Editorial Note (2006): With regard to salicylate content, there may be more up-to-date information on other guaifenesin related sites (e.g., http://guaidoc.com). For an update on my current view on guaifenesin and on what I now believe is a more effective approach to chronic fatigue syndrome and fibromyalgia, see the transcript of a talk I gave before a Support Group in 2005. I give an overview of what has helped me most, with an emphasis on a new approach, called the Marshall Protocol (MP).
This article discusses “natural” therapies and divides them according to whether or not they are likely to contain significant amounts of salicylates. This division is important because there are numerous people who should avoid salicylate intake. These include fibromyalgia patients using Dr. R. Paul St. Amand’s guaifenesin treatment approach, those with hemophilia and other bleeding disorders (including those on coumadin), and people with salicylate hypersensitivity or childhood fevers. Later sections of the article give further information on many of the natural treatment methods and identify other products and foods that may be significant sources of salicylates. Some rules to help determine whether a supplement contains salicylates and an example of the product choices of one fibromyalgia patient are also included. Some sections give additional information more specifically designed for fibromyalgia patients being treated with guaifenesin. For these patients, it is important to stress that there are many natural treatment options that can be used at the same time as guaifenesin. Since staying on the guaifenesin treatment on a long term basis is important for ultimate success, it is hoped that this information will prevent these patients from stopping their guaifenesin treatment too early due to the lure of herbal treatments containing hidden salicylates. (Note: R. Paul St. Amand, M.D. has reviewed the information on guaifenesin treatment, salicylates and the hypoglycemic diet and verifies that they are in agreement with his current knowledge of those subjects, but he does not use or endorse the “alternative” therapies mentioned. See Addendum for more specific information on Dr. St. Amand’s views on adjunctive, nutritional and symptomatic therapies for fibromyalgia).
Part A. Introduction
Although treatment of symptoms or infections with prescription medications certainly can be useful (e.g., levsin for irritable bowel syndrome, 1-20 mg doxepin and/or 2-10 mg Ambien for sleep, neurontin for neuropathic pain, diflucan for yeast infections), many people also want to use more “natural” therapies, like herbs, vitamins, minerals, amino acids (we use the term “natural” in a broad sense to include many dietary, nutritional and alternative treatments). There are a number of situations in which salicylates must be avoided , like hemophilia and other bleeding disorders (including those on coumadin), salicylate hypersensitivity, flu-like illnesses in children and fibromyalgia when being treated by guaifenesin. Thus a list of treatments has been developed and divided into salicylate-containing and salicylate-free therapies. The task was not as easy as it may seem because all plants produce salicylates to varying degree. Even the manufacturers are not generally aware of how much salicylate is in their product if it came from a plant source. Although there are quite a few treatments one must not use in order to avoid salicylates, there are many more salicylate-free alternatives that may have similar or sometimes superior levels of benefit. In some ways, many of the salicylate-free choices are more natural than the herbs. Salicylates and many of the active ingredients in herbs have drug-like effects, albeit often at a lower level, due to relatively low doses. On the other hand, the majority of the salicylate-free alternatives are actually attempting to correct deficiencies or to increase the levels of natural constituents of the body that are necessary for its optimal function. In some cases, research studies document the deficiency and show the supplement or treatment’s ability to correct it. Another advantage of the salicylate-free choices is that they are generally less likely to evoke hypersensitivity reactions since they are usually highly purified substances that are identical to substances within the human body, like vitamins and minerals, for instance. However, it should be noted that for highly sensitive individuals, adverse reactions to the salicylate-free alternatives can still occur. For example, reactions to charcoal, calcium citrate, calcium lactate and some types of vitamin C have been observed.
After the introductory information and general cautions in this section, Part B will provide an alphabetical listing of disorders and/or body systems that specify supplements that contain salicylates, followed by a listing of other therapies that probably do not contain significant salicylates. A few prescription and over the counter medications that do not really fit in the “natural” category will also be included. Part C will provide some further information and cautions on some of the listed supplements and further information on the low carbohydrate diet, allergies and sensitivities. Part D will provide information on finding knowledgeable physicians, laboratories, sources for supplements and helpful newsletters, and a reference section. Part E will also provide information on other products and foods that contain significant levels of salicylates. Part F will consist of questions and answers regarding the power of salicylates to block guaifenesin treatment of fibromyalgia. Part G will list items that are questionable and discuss general criteria for trying to determine if a supplement is salicylate-free when the actual salicylate levels have not been measured. Readers are invited to share any knowledge they might have about these supplements. Part H will give an example of the author’s personal choices of salicylate-free treatments and products, for patients who may feel overwhelmed by all the choices and want a simple point of reference. These choices should not be considered to be an endorsement of these brands. It should be noted that neither the author nor CISRA have any financial connection to any supplement or drug companies, laboratories or doctors. In the March 1, 1999 update, an Addendum with Dr. St. Amand’s views on adjunctive, nutritional and symptomatic therapies for fibromyalgia has been added.
It should be emphasized that inclusion in the table does not mean an endorsement of these treatments. For fibromyalgics using Dr. St. Amand’s guaifenesin treatment approach, it should be noted that he has not been using the listed treatments in his patients, except for the low carbohydrate diet and a few prescription and over-the-counter medications. Neither should one assume that all treatments are safe for everyone (e.g., iron, if already in excess, or hormones or their precursors, like DHEA–some cautions will be mentioned, but not all can be covered). Anyone considering using these treatments should discuss them with a physician who is knowledgeable both about the treatment and their particular medical history. It is highly recommended that readers also utilize the sources mentioned at the end, as well as others, to become familiar with the continually evolving evidence regarding their efficacy. For many of the treatments, the information is still largely anecdotal. With the exception of a few prescription and over-the-counter items (e.g., antibiotics, Nystatin, Diflucan, thyroid, cortisone, fludrocortisone, kutapressin, NSAIDS, Zovirax, Fosamax, Didronel, Benadryl, Tylenol PM and alpha-interferon), the FDA has not evaluated these products, and quality may differ depending on the manufacturer. Caution is advisable, and it is probably wise to start with smaller doses. The treatments are not listed in any particular order. It may be helpful to occasionally stop a supplement to test whether it is really helping, but this should be discussed with one’s physician first. Also, one should be aware that hypersensitivity may develop gradually over time, and an interruption in the use of an item can usually uncover the hypersensitivity and, in some cases, can produce withdrawal symptoms, like headache, fatigue and insomnia. Many of these supplements are costly, and it seems wise to take only the supplements that truly help or for which there is good evidence that they are needed. With the added problem of salicylate avoidance, it seems especially desirable to keep supplement use to a minimum. In general, a healthy skepticism is warranted and it is wise not to allow one’s expectations to be raised too high, since claims often exceed the benefit the average user will receive.
Certain multivitamin and multimineral formulas contain various plant extracts such as bioflavonoids, milk thistle, horsetail or grapeseed extract, silymarin, or pycnogenol, so ingredients must be carefully checked. Also, one should avoid nutritional supplements with a base of concentrated plants or herbal extracts. Items labeled as “natural” should be investigated further, to be sure they have not been extracted from a plant and thus be more likely to contain hidden salicylates. Synthetic substances may often be preferable when trying to avoid salicylates. In general, supplements advertised as hypoallergenic (e.g.,Twinlabs, Allergy Research Group or Nutricology brands) tend to be the purist and have less likelihood of added ingredients with hidden salicylates. Although items in the salicylate-free column should be fine, one should still check the labels for added ingredients that are plant-based since manufacturers differ. This will be of special concern for chewable or sublingual supplements to which artificial flavorings made of salicylates may be added. One should check again when buying new bottles, especially when changing brands. Many brands use ingredients like cellulose, stearic acid, magnesium stearate and dicalcium phosphate as fillers. So far, there is no evidence of any problem with salicylates in these. It should be remembered that if there is any doubt, it is best to seek an alternative product that is more certain to be salicylate-free. Inclusion in the table is not meant to imply any guarantees regarding lack of salicylate, but is just the best information we have at present. Information will be updated periodically, as more experience is gained and as new products come into use. It should be noted that patients who are allergic to salicylates will probably be more sensitive to salicylates at lower levels than guaifenesin users or people with bleeding disorders. See Part G for a description of the general rules used to determine the category for each particular supplement, as well as a list of some supplements in the category of questionable salicylate status. We hope to learn more over time about where to place these “maybes”, and would welcome reader input. We also have plans to submit a survey to several supplement companies to try to assess some of the more questionable items and will report the results in an update in the latter half of 1999.
Part B. TABLE OF NATURAL THERAPIES WITH AND WITHOUT SALICYLATES
(Warning: This is not intended as an endorsement or medical advice, nor does it include all possible salicylate-containing or salicylate-free items. Inclusion does not guarantee that the patient will not react to or be affected by an item–it is just our best information at present. Watch out for the term “natural” on the label for Vit. E, C, 5-htp, and other items, because it may be more likely to have been extracted from a plant and thus contain hidden salicylates. See Part G on assessing questionable items (“Maybes”) and see Part A for general cautions and disclaimers).
