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Q&A Session with R. Paul St. Amand, MD – December 7, 2007

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Welcome to ProHealth’s Live Chat Event with Dr. R. Paul St. Amand, MD. To many Fibromyalgia patients and the doctors who treat them, Dr. St. Amand needs no introduction. As director of the Fibromyalgia Treatment Center (FTC) in Marina Del Rey, California, Dr. St. Amand has seen thousands of patients and is known worldwide as developer of the Guaifenesin Protocol.

He is Assistant Clinical Professor of Medicine-Endocrinology at Harbor-UCLA Medical Center, and has written a number of books – including What Your Doctor May Not Tell You About Fibromyalgia (2006) – in collaboration with his expert Medical Assistant, Claudia Craig Marek.

For basic details on Dr. St. Amand’s theory of Fibromyalgia and the Guaifenesin protocol, read “Fibromyalgia – Its many possible symptoms, diagnosis via palpation of the musculoskeletal tissues (mapping) and the Guaifenesin Protocol.” And for readers seeking information not addressed in the following Q&A, the FTC offers an online forum where questions may be posted (http://fibromyalgiatreatment.com/board)


Q: Dr. St. Amand, why am I so tired?

Dr. St. Amand: Any time a doctor hears this comment from a patient, he or she knows that energy is not being made in the cells. In each cell there are a number of power stations, called “mitochondria” that convert the food we eat into energy. If a patient is tired, there is a malfunction at this basic level. Any theory about the cause of fatigue has to include this understanding.

* * * *

Q: Why do I hurt?

Dr. St Amand: Muscles, tendons, and ligaments lacking proper energy finally tighten up and stay tight. These contracted areas put pressure on nerves, which in turn tell the brain that you hurt all over.

* * * *

Q: What do you think is the underlying cause of Fibromyalgia?

Dr. St. Amand: We believe that something is hindering the body’s energy production and accounts for all the symptoms, from poor hair quality, brittle nails, sluggish digestive tract, and pain, to fatigue and poor cognition. Something is blocking the body’s ability to properly make the energy it needs. We know this because our bodies are getting fuel (food and supplements), and additional fuel doesn’t remedy the problem. Think of it as a car engine: You can put higher quality fuel and additives into the gas tank but if the engine will not turn over, the fuel doesn’t matter. That’s why diet and even stimulant medications never really change the situation (for long). We believe it is the slight retention of the normal body constituent – phosphate – which dams the system and makes it sluggish.

* * * *

Q: Why are all my lab tests normal?

Dr. St. Amand: There is no inflammation in Fibromyalgia. Phosphates are normal to the cell, so the body doesn’t perceive any abnormality.

* * * *

Q: If all tests are normal, how can you be sure of the diagnosis of Fibromyalgia?

Dr. St. Amand: First, a skillful history must be taken to ensure that no other problem exists. This will document the symptoms, showing a general progression from sporadic episodes to the later stages when a patient is symptomatic all the time. With minimal training a practitioner can feel areas of contracted tissue (in muscles, tendons and ligaments) all over the body. This is called body mapping.

* * * *

Q: Do you think Fibromyalgia is inherited?

Dr. St. Amand: Yes, I believe it is almost always inherited. At one time people were told differently, but I think now all physicians who treat FMS believe that it is. Studies are well underway now confirming these observations. Family histories often span three and four generations, from young children to those in their seventies. Boys and girls are equally affected before puberty, but in adults, females heavily predominate – about 85%.

* * * *

Q: And do you believe that Fibro, ME/CFS, and Multiple Chemical Sensitivities are different manifestations of the same thing?

Dr. St. Amand: Yes, I do.

* * * *

Q: What medication do you use, and how does it work?

Dr. St. Amand: We use guaifenesin. It was originally an herbal compound used to treat rheumatism, but it also thins mucus. It’s been used most recently (the last 70 or so years) in cough or sinus preparations. It also has some action on the kidneys, and that’s why we use it. It increases urinary excretion of phosphate, gradually helping with extraction of abnormal body-wide accumulations. [See also
“An FM Patient Counselor’s Primer on the Guaifenesin Protocol” by Claudia Marek.]

* * * *

Q: What is “body mapping” and why do you do it?

Dr. St. Amand: Tender point examination is limited for Fibromyalgia diagnosis, because pain thresholds vary greatly, and many patients take medications that obtund pain perception. Examination really must be objective, instead of subjective as in “Do you feel pain here?”

