Supplements for Arthritis  

 

Supplements for Arthritis 

For Release Oct. 8, 2024

 

PODCAST OPEN:      

You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. This podcast and other life-changing resources are made possible by gifts from donors like you. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control of arthritis with tips and ideas from our hosts and guest experts.

 

MUSIC BRIDGE

 

Jamie Nicole:

Hello there. Welcome to the Live Yes! With Arthritis podcast. My name is Jamie Nicole, and I am your guest host for this episode. A little bit about me… I have been navigating the challenges of osteoarthritis for about 20 years now, and then was diagnosed with rheumatoid arthritis last year. I'm also a certified health coach and fitness instructor, so anything with supplementation that's going to make my symptoms a little bit better, I am all excited about. The title of this podcast is Supplements for Arthritis.

 

We're talking about what they are, what to look for when you're shopping for them, and which ones might help if you have arthritis. Today, we're joined by Chris D'Adamo. He's an epidemiologist with expertise in the relationship between modifiable lifestyle factors and human health across the lifespan. So, Dr. D'Adamo, welcome to the show. We are thrilled to have you here. And can you tell us just a little bit about yourself?

 

Dr. D'Adamo:

Sure, my pleasure. And look forward to chatting. Hopefully, you'll come away with some things today that might help you and the listeners as well. I'm very interested in this topic. I also was a personal trainer and very much into exercise before I went to graduate school to do my studies in epidemiology. And I had some joint issues from, you know, frankly, overuse in the gym, and playing basketball and all these things that I did. So, I've been interested in this topic personally, even before I started to study it professionally.

 

We look at a lot of different things with my research team. But this is an area where we've done quite a bit of work, and there are a number of dietary supplements and natural products that can help with both osteoarthritis and rheumatoid arthritis. And so, I look forward to talking about that today.

 

Jamie Nicole:

Awesome. Me, too. I did a little research on what you do in your background when I first found out that you were going to be the guest for this show. And I know that you have a wealth of knowledge. I'm excited to dive right into it. So, first we're going to just ask about some general supplement information. For the audience who may not know, because we can’t assume that everyone knows what supplements are and what the difference is between supplements and regular over-the-counter medications or prescription medications… Can you let the audience know how they differ from one another?

 

Dr. D'Adamo:

Dietary supplements were defined in a Congressional Act of 1994, called the Dietary Supplement Health Education Act, or DSHEA. It's ingredients that are taken orally that are naturally derived. And there's several different classes: vitamins, minerals, amino acids like protein powders, and then botanicals, which are a lot of your herbal types of products and so on. You typically don't need a prescription, at least in the United States, for a dietary supplement. You can buy it over the counter or online, or through your physician's office sometimes as well. But that's from a very high level, kind of what might differentiate that from a pharmaceutical product.

 

Jamie Nicole:

Can you talk a little bit about how supplements are regulated in the U.S.?

 

Dr. D'Adamo:

Yeah, this is an area where there's some confusion. I think a lot of times we hear that dietary supplements aren't regulated. They actually are regulated by the U.S. FDA. But they're regulated as foods, and not as medications, which is a softer regulation. So, with that in mind, you know, we don't necessarily know about the purity of any particular product, which is why some of the resources — like labdoor.com and consumerlab and some of the third-party lab testing — can be helpful to ensure that you know what you're getting.

 

Jamie Nicole:

For supplementation for arthritis, there could be some pros and some cons. We all assume that you hear the word supplementation, and that it's something beneficial. Can you kind of discuss what some of the pros and cons are? Are there any risks involved with taking supplements?

 

Dr. D'Adamo:

The pros are that there are many supplements out there that have been shown to reduce the pain and stiffness, and even sometimes improve the structure, you know, under X-ray. And so, on the joint space narrowing of osteoarthritis and rheumatoid arthritis, there's some good evidence that they can be helpful with that. And they typically don't have many side effects.

 

Now, that doesn't mean that there aren't interactions with other products or medications and so on. But the good news is that some of them do work quite well. The bad news would be they're typically safe, but many are not going to be efficacious if it's a poor-quality brand that just entered the market and doesn't have much as far as quality control and research and other supportive aspects like that.