Alcoholism through Insomnia/Sleep Disorders/Anxiety
Likely to Contain Salicylate:
Evening primrose oil, borage oil, black current seed oil, silymarin/milk thistle extract, 5-htp from plant extract
Likely to be Salicylate-Free:
Vitamin C, B complex, glutamine, tryptophan, zinc, fish oil, calcium, magnesium, no sugar, low carbohydrate diet, no caffeine, no nicotine, allergy/sensitivity reduction, 5-htp (pharmaceutical quality), adequate water and salt
Likely to Contain Salicylate: Stinging nettle, bioflavonoids, bromelain
Likely to be Salicylate-Free:
Vitamins A, C & E, avoidance or immunotherapy (see Part C), magnesium, manganese, adequate water and salt
Likely to Contain Salicylate: Pycnogenol, grapeseed extract, rosemary, green tea extract, vegetable extracts
Likely to be Salicylate-Free:
Vitamins A, C & E, glutathione, Immunocal, CoQ10, selenium, alpha lipoic acid, beta carotene, N-acetyl-cysteine (NAC), magnesium, manganese, Microhydrin, stress reduction/meditation (reduces cortisol, which has oxidant effects)
Likely to be Contain Salicylates: Boswellia, turmeric, curcumin, evening primrose oil, borage oil, black current seed oil
Likely to be Salicylate-Free:
Glucosamine sulfate, chondroitan sulfate, MSM, shark cartilage extract, allergy/sensitivity reduction, fish oil, nonsteroidal anti-inflammatory drugs (NSAIDS), sea cucumber
Likely to Contain Salicylates: Gymnema, ephedra, 5-htp extracted from plants
Likely to be Salicylate-Free:
chromium, vanadium, B complex, low carbohydrate diet, carnitine, avoiding fructose if fructose intolerant, allergy/sensitivity reduction, low dose cortisone (ACTH stim. test), chitosan (avoid if shellfish sensitive), magnesium, growth hormone, arginine, lysine, serine, glycine, alanine, choline, 5-htp (pharmaceutical grade), tryptophan
Condition/System: Candida/Fungal overgrowth
Likely to Contain Salicylate: Grapeseed extract, Pau d’arco tea
Likely to be Salicylate-Free:
Acidophilus, low carbohydrate diet, Candida/food allergy desensitization, Nystatin, Diflucan, lactoferrin, colostrum
Likely to Contain Salicylate: St. John’s wort, 5-htp extracted from plant source
Likely to Be Salicylate-Free:
SAMe or TMG with B12, B6, folate tyrosine, phenylalanine, thyroid,, prayer or meditation, support groups, light therapy, allergy/sensitivity reduction, books on tapes, fish oil, low carbohydrate diet, estrogen, low dose cortisone, change negative thinking patterns, 5-htp (pharmaceutical grade), tryptophan
Likely to Contain Salicylate: Aloe vera, plant-based enzymes, piperine extract, Pepto bismal, bismuth subsalicylate, Alka Selzer with aspirin, ginger in pill form, herbal laxatives
Likely to Be Salicylate-Free:
Pepsin, hydrochloric acid, low carbohydrate diet, bentonite, glutamine, pancreatin, acidophilus, calcium lactate with high oxalate foods, SeaCure, allergy/sensitivity reduction, non-salicylate form of bismuth, adequate water and salt intake, Alka Selzer Gold (without aspirin), baking soda, antibiotics for Helicobacter-caused ulcers or bacterial overgrowth, magnesium for diarrhea (e.g. Milk of Magnesia), lactoferrin, colostrum
Condition/System: Dizziness with Hypotension (e.g., NMH)
Likely to Contain Salicylate: Licorice extract, DGL
Likely to Be Salicylate-Free:
Increased salt and water, low carbohydrate diet, fludrocortisone with potassium, allergy/sensitivity reduction
Condition/System: Energy/Mitochondrial Support:
Likely to Contain Salicylates: Ephedra, ginseng, guarana
Likely to Be Salicylate-Free:
NADH, carnitine, CoQ10, creatinine, magnesium, MSM, DMG, low carbohydrate diet, serine, B complex, iron, DHEA (pharmaceutical grade), pregnenolone (high purity or pharmaceutical grade), thiamine pyrophosphate, thyroid (TSH test), low dose cortisone (ACTH test), androstenedione, adrenal glandular extract, hyperbaric O, phosphorous (only if test abnormally low), Vitamin D, allergy/sensitivity reduction, low carbohydrate diet
Likely to Contain Salicylate: Garlic pills, chorella, gugulipids, hawthorn, aspirin, willow bark extract or tea
Likely to Be Salicylate-Free: CoQ10, taurine, TMG with B12, B6, folate, niacin (inositol hexanicotinate for no flush), Vit. E, fiber, calcium, magnesium, potassium, EDTA (with mineral supplements), fish oil, shark cartilage (for hypertension), MCT oil, chitosan (avoid if sensitive to shellfish), choline, lecithin, reduced saturated fat, trans fats, allergy/sensitivity reduction, meditation/prayer, reducing hostility in Type A persons, exercise, adequate/optimal water and salt intake, reduced sugar and lower carbohydrate dietsS to reduce hyperinsulinemia
Condition/System: Immune Support/Anti Microbial
Likely to Contain Salicylate: echinacea, goldenseal, astragalus, olive leaf extract, Maitake, Shiitake and Reishi mushrooms, LEM
Likely to Be Salicylate-Free:
Vitamins A, C & E, zinc, lysine, Immunocal, colloidal silver, allergy/sensitivity reduction, BHT, ozone, hydrotherapy, alpha interferon (low dose sublingual or injections to boost NK), Boiron oscillococcinum, baking soda in water, low dose cortisone (ACTH stim. test), Zovirax, low arginine diet for Herpes virus infections, N-acetyl-cysteine, thymus glandular extract, DHEA (pharmaceutical grade), human growth hormone, low carbohydrate diet, free form amino acids, SeaCure, lactoferrin, colostrum
Likely to Contain Salicylates: Valerian, chamomile, kava kava, passion flower, 5-htp extracted from plant sources
Likely to Be Salicylate-Free:
5-htp (prescription grade), melatonin (0.3- 5 mg), magnesium, taurine, calcium, low carbohydrate diet, allergy/sensitivity reduction, bedtime in sync with body temp. drop, relaxation/meditation, sleep apnea treatment, estrogen/progesterone, DHEA (pharmaceutical grade) at bedtime if cortisol elevated (ASI test), books on tape, magnets in mattress or pillow, methylcobalamin (a form of B12), light therapy, Benadryl, Tylenol PM, phosphatidyl serine, niacinamide, chromium, biofeedback, GABA
Liver/Detoxification through Vision
Likely to Contain Salicylates: Silymarin/milk thistle extract
Likely to Be Salicylate-Free:
N-acetyl-cysteine (NAC), alpha lipoic acid, high fiber diet, sauna detox programs, charcoal capsules, SAMe, TMG, B complex , bentonite, Vit. E, A, beta carotene, selenium, allergy/sensitivity reduction, colonic irrigation
Condition/System: Memory/Cognitive Function
Likely to Contain Salicylates: Gingko biloba, evening primrose, borage oil, black current seed oil
Likely to Be Salicylate-Free:
DMAE, phosphatidyl serine, choline, Vit. E, pyroglutamic acid, acetyl-L-carnitine, EEG neurofeedback, B complex,
B12 (sublingual or injections, 1-10,000 mcg) or methylcobalamin, magnesium, fish oil, allergy/sensitivity reduction, hyperbaric oxygen, food additive avoidance (Feingold diet), low carbohydrate diet, lecithin, adequate water and salt intake
Likely to Contain Salicylates: Dong quai, plant-based progesterone or estrogen creams, black cohosh, chaste berry, wild yam extract
Likely to Be Salicylate-Free: Prescription grade progesterone, estrogen, trigesterone, DHEA (pharmaceutical grade), thyroid (TSH test), magnesium, calcium, B complex, progesterone and/or estrogen desensitization, fish oil, calcium glucarate, low fat diet, Vit. E oil and low oxalate diet (for vulvodynia), biofeedback, allergy/sensitivity reduction
Likely to Contain Salicylates: Horsetail or silica from horsetail, angelica bark, shavegrass, licorice extract
Likely to Be Salicylate-Free: Calcium, magnesium, boron, Vit. D, C, E, copper, exercise, no caffeine, no alcohol, no nicotine, Fosamax, phosphorous or hydroxyapatite (take only if serum phosphorous abnormally low), estrogen,
Likely to Contain Salicylates: Arnica gel, salicylate-containing ointments like Ben Gay, 5-htp from plant sources, wintergreen oil, aspirin-containing pain relievers
Likely to Be Salicylate-Free: Zinc, Vit. A, E, C, beta carotene, N-acetyl-cysteine, alpha lipoic acid
Current list of “Maybes” (may have salicylates, but should avoid until investigated, see Part G for more information): CLA (conjugated linoletic acid), quercitin, rutin, hesperidin, malic acid, capsaicin, fructooligosaccharides (FOS), betaine, xanthan gum, lutein, lycopene, hydroxycitric acid (Citrimax), beta glucan, octacosanol, flax oil, Brewers yeast, Kombucha mushrooms, bromelain, papain, caprylic acid/caprylate/capric triglycerides, 5-htp extracted from seeds, vinpocetine, some lower purity over-the counter DHEA or pregnenolone.