As I indicated above, with minimal training a practitioner can feel areas of contracted tissue in muscles, tendons and ligaments all over the body…and this palpation and documentation is what we call mapping. Mapping also has more value to patients than tender points: We palpate abnormalities and document them. If insurance companies accuse patients of dramatizing pain for self-gain, this is moot if one deals with abnormalities that any practitioner can feel.

For those taking guaifenesin, we determine what dosage works by sequential muscle examinations until sufficient areas disappear.

* * * *

Q: What can I do if my doctor can’t do the “body mapping” or examination to make sure I am on the right dose?

Dr. St. Amand: You can use a “symptom journal” to document your progress, as well as have any trained body-worker try. Turn to our website for help. Follow in detail the instructions of the Admin Team in our online support group.

* * * *

Q: Why are symptoms worse when you start guaifenesin?

Dr. St. Amand: The reversal, initially, for most patients, causes an increased intensity of symptoms. This includes not only pain but fatigue and difficulty with memory and concentration, etc. The body puts fluid into the cells to dilute and flush out the phosphate and this swelling (fluid under high pressure) is the cause. The worsening represents the signs and symptoms of toxins and wastes being released by the guaifenesin – therefore an indication that the Protocol is working.

* * * *

Q: What is a “high dose responder”?

Dr. St. Amand: Anyone needing more than 2400 mg. of guaifenesin a day to begin reversal is a high dose patient. This really is less than 5% of patients.

* * * *

Q: How will I know my body is cleared of the phosphate buildup?

Dr. St. Amand: We establish a dosage by the gradual removal of symptoms in a cyclic fashion. Symptoms may come and go with diminishing severity as they clear. And, upon examination, a clearing of lesions is seen. You are “clear” when you have minimal or no symptoms.

* * * *

Q: In the last stages of clearing the phosphate, what do your patients experience?

Dr. St. Amand: At the end of the clearing period patients have occasional achey periods that are far apart. You know, short periods of feeling like you are coming down with the flu.

* * * *

Q: Doctor, what is the purpose of avoiding salicylates on the Guaifenesin Protocol?

Dr. St. Amand: This chemical can be extracted from plants or made synthetically. It is inexpensive and is used in many personal care products and pain relievers like ExcedrinR. It can be absorbed though the thin membranes of the skin and mouth and intestines, and even small amounts can block guaifenesin’s ability to help the body excrete the excess of phosphate. Salicylate works in the same area of the kidney as the guaifenesin does, and occupies receptors preferentially. It does the same with the uricosuric gout medications. [“Uricosuric” substances increase the excretion of uric acid.]

* * * *

Q: When you read about patients blocking [the clearance of phosphate] for a week, month, etc., once these patients remove the offending salicylate, how long does it take to make up the time? Are patients always a week, month, etc. behind from that moment on?

Dr. St. Amand: Hard to say, because people reverse at variable rates. And the genetic trait is stronger in some patients than others. Predictions are tough. The best thing is just to put it behind you and keep going. Don’t fret about the past and just get it done correctly. Because each patient reverses through his or her own timeline at his or her own rate, each progress is different, albeit predictable in some senses.

* * * *

Q: In terms of guai blocking, what’s the threshold between eating salicylate containing foods, okay, and “eating” salicylate containing plant extracts, not okay? Is there just a sal concentration above which enough “leaks” past the digestive tract to block?

Dr. St. Amand: Foods are not involved in blocking guaifenesin. The liver is able to counter salicylates in foods. Only medications and topical products can do it. We do not restrict diet in our patients.

* * * *

Q: When scanning for plant salicylates, is the “gel, extract, oil” rule exhaustive? For example, “cocoa butter” seems to be okay as an ingredient. Isn’t cocoa butter really an oil?

Dr. St. Amand: Cocoa butter is a processed fat from the oil…it is okay to use. Only oils, gels, extracts (the whole plants) would contain the salicylates you need to avoid. Esters, gums, waxes, glycerides…all these are chemical derivatives that still bear the plant name – unlike others such as cocamides and carrageenan.

* * * *

Q: Should someone taking guai avoid foods with mint in them?

Dr. St. Amand: Someone on guai should stay away from mint, yes. Mint oil, really. A leaf of mint in a salad won’t block. But anything with mint flavor (oil) should be avoided.

* * * *

Q: How long will I have to take Guaifenesin?… And once we have cleared the phosphates and the symptoms are gone, do we still need the guai?

Dr. St. Amand: Remember that guaifenesin is a treatment, not a cure. It only works when you are taking it. Without guaifenesin the energy blockade begins again and the symptoms return. Just like diabetes, high blood pressure and high cholesterol, you must work to control this (inherited) error in your metabolism. If you have something that is malfunctioning, not functioning properly, and the medication fixes that, it won’t keep fixing it when you stop.

