Q & A Library

Guaifenesin (pronounced gwai-FEN-es-en) is an ingredient used in many cough syrups to loosen mucus in the respiratory tract. For years it has been promoted as a natural treatment of fibromyalgia by a Los Angeles physician, R. Paul St. Amand, M.D., assistant clinical professor of medicine at Los Angeles Harbor/UCLA Hospital. Dr. St. Amand claims that guaifenesin relieves fibromyalgia symptoms by ridding muscles, tendons, joints, and other tissues of harmful calcium phosphate deposits that result from defective kidney function.

However, I have found no scientific studies that show that calcium phosphate deposits are a problem in fibromyalgia, or that guaifenesin actually relieves symptoms of fibromyalgia. What's more, there does not appear to be a single study in the medical literature demonstrating that guaifenesin is an effective fibromyalgia treatment. The only research I've seen is a yearlong, double-blinded, placebo-controlled investigation conducted by Robert M. Bennett, M.D., (now retired) professor of medicine and chairman of the Division of Arthritis and Rheumatic Diseases at Oregon Health & Science University. Dr. Bennett's study, completed in 1996, was never published but the results were widely publicized. They showed no difference between guaifenesin and placebo for fibromyalgia treatment - and no significant change in symptoms or in levels of phosphates.

Dr. Bennett's study has been criticized by guaifenesin proponents as "flawed" because participants may have used cosmetics and other topical products containing salicylates which, supposedly, interfere with guaifenesin. There is no evidence for that assertion either.

Nevertheless, guaifenesin still has adherents, and some patients claim it has helped them. I do not recommend it. Instead, I suggest the following approaches:

• Exercise. Daily aerobic activity (swimming, walking, or riding stationary bikes or using elliptical trainers) is one of the most effective fibromyalgia treatments. Stretching and yoga also help.
  
• Establish regular sleeping habits and get professional help to correct any sleep disturbances.
  
• To counteract stress, practice relaxation techniques (meditation, yoga or breathwork).
  
• Consider cognitive-behavioral therapy to learn how to cope with symptoms and stress.
  
• Try acupuncture or massage.
  
• Try the Feldenkrais Method for gentle exercises to help correct poor posture or habits of movement that may contribute to pain.
  
• Eat a diet rich in organic fruits, vegetables, and whole grains.
  
• Eliminate polyunsaturated vegetable oils, margarine, vegetable shortening, all partially hydrogenated oils, and all foods that might contain trans-fatty acids. Use extra-virgin olive oil as your main fat.
  
• Increase intake of omega-3 fatty acids.
  
• Eat ginger and turmeric regularly for their anti-inflammatory effects.
  
• In addition to my antioxidant formula, take 250 mg of magnesium and 500-700 mg of calcium daily to help relax and maintain nerves and muscles. (Men should skip the calcium supplements.)

Andrew Weil, M.D.