Ray D. Strand, M.D. Specialist in Nutritional Medicine
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Cardiovascular Disease
or Stroke
or Coronary Artery Disease
or Peripheral Vascular Disease
or Aneurysms

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The greatest killer we have in America today, (over 900,000 deaths each year making up approximately 42% of all deaths) is cardiovascular disease, which involves the process of atherosclerosis or “hardening of the arteries.” As our vessels degenerate, it just depends on which part of our body is affected the most. If the coronary arteries are primarily involved the risk for a heart attack increases. When the cerebral vessels are affected, one is at risk for a stroke. Peripheral vessels may also be involved putting the limbs at risk as well as the possibility of an aneurysm. Over 60 million people in the United States have cardiovascular disease affecting some part of their body.

There are over 1,500,000 heart attacks each year from which 500,000 people die. Most devastating perhaps is the fact that 250,000 of these deaths occur within one hour of the heart attack. Forty-five percent of all heart attacks occur in people who are under the age of 65 with the first sign of heart disease in over 30% being sudden death. When a person is fortunate enough to have a warning sign, the symptoms are subtle and easily passed off as minor indigestion.

Symptoms are usually characterized as substernal chest discomfort that comes on with exertion or stress and is relieved within a few minutes with rest or relaxation. There may be some referral of the pain into the shoulder, back, or down either arm and is sometimes associated with sweating or shortness of breath. The final event leading to a heart attack is the actual rupture of an atheromatous plaque (usually a smaller, less mature plaque) within the artery immediately followed by a thrombosis (blood clot) totally blocking the artery.

Cardiovascular Disease—An Inflammatory Disease

Heart disease, stroke, and peripheral vascular disease are diseases of inflammation of the arteries and NOT a disease of too much cholesterol in the blood. In fact, over half of the patients who suffer a heart attack actually have normal cholesterol levels. In a review article that appeared in the January 14, 1999 issue of the New England Journal of Medicine the cause of hardening of the arteries is clearly attributed to inflammation of the arteries.

Excessive free radicals created by high blood pressure, diabetes, cigarette smoke, fatty meals, elevated insulin levels with oxidized LDL cholesterol, elevated homocysteine, and possibly some infectious agents have the capability to cause inflammation of the surface lining of the arteries called the endothelium. This either causes an actual tear of the endothelium or causes the endothelium to function abnormally.

LDL cholesterol is then allowed to enter into the subendothelial space (area just under the lining of the artery) where it becomes oxidized and starts to build a plaque. The cholesterol actually comes along as a band-aid trying to repair the damage to the artery caused by inflammation. This is what creates hardening of the arteries.

The medical literature, as well as lay media , is finally acknowledging the fact that “hardening of the arteries” is the result of this low-grade inflammation. However, they still are not revealing the actual underlying cause of the inflammation. Instead, they are simply stating you need to be taking a “statin” drug that will not only lower your cholesterol but also reduce inflammation.

As a clinician, I desire to decrease or eliminate the actual causes of this inflammation so the process doesn’t start in the first place. Few know this can be accomplished by healthy lifestyles and nutritional supplementation.

Cholesterol

Did you know that elevated cholesterol in the blood has not always been considered a risk factor for coronary artery disease and stroke? When I first began practicing medicine in 1972, we considered any cholesterol level less than 320 normal. Now everyone is aware of the dangers of elevated cholesterol and we “know” to be especially concerned about LDL cholesterol (bad cholesterol).

In 1989, however, Dr. Daniel Steinberg reported in the New England Journal of Medicine (NEJM) that native LDL cholesterol is not bad. Claims Steinberg, it only becomes “bad” when LDL cholesterol is oxidized or modified by excessive "free radicals". When a person has enough antioxidants on board, LDL cholesterol does not become oxidized or “bad”.

Since this landmark review article, several clinical trials have substantiated the fact that individuals who have the highest levels of antioxidants (vitamin C, vitamin E, beta-carotene, etc.) do have the lowest level of heart disease. Now the medical literature is further indicating that individuals who take supplemental antioxidants have a significantly lower incidence of vascular disease.

In the August 7, 1997 issue of the NEJM, Marco Diaz, M.D. wrote a review article on the use of antioxidants and heart disease. It seems that antioxidants not only decrease the risk of developing heart disease, but even in patients with advanced coronary artery disease antioxidants offer a significant benefit. The Cambridge Heart Antioxidant Study showed individuals with advanced coronary artery disease who consumed at least 400 I.U. of vitamin E had 77% fewer nonfatal heart attacks over those who took a placebo. Dr. Diaz concluded that antioxidants stabilize the atheromatous plaque by reducing the inflammation of the artery, thus decreasing the risk of plaque rupture. This means that even those patients who have advanced coronary artery disease would benefit by the use of the recommendations found on this website.

