Virginia Osborne, ND and Christine C. White, ND
Fibromyalgia is characterized by musculoskeletal pain, non-restorative sleep and fatigue. It is accompanied by a host of mental, emotional and physical issues. Both fibromyalgia and chronic fatigue syndrome cases are statistically found to be two to seven times greater in women than in men. With the ever-increasing rate of these diagnoses, the use of IV nutrient therapy has proven to be quite effective.
In the treatment of these symptoms, the question becomes whether the underlying disorder is due to biochemical pathway deficiencies and/or excesses, toxic environmental exposures, an infectious disease or a combination of these factors. This multifaceted diagnosis for each patient will perhaps be exacerbated by chronic stress or an extreme stress-related event. As NDs, we have taken an oath to determine the underlying root cause of disease, and thus, when it comes to fibromyalgia, we must seek the individual cause in each of our patients.
All of this may be daunting when sitting across from someone who is living with chronic, unremitting pain, and who is also likely to fit the picture of chronic fatigue syndrome. The goal of this article is to explore treatment options for these chronic symptomatic conditions using IV micronutrient therapy. IV micronutrient therapy can and does serve as an adjunct to nutritional and dietary changes. Furthermore, it can support biochemically the deficient detoxification pathways. This can be observed whether diagnosed via testing or case history. As NDs, we understand the importance of digestive health and optimal nutrition. For the patient with a chronic condition, dietary changes can be difficult to implement. IV nutritional therapy is a way to start nutritional support that bypasses the gut and provides nutrition directly to the cells to increase cellular concentrations and support healthy metabolism, cellular nutrient exchange and waste removal.
Prior Research
A recent study by Yale researchers found that 40 patients, who received one injection weekly of the Meyers Cocktail for eight weeks, showed significant improvement in reducing tender points and depression while increasing their quality of life. The Meyers Cocktail is an intravenous micronutrient treatment containing magnesium, calcium, B5, B6, B12, vitamin B complex and vitamin C. While it is believed that the increase in intracellular magnesium, and perhaps other nutrients, is transient, this increase allows for more optimal functioning, at least for a short period of time. Clinically, it is observed that over time patients heal and are progressively better with each treatment (Gaby, 2002). Depending on the etiology of the fibromyalgia, nearly complete healing may be seen, or repeated injections over time may allow the patient to maintain quality of life.
The most important point to consider is the tailoring of the therapy to the patient. Standard protocols only take us so far; our strength as physicians lies in our ability to treat the various etiologies of fibromyalgia and chronic fatigue syndrome specific to each patient.
Micro-Nutrients Used in IV Therapy
- MSM (methylsulfonylmethane) While fibromyalgia is not thought to be an inflammatory disorder of the muscles, often times MSM will relieve accompanying inflammation and result in a reduced overall level of pain. MSM acts as an analgesic, reduces muscle spasm, generates vasodilatation, increases blood flow and passes through cellular membranes.
- Copper Copper deficiency has been shown under experimental conditions to lower enkephalin levels, and thus affect the endogenous control of how pain is perceived. Magnesium deficiency is also associated with an increase in the incidence of infection and the impairment of immune function.
- Magnesium It is well known that this mineral is the one of greatest deficiencies facing those with fibromyalgia and chronic fatigue syndrome. It is the activating mineral for at least 350 enzymes in the body, illustrating that it is crucial for many of the metabolic body functions. Magnesium is necessary for almost all of the enzymes that allow the glycolytic and Krebs cycles to turn the sugars and fats into ATP. Low levels of ATP have commonly been found in people with fibromyalgia, and it is believed that this plays an important role in many fibromyalgia symptoms. Deficiency promotes excessive muscle tension, leading to muscle spasms, tics, restlessness and insulin resistance. Magnesium is also responsible for the regulation of nerve function, and deficiency will result in exaggerated emotional reactions. Note that oral supplementation with magnesium results in little or no change in serum magnesium concentrations, whereas IV administration can double or triple the serum levels, at least for a short period of time. The positive responses with parenteral magnesium are consistent with the observation that nearly half of patients with fibromyalgia have intracellular magnesium deficiencies, despite having normal serum levels of the mineral.
