Alternative scenarios when taking Guaifenesin
Written by Tesa Marcon

The Guaifenesin protocol is a theory and as such, still considered by GG and many people to be experimental.  Not enough is known about the process to say anything factually.  All we know is that it works either fully for some people, to some degree for others and for some, not at all.  My own experience is that there was exacerbation but no good days or improvement overall.

The following is the theory of how it works according to my understanding of the written protocol , along with some of my own thoughts:

1. A *therapeutic dose of Guaifenesin

2. Non-therapeutic dose

3. Full blocking of Guaifenesin

4. Partial blocking of Guaifenesin

5. Stress impact on Progress

5a. Guai treatment makes the body work harder and can invoke hypoglycemic symptoms

6. A dose above one's lowest therapeutic dose

6a. Calcium, if taken with meals, binds to phosphates

7. Doses above a therapeutic dose

Summary of Above

Tesa speculates regarding infections (i.e., possible exacerbation of symptoms [Herxheimer response] due to various infectious agents finally being killed as the block of ATP is removed by guaifenesin)

Tesa speculates regarding another way that purging of phosphates might take place

Various Protocols for FMS, which includes the possibility of infections

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1.  A *therapeutic dose of Guaifenesin

• occupies all the receptors in the kidneys
• the kidney tubules are opened   
• phosphates in the bloodstream are carried out through the kidneys
• this allows (activates) excessively accumulated phosphates, and perhaps lesser excesses of oxalates and calcium (which are blocking the formation of ATP [energy]), to be released from their storage within the cells' mitochondria, out into the bloodstream
• they are then carried out through the kidneys 
• exacerbation of symptoms, called a 'cycle', is occurring and you are in the process of recovery.  Exacerbation of symptoms is caused by:
  1. extra fluid entering the cell to to aid in carrying out the excess constituents, and
  2. sometimes the flow into the bloodstream is such as to exceed the kidney's ability to purge. Mini-deposits could emerge all over the body which will probably invoke flu-like aching. This causes the symptoms of reversal to last varying lengths of time, until the kidneys catch up, cleanse this batch and end the cycle. It is possible that, by titrating perfectly with QA guai, one might be able to lessen the occurrence and invoke a less stressful cycling.

It is conjectured that everyone has a personal range of doses within which they are able to purge.  Outside those lowest and highest doses recovery level purging does not occur and no improvement of symptoms takes place.  While it's crucial not to go too low, it's also important to avoid too high a dose.

2.  A *non-therapeutic dose (Lower than lowest therapeutic dose [LTD])

• will occupy some receptors
• the kidney tubules will perhaps open to some degree
• some phosphates may be released from the mitochondria into the bloodstream
• some will be carried out through the kidneys 
• may cause some exacerbation of some symptoms
• may fool us into thinking it is enough for recovery to occur.

According to Dr St Amand, if the dose isn't enough to clear the left thigh then this is not enough release of excess phosphates to engender recovery and the person will continue to spiral deeper into FMS.  This, however, has not been borne out by the experiences of many Guai-Support members.

Dr Greg Penniston, who uses symptoms and mapping in his practice, finds that many people can cycle on lower doses of quick-acting (QA) guaifenesin than long-acting (LA).  He also notes that improvement can take place on either type before lumps are noticeably diminished.  He doesn't rely on the left thigh scenario to ascertain dose and says his patients recover very successfully.  GG believes this is satisfactory and doesn't entail reaching doses that cause intolerable pain and suffering.  Keep in mind that we are all individuals and thus may react differently.  Discuss your progress on the mailing list so that we can all make suggestions to help keep you focused on dose experimentation along with possible blocking issues (GG is a topics mailing list which allows you to discuss all symptoms and treatments under the appropriate topic).

3. Full Blocking

• Salicylate(s)¹ occupy the receptors 
• no Guaifenesin is taken into the receptors
• the kidney tubules do not open
• no stored phosphates are released from the mitochondria into the bloodstream
• still accumulating phosphates, no recovery, FMS progresses

^"..If anyone gets totally blocked by anything each of us, however responsive, is partially blocked by the same item."  "Susceptibility to blockage seems genetically determined and highly variable.  Some patients are blocked by tiny amounts of offending agents, yet others improve despite moderate usage."  (Dr St Amand, GG Archives, October 16, 2000)
"One could take twenty guaifenesin per day and not overcome a sufficient amount of salicylate."  (Dr St Amand, GG archives, November 4, 1997)

Blocking is not something that is easy to determine at any time but most especially once one's cycles of exacerbation lessen.  There will come a time when blocking tests will no longer work satisfactorily.  One could be using a blocker and not know it till they have regressed far enough. 

