Just like age, osteoarthritis can creep up on you. It starts out quietly, with some occasional stiffness. Later, you may begin to feel some occasional joint pain. Human nature tells you to ignore it, but maybe you shouldn’t. If you try some alternative therapies, you may be able to slow the disease before it does too much damage.
What’s going on is ordinary wear and tear for the most part. Take a look at the tread on a pair of tires after you’ve racked up about 50,000 miles. The tires are worn, their surfaces uneven. The steel belts may even be peeking through in places.
Inside your body, it’s the smooth, rubbery cushioning called cartilage that starts to erode. The gliding surface that normally acts as a shock absorber between your bones can become compressed and irregular. As the underlying cartilage and bone disintegrate, painful bone spurs can form in the joint. Ordinary movements can produce a grinding symphony of creaks and crackles.
While no one really knows what makes cartilage break down, heavy use of the joint seems to be a contributing factor. That’s why osteoarthritis typically strikes the fingers, back, hips, or knees. Moreover, a joint injured in the past tends to develop arthritis sooner than one that’s led a relatively pampered existence.
Scientists suspect that the damage from osteoarthritis may be due to an imbalance of enzymes in the joints. The right balance of enzymes allows for the natural breakdown and regeneration of cartilage. Too many enzymes, however, can cause the joint cartilage to break down faster than it can be rebuilt.
Among most people over age 60, signs of osteoarthritis show up in x-rays. But only about a third show any of the typical symptoms of pain, stiffness, limited range of motion, or inflammation. That’s one of the puzzling things about osteoarthritis. There doesn’t seem to be a relationship between the amount of pain and the degree of joint damage. Some people never have more than a mild ache. Others develop crippling pain.
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Molecules on the Bestseller List
Glucosamine is a word that’s pasted together from two other words that may be familiar from biology or chemistry—glucose and amine. Glucose is just blood sugar, the energizing “food” that your body uses in its cells. As for amine—well, it’s not an everyday word, but in chemistry it means that nitrogen and hydrogen are glued together in the same molecule. Put it all together, and you have a word that describes a simple molecule, one that combines the stuff of blood sugar, nitrogen, and hydrogen.
Despite its simple components, this molecule is a complex contributor to your body’s health, especially joint health. That’s where the osteoarthritis connection comes in. One theory holds that osteoarthritis results from the body’s inability as we age to make enough glycosaminoglycans, the major molecules that give cartilage its ability to bear weight, notes Amal Das, M.D., an orthopedic surgeon at Hendersonville Orthopedic Associates in North Carolina. “Your body has a hard time making glucosamine,” says Dr. Das. “It would be a lot easier if your body could get that glucosamine somewhere else—say, in a supplement.”
The second substance that may play a role, chondroitin sulfate, is actually built up from glucosamine. “If glucosamine is the two-by-four used to build a house of cartilage, then chondroitin sulfate is an entire wall,” says Dr. Das.
Chondroitin sulfate is a long chain of glucosamine molecules. According to Dr. Das, it helps promote water retention in the cartilage, which is necessary for shock absorption. There’s a big difference in the way your body absorbs chondroitin sulfate, however. Studies show that if you take a supplement of chondroitin, your body absorbs less than 8 percent of it. By comparison, you absorb about 90 percent of glucosamine sulfate from a pill or capsule.
Although we produce our own supplies of glucosamine and chondroitin sulfate, our aging bodies can always use some help from supplements, says Dr. Das. The glucosamine in supplements comes from chitin, a compound that forms crab shells. Chondroitin sulfate is found in cartilage. Although cow cartilage is usually the source, it doesn’t matter what animal the cartilage is from.
Apart from their absorption rates, another difference between glucosamine and chondroitin sulfate may lie in how they go about the business of saving cartilage from destruction. Whereas glucosamine may help with the rebuilding of cartilage to keep up with its breakdown, chondroitin may actually decrease the breakdown, says Dr. Das. |
Still, arthritis is the leading cause of disability among Americans over age 15. Osteoarthritis, the most common form, affects 20.7 million people. While there aren’t any miracle cures, there’s a lot you can do to minimize the damage.
The Basics of Care
First, maintain a healthy weight, doctors suggest, since people with osteoarthritis are more likely to be overweight. Research shows that losing weight can significantly reduce the risk of developing it. In a large study done in Framingham, Massachusetts, women who lost an average of 11 pounds were much less likely to get arthritis of the knee over the next 10 years than women who didn’t shed the pounds.