* * * *

Q: Doctor, what caused you to become interested in FMS? Your success rate is very good.

Dr. St. Amand: It was a metabolic riddle provoked by a patient who could remove tartar from his teeth taking gout medication. I had a number of patients who had complaints that could not be explained that I thought might be explained by this. Later I discovered I had it, and my children, and so it became personal for me.

* * * *

Q: When I was 42, my parents could run circles around me, at 82 and 84. At 44, I am better than they are.

Dr. St. Amand: Fibromyalgia is definitely a form of aging, isn’t it. So much so that we really call reversal “youthing.” It sounds corny, but we hear it all day every day – “I feel like I am 90 and I am 40.” Then when patients are better they comment that at 40 they feel better than they did at 20. I myself feel better now, at 80, than I did in my thirties.

* * * *

Q: In your book, I believe it says that when people follow the protocol strictly, around 90% of patients will eventually see improvement. Do you have any theories on the remaining 10%?

Dr. St. Amand: My general thinking is that perhaps we do not all have the same genetic abnormality. Remember we are diagnosing FMS by symptoms, really, and some muscle findings. So perhaps these people have something slightly different. It is hard to know about each individual failure as we are always at the mercy of a patient’s subjective symptoms and ability to check products for salicylates.

* * * *

Q: I take one [extended release 600 mg guaifenesin tablet] per day, as I cycle on 300 mg doses. Will that be effective?

Dr. St. Amand: About 20 percent of patients respond to 300 mg twice a day, so you could be responding at that dose. A symptom journal or mapping would give you the answer.

* * * *

Q: Thank you, Dr. St. Amand. Does the fast-acting guai [in 200 mg doses] need to be taken more often than the timed-release version?

Dr. St. Amand: Yes, you should probably take the fast acting three times a day at least. And keep a good symptom journal to make sure you can get by with all short acting.

* * * *

Q: Can you tell us more about the study you are involved in with the City of Hope and any findings to date? [See “City of Hope Embarking on Three-Year Study of Inflammatory Gene Activation in FM Patients.”]

Dr. St. Amand: I can’t give out the City of Hope results yet. It is a study looking at the biomarkers and genetics of FMS. The research is coming well, but we can’t comment on it yet. We have some interesting results is all I can say right now. We are waiting to get some of the early results published. Not our choice, of course, but what has to be done, because they could be published by someone else. We have to honor the researchers at COH, who are working so hard. Once it is accepted for publication then we will share!

* * * *

Q: When the City of Hope results are published, will there be news on your website, www.fibromyalgiatreatment.com?

Dr. St. Amand: Yes, any results of the City of Hope study will be on the website. And of course we also believe they will make the news! We are optimistic that there is a breakthrough coming! The initial research will of course need to be duplicated in bigger studies but I believe physicians will be more tempted to look at our theories. Will one study be definitive…probably not. But will it open doors, give new clues? Yes, and that is what we hope for.

* * * *

Q: How should we submit contributions to your research fund?

Dr. St. Amand: Research donations can be made directly to City of Hope or via the Fibromyalgia Treatment Center. For more details see our website (www.fibromyalgiatreatment.com/contribution.htm).

* * * *

Q: Hi Doctor. Does the guaifenesin act as an anti-inflammatory in any way? I can not take any anti-inflammatories with the prolotherapy that I am getting. [Note: Prolotherapy or ‘proliferative injection therapy’ involves injection of an irritant to strengthen injured/weakened connective tissue, as in a knee or other joint; sometimes used as an alternative to surgery.]

Dr. St. Amand: No, guaifenesin has no anti-inflammatory effects that are known. And remember it is a very old medication.

* * * *

Q: I’ve also had more fatigue recently and feel that is related to my hypoglycemia. It is very difficult to assess what causes what. Do you have any suggestions that would help? I feel that the guai has definitely helped the FM, but other issues still lurk. [See the article “Hypoglycemia – and Dietary Guidelines for Hypoglycemics.”]

Dr. St. Amand: Telling blood sugar issues from FMS is easy enough. You do the hypoglycemia diet perfectly (as written) for two months. After that all your blood sugar symptoms will be gone. What’s left is Fibro.

* * * *

Q: Can you comment on the severity of symptoms hypoglycemia can cause, please?

Dr. St. Amand: Hypoglycemia can cause anything from passing out to palpitations, panic, and anxiety attacks, fatigue, dizziness, muscle tightness and problems with memory and concentration.

