Low-dose Exposures
Two decades of research indicate that very low-dose exposures to toxic chemicals can have profound health effects. This counters the long-held belief that “the dose makes the poison” – a rationale that underlies much chemical regulation, including the use of various chemicals in cosmetics (i). The inaccurate assumption that very small amounts of toxic chemicals are safe allows for the continued use of toxic chemicals in personal care products (ii). Buy only natural, organic, non-toxic products.
There are at least three key problems with this assumption. First, this assumes that low doses are truly safe, which may not be the case. Research on laboratory animals, cell cultures and wildlife suggests that in some cases low-dose exposures may have more profound effects than higher exposures (iii). Second, this assumption of safety at low doses overlooks the fact that many of the toxic chemicals that appear in cosmetics and personal care products tend to show up in several products an average person uses daily, and that many of these chemicals show up in other consumer products as well (iv). As a result, what seem like small exposures add up to larger doses.
Finally, a long-standing approach to chemical regulation looks at chemicals one at a time. However, daily life exposes individuals to a multitude of various ingredients. For instance, an Environmental Working Group report shows that women use 12 cosmetic products with 168 unique ingredients each day and men use 6 products with an average of 85 ingredients (v). These ingredients, in combination with exposures from other consumer products and pollutants in the air and water, add up to a phenomenal array of combined exposures, in effect adding up to hundreds of exposures every day (vi).
Research indicates that, in many cases, these exposures add up and work in combination to affect health in ways that may be more profound than single exposures. Taking in multiple chemicals can have an additive effect, whereby multiple small exposures add up to a lot (2+3=5), or a synergistic effect, whereby multiple exposures increase the toxic effects of one another (2+3=10) (vii). For instance, several studies have found that combinations of various chemicals with estrogenic properties may have additive (viii) or synergistic effects (ix).
In addition, the timing of exposure may moderate the effects of low doses, so that low doses at certain points in development – prenatally, during puberty, etc. – may have stronger or qualitatively different effects on health (x).
More Information
For more information about how small doses of chemicals impact our long-term health, visit The Endocrine Disruption Exchange.
i Gray, J (2008). State of the Evidence: The Connection between Breast Cancer and the Environment. San Francisco, CA: Breast Cancer Fund.
ii Environmental Working Group (2004). Exposures Add Up – Survey Results. Available online http://www.cosmeticsdatabase.com/research/exposures/php. Accessed August 19, 2008.
iii Gray, J (2008). State of the Evidence: The Connection between Breast Cancer and the Environment. San Francisco, CA: Breast Cancer Fund.
iv Environmental Working Group (2004). Exposures Add Up – Survey Results. Available online http://www.cosmeticsdatabase.com/research/exposures/php. Accessed August 19, 2008.
v Environmental Working Group (2004). Exposures Add Up – Survey Results. Available online http://www.cosmeticsdatabase.com/research/exposures/php. Accessed August 19, 2008.
vi Centers for Disease Control and Prevention (CDC) (2003). Second National Report on Human Exposure to Environmental Chemicals. Available online at http://www.cdc.gov/exposurereport/. Accessed August 19, 2008.
vii Gray, J (2008). State of the Evidence: The Connection between Breast Cancer and the Environment. San Francisco, CA: Breast Cancer Fund.
viii Ramamoorthy K, Wang F, Chen IC, Safe S, Norris JD, McDonnell DP, Gaido KW, Bocchinfuso WP, Korach KS (1997). Potency of combined estrogenic pesticides. Science 275: 405-6.
Foster WG, Younglai EV, Boutross- Tadross O, Hughes CL, Wade MG (2004). Mammary gland morphology in Sprague-Dawley rats following treatment with an organochlorine mixture in utero and neonatal genistein. Toxicological Sciences 77: 91-100.
ix Xie L, Thrippleton K, Irwin MA, Siemering GS, Mekebri A, Crane D, Berry K, Schlenk D (2005). Evaluation of estrogenic activities of aquatic herbicides and surfactants using a rainbow trout vitellogenin assay. Toxicological Sciences 77: 91-100.