Exercise is another essential. Low-impact activities like brisk walking, swimming, and biking are best at strengthening muscles and are easy on your joints. Stronger muscles help protect the joints by providing support and added stability.
Exercise also helps the joints absorb fluid and needed nutrients. Unlike muscle or bone, cartilage doesn’t get its nutrients from blood. It soaks them up like a sponge from the fluid surrounding the joint. The more you exercise, the more you force fluid in and out of the joint.
Aspirin and other similar drugs called nonsteroidal anti-inflammatory drugs (NSAIDs) focus on nursing arthritis pain, but that pain relief isn’t in your long-term interest, according to doctors. While NSAIDs are easing the pain, they can actually speed up joint deterioration. Natural measures attempt to slow the progression of the disease and preserve cartilage and bone by providing the proper nutrients in the right amounts.
A Steady Supply of Building Materials
One of the arthritis treatments that has hit the spotlight is the supplement combo glucosamine and chondroitin, two substances that your body makes to help build and protect cartilage. In studies, these supplements do appear to slow the progression of the disease and help to relieve pain. But researchers haven’t found evidence that they rebuild lost cartilage.
Remember that worn tire? The way that glucosamine and chondroitin work is similar to pumping air into a punctured tire. If you can pump air into the tire as quickly as it leaks out, you can keep it from going flat, says Amal Das, M.D. an orthopedic surgeon with Hendersonville Orthopedic Associates in North Carolina.
When taken together, glucosamine and chondroitin seem to slow the loss of cartilage from the joint by pumping more cartilage-generating nutrients into the body, says Dr. Das. They don’t fix the hole in the tire, however, and they don’t work if the tire is already flat—that is, if there’s no cartilage left in the joint.
In a study conducted by Dr. Das, people with osteoarthritis were given two tablets containing 500 milligrams of glucosamine hydrochloride and 400 milligrams of chondroitin sulfate in the morning and evening. For people with mild to moderate arthritis, the supplements decreased pain and allowed them to decrease the amount of anti-inflammatory medication they used. They did not help people who already had severe arthritis in a joint—that is, bone rubbing on bone.
Scientists believe that glucosamine somehow stimulates the cartilage cells to produce two important compounds that are the building blocks of cartilage. Once you have taken it for eight weeks, the supplement seems to provide pain relief comparable to that of ibuprofen, but without side effects.
In a study done in Europe, 200 people with active osteoarthritis of the knee took either 400 milligrams of ibuprofen or 500 milligrams of glucosamine sulfate twice a day. Although the people in the ibuprofen group got immediate pain relief, 35 percent of them experienced adverse reactions such as upset stomachs. Glucosamine took a little longer to work—about two weeks—but none of the group reported any side effects.
While the research seems to paint a clear picture of the role of glucosamine supplements, the image is still fuzzy when it comes to chondroitin, says Lauri Aesoph, N.D., a health-care consultant in Sioux Falls, South Dakota, and author of How to Eat Away Arthritis. Glucosamine is a small molecule that is readily absorbed. Chondroitin is huge by comparison. Ranging from 50 to 300 times larger, it is unable to pass through the intestinal wall intact. Thus, the question arises: If it’s that much harder to absorb, why should you take it?
Apparently, they seem to make a good team. Although researchers aren’t sure, the two supplements seem to work best together, says Dr. Das. "Chondroitin inhibits the enzyme that breaks down cartilage. We’re really excited about it, because it may be the first disease-modifying agent for arthritis. It’s the first medicine to give us hope."
Two to the Rescue
Because the pair works best by preserving the cartilage you have left, don’t wait until you’re in agonizing pain to start on a supplement program, advises Dr. Das. If you’ve been diagnosed with arthritis, get your doctor’s approval first, then take 500 milligrams of glucosamine and 400 milligrams of chondroitin sulfate twice a day, says Dr. Das. From the time you start the double dose, allow from two weeks to four months to let the supplements do their work. You can continue to take them indefinitely.
Although the patients in Dr. Das’s study took glucosamine hydrochloride, many naturopathic physicians typically recommend taking glucosamine sulfate because it is the type that has been tested most thoroughly in clinical trials.
You might see a third form of glucosamine on store shelves called N-acetylglucosamine, commonly referred to as NAG. While the label may state that NAG is better-utilized and therefore more effective than glucosamine sulfate, research has not yet been conducted that would prove or disprove that claim, says Dr. Aesoph.
