Among all the theories about what causes fibromyalgia, one theory however is unique, because it makes us understand how a particular chemical imbalance could cause, by its own, all the symptoms of the disease.
The phosphate retention theory has been proposed by Dr. Paul St. Amand to explain the underlying cause of fibromyalgia. It also provides an explanation of how GUAIFENESIN works, why it is an effective treatment for all the symptoms of fibromyalgia, and why its action is blocked by the salicylates.
Fibromyalgia is nowadays known as metabolic disease. Fibromyalgia been of genetic influence, it would make sense that the metabolic underlying cause of fibromyalgia is the result of a genetic defect. Dr. Paul St. Amand believes that fibromyalgia is caused by an abnormality in phosphate excretion by the kidneys due to a genetic defect. Because GUAIFENESIN treats successfully all the symptoms of fibromyalgia, it seems evidence that it addresses to the underlying cause.
The various defective genes adversely alter the renal handling of phosphate. In people with defective genes there is, at birth, a minuscule retention of phosphate. Dr. Paul St. Amand believes that all the symptoms of fibromyalgia are due to a gradual accumulation of excess phosphate in the cells of the body due to an inherited genetic defect in the kidneys. It doesn't mean that the individual suffers from a disease of the kidneys, but that there is one specific defective biological function of the kidneys that creates all the disorders. The age at which a person begins to express symptoms is dependent upon the rate at which phosphate is being stored and where it is being stored.
• The role of phosphate
Phosphate, referring to phosphorus, is an essential mineral in the human body. If a person does not eliminate phosphate normally through excretion via the kidneys, it can slowly accumulate and cause problems. Cells utilize energy in the form of adenosine triphosphate (ATP) - the universal currency of energy- to perform metabolic chores and the other crucial tasks that are vital to our existence. Most of the phosphates are located in the cells. Although the kidneys of fibromyalgics are still excreting some phosphate, they are doing so at a slightly less than optimum rate. Back into the bloodstream, the phosphates are forced to reintegrate the cells in the body where they will be gradually stored. Retention of phosphate interferes with energy formation in affected cells. The inability to form adequate energy in the affected tissues explains the entire spectrum of the illness. The function of the cell is compromised. If there is insufficient energy, "nothing works right".
Symptoms are depending on where the excess phosphates are being stored. For example, mental fogginess, depression, sleep disorders would indicate that excess phosphate is being stored in the brain; critical levels in muscles and tendons cells would explain the location of pains; irritable bowel symptoms could be due to phosphate storage in the digestive tract; hormones disorders could be due to an impact on one or several glands of excess phosphate.
• The role of mitochondria
Energy is supplied to cells by mitochondria, little intracellular units which power every cell in the body, in form of ATP (adenosine triphosphate). It is used for all sorts of biochemical jobs, from muscle contraction to hormone production. Accumulation of phosphate in the cell due to an inherited inability of the kidneys to excrete phosphate normally, causes a mitochondria failure, and this results in poor supply of ATP, causing pain, fatigue, allergies and autoimmune disturbances, poor digestive function, hormone gland failure, slow liver detoxification, all fibromyalgia symptoms. (click for more)
• The findings on muscle biopsy
Biospies on trapezial lesions in fibromyalgics have been performed. There are marked differences from control biopsies obtained in healthy individuals. Decreases of 70% in ATP and 21% in phosphocreatine, the reservoir for high-energy phosphates, were discovered. Significantly, not all fibers within a given specimen are affected. This confirms that there is no innate defect in the muscle itself. Another study found lowered ATP levels in the red blood cells of fibromyalgics.
• The role of calcium
Calcium has a very important function inside all cells. It is together with calcium that the excess of phosphate initiate metabolic changes that produce the symptoms of fibromyalgia.
To maintain electrical equilibrium inside the cell, the two negative charges of each phosphate ion are counterbalanced by two positive charges of calcium. Whenever excess phosphate builds up in cells, excess calcium does too.
Calcium normally is present inside the cell in the endoplasmic reticulum, the cell's storage bin. When a stimulus arrives, the request for action is signaled to the endoplasmic reticulum, which releases calcium into the main fluid chamber of the cell, the cytosol. The amount released is just sufficient to perform the desired task, no more and no less. Calcium is the final battery terminal, the ultimate agent that says to a cell: "Do it! Do it!" The cell is instructed to act and to continue performing until calcium signaling stops. To stop this signal, cells have enzyme pumps, called ATPases because they use ATP as source of energy (as any function performed by the body), either to pump back calcium into storage in the endoplasmic reticulum or to extrude it from the cells.
Since energy needs are poorly met in fibromyalgia because of insufficient ATP, calcium accumulates in the cytosol where it should not be any more, where it is no longer needed. As a result of phosphate in excess in cells, affected tissues are in constant stimulation, yet continue in their excessive effort to function day and night to the point of exhaustion. Only calcium is able to provide this continual stimulation in the cytosol of the cell. Body cells are designed to rest between metabolic functions. It is this lack of rest, or a low quality of rest, that results in all the symptoms of fibromyalgia. In various degrees, it affects, or will affect all the cells of the body.