Part C. Additional Information on Supplements and Treatments– Allergy/Sensitivity Reduction and Low Carbohydrate Diet
A recent controlled study showed that reduction of delayed (“hidden” non -IgE) immune sensitivities can reduce fibromyalgia symptoms significantly (Deuster & Jaffe, J. of Musculoskel. Pain 6(2), accepted for publication in 1999) Allergy/sensitivity reduction can also be important in reducing susceptibility to sinusitis, gastrointestinal and other types of infections. Food and chemical reactions can also contribute to blood sugar fluctuations. Elimination diets and food diaries may be quite helpful in identifying reactive foods. An increase in the pulse of 10% or more, 30-60 minutes after a meal or single food challenge may help in identifying the most reactive items. A short-cut pulse test, which involves detecting a 10% increase in pulse after the food or supplement has been on the tongue for two minutes, allows one to test the food without ingesting it (Note: pulse tests may not work if one is taking beta blockers). The increased pulse reflects stimulation of the nervous system, and this stimulant effect may explain why many of one’s reactive foods are also favorite ones. The nervous system stimulation also may partly explain the withdrawal symptoms that occur in the first 3-7 days after stopping the reactive item. Rotation diets help many, but for those who are universal reactors, a relatively simple and constant diet of the least reactive foods, with only occasional rotation, may be more helpful at first, because this approach utilizes the masking effect to reduce reactions. The least reactive foods vary among individuals, but rice (especially white rice), quinoa, oats, chicken, tuna, raw sunflower seeds are good possibilities. A variety of laboratory and clinical testing and treatment methods are also available. The existence of 12 or more mechanisms for food and chemical reactions means that no single testing method is likely to detect all sensitivities. Some of the best known allergies/sensitivities are Types I, II, III and IV immune sensitivities, lactose, gluten, and fructose intolerance and lectin reactions. Chemicals, food additives, molds, dust and pollen may also cause problems. It should also be remembered, that sensitivity often increases the more one is exposed to the item. For further information, and physician and book lists, contact the American Academy of Environmental Medicine, at American Financial Center, 7701 East Kellogg, Suite 625, Wichita, KS, 316/684-5500; web site: www.aaem.com. For help in reducing exposures to inhalants, like dust, pollen and mold, one may obtain a catalog from Allergy Asthma Technology Ltd. (800-621-5545). For chemically sensitive patients, another resource for products and services is the American Environmental Health Foundation (800-428-2343, www.ehcd.com/ehc.html). Janice Corporation (800-JANICES) carries organic cotton barrier cloth and other products for the chemically sensitive. Another alternative if one is primarily concerned with allergic symptoms, such as asthma, rashes and rhinitis caused by pollen, mold and animal dander, is to obtain a referral to a traditional allergist from your doctor or HMO. They emphasize symptomatic treatment with drugs, with occasional use of desensitization for inhalant allergies and they are typically more limited in their approach to food, chemical and non-IgE mediated sensitivities.
Low Carbohydrate Diet for Hypoglycemia (a.k.a. low blood sugar or pseudohypoglycemia)
Many types of symptoms are helped by a low carbohydrate diet that reduces blood sugar fluctuations. With age and increased stress and illness, one’s ability to regulate blood sugar levels often declines. When blood sugar drops below a certain level (often still within the so-called normal range, Genter & Ipp, Metabolism 43(1):98-103, 1994, also see Harrison’s Principles of Internal Medicine, 1997, p. 2082 & 2086, discussion of pseudohypoglycemia), a surge of stress hormones are released to bring the blood sugar levels up. These stress hormones can result in dizziness, anxiety, and sleep disruptions. Fatigue and difficulty concentrating also occur, and there are many other consequences for the bodies various hormones and regulatory systems. For instance, the surges of insulin which occur with carbohydrate consumption cause important amino acids to be driven into the body’s cells, leaving less available for the brain to produce important brain chemicals, like serotonin, that affect mood. St. Amand’s recommendation for avoiding these blood sugar fluctuations and associated symptoms is to limit carbohydrates to the equivalent of 1 piece of bread or 1 piece of fruit for every 4 hour period of the day. High protein foods, vegetables, nuts, and vegetable oils are not restricted. He also specifies certain foods that are to be avoided entirely for 2 months (see below). After 2 months, one may cautiously experiment with adding a little more carbohydrate but should be prepared to return to the strict diet if symptoms begin to worsen. (For a more complete account of this diet, see St. Amand’s paper listed in References in Part D). Although a relatively large amount of animal protein may be consumed, cholesterol need not rise if animal fat is minimized and replaced by vegetable oils like olive, sunflower or canola oils. In St. Amand’s experience, even if there is a temporary rise in some lipids or cholesterol, ultimately weight loss, reduced triglycerides and reduced final lipids and cholesterol are the result in most cases. In fact, research in the last 10 years, published in many respected scientific journals, has shown a linkage between hyperinsulinemia, due to frequent consumption of concentrated carbohydrates, and cardiovascular disease, hypertension and diabetes (e.g, see the work of Dr. G. M. Reaven). Over many years of using the diet with his patients, Dr. St. Amand has never had a patient develop kidney disease from the relatively high (30-50%) protein diet, but to be on the safe side, one should drink 6-8 glasses of water per day (Caution: Patients with existing renal failure should not go on a high protein diet, and patients with gout or diabetes should consult their doctor, as should all patients with a medical condition. Changes in diet may affect need for insulin and other diabetes medications).
Foods to strictly avoid for St. Amand’s low carbohydrate diet for hypoglycemia.
Sweet wines, fruit brandy and champagne
Dried Fruits and Fruit Juices
Garbanzo Beans (Chickpeas)
Black-eyed peas (Cowpeas)
Pastas (All types)
Burritos and flour tortillas
Sweets of any kind
DO NOT USE PRODUCTS which contain: Dextrose, Glucose, Hexitol, Maltose, Sucrose, Honey, Fructose, Corn Syrup, or Starch. NO CAFFEINE or ALCOHOL.
For information on lysine and its use in CFS and herpes infections, see the “Lysine Special Report: Beating Chronic Fatigue” (Saturday Evening Post, Nov/Dec. 1995). Information on treating alcoholism with nutrition can be found in Dr. J. M. Larson’s book, Seven Weeks to Sobriety, available in bookstores or from the Health Recovery Center in Minneapolis (800/24-SOBER, also has information on their six-week treatment programs). For more on treating Candida overgrowth, as well as recurrent bladder infections, one can refer to Dr. William Crook’s The Yeast Connection and the Woman (Professional Books, Jackson, TN). SeaCure, a fish derived amino acid source can be obtained by calling 800/247-5656. Immunocal (800/296-8113) is a patented milk serum protein that has been shown to safely raise glutathione, the major naturally occurring antioxidant in the cell (Life Extension Foundation, 800/841-5433, also carries a similar whey protein product). Asthma, alcoholism, ulcers, constipation and stress-related symptoms are among the conditions that Dr. F. Bartmanghelidj believes to be helped by increasing consumption of water, along with optimal amounts of salt, including extra water to compensate for the dehydrating effects of any caffeine consumed (703/848-2333, www.watercure.com, for information on his books). Microhydrin is a very concentrated patented antioxidant using negatively charged hydrogen ions. It is sold by a multilevel marketing company called Royal Body Care (call 800/722-0444, or Clive Linsenbardt at 1-888-208-2053, or Cynthia Panettieri at 800-788-6737, or search for web sites). For information on SAMe or TMG, refer to articles in CFIDS & Fibromyalgia Health Resources’ newsletter (800-366-6056) and Life Extension Foundation (April 1997 issue, on web site at www.lef.com). SAMe or large amounts of TMG should be avoided by people with tendencies toward manic-depression. Certain supplements should not be used with anti-depressants, so one’s doctor should be consulted on this issue. Information on estrogen and progesterone desensitization and other treatments can be obtained from the Endometriosis Association (800/992-3636). Another book on balancing estrogen and progesterone is Screaming to be Heard by Elizabeth Lee Vliet, M.D. For more information on treatments for vulvodynia, such as low oxalate diet, calcium citrate, or biofeedback, contact Vulvar Pain Foundation (336/226-0704). Calcium supplements, especially calcium lactate, taken with oxalate-containing foods may reduce the irritating effect of oxalates in vulvodynia and in certain gastrointestinal disorders. Infrapulse therapy information can be obtained by calling 800/705-5559. Vertebral axial decompression is a therapy that may effectively treat herniated discs and sciatica (310/358-1000). Information on where prolotherapy can be obtained may be found by calling the American Association for Orthopedic Medicine (800/992-2063). Magnets can be purchased from Bioflex (800/619-2717) or Phillips (800/705-5559, ext. 1302). Alpha interferon injections are evaluated in a double blind placebo controlled study that showed a significant benefit for the subgroup of CFS patients with an isolated decrease in NK immune cell function (See & Tilles, 1996, Immunological Investigations, 25: 153-164). Low dose sublingual alpha interferon, 5-htp, tryptophan, DHEA and natural oral estrogen, triestrogen and progesterone can be obtained from College Pharmacy (800/888-9358, Note: they also have an excellent bargain on guaifenesin) and/or Belmar Pharmacy (800/525-9473). The various hormones and information are also available from Women’s International Pharmacy (800/279-5708). There are a number of types of ozone therapies. The newest type shows evidence of being able to modulate cytokine levels to improve immune regulation (information available at 702-884-3990 or www.antiagingmedicine.com). Aid in food additive avoidance can be obtained from the Feingold Association (127 E. Main St. Suite 106, Riverhead, NY 11901, 800-321-3287, web site: http://www.feingold.org). It also has information on autism, attention deficit disorder and hyperactivity, as well as the role of salicylate hypersensitivity as a possible contributor to asthma, urticaria and other disorders. Physiologics (800/765-6755) can provide information on the work of Professor Peter Pang on shark cartilage extract (avoid if pregnant, after surgery or if suffering from a circulatory disorder).
For pain, weakness and low energy, a test for serum phosphorous after 12 hours fasting (usually done as part of a chemistry panel, but one that should specifically be requested to include phosphorous), may detect phosphate deficiency in as many as 10% of chronic fatigue syndrome patients (De Lorenzo, Hargreaves, Kakkar, 1998. Postgrad Med J, 74(870): 229-32). If serum phosphorous is near or below the low end of the normal range, further testing should be done to determine if one has phosphate diabetes. If this is found, phosphorous and Vitamin D may be prescribed, and guaifenesin treatment for fibromyalgia should be avoided.