Kortenkamp A (2006). Breast cancer, oestrogens and environmental pollutants: a re-evaluation from a mixture perspective. International Journal of Andrology 29: 193-198.
x Gray, J (2008). State of the Evidence: The Connection between Breast Cancer and the Environment. San Francisco, CA: Breast Cancer Fund.
Showing posts with label SHIN Protocol for Fibromyaglia and Chronic Fatigue. Show all posts
Showing posts with label SHIN Protocol for Fibromyaglia and Chronic Fatigue. Show all posts
Monday, May 24, 2010
Thursday, November 29, 2007
Research: Benefit of Ribose in a Patient With Fibromyalgia
01-31-2005 Journal: Pharmacotherapy
Benjamin Gebhart, Pharm.D.; James A. Jorgenson, M.S., FASHP
Abstract and Introduction
Abstract
Ribose was added to the existing treatment regimen of a woman with fibromyalgia, resulting in a decrease in symptoms. It has been postulated that patients with fibromyalgia may have an alteration in muscle adenine nucleotide metabolism, leading to depleted energy reserves and an imbalance in cellular adenosine-triphosphate:adenosine 5'-diphosphate:adenosine 5'-monophosphate (ATP:ADP:AMP) ratios with an abnormal energy charge. As a key component in adenine nucleotide synthesis, ribose supplementation may be useful in such patients.
Introduction
Fibromyalgia is a syndrome that is manifested by generalized muscle pain and additional systemic symptoms of fatigue, tenderness and stiffness in multiple joints, sleep disturbance, and alterations in bowel activity.
The specific etiology is unknown; however, changes in muscle histology, energy metabolism, oxygen utilization, and the neuroendocrine stress-response system have been postulated to play a role in the development and persistence of this disorder.[1] Low levels of muscle adenine nucleotides, reflected in depleted energy reserves and an imbalance in cellular adenosine 5'-triphosphate:adenosine 5'-diphosphate:adenosine 5'-monophosphate (ATP:ADP:AMP) ratios with an abnormal energy charge, have been reported.[2-4] The unknown cause and varying presenting symptoms make fibromyalgia a therapeutic challenge for practitioners.[5-7]
The management of patients with fibromyalgia requires the integration of both pharmacologic and nonpharmacologic approaches. Pharmacologic options have included tricyclic antidepressants, selective serotonin receptor antagonists, analgesics, benzodiazepines, antiinflammatory agents, and corticosteroids.[5, 6, 8]
Routine daily exercise programs, dietary modifications, alternative therapies such as biofeedback and hypnotherapy, and nutraceuticals such as S-adenosyl-L-methionine (SAMe) have also been explored.[9] Unfortunately, less than 50% of patients achieve any meaningful relief of their symptoms with use of those therapies.[5]
We describe the case of a patient with fibromyalgia who had symptomatic relief when ribose was added to her existing treatment regimen. There have been anecdotal reports on the benefits of ribose in patients with fibromyalgia in whom conventional therapies have failed; however, to our knowledge, this is the first published case of use of ribose for this syndrome.
Case Report
A 37-year-old woman had daily episodes of intense musculoskeletal pain and stiffness, mental "cloudiness," bouts of diarrhea, and sleep disturbance. As she was a surgeon, these symptoms compromised the skills necessary to perform her daily duties in the operating room. She was diagnosed with fibromyalgia by exclusion of other diseases and syndromes and in accordance with the American College of Rheumatology criteria.[10]
The patient was treated with ibuprofen 800 mg twice/day, valdecoxib 10 mg once/day, diphenhydramine 50 mg-acetaminophen 1000 mg at bedtime, and physical therapy once/day. She stated that this therapeutic regimen had limited benefit and that the adverse effects from these drugs further impaired her ability to perform her operative duties.
Approximately 7 months later, in addition to her regular drug therapy, the patient began taking CORvalen (Bioenergy, Inc., Ham Lake, MN), a ribose-based product. She took 5 g of CORvalen mixed in water twice/day. She experienced no adverse effects, and after 14 days she reported a decrease in her symptoms. Specifically, she noted an improvement in sleep, mental alertness, a marked decrease in joint pain, and normal stools. This trend continued, and after an additional month of CORvalen therapy she reported near-normal functioning with a major reduction in her symptoms.
