People used to believe that osteoporosis and osteoarthritis were the result of aging and reduced intake of calcium and
milk products. Science has now shown that these bone and joint disorders are, in part, due to inflammation.
~ Life Extension Magazine, June 2014
Are your joints aching for attention? Would you rather avoid the potential side effects of prescription and over-the-counter anti-inflammatory drugs? You may be able to experience improved symptoms by addressing your arthritis naturally.
Definition & Causes
The term “arthritis” means “joint inflammation.” In every joint, one bone moves on another. Ligaments, like elastic bands, keep the bones in place and muscles relax or contract to make the joint move. By covering the bone surfaces to stop them from rubbing directly against each other, cartilage allows the joint to work smoothly and painlessly. A capsule surrounds the joint, and synovial fluid fills the space within the joint, known as the joint cavity, to nourish the joint and cartilage.
When arthritis strikes, one or a combination of these or other factors can explain the pain attendant to the breakdown of cartilage and synovial fluid:
- an autoimmune condition [e.g., rheumatoid arthritis (RA)]
- free radicals
- anatomical misalignment of joints, often from traumatic injury
- atherosclerosis in cartilage blood vessels
- cartilage calcification (deposit of calcium crystals in joints due to calcium and/or vitamin D deficiency)
- joint overuse
- long-term use of FDA-approved anti-inflammatory drugs.
Whatever the cause of joint discomfort, many factors contribute to the complex course of attendant inflammatory reactions, and the pain associated with it results from the overworking of the body’s normal defense system. The release of the hormone-like prostaglandin PGE2 triggers inflammatory response. Certain cytokines, proteins secreted by immune cells that increase with aging, contribute to it, and the enzymes cyclooxygenase (COX-2) and lipooxygenase (5-LOX) sustain it.
Side Effects of the Conventional Approach
While a wide variety of prescription and OTC drugs address the symptoms caused by inflammation, none actually prevent it and all have potential side effects, including:
- Corticosteroids (Cortisone, Prednisone): long-term pain, glaucoma, cataracts, candidiasis, hypertension, weight gain, increased risk of infection, and high blood sugar
- NSAIDs (ibuprofen, naproxen, aspirin, Celebrex): kidney/liver failure, stomach ulcers, edema, prolonged bleeding, and serious cardiovascular risk (Celebrex)
Some Key Natural Approaches
Herbs and other dietary supplements, some of which are discussed below, combined with an anti-inflammatory/weight control diet, can help ease arthritis symptoms. Not all nutritional supplements are equal, however, and quality and dosages impact results.
Boswellia extract has shown particular efficacy for knee osteoarthritis (OA) and potential, but less compelling, efficacy for RA. Boswellic acids, including one called AKBA (the most effective COX-2- and 5-LOX-inhibiting component), are extracted from the gum resin of the frankincense tree. Boswellia extract also inhibits enzymes that break down cartilage and connective tissues.
In one double-blind, randomized, placebo-controlled (DBRPC) study, researchers who administered 100mg or 250mg of a 30% AKBA boswellia extract (5-Loxin®, delivering 33 mg or 75 mg AKBA) to seventy-five OA patients found that both doses significantly reduced knee pain and improved physical functioning. In another 30-day DBRPC study of sixty subjects with knee OA, researchers examined the efficacy of 100mg of Aflapin® (patent-pending AprésFlex) and found that, in as early as five days, it significantly improved pain and physical function, and labeled it “a safe, fast-acting and effective alternative intervention in the management of OA.”
Curcumin from Turmeric
Curcumin is a yellow-orange polyphenol (a micronutrient found in food with antioxidant and potential disease-preventive properties) derived from turmeric, which has been used for more than 3000 years in Ayurvedic medicine. It combats both inflammation and oxidation, twin causes of most illnesses.
Due to its poor absorption from the intestines, and rapid metabolism and elimination, it is difficult for ordinary orally-administered curcumin to reach blood levels sufficient to be effective. Multiple curcumin preparations with drug delivery systems have thus been created to enhance its absorption beyond the common turmeric that is standardized to 95% curcuminoids (95%Turmeric), including Theracurmin, Meriva, patented BCM-95, and patented Curcumin C3 Complex® with BioPerine.
Fish & Krill Oils (EPA/DHA)
Almost 20,000 studies have proven the numerous benefits of omega-3 fatty acids, and researchers continue to examine whether various sources of these healthy fats impact the body differently. Recent scientific evidence suggests that obtaining omega-3s from both fish and krill oils provides complementary effects on different targets. Fish oil capsules derive from fish varieties rich in omega-3s (e.g. sardines, anchovies, mackerel, and salmon). Krill, a tiny shrimplike crustacean, is a source of omega-3s bound to phospholipids, a significant component of all cell membranes.
