http://www.sover.net/~devstar/guai.htm
Adapted from "Fibromyalgia and Chronic Myofascial Pain: A Survival
Manual", 2nd edition, 2001. Devin J. Starlanyl © 2001, New Harbinger. 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.
Fibromyalgia and Guaifenesin
by Devin J. Starlanyl
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 FMS. Dr. R. Paul St. Amand believes FMS 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 FMS.
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. 1986).
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 FMS because of
insufficient ATP, calcium is allowed to sit too long where it is no longer
needed.
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 the phosphoric and oxalic acids coming out in the urine (and sweat) may
carry with them other excess acids which may be significant. We don't know. I
believe some of the guai effects may be mechanical, by thinning thick, sticky
FMS secretions.
About 20 percent of Dr. St. Amand's patients go through FMS 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 FMS 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 reactive hypoglycemia
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 FMS 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, because:
1. The study was started before we knew the signs of reversal are not
obvious if uncontrolled reactive hypoglycemia is present. No one knew how common
reactive hypoglycemia 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
reactive hypoglycemia 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. I don't understand
how guai works, but I have seen many patients get a new lease on life with guai
and have experienced 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. There is a guai Internet support group and website and an
international support group.
Dr. St. Amand and I both feel that guai therapy should take place under
doctor's supervision. 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.
Addendum:
When one of my local support group members told me that the FDA was
changing its stance on guaifenesin, I contacted the expert, Dr. Paul St. Amand.
I found that after November 1st, 2003, guaifenesin will no longer require a
prescription but will be available in over-the-counter form. Dr. St.Amand told
me the following:
"There is a shortage of guaifenesin developing. Adams Company, Texas,
made a long-acting (12 hour) guaifenesin and proved it did indeed last for about
twelve hours. They were given permission to sell it over the counter. This
happened in July or so 2002.
"In October 2002 the FDA instructed all other companies to stop
manufacturing guaifenesin since they had never proven they were long-acting
(after 25 years) though all of them are (8-12 hours). The FDA has further
ordered that all guaifenesin that is not approved as long-acting must be removed
from pharmacy shelves by November 1, 2003.
"The law is that once a drug is made non-prescriptive, all of them must be
such. In other words, all of the companies must now prove they're long acting.
Those who do will also be over-the-counter drugs. We think a few are trying to
comply by the November date.
"One Company in Santa Barbara, CA, has obtained permission from Adams to
sell its product "Mucinex" under a different label. After November 1st the drug
will no longer be on prescription. Insurance plans will no longer pay for the
medication. I suggest you stock up also while waiting to see how all of this
settles."
I spoke with my pharmacist, and he assured me that he will stockpile guai,
since so many of the local support group people have had such a good response.
It is important to avoid any products with guai that have other medications,
such as epinephrine, that could be harmful. Devin J. Starlanyl