SUPPLEMENTS and ARTHRITIS
People with arthritis take a huge range of supplements
including herbal remedies, homeopathic medicines, vitamins,
minerals and dietary supplements. Supplements such as cod
liver oil and glucosamine are very popular.
So far there is little evidence that dietary supplements
improve arthritis or its symptoms, though recent findings
for omega-3 fatty acids and glucosamine are promising.
Bear the following in mind before taking supplements:
- Find out as much as you can about the supplements you
want to take.
- Remember that supplements will not cure chronic diseases.
- Check with your doctor or pharmacist for interaction
with prescribed drugs.
- Tell your doctor about any supplements you are taking
so that they are aware of all aspects of your treatment
plan. Report any side-effects to your doctor immediately.
- Keep a record of how you are feeling so you can try
to gauge if the supplements are having an effect.
- Buy brands from large, reputable manufacturers so that
you can be more sure of consistency in the product.
- Consider the costs: taking supplements is a long-term
commitment and can be expensive.
Below is a more in-depth look at some of the more widely
taken supplements.
Aloe vera
Aloe is known to soothe and reduce inflammation and has
long been used in the treatment of wounds and burns. It
is commonly used externally as a gel for these purposes.
It is also marketed for internal use — usually as
a drink — for some conditions such as rheumatoid arthritis
(RA). Studies on animals into its effectiveness in reducing
inflammation are promising, but not enough research has
been done into its safety. Taking aloe internally might
alter the effects of prescribed drugs, including steroids,
so check with your doctor before taking it.
Boswellia
Boswellia, also known as frankincense, comes from a tree
in Asia whose gum has been used in Indian ayurvedic medicine
for centuries to treat inflammation in arthritis and musculoskeletal
pains. Studies into its effectiveness have been mixed. Boswellia
can also be found in products containing a combination of
supplements. There are no known serious side effects, but
it can cause diarrhoea, nausea or a rash. Stop taking it
if you have any of these reactions.
Calcium
Calcium, a mineral found in our bodies, is essential for
a wide range of things including the construction and repair
of bones and teeth. It also keeps them hard. It is found
in many foods (see page 8), but only about a third of dietary
calcium is absorbed. Older people don’t absorb calcium
very well and might benefit from taking supplements. These
may be available on prescription from your doctor. Be careful
not to exceed the recommended daily dose. Calcium supplements
should not be taken by people with kidney problems without
medical advice.
Cat’s claw
Cat’s claw is a vine that grows in the Peruvian Amazon.
It is widely used in South America to treat joint pain and
inflammation. There have been no studies in humans to prove
how effective or safe it is, but animal studies indicate
that it can act as an anti-inflammatory and antioxidant.
Cat’s claw is available in tea bags as well as in
capsules. It may increase the risk of bleeding if taken
with other blood thinners. There are several variations
of cat’s claw available, one of which is toxic, so
be sure to choose the uncaria tomentosa variety.
Cayenne
Cayenne, or capsaican, is a red pepper made up from ground
chillies. It is usually applied externally as a cream to
gain temporary relief from the pain of osteo and rheumatoid
arthritis. Chillies prompt the release of endorphins, the
body’s natural pain killers. They are also thought
to block pain by tampering with the chemical responsible
for sending pain signals. You should not apply the cream
to broken or irritated skin and make sure you wash your
hands after applying as it can sting your eyes if they are
touched. It is available on prescription.
Chondroitin sulphate
Chondroitin sulphate exists naturally in your body and is
thought to give cartilage elasticity and to slow its breakdown.
In supplement form it is derived from the trachea of cattle,
or sometimes shark cartilage, and is often taken alongside
glucosamine to relieve the symptoms of osteoarthritis. There
is no proof that it reverses cartilage loss, but some studies
suggest it helps stop joint degeneration. Chondroitin is
a slow-acting supplement so don’t expect to see any
improvement for at least two months. It doesn’t help
everyone — if you have severe cartilage loss you probably
won’t get any benefit. There do not appear to be any
serious side effects, but minor ones include occasional
nausea and indigestion. It could increase your chances of
bleeding if you are taking any blood-thinning drugs. The
long-term effects of taking chondroitin are not known.
Collagen
Collagen exists naturally in healthy cartilage. However,
there is no evidence that taking collagen supplements, which
are generally extracted from animal cartilage, is of any
help in mending damaged cartilage. Studies currently taking
place into type II collagen aim to find out whether it can
suppress the autoimmune response associated with rheumatoid
arthritis. Research also suggests that type II collagen
may reduce inflammation and pain for some people with rheumatoid
arthritis with little or no side effects.
CM0
CMO (cetyl myristoleate) is advertised as a cure for almost
every kind of arthritis. It is available in capsules to
be taken daily for 1 0-20 days. It is made from beef tallow.