* * * *

Q: Just curious, were you one of the pioneers of the hypoglycemia diet, and did you discover hypoglycemia before FMS?

Dr. St. Amand: No, I worked with them about the same time. The story is in our book, but I was featured on the local news in a segment that ran many times, and so I got an influx of patients who helped me recognize and define them. It took some work to figure out both conditions and the overlap and interplay – and a lot of study and smart patients with good observations of course.

* * * *

Q: This guai is news to me! I have MS [Multiple Sclerosis] along with my Fibro, among other things. Would it help me or can I even take it? Thank you Doctor St. Amand.

Dr. St. Amand: Guai will help your Fibro only. But if you get better from your Fibro, your symptoms will be better…you will have less of a health burden. You can’t always tell exactly what is what, because FMS has so many symptoms. Sometimes you can only say that what doesn’t resolve with guai is something else. But there are certainly overlapping symptoms, and it can be hard to tell.

* * * *

Q: What is your opinion on the theory that FMS may be associated with trauma?

Dr. St. Amand: I think now all physicians who treat FMS believe that the proclivity for Fibromyalgia is inherited. Studies are well underway now confirming these observations. But of course a trauma can tip you into something for which you have a genetic predisposition. This is true, by the way, for all inherited conditions.

* * * *

Q: Are you saying that Fibro is caused by trauma?

Dr. St. Amand: No, Fibro isn’t caused by trauma. It is caused by defective genetics. But a trauma can tip the scales and start the cascade … your body cannot make enough energy to supply the increased demand – and so bang you have Fibro.

* * * *

Q: So you’re saying that you believe FMS is brought on by trauma in those that have a genetic predisposition (inability to process phosphates adequately)?

Dr. St. Amand: Yes, of course. Any trauma can demand energy that you as an FMS person can’t make. It can be physical or mental trauma – from a death in the family to an illness or a pregnancy. Anything that demands your body do more than it can. When that happens, something’s got to give.

* * * *

Q: Doctor, for weeks now (Day 15-27), I have been severely congested, fluish, and fatigued. Are cold/flu like symptoms normal for cycling on guai? How do I know it’s just not a lingering head cold/virus? Thank you!

Dr. St. Amand: Sometimes you can’t tell if you are coming down with cold or flu or it is your Fibro. You just have to wait for things to evolve…and see if you get distinctive symptoms for either. But body aches and fluey feeling is normal for FMS.

* * * *

Q: Thank you doctor. Are there any drugs that might interact with the guai that I should be aware of?

Dr. St. Amand: Guai has no known drug interactions. It has been on the market 75 years and none has ever been documented.

* * * *

Q: My doctor prescribed CymbaltaR [duloxetine] for my Fibro pain. It has worked! What is your opinion about its use?

Dr. St. Amand: Current wisdom is to suppress symptoms, but no medications are promoted to treat the cause. There is a lot of money in treating complaints, and Fibromyalgics have plenty of them. We really see a lot of polypharmacy (taking multiple medicines), some of it redundant, because patients with a lot of complaints see many physicians. On top of that, many also visit alternative practitioners who sell supplements and compounds, and take those too.

Some people get help from one thing and some from another. Of course there is nothing wrong with making patients comfortable, or promoting good nutrition and exercise. But these things do not treat the root cause of Fibromyalgia.

If the Cymbalta helps you and you and your doctor are pleased with it, that’s good. We believe that eventually your symptoms will be more difficult to suppress and the Cymbalta, over time, will not be adequate.

* * * *

Q: Over the last year, I’ve had horrendous acid reflux that does not seem to respond to any medication. Have you seen this with other patients with FMS? I am worried my esophagus is becoming damaged.

Dr. St. Amand: We do see this, generally speaking. Of course you all know that symptoms no one can really explain are the hallmark of FMS. Once you have had all the basic testing and done all the things the doctor asks you to do, you could observe it but be careful to return to the doctor if you have other unexplained symptoms. Fibro has an effect on every cell in the body.

* * * *

Q: Many doctors are treating subclinical hypothyroid in FM. Your thoughts, please.

Dr. St. Amand: I am an endocrinologist by training and teach this topic at Harbor-UCLA. I do not treat subclinical hypothyroidism. The rare exception would be if a patient feels bad with a normal, but high end of normal, TSH. At that point I might give a small dose of thyroid but I would always make sure the TSH is within normal range. [Note: TSH – thyroid-stimulating hormone – levels in the blood are measured to screen for under- or over-active thyroid. It is a hormone secreted by the pituitary.]