After another month of taking CORvalen and feeling "normal," the patient elected to discontinue the drug. Within 7 days, she regressed to her initial fibromyalgia state, as reflected in joint pain, sleep disturbance, morning stiffness, trigger-point flares, and diarrhea. She resumed taking CORvalen, at the same dosage as before, and a major reduction in her symptoms again occurred within 14 days. She noted continual benefit for the next month while taking CORvalen. She stopped taking the drug for a second time after this additional 30-day period, and once again she experienced a reemergence of symptoms. When CORvalen was restarted for a third time, the patient's symptoms again subsided.
At the time of this writing, the patient was continuing to take CORvalen and was satisfied that her symptoms had abated.
Discussion
Ribose is a simple carbohydrate that plays a role in high-energy phosphate and nucleic acid synthesis. After ischemia or hypoxia, myocytes have decreased levels of ATP and total adenine nucleotides. Several days are required for their recovery once normoxia has been reestablished.[11-13] In patients with chronic hypoxic conditions, the cellular energy charge may never be fully regained.[14]
These cells have the capacity to regenerate ATP; however, the pentose phosphate pathway of glucose metabolism utilized in the formation of the ribose that is needed to drive the regenerative process is slow in both heart and skeletal muscle cells due to poor expression of specific rate-limiting enzymes. Supplemental ribose has been shown to enhance the synthesis of adenine nucleotides, rebuilding depressed energy pools in both the heart and skeletal muscle after an ischemic or hypoxic insult.[11, 12] Ribose bypasses the rate-limiting enzymatic steps of the pentose phosphate pathway and accelerates the formation of ATP and subsequent tissue recovery.[15]
Supplemental ribose is initially converted to ribose-5-phosphate, subsequently forming 5-phosphoribosyl-1-pyrophosphate, a molecule key to the synthesis of ATP through the de novo purine nucleotide pathway. The safety of ribose has been investigated in standard laboratory and animal toxicology models and in human studies both subjectively and objectively. Investigators have concluded that ribose is well tolerated at dosages of up to 60 g/day, with no significant adverse effects.[16]
Ribose has been shown to improve the energy recovery time in skeletal muscle and to relieve fatigue, soreness, and stiffness after intense exercise.[12, 13, 17] It also has been reported to have a beneficial effect after high-intensity exercise in sports medicine.
One study concluded that ribose accelerated the replenishment of ATP after intense muscle contractions,[18] and bodybuilders and sprinters have reported subjective and objective benefits during exercise after the administration of ribose.[18-20] However, other reports have shown inconsistent results for ribose in relation to improving short-term anaerobic exercise performance, muscle strength, endurance, or body composition during cycling or resistance training.[20, 21]
Ribose has also been investigated for its potential medical efficacy in both animal studies and human clinical trials. To date, the most promising data have been reported in connection with the application of ribose in cardiovascular disease. Both short-term and long-term animal studies found that the use of ribose after myocardial ischemia resulted in enhanced recovery of ATP along with improved diastolic functional parameters.[22, 23]
Clinical benefits have also been observed. Patients with coronary artery disease or heart failure have decreased myocardial ATP levels. Daily supplemental ribose has been shown to improve cardiac function, increase exercise tolerance, and enhance quality of life in this population.[24]
Patients with fibromyalgia may experience an alteration in physiologic muscle metabolism. It has been found that they reach the anaerobic threshold in their muscles earlier, thereby using less of the available energy-rich phosphate metabolites at maximal work capacity.[25] In another study, patients with fibromyalgia were reported to have a potential abnormality in high-energy phosphate metabolism, as evidenced by significantly lower levels of ATP and ADP in affected muscles as compared with patients without the disease.[2]
Theoretically, the effect of ribose on increasing the muscle energy pool could reduce the metabolic strain in affected muscles and allow patients to assume a more active lifestyle. Considering the known musculoskeletal symptomatology in this syndrome and the reported benefits of ribose in skeletal muscle metabolism and physiology, supplemental ribose appears to have aided our patient in improving her quality of life.
