Natural herb for arthritis

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Rheumatoid Arthritis

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Rheumatoid arthritis is a much rarer disease than osteoarthritis, occurring in only one percent of the population. It is an auto-immune disease – a disease process where tissues that surround and cushion the joints are attacked by the body’s own immune system. As a result, the cartilage, bone and ligaments around the joint begin to deteriorate and form scar tissue. A healthy joint is surrounded by a joint capsule, which contains synovial fluid – a clear liquid that helps lubricate and nourish the cartilage and bone within the capsule. The synovium is the tissue that lines the joint capsule. In rheumatoid arthritis, the cells in the immune system attack the synovium, causing inflammation, redness, swelling and pain. As the disease progresses, the cells invade and destroy the surrounding cartilage and bone, weakening the muscles, tendons and ligaments that help support and stabilize the joint, causing pain, swelling, stiffness and a loss of function.

Rheumatoid arthritis affects the whole body, not just isolated joints. Women are affected almost three times as often as men. Rheumatoid arthritis typically occurs between the ages of 25 and 50, but it can strike at any age. Many people are able to control their symptoms with medications, but for some, the disease can be quite debilitating.

Causes and Symptoms

It is not clear why rheumatoid arthritis develops, but researchers believe genetics could play a role. It is often difficult to diagnose in its early stages. During a physical exam, doctors will look for inflammation in the joints, and observe muscle strength and reflexes. There is also a blood test that can check for the presence of rheumatoid factor, an antibody that is found in the bloodstream of people with rheumatoid arthritis. However, this test is not always accurate, particularly in the early stages of the disease. Another blood test, the erythrocyte sedimentation test is used to determine the extent of inflammation in the body. X-rays are frequently utilized to detect joint damage, although this is usually used in more advanced stages to monitor the disease.

Symptoms include:

  • Swollen, warm, painful joints, particularly after awakening or after long periods of inactivity.
  • Fatigue, occasional fever.
  • Inflammation occurring in a symmetrical pattern – if one wrist is involved the other will be also.
  • Typically, the small joints in the hands, fingers, feet, toes, wrists, elbows and ankles will be affected first.
  • Other affected joints may include the knees, shoulders and hips.
  • Some may develop hard bumps (nodules) under the skin near the affected areas.
  • As the disease progresses, the joints will become deformed and may freeze in one position, making it difficult to move them.

The symptoms vary quite a bit from person to person. Some may have symptoms that last only a few months and then disappear; others may have a moderate form of rheumatoid arthritis where symptoms come and go. Finally, there are those who develop a severe form of the disease where it is active most of the time, and eventually leads to joint damage and debilitation.

Suggested Lifestyle Changes

Lifestyle changes can moderate autoimmunity, and other strategies can help you control the symptoms of rheumatoid arthritis. Try the following recommendations:

  • Get regular aerobic exercise (swimming is best for those with rheumatoid arthritis).
  • Practice relaxation techniques. In addition, visualization can help moderate autoimmune responses and psychotherapy can help you change emotional states that keep the immune system off balance.
  • Try hypnotherapy or guided imagery. Look for a therapist willing to take on an autoimmune disease. Meditation and yoga can help, too.
  • Avoid health-care practitioners who make you feel pessimistic about your condition.
  • Eliminate or reduce intake of coffee and tobacco as both have been linked to an increased risk for rheumatoid arthritis.
  • Practice keeping a journal of your daily emotions, experiences and symptoms. This very simple activity has proven benefits for those with rheumatoid arthritis.

Nutrition and Supplements

  • Follow a low protein, high carbohydrate diet; minimize consumption of foods of animal origin.
  • Eliminate milk and milk products, including commercial foods made with milk.
  • Avoid all polyunsaturated vegetable oils, margarine, vegetable shortening and products made with partially hydrogenated oils of any kind.
  • Increase intake of omega-3 fatty acids by eating more cold-water fish, walnuts or freshly ground flaxseeds. You may also want to consider taking a fish oil supplement to help keep your protein intake low.