Homocysteine

In the past few years we are seeing study after study, indicating homocysteine as an independent risk factor for vascular disease (hardening of the arteries). Elevated homocysteine levels in our blood causes tremendous inflammation to our arteries. In a 1995 issue of JAMA, Boushey reviewed 27 previous clinical trials, which all showed even mildly elevated levels of homocysteine significantly increased the risk of vascular disease. He concluded that between 10 and 15% of every heart attack and stroke in this country was directly related to elevated homocysteine levels. In other words 150,000 to 225,000 heart attacks each and every year are solely related to elevated homocysteine levels.

WHAT IS HOMOCYSTEINE?

Homocysteine is a sulfur-containing amino acid that is involved in the metabolism of methionine, an essential amino acid. Methionine is an essential protein found most commonly in meats, eggs, and dairy products.

During normal metabolism within the body, methionine is broken down into homocysteine which in turn is broken down into cysteine (which is harmless), or sometimes actually turned back into methionine again. But in order to be turned back into methionine, an enzyme is needed requiring vitamin B12 as a cofactor and folic acid as a substrate. Homocysteine may also be broken down into cysteine, but this enzymatic reaction requires vitamin B6.

This may seem confusing to you but the important thing to remember is the simple fact that in order for homocysteine levels to remain in a safe range, you must have adequate levels of folic acid, vitamin B6, and vitamin B12. Elevated homocysteine levels in our blood are primarily the result of a nutritional deficiency of folic acid, vitamin B12, and vitamin B6. When these nutrients are given in supplementation for just pennies a day, our homocysteine levels will fall back into a safe range the majority of the time.

Other Causes of Inflammation

Other causes of inflammation in the arteries are brought about by excessive free radicals produced by high blood pressure, diabetes, cigarette smoke, hyperinsulinemia (elevated insulin levels in the blood), fatty meals, and possibly some infectious agents (usually bacteria from gum disease). All of these conditions can either be eliminated or significantly reduced through lifestyle changes and nutritional supplements.

My clinical approach to protecting patients who either already have cardiovascular disease or for those wanting to prevent this disease is the same—the goal is to reduce or eliminate all causes of inflammation in the arteries. Initially an evaluation must be made all of my patients, males over 35 years of age and females over 40 years of age, for risk factors (see below).

Evaluation for the Risk of Cardiovascular Disease
  • Complete history and physical

  • Chemistry profile, which should include a general screen for diabetes, kidney, liver, and thyroid function, along with a lipid profile

  • Other lab work should include a highly-sensitive CRP (hs C-Reactive Protein, which measures the inflammation in the arteries), homocysteine level (ideally this level should remain below 7), and fibrinogen level.

  • An exercise stress test with echocardiogram is recommended for those patients who are already having concerns about chest discomfort (seek medical advice from the attending physician about whether this test is indicated or not)

  • Cardiac calcification score—(ultra-fast CT imaging of the heart) this is a test that can determine how much micro-calcification is present in the coronary arteries. This provides an indirect indication of the amount of plaque already present in one’s coronary arteries. Because the first sign of heart disease over one-third of the time is sudden death, I like to find out whether my patients who may have some risk factors for heart disease actually have some evidence of plaque in the arteries already.

Nutritional Supplement Recommendations

I recommend that all my patients take the basic nutritional support I refer to as cellular nutrition. This foundational regime provides all the necessary micronutrients to the cell at ideal levels (not RDA levels) for significant health benefits as documented in the medical literature. When the cell is given maximum support, it can then determine what it does and does not need. Over a six-month period each cell is able to not only overcome nutritional deficiencies but also to optimize ALL the nutrients, which are needed to combat oxidative stress.

The synergistic affect of providing all the nutrients needed by one’s body at the most advantageous levels results in optimizing and rebuilding the body’s natural immune system, antioxidant, and repair systems back to their fullest fighting potential against disease.

Minimal support for Cellular Nutrition:

My minimal recommendation for creating cellular nutrition is to simply take Usana’s Mega Antioxidant and Chelated Minerals, called "The Essentials" at their recommended doses (3 of each daily). The Essentials offers the cell ALL of the antioxidants, B-cofactors, and antioxidant minerals needed by the cell at ideal levels. In order to achieve the best results, I recommend taking 1 Mega Antioxidant and 1 Chelated Mineral with each meal. Nutritionals should always be taken with food because of better absorption and better tolerance. However, as a physician, I realize that compliance with taking supplements three times a day is a major issue. Therefore, if you tend to frequently forget the lunchtime dose, I suggest taking the supplements twice daily: taking 2 Mega Antioxidants and 1 Chelated Mineral in the morning with breakfast and 1 Mega Antioxidant and 2 Chelated Minerals in the evening with the evening meal.