Most homeopathic treatments, since they are usually so dilute, probably have negligible amounts of salicylates. An exception is the type of homeopathic treatment applied to the skin, like Arnica gel. To be especially careful, one should limit homeopathic treatments with plant-based remedies to the higher dilutions (e.g., 3c or greater). Although the efficacy of homeopathic treatments is still a matter of contention, especially in the United States, there are a growing number of controlled studies that show they may improve certain conditions. One source for more information on homeopathy is the National Center for Homeopathy (801 N. Fairfax St., Suite 306, Alexandria, VA 22314, 703/548-7790, www.healthy.net/nch/resclnef.htm).
Magnesium is much better absorbed if taken in the form of an amino acid chelate, like magnesium glycinate or aspartate (e.g. Tyler or KAL brands). If one is deficient in magnesium, these well-absorbed types generally do not cause diarrhea even when 800-1200 mg/ day is taken. When the deficiency is corrected, the higher dose usually begins to cause diarrhea and must be reduced to 300-600 mg/day. Adjusting the dose to just the right amount of magnesium may be helpful for constipation. More poorly absorbed forms of magnesium, such as Phillip’s Milk of Magnesia, found in drug stores, will maximize the laxative effect. Intramuscular injections or IV magnesium are other options to remedy magnesium deficiency.
Part D. Physicians, Supplement Sources, Laboratories, Newsletters, References
On Finding a Physician.
More and more physicians treating fibromyalgia and related disorders are becoming familiar with nutritional approaches and the other approaches mentioned above. One way of locating physicians knowledgeable in these areas is to consult local support groups and contacts or ask a doctor for a referral. Other sources for lists of physicians specially trained in many of these approaches include the American Academy of Environmental Medicine (215/862-4544, and see above), the American Academy for the Advancement of Medicine (23121 Verdugo Dr. Suite 204, Laguna Hills, CA 92653, 714/583-7666 or 800/532-3688), and the Society For Orthomolecular Health-Medicine (2698 Pacific Ave., San Francisco, CA 94115, 415/922-6462). Another online resource for many alternative health care resources is at http://www.healthy.net.
Sources of Information and Products.
A good resource is CFIDS & Fibromyalgia Health Resources (800-366-6056). This is a good source for catalog sales, and its free newsletter contains articles on products and research. It also offers discounts to members of certain support groups and donates large sums for research into these disorders. A good source for a wide variety of hypoallergenic supplements from many manufacturers is NEEDS (The National Ecological and Environmental Delivery System, 800/634-1380, a nutritional doctor is available, free of charge, to answer questions). Other information and product resources include Vitamin Research Products (800-877-2447, has a free newsletter), Life Extension Foundation (800/841-5433, monthly magazine with $50-$75 membership fee) and Physiologics (800/765-6755). A well-known fibromyalgia specialist and researcher, Dr. Jacob Teitelbaum has a book and a newsletter that discuss many of the above therapies (From Fatigued to Fantastic, 800/333-5287). The nonprofit CFIDS Association of America’s CFIDS Chronicle has had articles over the years that have discussed many of the above therapies (e.g. see July/Aug. 1998 issue for articles discussing kutapressin, high dose B12, and neurofeedback; previous issues cover neurally mediated hypotension, hydrotherapy, the use of EFAs to improve red blood cell morphology and other treatments). They can be reached at PO Box 220398, Charlotte NC, 28222, or 800/44-CFIDS. The articles in most of the aforementioned newsletters provide citations that can guide one to scientific research on the various approaches.
Books on tape can be obtained from libraries and book stores or rental companies (e.g. Books on Tape, Inc. 800/626-3333). With a physician’s signature verifying that one’s illness interferes with one’s ability to read (e.g., due to fatigue, weakness, chemical sensitivity etc…), one can obtain books on tape free from Braille Institute (800/272-4553). For a small fee, the extensive library of educational books, textbooks, and literature from Recording for the Blind and Dyslexic is also available (800/221-4792)
Hormone and Other Testing.
Testing for hormones, parasites and digestive efficiency, done at Great Smokies Diagnostics Lab, can be helpful (800-522-4762). Diagnos-Techs Lab (800-87-TESTS) has done pioneering work in the clinical use of hormone saliva tests (e.g. adrenal stress index, ASI, includes gluten intolerance test), highly sensitive salivary parasite tests, and hormone challenge tests. Hormone challenge tests show to what extent certain hormone precursors, such as DHEA or pregnenolone, are converted into estrogen or testosterone. This information may be important to those with cancers or other hormone sensitive conditions. The various hormones (including over-the-counter ones like DHEA, pregnenolone and androstenedione) are very powerful and have important interactions that make it especially important to have adequate laboratory testing and doctor supervision. SpectraCell’s Essential Metabolics Analysis (800/227-5227) assesses nutrient adequacy and includes a test for fructose intolerance. Balco Laboratory tests for minerals in serum and red blood cells (415/697-6708). Immunosciences Lab (800/950-4686) does testing that can guide one in the choice of immunotherapeutic options as well as testing for treatable infections of the bacteria Mycoplasma fermentans, thought by some to play a role in Gulf War Syndrome, CFS, and FMS. The leading laboratory in Mycoplasma research and testing is the Institute for Molecular Medicine headed by Dr. Garth Nicholson (714/903-2900, http://www.immed.org). Carbon Based Corporation (609/825-8338) and Body Bio (800/722-8327) are two companies that use standard blood test data as well as analysis of the fatty acid content of red blood cell membranes to indicate what nutritional changes may be beneficial. A lab that specializes in amino acid analyses in blood and urine is Aatron Labs in Hawthorne, CA (800/433-9750, also see Dr. Dennis Gersten’s web site at http://www.aminoacidpower.com).
1. Balch, James F., M.D., and Phyllis A. Balch, C.N.C., 1997. Prescriptions for Nutritional Healing. Avery Pub., U.S.
2. Fauci, Anthony S., M.D., and others, editors. 1997. Harrison’s Principles of Internal Medicine. McGraw Hill.
3. Genter, P. and Ipp, E. Metabolism, Vol. 43, No. 1 (January) 1994, pp. 98-103
4. Goldberg, Burton. 1997. Alternative Medicine: The Definitive Guide. Future Medicine Publishing, Tiburon, CA.
5. Kirschmann, G. J. and J. D. Kirschmann. 1996. Nutrition Almanac. 4th ed., McGraw Hill.
6. St. Amand, R. Paul, M.D. and Claudia Potter, MA. 1997. “The use of uricosuric agents in fibromyalgia: theory, practice, and a rebuttal to the Oregon Study of Guaifenesin Treatment”. Clin. Bull. of Myofascial Therapy, Vol. 2(4):5-12, The Haworth Press.
7. St. Amand, R. Paul, M.D. papers on Fibromyalgia, Fibromyalgia: for physicians, and Hypoglycemia, available on the web at http://guaidoc.com
8. Randolph, Theron G., M.D. and Ralph W. Moss, Ph.D. 1982. An Alternative Approach to Allergies. Bantam, New York.
9. Rogers, S. A. 1994. The Scientific Basis for Selected Environmental Medicine Techniques. SK Publications, Sarasota, FL.
10. Teitelbaum, Jacob, M.D. 1995. From Fatigued to Fantastic. Deva Press. Annapolis, MD.
11. Starlanyl, Devin M.D. and Copeland, Mary Ellen. 1996. Fibromyalgia and Chronic Myofascial Pain Syndrome. A Survival Manual. Oakland, Ca. New Harbinger Publications Inc.
12. Williamson, Miryam Ehrlich. 1996. Fibromyalgia: A Comprehensive Approach. New York: Walker and Co.
Part E. Salicylates in Other Products and Foods
Salicylates occur in a wide array of other products, as will be indicated by the following extended quote from St. Amand’s patient handout for fibromyalgia patients using guaifenesin. For those with other medical conditions, such as salicylate hypersensitivity that causes allergic urticaria or asthma, some foods will need to be avoided and some of his statements do not apply. Foods will be discussed further near the end of the part.
Products to Avoid: Excerpt From “Fibromyalgia” by R. Paul St. Amand, M.D. (Assistant Clinical Professor, Dept. of Endocrinology, Harbor/UCLA School of Medicine (complete article available from http://guaidoc.com).
“Aspirin completely blocks the benefit of all medications we have used, including guaifenesin. The greatest source of patient error comes from taking aspirin-related agents, salicylate or salicylic acid, which interfere with guaifenesin at the kidney level. Skin readily absorbs these compounds. Almost all plants manufacture salicylates, often in large quantities. Parts from leaves, roots and seeds concentrate salicylate in herbal medicines. Patients can neither take these nor use any skin creams that contain plant products. This includes products such as nasal sprays or suppositories. Our warnings do not apply to foods, cooking herbs and spices though they do harbor salicylates. The content is insufficient to block benefits if cumulative, extraneous sources are not added.
This is deliberately repetitious because it is important. We cannot detect how easily or completely one’s genetic make-up allows blocking. Assume you are very sensitive. Be meticulous in conducting your search of current or replacement products. Manufacturers make sudden changes and often list only “active” ingredients. If you must use the product contact the manufacturer to learn of “inactive” ones, which might include aloe, mentholatum etc.
Many pain medications contain aspirin or have “salicylate” or “salicylic acid” as part of their contents. You cannot use these. Tylenol, Advil, Darvocet-N and anti-inflammatory drugs are acceptable.