* * * *

Q: I have a TSH of 15 and started [thyroid medication]. Been on guai 2 yrs. Should I be concerned that it’s this low and go to an endocrinologist? Sorry if this is off topic.

Dr. St. Amand: Yes, you need to be concerned. Guai has no effect on the thyroid. Something else is wrong. See an endocrinologist for help, absolutely. A TSH of 15 means that your thyroid is underactive, and it is not low, but high. The TSH works in reverse to thyroid hormone. High TSH means not enough thyroid hormone; low TSH means you are taking too much thyroid.

* * * *

Q: Doctor, do you have any patients who experience a continual weight loss on the guai? I stopped the guai because of the weight loss. I’d like to try it again because it was a success for me. I was getting better with a reversal of all my symptoms. How could I avoid the weight loss? My doctor never experienced this before.

Dr. St. Amand: No, weight loss is not something we see! You could go to our Fibromyalgia Treatment Forum and contact us about the diet. Perhaps we could help you, but weight loss is very uncommon. You might check the side effects of other medications you are taking.

* * * *

Q: How can I improve my exercise tolerance? My muscles tighten up afterwards.

Dr. St. Amand: There is only one way to improve exercise tolerance. Gradually build up your strength. Remember that there is an energy deficit in Fibromyalgia. Supplements or medications won’t help, because you can’t make energy. You have to build more mitochondria (power stations), and you can only do that by slowly and steadily working at it. [See “Planning Your Exercise Regimen” by Claudia Marek.]

* * * *

Q: My son (7) was diagnosed by you a year ago, been on guai, and seeing results. Left thigh is clear! [Note: “The most important site for confirming the diagnosis and establishing the efficacy of treatment is the left thigh,” Dr. St. Amand has written.] He has this mass of gelatin-like area, quite large, over his scapula/trapezius area (shoulder blade/neck/shoulder/back). It doesn’t seem to be going away. Do you think it’s phosphates?

Dr. St. Amand: I don’t know what it is. But what the lumps are in FMS is fluid in the cells…and when the body starts moving out the metabolic debris (phosphates), then the area does become soft and spongy. So it could be a former contracted area that now is clearing out. But without examining it I can’t be sure if this is the case.

* * * *

Q: Do you see many patients who are successful with guai over time, when they must also alternate it with taking an aspirin every other day?

Dr. St. Amand: We do have many patients who take a full dose of aspirin every other day and double the guai on the days they do not take aspirin. So yes, we see success this way. Guaifenesin also has some anti-thrombolitic activity, documented in medical journals, and so this helps prevent strokes too. You can share this with your cardiologist.

* * * *

Q: I understood that aspirin has salicylic acid, so how does this work with the guai?

Dr. St. Amand: It works because aspirin blocks guai 24 hours. So you are actually taking guaifenesin every other day. Your progress will probably be slower (a bit) but you will clear on every other day.

* * * *

Q: Do you ever see patients who you cannot diagnose with FM?

Dr. St. Amand: Yes, we do. Not as many as you would think, because most of our patients now come already diagnosed…know what they have. But I would say about one or two per month we do not have enough to go on to make an FMS diagnosis.

* * * *

Q: If someone comes to you with FM-like symptoms, but you don’t think they have FM, what do you look at first?

Dr. St. Amand: First we do a routine lab panel to check thyroid, diabetes, anemia, lupus, polymyalgia, etc. Or we might think it is simply hypoglycemia and put them on a diet for a few months. But it depends on the patient: age, demographics, etc.

* * * *

Q: And what would be the most likely disease if not FM?

Dr. St. Amand: Depends on the age and sex of the patient. For older women, polymyalgia. For younger, maybe anemia. Thyroid dysfunction, too, would be a common one.

* * * *

Q: I had neck X-rays which showed lots of calcification/bone spurs. Do you think this is from phosphates? Will it improve with guai? I’m 40 now.

Dr. St. Amand: Guaifenesin has no action on bones. Sorry. Just soft tissue.

* * * *

Q: Do you think FMS disrupts the HPA axis? If so, how can guai help this? [Note: the hypothalamic-pituitary-adrenal (HPA) axis represents a major part of the neuroendocrine system that controls reactions to stress and regulates various body processes including digestion, the immune system, mood and sexuality, and energy usage.]

Dr. St. Amand: We think Fibromyalgia affects every cell in the body. All hormones and nerve signals are off…everything functions marginally.

* * * *

Q: Can someone who has had FMS for over 30 yrs benefit from this protocol, and how long would it take?