Conclusion
Fibromyalgia presents a continuing therapeutic challenge. Ribose is a naturally occurring carbohydrate with documented medical benefits in patients with cardiovascular disease. To our knowledge, this is the first report to suggest its potential benefit in a patient with fibromyalgia, who had had suboptimal results with conventional therapies. We are designing a trial using objective outcome measures to further evaluate the effectiveness of this product in patients with fibromyalgia
Pharmacotherapy 24(11):1646-1648, 2004. © 2004 Pharmacotherapy Publications
References:
1. Olson NJ, Park JH. Skeletal muscle abnormalities in patients with fibromyalgia. Am J Med Sci 1998;315:351-8.
2. Bengtsson A, Henriksson KG, Larsson J. Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis Rheum 1986;29:817-21.
3. Eisinger J, Plantamura A, Ayavou T. Glycolysis abnormalities in fibromyalgia. J Am Coll Nutr 1994;13:144-8.
4. Park JH, Phothimat P, Oates CT, Hernaz-Schulman M, Olsen NJ. Use of P-31 magnetic resonance spectroscopy to detect metabolic abnormalities in muscles of patients with fibromyalgia. Arthritis Rheum 1998;41:406-13.
5. Leventhal LJ. Management of fibromyalgia. Ann Intern Med 1999;131:850-7.
6. Friedberg F, Jason LA. Chronic fatigue syndrome and fibromyalgia: clinical assessment and treatment. J Clin Psychol 2001;57:433-55. Lash AA, Ehrlich-Jones L, McCoy D. Fibromyalgia: evolving concepts and management in primary care settings. Medsurg Nurs 2003;12:145-59, 190.
7. Briley M, Moret C. Fibromyalgia syndrome: an overview of potential drug targets. Drugs 2003;6:668-73.
8. Holdcraft LC, Assefi N, Buchwald D. Complementary and alternative medicine in fibromyalgia and related syndromes. Best Pract Res Clin Rheumatol 2003;17:667-83.
9. Wolfe F, for the American College of Rheumatology. Criteria for the classification of fibromyalgia: report of the multi-center criteria committee. Arthritis Rheum 1990;33:160-72.
10. St Cyr J, Bianco R, Schneider J, et al. Enhanced high energy phosphate recovery with ribose infusion after global myocardial ischemia in a canine model. J Surg Res 1989;42:157-62.
11. Hellsten Y, Skadhauge L, Bangsbo J. Effect of ribose supplementation on resynthesis of adenine nucleotides after intense intermittent training in humans. Am J Physiol Integr Comp Physiol 2004;286:R182-8.
12. Williamson DL, Gallagher PM, Goddard MP, Witter J, Trappe S. Effects of ribose supplementation on adenine nucleotide concentration in skeletal muscle following high-intensity exercise [abstr]. Med Sci Sport Exer 2001;33(5 suppl).
13. Ingwall JS. ATP and the heart. Boston: Kluwer Academic, 2002:55-95.
14. Pauly DF, Pepine CJ. D-ribose as a supplement for cardiac energy metabolism. J Cardiovasc Pharmacol Ther 2000;5: 249-58.
15. Pliml W, von Arnim T, Stablein A, Hoffman H, Zimmer HG, Erdmann E. Effects of ribose on exercise-induced ischaemia in stable coronary artery disease. Lancet 1992;340:507-10.
16. Butler T, St Cyr J. Use of ribose to prevent cramps and soreness in muscles. U.S. patent 6159943. December 12, 2000.
17. Zarzeczny R, Brault JJ, Abraham KA, Hancock C, Terjung R. Influence of ribose on adenine salvage after intense muscle contractions. J Appl Physiol 2001;91:1775-81.
18. Van Gammeren D, Antonio J, Falk D. The effects of four weeks of ribose supplementation on body composition and exercise performance in healthy, young, male recreational bodybuilders: a double-blind, placebo controlled trial. Cur Therapeut Res 2002;63:486-95.
19. Berandi JM, Ziegenfuss TN. Effects of ribose supplementation on repeated sprint performance in men. J Strength Cond Res 2003;17:47-52.
20. Falk DJ, Heelan KA, Thyfault JP, Koch AJ. Effects of effervescent creatine, ribose, and glutamine supplementation on muscular strength, muscular endurance, and body composition. J Strength Cond Res 2003;17:810-16.