• Lumps and bumps: the MAPPING
The cells storing the excess phosphate not only creates symptoms throughout the body, but also respond by retaining calcium, water and other chemical substances which constant accumulation creates lumps and bumpsfound when we palpate muscles, tendons and ligaments on people suffering from fibromyalgia. It was William Balfour, M.D. of Edinburgh who in 1816 first mentioned the occurrence of "indurated nodules" associated with "rheumatism".
Mapping, a term used by Dr. Paul St. Amand, is a method of palpation of these swellings (lumps and bumps). Their location and size which will be marked on a drawing.
Fibromyalgic patients don't always meet the minimum 11 tender points out of 18 required for the diagnosis. Mapping is an alternative to the tender points.
The lumps and bumps may be easily felt, but can require an experienced doctor to be found.
The mapping, in addition to providing confirmation of the diagnosis of fibromyalgia and to validating patients complaints, is used to determine when the therapeutic dose of GUAIFENESIN has been reached. The lumps and bumps diminish in size and/or numbers, when compared to the original map and successive ones. GUAIFENESIN "cleans" the lumps and bumps. The extracellular liquid when getting into the cells creates more pressure and pain according to its incidence on the size of the lumps and bumps. When some liquid is expulsed, their size decrease, as well does the pain. In fact, the bloodstream meets qualitative and quantitative (volumetric) fluctuations according to the importance of the cellular draining and the number of affected sites. GUAIFENESIN efficacy in fibromyalgia is due to its action on the kidney filter by facilitating the draining of all the body cells. In fibromyalgic, all depends on the ability of the kidneys to eliminate the phosphates, allowing a purge of all the body cells, and thus the restoration of an adequate ATP for proper metabolic functions of all the biological systems.
• The major role of the kidneys
The urine is the most important route for elimination. The urine is formed from the blood after been filtered through millions of kidney filters, each one called glomerulus. The primitive urine is formed in the proximal tubule following the glomerulus. The urine will then flow into bigger tubes and from them into the main excretory canal.
The proximal tubule is edged with cells, like a corridor in a hotel leading on both sides to the rooms. Those cells have the ability either to let the chemical substances carry on their way in the urine and be definitively eliminated, or to reabsorb some of them, allowing them to get into the kidney cells (placed next to the tubule cells) and from there, through the kidney blood-vessels, back to the general bloodstream. Another route for elimination, avoiding the glomerulus, allows a small amount of blood to be filtered directly through the kidney cells to the tubule cells, and from there into the tubule itself.
The kidneys control the level of phosphate in the blood. The blood transports phosphate to the kidney, which either excretes the phosphate into the urine or retains it and send it back into the bloodstream, depending on the body needs and the ability of those renal tubular cells to excrete it into the urine. These actions are each controlled by different enzymes. Normally an enzyme is present in the renal proximal tubular cell, which excretes the phosphate into the urine. In fibromyalgia this enzyme is defective. Normally an enzyme allows the entry of phosphate from the bloodstream into the glomerulus filters. In fibromyalgia this enzyme may be defective. Another enzyme allows some blood to be directly filtered into the tubular cells (avoiding the glomerulus filters). In fibromyalgia this enzyme may as well be defective.
Fibromyalgics have totally intact kidneys except for this unique problem. Their kidneys cannot excrete phosphate rapidly into the urine due to the genetically defective enzymes which interfere with the normal physiological process. A lot of diseases are due to defective enzymes from genetic origin. The fibromyalgics are unable to open wide enough the holes of their filters to excrete all the accumulating metabolic debris, especially the phosphate. The phosphate will be reabsorbed into the blood, but the body does not store excess phosphate in the blood – let us learn why.
• Why blood tests will not show high levels of phosphate?
The body does not tolerate phosphate accumulation in the blood as it is a reciprocal to calcium. Thus if phosphate rises, the calcium must necessary fall, and the body does not tolerate this either. The four parathyroid glands in the neck (behind the thyroid gland but without relation to it) then respond by secreting parathormone (PTH) which attempts to maintain serum calcium levels at a constant level. In fibromyalgia, the phosphate that cannot be excreted in the urine, nor be stored in the bloodstream is transferred to the bones. When the bones become saturated, phosphate is pumped and forced to be reintroduced into cells around the body, and not only in the previous affected fibromyalgic cells. Water enters the cells to dilute the concentration of phosphate and its accompanying mineral calcium, avoiding crystallization. Swelling occurs, symptoms resume.
Each cycle ends up, ruled by the present metabolic activity. Each cycle is followed by a rest period. The process maintains a vicious cycle of the disease. The permanence of the symptoms depends on the quality and the duration of these rest periods. Initially some tissues will be sporadically affected. More and more lumps and bumps will appear with the time. As the energy production will become permanently defected, the rest periods will be shorter, the symptoms will get worse and more or less permanent, with more and more symptoms. The severity of the disease depends on the duration of involvement.
• In summary: the cause of this phosphate retention is believed to be the result of an inherited inability of the kidneys to excrete phosphate normally. Phosphate excesses greatly impedes the formation of adequate energy (ATP). This dysfunction leads to an excess of calcium that stimulates the cell to keep working. The ensuing cellular malfunction is actually an overworking and energy-deprived syndrome.
Only restoration of normal ATP production can reverse this errant metabolism. GUAIFENESIN is designed to restore energy production by releasing the body from biochemical blockage which is genetic in origin and specifically targets the kidney.