Heparin, guaifenesin, whey, celiac, NMH, Raynaud's, migraines, etc.

[Guest guest]

In the following short paper, I will try to show a connection between all

the things I mentioned in my subject line, and more.

In the 1990s, Dr. Couvaras, an infertility expert, who was using heparin

for fertility problems, discovered that it helped many symptoms of his

patients who also had CFS and fibromyalgia. Heparin is an anticoagulant that

prevents platelet aggregation. While I've seen people with CFS trying this

therapy, I haven't noticed much attention being paid to it in fibromyalgia

world (FWIW, Dr. Couvaras posted a message to alt.med.fibromyalgia in

1997 about his discovery, but obviously no one paid attention to it back then

either).

However, I became interested in it when I was researching the use of

guaifenesin for fibromyalgia. Dr. St. Amand recommends that drug, because he

found that drugs that increase urinary uric acid, i.e. uricosuric drugs,

were helping his fibromyalgia patients. Previous to guaifenesin, he used both

anturane and probenecid. He doesn't believe that it's the uric acid that is

making a difference, but something else being excreted, which he hypothesizes

to be phosphate. On the other hand, all these drugs also share another

ability, which is an anticoagulant effect. In fact, other known uricosuric

drugs similarly have both effects, such as aspirin. If different

anticoagulants can help both CFS and fibromyalgia, even ones like heparin

which are not uricosuric, it's possible that there is a more general effect

at work.

One possibility is that platelet aggregation is known to cause an increase in

plasma serotonin, due to the fact that platelet activation causes a release of

serotonin from platelets. Many conditions are now being recognized as being

influenced by serotonin, such as IBS, headaches, hypoglycemia, asthma,

Raynaud's syndrome, and blood pressure problems like Neurally Mediated

Hypotension, all conditions commonly found in people with fibromyalgia/CFS.

Some of these conditions are either being directly affected by the serotonin,

or are being exacerbated by the vasoconstriction effect caused by serotonin.

And a recent study has coorelated levels of some fibromyalgia symptoms with an

increase of plasma serotonin levels, and a decrease in serum serotonin. As

an aside, serotonin disturbances have also been found in celiac disease, which

might account for the significant overlap between celiac and fibromyalgia.

And platelet activation also causes a release of other substances which might

further cause some of the other symptoms seen in fibromyalgia/CFS. For

example, there is a release of ATP, and thus this might be the reason for

reduced ATP in red blood cells.

This is still only a hypothesis. But if one wanted to look for causes of

platelet activation, there are many possibilities. Two that immediately come

to mind are low levels of magnesium and low levels of glutathione and thiols.

The latter is interesting, because there are a number of people using a

combination of both guaifenesin and whey supplements.

And it could be there are a combination of different factors involved. For

example, people with diabetes often have hypersensitivity to platelet

aggregation factors for a number of possible reasons, so it's likely that the

same holds for people with fibromyalgia or CFS. In diabetes, arginine levels

are low, and arginine supplementation has been found to help. In diabetes

with insulin resistance, there can be platelet resistance to nitric oxide,

which normally would inhibit platelet aggregation. And since insulin

resistance has often been mentioned in relation to fibromyalgia and CFS, one

might wonder if this situation also is present. This might explain the

paradox of the possibility of there being hypercoagulation, while there is

also evidence that serum nitric oxide levels are elevated. The effect of

nitric oxide could be blocked. In fact, it should be noted that platelet

activation can trigger nitric oxide synthesis, since the release of platelet

ATP is known to stimulate nitric oxide production.

Not all anticoagulants affect platelet activity in the same way, so it's

possible that if one doesn't work, another one might. For example, the

uricosuric drugs appear to be able to reverse renal disfunctions which are

caused by platelet aggregation. This ability might actually be the reason for

phosphate excretion being seen by Dr. St. Amand. Renal impairment occurs in

more severe cases, due to reduced renal plasma flow, which happens to be a

major reason for phosphate retention. However, some studies show that heparin

has very little effect on certain renal problems as compared to other

antiplatelet drugs that also are uricosuric, such as aspirin.

Guaifenesin also has a known skeletal muscle relaxant effect, which could

be useful. On the other hand, this property can result in side effects at

high enough doses in some people. Not to mention guaifenesin's expectorant

effect, which while being useful, can also cause side effects at high doses,

since it's effect is due to irritating gastric linings. Also, in many

people, guaifenesin is metabolized very quickly from the blood, in which case

very high doses would be required to see an anticoagulant effect. This may

explain why some people do take much higher doses than others. But side

effects at those high doses might prevent some people from using it at those

levels. Plus, very little is known about other urinary excretion effects of

guaifenesin, as few studies have been done.

For more information about guaifenesin, and some links to studies that discuss

some of problems associated with serotonin, see here:

http://web.mit.edu/london/www/guai.html

I have posted my ideas on several other mailing lists already, and to some of

the doctors involved. I decided to post it here after hearing from someone

that a lot of people here are using the heparin treatment. Plus, I've updated

it a bit in the last few days.

Mark London

MRL@... (and no, my work at MIT has nothing to do with this)