Interest in 9-cis-cetyl myristoleate (CMO) a fatty acid
apparently found in mice -- and in a species known for immunity from arthritis -- has been
intense at least since Dr. Jonathan Wright interviewed the discoverer, Harry Diehl, in
Nutrition and Healing over a year ago. (1) Until recently, animal data provided by
Diehl(2) were supported only by anecdotes in humans.(3)
For several months, the text of a double-blinded randomized trial with CMO executed by
Humberto Siemandi, a medical doctor from Mexico, has been circulating in the world of
natural medicine. The full text was recently published in the Townsend Letter.(4) Whether
the author of that report has any vested interest in "CM Plus" or other CMO
products produced by Draco International was not clear from the Townsend Letter report.
In that report, placebo or 90 grams of oil containing 18 g of CMO was administered over
the course of one month, with or without the addition of glucosamine HCl, sea cucumber,
and cartilage, for "a total dosage of 18 grams each of these nutrients."
Apparently this means 600 mg of each ingredient per day. Topical CMO was also applied as
60 cc of 25% solution -- again, this appears to have been the total dose for the month.
("CM Plus" contains all four ingredients; the same supplier sells topical CMO as
a separate product.) The follow-up appears to have been done in eight week cycles.
The daily dose of glucosamine sulfate used in virtually all previous research is 2.5
times the amount of glucosamine HCl used in this trial. Moreover, The HCl version has not
yet been tested, making its inclusion and the dose selected for it both poor choices for a
multi-agent trial. Almost certainly, the 600 mg per day of cartilage is too low a dose to
affect humans. Doctors of natural medicine generally use higher amounts if they use
cartilage at all. The optimal amount of sea cucumber remain a matter of conjecture, but
the support for this product in the treatment of rheumatoid arthiritis (RA) is weak enough
to have made its inclusion in the protocol a potential mistake.
Although the study is labeled "multicentric," it has only one author.
Nonetheless, the large number of subjects (N = 382 completed the study) appears to support
this claim. Most patients had RA, though a few had psoriatic arthritis. Tobacco and
caffeine were discouraged for participants in all groups. The placebo contained
salicylates or ibuprofen as excipients -- a questionable choice that could have worked
against an anticipated positive effect for CMO.
Among those receiving all interventions, 88% reported subjective improvement compared
with 59% for CMO alone and 16% for placebo. The overall assessments by attending medical
doctors were similar. Moreover, a treatment response was seen in 87% of those taking all
interventions vs. 63% receiving only CMO and 14.5% on placebo. These results were highly
Although a fair amount was said about indices Siemandi followed in determining a
"response," the actual definition of clinical "response" was not
stated. The fact that nothing was said about complete responses suggests that they did not
occur. Diehl, on the other hand, had originally described CMO as a "cure" for
It is fair to say that this report would not have been published in its current form by
a normal peer-reviewed journal. The Townsend Letter claims to have recently initiated a
partial peer-review process, but the quality of some of its articles suggests otherwise.
Nonetheless, the inclusion of a double-masked protocol paired with highly statistically
significant outcomes suggests that something did happen. It now becomes critically
important for CMO, with or without adjunctive natural therapies, to be studied. It may be
equally critical that the principal investigator be unaffiliated with any commercial
interests -- this may or may not have been the case with the current trial but the written
report remains unclear in this regard. The results also need to be published in a
peer-reviewed journal. The definition of "response" must also be dearly
delineated. If/when all that is successfully achieved, CMO may potentially become an
important part of the natural treatment of RA.
Until then, it remains an expensive (though apparently safe) experiment. There can be
little doubt, however, that the current report will stimulate great interest in CMO. Let's
hope it also stimulates some more research.
(1) Wright JV. Searching for a cure for arthritis. Nutr Healing 1996; Aug:5-6.
(2) Diehl HW, May EL. Cetyl myristoleate
isolated from Swiss albino mice: an apparent protective agent against adjuvant arthritis
in rats. J Pharmaceutical Sci 1994; 83:296-9.
(3) Cochran C, Dent R. Cetyl myristoleate
-- a unique natural compound valuable in arthritis conditions. Townsend Letter for Doctors
& Patients 1997; July:70-74.
(4) Siemandi H. The effect of cis-9-myristoleate (CMO) and adjunctive therapy on
arthritis and autoimmune disease -- a randomized trial. Townsend Letter for Doctors &
Patients 1997; Aug/Sept:58-63.
Article copyright Natural Product Research Consultants, Inc.