Dr. St. Amand: We have many patients who start guai at age 60, 70, or older. Yes, they will see some improvement. How much, how fast? I don’t know. Is it worth it? I think so. You don’t know how long you’ll live. (We had a woman who started at 80 and lived to be 101!) I think if you can make progress to feel better, it’s worth it. Ask it this way: If you could feel the way you did 10 years ago, would that be an improvement? If yes, then the guaifenesin is a worthwhile option.

* * * *

Q: I went to the MD today to rule out RA [Rheumatoid Arthritis]. This is the first time I mentioned to her that I’ve been in pain from head to toe and everywhere in between for a while. She did blood work and X-rays. The only part of my body she ordered X-rays on was my shoulders. If the tests don’t indicate RA should I ask about Fibromyalgia?

Dr. St. Amand: Yes, get the results of these tests and if they are negative ask her “Could I have Fibromyalgia?”

* * * *

Q: She also mentioned the possibility of lupus. Could that be a possibility? I don’t know much about lupus.

Dr. St. Amand: There are good tests for lupus – blood tests – and doctors will rule it out or in pretty easily.

* * * *

Q: How much does FMS exacerbate other conditions, like say disc damage…does it make that pain worse too?

Dr. St. Amand: I think the energy drain that is FMS makes everything else worse and vice versa. If you are barely functioning, one more thing can really make your life miserable

* * * *

Q: I have had 3 teeth chip while eating in the past few years. Is this correlated with FMS?

Dr. St. Amand: No, not with FMS. Dr. Flora Stay, DDS, a specialist in FMS and dental issues, has a book out on the subject [ The Fibromyalgia Dental Handbook (2005)].

* * * *

Q: Sometimes my hands and feet are freezing, and the rest of me can be hot. Is this an FM thing, possibly? I know we can cycle hot flashes, but this is nuts!

Dr. St. Amand: It does sound like Fibro, but you should be checked for possible circulatory things as well, of course.

* * * *

Q: My nose is cold, along with my hands. Does this have anything to do with FM?

Dr. St. Amand: It might. Remember the body just doesn’t have enough energy to function well. So there is always something!

* * * *

Q: We read that the FM pain may be result of the nerve pathway becoming more sensitive due to a previous injury and so keep generating pain – can you comment?

Dr. St. Amand: I do not espouse this theory. Mine can be found in my books and website. But we see many pediatric FMS patients who have not had previous injuries, and many people with injuries who do not have FMS.

* * * *

Q: Do you see a trend in ultra sensitivity to caffeine in your patients? If I drink a cola mid-afternoon, I have trouble getting to sleep by 2-3 am.

Dr. St. Amand: Fibromyalgics are more sensitive to everything. It really is the “irritable everything” syndrome. Nothing works right. People are more sensitive and respond poorly to many compounds. What you are describing is a falling of blood sugar. If you cut out caffeine you could avoid it.

* * * *

Q: This is only the second day I have chatted with people about my pain, and it’s very interesting. I haven’t related a lot of things to my pain – including chronic fatigue, poor sleep, and many, many drug allergies.

Dr. St. Amand: Pain is a fascinating topic. A lot of good research being done on the mechanisms.

* * * *

Q: I developed menstrual migraines during the past year (I am 36 years old). Could this type of migraine be from Fibromyalgia, or would this just be a hormonal issue unrelated to my Fibromyalgia?

Dr. St. Amand: These migraines would be unrelated to FMS, in that people get them without FMS. But those with Fibro are more sensitive, and our bodies struggle more. Related in the sense they are in the same body.

* * * *

Q: Are you training any other doctors about the Guai Protocol? Many FMS docs now agree guai helps and use it in treatment but don’t see the phosphate problem as the cause.

Dr. St. Amand: We train any physician who asks us.

* * * *

Q: What is the average age of newly diagnosed patients with Fibromyalgia?

Dr. St. Amand: In our patients it is 34.

* * * *

Q: In surgery, is it “normal” for people with Fibro to respond unusually to anesthesia – either go too deep or not deep enough?

Dr. St. Amand: All abnormal results are possible and we hear this one a lot.

* * * *

Q: Thank you for answering all of my questions tonight. For someone who’s severely underinsured, your book and advice are truly wonderful. I also want to thank Claudia Marek and the other folks who run the Fibromyalgia Treatment Center support group online. Many have reversed with that and your book. Thanks for thinking of those who can’t make it in to see you in person.

Dr. St. Amand: The online support group has members all over the world, and we believe it really helps.