"The big argument now is what form to use," she explains. "We need studies where these different forms are compared head-to-head." In the meantime, glucosamine sulfate is the supplement of choice. "The bulk of the research is on glucosamine sulfate," says Dr. Aesoph, "so we know that works."
Antioxidant Relief
Antioxidants—especially vitamin C, vitamin E, and beta-carotene—are another means of preventing your cartilage from wearing away.
"Arthritis is known to increase free radical production, so your need for antioxidant nutrients increases," says Dr. Aesoph. Those free radicals are free-roaming, unstable molecules that can set off a chain reaction in the body, aging cells prematurely and sometimes harming the genetic material. While the healing powers of antioxidants may seem somewhat mysterious, the process is crucial when it comes to protecting your joints.
If you have arthritis, antioxidants can protect joints from damage caused by oxidative stress, a process that speeds up cartilage breakdown. Joints damaged by osteoarthritis release the unstable free radical molecules that are missing an electron. Like scavengers, these highly reactive compounds look for a place from which to snatch an electron in order to stabilize themselves. They usually attack the nearest healthy molecule, which then becomes a free radical itself.
Antioxidants help break this chain reaction and stop cell damage by offering up their own extra electrons. No one is sure exactly how this process occurs in the joints, but research has shown that diets high in antioxidants help reduce pain and cartilage deterioration.
Three Protectors
Researchers in the Framingham osteoarthritis study evaluated the diets of 640 people to see if there was a link between their osteoarthritis and their intake of vitamins C and E and beta-carotene, the highly pigmented component that is converted to vitamin A in the body. The results showed that the trio of antioxidant nutrients won’t prevent you from getting osteoarthritis, but it may keep it from getting worse.
After reviewing knee x-rays of the participants over a 10-year period, researchers concluded that people who had the most vitamin C in their diets were three times less likely to experience progressive deterioration of the joint. They also were less likely to develop knee pain. Vitamin E and beta-carotene also helped ailing joints stay healthier.
The benefits of vitamins C and E extend beyond their antioxidant properties. Together, they enhance the stability of components called proteoglycans that help to protect your cartilage, according to Jody Noé, N.D., a naturopathic doctor at the Brattleboro Naturopathic Clinic in Vermont. Vitamin C helps to form the structural protein known as collagen, the single most important protein in connective tissues.
To protect your cartilage and quell those aches and pains, take 1,000 milligrams of buffered vitamin C three times a day, says Ruth Bar-Shalom, a naturopathic doctor in Fairbanks, Alaska.
Studies show that vitamin E offers relief from inflammation. In research conducted by German scientists, people with osteoarthritis who took 600 international units (IU) of vitamin E every day for six weeks had significantly less pain. They also had better range of movement and were able to take fewer pain relievers. To get these benefits, include 600 IU of vitamin E and 10,000 IU of beta-carotene in your daily antioxidant regimen, says Dr. Bar-Shalom.
Crucial Cartilage Nutrients
If you’re not getting the right nutrients, your body cannot make and maintain cartilage. In addition to antioxidants, four key players in the production process are pantothenic acid, zinc, copper, and vitamin D. A deficiency of any one of these can cause accelerated joint degeneration, says Dr. Bar-Shalom.
Although many mainstream doctors view osteoarthritis as an inevitable part of growing older, naturopathic doctors contend that it is a metabolic disorder brought on by the body’s inability to regenerate bone and cartilage. Taking a holistic approach to treating arthritis, a naturopathic doctor looks at imbalances that may be occurring in the whole body, then attempts to correct those imbalances. Among the factors that play a part are diet, exercise, and regular bowel movements to eliminate inflammation-producing toxins from the body.
"Permanent relief will always require lifestyle changes," says Dr. Bar-Shalom. "Just taking natural pills will not make someone healthy. It’s the same as going into a really dirty house and just hanging a few pictures to try to make it look better. You’ve got to clean house."
Dr. Bar-Shalom customizes the diet plan for each of her patients, but in general, she suggests starting with a low-fat diet that is high in fiber and complex carbohydrates and drinking at least eight full eight-ounce glasses of water a day. Then you’re ready to supplement a healthy diet with other crucial cartilage nutrients.
Pantothenic acid is one of those nutrients, according to Dr. Bar-Shalom. Without pantothenic acid, cartilage can’t grow. Studies have found that supplements of this B vitamin relieved arthritis symptoms, and research with animals has shown that if animals have a profound deficiency of pantothenic acid, their cartilage will stop growing.