Those with higher blood levels of omega-3s are less likely to suffer arthritis-related cartilage loss compared to those with lower levels. In one study of 177 patients with moderate-to-severe hip or knee OA, a combination of omega-3 fatty acids (containing EPA and DHA) and 1500 mg of chondroitin sulfate provided greater pain and morning stiffness relief than the chondroitin alone.
In one mouse study, krill oil supplements reduced RA scores and greatly diminished joint swelling. In a DBRPC study of 90 patients, researchers determined that, in a treatment period of just 7-14 days, a dose of 300 mg/day of krill oil significantly inhibited inflammation (reduced CRP by 19.3% after 7 days, and by 30.9% after 30 days) and reduced arthritic symptoms.
Combined Glucosamine (GS) – Chondroitin Sulfate (CS) – MSM
GS, which naturally occurs in the body, builds soft tissue, including cartilage. Although proper dosing is weight dependent, numerous studies have shown 1500 mg/day of GS to be an effective divided dose, and an average of 4-10 weeks to be the timeframe in which one can expect results.
According to studies, CS inhibits free radicals that degrade joint cartilage and collagen. By improving blood circulation to joints, CS also enables antioxidants and GS to enter inflamed joints to stimulate the repair process. In a recent 2-year study, researchers proved that, although both Celebrex (200mg) and CS (1200mg) are equally effective inhibitors of knee OA symptoms, only pharmaceutical-grade CS slows OA progression by reducing loss of cartilage. They encouraged further examination of the impact of CS on other joints.
MSM is a naturally occurring, organic sulfur compound found in food, which then naturally occurs in the body (in the collagen of skin, joints, blood vessels, and the keratin of hair/nails) due to its consumption. Animal and human studies have shown that MSM reduces joint degeneration and pain when ingested or applied topically. (DMSO is a pure, safe source of topical MSM which can provide valuable support to OA patients who are not on blood thinners.) In one DBRCP study of OA patients, researchers concluded that the oral combination of GS and MSM had a stronger and faster analgesic and anti-inflammatory effect (reduced joint pain, swelling, and functionality) than either nutrient alone.
Green Lipped Mussel (GLM)
New Zealand Maoris who regularly consumed GLM were found to suffer less arthritis than their inland relatives. This led to the development of a freeze–dried, concentrated powder (Seatone®) and, later, an omega-3 stabilized mussel powder extract (GLME) that was shown to have much greater anti-inflammatory effects than multiple un-stabilized extracts (patented Lyprinol®).
The efficacy of New Zealand GLME for treatment of OA and RA symptoms has modest preliminary scientific support, but greater support from consumer testimonials, which include side effects such as stomach upset, gout, and rashes. In one study of 21 subjects diagnosed with knee OA, researchers who administered 3,000 mg/day of GLME found that it significantly improved knee joint pain, stiffness and mobility.
Type II Collagen
Collagen is the protein building block found in connective tissue (skin, ligaments, tendons, bone, cartilage, blood vessels). Type II collagen, the most abundant in the human body and found in all joints, has been shown to alleviate the pain and swelling in both RA and OA.
Hyaluronic Acid (HA)
HA, which attracts 1000 times its weight in water, is an abundant carbohydrate in synovial fluid that is chiefly responsible for joint lubrication and shock absorption, but breaks down with age. In articular cartilage (covers the ends of bones), it forms the infrastructure to which the rest of the joint’s structural components attach. Both intra-articular HA injections and oral HA have been clinically proven to be effective.
Based on his clinical trial, Douglas W. Kiburz, M.D., determined that sufficient quantities of HA are important to getting the maximum benefit from GS and CS because HA is required for them to form correctly.
Vitamin D, Calcium+
When calcium deficiency results in low blood calcium, it causes the parathyroid to pull this mineral from the bones into the blood. Joint calcification results when this calcium subsequently is deposited in the joints. High-dose vitamin D, with the right dose of vitamin K2, calcium and other minerals, can prevent or reverse this process.
It is best to seek the advice of a holistic practitioner when attempting to change the course of any type of arthritis. Do your own research regarding drug interaction before mixing natural remedies with any medications, and advise your doctor of your desire to incorporate complementary medicine into your health program.
The statements in this article have not been evaluated by the Food and Drug Adminis-tration (FDA) and are not intended to take the place of a physician’s advice. Unless supported by specific cited research, the natural remedies discussed herein are not intended to diagnose, treat, cure or prevent any disease.
Submitted by Michael Dworkin, PD, CCN, a Registered Pharmacist and State Certified Clinical Nutritionist (CT Cert. No. 232), with J. Erika Dworkin, Certified Lifestyle Educator and Board Cert. Holistic Nutrition (Cand.). Owner of the Manchester Parkade Health Shoppe (860.646.8178, 378 Middle Turnpike West, Manchester, CT, www.cthealthshop.com), Pharmacist Dworkin has been guiding patients since 1956. Erika is available to speak to groups.
All statements in this article are research-based and references are available upon request.