- Selenium This mineral has synergistic activity with vitamin E. A deficiency of selenium and vitamin E has not been conclusively established for fibromyalgia; however, selenium deficiency is associated with muscle pain, shown as two selenium attached to the glutathione peroxidase molecule. Upon inspection, selenium is noted to reduce any further opportunity for cell destruction from free radical damage, theoretically reducing pain.
- Zinc A requirement for the development of white blood cells, it can be critical in any situation where compromised immune function is a consideration, or if testing clearly indicates a deficiency.
- Vitamin B5 (dexpanthenol) Required for energy production. In addition, a deficiency depresses humoral responses to various antigens. (This is actually true of all B vitamins, including folic acid.)
- B6 (pyridoxine HCl) B6 helps normalize thiamine status as measured through erythrocyte transketolase activity and is the likely mechanism by which B6 has been shown to treat muscle spasms in the extremities. B6 is also required for the conversion of dietary tryptophan to serotonin, which has been shown to be low in patients with fibromyalgia. This deficiency is either an innate deficiency or as a result of chronic pain.
- B12 (hydroxycobalamin or methylcobalamin) Shown to decrease muscle cramping and to have an analgesic effect. Methylcobalamin further enhances the effect of the neurological symptoms.
- B complex, generally comprised of thiamine, niacinamide, riboflavin, dexpanthenol and pyridoxine Riboflavin has been shown to decrease neuromuscular irritability. B complex given to patients with chronic pain showed antinociceptive effects.
- Vitamin C Much greater plasma concentrations of vitamin C can be achieved with IV administration than through oral dosing. When the daily intake of vitamin C is increased 12-fold, from 200mg/day to 2,500mg/day, the plasma concentration increases by only 25%, from 1.2 to 1.5mg/dL. The highest serum vitamin C level reported after oral administration of pharmacological doses of the vitamin is 9.3mg/dL. In contrast, IV administration of 50g/day of vitamin C resulted in a mean peak plasma level of 80mg/dL. Higher dosing will enhance the oxidative effect, whereas lower dosing will augment the antioxidant quality.
- Vitamin D Responsible for the regulation of calcium/phosphorus homeostasis. A deficiency of vitamin D leading to calcium/phosphorus deficiency will lead to muscle pain.
- Folate A deficiency has been shown to generate peripheral neuropathy, and such a deficiency is present in malabsorption conditions such as IBS and celiac disease.
- Glutathione Given intravenously, it can be both anti-viral and supportive to the detoxification pathways. A deficiency can be induced by ultraviolet and other radiation, viral infections, environmental toxins, household chemicals and heavy metals, surgery, inflammation, burns, septic shock and dietary deficiencies of GSH precursors and its enzyme co-factors. It aids in reduction of oxidized forms of vitamins C and E, improving the overall function of muscle tissue.
- Hydrochloric acid In 1-5cc dosages, depending on the degree of carrier solution and overall health of the patient, HCl has been demonstrated to enhance immune function, which can be particularly helpful when there is a suspected fungal, viral or bacterial etiology.
- Hydrogen peroxide Delivers oxygen to the tissues and acts as an anti-microbial substance, just as it does when secreted by the body’s peroxisomes in response to an antigenic presence.
- Potassium chloride It is well known that hypokalemia causes muscle cramping, and that the Standard American Diet is potassium deficient and has excessive sodium intake.
Case Study 1
John is a 55-year-old male who has been diagnosed with chronic fatigue syndrome and fibromyalgia for nearly 20 years. He is an electrician by trade who owns his own business and works sporadically, depending on how well he feels. He recently presented with significant overall body pain (particularly his hands and thighs), severe occipital headaches, extreme fatigue, irritable bladder, chronic diarrhea and inconsistent sleep. He has been taking a multivitamin, mineral, herbal supplement for several years that is designed for fibromyalgia and chronic fatigue syndrome, and does feel somewhat better when he takes this. On initial assessment, his symptoms were consistent with a chronic infection, complicated with chemical and heavy metal exposure, as well as a possible defect in detoxification pathways. An Adrenal Stress Index was ordered (which showed stage 7 – adrenal failure), along with an IGeneX Western Blot for Borrelia burgdorferi (which returned positive); his CBC and chemistry pane.