21. Schneider J, St Cyr J, Mahoney J, Bianco R, Ring W, Foker J. Recovery of ATP and return of function after global ischemia [abstr]. Circulation 1985;72(4 pt 2):III-298.
22. Zimmer HG. Normalization of depressed heart function in rats by ribose. Science 1983;220:81-2.
23. Omran H, Illien S, MacCarter D, St Cyr J, Luderitz B. D-ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility study. Eur J Heart Failure 2003;5:615-19.
24. Lund E, Kendall SA, Janerot-Sjoberg B, Bengtsson A. Muscle metabolism in fibromyalgia studied by P-31 magnetic resonance spectroscopy during aerobic and anaerobic exercise. Scand J Rheumatol 2003;32:138-45.
Source: MedScape
Benjamin Gebhart, Pharm.D.; James A. Jorgenson, M.S., FASHP
Abstract and Introduction
Abstract
Ribose was added to the existing treatment regimen of a woman with fibromyalgia, resulting in a decrease in symptoms. It has been postulated that patients with fibromyalgia may have an alteration in muscle adenine nucleotide metabolism, leading to depleted energy reserves and an imbalance in cellular adenosine-triphosphate:adenosine 5'-diphosphate:adenosine 5'-monophosphate (ATP:ADP:AMP) ratios with an abnormal energy charge. As a key component in adenine nucleotide synthesis, ribose supplementation may be useful in such patients.
Introduction
Fibromyalgia is a syndrome that is manifested by generalized muscle pain and additional systemic symptoms of fatigue, tenderness and stiffness in multiple joints, sleep disturbance, and alterations in bowel activity.
The specific etiology is unknown; however, changes in muscle histology, energy metabolism, oxygen utilization, and the neuroendocrine stress-response system have been postulated to play a role in the development and persistence of this disorder.[1] Low levels of muscle adenine nucleotides, reflected in depleted energy reserves and an imbalance in cellular adenosine 5'-triphosphate:adenosine 5'-diphosphate:adenosine 5'-monophosphate (ATP:ADP:AMP) ratios with an abnormal energy charge, have been reported.[2-4] The unknown cause and varying presenting symptoms make fibromyalgia a therapeutic challenge for practitioners.[5-7]
The management of patients with fibromyalgia requires the integration of both pharmacologic and nonpharmacologic approaches. Pharmacologic options have included tricyclic antidepressants, selective serotonin receptor antagonists, analgesics, benzodiazepines, antiinflammatory agents, and corticosteroids.[5, 6, 8]
Routine daily exercise programs, dietary modifications, alternative therapies such as biofeedback and hypnotherapy, and nutraceuticals such as S-adenosyl-L-methionine (SAMe) have also been explored.[9] Unfortunately, less than 50% of patients achieve any meaningful relief of their symptoms with use of those therapies.[5]
We describe the case of a patient with fibromyalgia who had symptomatic relief when ribose was added to her existing treatment regimen. There have been anecdotal reports on the benefits of ribose in patients with fibromyalgia in whom conventional therapies have failed; however, to our knowledge, this is the first published case of use of ribose for this syndrome.
Case Report
A 37-year-old woman had daily episodes of intense musculoskeletal pain and stiffness, mental "cloudiness," bouts of diarrhea, and sleep disturbance. As she was a surgeon, these symptoms compromised the skills necessary to perform her daily duties in the operating room. She was diagnosed with fibromyalgia by exclusion of other diseases and syndromes and in accordance with the American College of Rheumatology criteria.[10]
The patient was treated with ibuprofen 800 mg twice/day, valdecoxib 10 mg once/day, diphenhydramine 50 mg-acetaminophen 1000 mg at bedtime, and physical therapy once/day. She stated that this therapeutic regimen had limited benefit and that the adverse effects from these drugs further impaired her ability to perform her operative duties.
Approximately 7 months later, in addition to her regular drug therapy, the patient began taking CORvalen (Bioenergy, Inc., Ham Lake, MN), a ribose-based product. She took 5 g of CORvalen mixed in water twice/day. She experienced no adverse effects, and after 14 days she reported a decrease in her symptoms. Specifically, she noted an improvement in sleep, mental alertness, a marked decrease in joint pain, and normal stools. This trend continued, and after an additional month of CORvalen therapy she reported near-normal functioning with a major reduction in her symptoms.