 

And then there's even some products that can be tainted with pharmaceuticals, or have other products that you don't want in it. Now, that's not real common with joint health. That would be more common in things like weight loss, bodybuilding or sexual function types of things. They tend to have a lot of those adulterated ingredients. Joint health dietary supplements don't typically have that as much.

 

Jamie Nicole:

That leads right into the next question. As someone who does her research on supplements and is very interested in it, sometimes I go to the store… And it didn't used to be like this, but you have a wall of different supplement. Also online, there's been talk of making sure that you get the right brand and like you just mentioned, not all of them are the best. So, what should we look for when we're going to buy supplements? Is there something on the markings on the bottle, a certain brand that we should be looking for that will let us know that one is better than the other?

 

Dr. D'Adamo:

It's a tough question. A couple of things you could look for. One is… Most are safe, but they're not always going to be effective because they may not have what they say they have on the label. So, it may say it has X number of milligrams of something, but it really only has Y, or it might not have any at all. We have seen that. Sometimes, products will have third-party lab testing to ensure that what they say on the label is actually in the bottle. So, that would be one good thing to look for. And there's different labs that do that. Another would be: Is it used in actual clinical research? Not many of them have that, but some do.

 

And then, I think, just having that brand that's established, has been on the market for a while. You get a lot of new brands that pop up out of nowhere, and often sold exclusively online and so on. You may not be getting very much from that, but there's some good resources we can talk about. Like, labdoor.com is a free resource where you can put the supplements you're taking and see: Is what's on the label actually in the bottle? And they've done that for off-the-shelf types of things.

 

There's consumerlab.com. That one requires a membership, but there are some of these resources that will help you have assurance that you're actually getting what you pay for. And you're putting in your body what you want to put in your body.

 

Jamie Nicole:

That is some good information. I had to write that down. I wish I had known that a couple of weeks ago, just on this topic. My knee went out, so I was looking for a different supplement, and so I made a spreadsheet. Had I known about these websites, that would've been a lot more helpful.

 

Now I want to dive a little bit into supplements specifically for arthritis. Can you explain which supplements might be beneficial for arthritis, and particularly osteoarthritis, and how do they help?

 

Dr. D'Adamo:

I will list three and then go into detail with those. Probably the one that has the most research data and the longest history of use with success would be glucosamine chondroitin, I'd say would be number one. Number two would probably be curcumin, which works quite differently. And then I'd say number three would probably be one called SAMe. And they all work a little bit different. And there's some other ones, too. Maybe I'll give you five, how about that? Because they all work a little bit differently.

 

Boswellia serrata would be a fourth that tends to work well for osteoarthritis. And then ginger would be a fifth. So, five that have good research data behind them. Six would be collagen. So… (laughs) And because they all work a little bit differently. You don't necessarily need to take all of these. You know, collagen, I must view that kind of more as a food because it's a powder that you will often put in with food or just put in with water and drink it. But each of those work a little bit differently. And I can give you some high-level descriptions of how they work and and some of the studies on them if you like.

 

Jamie Nicole:

Sure.

 

Dr. D'Adamo:

Glucosamine chondroitin's the one that's been around the longest that has the most studies behind it. In fact, in the past year, there have been a couple of systematic reviews and meta-analyses, which just mean that they look at all the studies that have been done together in one study that have found that it's helpful for osteoarthritis of the knee, but also of the temporomandibular joint; we don't think about that as much, but that's another problem for a lot of people. So, TMJ…

 

And this one works a couple of different ways, essentially lubricating joints in a way. We're not too into the depths of the details of that, but reducing inflammation, which is a common one across both osteoarthritis and rheumatoid arthritis. Potentially even helping rebuild, at least protect, cartilage. So, many, many studies have been done over decades now that show that glucosamine chondroitin can be helpful.

