A reader wrote about constant pain. One common cause of pain in FM is low oxygen level – typically caused by one or more of the following:

• Vasoconstriction (narrowing of blood vessels, reducing oxygen delivery volume)
• Fibrin deposits (blocking access of the blood’s oxygen into tissue)
• Coagulation (thick blood) – blood moves slower, so less oxygen is delivered.

Some literature:

• Hyperbaric oxygen therapy can diminish fibromyalgia syndrome–prospective clinical trial [2015].
• Pain severity is associated with muscle strength and peak oxygen uptake in adults with fibromyalgia [2014]. “lesser values of … peak VO2 uptake were predictive of greater pain severity scores.”
• Noninvasive optical characterization of muscle blood flow, oxygenation, and metabolism in women with fibromyalgia [2012]. “However, tissue relative oxygen extraction fraction during exercise in subjects with FM was significantly lower than in healthy controls, and the half-times of oxygenation recovery … were significantly longer following fatiguing exercise and cuff occlusion.” – i.e. the ability to deliver oxygen is impaired.
• “Women with fibromyalgia had greater impaired of functional capacity, exacerbation of pain and exertion during the 6 Minute Walk Test  when compared to healthy women… In the fibromyalgia group, there was a negative correlation between distance in 6MWT  and oxygen consumption”[2011] the further walks, the less oxygen was consumed… contrary to normal people…  [2011]

Vasodilators

I have often taken a vasodilator. Brain fog and the occasion pain disappeared. Which one, flushing niacin, which often create a major flush on occasion still. Unfortunately, the reader is unable to take niacin. The following are alternatives, my first choice would be 800 mg of magnesium per day, while slow — magnesium is reported to improve fibromyalgia [1995]

• L-arginine is an amino acid that is a vasodilator. According to studies, it is higher in urine of CFS patients[2006], but is generally low  [1993]. It also shifts the Firmicutes-to-Bacteroidetes ratio to favor Bacteroidetes [2014] which unfortunately is the same type of shift seen in CFS “a higher relative abundance of Bacteroidetes and lower abundance of Firmicutes observed in ME/CFS patients compared to healthy controls.” [2015]
• ” It is suspected that the cerebral vasodilator effects of Danshen and Gegen produced either on their own or in combination, can help patients with obstructive cerebrovascular diseases.” [2014]
  • The anti-hypertensive effect of Danshen (Salvia miltiorrhiza) and Gegen (Pueraria lobata) formula in rats and its underlying mechanisms of vasorelaxation [2011].
• Long-term intake of rosemary and common thyme herbs inhibits experimental thrombosis without prolongation of bleeding time [2008]. “both rosemary and common thyme significantly inhibited platelet reactivity and enhanced the flow-mediated vasodilation.”
  • “Common thyme and rosemary showed significant antithrombotic activity in vitro and in vivo. Neither herb affected flow-mediated vasodilation.” [2005]
• Chakalaka-induced vasodilatation in patients with chronic myeloid leukaemia on tyrosine kinase inhibitors [2009]. Chakalaka is a South African vegetable relish,
• ” our study confirmed the functional effects of fennel derived-nitrites using in vitro and ex vivo models that describe the promotion of angiogenesis, cell migration, and vasorelaxation.” [2012]
• ” the effects of a dietary supplement containing β-hydroxy-β-methylbutyrate (HMB), glutamine and arginine on endothelial-dependent vasodilation of older adults…revealed a 27% increase in flow-mediated dilation among the treatment group” [2016]
  • • Glutamine, N-acetyl cysteine and zinc in combination improves symptoms http://www.ncbi.nlm.nih.gov/pubmed/19112401 (2008)
• “The current meta-analysis, therefore, does not provide unambiguous evidence to support the use of fat-soluble vitamin supplements (Vitamin D and E) to improve fasting flow-mediated vasodilation in adults.” [2015]
• “Garlic-derived polysulfides stimulate the production of the vascular gasotransmitter hydrogen sulfide (H2S) a… which induce smooth muscle cell relaxation, vasodilation, and BP reduction.” [2014]
• Some sites mention [source] [source]
  • Catuaba Catuaba, Erythroxylum catuaba
  • Cayenne Pepper Cayenne Pepper, Capsicum minimum
  • Ginger Root Ginger Root, Zingiber officinale
  • Ginkgo biloba Ginkgo biloba, Ginkgo biloba L.
  • Gotu Kola Gotu Kola, Centella asiatica (L.)
  • Jiaogulan Jiaogulan, Gynostemma pentaphyllum
  • Lemon Balm
  • Lotus Lotus, Nelumbo nucifera
  • Nettle
  • Olive Leaf
  • Orange Orange, Citrus sinensis, Citrus spp.
  • Parsley Parsley, Petroselinum crispum
  • Schisandra Schisandra, Schisandra chinensis
  • Skullcap
  • Valerian
  • “According to Linus Pauling Institute, magnesium supplement at a dose of 730 milligrams per day can cause a 12-percent improvement in the normal dilation response of arteries. ” [source]

Fibrin Removers

Back in 2012, I did a series of posts on those available as supplements

• Serrapeptase
• Nattokinease
• Lumbrokinease
• Bromelain

All of these also increases penetration of antibiotics into tissue (up to 10x higher concentrations).