Final Comments

Chat Admin:

Our Live Chat Event with Dr. St. Amand is about to close. We thank him for his generous participation today, and thank you all for contributing to this lively exchange. Transcripts of the chat will be available in our e-mail newsletters and online library.


n Doctor, I want to thank you from the depths of my soul for giving me my life back. I’m not clear yet – I’m 2 yrs in and 5 to go, but life is SO much better! I can walk, be happy, and take care of my home & family now.

n Yes – Guai is a success. I improved so much because of it. I am able to pursue working again. Thank you.

n The guai protocol has been a life saver for me. Thank you so much! Also thank Claudia for me. She responds quickly and courteously to my e-mails.

n I just have to take this time to say thanks a million. No words can express my gratitude for how guai has changed my life. Because of you my son won’t know the suffering I have. My mom started guai too!

Dr. St. Amand:

Thank you all, and you are welcome. Thanks from Claudia too. Believe me, we see the suffering every day and are heartbroken by the stories and experiences. We do what we can do, and are glad to do it. It is our mission and what keeps us going. You can contact us via the Fibromyalgia Treatment Forum (http://Fibromyalgiatreatment.com/board) if you have more questions we didn’t get to!


Note: The content of this article reflects the views of R. Paul St. Amand, MD. ProHealth/ImmuneSupport.com does not endorse this or any other specific protocol as a treatment or cure for FM or ME/CFS. This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, mitigate, treat, or cure any illness, condition, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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10 thoughts on “Q&A Session with R. Paul St. Amand, MD – December 7, 2007”

  1. SusanLeeScott says:

    I would like to inject a note of skepticism. I gave guai my very best try for about three years, including flying out to California (from Virginia) for examination and confirmation of FMS diagnosis by Dr. St. Amand, scrupulous adherence to the no-salicylates regime, attempts to have my body “mapped” for the lumps and bumps, and raising the guai dose to the very highest (I don’t remember now exactly what it was). IT DID ABSOLUTELY NOTHING.
    I am now doing much better taking Effexor XR for pain, which helps my fatigue somewhat (insofar as being in pain makes you tired). This is the only medication I have found in 9 years of FMS/CFS which has helped me at all.
    I am not at all convinced that all of us have the same illness, the FMS is the same thing as CFS, etc. I think Dr. St. Amand raises unrealistic hopes by promising absolutely that you will feel better if you follow his protocol strictly. I did follow it strictly, participated for several years in the guai support group, and all it did was waste time and money.
    For those who get better, bless you. For those who feel better because of a placebo effect, bless you too. I hope it lasts awhile. For those that don’t benefit, keep looking. This is not the be-all and end-all of treatments for a disease (or diseases) that is (are) still poorly understood.


    1. frostylori says:

      better life. Thanks you for finding a solution that may not be a cure but can help me to live a more full enriched life.

    2. liztom says:

      Interesting that guai has antithrombolic features – I had a brain haemorrhage after being on guai for 8 months. (May have been a coincidence of course, but I’m not going back on it.)It had no effect on my ME.

    3. devo433 says:

      Sounds like you needed to raise your dose again. I started reversing at 2400, but later had to go up much higher. Some of our bodies adapt to medication and destroy it in the digestive track, making it unavailable. I now need to take 3200 mgs which is very unusual. Also, do you take some quick release Guaifenesin along with your 12 hour med? This helps beat the gut problems.

      I have gone to see Dr. St. Amand all the way from Rhode Island. I probably would not have figured out to raise my dose so high, by just the book and group.

      I am starting to see more changes in my tight muscles. My chiropractor mentioned recently that I am softening up. I need less visits which is great!

      If I were you I’d try again, and don’t be afraid to titrate higher.

    4. devo433 says:

      I found the Q&A session with Dr. St. Amand very interesting. It never hurts to find out more about your illness. His theory is the only one that makes sense to me, of all the things I have read over the twenty years I’ve had the disease. Over the years I have tried every pill, potion, & therapy possible. This treatment is a little challenging, but it is definately worth it.
      I can actually sit through a whole movie with out major pain. I still have a long way to go, as I respond at a high dose, but the improvements are there, no denying it.

    5. judelew says:

      I was recently tested with Vitamin d deficency, which I found out causes pain. This has just come to attention of my PCP. Have you heard of this? Also, what is your pain manangment plan. I am not doing well at all. I’m homebound most of the time. Winter is so difficult for me. What doctors do you see and are you satisfied with there treatmnet for you? I find today you get so much fragmented care and it drives me nuts.Thanks Judelew

    6. SusanLeeScott says:

      I recommend Jonathan Forester, M.D.’s book {Conquering Chronic Fatigue: Answers to a Vastly Misunderstood Epidemic.} That’s where I got the idea of using Effexor for FMS pain, which worked for me. The book is written from a Christian standpoint, which some people may find strange in a medical book. But his medical approach is not religious as such, and seems to be based on long and careful experience and with no axe to grind.

