CISRA’s Synergy Health Newsletter

Issue 5. Can One Slow the Progression of Fibromyalgia Without Guaifenesin? (1999)

by J. C. Waterhouse, Ph.D.

I frequently hear from people who are intrigued by Dr. St. Amand’s theory of excess phosphate retention as a cause of fibromyalgia and the use of guaifenesin to reverse it, but for various reasons, feel they are unable to try guaifenesin at this time. For these people, I have come up with a list of suggestions of things one might try that may slow the progression of fibromyalgia. These are only my suggestions based on Dr. St. Amand’s theory, and it is currently unknown whether they will significantly reduce the progression of fibromyalgia, much less reverse it. For those who prefer not to go on guaifenesin at this time, I would also suggest reading the article, “Guaifenesin and a hypoglycemic diet in fibromyalgia: common errors and misconceptions” (Waterhouse, 1999) or the new book on the guaifenesin approach (St. Amand & Marek, 1999), since it is possible that further information would cause you to reconsider your decision not to use guaifenesin.

Consult your physician before making any significant changes to your diet or treatment regime. A small proportion of people may actually be deficient in phosphate, and should not reduce their intake and should consult their physician about this (De Lorenzo et al., 1998). If you feel weaker when you lower your phosphate and better when taking it, or your lab tests suggest low phosphate, do not follow the suggestions below. On the other hand, it might be that reducing phosphate intake in some people might be enough to start reversing some lesions, and thus it seems possible that you might experience some reversal symptoms, which are considered a good sign (see St. Amand and Marek, 1997, 1999). (Note: Phosphate and phosphorous will be regarded as more or less equivalent for the purposes of this article.)

First-Line Strategies to Reduce Phosphate:

1. Taking calcium and magnesium supplements with meals to help bind phosphates in the diet. If you start experiencing diarrhea, reduce your magnesium intake or change to a better absorbed type (e.g., amino acid chelates, glycinate, aspartate etc…), to see if the diarrhea is due to excess unabsorbed magnesium in the gut. If you experience constipation from the calcium, increase the magnesium or reduce the calcium. Suggested intakes of calcium vary from 800-1500 mg/day and for magnesium, from 300-1000 mg/day (the high levels may help at first, and may need to be reduced as magnesium is repleted).

2. If you are taking supplements containing phosphate, like certain calcium or bone/joint support formulas, be certain you are not taking a type with phosphate. Hydroxyapatite and bone meal contain large amounts of phosphate. In fact, if you are eating salmon and sardines and eating the tiny bones, you will be consuming extra phosphate from that source too.

3. Avoiding or reducing sodas and sports drinks containing phosphate, and processed foods with phosphate-containing additives. In general, sodas, contain phosphoric acid and amounts can add up to significant levels, particularly for those who drink several per day. It may be that some health food stores have sports drinks without phosphate, but you will have to shop around.

4. If you are hypoglycemic or crave carbohydrates, a low carbohydrate diet can reduce insulin. Since high insulin promotes phosphate retention and drives phosphate into cells, reducing carbohydrates may reduce the intracellular phosphate accumulation (St. Amand and Malek, 1999). Also avoid foods and chemicals to which you are sensitive, since there is evidence that these reactions can raise insulin too (see other articles from this issue and past issues).

Second-Line Strategies for Reducing Phosphate:

5. Avoiding or reducing dairy products, which are relatively high in phosphate. Assuming evolution would arrive at the best ratio of phosphate to calcium, the fact that the ratio of phosphate to calcium in human milk is significantly lower than it is in cows or goats milk supports the idea that high consumption of dairy products could contribute to problems with excess phosphate.