Try changing your diet in the following way. One at a time, eliminate the following categories of food for two months:

  • All sugar except natural fruits
  • All citrus fruits
  • Wheat, corn and soy

At the end of each trial period, restore the eliminated items to your diet. You may find that one or more has an influence on your arthritis symptoms. The following supplements and medications help alleviate pain associated with rheumatoid arthritis:

  • For symptomatic treatment use aspirin and other over-the-counter anti–inflammatory drugs.
  • Take feverfew (Tanacetum parthenium) for its anti-inflammatory effect; one to two capsules twice a day
  • Use anti-inflammatory herbs, ginger and turmeric are particularly effective. You can continue to take these herbs indefinitely.
  • Experiment with traditional Chinese medicine, Ayurvedic medicine, homeopathy, Native American medicine and healers.
  • Try long-term fasting in a facility staffed by experienced health professionals. For additional information on fasting, check out www.dmoz.org.
  • Investigate apitherapy (bee-sting treatment); a local bee keeper should be able to advise you.

Explore natural remedies for rheumatoid arthritis or view Dr. Weil’s collection of arthritis Q&As.

Beat Rheumatoid Arthritis Naturally

Rheumatoid arthritis (RA) is an autoimmune disease that primarily attacks the synovial tissues around the joints. Autoimmune diseases cause the body’s immune system to mistake its own tissues for foreign invaders, such as bacteria or viruses. The confused immune system develops antibodies to seek out and destroy the “invaders” in the synovium.

RA is a systemic disease, in that has the ability to affect the whole body. It can attack many different organs, such as the heart, the lungs, or other tissues like muscles, cartilage and ligaments. RA causes chronic swelling and pain that is sometimes severe, and it can cause permanent disability.

Rheumatoid Demographics:

RA is a common chronic disease that affects about 1% of the world population. RA occurs at twice the rate in women compared with men, with a prevalence of 1.06% in women (as a percentage of the total population) compared with 0.61% in men (1).

The incidence (new cases per year) of RA increases with increasing age in most populations until about the eighth decade of life, when it declines (2). The prevalence of RA varies widely from population to population, with the lowest rates in Asian countries and higher rates among certain Native American populations (3).

Symptoms of Rheumatoid Arthritis:

The early onset of RA typically effects the small joints such as the fingers and toes. Many just feel as though these areas are mildly warm, stiff or swollen. These symptoms are often intermittent, only flaring up for a few days at a time and most people ignore the issue for a while.

Over time, RA symptoms can get worse and cause deformity in the fingers and toes. The disease can also progress to larger joints such as the shoulders, knees and hips. RA may cause significant damage to the joints within 2 years of onset.

Other symptoms associated with RA include:

  • Fatigue
  • Low-grade fevers
  • Pain and stiffness for longer than 30 minutes in the morning or after sitting
  • Anemia
  • Weight loss

RA also has been shown to significantly increase the risk of heart attack and stroke because it can damage the protective sheath around the heart called the pericardium (4).

Pathogenesis of RA:

The development of RA is based around both genetic and environmental factors that effect the major histocompatability (MHC) genes and the bodies innate immunity. Environmental factors that increase the activation of the innate immune system can disrupt immune balance and cause chronic inflammatory activity in the body (5).

The process of developing RA can take many years. One key factor is the induction of the peptidyl arginine deiminase (PAD) enzymes, which convert arginine to citrulline. Increased citrullination is not specific to RA and occurs regularly with any environmental stress, including in lung alveolar macrophages in cigarette smokers (6).

What is unique to RA is the propensity for immune reactivity to the neoepitopes created by protein citrullination with the production of anti-citrullinated protein antibodies (ACPAs) (7, 8). In “pre-RA,” ACPAs and autoantibodies like rheumatoid factors (RFs) can appear more than 10 years before clinical arthritis.