 

You typically need to take it for a while. Unlike taking an NSAID or acetaminophen, where you'll get relief quite quickly, you may need to take it for a few weeks for it to start to really kick in. It just takes time; a few weeks, maybe even a month or so, often you will start to notice a benefit and pain reduction. I take that myself, too. I’ve put a lot of miles on my tires, so to speak. It's like a cornerstone for me. I've taken it for many years now.

 

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Jamie Nicole:

Does it matter if you purchase these supplements individually? Because now I've been seeing a lot where they've been combined.

 

Dr. D'Adamo:

Yeah.

 

Jamie Nicole:

A lot of the ones that you mentioned. Does that make a difference when you're selecting a supplement?

 

Dr. D'Adamo:

There are studies for both glucosamine individually and chondroitin individually, so there's a lot of both of those. And there seems to be some added benefit when you have the two together. So, I would personally think it's best to take the combination glucosamine and chondroitin together.

 

Jamie Nicole:

OK. Because, yeah, we've been seeing a lot more than just those two combined.

 

Dr. D'Adamo:

Oh, you mean other ingredients too? Yeah, sometimes those combinations can be useful. Like, let's say it was glucosamine chondroitin and something like… MSM might be one, that's in that SAMe — sometimes you see a combination. You want to make sure that there's enough of the ingredient in there. And then ideally there would be some research on that, too. But yeah, I think combinations can be a good idea.

 

Jamie Nicole:

That's always important information that I go back and forth on when trying to select. So, I appreciate you sharing that information. I specifically asked about osteoarthritis. Are those the same supplements that you would recommend if someone has rheumatoid arthritis or gout?

 

Dr. D'Adamo:

Rheumatoid arthritis would be a little bit different, actually. So, some of the ones they may benefit, but they haven't been studied as much. There are some that are maybe more specifically for rheumatoid arthritis, and that would be omega-3 fats would be probably on the top of that list. That would be fish oil, krill oil, those types of things. There's been a number of studies that have shown that omega-3 fats can be helpful for rheumatoid arthritis. Another would be, interestingly, it's an omega-6 six fatty acid called gamma-linolenic acid. So, that can be from, borage oil is one. Evening primrose oil would be another one. Then black current oil.

 

Those are the ones that have been studied the most for rheumatoid arthritis specifically and can be helpful. Now, curcumin has been studied for both, too, so that would be another good one. And curcumin is a very strong anti-inflammatory, predominantly how that works. So that would be good for both conditions.

 

Jamie Nicole:

And the ones that you recommended for rheumatoid arthritis would be beneficial for any type of inflammatory arthritis?

 

Dr. D'Adamo:

They don't seem to have benefited osteoarthritis as much. The ideology of these conditions is a little bit different. I mean, they may, but the science isn't as strong. Like, the first six that I mentioned, you know, have good science for osteoarthritis and sort of mixed, you know, for rheumatoid arthritis. And then the two for rheumatoid arthritis may help a little bit for us with osteoarthritis, but seem to be more, a little bit, for rheumatoid arthritis. But the exception of curcumin has been studied for both, so…

 

Jamie Nicole:

We've talked about some of the benefits and the recommendations that you have for these different types of arthritis. Are there any supplements that people with arthritis should avoid or that may interact with medications?

 

Dr. D'Adamo:

Some can interact with medications. So, if somebody's on an anticoagulant like Coumadin, they would want to be a little bit mindful of probably the omega-3 fats, of curcumin and of ginger. Because those supplements themselves might have some anticoagulant effects. We haven't really seen that so much in the research, but it is at least something you'd want to talk with your physician about if you are taking any anticoagulant. And most of those products for that matter. Collagen, I don't think really operates so much by anti-inflammatory effects, so that would be one sort of contraindication potentially.

 

And as far as ones to avoid, I'm not real big on the weight loss supplements. I don't think that there's a lot of good evidence for them. And a lot of times, when someone has osteoarthritis, not all the time, of course, but sometimes they are advised to try to manage their weight. And that's going to be best done with nutrition and movement and sleep and stress; some other thing that matter, too, for weight. But a dietary supplement's probably not going to be the best way to lose weight, especially if you're not doing those other foundational lifestyle factors.