Main concerns about CMO stem from a sales pitch that advises
customers to stop taking prescribed medication, including
methotrexate and steroids, as they interfere with CMO activity.
No human research has been published so there is no proof
that CMO is either safe or effective. Always consult your
doctor before stopping any medication.
Devil’s claw
Devil’s claw is an African plant whose roots contain
harpagoside which contains anti-inflammatory and pain-killing
properties. It is popular for RA. Scientific studies have
produced mixed findings. Most commonly it comes as a tea
or as a capsule. Make sure it contains the active ingredient
harpagoside. Devil’s claw stimulates stomach acids
so it is not recommended for people with ulcers or on NSAIDs.
Devil’s claw obtained abroad may contain steroids.
DMSO
DMSO (dimethyl sulfoxide) is a chemical by-product of wood
processing which has many medical uses including the treatment
of arthritis. It can be taken internally or applied externally
to relieve inflammation in joints and soft tissue. It is
used for both osteo and rheumatoid arthritis. Research has
been mixed, but some studies indicate it helps relieve symptoms
of arthritis, Raynaud’s syndrome and scleroderma.
Its safety is not proven. If you want to try it, ask your
doctor to find you a medical-grade source as DMSO on sale
to the public is usually industrial strength which is not
suitable for humans. It can cause a number of side effects
including skin irritation and bad breath. Taking an impure
product may affect the kidneys, liver and vision.
Echinacea
Echinacea is currently enjoying media attention as a tonic
against colds and flu. It is a herbal product claimed to
be an immune system regulator Trials, mainly on animals,
have been inconclusive. There is concern about what echinacea
may do to people with autoimmune diseases whose immune system
is already overactive. Most experts advise people with rheumatoid
arthritis and lupus not to take it. Echinacea comes in many
forms, but is most commonly taken in capsules. It might
interact with or intensify conventional drugs so check with
your doctor first.
Evening primrose oil
Evening primrose oil (EPO) contains the fatty acid gamma
linolenic acid (GLA) which is an omega-6 acid converted
by the body to make anti-inflammatory agents. Several studies
have shown that GLA supplements can relieve inflammation
and RA. EPO needs to be taken for three to six months to
give full benefit and the effect is lost when EPO is stopped.
It may also be of value when taken with fish oils.
Fish oils
The body uses the omega-3 fatty acids in fish oils and cod
liver oil to make chemicals that are less inflammatory than
those made from a diet rich in animal fats. Fish oils can
produce a modest improvement in joint pain and stiffness
and have a good record of easing the symptoms of OA, RA
and Raynaud’s. Recent research has found that omega-3
fatty acids are effective because they reduce the activity
of the enzymes responsible for cartilage damage and they
switch off another enzyme known to cause much of the pain
and inflammation of arthritis. A daily dose, often in capsule
form, must be taken for at least three to six months. Any
benefit is lost when you stop taking it. Care should be
taken not to exceed safe levels of vitamins A and D when
taking cod liver oil. People taking high dose supplements
should check with their doctor first, particularly if they
are taking blood thinning medication such as aspirin, and
studies need to be carried out into the possible long-term
toxicity of taking fish oils.
Ginger
This root shows anti-inflammatory and pain-killing potential
as it inhibits the production of prostaglandins and leukotrienes
which cause pain and swelling. It comes in a number of different
forms including tablets and powder or you can use generous
amounts in cooking. Ginger can increase the risk of bleeding
if you are taking blood-thinning drugs.
Ginkgo
Ginkgo is a herb derived from leaves of a tree. Scientists
still aren’t sure how it works, but a German study
shows that it significantly increased the blood flow in
finger capillaries so it may ease Raynaud’s symptoms
by increasing the circulation in hands and feet. It must
be taken for six to nine weeks to have any effect. There
is a low risk of side effects with Cingko, but it can increase
the risk of bleeding if you are taking blood thinning drugs.
Don’t take gingko biloba with aspirin.
Ginseng
Asian (Panax) ginseng is the most widely used variety. There
is no evidence that it helps arthritis, but it may offer
some benefit as an energy booster. It is normally taken
in capsule or tablet form and it is available as a tea.
Panax ginseng could increase the effects of steroids, so
you should not take it if you are on these drugs.
Glucosamine
Glucosamine is popular with people with osteoarthritis.