Pantothenic acid is found in foods such as whole grains, legumes, fish, and poultry. The Daily Value is 10 milligrams, but Dr. Bar-Shalom recommends 12.5 milligrams of pantothenic acid plus 50 milligrams of vita min B6 daily to encourage your body’s ability to regenerate cartilage as it’s being lost.
Add Zinc and D
Zinc is another of the body’s much-needed resources. While virtually all cells contain zinc, some of the highest concentrations are in bone. If you have a deficiency, your body’s ability to make collagen—the "glue" for your connective tissues—is seriously impaired.
To promote tissue repair, Dr. Bar-Shalom recommends a daily dose of 45 milligrams of zinc. Doses above 20 milligrams must be taken under medical supervision. When zinc intake is high, it can interfere with your absorption of copper, so Dr. Bar-Shalom adds 1 milligram of copper to the daily supplement regimen.
Underneath degenerating cartilage, bone also deteriorates. Vitamin D, a necessary nutrient for absorption of calcium, can help preserve bone and slow the loss of cartilage, says Dr. Aesoph.
In the Framingham research, doctors also examined the influence of vitamin D levels on osteoarthritis. They found that people who had low levels of vitamin D were three to four times more likely to experience progressive joint damage. You can get vitamin D from exposure to sunlight or from fortified milk. If you’re over 50 or have osteoarthritis, you should supplement with 400 IU of vitamin D daily.
Turn Off Inflammation
The word arthritis, derived from Greek, literally means "inflammation of the joint." While this definition certainly applies to another kind of arthritis—rheumatoid arthritis—the term is somewhat contradictory in referring to osteoarthritis. People with osteoarthritis generally have very little inflammation.
Nevertheless, doctors do recommend anti-inflammatory medicines such as aspirin and ibuprofen for pain relief. Are they effective?
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A Devilish Pain Reliever
Devil’s claw gets its odd name from the woody fruits of the plant, which look like a clawlike hand. The active substance, a compound called harpagoside, is found in the tuberous roots. The bitter compound is used primarily by herbalists as an appetite stimulant and as a supplemental treatment for arthritis and rheumatism.
The plant grows in the savannas of southern Africa, where it is used in traditional folk medicine to treat indigestion and fevers and as a laxative. Externally, devil’s claw is used to help heal sores, boils, and other skin lesions.
The herbal drug was introduced in Europe in 1953, where it has been used to treat a wide variety of conditions, including diseases of the liver, kidneys, and bladder; headache; allergies; and digestive disorders.
Extracts of the root are available in supplement form as capsules, tablets, tinctures, and ointments. |
While they do relieve pain, these over-the-counter drugs, along with many prescription-strength pain relievers, take a toll on your body, says Dr. Aesoph. Their long-term use has been associated with ulcers and gastrointestinal bleeding.
"The side effect that is often overlooked is that they prevent cartilage repair," says Dr. Noé. Those pain relievers actually interfere with the way the body creates new tissue around the joints, she notes. They actually accelerate the destruction of cartilage.
Given those side effects, it certainly makes sense to look for an alternative way to stop pain and inflammation. For drug-free relief, take one tablespoon of flaxseed oil and 500 milligrams of black currant oil (or three capsules of evening primrose oil) every day, says David Perlmutter, M.D., a neurologist in Naples, Florida, and author of Lifeguide.
Studies show that these two supplements switch on your body’s natural inflammation-fighting powers. Rich in omega-3 and omega-6 essential fatty acids, they also generate some hormonelike substances that have a beneficial effect.
"The entire process of turning inflammation on and off is controlled by a group of hormones called prostaglandins," says Dr. Perlmutter. "Basically, there are two groups of prostaglandins. One group starts inflammation, and one group reduces the inflammation." By adding the right essential fatty acids to your diet, you can stimulate your body to produce increased levels of good prostaglandins and reduce inflammation, he says.
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Soothe with Yucca
Natives of the desert, yucca plants now dot the landscape of thousands of suburban lawns in the southwestern part of the United States. Clusters of spiny, swordlike leaves stick up from the manicured green lawns like the quills on a porcupine’s back—and they can hurt just as much.
Before it became an ornamental cactus, yucca was used for centuries by the native people of North and South America to treat everything from hair loss to constipation. For those who had to contend with the limited vegetation resources of the desert, yucca provided valuable raw materials for basic household necessities like baskets, paint brushes, and soap. It was also a rich source of herbal remedies.