Optimal support for Cellular Nutrition:

For the most favorable results for basic cellular nutrition, I also recommend adding to the Usana Essentials either OptOmega (2 tsps daily) or BiOmega-3 (4 capsules daily), which provides the essential fats and Fibergy, which assures the individual is receiving the additional fiber his or her body needs. I also recommend adding Active Calcium (4 tablets daily) to provide additional calcium, magnesium, and vitamin D that our bodies need. These recommendations provide all the nutrients at their ideal levels creating the cellular nutrition I recommend in my book, What Your Doctor Doesn’t Know About Nutritional Medicine May Be Killing You.

Optimizers

It is critical that you know the necessity of adding optimizers to your foundational cellular nutrition for optimal results. Patients who are suffering from a chronic degenerative disease or illness are under more oxidative stress than the average healthy individual. Therefore, adding potent Optimizers to the basic cellular nutrition offers you the best chance to bring this oxidative stress back under control. The synergy and increased potency created by this approach to nutritional medicine is why I’m able to get such consistent results in my patients.

However, to suit each individual’s unique needs, I always offer both an optimal and a minimal plan for cellular nutrition and for adding Optimizers. Obviously, one’s improvement will be quicker and more consistent with the optimal recommendations; however, a minimal regime can still produce significant clinical results.

Recommended Optimizers:

Optimal:

  • Proflavanol 90*--3 tablets daily
  • Coquinone 30—2 capsules daily

Minimal:

  • Proflavanol 90—2 tablets daily

*Proflavanol 90 is equal to 3 Proflavanol C

Optimal Recommendations

Nutritional Supplement Breakfast Lunch Dinner
Mega Antioxidant (Mega AO)
Chelated Mineral (Multi Mineral)
Active Calcium
Proflavanol 90
Coquinone 30  
Optomega 2 tsps.     
Biomega-3 (an option instead of Optomega)
*Adding at least one serving of Fibergy daily will enhance these recommendations.

Minimal Recommendation

Nutritional Supplement Breakfast Lunch Dinner
Mega Antioxidant (Mega AO)
Chelated Mineral (Multi Mineral)
Proflavanol 90  

If you are frequently going to miss taking your lunchtime dose, it is better to simply take your nutritionals twice daily. I recommend taking 2 Mega Antioxidants, 1 Chelated Mineral in the morning with breakfast and then taking 1 Mega Antioxidant, 2 Chelated Minerals in the evening. You should try to divide up your Active Calcium, essential fats, and Optimizers equally as possible between the AM and PM dose.

Consider a Power Shake

USANA has a fantastic line of nutritionally balanced drinks that many of my patients consume as a meal substitute. In fact, I personally start every morning with 2 scoops of Fibergy, 2 scoops of Soyomax, and 2 teaspoonfuls of OptOmega. This provides me with a perfect, balanced, unpolluted meal to start my day. It allows me the opportunity to supplement my diet with soy protein; extra needed fiber, and essential fat. This meal is also a low-glycemic meal, which will not spike my blood sugar. Likewise, many USANA associates are using their imaginations to create exceptionally tasting meals with Fibergy and OptOmega. By blending in frozen, whole fruit for added flavor they are creating a variety of great tasting drinks.

Isn’t it remarkable that by simply taking USANA Essentials, Active Calcium and a power drink (remember, to consider this part of your food budget, since it is replacing an entire meal), the body is supplied with complete, and balanced cellular nutrition for every cell in the body? The synergy that is created, especially when adding needed Optimizers is phenomenal. Remember, the underlying problem is oxidative stress NOT a nutritional deficiency.

Why I recommend USANA Products

USANA strictly follows pharmaceutical-grade Good Manufacturing Practices (GMP). This means they not only purchase pharmaceutical-grade raw products, but also manufacture the products according to tough pharmaceutical-quality guidelines. In addition, USANA Health Sciences follows USP guidelines for potency, uniformity, and dissolution of the tablet. In a nutshell, USANA manufactures their products to the strict standards of over-the-counter drugs even though not required to do so—assuring all of their customers and associates that what is on the label is actually in the tablet.

Usana's essentials are complete and balanced and provides the cellular nutrition that I strongly recommend in my book, What Your Doctor Doesn't Know About Nutritional Medicine May Be Killing You. This improves compliance and makes taking these advanced levels of nutritional supplements easier.

Starting Your USANA Nutritional Program

Over eighty percent of my patients are able to start the USANA Nutritional Program with absolutely no set backs while beginning to experience the health benefits of high-quality nutritional supplements immediately. Please keep in mind these supplements are extremely potent and optimal levels of nutrients are being provided that the body has never had before. The body is therefore able to finally rid itself of toxins, which have been accumulating for years (called detoxification). This is especially true in those who are suffering from a serious illness and are taking a significant amount of medication. It is important to understand the possible signs and symptoms of detoxification so that you can deal with them confidently and properly.