After another month of taking CORvalen and feeling "normal," the patient elected to discontinue the drug. Within 7 days, she regressed to her initial fibromyalgia state, as reflected in joint pain, sleep disturbance, morning stiffness, trigger-point flares, and diarrhea. She resumed taking CORvalen, at the same dosage as before, and a major reduction in her symptoms again occurred within 14 days. She noted continual benefit for the next month while taking CORvalen. She stopped taking the drug for a second time after this additional 30-day period, and once again she experienced a reemergence of symptoms. When CORvalen was restarted for a third time, the patient's symptoms again subsided.
At the time of this writing, the patient was continuing to take CORvalen and was satisfied that her symptoms had abated.
Discussion
Ribose is a simple carbohydrate that plays a role in high-energy phosphate and nucleic acid synthesis. After ischemia or hypoxia, myocytes have decreased levels of ATP and total adenine nucleotides. Several days are required for their recovery once normoxia has been reestablished.[11-13] In patients with chronic hypoxic conditions, the cellular energy charge may never be fully regained.[14]
These cells have the capacity to regenerate ATP; however, the pentose phosphate pathway of glucose metabolism utilized in the formation of the ribose that is needed to drive the regenerative process is slow in both heart and skeletal muscle cells due to poor expression of specific rate-limiting enzymes. Supplemental ribose has been shown to enhance the synthesis of adenine nucleotides, rebuilding depressed energy pools in both the heart and skeletal muscle after an ischemic or hypoxic insult.[11, 12] Ribose bypasses the rate-limiting enzymatic steps of the pentose phosphate pathway and accelerates the formation of ATP and subsequent tissue recovery.[15]
Supplemental ribose is initially converted to ribose-5-phosphate, subsequently forming 5-phosphoribosyl-1-pyrophosphate, a molecule key to the synthesis of ATP through the de novo purine nucleotide pathway. The safety of ribose has been investigated in standard laboratory and animal toxicology models and in human studies both subjectively and objectively. Investigators have concluded that ribose is well tolerated at dosages of up to 60 g/day, with no significant adverse effects.[16]
Ribose has been shown to improve the energy recovery time in skeletal muscle and to relieve fatigue, soreness, and stiffness after intense exercise.[12, 13, 17] It also has been reported to have a beneficial effect after high-intensity exercise in sports medicine.
One study concluded that ribose accelerated the replenishment of ATP after intense muscle contractions,[18] and bodybuilders and sprinters have reported subjective and objective benefits during exercise after the administration of ribose.[18-20] However, other reports have shown inconsistent results for ribose in relation to improving short-term anaerobic exercise performance, muscle strength, endurance, or body composition during cycling or resistance training.[20, 21]
Ribose has also been investigated for its potential medical efficacy in both animal studies and human clinical trials. To date, the most promising data have been reported in connection with the application of ribose in cardiovascular disease. Both short-term and long-term animal studies found that the use of ribose after myocardial ischemia resulted in enhanced recovery of ATP along with improved diastolic functional parameters.[22, 23]
Clinical benefits have also been observed. Patients with coronary artery disease or heart failure have decreased myocardial ATP levels. Daily supplemental ribose has been shown to improve cardiac function, increase exercise tolerance, and enhance quality of life in this population.[24]
Patients with fibromyalgia may experience an alteration in physiologic muscle metabolism. It has been found that they reach the anaerobic threshold in their muscles earlier, thereby using less of the available energy-rich phosphate metabolites at maximal work capacity.[25] In another study, patients with fibromyalgia were reported to have a potential abnormality in high-energy phosphate metabolism, as evidenced by significantly lower levels of ATP and ADP in affected muscles as compared with patients without the disease.[2]
Theoretically, the effect of ribose on increasing the muscle energy pool could reduce the metabolic strain in affected muscles and allow patients to assume a more active lifestyle. Considering the known musculoskeletal symptomatology in this syndrome and the reported benefits of ribose in skeletal muscle metabolism and physiology, supplemental ribose appears to have aided our patient in improving her quality of life.