Heed the warning: all plants make salicylates. “Natural” refers to something made in nature. Poison ivy, oleander and hemlock are all natural but that does not make them safe. You must avoid products with that word including such things as aloe, ginseng, menthol, mentholatum, almond, grape seed oils etc. in creams, lotions and herbal medications.
Castor oil and camphor have recently appeared in many lotions, lipsticks and underarm deodorants–they are high in salicylates.
Ingredients with plant names butchers’ broom, rosemary, geranium, St. John’s Wort) must be avoided.
Oils made from plant parts must not be applied to the skin.
Avoid Vitamin E derived from Rose Hips and vitamins from “natural” sources such as vitamin C with bioflavonoids, which may contain quercetin, a source of salicylates.
Avoid all lip balms with the exception of plain Vaseline. Tubes of this product are available.
All creams and lotions for muscle and rheumatic pains such as Ben Gay contain salicylates and cannot be used. All sunscreens or sunless tanning products with plant derivatives, including oxylsalicylate readily block.
Cleansing lotions, astringents, exfoliants, lotions for oily skin and acne compounds, such as Stridex, often contain salicylates. It is best to avoid herbal shampoos and hair conditioners though they are not on the scalp long. Herbal hair sprays will land on the skin and deliver salicylates. Avoid shaving creams or soaps with menthol or aloe; microscopic cuts produced by razors with aloe-coated, white or colored strips provide direct access into the bloodstream.
Use no herbal bubble baths.
Wart and callus removal products almost all contain salicylates.
Peptobismol is bismuth subsalicylate.
Certain mouthwashes such as Listerine, contain salicylate as do toothpaste’s with “gum care ingredients.”
These offending substances will be absorbed and partially or totally block the effect of guaifenesin. No adverse reaction ensues but no benefit is attained. Be aware, a few pharmacies have made serious errors. Patients should obtain plain “guaifenesin,” not a tablet containing decongestants or anti-cough preparations.
Our therapeutic approach is not for the weak of courage. As we warned above, reversal of the disease often produces many symptoms causing some patients to doubt their progress during the initial two to four months. It takes confidence and strength to get through this early phase. Cyclic appearance of good days and improvement on mapping provides the needed encouragement to go on.”
(Author’s note: Dr. St. Amand has recently informed me that some guaifenesin users have traced salicylate exposure to plant sap and other materials coming into contact with their hands while gardening. He suggests wearing hard-palmed gloves while gardening, if this sort of contact occurs. Also, with regard to the herbal sweetener Stevia, he believes it can be used in very small amounts, like for coffee, but could be a problem if used in larger amounts. It is not a problem for hypoglycemia.)
Some foods do contain significant amounts of salicylates; however, they generally will only be of concern to those who have a hypersensitivity to salicylates. Fibromyalgics using guaifenesin and people with bleeding disorders should just be aware of the high salicylate foods so as not to greatly increase consumption of them. (Most of the following information is taken from Swain, Dutton and Truswell, 1985, “Salicylates in Food,” The American Dietetic Association: Research, Vol. 85(8):950-960).
In the food category, fruits had the largest amount of salicylates, particularly berries (the range of berries was from mulberries, 0.76 mg/100 gm to raspberries at 4.4 mg/100 gm). Apples were quite variable, from 0.19 mg-0.59 mg per 100 grams of fruit. Dried fruits tended to be fairly high (figs were 4.4mg and raisins were 5.8-6.2/100 gm). The researchers had the impression that the low salicylate fruits were the ones that had a less piquant flavor, e.g., mangos, pears, as compared with pineapples, oranges, and the berry fruits, which had higher salicylate levels. On the whole, vegetables did not have very high amounts, except for gherkins (6.1 mg/100 gm). Tomato sauce had a significant salicylate level, but this appeared to be due to additional herbs and spices. Some herbs and spices were quite high. For curry powder, there was 218 mg/100 gm. Others that were almost as high were paprika, thyme, dill powder, garam masala, oregano, and turmeric. However, since the amounts one uses in cooking are usually quite small, probably at the most 0.1-0.5 grams per day, this is not very significant for most people. Meat, poultry, fish, eggs and dairy products all have little to no salicylates. Of the legumes, seeds, nuts, and cereals, only almonds, water chestnuts and peanuts had significant amounts (3.0, 2.9 and 1.1 mg salicylate per 100 gram, respectively). For drinks, cocoa and decaffeinated coffee had negligible amounts, whereas a number of teas had fairly high levels (2-7 mg for 100 ml of tea made from 2 tea bags). The teas tested were a number of different Twinings brands and some Chinese teas. The lowest tea was a decaffeinated tea, at 0.37 mg. Coffees were lower than 1.0 mg salicylate per 100 ml coffee, except for a type of chicory coffee (2.26 mg/100 ml). Wines were in the range 0.35-1.0 mg/100 ml. Among the other alcoholic beverages Benedictine and one type of port stood out as high (9.04 and 4.2, respectively). Quite high amounts of salicylate were found in licorice (8-10 mg/100 gm) and peppermint (0.8-7.9 mg/10 gm). Mint candies are often given additional flavorings like methyl salicylate. Artificial flavors that are often made from salicylates also include strawberry, grape, butter, vanilla, cinnamon, caramel and walnut. Some of the other products that include artificial flavorings are baked goods, soda, candy, chewing gum, ketchup, ice cream, puddings, tooth pastes and mouth washes (Feinleib and Ingster, 1996, American Heart Association meeting).
As noted above, it is primarily salicylate-sensitive people who have to be really concerned about the food sources (for more on salicylate avoidance, one can contact Feingold Association, see Part C). Others, like fibromyalgics using guaifenesin, should just be aware of the items and avoid large increases in consumption. If large changes in consumption do occasionally occur, one should note if any changes in symptoms occur. Certain berries and other fruits, certain teas, candies, gum, toothpastes, breath savers and mouthwashes are probably of most concern. Dr. St. Amand has observed reversal of progress in guaifenesin treatment arising from breath savers and gums flavored with mint, peppermint, spearmint and wintergreen, as well as with certain toothpastes and mouthwashes. These should be avoided by those taking guaifenesin to treat fibromyalgia and probably by those with bleeding disorders as well.
(This is for information only and is not medical advice. See Part A for additional disclaimers and warnings.)
Part. F. Some Questions and Answers Regarding the Power of Salicylates to Block Guaifenesin Treatment
Question 1. Why are some sources of salicylates forbidden, whereas other sources, like foods, are not generally forbidden?
Answer. Dr. St. Amand has not found that food has been a source of reversal of progress in fibromyalgia patients he has treated. Apparently, the initially determined guaifenesin dose has been sufficient to overcome any salicylate in foods. For most people, their dietary intake probably tends to remain fairly constant. If anything, his hypoglycemic patients have to cut intake from many of the largest sources, like artificially flavored candy, baked goods, certain teas and fruits. His patients who do not go on the hypoglycemic diet, are probably at least somewhat encouraged to cut back on these items, or at least not to increase them. This contrasts with herbal medications and cosmetics, which may suddenly be added or changed and may have fairly high amounts of salicylates. It also may be that the other nonfood sources have types of salicylate that have longer retention times. Salicylates also may be a more significant source in cosmetics and lotions since they enter through the skin, bypassing processing by the liver, and thus have a more powerful blocking effect.
Question 2. What should one do if a new item has been added to the list of items to avoid, and one is using that item?
Answer. This depends on the situation (see below).
Situation 1. The item has been used continuously from the beginning of treatment, and one has been having no trouble progressing. In this case, one can probably just continue using the item, since apparently the guaifenesin dose has been sufficient to make up for the level and type of salicylate.
Situation 2. The item was added months after determining the adequate dose of guaifenesin. Reversal symptoms have declined over time, and it is not completely clear whether or not reversal of lesions is still occurring. In this case, one should remove the item and see whether reversal symptoms increase again. If upon removal, the reversal symptoms increase, this item may have been blocking progress. If one removes the item and there is no change in symptoms, it probably was not blocking progress. If in doubt, discuss with a doctor the possibility of deleting the item. It should be noted that there is a tendency in some patients for a slowing of the reversal process after the first few months of guaifenesin. For these patients, the possibility of raising the guaifenesin dose by 300-600 mg or more after 6-8 months should be considered as a way to ensure the pace of continued progress. It is very important to maintain an adequate dose. If one’s dose is just barely above the threshold dose needed for progress, one will be much more likely to be susceptible to blocking by relatively small amounts of salicylate. Unfortunately, if the guaifenesin dose is inadequate, one will rapidly lose the progress one has achieved. Half the dose does not mean half the rate of progress; it generally means rapid return of lesions.
Question 3. What should one do if a particular herbal medication is very important to him/her, and he/she does not want to give it up?
Answer. One can usually find another alternative to the herbal medication that can be substituted for it and will work as well (see Table in Part B). There are lots of salicylate-free things to try that allow one to continue on guaifenesin. This is important because for some, it may take a year or more to really observe the progress with guaifenesin. It would be unfortunate if one were prevented from using guaifenesin or stopped too early just because one falsely assumed that using guaifenesin prevented one from using “natural” treatment options.