Detoxification:

The most common detoxification reaction is muscle aches and/or mild headache. These symptoms will usually pass within a few weeks. If the discomfort is not unbearable, I simply have my patients continue their program as I have prescribed. However, occasionally there is a more severe reaction. The patient is not in danger, rather, the amounts of nutrients are just too much too fast. In this case, I have my patients quit their supplements for a few days until the reaction subsides. I will then have them start back on their program but initially at lower doses (approximately one third of the recommended dose). Once they are tolerating this amount of supplementation, I suggest slowly building up to the recommended doses.

Some of my patients actually develop a "detox" skin rash somewhere on their body. As you know, the skin is an important route for ridding the body’s toxins. This rash is a dry, red rash that looks almost like a mild sunburn. Some people confuse this with an allergic reaction to the supplements. This is not typically so. I have never seen an allergic reaction to the USANA Essentials and can only recall a couple of patients who reacted to Proflavanol because they were actually allergic to grapes.

Patients may also experience some aspect of loose stools or even diarrhea. This again is a common "detox" reaction because the GI tract is another prime route for eliminating toxins from the body. This symptom will usually diminish within a couple of weeks. It is an important part of the detoxification and healing process. Therefore, I usually encourage my patients to continue the supplements as recommended unless their bottom gets too sore. I will then again recommend lower doses of the supplements until they feel better and then begin adding the supplements back more slowly until the recommended doses are reached. Diarrhea can be the result of the magnesium in the Active Calcium or by the Proflavanol. Again, this is usually a mild reaction and will improve over the first week or two. However, some of my patients need to discontinue the Active Calcium and/or the Proflavanol until this settles down. I then have them slowly add back the Proflavanol and eventually the Active Calcium.

Increasing dietary fiber may also increase the amount of intestinal gas and the frequency of bowel movements. This will improve with time as the body adjusts to the higher intake of fiber, but is an important aspect of getting rid of the toxins, which have accumulated in the body.

Natural Relaxation Response:

A small percentage of patients develop a natural relaxation response when minerals are absorbed into their body. This is of great concern to those patients who have just been told that nutritional supplementation will help improve their energy level. They take the supplements as recommended only to find themselves more fatigued and dragging themselves through their day. If you experience this response, I recommend that you take all of your minerals (including the Active Calcium) with a light bedtime snack. This allows you to take advantage of your body’s response while getting a good night’s sleep.

Stomach Upset:

A small percentage of patients have difficulty tolerating vitamin C. It can cause an upset stomach that will usually become evident a couple days after starting their nutritional program. With USANA’s specially combined vitamin C into Poly C, I have seen many of people who could not previously tolerate any nutritional supplements do very well with USANA’s Mega Antioxidant. However, if nausea is experienced, I suggest taking one Mega Antioxidant with the largest meal. Once this level of supplementation is better tolerated, I suggest slowly adding another Mega Antioxidant to the next largest meal. I anticipate building them up to the recommended level of supplementation, but sometimes this is just not possible. For those extremely sensitive, I advise using Body Rox (the teenage dose of Antioxidants and Minerals) as the best alternative option.

Taking Your Supplements with Your Medication

I am often asked, "Can I take my nutritionals with my medication?" To this I respond with this question, "Can you eat?" I hope my point is made gently but clearly—nutritional supplements simply contain nutrients we should be getting from our foods, but at levels we can no longer obtain from our foods. If you can eat anything, you can also take nutritional supplements. The only exception to this is for those taking the medication, Coumadin (Warfarin), which blocks vitamin K in the body as a way of thinning the blood. If a patient is on Coumadin, I recommend he or she take the Canadian Essentials and Canadian Active Calcium because they contain no vitamin K. Also, patients who are on thyroid medication should take their medication on an empty stomach at least 1 hour prior to meals or prior to taking supplements. Thyroid medication should not be taken with food or with supplements because calcium can block the absorption of the medication.


Disclaimer

Every effort has been made to make this web site as accurate as possible. The purpose of this site is to educate and inform. As such it is based on scientific evidence and my clinical training and experience. No individual should at any time use the information found on this web site for self-diagnosis, treatment, or justification in accepting or declining any medical therapy for any health problems or diseases. Any application of the advice herein is at the reader’s own discretion and risk. Therefore, any individual who has a specific health problem or is taking medications must first seek advice from his or her personal physician or healthcare provider before starting a nutritional supplement program. Dr. Strand shall have neither liability nor responsibility to any person or entity with respect to loss, damage, or injury caused or alleged to be caused directly or indirectly by the information contained in this web site. We assume no responsibility for errors, inaccuracies, omissions, or any inconsistency herein. Any slights of people, places, or organizations are unintentional.

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© 1999, 2000, 2001, 2002, 2003, 2004 Ray D Strand, M.D. P.C.
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