Additionally, inflammatory cytokines such as TNF-alpha, IL-6 and IL-1 are active in individuals with pre-RA and this extends into RA where these cytokines only grow in number and accelerate the inflammatory storm in the joint and organs (9).

4 Stages of Rheumatoid Arthritis:

Early stage RA (stage I) is characterized by synovitis, or an inflammation of the synovial membrane, causing swelling of involved joints and pain upon motion. During this stage, there is a high cell count in synovial fluid as immune cells migrate to the site of inflammation. However, there is generally no x-ray evidence of joint destruction, with the exception of swelling of soft tissues and possibly evidence of some bone erosion.

Stage II.

In moderate RA, stage II, there is a spread of inflammation in synovial tissue, affecting joint cavity space across joint cartilage. This inflammation will gradually result in a destruction of cartilage, accompanied by a narrowing of the joint.

Stage III.

Severe RA, stage III, is marked by formation of pannus (vascular scar tissue that extends over the surface of an organ or joint) in the synovium. Loss of joint cartilage exposes bone beneath the cartilage. These changes will become evident on x-ray, along with erosions around the margins of the joint. Joint deformities may also become evident.

Stage IV.

Stage IV is called terminal or end stage RA. The inflammatory process has subsided and formation of fibrous tissue and/or fusing of bone results in ceased joint function. This stage may be associated with formation of subcutaneous nodules.

Immune Modulation:

Chronic inflammatory disorders are characterized by a hyper responsive immune system. There are several key factors that must be addressed to regulate and better coordinate the immune system.

1. Poor Blood Sugar Stability: Blood sugar imbalances cause immune dysfunction and malcoordination. Stable blood sugar is critical for a healthy immune response.

2. Low Vitamin D Levels: Individuals with low vitamin D3 levels (below 40 ng/ml) are at significant risk for developing chronic inflammation and auto-immunity (10).

3. Gut Dysbiosis: Poor microbial balance in the gut microbiome leads to leaky gut syndrome and chronic inflammation (11). The gut must be addressed in order to get well.

4. Mitochondrial Dysfunction: The mitochondria are the energy producing organelles in each cell of the body. They are extremely key in the bodies ability to handle oxidative stress. Dysfunction in the mitochondria leads to increased free radical and oxidative stress which creates immune alterations. Many researchers believe that other autoimmune diseases such as multiple sclerosis are primarily a mitochondrial disease (12).

5. Low Glutathione Levels: Glutathione is the major anti-oxidant within every cell of the body. It is critical for white blood cell (WBC) function as the WBC’s encounter tremendous amounts of free radical and oxidative stress every second of the day. Low glutathione leads to chronic inflammation and often to auto-immunity (13).

6. Poor Omega 6:3 ratio: The average person has significantly more omega 6 fats than omega 3 fats. The increased omega 6 stimulate the release of pro-inflammatory mediating prostaglandin molecules. This is a key factor in the development of chronic inflammation and auto-immunity (14).

7. Upper Cervical Subluxation: The bottom of the skull (occiput) and the first bone (atlas) play a significant role in the coordination patterns of the brain and immune system. Dysfunction at this joint torques and compresses the top of the spinal cord and increases inflammatory activity in the body (15).

8. Environmental Toxins: Exposure to high levels of infectious microbes, environmental chemicals such as plasticizers, pesticides, herbicides, personal care products, heavy metals and biotoxins such as mold wear down the bodies glutathione levels, alter the gut microflora and increase inflammatory activity in the body (16, 17, 18).

9. High Stress and Poor Breathing Habits: High mental and emotional stress increases stress hormone production which induces inflammatory activity within the body. Short and shallow breathing habits can simulate chronic mental and emotional stressors on the physiological level (19).

10. Lack of Sleep: Poor sleep promotes immune dysfunction and increased inflammation. Good sleeping habits and optimal melatonin secretion reduce inflammation and promote improved tissue healing (20).