Another, risky alternative is to use a higher dose of guaifenesin while on an herb or other questionable product to see if it will be able to compensate for the extra salicylate. This may not work, depending on the individual and the amount of salicylate and is mentioned only for those who find it impossible to use guaifenesin unless they are able to continue using a particular product. If one is going to try this, it would be best if lesions could be mapped frequently to ensure that the herb does not block progress. It has been observed that patients on guaifenesin who have been blocked by an herb, e.g. Echinacea, or a sunscreen or cosmetic, have a quite rapid rate of lesion return, which may set one’s progress back days, weeks or even months, depending on the individual and the length of time the product was used. Another possibility is to take a high enough dose of guaifenesin to the point where one can be certain from the symptom increase that progression is still continuing despite the salicylates. This has pitfalls, however, since one can make mistakes in interpreting the cause of symptoms. Observing changes in the urine can also sometimes be misleading and one should not rely on it too much in judging progress. It is to be hoped that in the future, the active ingredients from herbs will be available in more highly purified forms, or the herbal extract manufacturers will have independent laboratories test all their products for salicylates. Perhaps, greater awareness of salicylates will eventually cause many types of manufacturers to make certain their products are free of salicylates. As a start in this process, one fibromyalgia patient has started a company to sell personal care products guaranteed to be salicylate-free (Andrea Rose Salicylate Free Skin Care: Call toll free at 1-888-712-7673).
Part G. Some General Rules for Assessing Salicylate Content and Some “Maybes”
Since there is not yet any laboratory data available on salicylate content of most products, a number of general rules and observations have been used in assessing salicylate content for the purposes of this article:
1. Since it is known that all plants make salicylates to some degree, and herbs used for various medicinal purposes seem to be especially prone to concentrate salicylates, all medicinal plants (except in their homeopathic form, see Part C) have been assigned to the salicylate-containing column. When more information is available on different herbs, it may be possible that some can be distinguished as essentially free of salicylates.
2. Since prescription medicines, minerals, vitamins and supplements are typically synthesized and purified, manufacturers are generally able to include in their supplements only what they intend to put in them and thus do not include salicylates. Those designed to be hypoallergenic, often explicitly state that they contain no salicylates and give an extra degree of assurance. Thus, these items can usually be safely placed in the salicylate-free column–but one should still check the list of ingredients. They may have no added salicylates, but if they contain a plant extract, there may be hidden salicylates.
3. Supplements and other substances obtained from animal sources contain essentially no salicylates and thus can be safely placed in the salicylate free column as long as they are not mixed with other ingredients that contain salicylates.
4. Another source of information has been Dr. St. Amand’s experience with patients using guaifenesin. Many herbs, plant extracts, sunscreens, cosmetics, body rubs etc… have caused loss of progress in his patients due to salicylates blocking the action of the guaifenesin at the level of the kidney (analogous to salicylate’s ability to block uricosuric drugs for gout). Examples include popular herbs, like Echinacea and ginkgo biloba, and plant extracts, like bioflavonoids and aloe vera gel, as well as many others.
5. Supplements described by their chemical name that are originally derived from a plant may be salicylate-free if they are very pure. Thus, pharmaceutical grade natural estrogen and progesterone, though originally derived from a plant, are essentially 100% pure and do not contain salicylates. This category, however, can be problematic. The manufacturer does not always state whether the substance is plant-derived or how pure it is. This results in the need for a “maybe” category of supplements whose salicylate status has not yet been determined. Variation in purity among different brands further complicates the issue.
Current List of “Maybes”:
CLA (conjugated linoletic acid), flax oil,
quercitin, rutin, hesperidin from citrus or other bioflavonoids,
malic acid from apples (synthetic type is O.K.), capsaicin from peppers
fructooligosaccharides (FOS) from Jerusalem artichokes or raw cane ,
betaine from beets, xanthan gum, vinpocetine
lutein, lycopene, octacosanol, Brewer’s yeast, Kombucha mushrooms
hydroxycitric acid from garcinia camboga (Citrimax),
beta glucan from yeast, bromelain, papain and other plant-derived enzymes,
caprylic acid/caprylate/capric triglycerides from coconut or other sources,
5-htp from Griffonia seeds (synthetic and/or prescription types O.K.),
lower purity over-the counter DHEA and pregnenolone (some may be only 80-90% pure and they may be plant derived)
(Note: Betaine, FOS, caprylic acid, DHEA, pregnenolone, bromelain and papain have been identified as being salicylate-free by others. Since they are often plant-derived and are likely to vary among brands, we will wait to definitely classify them until we have surveyed several supplement companies regarding their purity. We plan to report the results in the latter half of 1999.)
One way to assess these items is to call the manufacturer and ask for a complete breakdown of the contents and the level of purity of any substance derived from a plant. Do not be surprised if, when asked, the manufacturer resolutely maintains that there are no salicylates in the product. Just tell him/her that all plants produce salicylates and that even though the manufacturer did not add them, they may still be found in the product. Ask the mail order company or manufacturer for the complete list of ingredients and their sources. If the source of a chemical is a plant, ask for the purity level, specifically the percentage of the product that is the active ingredient (e.g. octacosanol or malic acid). If it is 99.0% pure, then that leaves 1% that could be salicylate, given the worst case scenario. Still assuming the worst case scenario, if it were 1% salicylate and one takes 500 mg per day, then one could potentially consume 5 mg (0.01 multiplied by 500 mg) of salicylate each day. This amount might be too much, depending on the circumstances and the type of illness. If this amount were taken through the skin, it probably would be too much in many cases. Taking another example, if the manufacturer said it was guaranteed to be 99.9% pure, then the maximum amount of salicylate would be only 0.5 mg (0.001 multiplied by 500 mg), which might be tolerable as an oral dose in most circumstances, but could still be a problem for the salicylate hypersensitive person. It would also help if one could know the salicylate content of the food or herb that was used to derive the supplement. If it were citrus, with its relatively high salicylate content, as in the case of some quercetin, rutin and hesperidin, one would expect a greater possibility that the unaccounted for percentage had significant salicylate. Unfortunately, this has limited usefulness because we don’t have data for all foods. There is also the problem that the extraction process might tend to greatly concentrate the salicylate. Thus even though beets may not have much salicylate, if a very large amount of beets were used, and the process concentrated the salicylate that was there, then there might be a lot of salicylate in the derived substance, for example in beet-derived betaine. There is also the problem of variation among patients, since some patients may be more susceptible to the effects of salicylates. Also, plants may vary from year to year and location to location in their production of salicylates, since salicylate production is partly related to environmental stressors that the plants experience.
In the past it was stated that quercitin, a compound found in bioflavonoids, was a salicylate. Now, it appears that this was a mistake. There are salicylates within the mixture of substances in the bioflavonoids from which it is derived, but pure quercitin itself is not a salicylate. As noted above, the purity of quercitin products is still uncertain at present, and therefore we have placed it among the “maybes”.
Part H. An Example of One Person’s Choice of Salicylate-Free “Natural” Therapies (1998)
For those who just want a simple place to start, the following supplements and products have been taken by the author (a guaifenesin user who is not hypersensitive to salicylates). Not all products were taken all the time. Some mild symptom improvement was noted with magnesium glycinate (see Part C), GABA and taurine. The homeopathic treatments, zinc and vitamin C did seem to help with preventing or alleviating colds and flus. Overall, a much more dramatic benefit was achieved with the low carbohydrate diet and allergen and sensitivity treatments and avoidance (see Part C and Synergy Health Newsletter Vol. 1(1) and Vol. 1(2)). Most of the supplements, like multivitamins and antioxidants, were taken for “insurance”, as a trial, or for theoretical reasons based on research results. A few supplements were added due to test results (see Part C). Magnesium and zinc were found to be low by a red blood cell mineral analysis done by Balco Laboratory. At one time, a Spectra Cell Lab analysis showed slight deficiencies in some of the B vitamins and a fructose intolerance (found in fruits, some corn syrups, some sodas and baked goods, beans and asparagus). Fructose avoidance was helpful in reducing hypoglycemia. Oxalate avoidance or use of calcium lactate with oxalate containing foods (see Part C) also helped gastrointestinal symptoms.
(This is not meant to endorse any particular brands and is for information only. Consult your doctor for all medical advice. Diabetics should be especially cautious about dietary changes or supplements, such as chromium, which may result in the need to change their dosages of diabetic medications.)
Nutricology MultiViMin (available with or without copper and iron, ordered from NEEDS, 800/634-1380)
Twinlab Daily One Caps (available with or without iron from health food stores)
Nutricology Super B Complex,
Twinlabs Ester C or Natrol Ester C (be sure to get type that has NO BIOFLAVONOIDS)
Solgar sublingual Vit. B12 (1000-5000 mcg), Twinlabs Choline/Inositol (from health food store)
Various Supplements from CFIDS and Fibromyalgia Health Resources (800-366-6056):
Calcium/Magnesium (a chelated form)
Psillium fiber with acidophilus, GABA for sleep
Amino acids: lysine, tyrosine, taurine, glutamine, N-acetyl-cysteine, acetyl-L-carnitine
Selenium, Chromium GTF (chromium polynicotinate)
Magnesium Ester C, Alpha Lipoic Acid, Phosatidyl Serine
Folic Acid, Ultra EPA (fish oil), NADH, CoQ10
Tyler brand Magnesium Glycinate Plus (from NEEDS)
KAL brand Magnesium Glycinate (from a health food store)
Zinc-220 (provides 50 mg zinc–take separately from calcium and magn., Vitaline Formulas, ordered from NEEDS)
Calcium Lactate (Twinlabs from a health food store)
Manganese (Twinlabs from a health food store, take separately from calcium)
(Note: I avoid mineral supplements with hydroxyapatite or bone meal because they contain a lot of phosphorous, a mineral that St. Amand’s theorizes is in excess in fibromyalgia and is the reason guaifenesin reverses the illness).