Coagulation (thick blood)

This is more complex, this post lists some items.

As with my last post, I have not done a specific post on black walnut leaf (Juglans nigra). It was cited as reducing peroxynitrite which is suspected to cause environmental illness/multiple chemical sensitivity.

• “the most valuable and cited medicinal plant species [for dental problems] used by the traditional drivers are Juglans regia”[2016]
• “The medicinal plant species with highest fidelity level was of  … Juglans regia … each cited 100% for ..easy digestion …” [2016]
• “The essential oils from three different samples of. J. nigra contained (E)-caryophyllene (17.3%-20.4%) and germacrene D (7.1%-22.5%) with smaller amounts of juglone (1.0%-8.8%), alpha-hydrojuglone (1.0-9.5%), and delta-cadinene (3.8%-8.7%). J. regia leaf oil, devoid of juglone, showed allelopathic activity, while J. nigra leaf oil was less phytotoxic.” [2013]
• “The essential oil and its major components exhibited broad spectrum inhibition against all the bacterial strains with Gram-positive(Staphylococcus epidermidis MTCC-435, Bacillus subtilis MTCC-441, Staphylococcus aureus) being more susceptible to the oil than Gram-negative bacteria.(Proteus vulgaris MTCC-321, Pseudomonas aeruginosa MTCC-1688, Salmonella typhi, Shigella dyssenteriae, Klebsiella pneumonia and Escherichia coli).” [2012]
• “Walnut leaves selectively inhibited the growth of Gram positive bacteria, being B. cereus the most susceptible one (MIC 0.1mg/mL). Gram negative bacteria and fungi were resistant to the extracts at 100mg/mL.” [2007]
• “The zones of inhibition due to the … Juglans regia leaf extracts ranged from 17.6 mm against P. acnes, 15.7 mm against S. aureus and 15.5 mm against S. epidermidis, respectively….These zones of inhibition were… less… to those obtained from doxycycline or clindamycin…. may be beneficial in treating acne especially when they are known to have anti-inflammatory activities. ” [2005]
• “derum (Juglans regia; walnut tree) …The most sensitive organisms were A. viscosus, followed by S. mutans, S. salivarius, with L. casei being the most resistant.” [2006]

Bottom Line

Black Walnut Leaf (actually Walnut Leaf) is far more effective against a variety of Staphylococcus than the Lactobacillus tested. Folklore from tribal area in India and Pakistan had it helping with digestion and with bad teeth bacteria.

It continues to be in the recommended list of herbals.

Note: There are no studies for FM/CFS/IBS.

Pau D’Arco (Tabebuia spp) was cited by a reader in a recent post. I had listed it in my post for herbs for treating CFS in 2015 but have not done a post focused on it. β-Lapachone (β-LAP) is a major part.

• “Tabebuia species have several uses in folk medicine, including their use to treat inflammation and rheumatism…showed significant antioxidant activity in the three evaluated assays….can be promising agents for the treatment for gouty arthritis, hyperuricemia, and inflammation.  ” [2016]
• In vitro antioxidant and free radical scavenging activity of different parts of Tabebuia pallida growing in Bangladesh [2015].
• “The strong anti-inflammatory/anti-oxidant effects of β-LAP [a natural naphthoquinone compound isolated from the lapacho tree (Tabebuia sp.)] may provide preventive therapeutic potential for various neuroinflammatory disorders.” [2015]
• “has been used in folk medicine as anti-inflammatory and in the treatment of ulcers, bacterial and fungal infections.” [2013]
• Antibacterial activity of Tabebuia impetiginosa Martius ex DC (Taheebo) against Helicobacter pylori [2006].
• “The present review focus in quinones found in species of Brazilian northeastern Capraria biflora, Lippia sidoides, Lippia microphylla and Tabebuia serratifolia.” [2007]
• “These two isolates (dentified in the inner bark of taheebo, ) exhibited weak inhibition of Clostridium perfringens and Escherichia coli at 100 microg/disk while no adverse effects were observed on the growth of Bifidobacterium adolescentis, Bifidobacterium bifidum, Bifidobacterium infantis, Lactobacillus acidophilus, and Lactobacillus casei at 1000 microg/disk.” [2005]
• “Tabebuia impetiginosa bark, Achyrocline sp. aerials parts, Larrea divaricata leaves, Rosa borboniana flowers, Punica granatum fruit pericarp, Psidium guineense fruit pericarp, Lithrea ternifolia leaves and Allium sativum bulbs produced some of the more active extracts.
• β-Lapachone activity in synergy with conventional antimicrobials against methicillin resistant Staphylococcus aureus strains [2013]. “Among the naphthoquinones, β-lapachone was the most effective against S. aureus strains…. This study demonstrated that, in general, β-lapachone combined with beta lactams antimicrobials, fluoroquinolones and carbapenems acts synergistically inhibiting MRSA strains.”
• ” Staphylococcus aureus strains were susceptible to extracts of Punica granatum and Tabebuia avellanedae…. demonstrated antibacterial activity against all S. aureus strains tested. ” [2003]
• Activity of β-lapachone derivatives against rifampicin-susceptible and -resistant strains of Mycobacterium tuberculosis [2010].
• Generation of superoxide anions and hydrogen peroxide from beta-lapachone in bacteria [1978]. i.e. more hydrogen peroxide is produced which inhibits many bacteria.

