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  The Guaifenesin Protocol
     Fibromyalgia is a legitimate, common entity. It is a cyclic and progressive disease which affects millions of patients, primarily women, regardless of race.  Manifested by multiple symptoms that may initially last only a few days, it eventually progresses to affect multiple areas and bodily systems until patients simply cycle from bad to worse. At present, there are no diagnostic laboratory tests for fibromyalgia. Our recent research paper reported several abnormal cytokines that change during the course of our treatment.1

     Patients are often referred from one doctor to another, and told that they have chronic fatigue, systemic candidiasis, myofascial pain, irritable bowel or vulvar pain syndrome.  Too often, physician and patient focus on symptoms and fail to perceive the much larger problem. These dead-end diagnoses result in the treatment of symptoms which is only partially effective and at the same time ignores the underlying cause and the disease that continues to worsen over time.

    The American College of Rheumatology recommends searching for tender points at eighteen predetermined sites on the body to establish a diagnosis of fibromyalgia. However some patients simply have higher pain thresholds so while they complain of body aches or stiffness, they focus mainly on fatigue and cognitive impairments. These so-called Chronic Fatigue Syndrome patients suffer from the same metabolic abnormality. Since pain perception varies greatly, we urge physicians to seek objective evidence instead of the purely subjective response to variably tender points. The confirmation of fibromyalgia is far more secure when using our method of palpation that we call mapping (see below).

     Fibromyalgia has no set symptoms and many combinations from the following list are interwoven:
Central Nervous System: Fatigue, irritability, nervousness, depression, apathy, listlessness, impaired memory and concentration, anxieties and suicidal thoughts. Insomnia and frequent awakening due to pain result in non restorative sleep.
Musculoskeletal: Pain and generalized morning stiffness could arise from muscles, tendons, ligaments and fascia of the shoulders, neck, entire back, hips, thighs, knees, ankles, feet, inner and outer elbows, wrists, fingers, and chest. Injured or old operative sites are commonly affected. Though fibromyalgia is described as a “non-articular” disease many know better: Joint pains with or without swelling, redness and heat are frequent. The litany includes foot or calf cramps, numbness and tingling of the face or extremities.
Irritable Bowel: (Often called leaky gut, spastic colon or mucous colitis). Symptoms include nausea (often brief, repetitive waves), indigestion, gas, bloating, pain, cramps, constipation alternating with diarrhea and sometimes mucous stools.
Genitourinary: Common are pungent urine, frequent urination, bladder spasms, burning urination (dysuria) with or without repeated bladder infections and interstitial cystitis. Vulvodynia (vulvar pain syndrome) includes vaginal spasms, irritation of the vaginal lips (vulvitis) or opening (vestibulitis) and painful intercourse (dyspareunia). It typically mimics a yeast infection but without the cottage-cheese discharge. Intense PMS and uterine cramping are common. Symptoms of fibromyalgia are worse premenstrual.
Dermatological: Various rashes may appear with or without itching: Hives, red blotches, itchy bumps or blisters, eczema, seborrheic or neurodermatitis, and rosacea. Nails are often brittle and of poor quality and hair falls out prematurely. Strange sensations are common such as cold, heat (especially palms, soles and thighs), crawling, electric vibrations, prickling, super-sensitivity to touch, and flushing that is sometimes accompanied by sweating.
Head, Eye, Ear, Nose, and Throat: Headaches (migraines), dizziness, vertigo (spinning) or imbalance; dry eyes as well as itching and burning with or without sticky or crusty discharge upon awakening; blurred vision; nasal congestion and post-nasal drip; painful, burning tongue, mouth and abnormal tastes (scalded, bad or metallic); ringing in the ears (tinnitus) or lower-pitched sounds; ear and eyeball pain; sensitivity to light, sounds and odors.
Miscellaneous Symptoms: Weight gain; low grade fever; lowered immunity to infections; morning eyelid and hand swelling from fluid retention that gravitates to the lower extremities by evening where it stretches tissues causing the restless leg syndrome.
Hypoglycemia Syndrome: This is a separate entity. Thirty percent of female and twenty percent of male fibromyalgics suffer both conditions (fibroglycemia). Symptoms greatly overlap those of fibromyalgia, but sugar craving accompanied by tremors, sweating, anxiety, panic attacks, heart pounding, faintness, and frontal headaches, especially if hunger induced, are solid clues to the diagnosis. Hypoglycemics must follow a prescribed diet or recovery will not be complete even with the reversal of fibromyalgia. (See Hypoglycemia for more information.)
     Trauma, infection or stress can aggravate or tip susceptible individuals into fibromyalgia but are not the basic causes. It is generally accepted now as an inherited disease and preliminary results from our research team at City of Hope support this belief.  We have treated family members that spanned three generations including four two-year-olds as well as patients who became symptomatic only in their seventies. This age spread strongly suggests a multi-genetic disease in various combinations. Boys and girls suffer equally before puberty but females predominate (85% to 15%) thereafter. Forty percent of our patients recall "growing pains" in childhood that disappeared during the true growth spurt of puberty. Untreated fibromyalgia ultimately leads to a "tartar of joints" that we recognize as osteoarthritis.

