~Arthritis, part 5 - Summary

~Arthritis, part 5 - Summary
SUMMARY

Unlike toxic FDA-approved drugs, natural therapies and diet modification can often provide relief from chronic inflammation and pain. One of the most compelling reasons for using natural therapies in arthritic conditions is that while some drugs can cause cartilage destruction, natural therapies correct the underlying factors involved in arthritic cartilage degeneration. Natural therapies have been shown to work by the following mechanisms:

  • Inhibiting COX-2
  • Suppressing TNF-alpha, IL-1b, and IL-6
  • Reducing production of LTB4
  • Preventing the overexpression of NF-KB
  • Inhibiting the formation of PE2
  • Promoting the synthesis of proteoglycans and glycosaminoglycans in the joints
  • Suppressing cartilage-destroying enzymes, collagenase and phospholipase
  • Attracting water to the cartilage to enhance synovial lubrication


There are several different natural antiarthritic combinations that one may try to find the ideal program to suit their individual need. A convenient way of using several different natural approaches at once can be found in a product called ARTHROMAX ADVANCED WITH UC-II & APRESFLEX. Some of the better-documented, cartilage-protection and inflammation-suppressing supplements are contained in each packet of ArthroMax. The suggested dose for the first 3 months is 1 packet of ArthroPro twice a day, with or without food. After 3-6 months, some persons may be able to reduce the dose to just 1 packet a day. Each dosage packet provides the following ingredients:

  • EPA (fish oil)
  • DHA (fish oil)
  • Nexrutine
  • Nettle leaf extract
  • Glucosamine
  • Chondroitin sulfate
  • Vitamin E
  • Salicin combination


Note: Persons who are allergic to aspirin may not be able to use ArthroPro because of the small amount of naturally derived aspirin contained in the willow bark extract.

In addition to the 2 packets a day of the AthroPro formula, persons with arthritis might want to use:

1. SAMe, 400-1200 mg a day; or MSM, 2000-3000 mg daily.

Based on data from published studies, 800-1200 mg of SAMe should be taken a day to start. If GI upset occurs, SAMe should be reduced by half, then gradually increased again. In a long-term study, patients were given 600 mg of SAMe a day for the first 2 weeks, then 400 mg daily. In other studies, patients were consistently given 1200 mg of SAMe from day one. People taking SAMe should experiment with the 400-1200 mg range to find the best dose for them. Several studies indicate that it may take several weeks or months for SAMe to achieve its full effect. SAMe is a substance that is naturally made in the body. No serious side effects have ever been reported with SAMe, even in high doses administered intravenously.

MSM has reduced inflammation and eased joint pain in some people with arthritis. Daily dosages of between 2000-3000 mg, and in severe cases up to 5000 mg daily, have been used without side effects. Since SAMe and MSM work via similar mechanisms, it may only be necessary to take one of the other to obtain desired benefits.

2. MEGA GLA WITH SESAME LIGNANS: Up to five softgels can be taken daily.

GLA is a fatty acid found in evening primrose oil, borage oil, and black currant seed that can suppress chronic inflammation by boosting production of the anti-inflammatory PE1. The most efficient way of obtaining high amounts of GLA is to use borage oil. Those taking ArthroPro may consider taking a borage oil supplement that provides 800-1200 mg a day of GLA.

3. Life Extension Mix: 9 tablets, 14 capsules, or 1 tbsp of powder daily.

Life Extension Mix is a multinutrient supplement containing pharmaceutical grade extracts from vegetable, fruits, herbs, and other food concentrates known for their potent antioxidant action. Life Extension Mix also provides a potent amount of N-acetyl-cysteine (NAC) and vitamin E. The proper amount (1 mg) of the anti-inflammatory agent copper is also included. Copper has been shown to be deficient in many people with RA. Life Extension Mix is available in three varieties: tablets (9 daily), capsules (12 daily), and powder (3 scoops daily).

If taking ArthroMax, GLA, SAMe (or MSM), and Life Extension Mix do not provide adequate relief from arthritis inflammation and pain, consider having your blood tested for markers of systemic inflammation (such as C-reactive protein). With the availability of cytokine blood profile tests, it is now possible to ascertain the underlying cause of chronic inflammatory disease. The appropriate drugs and additional nutrients can then be used to suppress the specific cytokines (such as TNF-alpha or IL-6) that are promoting the inflammatory cascade.

If a cytokine profile blood test reveals excess levels of the inflammatory factors TNF-alpha, IL-1b, IL-6 or LTB4, the following supplements are suggested:

1. High doses of the DHA fraction of fish oil. Some studies suggest that DHA works much better than the EPA fraction of fish oil in suppressing inflammatory cytokines. A product called Super SUPER OMEGA 3 EPA/DHA provides EPA along with a potent combination of DHA from fish oil. The suggested dose for those with elevated cytokines is 8 capsules a day of SUPER OMEGA 3 EPA/DHA.

