Post by Ask Jan on May 30, 2011 6:22:42 GMT -8
Eosinophilia–myalgia syndrome (EMS) is an incurable and sometimes fatal flu-like neurological condition that is believed to have been caused by ingestion of poorly produced L-tryptophan supplements. Similar to regular eosinophilia, causes an increase in eosinophil granulocytes in the patient's blood.
Eosinophilia–myalgia syndrome first recognized after the doctors of three American women with mysterious symptoms talked together in 1989. However, many people became ill. It was as long as 2–3 years before the illness was reported to the Centers for Disease Control and Prevention . Rheumatologists experienced a large surge of new patients with mysterious symptoms during this period. It is possible that as many as 60,000 individuals became ill from using L-tryptophan. Additionally, when first marketed, 27 people died.
Some epidemiologist studies traced the cause to consumption of L-tryptophan from a single Japanese manufacturer. The company supplied the majority of L-tryptophan to the United States under various brand names. There was evidence that new batches of L-tryptophan may have been improperly prepared. First, the specific bacterial culture used to synthesize this tryptophan had recently been genetically engineered to greatly increase tryptophan production. The increased concentrations of tryptophan in the fermentor may in turn have led to increased production of trace impurities. It is also likely that contaminants were increased because the L-Tryptophan producing bacteria were being grown in an open vat in a fertilizer factory. Second, shortcuts were taken in the purification process to reduce costs. For example, a purification step that used charcoal adsorption to remove impurities had been modified to reduce the amount of charcoal used. It is possible that one or more of these modifications and/or the environment for manufacture allowed new or greater impurities through the purification system. More than 60 different impurities were identified in the L-tryptophan lots, which had been associated with cases of EMS.
The specific impurity (or impurities) responsible for the toxic effects was never firmly established, however two compounds, EBT (1, 1’-ethylidene-bis-L-tryptophan) and MTCA (1-methyl-1, 2, 3, 4-tetrahydro-beta-carboline-3-carboxylic acid), which are close chemical relatives of L-tryptophan were implicated.
Regardless of the origin of the toxicity, L-tryptophan was banned from sale in the US in 1991; and other countries followed suit. In February 2001, the FDA loosened the restrictions on the marketing of tryptophan (though not on importation). The supplement 5-HTP (a hydroxylated form of tryptophan and a precursor to serotonin) remains widely available.
An alternative explanation for tryptophan-associated EMS has recently been proposed. Consumption of large doses of tryptophan can lead to production of metabolites, some of which may interfere with normal histamine degradation. Furthermore, excessive histamine activity has been linked with blood eosinophilia and myalgia.
EMS was first recognized in 1989 in New Mexico. Three women sought medical help for a mysterious, undiagnosable condition whose symptoms were marked by debilitating muscle pain and a high Eosinophilia count (a type of white blood cell that is usually found when a toxin or parasitic infection is present). It was eventually discovered that all of the women had one thing in common: they had been taking L-tryptophan, a health food supplement sold as a sleep aid.
The tainted product traced back to Showa Denko Inc, a Japanese company that had been cutting corners in their purification procedure to reduce their manufacturing costs. Additionally, they were experimenting with genetically engineered bacteria in order to accelerate and increase the efficiency of their production process. As a result, contaminated batches of L-tryptophan were placed on the market. Within three months, 37 people died and over 1500 were permanently disabled from using this product.
By early 1990, officers of the Food and Drug Administration (FDA) banned the sale of all over the counter L-tryptophan dietary supplements because it was found to be the common link in the EMS cases. Research was conducted to discover the cause of this illness. By using high performance liquid chromatography, an unidentified impurity, called "peak E" was found in batches of L-T as well as nearly 60 other contaminants. These batches were traced back to one manufacturer, Showa Denko KK (SDKK), one of Japan's largest petrochemical companies.
Both the CDC and the FDA agreed that considering the amount of L-T manufactured by Showa Denko KK, which had been sold from 1988 to 1989, there are potentially several times the original 1,500 reported cases. However, there are still no medical tests to diagnose this incurable illness. Hence, many doctors shrug off victims' complaints and attribute their symptoms to fibromyalgia (a chronic condition involving acute muscle pain not verifiable by laboratory tests), Chronic Fatigue Syndrome, Lupus, Arthritis, Fasciitis, and other autoimmune or neuromuscular disorders with similar symptoms.
Those of us who were poisoned by L-tryptophan continue to suffer a host of maladies and live each day of our lives in pain. According to the 1992 FDA bulletin, there is evidence that "non-epidemic" cases were occurring for months to years prior to the sudden increase in incidence, which peaked in October 1989. We suspect there are many other over-looked victims still out there.
A complex systemic syndrome with inflammatory and autoimmune components that affect the skin, fascia, muscle, nerve, blood vessels, lung, and heart. The varied symptoms include severe muscle pain and abnormally high numbers of eosinophils. This disease has presented itself only in people taking the amino acid l-tryptophan and it is believed that a specific impurity (probably stemming from a genetically engineered bacterial strain) in lots of l-tryptophan made by a single manufacturer may be the cause of the syndrome.