 

Jamie Nicole:

I want to dive a little bit into supplement effectiveness and testing. How can someone determine if a supplement is helping with their arthritis symptoms. And then how long should they expect to wait before noticing results? I know you mentioned earlier about it's about a couple of months, not right away. Could it be even longer?

 

Dr. D'Adamo:

It could be. Usually, you're going to know after a month or so, but that's actually one of the biggest distinctions, too, between a lot of the medications that work pretty fast, but a lot of times they have adverse event profiles. Whether it's potentially cardiovascular risks or gastrointestinal bleeding and things like that. But the challenge of the supplements, they tend to take a little bit longer. I think for pretty much all of them: It's going to be a few weeks before you see maximal benefit. One of the things that a lot of studies will do is to see, OK, someone will start taking these dietary supplements. Can we see if they can reduce their medication usage? That's actually an outcome in a lot of the studies is, all right, you know, we're going to take curcumin and can actually cut down on their NSAIDs.

 

Or they're going to take glucosamine chondroitin, whatever, and see if they can reduce the amount of NSAIDs or other medications that they have to take. NSAIDs are nonsteroidal anti-inflammatory drugs that have some issues. So, it's going to take a few weeks, maybe a month. I'd say after a couple of months, if it's not working, it's probably not going to work for the most part. Unless you're like in a research study, it's usually just going to be how are you feeling.

 

If you're in a research study, they'll actually measure through X-ray the joint space in your joints and if it’s not narrowing as much; you don't want it to narrow. But usually, it's going to be: How are you feeling? Are you feeling better? And that's measured by pain, stiffness, function, those kinds of things that are quite common with arthritis.

 

Jamie Nicole:

Should people with arthritis get tested for nutrient deficiencies before starting supplementation? And if so, how often should they get tested?

 

Dr. D'Adamo:

That's a great question for a lot of supplements. I don't know that it matters quite as much for arthritis supplements as it would like, if someone was going to take a nutrient like, let's say, vitamin D or magnesium. If you're taking that nutrient, you're going to know what your levels are before you start and after you start. That would be ideal. Even for vitamin D and magnesium, they're generally pretty safe. Do you really need to do that? Not necessarily, but it would be a good way to know: Are you likely to benefit? Is this something that… Do you have an issue with iron? If someone's on like a plant-based diet, they might not have enough B12. So, they would want to get that assessed.

 

But for joints, there aren't really great tests for that. In terms of, like, before and after, you can maybe measure inflammation. There are finger stick tests you can do where you do a little stick on your finger and put it on a piece of paper. And you can mail that in to measure Omega-3s, which might be interesting for people to know before they take an Omega-3. And of course, if you're eating cold water fish, you might be pretty good with eating salmon, that kind of stuff; it might be pretty good. I'd say, for the most part, it may not be as necessary for joint supplements as it might be for some other types.

 

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Jamie Nicole:

One of the things that comes to mind with me, as I was going through this journey… The same time every year I would have issues with my back where it would go out. And long story short, over time, finally connected the fact that I was low in vitamin D every winter because I wasn't going outside as much. And then also, you know, I have melanated skin, so…

 

Dr. D'Adamo:

Yeah.

 

Jamie Nicole:

...the absorption of vitamin D. So, to your point of making sure you pay attention to your body's cues. Over the years I learned to do that, and so I would go get tested to make sure that it was sufficient before I got to that point.

 

Dr. D'Adamo:

That's a great idea. Yeah. And that's typically when it happens. I mean, you mentioned some of the risk factors. Older age would be another one. Those that are just… really avoid the sun, too… depends on where you live, too. I mean, if you're north of like, I think it's from the 37th parallel, it's probably Atlanta, Jacksonville, something around there. If you're north of that, then you're not going to be able to get much vitamin D during the winter, you know, fall and winter. So, it's very common for people to run low on that. So, yeah. I think vitamin D's a great supplement to take for a lot of reasons.

 

Jamie Nicole:

But then also, too, I was taking it, and then it was too high on the other end.