6. Replacing some high phosphate protein sources with low phosphate, usually vegetarian ones (e.g., eggs, soy, or even concentrated rice protein or bean-derived protein). This option may not be open to everyone, since a low carbohydrate, higher protein diet is needed by many hypoglycemics (see above), and many of the vegetarian protein options may not be viable for some people due to food allergies/sensitivities. This problem points to a need for a greater variety of hypoallergenic vegetable protein, which I hope that the food products industry responds to. Unfortunately, soy protein is the one that is pushed at present, and I believe the potential allergenicity of soy in susceptible people is too often overlooked.

7. Consume more alkaline foods, or antacids, like baking soda in water, between meals, if your urine is too acidic. Acidity of the urine may be measured with pH paper obtainable from various companies (e.g., Allergy Alternative: 800-838-1514). The pH should generally be around 6 to 7.5. Excessive acidity may promote phosphate retention. According to Dr. St. Amand, a more alkaline urine tends to reduce phosphate retention, and for this reason, he suggests the citrate form of calcium be used for your calcium supplementation (contact the Vulvar Pain Foundation, 336-226-0704 to find out more about calcium citrate’s use in reducing vaginal/vulvar pain). Calcium carbonate is also an alkaline form, and might be used if you do not tolerate the citrate form (some chronic fatigue syndrome patients have excess citrate in the blood and believe it contributes to their symptoms).

If you can’t do all these things, you might try doing the “First-Line Strategies,” to the extent that you can, until you can go on guaifenesin. In some mild, shorter-term or borderline cases, these measures might be sufficient to reverse the formation of lesions. In most cases, however, it may only be enough to slow the development of lesions. Research, involving “mapping” fibromyalgia lesions before and after making all or some of the above changes, will be needed to determine these issues. The fact that some people feel that dietary changes or supplements have reversed or significantly helped their illness may suggest that their improvement may be at least partly due to the effects on phosphate intake and excretion of the various changes mentioned above. The diverse factors that may affect phosphate consumption, absorption and excretion may partly explain the diversity of factors that people report are beneficial. However, it should be remembered that many who say they have recovered through diet and supplements alone are not really completely recovered. Others who have recovered in this way, may only await a future triggering event, or other aging-related factors, to develop symptoms and lesions again.

The final point to stress is that Dr. St. Amand and other have found that the use of guaifenesin is the most certain way to reverse fibromyalgia lesions and can do so completely and permanently (St. Amand and Marek, 1997, 1999). If you use guaifenesin properly (e.g., the correct dose, and avoiding hidden salicylates, including the newer sources, see Waterhouse, 1999 for more on common errors), it should not be necessary to reduce your dietary intake of phosphate. However, many will still have to use the low carbohydrate diet if they have hypoglycemia, and I believe many will benefit from allergen reduction.

(Note: Dr. St. Amand does not endorse all the above suggestions. For those not yet on guaifenesin, he feels most favorably regarding the use of non-phosphate containing supplements, calcium supplements, reducing phosphate from sodas and additives and the low carbohydrate diet for hypoglycemia. Dr. St. Amand also thinks magnesium supplementation is unnecessary in most people. He also would reiterate that using guaifenesin and doing it properly is needed to treat fibromyalgia and related conditions and would not encourage patients to try to reverse lesions with only the sorts of changes mentioned above).

Editorial Note (2008):  I stopped progressing on guaifenesin and am now progressing well using the Marshall Protocol.  For information on this anti bacterial protocol, see: and more recent issues of this newsletter.


De Lorenzo et al. 1998. Phosphate diabetes in patients with chronic fatigue syndrome. Postgrad Med J., 74(870): 229-32.

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 Medical Press, Binghamton, NY.

St. Amand, R. Paul, M.D. 1999. Papers on “Fibromyalgia: For Patients,” “Fibromyalgia: For Physicians,” and “Hypoglycemia,” and Salicylate-Free product list at: and further information available at:

Waterhouse, J.C., Ph.D. 1999. Guaifenesin and a hypoglycemic diet in fibromyalgia: common errors and misconceptions. CISRA’s Synergy Health Newsletter, Issue 4, Vol. 2(1).

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, 1999 at 1:49 am

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