4.  Partial Blocking

• salicylates occupy some receptors
• kidney tubules open to some degree
• some phosphates are released from the mitochondria
• some phosphates are carried out through the kidneys
• depending on the levels of salicylates occupying the receptors, the amount of phosphates excreted may exceed the amount stored and a very slow recovery could be possible, i.e. recovery should correspond to the amount of phosphates released.

A blocking test doesn't typically help detect partial blocking although it may do in some cases.

Blocking is not something that is easy to determine at any time but most especially once one's cycles of exacerbation lessen.  There will come a time when blocking tests will no longer work satisfactorily.  One could be using a blocker and not know it till they have regressed far enough. 

5. Stress impact on Progress

"Stress has nothing to do with the kidneys except very indirectly. The brain has more energy--producing stations (mitochondria) ounce for ounce than any tissue in the body. Under stress, it will burn considerable energy robbing Peter to pay Paul as it were, but nothing comparable to exercising muscles. Stress does not often stop or actually reverse benefits of guaifenesin. We have seen what appeared to be slowing down of purging but usually nothing major." (R. Paul St. Amand, e-mail, April 10, 2002)

(Some people have reported that stress, both through another medical condition or emotional causes, has completely stopped their recovery progress and some have even regressed.  Several of those have reported confirmation by mapping.)

5a.: Guai treatment makes the body work harder and can invoke hypoglycemic (HG) symptoms.  When recovery has taken place the HG can also disappear.  Some may continue to experience the HG symptoms during stressful times and perhaps when premenstrual.  Those who continue to experience any of the insulin related challenges (e.g., Hypoglycemia, Insulin Resistance, Diabetes, Diabetes Type ll [Syndrome X] will need to continue addressing those conditions.  GG believes that insulin resistance is more prevalent even in those who do not suffer from overt symptoms and recommends a carb or amylose restricting diet.  At least as an experiment.  I believe that insulin related conditions are part and parcel of Fibromyalgia (a misnomer if ever there was one!) along with all its other systemic symptomology.

6. Doses Above the Lowest Therapeutic Dose (LTD) but within one's personal therapeutic range)

• will stimulate the kidneys to work even faster causing the body to purge even more phosphates
• some phosphates may be re-stored temporarily around the body while the kidneys catch up (this can also happen on one's therapeutic dose)
• these temporary sites should clear rapidly
• this process will speed up one's recovery time but often make the FMS symptoms intolerable - ONLY do this if you can tolerate the increase in symptoms as it can cause added stress due to pain and fatigue to the body.  This can also lead some to dropping the protocol (as can too low a dose or a guai product that is not the correct one for the individual).
• People with very high pain thresholds or who are on narcotics or anti-depressants can often tolerate high doses for long periods of time. 
• As the guai invokes action in the deeper, more difficult to clear, layers some might like to increase above their clearing dose.  Athletes often have high pain thresholds and may need to look to the brain symptoms for evidence of purging/cycling.
• Alternating between one's lowest and highest therapeutic doses may kick start what seems like stalled progress or it might speed progress for one who cannot tolerate the exacerbation of symptoms for very long at higher doses (e.g., coast along at LTD but raise dose for a day or more now and again).

6a. Calcium, if taken with meals, binds to phosphates in the gut and carries some of it out of the body through fecal elimination thus preventing its absorption.  How much this exacerbates symptoms is individual.  I assume that the less phosphates being absorbed and going into the cells indicates the more that would be purged from the cells with one's usual guai dose.  Whether that allows one to lower their dose would depend on experimentation.  See:  The Use of Uricosuric Agents in Fibromyalgia, St Amand, September 1996). 