It is a natural substance extracted from crab, lobster or
prawn shells. There are many wild claims going around that
it cures arthritis. While this has not been proven, glucosamine
does seem to help ease the pain and stiffness of osteoarthritis
in some people. Recent research in Belgium indicates that
it also slows down joint narrowing in OA. To see any effect
you must take glucosamine for about two months. It doesn’t
help everyone so if you haven’t seen any improvement
after two months it probably won’t help you. There
are no known serious side effects, but lesser ones include
nausea and indigestion. It is unlikely to cause a reaction
in those with an allergy to shell fish. Glucosamine is often
taken in combination with chondroitin (see above). Glucosamine
comes in capsule form.
Green tea
Little research has been done on humans, but animal tests
suggest green tea may be useful in treating and even preventing
RA. It contains polyphenols which are antioxidant compounds
found to help reduce inflammation. It is available for brewing,
but don’t add milk to your cup as it might interfere
with the polyphenols. It is also available in capsule and
tablet form. There are no known serious side effects.
Iron
Iron levels may be low in people taking steroids or NSAIDs
as they can lead to bleeding of the gut. However, anaemia
in RA does not always respond to iron supplements so you
should talk to your doctor before taking iron.
Magnesium
Magnesium is needed to maintain healthy bones. Supplements
of this mineral have been shown to significantly improve
pain and fatigue. Magnesium is found in nuts, grains and
whole foods, but people who eat mainly processed foods may
not be getting enough. Magnesium may help relieve fibromyalgia
symptoms. Check with your doctor before taking magnesium
as it can interact with other drugs and it can be toxic
if too high a dose is taken.
MSM
MSM (methyl sulfonyl methane) is touted as a cure for arthritis.
There is no scientific evidence to back this claim. MSM
is a sulphur compound formed in the breakdown of DMSO (see
above). It can be found in fresh fruits and vegetables,
milk, fish and grains, but is destroyed when foods are processed.
Some animal studies are promising, but there have been no
human trials. There is no research to show that MSM is safe
despite claims that it is non-toxic. MSM is available in
capsules and as a lotion.
New Zealand green-lipped mussels
Omega-3 fatty acids (see page 1 6) are thought to play a
part in the efficacy of New Zealand green-lipped mussel
preparations. Researchers have found that both stabilised
mussel powder and a lipid extract may be effective in reducing
pain, swelling and stiffness in both CA and RA. Products
come in varying levels of concentration the more concentrated
versions are more likely to be effective. New Zealand green-lipped
mussel extract commonly comes in capsule form.
SAMe
SAMe (S - adenosylmethionine)) is produced from adenosine
triphosphate (ATP) and a sulphur-containing amino acid called
methionine. Marketed as a supplement for OA, it is thought
to improve joint mobility and relieve pain by boosting levels
of ATP and supporting cartilage production. Some clinical
trials have shown that SAMe relieves OA pain about as well
as NSAIDs. Side effects can include nausea or stomach upset.
St John’s Wort
This is a popular herbal remedy, particularly for depression.
It comes from a flower and appears to act as an anti-depressant
by raising serotonin levels which are low in people who
are depressed and those who have fibromyalgia. Studies show
that it can relieve mild depression, but more trials are
needed to find out its long-term effects and the best dosage.
St John’s wort must be taken for a number of weeks
to feel an effect. It should not be taken with other anti-depressants
or alcohol.
Recent research has suggested that St John’s wort
can reduce the effectiveness of some medication prescribed
to people with arthritis, such as cyclosporin, by stopping
it working properly. If you are taking prescribed medication
you should consult your doctor before taking St John’s
wort. People with Iupus should avoid it as it can increase
sensitivity to sunlight. St John’s wort usually comes
in tablet form.
Selenium
Selenium is an essential mineral that is known to be low
in people with inflammatory conditions such as rheumatoid
arthritis. It is essential for the action of glutathione
peroxidase which helps limit the harmful effects of inflammation.
There is no clear evidence that correcting a selenium deficiency
has any positive effect on arthritis. The body does not
need high levels of selenium and it can be toxic in high
doses. It is found in a number of multivitamins so care
should be taken not to exceed the recommended dose.
Valerian
Valerian is a wild flower whose root is a popular treatment
for insomnia. Several studies show it might be an effective
and safe alternative to prescribed drugs. Valerian is non-addictive
and there are no known serious side effects, but it should
not be mixed with alcohol or other sleep inducing drugs
as it will increase the sedative effects. Valerian commonly
comes in a capsule and it is best taken an hour before going
to bed.
Zinc sulphate
Zinc levels are often low in people with rheumatoid arthritis
and some studies have found that joint swelling and morning
stiffness are reduced when taking zinc. Check with a doctor
before taking zinc supplements as many people are getting
enough already.
Information Courtesy of
Arthritis Care
18 Stephenson Way
London NW1 2HD
Tel: 020 7380 6500
Fax: 020 7380 6505
Reg charity No. 206563
For Further information visit the website
www.arthritiscare.org.uk
