteria even more freedom to reproduce.This is why the Marshall Protocol is so effective in spite of the side effects people are critical about,because it lowers your 1,25 D so the immune system begans to kill the funk causing the illness.So because l-forms are slow growing and have probably been in the body for decades in chronically ill folk...it will take time to kill them and yes you will experience side effects as a result of them dying. But the healing that results is undeniable.I know this also first hand from experience in treatment with the MP. I don't know Aussie Barb at the Marshall Protocol...but I know she has only been on the MP since 2007, and is definately seeing tangible results.In my opinion,people who embark on the MP are intelligent and brave.Intelligent because they have made a decision based on real science,brave because they perservering through the killing of the pathogens with the reward of being cured in plain site.
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Marshall protocol works for Lyme !!!!
Posted by: pinevalley
Sep 3, 2009
I refute the snake oil comment concerning the Marshall protocol. Anyone can stand back and say that the Marshall protocol does not work touting a little medical knowledge, but I suggest that you go a little deeper in researching this protocol and listening to those who have tried it. I have spent years trying many protocols, but for me, the Marshall Protocol is one that works. You ask why it is not widely accepted by the medical community: it is because the MP concept is 180 degrees out from the common belief that we cannot get enough vitamin D. It is supplemented in our milk, cereal, yogurt, etc. I have chronic Lyme disease. My career was going down the drain fast while suffering from the effects of Lyme disease (muscle pain, fatigue, brain fog, etc.). I was desperate to find a cure for this debilitating disease. I tried Dr. Shoemaker’s cholestyramine treatment and experienced a little temporary improvement (I think the small improvement resulted from removal of Lyme toxins). I tried expensive mega vitamins and immune enhancing supplements recommended by Dr. Teitelbaum and prescribed by associated Fibro & Fatigue centers. My symptoms became so much worst that it was scary (probably due to the high doses of vitamin D included in the treatment). I became so weak that I could not walk 50 feet without my legs giving out from under me. I was definitely headed for a wheel chair to vegetate in pain. In desperation, I tried fibro and fatigue center recommended Burrascano protocol for a year. Essentially, this protocol involves throwing every powerful antibiotic in triple combinations at this disease for at least a year with the hope that if it does not kill the patient, it might cure the disease. It helped for a while, but within weeks of stopping the protocol, I fell into relapse. My last attempt was the Marshall Protocol. I am now completing phase two and going on to the third and last phase). I made the mistake of dropping out of the protocol for several months when I had shoulder surgery. I felt fine for awhile, but the symptoms started coming back. I was unable to go back to phase three protocol (too much herx at that level) and I have had to work my way back from phase 2 again. I am not fully cured yet, but I have improved hundreds of percent from where I was. I can walk long distance again. The proof is in the pudding. I have tried pushing the protocol to get done faster, but killing off the bacteria too fast creates a great deal of herx pain. It is best to take it easy at a tolerable pain level. The Marshall Protocol staff (at marshallprotocol.com) are a great help in getting through the treatment and answering your questions. The protocol takes 1-3 years, it is painful with lots of herx pain from killing off bacteria, but worth the journey. From my personal experience, this protocol works like no other – and I have tried many of them. I hope that my experience helps someone out there…. Best to you in healing
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RA or Lymes I don't know
Posted by: rotomill1
Dec 12, 2009
I have had the circuit with the so called experts.I also think capital punishnment should be used on the snake oil pushers that promise the world and give you squat. I do know I have something, when it flares up I can't get out of bed,my hands swell up so I can't even pick up my socks, My feet swell up so I can't walk, the small bones on the top of my feet feel like they are going flat. My right elbow and both of my shoulders and hips give me trouble also.' Is there any one here with symptions like these. About 10 years ago I worked in Indiana and I was exposed to ticks and I do remeber the rash also. I am 62 and not ready to give up yet/ But I am sick of being taken. Is any one useing this on Lymes or Rheumatoid Arthritis please let me know.
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