Supplemental Relief
Get the Facts About 5 Supplements for Arthritis Pain
By Gina Roberts-Grey
Store shelves are stocked with an array of supplements and herbs appealing to people with arthritis. The labels tout “healthy joints” implying pain and inflammation relief, healthier cartilage and more. You may wonder which ones are worth a try.
So Arthritis Today (AT) decided to take an in-depth look at five supplements closely associated with arthritis, as well as one supplement that’s not been studied in humans yet, but is already garnering attention.
We evaluated the scientific studies. For some of these supplements, the research evidence is solid. For others, it’s inconsistent or preliminary. We also talked to doctors to get their take on the science and find out what they tell their patients.
Before taking supplements, talk to your doctor, because each supplement should be evaluated for safety and in context of your health status, risk profile and treatment regimen. Supplements are not to be taken on a whim.
"The promise of being 'natural' is misleading because it implies there are no side effects," says David Pisetsky, MD, PhD, chief of rheumatology, allergy and clinical immunology at Duke University Medical Center in Durham, N.C.
After all, some of the earliest drugs came from plants, and today some drugs are synthesized to mimic plants' medicinal chemicals. These chemicalsaffect the body's systems and processes, and have the potential to interact with other supplements, as well as with conventional medications.
Dr. Pisetsky points out that, unlike with prescription medications, FDa regulations do no require supplements to go through clinical trials to be evaluated for dangerous side effects to prove they work.
Furthermore, he believes that it is important to ensure that people are receiving other appropriate therapy before a supplement is tried. A supplement should no be a substitute for standard treatment, Dr. Pisetsky says.
All of that means it’s important to do your homework. This AT review is a good place to start.
1. Fish Oil
What it is:
Fish and fish oil is an excellent source of omega-3 fatty acids, containing two important oils, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). DHA and EPA are derived from cold water fish, such as, herring, salmon, tuna and lake trout.
What it does:
Fish oil is an anti-inflammatory, and has been shown to relieve joint pain and stiffness. Paul F. Howard MD, a rheumatologist at Arthritis Health in Scottsdale, Ariz., says it works differently than aspirin or corticosteroids. “Rather than suppressing an inflammatory reaction, fish oils is preventive,” he says.
A colleague in Dr. Howard’s practice, Keith Wilkinson, a naturopathic physician, explains. “Fish oil results in the production of a specific class of prostaglandins that prevent inflammation.”
Fish oil also has shown benefits for other inflammatory conditions, such as psoriasis and lupus, and it may reduce cholesterol levels and prevent clots by thinning the blood.
What we know about it:
While studies have shown that fish oil can reduce the number of tender joints and lessen the morning stiffness of rheumatoid arthritis (RA), it does not affect the level of disease activity.
Recent studies show fish oil can help reduce the dose of some drugs. A 2008 study from Ninewells Hopital and Medical School in Dundee, U.K., of 97 patients with RA randomized to take either rish oil or placebo found that, starting at 12 weeks and through the final evaluation at nine months, 40 percent of the participants who were taking the fish oil were able to reduce their nonsteroidal anti-inflammatory drug (NSAID) dose by more than one-third.
Side effects can include mild nausea, diarrhea and flatulence and fishy smelling breath. Fish oil also may cause bleeding if taken with blood-thinners such as clopidogrel (Plavix), warfarin (Coumadin), asprin or heparin, so it should be avoided two weeks before surgery.
How much you need:
A diet high in fish rich omega-3 is recommended, but doctors say that in order to receive arthritis- related benefits, you will need to consume higher amounts of fish oils by supplementation.
For inflammatory conditions like RA dosing is a minimum of 4,000 milligrams, mg, of combined EPA and DHA in two daily doses is necessary. Dr. Howard and Wilkinson say they have found it is often useful to start a patient on 6,000 mg or more (depending on a patient's weight) for several weeks or months, and then have them level off at 4,000 mg daily.
For low-level inflammation in osteoarthritis (OA), approximately 2,000 mgs of combined EPA and DHA will do.
Look for pharmaceutical grade fish oil, and read the package--listing "fish oil" as an ingredient isn't enough. "Quality products list total fish oil as well as the specific amounts of EPA and DHA per serving," says Wilkinson. "The milligram amount of EPA and DHA combined is most important in determining dosage."
You’ll find fish oil capsules in 400-, 500-, 1000-, 1200-, and 2000-mg doses of combined EPA and DHA. Taking a few tablespoons daily of fish oil in liquid form, rather than four to 10 pills a day, makes it easier to take a higher dose, Wilkinson says.
Bottom line:
Fish oil is good for your heart, brain and joints.
