Sunday, August 27, 2006

FMS/CFS Case Studies

or Chronic Fatigue
Fibromyalgia/chronic fatigue is a disease of exclusion. In other words, these patients have an array of symptoms and complaints, which mimic many illnesses. Physicians usually do very extensive workups only to find that everything appears pretty much normal.

This disease used to be called "psychosomatic rheumatism." I fear that many physicians still believe this disease is simply in the patient's head. More and more doctors, however, are beginning to realize the seriousness of this disease and its tremendous affect on patients’ lives. Statistics estimate there are over 8 million people in the United States alone suffering with this disease. Eight out of nine are women.
Fibromyalgia and chronic fatigue are considered by many to be different expressions of the same disease. All of these patients suffer from overwhelming and usually disabling fatigue. Fibromyalgia patients experience total body pain, unrestful sleep, and a myriad of other symptoms. Patients with chronic fatigue, on the other hand, have more swollen glands, recurrent fevers, and frequent infections.

Fibromyalgia is diagnosed by excluding other possible diseases and then by doing tender point testing. By eliciting tenderness in at least 11 of 18 predetermined spots, a physician is able to diagnose the disease. Essentially all laboratory tests, X-rays, biopsies, and MRI's will come out negative.

Chronic fatigue patients are diagnosed by eliminating all other possible causes of fatigue. Anyone who has suffered for more than six months with disabling fatigue essentially has chronic fatigue. The sad truth is that it usually takes approximately 6 to 8 years for these patients to finally be diagnosed by their physician with one of these diseases.

Traditional medicine has no specific treatment for these diseases. With fibromyalgia, physicians typically place patients on a non-steroidal anti-inflammatory for pain, amitriptyline for sleep, perhaps a muscle relaxant and anti-depressant and then they tell the patient to find a support group and learn to live with it. What is even more concerning is the frequency with which these patients are being treated with narcotic pain medication. Now, they not only have a horrible disease but are also hooked on narcotic pain medication.

My wife has suffered with fibromyalgia for the past 18 years. During the first 12 years of our marriage she needed to be in bed before 8 P.M. She never had a restful night's sleep and would get up just as tired as when she went to bed. Living with this illness for the past 17 years has totally changed my perception on the seriousness of this disease. Early morning stiffness, mental fog, muscle spasms (my massage technique has certainly improved), fatigue, and pain were daily encounters with which she had to learn to live.

My wife has always joked that she thought marrying a physician would allow her to improve her health. But I’m afraid I was not the answer. The frustration felt by a physician when he or she is unable to do anything for a patient cannot be overstated. And I now realize, first-handedly, the frustration patients with fibromyalgia and chronic fatigue have with their doctors.

When my wife was struggling with the most difficult fatigue, she asked if she could try some nutritional supplements given to her by a friend. For 23 years, I would do most anything to get my patients off any kind of supplements. However, my response to her shocked even me. I told her she could certainly try since I had not been able to find anything to help her through traditional medicine.

Within a week she saw marked improvement and within three weeks she was back to her normal self and off all medications. Over the next year she not only totally recovered, but felt more energetic than she had in years. She has added three to four hours to each of her days. She has significantly less pain and fewer muscle spasms, and her energy level has now surpassed mine.

Obviously this caught my attention. Her recovery challenged me to try to understand what had happened. This was the beginning of my newly found interest in nutritional supplements.

Shortly after this experience, I read a book by Kenneth Cooper, M.D., called "The Antioxidant Revolution." I have always admired Dr. Cooper, who started the exercise revolution back in the early 1970s. I became so intrigued with his book I researched his research. One part of the book especially caught my attention: at his aerobics clinic in Dallas, Dr. Cooper evaluated several athletes suffering from over-training syndrome. His theory was that oxidative stress was the cause.

