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

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.

Dr. St. Amand and I both feel that guai therapy should take place under a 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.

--------------------------------------------------------------------------------

Your doctor may contact Dr. St. Amand at the following:

R. Paul St. Amand, M.D.
4560 Admiralty Way, Suite 355
Marina del Rey, CA 90292
310-577-7510