     Over forty years ago, one of my patients taking gout medication observed he could peel tartar (calcium phosphate) off his teeth with his fingernail. This observation indirectly led me to study an unrecognized systemic problem reflected by deposits from the disturbed saliva. We now postulate that a defective metabolism, possibly a kidney enzyme, forces a minuscule retention of phosphate, which gradually accumulates to detrimental levels in many tissues. The excess results in inadequate energy formation (ATP), cellular fatigue and other malfunctions that explain all the symptoms of fibromyalgia. Our physicians paper for interested professionals defends that theory.

     We no longer prescribe gout drugs (uricosurics). We now use guaifenesin for fibromyalgia because it has no side effects and is even safe for children. It is marketed for respiratory mucus problems and is available without prescription in various strengths, though some brands may not be effective for fibromyalgia. Currently, we can only advocate three products: the long-acting 600 mg Mucinex also sold by Pro Health under their label, and a 600 mg. tablet compounded by Marina del Rey Pharmacy.  Capsules and 400 mg. tablets may be added to boost the basic dose as short acting compounds.

We begin patients with 300 milligrams of long acting guaifenesin twice a day for one week. Feeling distinctly worse suggests adequate dosage and patients remain on that amount. This suffices for only 20 percent of patients; if symptoms do not worsen, we increase to 600 mg. twice daily. Reversal begins for 80 percent of patients at one of these two levels leaving 20 percent who will need more.
 

During reversal, symptoms are intensified and new ones may be experienced. These are not side effects, but signal that reversal is underway. Better hours eventually appear and then cluster into days and finally weeks. The palpable lumps and bumps soften, fragment and gradually clear. Recovery is more rapid than the time it took to develop the illness. Even genetically-slower responders, may clear one year of metabolic debris every few months. Newer lesions clear first and the oldest ones last.

The original description of fibromyalgia as “rheumatism with hard and tender places” has certainly been forgotten. Tender-point examination limited to a few preordained parts of the body has less value than our totally objective body mapping. We use our finger pads as though we were trying to iron out underlying tissue and thereby find the swollen places within muscles, tendons and ligaments. We record their location, size and degree of hardness on a body caricature that becomes a baseline for future comparisons. Unless swollen, the purely subjective tender spots are excluded in mapping. Subsequent examinations and patient inputs readily determine drug dosages and sequential disease regression. We hide previous maps until we complete the examination and only then compare them to confirm progress. The most important site for confirming the diagnosis and assuring future success is the left thigh. The outside of the quadriceps muscle (Vastus lateralis) and the front part (Rectus femoris) are involved in 100% of adults and clear within the first month upon attaining adequate dosages.

Ignoring the following will guarantee treatment failure. All salicylates including aspirin completely block the benefits of guaifenesin for fibromyalgia. This occurs at a kidney site—something well documented with uricosuric gout medications. Salicylates are often found in pain medications and exfoliating products. Less appreciated is the fact that all plants manufacture them in quantities that vary with genus and from crop to crop. They are stored in bark, leaves, roots, and seeds where they serve to repair damage or as weapons against soil bacteria and fungi. Salicylates are readily absorbed through the skin and intestine when introduced from medications and supplements including plants oils, gels and extracts. Individual genetics determine ease of blocking but all patients should assume a high level of susceptibility and take no risks. New or replacement products should be carefully inspected for changes made by manufacturers. Items on Salicylate-free lists should be double checked for accuracy before purchasing.