Bottom Line

Pau D’Arco (Tabebuia spp) continues to be acceptable list for the following reasons:

• Does not inhibit Lactobacillus or Bifidobacterium.
• Minor effect against E.Coli
• Effective against S. aureus – which is implicated as being a significant bacteria with CFS (see this earlier post).
• Effective against Candida

Note: No PubMed studies with CFS/FM/IBS were found. There are many some forum posts indicating it helps with candida.

“Pau d’arco. While herbalists do use pau d’arco for CFS treatment, it hasn’t proven to be very effective. People on blood-thinner medications should not take pau d’arco.” [source]

In my last post, a reader cites taking caprylic acid or octanoic acid which I have not covered yet in any post.

• “Taken together, these results indicate that combined treatment with low concentrations of caprylic acid and citric acid, which are of biotic origin, can eliminate microorganisms from unpasteurized carrot juice.” [2015]
• “The levels of medium-chain fatty acids (MCFAs: pentanoate, hexanoate, heptanoate, octanoate and nonanoate), and of some protein fermentation metabolites, were significantly decreased in patients with CD, UC and pouchitis.” [2015]
• “the 4 fatty acids : caproic acid, caprylic acid, capric acid and lauric acid in vitro. All four inhibited not only the mycelial but also the yeast-form growth of Candida albicans. In particular, capric acid and caprylic acid inhibited Candida mycelia growth at very low concentrations.”
• “The data indicate that exposure to lauric acid (C12) was the most inhibitory to growth [of Clostridium difficile] (P<.001), as determined by a reduction in colony-forming units per milliliter. Capric acid (C10) and caprylic acid (C8) were inhibitory to growth, but to a lesser degree.” [2013]
• Caprylic Acid reduces enteric campylobacter colonization in market-aged broiler chickens but does not appear to alter cecal microbial populations [2010].
• “Results indicated that caprylic acid, monocaprylin, and sodium caprylate could potentially be used to treat Dermatophilus congolensis infections.” [2011]
• Antibacterial effect of caprylic acid and monocaprylin on major bacterial mastitis pathogens [2005].

Clear impact on Lactobacillus, Bifidobacteria and Enterococcus could not be found. It was effective in reducing bad E.Coli strains. There are no results for fibromyalgia, chronic fatigue syndrome or irritable bowel syndrome.

Bottom Line

There is nothing that explicit said that you should not use it. On the other side, there is nothing that clearly says that you should use it (unless you have candida). It does not appear to alter the microbiome in any significant method.

Bottom Line: No opinion.

A reader posted a comment on AHCC. He reported improvement from it and add it to his other rotating antimicrobials.

“Antimicrobials were wormwood, black walnut, olive leaf extract, curcumin, turmeric/piperine, monolaurin, thyme, oregano oil, Pau D’Arco, neem, caprylic acid, boswellia and now AHCC. Most I have done a couple of rotations. I may have forgotten one or two. In the early days I did one at a time, but later on did two at a time.”

Ken did a post a few months ago on amino acids. I have benefited from supplementing them as well.” – Reader

I was curious on what it is known about AHCC.

• “Active hexose correlated compound (AHCC) is a product prepared from the mycelium of edible Basidiomycete fungi that contains oligosaccharides…rats treated with AHCC had higher aerobic and lactic acid bacteria counts as well as higher bifidobacteria counts, whereas clostridia were reduced when compared with the TNBS group. ” [2007]

• Active hexose-correlated compound and Bifidobacterium longum BB536 exert symbiotic effects in experimental colitis.[2013]

• “the oral treatment with AHCC protected mice from lethal infection with Pseudomonas aeruginosa and intraperitoneal one also protected mice from infection with methicillin-resistant Staphylococcus aureus (MRSA).” [2000]
• “ administration of AHCC… increased ability to clear bacteria. ” [2003]
• “ AHCC may display a protective role against opportunistic fungal infection” [2003]
• “suggest that AHCC protects mice in this model by restoring the immune and other systems negatively affected by trauma, infection, and food deprivation. ” [2006] – which may also include mal-absorption.
• “AHCC appears to induce an early activation of the immune response, leading to an effective clearance of bacteria and rapid recovery.” [2008]
• “Supplementation with AHCC appears to modulate immunity and increase survival in response to acute infection (including influenza virus, avian influenza virus, Klebsiella pneumoniae, Candida albicans, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus)  and warrants further investigation.” [2008]
• “Enhanced immune function observed with AHCC could be caused by attenuated concentrations of stress hormones and catecholamines.” [2013]

Bottom Line

AHCC looks very promising for CFS.  It shifts bacteria in the right direction and kills off and clears many pathogens.