When people exercise moderately the body is able to handle the amount of free radicals produced. However, in cases of excessive exercise as in the training of professional athletes, the amount of free radicals goes up exponentially. It struck me that these athletes with over-training syndrome had the same symptoms as patients with fibromyalgia and chronic fatigue syndrome. I was baffled and wondered, Could it be possible that the root cause of fibromyalgia /chronic fatigue is oxidative stress?

As we learn more and more about how oxidative stress can cause degenerative diseases, one has to wonder if this is the cause of the fibromyalgia/chronic fatigue syndromes. These syndromes are not high on the totem pole for research dollars. I have been unable to find any significant studies that have considered this as a possibility. I am hopeful more funds will be allocated toward these disabling diseases in the future.

For the past six years, I have been evaluating and treating a group of patients with the belief that the underlying cause is oxidative stress. Since these diseases are able to mimic many other diseases, I must first rule all other possibilities out. I then place these patients on a complete and balanced nutritional supplement program.

I have observed a fairly consistent pattern of improvement in my patients. The most common response I get at the two-month follow-up exam is their thinking and focus is significantly improved. They feel they have come out of a mental fog. At the four-month exam, they are usually sleeping better and noticing some improvement in their energy level. The last things to improve are the pain, fever, and frequent infections. The decrease of infections and fevers is evidence that one’s immune system is definitely improving. Many of my patients comment, “I actually have my life back!”

I have now been involved with over 500 patients with fibromyalgia and chronic fatigue and have been able to achieve good to excellent results in over 70 to 75% of these patients. By bringing oxidative stress back under control, their disease has been captured.

The majority will have significant improvement while using high-quality, complete and balanced nutritional supplements along with necessary optimizers. I have found that the optimizers must be varied or increased depending on the initial response of the patient or the severity of one’s disease. It often takes six months for these patients to be convinced of their improvement and they may still not be fully recovered at that point—but they know they are on the right track.

Once I see a significant clinical response, I keep my patients at that level of optimizer (in this case, Grape Seed Extract) for another two to three months. I then slowly start to back off the level of grape seed extract until the patient reaches what I call a maintenance level. If she becomes worse for any reason while pulling back the amount, I move her to a higher level again until she begins improving. Economically, it’s best to use the least amount of grape seed extract necessary in maintaining the patient's improvement. Patients usually continue to improve even at lower levels once oxidative stress has been brought back under control.

Patients with fibromyalgia /chronic fatigue have flare-ups and remissions. Therefore, I advise my patients who have had a great response and are now on a maintenance nutritional program that they will have flare-ups and some difficult days. When this happens, I simply have them increase the amount of antioxidants and grape seed extract they are taking. They may need to stay at this increased level of antioxidants for 10 to 14 days or until they are feeling better, and then they slowly drop back to the maintenance level again.

Everyone needs to review the web page on "Oxidative Stress" to learn what factors increase the amount of free radicals produced by the body. Patients do best who’ve learned to anticipate situations that cause more oxidative stress. This may include a highly stressful situation, a vigorous work out, or even exposure to an increased amount of toxins which otherwise cannot be avoided. By increasing the amount of antioxidants before a potential setback, it allows the patient a jumpstart and the possibility of even avoid the setback altogether.

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.

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
  • Proflavanol 90*--2 tablets daily
      *Proflavanol 90 is equal to 3 Proflavanol C
Optimal Recommendations
Nutritional Supplement Breakfast Lunch Dinner
Mega Antioxidant (Mega AO) 1 1 1
Chelated Mineral (Multi Mineral) 1 1 1
Active Calcium 1 1 2
Proflavanol 90 1 1 1
Coquinone 30 1
Optomega 2 tsps

Biomega-3 (an option instead of Optomega) 1
*Adding at least one serving of Fibergy daily will enhance these recommendations.

Minimal Recommendation
Nutritional Supplement Breakfast Lunch Dinner
Mega Antioxidant (Mega AO) 1 1 1
Chelated Mineral (Multi Mineral) 1 1 1
Proflavanol 90 1

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.

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.

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

1 comment:

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