     The following is a guide to natural and synthetic salicylates that must be avoided:

Medications: (1) Pain products containing salicylate or salicylic acid, for example, aspirin, Salflex, Anacin, Excedrin, Disalcid. (2) Herbal medications such as St. John’s Wort, gingko biloba, saw palmetto, Echinacea; vitamin supplements with alfalfa, rose hips or (3)Bioflavonoids (quercetin, hesperiden, rutin). (4) Topical medications such as wart or callus removers, acne products and dandruff shampoos that contain salicylic acid. (5) Pain creams, balms and lotions such as Ben Gay, Myoflex or Salonpas (containing salicylate) (6) Medications such as Pepto Bismol, Asacol, Alka Seltzer or Urised that contain the word salicylate as part of their generic names.
Cosmetic and Topical Products: (1) Skin cleansers or exfoliants that use salicylic acid. (2) Hair shampoos, conditioners or sprays with plant extracts or salicylic acid (3) Bubble baths and lotions containing aloe, ginseng, lavender; almond or grape seed oils or extracts etc. (5) Sun screens or tanning lotions with aloe, octisalate, homosalate, mexoryl or meradimate. (6) Lipsticks, balms,  or medicated topicals with ingredients such as salicylic acid, aloe, camphor, menthol, or castor oil. (7) Deodorants with castor or other plant oils or extracts. (8) Sticky plant juices or saps adhere to the skin while gardening or weeding (Patients should wear waterproof gloves when gardening). (8) Ttoilet paper and baby wipes with aloe.
Shaving Aids: (1) Shaving creams with aloe, mint, menthol or mentholatum will block. (2) Razors with aloe strips adjacent to the cutting edge deliver salicylates through microscopic cuts. Vitamin E, lanolin, cocoa/shea butter and mineral oil are all acceptable.
Oral Agents: (1) Most mouth washes contain mint, wintergreen or salicylate (Listerine). (2) Toothpastes contain salicylates, as well as fresh or artificial mint, often unlisted. Use Cleure toothpastes, the non-mint ones made by Tom’s of Maine or others listed on our website. Baking soda and/or peroxide provide good cleansing and whitening. The non-mint pre-brushing rinses are acceptable as are Cleure Mouthwashes. (3) Use no lozenges, dental floss, breath fresheners or chewing gums with any mint flavor, including menthol, wintergreen, peppermint or spearmint. (Fruit/Cinnamon flavors may mask mint hidden by the stronger flavors.).

The QUICK CHECK here on the website will detail exactly how to check your products.

  Dictionaries or online references can help identify ingredients. When calling manufactures ask for a list to check yourself because often personnel do not realize that plants make salicylates. This web site can connect you to a support group to help with updated safe-product listings and answer questions. 

PHYSICIANS CANNOT BE EXPECTED TO RECOGNIZE OR KNOW ALL THE INGREDIENTS IN YOUR TOPICAL PREPARATIONS. DOCTORS WILL ASSUME GUAIFENESIN HAS FAILED IF PATIENTS DO NOT COMPLETELY PURGE SALICYLATES. IT IS YOUR RESPONSIBILITY TO FOLLOW OUR PROTOCOL EXACTLY.

No diet is required for fibromyalgia since the liver alters food salicylates. The only exception to this is that we ask patients not to drink tea. The camellia plant is very high in salicylates and steeping makes it stronger. (There is no problem with coffee and with plants other than those in the tea or mint family.)

Do not use decongestants or cough medicines to get guaifenesin. There are potential side effects from various additives. Single ingredient guaifenesin has no side effects (save rarely mild, but transient nausea) and no known drug interactions. Using it with salicylates causes no ill-effects, it simply negates the drug’s effectiveness for fibromyalgia.

Pain medications such as acetaminophen (Tylenol), Ultram, Imitrex, non-steroidal drugs such as Advil, and Aleve, will not block guaifenesin.


Our treatment is not for those lacking courage. It calls for patient skills and, hopefully, physician assistance. Remember, reversal of the disease reproduces past symptoms and may cause new or long-forgotten ones to re-surface. The intensity of these early cycles often causes concern during the initial weeks of treatment. Such symptoms are not guaifenesin side effects. Patients realize they were getting steadily worse long before starting our protocol despite medicinal Band-Aids used to mask symptoms. We offer hope to those with determination to try once more despite previous failures. This is a highly-effective protocol.