Conclusion
Fibromyalgia presents a continuing therapeutic challenge. Ribose is a naturally occurring carbohydrate with documented medical benefits in patients with cardiovascular disease. To our knowledge, this is the first report to suggest its potential benefit in a patient with fibromyalgia, who had had suboptimal results with conventional therapies. We are designing a trial using objective outcome measures to further evaluate the effectiveness of this product in patients with fibromyalgia
Pharmacotherapy 24(11):1646-1648, 2004. © 2004 Pharmacotherapy Publications
References:
1. Olson NJ, Park JH. Skeletal muscle abnormalities in patients with fibromyalgia. Am J Med Sci 1998;315:351-8.
2. Bengtsson A, Henriksson KG, Larsson J. Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis Rheum 1986;29:817-21.
3. Eisinger J, Plantamura A, Ayavou T. Glycolysis abnormalities in fibromyalgia. J Am Coll Nutr 1994;13:144-8.
4. Park JH, Phothimat P, Oates CT, Hernaz-Schulman M, Olsen NJ. Use of P-31 magnetic resonance spectroscopy to detect metabolic abnormalities in muscles of patients with fibromyalgia. Arthritis Rheum 1998;41:406-13.
5. Leventhal LJ. Management of fibromyalgia. Ann Intern Med 1999;131:850-7.
6. Friedberg F, Jason LA. Chronic fatigue syndrome and fibromyalgia: clinical assessment and treatment. J Clin Psychol 2001;57:433-55. Lash AA, Ehrlich-Jones L, McCoy D. Fibromyalgia: evolving concepts and management in primary care settings. Medsurg Nurs 2003;12:145-59, 190.
7. Briley M, Moret C. Fibromyalgia syndrome: an overview of potential drug targets. Drugs 2003;6:668-73.
8. Holdcraft LC, Assefi N, Buchwald D. Complementary and alternative medicine in fibromyalgia and related syndromes. Best Pract Res Clin Rheumatol 2003;17:667-83.
9. Wolfe F, for the American College of Rheumatology. Criteria for the classification of fibromyalgia: report of the multi-center criteria committee. Arthritis Rheum 1990;33:160-72.
10. St Cyr J, Bianco R, Schneider J, et al. Enhanced high energy phosphate recovery with ribose infusion after global myocardial ischemia in a canine model. J Surg Res 1989;42:157-62.
11. Hellsten Y, Skadhauge L, Bangsbo J. Effect of ribose supplementation on resynthesis of adenine nucleotides after intense intermittent training in humans. Am J Physiol Integr Comp Physiol 2004;286:R182-8.
12. Williamson DL, Gallagher PM, Goddard MP, Witter J, Trappe S. Effects of ribose supplementation on adenine nucleotide concentration in skeletal muscle following high-intensity exercise [abstr]. Med Sci Sport Exer 2001;33(5 suppl).
13. Ingwall JS. ATP and the heart. Boston: Kluwer Academic, 2002:55-95.
14. Pauly DF, Pepine CJ. D-ribose as a supplement for cardiac energy metabolism. J Cardiovasc Pharmacol Ther 2000;5: 249-58.
15. Pliml W, von Arnim T, Stablein A, Hoffman H, Zimmer HG, Erdmann E. Effects of ribose on exercise-induced ischaemia in stable coronary artery disease. Lancet 1992;340:507-10.
16. Butler T, St Cyr J. Use of ribose to prevent cramps and soreness in muscles. U.S. patent 6159943. December 12, 2000.
17. Zarzeczny R, Brault JJ, Abraham KA, Hancock C, Terjung R. Influence of ribose on adenine salvage after intense muscle contractions. J Appl Physiol 2001;91:1775-81.
18. Van Gammeren D, Antonio J, Falk D. The effects of four weeks of ribose supplementation on body composition and exercise performance in healthy, young, male recreational bodybuilders: a double-blind, placebo controlled trial. Cur Therapeut Res 2002;63:486-95.
19. Berandi JM, Ziegenfuss TN. Effects of ribose supplementation on repeated sprint performance in men. J Strength Cond Res 2003;17:47-52.