From Life Extension Foundation (800/841-5433):
TMG (500-2000 mg /day), or SAMe (200-400 mg/day)
Allergy Research Group hypoallergenic Cellulose Fiber supplement (from NEEDS),
Boericke and Tafel Alpha CF, Boiron oscillococcinum (homeopathic cold and flu treatments, widely available),
Baking soda (1/4 – ½ tsp.) in water between meals to bring urinary pH to a more moderate level (6-7, measured on pH measuring tape ordered from Beyond Health 800/250-3063).
(Note: NEEDS stands for National Ecological and Environmental Delivery Service, 800-634-1380)
Personal Care Items
(I choose unscented products due to chemical sensitivity, not for salicylate avoidance)
(Dr. St. Amand has a much longer list of salicylate-free personal care items and cosmetics–Send an SASE with your request to 4560 Admiralty Way, Suite 355, Marina Del Rey, CA 90292 or refer to the following web site: http://www.guaidoc.com.
Granny’s brand Shampoo and Conditioners (available from health food stores)
Simple brand Shampoo, Conditioner, and bar soap (from NEEDS, or The Allergy Store, 800/838-1514)
Queen Helene Natural Unscented Deodorant Stick (from a health food store)
French Chef Soap (from NEEDS), Neutrogena glycerin bar soap–unscented
For toothpaste, I dip a wet toothbrush into ½ tsp. of baking soda, Unflavored dental floss
Neutrogena Norwegian Formula Hand Cream, Unscented
Jhirmack Extra Hold Hairspray– Unscented
Bain de Soleil, All Day For Kids Sun Block, SPF 30 UVA/UVB, unscented
(Warnings: Check items again when you buy them to be sure the formulas have not been changed. Not all items for a brand are equally acceptable. For instance, Simple brand facial toner has witch hazel and must be avoided, whereas some other Simple brand products are salicylate-free).
For a skin moisturizer, I often use 100% pure Vegetable Glycerine from a health food store (current brand I am using is Starwest Botanicals, but I did use another brand before–apparently it is O.K. if 100% pure). I pour about ¼ cup glycerine into another container and add about ½ -1 Tablespoon of water and stir. For a skin toner, I fill a container about ¾ full with water, and add ½ teaspoon to 1 Tablespoon rubbing alcohol and a similar amount of glycerin. For someone who is too ill to bathe every day, this liquid can also be used to wet a paper towel or Kleenex to freshen up underarm areas etc… before putting on clean clothes.
Sunflower lip balm (from Special Foods, 9207 Shotgun Court, Springfield, VA 22153 703/644-0991).
This is made from beeswax and a little sunflower oil. Since sunflower oil is relatively low in salicylates and only small amounts are used, it appears to be O.K. Dr. St. Amand generally recommends Vaseline to moisten lips, but for one with a lot of allergies or very sensitive skin, this lip balm seems to be an acceptable alternative. Some of the other types of lip balm from this company are O.K. as well, specifically the safflower, sesame, soy and coconut varieties. (Note: in some of the types of lip balm, a plant name is mentioned; however, it just refers to the type of plant the bees were pollinating and should not be of concern for salicylates, e.g. for thistle/safflower lip balm, thistle refers to the source of the beeswax).
Editorial Note (August 12, 2006): The supplements I use have changed in order to avoid vitamin D and to further reduce allergies/sensitivities. For an update on my current supplements supplements without vitamin D and to read about my progress with a new approach, called the Marshall Protocol, see recent issues of CISRA’s Synergy Health Newsletter.
Issue 3 Update (July, 2000) NATURAL THERAPIES WITH AND WITHOUT SALICYLATES
The following information is an update to the above article: Natural Therapies With and Without Salicylates, Parts A through Part H
As promised, we sent surveys to a number of supplement companies regarding salicylate content of certain products. However, only Solgar (www.solgar.com) responded by sending some information. We appreciate their cooperation very much. Unfortunately, they do not carry any of the products in the “maybe” category that we were most interested in, but they do have many vitamins, minerals, and amino acids etc… that are salicylate free. If you know of a supplement company that would like to provide information, please notify us. We are particularly interested in information in the “maybe” category (Part G) and have a form they can fill out. Any information on the salicylate content of particular products that our readers can share with us would also be appreciated.
Part B. TABLE OF NATURAL THERAPIES WITH AND WITHOUT SALICYLATES
(Warning: This is not intended as an endorsement or medical advice, nor does it include all possible salicylate-containing or salicylate-free items. Inclusion does not guarantee that the patient will not react to or be affected by an item–it is just our best information at present. Watch out for the term “natural” on the label for Vit. E, C, 5-htp, and other items, because it may be more likely to have been extracted from a plant and thus contain hidden salicylates. See Part G in the complete article on assessing questionable items (“Maybes”) and see Part A for general cautions and disclaimers. Also see Part C, below).
Likely to Contain Salicylate: No changes
Likely to be Salicylate-Free: oxygen therapy, Buteyko breathing
Condition/System: Energy/mitochondrial support
Likely to Contain Salicylate: VesPro GHS
Likely to be Salicylate-Free: Amino acid combinations to increase GH improved deep sleep also helps maximize GH (see below)
Likely to Contain Salicylate: No change
Likely to be Salicylate-Free: 1 to 2 grams arginine for hypertension (see warning, Part C, below)
Condition/System: Immune support/anti microbial
Likely to Contain Salicylate: SPV-30, plant-derived Traditional Chinese Med.
Likely to be Salicylate-Free: cetyl myristoleate, Pro Boost Thymic Protein A
Condition/System: Liver/detoxification and Vision
Likely to Contain Salicylate: mixed carotenoids, plant-derived Traditional Chinese Med.
Likely to be Salicylate-Free: carotenoids from many vegetables
Likely to Contain Salicylate: capsaicin (pepper extract)
Likely to be Salicylate-Free: osteopathy, Neural Therapy, Photonic Stimulator
Part C. Additional Information on Supplements and Treatments
Updating reference in allergy section: A recent controlled study showed that reduction of delayed (“hidden” non -IgE) immune sensitivities can reduce fibromyalgia symptoms significantly (Deuster & Jaffe, 1999, Musculo Pain 1998; 6: 133-149, copies available from Serammune Physicians Lab, 800-553-5472)
For information on oxygen therapy for chemical sensitivities and carbon monoxide poisoning, contact — Albert Donnay, President, MCS Referral & Resources, Inc., 508 Westgate Rd, Baltimore MD 21229, 410-362-6400, http://www.mcsrr.org, http://www.mcsrr.org/poe/cohome.html. Dr. William Rea (Environmental Health Center, Dallas) presented a study indicating MCS patients benefited from oxygen therapy (AAEM conference, 1998; tape available from 1-800-NOW-TAPE). People with respiratory problems like asthma, allergies and a number of other conditions may be helped by the Buteyko breathing method, which counteracts a tendency to hyperventilation (see Breathing Free, by Teresa Hale, http://www.breathconnection.com. See Issue 6 for more on asthma).
ImmunoCal (800/296-8113) is a patented milk serum protein that has been shown to safely raise glutathione, the major naturally occurring antioxidant in the cell (Life Extension Foundation, 800/841-5433, also carries whey protein products, as does NEEDS, 800/634-1380, and CFIDS & FM Health Resource, 800-366-6056). There is also a non denatured whey product derived from goat’s milk from Capra Mineral Whey (800-789-1577). Pro Boost Thymic Protein A may be obtained either through Dr. Teitelbaum (800-FEEL-BTR) or the manufacturer (800-933-9440). Information on where Prolotherapy and Neural Therapy can be obtained may be found by calling the American Association for Orthopedic Medicine (800/992-2063). For apitherapy, see www.beesting.com. Information on the Photonic Stimulator can be obtained from www.alternativemedicine.com or www.balesscientific.com or the Oct./Nov., 1999 issue of the health magazine, Alternative Medicine.
Dr. Jay Goldstein has found that H2 blockers such as Tagamet (now available over the counter, warning–do not take if taking Coumadin) can abruptly relieve symptoms of infectious mononucleosis (Ann. Int. Med. 99(3): 410-411) and it helps in some cases of what has sometimes been called chronic Epstein-Barr virus (Ann. Int. Med. 105(1): 139). Dr. Jacob Teitelbaum, has reported confirming Goldstein’s findings for acute infectious mononucleosis (often called “mono”), even in patients who were hospitalized for a month with the illness (From Fatigued to Fantastic Newsletter, Vol. 2(2), 1999).
Research has shown that a combination of amino acids at bedtime is helpful in increasing GH (growth hormone) production in children and anecdotally in the elderly (2 g. arginine, 1 g. lysine, 2 g. ornithine and 1 g. glutamine at bedtime is what is suggested, see Grow Young with Growth Hormone, by Ronald Klatz). See sleep article in this issue, as well as the listed therapies under “insomnia” in Part B, since good quality sleep may increase growth hormone production. Among prescription drugs, Ambien has been shown to be better at preserving deep sleep, the sleep stage when the most growth hormone is produced. Sometimes as little as a quarter of a tablet may be enough.
There have been anecdotal reports of supplements of the amino acid, arginine (1 to 2 grams per day) helping decrease hypertension. It is thought to act by increasing nitric oxide, a vasodilator. It should be used only under the advice of your physician, especially if you have an autoimmune disease, like Type I diabetes (Lucy Dechene, Ph.D., personal communication). If you have a Herpes infection, you may also need to take some lysine to balance the potential effect of arginine in promoting Herpes infections (see Lysine Special Report: Beating Chronic Fatigue” (Saturday Evening Post, Nov/Dec. 1995).
Part D. Physicians, Supplement Sources, Laboratories, Newsletters, References
The leading laboratory in Mycoplasma research and testing is the International Molecular Diagnostics, Inc., (you can call for an information packet and published articles, 888-882-8838, www.imd-lab-com). Mycoplasma are bacteria that have been implicated in CFS, FM, Gulf War Syndrome and a number of autoimmune and rheumatic diseases.
