Ray D. Strand, M.D. Specialist in Nutritional Medicine
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Rheumatoid Arthritis

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Arthritis is a degenerative process of the joints. Though it is not a disease that will typically shorten one’s life, it will certainly cause significant pain if left untreated. Rheumatoid arthritis can be severely disabling as well.

There has been great interest among researchers for the past 20 years involving the role of oxidative stress in the development of arthritis. Most studies have not separated rheumatoid arthritis and osteoarthritis (degenerative arthritis) when looking at free radical reactions and these diseases. Information provided here is consistent with a comprehensive review article written by Dr. Henrotin in 1992 regarding oxidative stress and how it is involved in inflammatory joint disease. Several recent studies have further established oxidative stress as being the plausible cause of these diseases, thus supporting my recommended treatment.

When researchers study joint fluid extracted from an inflamed joint, they note a significant increase in the number of excessive free radicals. In contrast, fluid from a normal joint, has no free radicals present. Studies have shown a significant increased risk of developing rheumatoid arthritis in those individuals who have low levels of vitamin E, beta-carotene, and selenium. Research has further indicated low levels of vitamin D and vitamin C in patients suffering severe joint disease and in those whose disease progresses much more rapidly than the norm.

Many different factors may be contributors of increased oxidative stress within the inflamed joints. One such factor is a significant inflammatory response within the joint space, especially in those with rheumatoid arthritis. This is an autoimmune disease wherein one’s own immune system is essentially attacking the joints. It is this inflammatory immune response that creates all the destructive oxidative stress within the joint. Neutrophils (a type of white cell) are a predominate cell in this inflammatory response and has been shown to release a significant amount of free radicals within the joint space. This causes a marked rise in oxidative stress.

The destruction of the joint in rheumatoid arthritis is also due to the release of certain enzymes within the joint space. These enzymes are under the control of certain cytokines called IL-1 and TNF-a (interleukin 1 beta and tumor necrosis factor alpha). The levels of IL-1 and TNF-a in the joints of rheumatoid arthritis patients are very high. They too create tremendous amounts of oxidative stress. Certain cells from the cartilage of an inflamed joint (called chondrocytes) have also been found to actively generate free radicals. These different sources of increased free radical production cause heightened oxidative stress within the inflamed joint. This overloads the antioxidant defense system of the joint space. The synovial fluid (joint fluid), which is usually very thick becomes thin and all components of the cartilage become damaged as the process of joint destruction begins taking place.

I was taught in medical school that autoimmune diseases were the result of an overactive immune system since the body was essentially attacking itself. Consistent with my training, almost all of the medical therapies that physicians offer patients with an autoimmune disease are based on this premise. This is why most of these patients are placed on chemotherapeutic medications, which primarily suppress the immune system. Medications like Methotrexate, Plaquinil, and Immuran are just a few of the potent medications that are used. Corticosteroids like Prednisone are also used not only because of its strong anti-inflammatory qualities but also because they suppress the immune system. Even though these therapies may help to slow down the damage caused by this autoimmune process, they have serious side effects and can cause significant harm to the patient.

Since specializing in Nutritional Medicine, I have seen amazing results in my patients with autoimmune diseases who are using an aggressive nutritional supplementation program. My only explanation for such unbelievable results in my patients is the fact that they are not dealing with an overactive immune system, but rather a confused immune system.

The immune system is intended to be our reliable protector. It is always checking for self (one’s own body) while it is looking for non-self (any foreign substance or abnormal cell). When the immune system finds a virus, bacteria, or foreign body it destroys and eliminates it from the body. However, in autoimmune diseases the immune system actually attacks itself rather than a foreign substance. If it attacks the joint space, a person is diagnosed as having rheumatoid arthritis. If it attacks the bowels, it manifests as Crohn's disease or ulcerative colitis. When the connective tissue is attacked, a person might end up with scleraderma or lupus. If the myelin sheath around the nerve is the target, multiple sclerosis (MS) ensues.

In the case of autoimmune diseases, I believe one’s immune system is not able to distinguish self from non-self. Being confused, the body is essentially destroying itself. In addition to treating my patients who are usually already taking traditional medicine with attempts to suppress and shut down the immune system, I administer potent nutritional supplements. In doing so, I am not only building up their NATURAL antioxidant defense systems, but also I am building up their own NATURAL immune system. I find this helps my patients on both sides of the disease.

I believe their immune system becomes less confused and begins to recognize “self” again. This means the immune system more readily identifies outside invaders--not attacking “self” as much. In addition, my patients’ antioxidant defense system is also built up to balance out the tremendous number of free radicals being produced. This brings the root cause of the damage--oxidative stress--back under control. Therefore, it is absolutely critical that I place my patients on the most potent antioxidant combination available.

Am I promoting alternative medicine? Absolutely not. I never take my patients off of their medications until they’ve experienced significant improvement. Nutritional supplementation is always used in tandem with their present medical regimen. They not only tolerate their medications better, but I believe the nutritional supplements actually enhance the pharmaceutical effect the drugs.

My goal is to have patients improve so much that their rheumatologist or primary care physician is able to decrease or eliminate some or all of their medications. I can't emphasize this enough. No one should stop taking the medications that have been prescribed to him or her by the specialist. Almost all physicians desire to get their patients off of these potent and potentially dangerous medications. However, this decision must involve the personal physician.

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
  • Procosamine II (Procosa II)—4 tablets daily
  • Additional Essential Fats—Either 1 tablespoonful of OptOmega twice daily or 6 capsules Biomega 3 daily

Minimal:

  • Proflavanol 90*--2 tablets daily
  • Coquinone 30—2 capsules daily
  • Essential Fats—1 tablespoonful of OptOmega twice daily or 6 capsules of Biomega 3

*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  
Procosamine II
Optomega 1 tbls    1 tbls 
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  
Coquinone 30  
OptOmega 1 tbls    1 tbls 
Biomega 3

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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