Dr. Jacob Teitelbaum's Column
...expert advice on CFS, Fibromyalgia and other Health Topics.
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Tuesday, April 24th, 2012:
9-Step Program for Rheumatoid Arthritis & Arthritis
Waking Up in the Middle of the NightWaking Up in the Middle of the NightWaking Up in the Middle of the Night
by Jacob Teitelbaum MD
Recently, I received an email from Cindy H, a woman with rheumatoid arthritis (RA) who had seen me on Dr. Oz and had read several of my articles. She asked some excellent questions about her condition, a condition she shares with about two million Americans (four times more women than men, and most of them middle-aged or older). What's happening to those folks?
RA is an autoimmune disorder: the body's immune system attacks the joints, which become hot, swollen and painful. But those symptoms (and others, like fatigue) aren't always constant. They can come and go in flare ups, which are often triggered by an infection of one kind or another.
I'd like to share my answers with those who have RA — or know somebody who does (if so, I encourage you to forward this to them, or send them a link; and much of this information can also be very helpful for regular arthritis).
Here are her questions:
- How can I find a holistic doctor to treat my RA?
- I'm scared of my medications and their side effects. Should I be?
- You say infections can trigger flare ups. Can those infections be controlled?
- Do you think I might have fibromyalgia, too?
- I've read about the over-the-counter hormone DHEA. Is it helpful?
- Speaking of hormones, should I ask my doctor to check for hormonal imbalances?
- Are there supplements that are good for RA?
- I read about a technique called JMT for autoimmune problems. Do you think it's helpful?
- RA is attacking my joints. Should I be doing something about osteoporosis?
1. How can I find a holistic doctor to treat my RA?
What you want is not a holistic doctor who specializes in RA (I don't know anyone who does this), but a holistic doctor and a good rheumatologist, so you get the best of both worlds: holistic medicine and conventional medicine. To locate a holistic physician in your area, use the "Find a Holistic Physician Near You" feature at The American Board of Holistic Medicine website.
2. I'm scared of my medications and their side effects. Should I be?
Don't be too afraid of using medications for RA — except for the steroid prednisone, which can have very negative side effects if used long term. Also, herbals can be much more effective than the arthritis medications (called NSAIDs) like ibuprofen, Voltaren, etc — without causing bleeding ulcers. End Pain and Curamin are excellent options, and can be used with these medications while also helping you get off them. The other medications can be a good idea. Unlike other illnesses where docs get aggressive with medications at the patient's expense, in RA an ounce of prevention is worth a pound of cure, because early treatment can prevent long-term joint damage. Several medications, including the DMARDS (disease-modifying antirheumatic drugs) the rheumatologist will add, can decrease the amount of prednisone and NSAID medication needed (and sometimes it simply is needed). So be at peace with using the meds, and focus on adding inflammation-easing natural compounds (more about them below) so you can lower the amounts of medication needed, especially the prednisone. When you get prednisone down to 5 mg a day, instead of tapering off further, simply ask the holistic doctor or your Rheumatologist to put you on the prescription Cortef (a bioidentical cortisol) at 20 mg a day — that's about equal to 4 mg of prednisone. It is safe to use long term at 20 mg or less a day, avoiding the severe flares (often from suppressed adrenal function from the prednisone) that occur as the prednisone dose is lowered to under 5 mg.
3. You say infections can trigger flare ups. Can those infections be controlled?
Yes. If you have rheumatoid arthritis, the inflammation is often triggered by your body fighting a hidden infection. I recommend adding long-term antibiotic treatment with Minocycline (Minocin, a tetracycline antibiotic). To prevent Candida overgrowth, you should also take the anti-fungal diflucan (200 mg, 2x a day, 1 day a week — e.g., each Sunday). And add a probiotic (like Pearls Elite) 1 each day, taking it at a different time of day than you take the antibiotic. For a detailed discussion on how powerfully effective antibiotics can be for RA, see my article on this on the Dr. Oz website.
4. Do you think I might have fibromyalgia, too?
If you have widespread pain and insomnia (especially if you also have fatigue and/or "brain fog"), you also likely have fibromyalgia with the RA. Treating the fibro with the S.H.I.N.E. protocol (which addresses Sleep, Hormones, Infections, Nutrition and Exercise) can dramatically decrease the amount of prednisone and other meds you need, and leave you feeling much better.
5. I've read about the over-the-counter hormone DHEA. Is it helpful?
In my (and other clinician's experience) adding DHEA at a dose of 10-25 mg a day (25-50 mg a day in men) seems to decrease the amount of prednisone needed, and prednisone's side effects. If the DHEA causes acne or any darkening of facial hair in women (a rare side effect for those with RA), lower the dose to 10 mg a day.
6. Speaking of hormones, should I ask my doctor to check for hormonal imbalances?
Ask the holistic doctor to test for testosterone, because low or low-normal levels are linked to more pain. If your testosterone is low or even in the lower third of the normal range, ask the holistic doctor to add 1/2 mg a day of topical testosterone (50 mg in men) to your treatment regimen. (Don't use too much, as that is counterproductive.) The DHEA will also raise a woman’s testosterone. In fact, 25 mg a day should boost a woman’s testosterone on its own.
7. Are there supplements that are good for RA?
Adding natural supplements like Curamin (1-2 caps 3x day), End Pain (1-2 tabs 3x day), glucosamine sulfate (750 mg 2x day), chondroitin (400 mg 2x day), and MSM (2,000 mg a day) can be very helpful for RA. I would use them all together for 12 weeks to lessen pain. Then I would stay on the glucosamine and End Pain (1 tab 3x day) long term, using the others as needed. This recipe is also excellent for regular arthritis. In RA, I would also add a special Omega 3 (fish oil) called Vectomega (1-2 a day, instead of 8-16 caps of most fish oils!), which can markedly decrease inflammation. These can be taken with the RA medications.
8. I read about a technique called JMT for autoimmune problems. Do you think it's helpful?
JMT is a technique that uses muscle-testing and simple pressure point treatments (similar to acupressure) to isolate and eliminate infections that weaken the immune system. And it's been very helpful for many with RA. (Learn more about JMT.)
9. RA is attacking my joints. Should I be doing something about osteoporosis?
Have your physician do a DEXA scan for osteoporosis, especially if have been on prednisone over 6 months. If you have loss of bone density, take strontium 340 mg 1-2 each morning and Osteostrong 3-4 tabs at bedtime. These are much more effective than osteoporosis medications — and much safer. (To learn more about osteoporosis, see Osteoporosis and Osteopenia — Loss of Bone Density.)
So now you have a 9-step program to help you recover from RA!
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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