For birth control, Navajo women drank suds from the rotten root. The water-filled leaves from the plant were used for their laxative and sedative effects. Several tribes used the crushed root to make a shampoo to cure baldness.
Modern herbalists use yucca root primarily as an anti-inflammatory to treat arthritis. The plant contains large quantities of saponins, bitter substances that are known for their ability to foam when mixed with water. In animal studies, saponins have demonstrated an ability to reduce inflammation.
Yucca root is available in 500-milligram capsules or as a liquid. |
Gentle Pain Relief
Supplementing with the herb devil’s claw can sometimes relieve joint pain, says Dr. Bar-Shalom. Studies have shown that this herb provides some relief from pain and inflammation.
In a German study of 54 people with chronic back pain, 9 became completely pain-free after taking 800 milligrams of extract three times a day for one month. In a comparable group that didn’t take the extract, just 1 person showed the same recovery. The study suggests that devil’s claw may work when traditional pain relievers fail. Most of the people had experienced back pain for 15 years even while taking conventional painkillers.
The active substance at work is harpagoside, a compound found in the tuberous roots of the plant. It reduces inflammation in the joints and helps stimulate cortisol, your body’s natural version of pain-relieving cortisone. A sensible dose to start with is 400 milligrams of dry standardized extract three times a day, says Dr. Noé. Do not use devil’s claw, however, if you have gastric or duodenal ulcers.
Although better known for its power to defuse migraines, feverfew also inhibits an enzyme that causes inflammation, says Betzy Bancroft, a professional member of the American Herbalists Guild in Washington, New Jersey.
To control joint pain, take 125 milligrams of standardized extract containing at least 0.2 percent parthenolide or one to three milliliters of tincture daily, says Dr. Noé.
Maybe It’s All in Your Gut
Yucca, an herb with more than 40 species, is recommended for relief of joint pain, by Jill Stansbury, N.D., assistant professor of botanical medicine and chair of the botanical medicine department at the National College of Naturopathic Medicine in Portland, Oregon.
In treating arthritis, herbalists believe that yucca works best when it is used with other herbs that fight inflammation, such as ginger, turmeric, devil’s claw, angelica, and willow bark.
Another theory is that the plant eases arthritis pain by reducing the absorption of wastes produced by bacteria in the intestine. "We think that arthritis might have its roots in the digestive process," says Dr. Stansbury.
A link between the gut and sore joints may sound far-fetched, but an animal study has shown that an accumulation of bacterial wastes in the intestine can impair cartilage growth. When your food is not broken down properly during digestion, undesirable bacteria can multiply rapidly and produce toxic substances called endotoxins. If absorbed through the walls of the intestine, these toxins can travel through your body and inflame the connective tissue, says Dr. Stansbury.
Naturopathic physicians believe that yucca may decrease absorption of endotoxins in the intestine. It works very gradually, however, and sometimes takes up to three months before providing signs of improvement, says Dr. Stansbury.
Yucca may be difficult to find in your local health food store. You’re more likely to find it as part of an herbal arthritis formula. Dosage recommendations on the package tend to be on the low side, says Dr. Stansbury. If the formula gives a dosage range such as ½ to 1 teaspoon of liquid two to five times a day or one or two capsules two to four times a day, she recommends aiming for the high end.
Try Niacinamide—With Caution
Since the 1940s, some doctors have recommended niacinamide, a form of niacin, to treat osteoarthritis. There is growing evidence that large doses of this B-complex vitamin can improve joint flexibility and reduce inflammation.
A study of 72 people with osteoarthritis at DeWitt Army Community Hospital in Fort Belvoir, Virginia, confirmed what early research showed. After 12 weeks, symptoms improved in the group that took 500 milligrams of niacinamide six times a day. They were also able to reduce the amount of pain medication that they were taking.
The niacinamide form of the vitamin is used because it produces fewer side effects, such as the uncomfortable flushing and rash associated with niacin. How it works is still uncertain. Doctors and researchers think that large amounts of extra niacinamide somehow improve the ability of the cartilage to repair itself.
Before you stock up on this supplement, check with your doctor. The 3,000-milligram daily dose used in the study is 150 times the Daily Value of 20 milligrams. "At high doses there is a significant risk for liver damage," says Dr. Noé. "You need to be monitored by a health-care professional when you’re taking high-range doses."
Anyone taking more than 1,500 milligrams of niacinamide a day should have a blood test for liver enzymes after three months of treatment, Dr. Noé advises. If the levels are elevated, the dosage will have to be reduced. Nausea is an early warning sign of stress on the liver.