? Acute pain
? Elevated eosinophil count
(a type of white blood cell that is usually found when a toxin or parasitic infection is present).
? Severe myalgias
(muscle cramps and muscle pain)
? Myofascial pain syndrome
(a condition characterized by chronic pain in the muscle tissues, similar to fibromyalgia)
(a problem with functioning of the nerves. Symptoms include numbness, weakness, burning pain especially at night and loss of reflexes)
? Neurologic pain in joints
? Tremor, Myoclonus
(abnormal repetitive shaking and contraction of muscles or portions of muscles)
? Peripheral edema
(the swelling of soft tissues as the result of excess water accumulation in the extremities)
(an abnormal sensation of the body, such as numbness, tingling, or burning)
(a tenderness & swelling of the extremities which occurs when eosinophils infiltrate the fibrous layer surrounding the muscle and the muscle itself)
(patches of yellow or ivory colored rigid dry skin that become hard and slightly depressed. When generalized can cause underlying muscles to tighten & atrophy)
? Low grade fever
? Pulmonary disorders
(having to do with the lungs)
? Weakness & severe fatigue
? Gastro-intestinal disorders
(referring to the stomach and intestines)
? Cardiac arrhythmias
? Hair loss
? Despnea or cough
? Neurocognitive Dysfunction
(short term memory loss, concentration & communication problems)
? Chronic Myalgias & Arthralgias
(muscle & joint pain)
? Severe Axonal Neuropathies
(pain along the long fiber of a nerve cell (a neuron) that acts somewhat like a fiber-optic cable carrying outgoing messages to the body)
(disease of the heart muscle)
? Chronic liver disease- Cirrhosis
(irreversible scarring of the liver)
? Internal Fibrosis
(excessive growth of hard, fibrous tissue that replaces normal bone tissue in a single bone. Symptoms include pain and bone fracturing)
? Pulmonary Hypertension
(high blood pressure)
? Desmoids Tumor
(benign soft tissue tumors which intertwine extensively with the surrounding tissues)
? Malignant Fibrous Histiocytoma
(a rare disorder in which histiocytes start to multiply & attack the person's own tissue or organs resulting in tissue damage, fatigue and other symptoms)
? Scleroderma-like Syndrome
(a disease of connective tissue (fibrosis) in the skin and sometimes also in other organs of the body)
? Fibromyalgia Syndrome
(chronically causes pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation)
? Chronic Fatigue Syndrome
? Post Traumatic Stress Disorder
(a psychological disorder that develops in individuals who have had major traumatic experiences)
? Visual & Dental problems
? Sleeping Disorders
Almost any body system can be affected. It is possible to find people with only one body system affected but most persons have at least two body systems affected.
There are significant levels of eosinophils and inflammatory markers in the tissues and this immune response is thought to be the reason for the tissue damage that occurs to muscles, skin, nerves and other organs. Respiratory symptoms include shortness of breath, non-productive cough and pleuritic chest pain. After early pruritus and swelling, the skin becomes thickened and feels tight with changes that look like scleroderma. Unlike scleroderma, the fingers and the toes are usually spared, and there is no Raynaud’s phenomenon. Gastrointestinal symptoms are rarer and include dyspepsia, dysphasia or diarrhea.
Treatment is usually symptomatic and supportive and may include analgesia and muscle relaxants. Prednisolone may be commenced and tapered off as symptoms resolve. Steroids seem to be of benefit in the short term but not in the long term. If there were pneumonia, it would be treated accordingly. If there were headache, then some kind of analgesic would be necessary. If there is skin involvement, perhaps various types of dermatologic creams, lotions, etc., might be used. During the chronic phase of the disease, avoid strenuous physical activity that may cause muscle pain and cramps.
Cannabinoid Treatment (Medical Marijuana):
Defined substances, such as purified cannabinoid compounds, are preferable to plant products,
Which are of variable and uncertain composition? Extracts or concentrates of a specific type (strain) would be the best treatment.
There are so many symptoms with this syndrome that it is almost overwhelming. The wonderful thing is medical marijuana (cannabinoids) can relieve almost all of them! With little or no side effects!
• Unlike smoked marijuana, vaporized marijuana delivers zero carcinogens to the patient, while releasing only the medicinal properties of the plant for inhalation.
• Vaporization allows patients to better titrate each dose of medical marijuana as needed or recommended by the patient’s doctor.
• Vaporization is safe and effective.
• Recommended for patients who prefer to receive their medication without having to inhale it or taste it.
3. Tinctures/Oils, Extracts and Concentrates
• Recommended for patients looking to create their own medical marijuana edibles or for direct ingestion.
• Recommended for patients who are either unable to vaporize or eat edibles.
• Recommended for those looking for pure properties of a strain.
• Recommended for patients with chronic conditions.