2. DHEA, 15-75 mg a day (refer to the DHEA Replacement Therapy protocol for safety information)

3. Vitamin K, 10 mg daily.

If these nutrients fail to lower proinflammatory cytokine levels to the safe ranges (as indicated on the following chart), then ask your physician to prescribe 800 mg daily of the drug pentoxifylline (PTX). PTX is a cytokine-suppressing drug that has been overlooked by most of the medical establishment. Supplements such as fish oil, nettle leaf, DHEA, and vitamin K possess mechanisms of suppressing inflammatory cytokines similarly to PTX, but some people may require PTX. There are no side-by-side comparisons to categorically state whether PTX or natural agents (such as DHA fish oil) work better.

For those who have arthritis that is not alleviated by diet modification and supplements, we recommend the cytokine profile blood test.

If you have tried different combinations of these inflammatory-suppressing nutrients and blood tests show that you still have high levels of inflammatory cytokines, you should consider 800 mg daily of low-cost PTX or the higher-priced Enbrel.

For potential immediate relief of arthritis pain, consider applying NATURAL RELIEF 1222 Topical Analgesic cream topically to arthritic areas of the body.

Inflammatory Cytokine Blood Reference Ranges

There are at least three different methods of testing blood levels of the proinflammatoray cytokines. Listed below are the standard reference ranges for each different type of test. To protect against arthritis and other diseases associated with chronic inflammation, people should be within or below these reference cytokine ranges. (Other blood testing laboratory methods may have different reference ranges.)

Optimal Range (pg/mL)

Proinflammatory CytokineLabCorpISIDPCQuest
TNF-a< 8.110-500-8.10-25
IL-6< 12.02-290-9.72-29
IL-1b< 15.00-1500-50-150
IL-8< 32.010-800-6210-80


Note: The symbol < means less than.

Ask your doctor to prescribe these cytokine blood tests for you. You may also inquire about ordering these cytokine blood tests by calling (800) 208-3444.

One test that can help determine if your arthritis is a result of systemic inflammation is the inexpensive C-reactive protein (high-sensitivity) blood test (CRP-hs). If your C-reactive protein level is over 1.3 mg/L, this is an indication that you have an inflammatory event occurring in your body. Those with elevated CRP-hs levels (and who have arthritis) should consider using the supplement protocol and/or prescription drugs known to suppress elevated proinflammatory cytokines. Using the cytokine profile blood test will help monitor their progress.

A high-sensitivity C-reactive protein blood test may be ordered by calling (800) 208-3444. This test may also be obtained at your physician's office.

Pentoxifylline (PTX)

PTX should not be used in persons with bleeding disorders such as those with recent cerebral or retinal hemorrhage (PDR 2001). Patients taking Coumadin should have more frequent monitoring (once a week is suggested) of prothrombin times and regular template bleeding time tests (White et al. 1989; Stigendal et al. 1999). Those who have other types of bleeding should receive frequent physician examinations. According to two studies, PTX should be avoided by Parkinson's patients (Godwin-Austen et al. 1980; Serrano-Duenas 2001).

It is important to note that the body uses TNF-alpha to acutely fight infections. If patients are showing any sign of infectious disease, drugs such as Enbrel (that inhibit the effects of TNF-alpha) are temporarily discontinued. A new FDA advisory states that patients should be tested and treated for inactive tuberculosis prior to therapy with another TNF-alpha inhibiting therapy (infliximab). Since PTX, fish oil, and nettle directly suppress TNF-alpha, perhaps these agents should be temporarily discontinued during the time when one has an active infection.

Refer to the Chronic Inflammation protocol for further information.

Contact the Arthritis Foundation (800) 283-7800.

Addendum: Food and Arthritis... Aggressive Dietary Strategies

Conventional research, particularly in the area of RA, but also in OA, has shown that in many cases the inflammation of arthritis can be significantly and positively affected by nutrition. The impact of diet on arthritis is almost certainly related to the strong connection between the intestinal lining, where food is absorbed, and the surrounding immune system structures known as gut-associated lymphoid tissue (GALT). Hunter (1991) first suggested in conventional medical literature that metabolic changes in the gut can cause the individual to react to the influence of gut bacteria and incomplete breakdown products of digestion on the immune system (Nenonen et al 1998). Buchanan et al. (1991), writing in the British Journal of Rheumatology commented: "There is evidence from several well documented case reports that occasional patients with rheumatoid arthritis (RA) may develop aggravation of their arthritis as a result of allergy to some ingredient in the diet. A variety of foodstuffs have been implicated including milk and milk products, corn..."

Five years later, a unique series of papers by Kjeldsen-Kragh and a number of coauthors in various rheumatology journals showed the effect of vegetarian diet in RA over a 2-year period (Kjeldsen-Kragh 1994a; 1994b; 1995a; 1995b; 1999). Overall, these papers demonstrate that not only do omnivores with RA improve with fasting and a subsequent vegetarian diet, but immune parameters, bowel bacterial balance, and several other markers of RA also change in a positive way. Furthermore, they identified a group of responders versus nonresponders to diet. About one-third of the total appears to be responders. Over the 2-year period, in which participants were allowed to return to a regular diet if they wished, compared with baseline, the improvements measured were significantly greater in the vegetarians who previously benefited from the diet (diet responders) than in diet nonresponders and omnivores. The beneficial effect could not be explained by patients' psychological characteristics, antibody activity against food antigens, or changes in concentrations of prostaglandin and leukotriene precursors. Dietary responders appear to make up about one-third of the population of RA studied in these papers.