 

Dr. D'Adamo:

That's a good point, too. Yeah. You can get too much of a good thing, you know, with all these things, so... (laughs)

 

Jamie Nicole:

Exactly. There's been a lot of talk about CBD for pain relief and inflammation management. Can you share your thoughts on whether CBD might be beneficial for people with arthritis? And if so, how should it be used?

 

Dr. D'Adamo:

It's been an area where there's been a lot of hype in recent years. And there's been some science on it, too. So, I think it can be helpful potentially for people with arthritis. In fact, I was involved in a clinical trial where we looked at full spectrum hemp, so it had some THC as well, but it had CBD and some other botanicals that were in it. And it was able to reduce pain. So, I think it can be helpful.

 

I wouldn't say it's maybe quite at the level of the other ones in terms of the amount of science that there is for the other ones and the track record of use over many, many years. But it's one to think about adding to the potential arsenal. It can also help people with sleep. A lot of times, poor sleep travels with arthritis pain. Because you're uncomfortable, it's hard to sleep.

 

Jamie Nicole:

I know personally that it can, arthritis can impact my sleep, my pain levels at night, especially from being stiff early in the morning. Impact your fatigue, your energy levels, which also makes it harder to manage weight. I know you don't believe in weight loss supplements, but the excess weight can impact your joints and all of those other symptoms that I mentioned. Are there any other supplements that you can recommend to help improve the quality of sleep, boost energy and support weight management?

 

Dr. D'Adamo:

I'd say melatonin is probably the most well established one with that. And if someone's going to take that, it's interesting: Our body produces like micrograms, so we produce small amounts of melatonin. We produce less as we get older. And then we also, in this environment we live in, where we have bright lights on in our house at night, that suppresses it.

 

So, you may have seen people wearing the kind of nerdy orange or red glasses, which I myself wear in the evening because that will help block blue light. I don't mean necessarily the color blue, it could be like your typical bright light bulbs have a lot of blue light in it. It keeps you alert during the day, but in the evening it's going to keep you alert when you should be trying to sleep. Taking melatonin is not a substitute for being aware of light hygiene at night, but it can help you get the melatonin that you need to sleep better. So, that would be one that's been quite time tested.

 

Chamomile would be another one. Sometimes drinking a chamomile tea. You can get chamomile in capsules, too: valerian. I'd say melatonin would probably be the main one to think about. But again, that's another one… You can take too much of a good thing. I would look at something like one to three milligrams at the most. And you can have time release ones. Some people take melatonin and they wake up at 3:00 in the morning, like, "Why am I so awake?" If you get a time release one, it administers it more slowly.

 

Jamie Nicole:

What about… I've been hearing a lot about it, and I'm sure some in the audience have as well. They even have the capsules now. I just originally saw just the juice, the tart cherry juice.

 

Dr. D'Adamo:

Oh, yeah.

 

Jamie Nicole:

We could talk about that for muscle aches and then also for helping with sleep.

 

Dr. D'Adamo:

Yeah. Tart cherry juice is, for pain, is quite a good one. I'd normally think about that as a juice, but you can actually get tart cherries. You can get, again, frozen in a lot of places, too. And they're pretty tart. (laughs)

 

Jamie Nicole:

It's surprising how some cherries can be beneficial for your joints and for sleep as well. So, it's multipurpose. I've heard that it can be used for gout as well?

 

Dr. D'Adamo:

That's right. Cherries are probably the top natural product for gout, and that includes both tart cherries, which we talked about for joint health and muscle pain and so on. But even your classic black cherries, the bing cherries, the one that you see most often at the store, can be helpful for that. Another option would be vitamin C. There have been a number of studies that taking vitamin C can help with gout. So, there are some tools in the toolbox to help gout.

 

Jamie Nicole:

So yeah, I just need to make me some tart cherry orange juice in the morning to help with that and just incorporate it into my morning breakfast to help with my joint pain. That's awesome. Thank you for that information.

 

Dr. D'Adamo:

I think they're good. A lot of people eat them. There are supplements where you can get either powders or in capsules, and that can help, too. It's not been studied as much as melatonin, but it can help increase your melatonin levels, and it can be helpful for pain, too. There's been a lot of science looking at that for muscle soreness and for around exercise and that type of thing. It's worth thinking about bringing to the mix.