20. Falk DJ, Heelan KA, Thyfault JP, Koch AJ. Effects of effervescent creatine, ribose, and glutamine supplementation on muscular strength, muscular endurance, and body composition. J Strength Cond Res 2003;17:810-16.
21. Schneider J, St Cyr J, Mahoney J, Bianco R, Ring W, Foker J. Recovery of ATP and return of function after global ischemia [abstr]. Circulation 1985;72(4 pt 2):III-298.
22. Zimmer HG. Normalization of depressed heart function in rats by ribose. Science 1983;220:81-2.
23. Omran H, Illien S, MacCarter D, St Cyr J, Luderitz B. D-ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility study. Eur J Heart Failure 2003;5:615-19.
24. Lund E, Kendall SA, Janerot-Sjoberg B, Bengtsson A. Muscle metabolism in fibromyalgia studied by P-31 magnetic resonance spectroscopy during aerobic and anaerobic exercise. Scand J Rheumatol 2003;32:138-45.
Source: MedScape
Thursday, November 8, 2007
The SHIN Approach and Treatment Protocol
Understanding The SHIN Approach to CFS/FM Treatment
In his 30 years of clinical experience, and in his landmark study on Effective Treatment of CFS/FM, Dr Teitelbaum has found that his SHIN approach to treating CFS/FM is successful in the vast majority of patients. The SHIN Treatment Protocol is a list of the more common treatments for CFS/FM.
SHIN represents four areas of health issues that need to be addressed when creating a treatment program.
These health issues and their roles in treating CFS/FM are as follows:
In his 30 years of clinical experience, and in his landmark study on Effective Treatment of CFS/FM, Dr Teitelbaum has found that his SHIN approach to treating CFS/FM is successful in the vast majority of patients. The SHIN Treatment Protocol is a list of the more common treatments for CFS/FM.
SHIN represents four areas of health issues that need to be addressed when creating a treatment program.
These health issues and their roles in treating CFS/FM are as follows:
- S = SLEEP: Get adequate sleep, preferably eight to nine hours a night. Sleep replenishes the body's energy and heals its muscles. Inadequate sleep will leave you exhausted and in pain.
- H = HORMONES: Get tested for hormone deficiency and treated if needed. Hormone deficiencies can contribute to fibromyalgia and chronic fatigue syndrome.
- I = INFECTIONS: Get treatment when symptoms of infections occur. The lack of restorative sleep in CFS/FM leads to dysfunctional immune systems. Underlying viral, bacterial, bowel, sinus and yeast infections are common and can be a contributing cause or result of CFS/FM.
- N = NUTRITONAL SUPPLEMENTS: Optimal nutritional supplementation is essential. Many nutrients can be depleted as a result of CFS/FM. B-12, magnesium, Acetyl L Carnitine and glutathione, as well as your basic A, B, C and D vitamins need to be supplemented at a level that your average over the counter multivitamin cannot provide.
See the SHIN Treatment Protocol that Dr. Teitelbaum used in his own practice and his study. This protocol is used worldwide by practitioners who want to effectively treat CFS/FM, as well as patients who want to start natural remedies on their own. You can print it and use this as a guide with your practitioner to tailor your treatment regimen to your specific symptoms. Click here to see the SHIN Treatment Protocol
What to Expect
It takes an average of six weeks to begin to feel the benefits of your treatment. During this time, you should chart important information about your treatment progress, such as dates when you start or stop individual treatments, and their effects. For most of you, CFS/FM took months to fully manifest. It can also take several months to get well.
Although the SHIN protocol gives you the fastest path to healing, keep in mind that total recovery can take several months to over a year. You should remain on the treatment program until you are feeling consistently well for six months or more (with no back-sides). After that, you can taper off the program by discontinuing one treatment every one to two weeks. The gradual tapering is recommended so that you can make sure a particular treatment is no longer needed.
Although it isn't usually necessary, any or all of the treatments can be used forever without harm. Many patients choose to continue several treatments long term after stopping the majority of them. Reading your body’s signals and taking your practitioner’s advice are your best tools in determining which treatments should be continued to remain well.
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