Nenonen et al. (1998) tested the effects of an uncooked vegan diet, rich in lactobacilli (friendly gut bacteria), in RA patients randomized into diet and control groups. The results showed that this uncooked vegan diet, rich in lactobacilli, decreased subjective symptoms of RA (Neonen et al. 1998). They also found that large amounts of living lactobacilli consumed daily may have positive effects on objective measures of RA but that it was difficult for patients to stick to such a strict diet. They concluded that a vegan diet changes the fecal microbial flora in RA patients and changes in the fecal flora are associated with improvement in RA activity. Similar results were reported in the British Journal of Rheumatology (Peltonen et al. 1994).

An uncooked vegan diet consists of berries, fruits, vegetables, roots, and nuts, with germinated seeds and sprouts, which are rich sources of carotenoids, and vitamins C and E. Hanninen et al. (2000) demonstrated that the subjects eating this type of diet showed highly increased levels of alpha- and beta-carotenes, lycopene, and lutein in their blood. Also, the increases of vitamin C and vitamin E were statistically significant. Because the berry intake was threefold that of controls, the intake of antioxidant compounds such as quercetin and myricetin was much higher than in the omnivorous controls. RA patients subjectively benefited from the vegan diet rich in antioxidants, lactobacilli, and fiber, and this was also seen in objective measures (Hanninen et al. 2000).

Studies concerning OA and diet in peer-reviewed literature are lacking. Again, the fields of alternative and complementary medicine show significant benefit with nutritional and dietary changes for OA in clinical observation. As noted previously, peer-reviewed literature has shown that NSAIDs significantly alter intestinal permeability, increase inflammatory response, and cause a hyperimmune state. This is true not only for people with RA, but also OA.

Changing Your Diet

Life Extension Foundation supports nutritional change as a means of preventing or alleviating chronic disease. Nowhere is this more significant than in the case of arthritis, and it is suggested that significant nutritional change be made by persons who suffer from the effects of arthritis, in addition to the suggested supplementation. Although it is sometimes difficult to change dietary and eating habits around food intake, the significant benefits to be gained are worth the challenge. The following dietary changes are suggested as an initial start to combating arthritis. The elimination of common food allergens along with a shift in the types of fat in the diet is likely to bring fairly significant relief to those who are nutritional responders. This will apply both to RA and OA.

Remove as many processed foods as possible from your diet. This means eliminating all sugar-containing foods and high-fat foods. Learn to read food labels effectively.

  • Common food allergens include wheat, rye, oats, and barley (all of which contain a protein called gluten). Antigluten antibodies have been found in many people with RA. Other common allergens include corn, dairy, and red meats. Significant inflammation can also occur with the nightshade family foods: These are all types of peppers, potatoes, tomatoes, and eggplant. For at least the first 2 weeks it is suggested that these foods be removed.

  • Avoid all citrus fruits for the first 2 weeks, then reintroduce as described.

  • Drink plenty of filtered water. Fish (preferably the cold water variety: herring, mackerel, salmon, or tuna) or soy are the preferred proteins. Except for these examples, your diet can contain any vegetables and fruits. Sulfur-containing vegetables such as broccoli and cauliflower, cabbage, onion, and garlic are particularly good for detoxification. Depending upon the degree of toxic load your body is carrying, you can expect some detoxifying symptoms as those elements start to work their way out of your system. These symptoms usually start on day 2 or 3 but keep in mind that they usually begin to be resolved by day 4 or 5. Typical symptoms of detoxification during these initial days are mild-to-strong headaches and an increase in muscular aches and pains, weakness, light-headedness or a feeling that everything is happening in slow motion, plus a variety of intestinal symptoms, including loose bowels or cessation of bowel movements.

  • By the end of the first week, you may begin to feel some relief from your symptoms of arthritis. If you do, you can be fairly sure that food is a significant contributor to your arthritic symptoms. If you do not have some relief after 2-3 weeks on this program, you may not be a dietary responder. Even if this is not the case, you will have now embarked upon a healthy diet anyway, so stay with it.

  • You may begin to reintroduce the foods that you have eliminated: one new food every 3 days. You may develop symptoms of joint pain if you eat a food to which you are intolerant, usually within about 1-2 days. If this is the case, eliminate the food again. In any event, stay away from processed foods and a saturated high fat diet. You may find that you can reintroduce dairy and wheat without difficulties; however, these are two of the common foods that cause sensitivity.

  • A maintenance diet should be those foods which you have found tolerable, with a focus on low-to-moderate fat, preferably from fish or flaxseed oil, and with an emphasis on high concentrations of fresh fruits and vegetables.


This is a simplified nutritional detoxification program. There are products on the market that will aid in detoxification. After removal of toxins, you should begin to replace any vitamins and minerals that may be deficient or ones that have been found in the research to benefit people with arthritis.


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