 

Jamie Nicole:

Awesome. Thank you so much. I have learned a lot in this short period of time that is going to be beneficial for me, I know for sure, going forward. But before we go, I want to ask: Is there anything else that you would like to add that we have not covered already?

 

Dr. D'Adamo:

Yes, I would say that supplements can be quite helpful. But I think the cornerstone is going to be movement and a healthy nutrient-dense diet in the first place. I see your shirt, is that AIP for autoimmune and paleo? Is it something else?

 

Jamie Nicole:

Yes, I have a nonprofit for the Autoimmune Protocol, I’m a certified AIP coach, so yes.

 

Dr. D'Adamo:

Very cool. So, diets like that, you know, whole food diets, minimizing ultra-processed foods, because what that is going to do is help minimize, again, the inflammation in the body more generally. Then there's other strategies you can look at, too. Things like acupuncture maybe could be helpful for some people that are suffering from arthritis pain, you know, just movement in general. Whether it's water exercise or walking or that type of thing. To answer your question maybe more succinctly, I think just recognizing it's a whole lifestyle and helping manage the pain. The dietary supplements can be a part of that lifestyle, but it's an entire lifestyle, I think, that's going to help bring about the best results.

 

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Jamie Nicole:

We typically end the episode with our top three takeaways. So, what are your top three takeaways from this discussion on supplements for arthritis?

 

Dr. D'Adamo:

The top takeaway would be that there are a number of good supplements out there that can help, and they can help in different ways. So, I think it makes sense to consider several of them. I think glucosamine chondroitin might be the cornerstone, but getting collagen would help a little bit differently. Curcumin's going to help a little bit differently, as an NF-κB inhibitor's going to manage inflammation. Boswellia might help manage it a little bit differently. So, just think about the different pathways that these things can help.

 

Two would be: It's a whole lifestyle, so you wouldn't want to neglect the movement and, you know, eating real whole foods and just doing the supplements, because that's going to be a big part of it. Three, I guess, would be that people have more power in this than they may often think. They're going to be subjected to the pain and only medication can help. There are other things that can help, too. It could be a journey. Sometimes it might take some time to figure it out and manage it. But to keep striving and trying some of these other things that are out there.

 

Jamie Nicole:

You are absolutely right about it being a journey. It has been one for me as well, and I'm constantly learning day by day. So, thank you again. I'll just share my three takeaways. The first one was research, making sure that you are doing your due diligence in making sure that you're finding supplements that are right for you, number one. That have quality ingredients and they're going to be useful and impactful. And not just buying something off the shelf that's not going to work. And so, you gave the consumerlabs.com and then also labdoor.com, which are websites that people can use to do that research.

 

Also listening to your body. It is not always a lab test that's going to tell you what you need. Sometimes it's just tingling fingers, tingling feet, that can tell you that you need a supplement. So, make sure that you're listening to your body. And then also to reiterate what you said as well: I am completely 100% into integrative medicine, a holistic lifestyle. And it is something that is coming to the forefront more than it used to in the past. And just from experience, from seeing others, I know how beneficial it is. Just reiterating those points that you made throughout the podcast on that: that it really is about not just supplements or medication — they're useful tools — but it really is about making sure that you have a holistic lifestyle, holistic and life modifications.

 

Dr. D'Adamo:

Right on. Well said. (laughter)

 

Jamie Nicole:

Thank you so much, Dr. D'Adamo. It's been a pleasure speaking with you today. And that concludes this podcast, and I hope you have a great rest of your day.

 

Dr. D'Adamo:

My pleasure.

 

PODCAST CLOSING:

The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation. Gifts from people like you make our podcast and other life-changing resources possible. You can donate at arthritis.org/donate. This podcast aims to help people living with arthritis and chronic pain live their best life. For a transcript and show notes, go to arthritis.org/podcast. Subscribe, rate and review us wherever you get your podcasts. If you subscribe through Spotify, leave a comment on their platform, letting us know what you think about this episode. And stay in touch!