7. Doses Above a Therapeutic Dose (above highest therapeutic dose [HTD])

• will not invoke any further response, i.e. no more phosphates are released from cells.  This is said not to invoke further release of phosphates or other excess constituents and no further pain should be felt.  In fact not feeling any further exacerbation should indicate you have gone beyond your personal therapeutic dose.

In summary re the above, at any dose, even a therapeutic one, we are told that the kidneys may take some time to catch up to the amount of phosphates released from the cells and thus exacerbation of symptoms occurs until they do.

At this point a rest period might ensure for some and then the cycle starts again. Some people don't have the intense exacerbation and thus may go straight into feeling good. Obviously this means the phosphates released from the mitochondria are carried out through the kidneys smoothly with no backing up at all.  Perhaps one might feel a tolerable worsening of FMS symptoms due to water entering cells to flush out the phosphates as the cells swell and push on nerves in the area.  Later exacerbation of symptoms may ensue.

From Diagram of kidney phosphate control, page 57 of 'What Your Doctor May Not Tell You About Fibromyalgia' by R. Paul St. Amand M.D. and Claudia Marek:

a. Blood bring inorganic phosphate Pi to the kidney.

b. Pi is filtered through the glomerulus and is delivered to the tubule.

c. Pi can also be delivered directly through the blood and through the kidney cells into the tubule.

d. Pi can go two ways from the tubule

l. Out into the urine.

2. Re-absorbed from the tubule into the kidney cell and back into the bloodstream.

This is how kidney cells "decide" to keep or eliminate phosphates according to what the body needs.

Tesa speculates regarding infections
I wonder if after guaifenesin has removed enough of the phosphates blocking ATP, at least some of the various infectious agents that the immune system has not 'seen' (or been too sluggish to accomplish) may finally be killed, even without taking antibiotics or other treatments for the purpose.  If this is the case then at least some of the exacerbation felt during the treatment may be able to be put down to a Herxheimer response (i.e., the response felt when bacteria are killed by the immune system - it causes them to spew metals and other toxins during the dying process).  This may be the reason some people cannot get any improvement from guaifenesin but tend to go on feeling an intolerable exacerbation of symptoms with none of the recovery.  These people may also need to take treatments for binding metals and other toxins in order to carry them out of the body. 

It may be that some people may need a treatment specifically to kill infections to set them on the road to recovery.  Perhaps various options are best utilised either at different times or in tandem with each other.  Also see What is a Cycle.

Tesa speculates regarding another way that purging of phosphates might take place

An online textbook has this chart
Effects of 1,25?D (1,25?dihydroxyvitamin D) on Mineral Metabolism
Bone
Promotes mineralization of osteoid
Increases resorption at high doses
Kidney
Decreases calcium excretion
*Decreases phosphorus excretion* (i.e., increases phosphorus retention)
Gastrointestinal Tract
Increases calcium absorption
Increases phosphorus absorption
Blood
Increases calcium
Increases phosphorus

Role of 1,25-D in maintaining phosphorus
Y. Tanaka and H. F. Deluca
PNAS | April 1, 1974 | vol. 71 | no. 4 | 1040-1044
http://tinyurl.com/pxlg6

Role of 1,25-dihydroxyvitamin D3 on intestinal phosphate absorption in rats with a normal vitamin D supply.
J Clin Invest. 1977 Sep;60(3):639-47.
FULL TEXT: http://tinyurl.com/le3q4
PMID: 893667 [PubMed - indexed for MEDLINE]


I was directed to this table by someone who deduced that this meant absorption of 1,25D increases phosphate retention, i.e., infection by cell wall deficient bacteria (CWD) = raises 1,25D¹ = phosphate retention (increased phosphate inside cells).

From that I deduce that limiting 1,25D would not only affect the life of CWD bacteria but would also increase phosphorus excretion.

This all indicates to me that limiting natural light and supplements containing Vit D, and to a lesser extent, foods containing Vit D, while also taking guaifenesin would increase cycling (purging more phosphates).  In some cases that might make the journey rougher so it might be best if one or the other were adjusted till things settled down a bit.

I must add once again that I'm speaking as a lay person only and my theories should be viewed in that light. There may be glaring holes in my thinking.


1 Trevor Marshall's TH1 theory

The Marshall Protocol For FMS
The Marshal Protocol In Layman Terms

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