SUPER SUPPLEMENTS FOR ARTHRITIS
While alternative therapies offer much to a sufferer of arthritis in any of its forms, there’s a great deal that you can also do for yourself. Besides a radical change of diet, a low-impact exercise programme and the introduction of vitamin and mineral supplements into your daily regime can result in enormous benefits, just as they have for many thousands of others before you. That said, it’s advisable to work with a qualified, experienced nutritional therapist on any major changes to your diet or before beginning supplementation.
Below you’ll find guidance on the best-researched supplements shown to have good effects in terms of lowering inflammation and improving joint function. But do bear in mind that these are not magic bullets. They mainly work as part of a holistic treatment that includes discovering the causes of your inflammation and incorporating the right diet, exercise and mind–body medicine.
The following list of bio-compounds, herbs, enzymes, minerals, vitamins and plant extracts comes from a wide variety of sources and geographic locations, including Indian Ayruvedic medicine, Traditional Chinese Medicine, and traditional folk medicine from a wide variety of countries. The first section in this chapter is dedicated to supplements that directly treat arthritis and its symptoms. The second section offers a list of natural painkillers. However, a number of these supplements do both.
They work best in combination with all the lifestyle and mind–body suggestions put forward in this book.
These two unusual, naturally occurring compounds, sold as nutritional supplements, have been revolutionizing alternative treatments for arthritis. Both substances are of major importance in assisting the growth of cartilage, the spongy material that covers the ends of bones in the joints and protects them from wear.
Glucosamine is the major building block of proteoglycans, the large molecules in cartilage that give it its elastic and protective properties, maintaining joint lubrication and flexibility by trapping water in the cartilage matrix. Chondroitin, an even larger cartilage molecule, helps to maintain joint fluidity, while slowing cartilage destruction and helping with its repair.1 Glucosamine works by stopping the breakdown of proteoglycans and by rebuilding damaged cartilage. Clinical trials show that it appears to be a natural anti-inflammatory as well.
Chondroitin helps reduce cartilage loss in as little as six months after starting supplements.2 A recent review of the evidence concluded that oral chondroitin sulphate ‘is a valuable and safe symptomatic treatment for OA [osteoarthritis] disease.’ Interestingly, 800mg/day had nearly the same effects as 1200mg/day in one study.3 It’s often recommended that chondroitin be taken in combination with glucosamine. One theory is that both these agents work by improving the quality of the synovial fluid between the joints.4
Overall evidence for their healing effect is impressive. One of the most comprehensive trials was an international study on more than 200 patients with osteoarthritis of the knee. They were given either 1500mg of glucosamine or a placebo daily over the course of three years. Double-blind assessment showed that, while there was the predictable deterioration of the joints in the placebo group, the glucosamine group’s joints remained intact. There was a corresponding improvement in pain and joint mobility, with no significant side effects. The researchers were impressed by glucosamine’s ‘long-term combined structure-modifying and symptom-modifying effects’. This therefore appears to be one of the first natural substances to have a genuine effect on the disease itself.5
This study proved to be a breakthrough for supporters of nutritional supplements, since medical commentary accompanying publication of the study included the admission that doctors must begin to ‘accommodate the possibility that many nutritional products may have valuable therapeutic effects’.6
In another study 80 patients with osteoarthritis were given either 500mg of glucosamine sulphate or a placebo three times a day. While symptoms decreased in both groups, those receiving glucosamine had a significantly greater reduction in symptoms compared with placebo – 73 versus 41 per cent. Furthermore, a sample of cartilage from the placebo group, looked at under electron microscopy, showed evidence of osteoarthritis, whereas samples from the treated patients looked more like healthy cartilage.7
The medical community has generally disparaged these supplements, pointing to studies showing glucosamine to have no effects – trials that have since been criticized as having serious flaws and poor study design – while failing to take seriously an ever-rising tide of studies that have been conducted properly and that clearly demonstrate glucosamine’s effectiveness.
More recently, glucosamine has been compared with conventional NSAIDs. In a recent trial of 600 osteoarthritis patients conducted all over Europe, a chondroitin and glucosamine combination was pitted against celecoxib, one of the major COX-2 inhibitor drugs. The supplements worked as well as the COX-2 drug: both groups saw a more than 50 per cent reduction in joint swelling, with similar improvements in joint pain, stiffness and function after six months.8
Moreover, when 54 trials involving more than 16,000 patients were pooled together, glucosamine and chondroitin, either alone or together, were shown to be just as effective as celecoxib for relieving painful knee osteoarthritis, although only the supplement combination significantly improved joint function and led to a marked improvement in the knee-joint space narrowing commonly seen in the condition.9
Chondroitin alone also beat celecoxib at reducing cartilage loss in knee osteoarthritis, although both pills were equally good at easing pain and improving function.10
Glucosamine also wins out against ibuprofen as a painkiller for treating osteoarthritis. In one study, patients with temporomandibular joint (TMJ) disorders treated with glucosamine had less pain and less difficulty opening their mouths than those treated with the common painkiller.11
Although they take a little longer to work, glucosamine and chondroitin deliver as much painkilling and anti-inflammatory action as the standard NSAIDs, and even actually improve joint function and reduce cartilage loss – all without serious side effects.
