Adapted from “Fibromyalgia
and Chronic Myofascial Pain: A Survival Manual", 2nd edition, 2001.
Devin J. Starlanyl © 2001, New Harbinger, updated 2009. All rights reserved.
Please be aware that we cannot hope to put all the information from
ours and several other books for patients on these disorders. Please get additional
information from one of these sources. We have listed some in the bibliography.
Excess calcium and
inorganic phosphate may cause a hyper-permeability problem in the
mitochondria (Savage and Reed, 1994). This may be part of what
happens in FM. Dr. R. Paul St. Amand believes FM is caused by an
abnormality in phosphate excretion, which may be due to a genetic defect.
Retention of phosphates eventually interferes with energy production in
affected cells. One study (Bengtsson, Henriksson, and Larsson, 1986)
found a twenty-percent reduction in the level of ATP in muscle biopsies
taken from people with FM. Excess phosphate in the mitochondria,
your power-generating factories, slows formation of ATP because of the
presence of excess inorganic phosphate. Muscle pain after exercise is also
linked with an inorganic phosphate increase (Aldridge, Cady, Jones et al.
Calcium is the main
buffer for phosphate. Whenever and wherever excess phosphate builds
up in cells, excess calcium does too. About forty percent of a cell’s
energy is expended in moving calcium in and out of storage or out of the
cell completely. Since energy needs are poorly met in FM because of
insufficient ATP, calcium is allowed to sit too long where it is no longer
Guaifenesin (guai) is
usually an ingredient in cold preparations. In 1530, in its original form,
a tree bark extract called guaiacum, it was in use for rheumatism.
In the new PDR for Herbal Medicines [in ref] guaiacum officinale is again
indicated for rheumatism. Over twenty years ago it was synthesized,
named guaifenesin, and pressed into tablets. Guai is totally
absorbed through the intestinal tract within two hours after you take it.
There are timed-release forms.
Dr. St. Amand found a
sixty-percent increase in phosphate excretion and a thirty-percent
increase in oxalate and calcium excretion with guai therapy.
I believe that mineral deposits and other
substances are stuck in the ground substance of the myofascia. These
substances can cause dysfunction. The lumps and ropy bands that Dr. St.
Amand considers part of FM are actually myofascial trigger points.
Guaifensin releases some of these deposited materials that are processed
by the kidneys, allowing tissues to become more supple.
About 20 percent of Dr.
St. Amand’s patients go through FM reversal relatively quickly at 300
mg twice a day. If the cyclic process hasn’t started in two weeks,
patients are raised to 600 mg twice a day. Seventy percent of all
patients experience reversal at that dose. Another twenty percent
need 1800 mg a day. The final ten percent require 2400 mg or more
per day. When the first cycle begins, there is usually a period of
flu-like fatigue as stored toxins and excess phosphates start releasing.
Your body works hard to process chemical toxins and excess materials so
that they can be excreted. For the first few months, expect to spit
out mucus that has been clogging your airways. Headaches are very common
during this process. You may have other symptoms, including strong
smelling perspiration and urine and burning on urination (excess acid
phosphates are excreted). Your urine may become very dark. You
may be sore in the crease between your buttocks and in the perineal area
and need to use a protective ointment or cream.
It is important to follow
the guaifenesin protocol. Do not change your dosage of guai or any
other medication without talking to your doctor. Keep track of what
happens. Start slowly by taking 300 mg of guaifenesin twice a
day. Take 300 mg twice a day for one week. If you become
distinctly worse, you have found the dosage right for you. If you
are especially sensitive to medications, you may want to begin with
less. Take it slowly and give your body a chance to detoxify the
material that is being released. When you reach your dose, your
symptoms will get worse. The signs and symptoms in reversal are not
side effects of guaifenesin. They are from the chemical toxins and
wastes being released by the guai and are good signs, although they won’t
feel like it at the time. Salicylates in medication and herbal
products can block the action of guaifenesin. Blocking effects vary
with the individual.
Guai therapy for FM is
not simple. Doctors can’t just prescribe the medication and expect
symptom remission. St. Amand begins by taking a careful medical
history of the patient. He examines the patient for swollen areas,
which he maps. As patients progress, the symptoms tend to disappear
in the reverse order in which they first appeared. Patients with
insulin resistance must be on a balanced diet for the reversal to be
evident. This means no excess carbohydrates. I have found that
the Zone-type diet works well, although it must be tailored to individual
needs. Guaifenesin therapy seems to result in remission of symptoms
for many people. There may be co-existing conditions, such as
myofascial TrPs, that also need attention, and you may have other
perpetuating factors that must also be identified and addressed.
The only double-blinded
study on FM guaifenesin therapy was done at the University of
Oregon. This study of 20 women showed guaifenesin equal to
placebo. The study was flawed, through no fault of the researchers,
1. The study was
started before we knew the signs of reversal are not obvious if
uncontrolled insulin resistance is present. No one knew how common
insulin resistance or insulin resistance is.
2. All the patients
in the study were given 600 mg guai twice a day. Dr. St. Amand has
found that only about 50 percent of patients respond at this dosage, and
even in these patients, the reversal won’t be evident if they have
insulin resistance and are eating excess carbohydrates. The
dosage must be individually tailored.
3. Dr. St. Amand
did not know about the blockage of guai by some salicylate-containing
herbs until September 1995. The study ended in June 1995. Each
of us has a varying tolerance of salicylates. It has been my
observation that when someone who is successfully cycling on guai calls me
about a sudden downturn, we invariably find a blocking agent. When
it is removed, the patient starts to improve once again.
4. Some people say
Dr. St. Amand’s patients feel better because he’s charismatic.
He is. But how can these positive attributes cause me to have dark,
smelly, acidic urine that cleans iron stains off my toilet bowl?
Toilet bowls do not respond to the placebo effect.
Dr. St. Amand and I agree
to disagree on some issues. There are
no fibromyalgia trigger points. Trigger points are part of myofascial
pain, a totally different condition that often co-exists and interacts
with FM. I have seen many patients improve dramatically on guai therapy
and take it myself. If you wish to learn more about guai, read
"What Your Doctor May Not Tell You About Fibromyalgia" (Reading
List). Some of the data from this section is adapted from this book,
with permission from the authors.
Dr. St. Amand and I both
feel that guai therapy should take place under a doctor’s
supervision and that doctor must understand
guai therapy and the need for individual titration. The timed-release
form of guaifenesin is available over the counter as Mucinex. Avoid over-the-counter forms of guaifenesin that have
other ingredients in them, such as alcohol or sugar. Avoid any
medications that have pseudoephedrine. Research indicates that
epinephrine-like products may worsen fibromyalgia symptoms. Guai may
be purchased over-the-counter through Hyrex Pharmaceuticals at
1-800-238-5282, 3494 Democrat Road, Memphis, TN 38118, and they will ship
to other countries. The author has no connection with this company.
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