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A favorite IV additive, glutathione is known by those who use it to have extremely positive effects in the treatment of a wide range of illnesses. In the FMS/CFS setting, it also is known to be a helpful addition to most IV protocols. Although much has been written about the potential benefits of glutathione augmentation in medicine, the FMS/CFS patient may have a greater need for glutathione augmentation due to higher oxidative stress loads as well as a greater need for appropriate cell regulation.37,38 In addition to these factors, a connection between FMS/CFS and MCS is clinically noted in many patients. Glutathione is one factor in aiding repair of cell metabolism in MCS as well as damaged redox states in FMS/CFS.45,51,52 These and other likely reasons for inclusion are why the author includes glutathione IV in all FMS/CFS patient protocols. General doses are between 1 and 3 grams and may be as high as 6 to 10 grams in some cases. Clinically, the use of glutathione IV appears to be more efficient when support nutrients (such as are found in the general nutrient IV formulas) are given before the glutathione infusion. As some patients will have sulfation SNP defects and other reasons not to tolerate glutathione, the author typically uses a lower test dose on the first IV infusion of glutathione ranging from 100 to 500 mg.
The Lipoic–Acid Based Thiols
Alpha-lipoic acid (ALA): ALA is a thiol and as such is known in basic science to support levels of glutathione in the liver and other tissues. In experimental models, ALA has been shown to be helpful in pushing the redox balance in a positive direction via modulation of inflammatory cytokines such as tumor necrosis factor and NF-kappaB.39,40 Like glutathione, the lipoic acid molecules bring a high level of respect for clinical efficacy from those who use them. Due to recent changes in pharmacologic compounds of ALA, it is recommended that practitioners discuss dosing and potential reactions based on the available form of ALA from their individual compounding pharmacies before administration.
Lipoic acid mineral complex (LAMC): Known in North America as the proprietary formula Poly MVA, LAMC has shown to be helpful in cell repair, mitochondrial repair, and radioprotection.41–44 The author has found that low IV doses (5–15 mL) combined with low oral doses (5–10 mL b.i.d.) improve energy and other quality of life measures in FMS/CFS patients. Like ALA, LAMC does take time to work, so most patients are advised that either therapy (like all others) may need to be continued for a number of months for a positive effect to be noted.
The sulfur-containing molecules DMSO and MSM have been reported as potentially therapeutic in FMS/CFS as well as useful in pain syndromes for palliation.46,50 DMSO is also used to transport drugs and nutrients across membranes including the blood–brain barrier.47–49 Given these data, as well as a long clinical history with both substances, the author utilizes both in the therapy of those with FMS/CFS. IV MSM is water soluble and mixes with most any water-soluble IV formula. DMSO is fat and water soluble and mixes well with most water-soluble formulas as well. As DMSO is a solvent, special handling and administration guidelines as taught in standard IV training should be observed. The author favors DMSO for acute and neuropathic pain syndromes and MSM for long-term therapies in FMS/CFS.
It is clear that there are many potential therapies both oral and parenteral for the patient suffering from FMS/CFS. Both the data presented and the author's experience would speak to the utility and improvement in outcomes when the above, and many other, interventions are used in a well-planned comprehensive care plan for these patients. Basic training and understanding of the biochemistry and pharmacology of these agents allow for safe and effective use in the IV or IM setting.
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Paul S. Anderson, NMD, is medical director of Anderson Medical Specialty Associates, a clinic focusing on the care of patients with cancer and chronic diseases. Former positions include professor of pharmacology and clinical medicine at Bastyr University and chief of IV services for Bastyr Oncology Research Center. Dr. Anderson is a graduate of NCNM and began instructing classes at naturopathic medical schools in the early 1990s. He continues to hold board review classes and CME courses for most of the US and Canadian ND programs including BU, NCNM, Boucher Institute, UB, SCNM, and CCNM. He also is a founding board member of the Academy of Parenteral Therapies specialty group and an instructor and author for the IIVNTP IV Therapy training group.
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