R. Paul St. Amand, M.D.
Assistant Clinical Professor Medicine
Endocrinology--Harbor-UCLA

Claudia Craig Marek
Medical Assistant
fmsnurse@aol.com

Important: Do not assume fibromyalgia is the cause of all symptoms. When in doubt or confronted with new problems, please consult your personal physician or appropriate specialist.

Addendum:
Fibromyalgics with hypoglycemia must follow a low carbohydrate diet as prescribed, or they will not feel better, even when guaifenesin clears the lesions of fibromyalgia. Though not mandatory, fibromyalgics with carbohydrate craving will get a "jump-start” with similar dietary modifications for the first thirty days of treatment. Carbohydrates (sugars and starches) release insulin. This hormone not only induces kidney reabsorption of phosphate but also drives it into various cells and intensifies symptoms. Elimination of the following foods prevents the wide fluctuations of blood sugar that allows a surge in energy and lessens bouts of fatigue.

Foods to Avoid Strictly:
All alcohol, dried fruits, fruit juice, baked beans, refried beans, lima beans, barley, black-eyed peas (cowpeas), lentils, garbanzos, rice, bananas, pasta (all types), flour tortillas as in burritos, tamales, corn, potatoes, sweets of any kind including dextrose, glucose, hexitol, maltose, sucrose, honey, fructose, corn syrup, starch. Caffeine and alcohol are permitted for those without hypoglycemia.
 

1.Zang, Z, Cherryholmes, G, Mao, A, Marek, C, Longmate J,

Kalos, M, St Amand, RP Shivley JE: High plasma levels of MCP-1, and Eotaxin provide evidence for an immunological basis of Fibromyalgia.  J of Ex Bio Med 2008 Oct.


Other Information:
This is not the full bibliography in support of our theory. (Interested physicians may contact us for a theoretical, more technical, paper or consult the Technical Appendix of our book)

Online Guaifenesin Support group: http://www.fibromyalgiatreatment.com/newsgroup.htm
 

Cleure Salicylate Free Products. A full line of dental, personal and medicinal products: www.myfibrosmile.com/ftc or (888) 883-4276. All purchases benefit The Fibromyalgia Treatment Center

Starlanyl, Devin M.D. and Copeland, Mary Ellen: Fibromyalgia And Chronic Myofascial Pain Syndrome-A Survival Manual. New Harbinger Publications, Inc., 1996. Starlanyl, Devin M.D.: The Fibromyalgia Advocate. New Harbinger Publications, Inc. 1998.www.sover.net/~devstar

Williamson, Miryam Erlich: Fibromyalgia: A Comprehensive Approach. New York: Walker and Co. 1996 and The Fibromyalgia Relief Book, 213 Ideas for Improving Your Quality of Life, 1999. www.shaysnet.com/wmson

St. Amand, MD, R. Paul and Marek, Claudia: The Use of Uricosuric Agents in Fibromyalgia: Theory, Practice and a Rebuttal to the Oregon Study of Guaifenesin Treatment. Clinical Journal of Myofascial Therapy, Vol 2, No 4, 1997.

St. Amand, MD, R. Paul and Marek, Claudia: A Description of Fibromyalgia and Hypoglycemia: Their Combined Morbidity and Therapy with Guaifenesin and Diet. AAEM Symposium Syllabus, 1998.

"What Your Doctor May Not Tell You About Fibromyalgia" (ISBN 0-446-675-121),

"What Your Doctor May Not Tell You About Pediatric Fibromyalgia
" (ISBN 0-7595-5002-6),

"What Your Doctor May Not Tell You About Fibromyalgia Fatigue"
(ISBN 0-466-67730-2) by R. Paul St. Amand, M.D. and Claudia Craig Marek, all published by Warner Books.

"Fibromyalgia: The First Year. A Patient Expert Walks You Through Everything You Need to Learn and Do"
by Claudia Craig Marek. ISBN 1-56924-521-5 published by Avalon Books.

All are available in bookstores, online book sellers and from The Fibromyalgia Treatment Center.

DVD of Dr. St. Amand’s method for diagnosis, treatment, and mapping is available from The Fibromyalgia Treatment Center P.O. Box 64339 LA, CA. 90064 for $25.00 including shipping and handling, or order here. Copies of this paper and others available free of charge.

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