The effects of glucosamine sulphate are known to improve over time. So, if you wish to try it, give it at least three months.
Suggested daily dosages:
Glucosamine sulphate: up to 3,200mg
Chondroitin: up to 3,600mg
Collagen hydrolysate, a gelatin, has been shown to be successful in the treatment of osteoarthritis and other joint disorders in arthritis patients12 and to halt its progression in mice. 13
Suggested daily dosage: up to 1,200mg
CH-Alpha is a registered product whose main active ingredients are hydrolyzed collagen, extracts of Zingiber officinale (ginger) root, Boswellia serrata, Rosa canina fruit (rosehip), and vitamin C. It comes in oral and gel applications. The gel contains Arnica montana and sunflower seed oil as well.
Several studies have been done on CH-Alpha.14 In one of them, 100 athletes at the Rhein-Ruhr Olympic Training Facilities in Essen, Germany, were each given 10g of CH-Alpha daily for 12 weeks after having their movement and pain levels initially assessed. The patients taking the supplement showed significant improvements in all areas of pain and mobility, compared to initial assessments.15
Hyaluronic acid is a fluid carbohydrate and another of the building blocks of cartilage, and taken as a supplement it appears to decrease the production of enzymes that damage healthy cartilage tissue and also interfere with pain signals. When injected directly into the knee joint, it can help improve function.16 It can also be taken orally. Based on animal studies (which, of course, may not apply to humans), this appears to work best when taken in a preparation that includes phospholipids.17 And in a study of people, those with osteoarthritis of the knee had less pain and overall improvement in function with oral daily supplements taken for eight weeks.18
Hyaluronic acid is sometimes injected directly into the joint to act as a lubricant – a process referred to as ‘viscosupplementation’. Recent studies have shown that this is effective for osteoarthritis of the knee and ankle, with patients reporting significant improvements in pain and function.19
Suggested daily dosage: 40mg
A source of bioavailable sulphur found in the tissues and fluids of all plants, animals and humans, MSM can reduce pain and swelling, and stop the destruction of joints by scavenging the free radicals that cause inflammation. It’s been shown to reduce pain and improve function when taken orally for at least 12 weeks.20
Suggested daily dosage: up to 1,200mg in divided dosages
This naturally occurring compound, present in virtually every tissue and fluid in the body, is known to be a powerful anti-inflammatory. Besides reducing pain, it can improve joint function and ease stiffness.21 Double-blind trials show that SAMe (1,200mg/day) reduces pain, stiffness and swelling in osteoarthritis sufferers better than a placebo, and with the same effectiveness as painkilling drugs such as ibuprofen and naproxen.22
SAMe appears to stimulate the production of cartilage and, although researchers don’t know exactly why, it may even reduce inflammation, influence cartilage synthesis and survival, and boost the production of antioxidants.23
Suggested daily dosage: Up to 1,200mg in divided dosages
These special oil mixtures can promote cartilage repair and reduce circulating levels of pro-inflammatory cytokines, so improving function and reducing pain as well as the need to take NSAIDs.24
If arthritis is already present, the antioxidants vitamins C and E and the mineral selenium have been shown to reduce the pain of rheumatoid arthritis.25 Rheumatoid arthritis sufferers have been found to benefit from supplements of vitamin E, beta-carotene and selenium26 and to be deficient in zinc.27
Suggested daily dosage: Doctors such as Dr John Mansfield recommend that patients supplement with a good multivitamin/mineral, a B complex vitamin formula with at least 25mg of B5 (pantothenic acid) and B3 (niacinamide), plus zinc (50mg), selenium (200mcg), and vitamin D (2,000–3,000IU) if you’re deficient in it.
Vitamin C is essential for collagen synthesis; taking megadoses of 1g or more can reduce the risk of cartilage loss by 70 per cent.28 Vitamin E can also help to reduce pain – and may even have an anti-inflammatory effect.29 So take both vitamins together. Dosages of 1,200 to 1,800IU per day of vitamin E can significantly decrease joint pain.30
Suggested daily dosages:
Vitamin C: 1–3g
Vitamin E: 1,200–1,800IU
Individual B vitamins have been shown to help increase movement and reduce pain in arthritis sufferers. Niacinamide, a form of vitamin B3, reduces inflammation, increases joint mobility and reduces the need for painkilling first-line anti-inflammatories that osteoarthritis sufferers need to take.31
B5 (pantothenic acid) and B3 (niacinamide) have been shown to be beneficial at doses of 25mg. Vitamin B12 and folic acid have been shown to help improve grip strength in patients with arthritis of the hands and fingers.32 For rheumatoid arthritis sufferers taking methotrexate, folic acid supplements can reduce the toxicity of this powerful immunosuppressant drug.33
Suggested daily dosages: The B vitamins should be taken within a balanced B-complex supplement and should not be taken at night.