Aside from general naturopathic recommendations, on the first visit he was given the following IV treatment:
- 9% saline, glass, 250cc
- H2O2, 3cc
- Magnesium sulfate, 500mg/ml 3cc
- Manganese, 5cc
- HCl, 2cc
- Selenium, 40mcg/ml 5cc
- Dexpanthenol
- Pyridoxine
- B complex
- Hydroxycobalamin
- Methylcobalamin, 10mg/ml 1cc.
John’s headache resolved with first treatment, to return less than 24 hours later with increased pain and fever, likely due to increased immune response.
Subsequently, the IV was changed to be more supportive and build him up before addressing the infection more directly.
- Normal saline (0.9% NaCl), bag, 250cc
- Magnesium sulfate, 500mg/ml 3cc
- Potassium chloride, 149mg/ml 5cc
- Dexpanthenol, 250mg/ml 3cc
- Pyridoxine, 100mg/ml 3cc
- B complex, 100 2cc
- Hydroxycobalamin, 1000mcg/ml 2cc
- Methylcobalamin, 10mg/ml 1cc
- Chromium, 4mcg/ml 5cc
- Zinc, 1mg/ml 2cc
- Copper (as cupric sulfate), 0.4 mg/ml 1cc
- MSM 15%, 30cc
- Glutathione, 100mg/ml, 10cc.
Fevers remitted with the change in IV. James reported almost complete elimination of pain, both joint and muscular. Nearly daily severe headaches almost completely resolved – some days he had no pain, other days only mild. His energy level improved during each IV and held for 4-6 days. With symptom improvement, John’s treatments will be modified to be more anti-microbial and immune stimulating. His case is still evolving, but the regular IV micronutrient therapy made a major impact in just four weeks.
Case Study 2
Janet is a 35-year-old part-time home healthcare nurse and mother of three with a busy family life and who also runs a business with her husband. She presented with a fibromyalgia diagnosis of several years with no consistent resolution in pain, in spite of many different treatment protocols, including changes in diet and the self-prescribing of herbal medicine. Initially, she was given the following IV drip:
- 9% sodium chloride, 250cc
- Magnesium sulfate, 4cc
- Potassium, 10cc
- Selenium, 2 cc
- Vitamin C, 10 cc
- Glutathione, 10 cc
- Dexpanthenol, 2 cc
- Pyridoxine, 2cc
- Hydroxycobalamin, 2cc
- B complex, 1cc
- MSM, 10cc.
After the first treatment, Janet reported mild improvement, but it only lasted one day. Subsequent treatments were given 1-2 times per week. After the fourth treatment, she and her husband called to report that for the first time in years, she didn’t have to crawl to the bathroom in the morning because of the pain. Treatments continued in decreasing frequency, depending on how she was feeling. She subsequently removed all gluten from her diet and improved significantly. Chelation therapy was implemented for the heavy metal toxicity diagnosed. Over the next two years, I saw Janet about every three months, when stress and diet exacerbated her symptoms. She has been relatively pain free for the past two years.
Virginia Osborne, ND is a graduate of NCNM. She is part of the adjunct faculty at NCNM in IV therapy and environmental medicine, and lectures internationally on IV and EDTA therapies. Osborne has a clinical practice in Portland.
Christine C. White, ND is in private practice in Missoula, Mont., with nearly 20 years’ experience working in human services. She received her doctorate in naturopathic medicine from NCNM. Her practice, Black Bear Naturopathic Clinic, PC is a comprehensive family practice where she treats prenatal to elders, and emphasizes endocrinology, environmental medicine, and IV micronutrient therapy and chelation.
References
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Huntsman RW:Three years of HCl therapy, The Medical World 1935.
Zhou Q et al: Influence of low magnesium concentrations in the medium on the antioxidant system in cultured human arterial endothelial cells, Magnes Res Mar;12(1):19-29, 1999.
Carter D et al: Parenteral Micronutrient Therapy. CITY, 2004, PUBLISHER.
Levy T: Vitamin C, Infectious Diseases and Toxins, Philadelphia, 2002, Xlibris Corp.
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