Some Risks with the use of Benicar and other ARBs with CFIDS/GWI Patients
In 1997, GA Rook and Z. Zumla, University College London Medical School - UK, suggested regimens that induce a systemic Th1 bias. CFIDS is generally recognized as being a disease where the immune response favors Th2. Ang II promotes a switch towards the Th1 response thus decreasing it promotes a switch to the Th2 response.
Recently, Trevor Marshall, PhD (Electrical Engineering), has been stating the opposite from accepted findings that CFIDS is a Th1 bias illness based on Vitamin 1,25D levels and been advocating shifting towards Th2 from Th1 by decreasing Ang II. Medical staff of MarhsallProtocol.com has been asserting that CFIDS is a Th1 illness. The arrival of Angiotensin Receptor Blockers (ARBs) with their apparent safety presented the opportunity to test this later interesting approach. ARBs having significant impact on inflammations indicators appears to be a significant additional clinical benefit  , especially if statins are used concurrently . Anecdotal reports indicate significant improvement of symptoms with many CFIDS/GWI patients regardless of manipulation of Vitamin D levels. Two ARBs, Candesartan and Telmisartan are particularly attractive because of their ability to cross the blood-brain-barrier . Telmisartan has the greatest half-life of ARBs and thus have the simplest dosage regimen. Recently, adverse side-effects with some patients has resulted in a careful review of the literature and found a significant risk that should be monitored for all CFIDS/GWI/FM patients taking ARBs.
It is well recognized that patients with CFIDS and related illnesses frequently suffer from aldosterone insufficiency . Safety testing of ARBs have been done on two populations: normal healthy patients and hypertensive patients. Hypertensive patients have higher levels of plasma renin activity and serum aldosterone levels than normal patients.
There are few studies on the long term impact of ARBs, one of these studies found for Benicar (olmesartan):
“This study also found an increase in PRA and a decrease in plasma Ang I, Ang II and aldosterone levels during the long-term administration of olmesartan.”
The charts below shows the decreases observed over time.
The appropriateness of further shifting CFIDS/GWI patients further in favor of a Th2 response is very questionable especially since the basis of it is a measurement of Vitamin 1,25D. The drop of aldosterone levels is a significant concern for the treatment of CFIDS/GWI patients due to the low levels normally seen with them. A severe drop in aldosterone levels may result in (or induce) Addison Disease or other conditions. Patients should be screened for the aldosterone levels prior to commencing any ARB and at least every quarter while prescribed. If the dosage of benicar exceeds the FDA MRHD of 40mg/day, monthly testing of aldosterone levels may be advised for patients.
Incidences of this Addison Disease are being reported today, one patient experience is described at http://creatocracy.org/
Long term use of ARBs must be carefully evaluated against the potential impacts and risk of reduced plasma Ang I, Ang II and aldosterone levels in the patients being administered to.
Ken Lassesen, M.S.
 Department of Bacteriology, Department of Medicine, University College London Medical School, London W1P 6DB, UK
 Academic Infectious Diseases Unit, Department of Medicine, University College London Medical School, London W1P 6DB, UK
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 "We found that you can measure a hormone (in the blood) resulting from the Th1 inflammation produced by these tiny bacteria, and that it is elevated in Sarcoidosis patients. It is also often elevated in CFS patients, indicating that the inflammation of CFS is often very similar to that of Sarcoidosis." The Marshall Protocol for Treating Chronic Fatigue Syndrome: Interview with Trevor Marshall, Ph.D. http://www.immunesupport.com/library/showarticle.cfm/id/5784
"I think most, if not all, of the CFS patients who have tested so far
have been Th1 dominant." Meg Mangin R.N. Research Team on