B5: 25mg
Niacinamide: from 900mg to 4g a day in divided doses – but only under medical supervision as high levels can cause glucose intolerance and liver damage
B12 and folic acid: 800mcg each
Boron, a natural mineral, has been used for years as a supplement for arthritis – without side effects.34 It’s also given for osteoporosis. Boron given to rats and chicks has increased bone strength. However, clinical studies are needed to clarify boron’s effects in humans.35
What Doctors Don’t Tell You panel member Dr Melvyn Werbach suggests that, as the minimum daily allowance for boron still isn’t established, patients should increase their consumption of boron-rich foods (vegetables such as soybeans, cabbage, lettuce and peas; fruits such as apples, dates, raisins and prunes; and nuts, especially almonds, hazelnuts and peanuts).
When magnesium levels fall, there’s a marked increase in inflammatory cytokines, along with increased levels of histamine – at least in rodents.36 Many people claim that spraying magnesium oil regularly onto the skin and rubbing it into painful areas has brought relief for the joint pain associated with arthritic conditions.
If you have RA, consider getting your copper levels tested, as sufferers are often deficient in this mineral. Supplement only under the guidance of a qualified, experienced professional.
Supplements that may help with gout include fish oils, the B vitamins (particularly folic acid), vitamin E and vitamin C.
As we’ve seen, many of the above supplements that serve as remedies for arthritis also work as effective pain relievers, and one of the most interesting natural supplements to consider for pain relief of arthritis is vitamin D.
In a nationwide study of nearly 7,000 adults from across Britain, scientists at the Institute of Child Health in London discovered a link between low levels of vitamin D and chronic widespread pain. Although the findings weren’t significant for men, in women the prevalence of this chronic pain varied according to vitamin D concentrations. Women with vitamin D levels between 75 and 99nmol/l – the range deemed necessary for bone health – had the lowest rates of pain: just over 8 per cent. In contrast, in women who had levels less than 25nmol/l, pain rates were nearly doubled at 14.4 per cent.37
Similar results were reported in an American study. Mayo Clinic researchers in Rochester, Minnesota, found a connection between inadequate vitamin D levels and the amount of opiate-containing medication taken by patients suffering from chronic pain. Those who had low vitamin D levels were taking much higher doses of pain medication – nearly twice as much – as those whose levels were adequate. Moreover, they reported poorer physical functioning and poorer overall perception of health.38
Although these two studies aren’t proof that a lack of vitamin D causes chronic pain, they do contribute to a mounting body of evidence suggesting an important role for this vitamin in pain control. Indeed, according to an extensive review of the research so far, inadequate vitamin D has been linked to a long list of painful maladies, including bone and joint pain, muscle aches, fibromyalgia, rheumatic disorders, osteoarthritis and other complaints.39
Much of the research has focused on chronic musculoskeletal-related pain. Indeed, the review’s author, Dr Stewart Leavitt, identified 22 clinical studies investigating vitamin D status in patients with this sort of pain. Across these studies overall, an average of around 70 per cent of patients with chronic musculoskeletal pain were found to be deficient in the vitamin.
The evidence also shows that supplementing with vitamin D can lead to a dramatic reduction in pain. In more than 350 people with chronic back pain, vitamin D therapy led to symptomatic improvement in 95 per cent – and in 100 per cent of those with the most severe vitamin D deficiencies.40
According to Leavitt, vitamin D deficiency can contribute to musculoskeletal pain by causing hypocalcaemia – low levels of circulating calcium – which ‘sets in motion a cascade of biochemical reactions negatively affecting bone metabolism and health’. One of these reactions is an increase in parathyroid hormone (PTH), which can impair proper bone mineralization, causing a spongy bone matrix to form in the skeleton. This matrix absorbs fluid and expands, causing the resultant ballooning pressure to trigger pain in the tissues overlying the bones, since sensory pain fibres are abundant in these tissues.
In addition, vitamin D deficiency can contribute to pain in other ways. Several studies cited by Leavitt in his report found that vitamin D may play a role in non-musculoskeletal pain syndromes, including neuropathy, migraine headaches and inflammatory autoimmune conditions such as inflammatory bowel disease.
Whatever the mechanism involved, the data suggest that checking for vitamin D deficiency – and correcting it – should be an important part of chronic pain management.
Sunlight is the best source of this vitamin but, as most of us don’t get enough of it this way, Leavitt recommends taking – with the supervision of a qualified practitioner – a daily supplement of 2,000IU of vitamin D3 (cholecalciferol), along with a daily multivitamin that includes calcium and 400–800IU of vitamin D. He notes that it may take up to nine months to experience the maximum effect of such a regimen.
Besides vitamin D, other nutrients may be beneficial for people with chronic pain. These include proteolytic (digestive) enzymes such as bromelain, as suggested in the chapter on gut problems, and amino acids such as d-phenylalanine and l-tryptophan. Taken with a glucosamine/chrondroitin sulphate combination, proteolytic enzymes are known to be as effective as NSAIDs for inflammatory conditions such as arthritis of the shoulder or knee,41 while amino acids appear to increase pain tolerance.42
For natural pain relief of gout, varieties of the herb devil’s claw (Harpagophytum procumbens or H. radix) have often been recommended, based on evidence for its effectiveness in various forms of arthritis.43
Alternatively, try homeopathic remedies.