St. Amand, R. Paul, M.D. ,and Claudia Marek, M.A. 1999. What Your Doctor May Not Tell You About Fibromyalgia: The Revolutionary Treatment that Can Reverse the Disease. Warner Books, New York, NY. (Purchases made by first going to guaidoc.com and then clicking on the connection to Amazon.com will have a portion of the proceeds donated to a foundation for fibromyalgia research.) Lawson, Lynn, Living Well in a Toxic World: Understanding Environmental Illness, Multiple Chemical Sensitivities, Chemical Injuries, and Sick Building Syndrome. To obtain a copy, write a check to Lynn Lawson for $15.95 plus $3 s&h (Illinois residents add $1.28 sales tax) and send to: Staying Well, P.O. Box 1732, Evanston, IL 60201. She also edits a newsletter called CanaryNews (free sample newsletters are available from the same address, web site: http://www.mcshealthenviron.org).
Part E. Other Products and Foods (salicylate content)
Also avoid liquid, sublingual or chewable medicines with the mint, peppermint, spearmint and wintergreen flavors (e.g., some types of doxepin elixir or levsin tablets), since they may contain salicylates.
Part G. Some General Rules for Assessing Salicylate Content and Some “Maybes”
Update (July 25, 2000): Plant-derived products that are derived solely from any of the common grains (except maize meal), bran, soy or other legumes (like lentils, lima beans etc…) are probably essentially salicylate-free, since according to Swain et al. (1985), the salicylate content of grains and legumes are negligible (however, see disclaimers in Parts A and B of the entire article).
“Maybes” List: removed capsaicin (it is now in salicylate category) and added MGN-3, Huperzine A and cholestaid. This category is for items that should not be used until more information on their salicylate content is available from particular manufacturers.
Part H. An Example of One Person’s Choice of Salicylate-Free “Natural” Therapies
(Note: 2006 Update on supplements without vitamin D: 2006 Supplements List)
Vitamins: Unique E–a brand of Vit. E with mixed tocopherols (from NEEDS, 800/634-1380)
Miscellaneous: Baking soda (1/4 – ½ tsp.) in water between meals to bring urinary pH to a more moderate level (6-7, measured on pH measuring tape ordered from Beyond Health 800/250-3063). Update (July 25, 2000): I decided to stop the baking soda because the pH of my saliva was too alkaline and the extra baking soda made it worse (it was greater than 7.5, whereas it is supposed to be between 6.0 and 7.0).
Personal Care Items: Lipstick or gloss from Andrea Rose Salicylate Free Skin Care (888-712-7673, www.andrearose.com, she is also coming out with a salicylate free toothpaste).
The Views of R. Paul St. Amand, M.D., on Adjunctive, Nutritional and Symptomatic Therapies for Fibromyalgia
This article has presented a very inclusive listing of mostly natural therapies for numerous types of conditions. However, since many readers are using St. Amand’s approach to fibromyalgia using guaifenesin, this section is provided to let them know St. Amand’s views on various other therapies. Although he is willing to be innovative (his basic approach is an innovation), he tends to be fairly conservative with regard to nutritional supplements, medications that affect the brain, and narcotic painkillers. Dr. St. Amand’s general philosophy is to use the minimum number of therapies necessary for a patients healing. From his years of experience with fibromyalgia patients, he finds that almost all his patients who take guaifenesin long enough at an adequate dose, keep free of blocking salicylates, and use the low carbohydrate diet (if hypoglycemic) will eventually get well. He believes it is better for patients to keep the approach simple, partly so they will concentrate on the essentials of his approach and partly so that when they recover, they will know what it is that is responsible for the recovery. He has occasionally had patients who tried supplements and he has prescribed things for symptomatic relief and has arrived at some conclusions that provide the basis for his own recommendations.
For nutritional supplementation, Dr. St. Amand does not recommend multivitamins because some of them have levels of Vitamin A that some studies think excessive (Editor’s note: beta carotene is a safer precursor form of Vitamin A, RDA for Vitamin A is 4000 IU for women and 5000 IU for men, but food sources should be counted as well). For older people, he suggests 400 IU Vitamin E and folic acid and B 6 in a Vitamin B complex. He thinks other nutrients will generally be adequate if one eats a balanced diet, in particular, by consuming plenty of vegetables and adequate protein.
If patients have trouble sleeping, often the low carbohydrate diet will be helpful, especially when one is awakens in the night or early morning, often with an increased pulse, intense dreams or night sweats. These autonomic nervous system symptoms are caused by epinephrine released in an attempt to raise falling blood sugar levels during the night. He finds that some patients, particularly the older ones, may be helped by melatonin at bedtime. Other options are over-the-counter antihistamines, like Benadryl, to help with sleep, or a warm bath to help one relax. He thinks one should only use a hypnotic, habit-forming sleep medication like Ambien if all else fails. In general, he does not prescribe anti-depressants unless the patient is already on them and then they are usually tapered off over time as the guaifenesin reversal process leads to improvement.
For muscle pain, he suggests Epsom salt/baking soda baths. One puts 1-2 cups of Epsom Salts and 1/2-1 cup of baking soda in a bathtub of warm water for a soak of about 20 minutes to ease the pain. Ice or heat packs may also be helpful. Tylenol and NSAIDS are other possibilities that may help, but he advises to keep consumption down to a minimum. If used too frequently, they tend to lose their effectiveness. He thinks prescription narcotics should be avoided as much as possible and does not prescribe them himself. If unavoidable, he thinks Darvocet-N preferable to codeine or vicodin. Dr. St. Amand occasionally gives an injection of lidocaine or cortisone in a trigger point area to temporarily relieve a localized pain, if the level of pain warrants it. He acknowledges physical therapy, chiropractic and massage seem to help some, but feels that their benefits are rather limited for the time, money and effort expended for repeated visits.
For constipation, he suggests a Tablespoon of mineral oil at night and/or increased fiber intake. For diarrhea, lomotil or over-the-counter anti-diarrheals, like Imodium. Pepto bismal (with bismuth subsalicylate) and Alka Selzer (with aspirin) must be avoided due to salicylate blocking the guaifenesin. Calcium antacids, baking soda or Alka Selzer Gold (without aspirin) may be used to neutralize excess acid in heart burn. A rare patient will experience stomach upset from guaifenesin and these patients can place the guaifenesin tablet inside a gelatin capsule so that it will not dissolve until it reaches the intestine.
Dr. St. Amand does not find the need, at present, to treat allergies and sensitivities in his patients. He thinks it is costly, time-consuming, uncertain in its results, and within his patient population, he feels it is unnecessary. In some patients, rashes and other symptoms related to allergies gradually improve as their fibromyalgia is treated with guaifenesin. However, he has not had many patients with very severe environmental sensitivities and so no firm conclusions can yet be drawn. Of course, he does not object to patients avoiding a food or chemical if they believe it makes them worse, but it isn’t part of his approach.
As far as some of the other types of testing mentioned earlier (e.g., amino acids, parasites, Mycoplasma), at present Dr. St. Amand thinks them unnecessary and of unproven usefulness. Occasionally a patient may have abnormal thyroid function as evidenced by a TSH level outside the normal range and this should be investigated further. He thinks low dose cortisone is dangerous in that it may suppress the immune system and the adrenal gland (Editor’s note: A study by McKenzie et al, 1998, JAMA 280(12):1061-6 of CFS patients also concluded cortisone’s dangers outweighed its benefits; a second study with even lower levels (5-10 mg) is now being conducted).
Dr. St. Amand is commonly asked about his opinion of other supplements, like magnesium, taurine, glucosamine sulfate and 5-htp; he knows some patients think they help. He doe not routinely encourage their use, believing they are usually unnecessary. On the other hand, he knows of no harm in their being tried if the patient wants to, as long as they don’t accidentally take supplements with hidden salicylates. Herbal supplements should be strictly avoided by those using guaifenesin, since they contain salicylates which will cause progress to be blocked or reversed. He thinks some may even be dangerous, however he does not consider supplements to be his area of expertise.
(This addendum was reviewed and edited by R. Paul St. Amand, M.D. in 1999)
Editorial Note (2008): I was helped by guaifenesin, but at a certain point, I stopped improving. I now believe that a more effective approach that gets to the underlying cause is an anti bacterial treatment called the Marshall Protcol, for more see recent issues of this newsletter and http://AutoimmunityResearch.com.
Disclaimer: All articles provided on the SynergyHN website are for information only and are not intended as medical advice. An effort is made to be accurate, however readers are advised to verify what is presented here and check with their own doctors. No guarantee of accuracy is expressed or implied. Neither CISRA nor the author receives any funding or income from any organization or manufacturer connected with the topics discussed.
Written by synergyhn
October 30, 2000 at 4:06 am
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All articles provided on the SynergyHN website are for information only and are not intended as medical advice. An effort is made to be accurate, however readers are advised to verify what is presented here and check with their own doctors. No guarantee of accuracy is expressed or implied. Neither CISRA nor the author receives any funding or income from any organization or manufacturer connected with the topics discussed.
Furthermore, the articles presented here should not be relied on to suggest a course of treatment for any individual. The information should not be used in place of a consultation or a visit with your physician or licensed health care provider. Implementation of any treatments discussed are undertaken at your own risk. The reader of articles on this site agree not to hold liable anyone connected with the SynergyHN website for any use or misuse of the information discussed here. The articles are not written by a medical physician or licensed health care provider. If you have any health-related questions, consult your physician or other qualified health care provider.