      I think I have CFS more than FMS, although I do have FMS-type pain. But no tender points and all that.

      My “pain management plan” is simply this: I limit my work schedule to what I can manage, take a nap in the afternoon, walk, do stretching exercises, take Effexor XR 150 mg and one Darvocet at mid-day. (The combination is very constipating, unfortunately, so I have to take Miralax to counteract that.) I use a heating pad before stretches and whenever it seems like a good idea. I take Klonopin for sleep. I also take thyroid medication (synthroid and armour thyroid–the latter helped my sleep a lot when I began taking it some years ago; I haven’t stopped since, so I don’t know if it’s still needed or helpful). I have hypertension, so I take medication for that. If I find I’ve overdone it, I try to get extra rest.

      This is no miracle cure, and it sounds as though you have a worse case than I do, but check the Forester book.

      None of the many doctors I’ve seen have been any use whatsoever. Only my PCP, who has no solutions, but is open-minded and willing to try whatever I come up with from my reading, as long as he doesn’t think it will hurt me.

      My main advice to you (I’ve had this for almost 10 years) is not to give up, keep looking for solutions. Every case is different, and research is going on all the time–although not at the level of funding and pace that we would wish. Don’t believe all the hype from people/advertisements/catalogues/websites that say they have a miracle cure. (I tried a zillion vitamin supplements, and they did absolutely nothing but give me expensive urine.)

      Good luck, Susan

    7. judelew says:

      Thank you so much for your reply. I also have found that my PCP is the best source of medical care and is open to new things if they are not detrimental to my heath. But there again, I have to research and ask. Depression is a hugh issue now, as I have not had a good home support system. Everyone is in therapy now, so I hope there will be some positive results.

      It sound like we are on the same page as far as being in tune with our bodies . I agreed with having Fibro ,there is no magic pill, just finding a combination of things that may work for you. I take Loritab 5 and experience the same problems with constipation and have a fiber tablet to help or ward off that side effect.

      I take Ambien for sleep as my TMJ is so painful, it is the only saving grace. Althogh I read in the pharmuecutal reports it can cause muscle aches…I really would like to stop using it, but I’m in a catch 22 on that issue.

      Thank goodness I have always been a skeptic and have spent very money little on advertised vitimans,etc.

      You mentioned thyroid meds, I assume your blood test indicated abnormal levels? My daughter has Grave’s disease and the doctor is suprised I do not have it, as she is the only one in the famiy that does, to date.

      I recently have tried accupunture and did okay two times ,but the third time I was so ill I’ve been reluctant to try as I don’t want to go through the two day of the toxins getting out of the body and being so sick.

      The TMJ is the most pain I have and there is very few dentist that are really knowledgable. I spent a hugh amount of money on restoration and still have overbite problem . I think they want to blame it mostly on the Fibro, but I feel strongly feel if I could get a good occlusion ,therapy and trigger point injection as part of the whole picture, I would have much improvement in thie area. The Loritab 5 helps very little with this pain .

      I know I have wrote a book about me, but hoping others will read and provide some imput…I will get the book you mentioned. Thank you so much for sharing your information. I hope someday before my time is up here on earth they will find a cure,but if not I hope for a cure for those that may follow and have suffered needlessly. I will continue to look for an answer to this disease also

      Good Luck in your search for a cure.



      I just ordered the Gaui,but until my vitamin D is back to a normal level ,I’m reluctant to try.

    8. Bluebottle says:

      In 20 years of severe M.E. & fibromyalgia I have tried many different treatments, some of them much more expensive than this (the only money Dr St Amand will ever make from me is the royalties to his book). The guaifenesin protocol is the only treatment that has made any difference. It is not any easy thing to do but for me it is worth it.There are no doctors that offer the protocol in my country; I wish there were as my progress might be faster with medical supervision. We do have a UK on line support group that is very helpful.

      People often post that they are taking guaifenesin & it isn’t helping; they fail to realise that the book has to be followed exactly & salicylates avoided. Some people try the protocol for a few months & then complain they aren’t better. This is not a quick fix! It will take me a minimum of five years.

    9. JuanitaStone says:

      I now live in San Diego near my son. My no. Is 858 673 7597. Hoping to get in touch. Allan passed almost two years ago. I have had quad bypass and back on guai with not too much success. But mostly I just
      wanted to get in contact with an old friend.

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