11. Methylation: Methylation is a key process that protects DNA, turns on and off genetic traits and helps to detoxify environmental chemicals. Many individuals have certain genetic polymorphisms that limit their ability to appropriately methylate. Methylation plays a very important role in T cell function and poor methylation status is associated with the development of auto-immunity (21).

12. EMF Exposure: Electromagnetic frequency exposure has been shown to alter the function of the immune system and increase one’s susceptability to developing an auto-immune condition (22)

I will touch on a few of these key areas and how they relate to Rheumatoid arthritis in this article.

Gluten Sensitivity and Rheumatoid Arthritis:

Gluten is the common protein molecule found in wheat, barley, rye, kamut and spelt. Gluten is a sticky storage protein that binds to the small intestinal wall where it often causes digestive and immune system disorders. Gluten sensitivity is an epidemic that is a major factor in the development of auto-immunity.

Research has shown a high prevalence of gluten sensitivity in individuals with auto-immune connective tissue disorder such as RA, lupus, scleroderma and Sjograns disease (23). Studies have shown that a gluten-free diet has improved anti-body counts and symptoms in many individuals with rheumatoid arthritis (24).

Vitamin D and Rheumatoid Arthritis:

Vitamin D is critical in the development and maturation of the immune system. It helps to enhance self-tolerance and reduce the risk of auto-immunity and chronic inflammation. Low vitamin D levels are a common finding in auto-immune diseases (25).

Reduced vitamin D intake has been linked to increased susceptibility to the development of rheumatoid arthritis (RA) and vitamin D deficiency has been found to be associated with increased disease activity in patients with RA (26, 27).

The MicroBiome and RA:

The gut microbiome is made up of over 1000 different species of microbes and it plays a huge role in nutrient absorption, detoxification and the development and maturation of the immune system. Certain bacteria of the gram negative classification are known to release a potent inflammatory mediator called lipopolysaccharide (LPS).

Researchers have found that individuals with RA have high levels of the gram-negative bacterium Prevotella copri, which is correlated with an increase in LPS and inflammation. Additionally, these individuals had an overall loss of beneficial anti-inflammatory microbes. Additionally, the P Copri drove up the inflammatory cytokine Th-17, which promoted inflammation through another mechanism (28, 29).

Small Intestinal Bacterial Overgrowth:

Individuals with RA have a much higher tendency to have small intestinal bacterial overgrowth (SIBO) than the normal population (30). We should normally have the majority of our bacteria in the large intestine and not in the small intestine.

SIBO develops when the normal homeostatic mechanisms that control intestinal bacterial populations are disrupted. The two processes that most commonly predispose to bacterial overgrowth are diminished stomach acid secretion and lack of small intestine motility (31). SIBO can lead to key nutritional deficiencies and chronic inflammation.

Leaky Gut Syndrome and Auto-Immunity:

When the microbiome is dysregulated it often leads to a damaged gut lining and intestinal permeability. This is found in the pathogenesis of rheumatoid arthritis and other auto-immune diseases (32, 33).

This “leaky gut” causes undigested food particles to pass into the bloodstream where they are tagged by the immune system and attacked with massive inflammatory processes that have the ability to affect nearly every system in the body. This creates a food allergy or sensitivity that the body reacts to whenever it is exposed.

The most common food based culprits include all processed foods, artificial sweeteners/preservatives and gluten containing products. Soy, peanuts, pasteurized dairy, corn and eggs are often not tolerated well. The nightshade family of eggplant, potatoes and tomatoes are often challenging on the system as well.

The most common medications given to individuals with RA, non-steroidal anti-inflammatory drugs, have been shown to increase intestinal permeability (34). So these medications may reduce inflammation and pain by suppressing key inflammatory prostaglandins, but they also promote further development of the disorder.

Mitochondrial Dysfunction and RA:

Every cell of the body has mitochondria within it that produce energy for the cell. The mitochondria are the battery packs of the cell and they are extremely important. High levels of oxidative stress wear down the mitochondria and cause a dysfunctional state.

Mitochondria are one of the main cellular sources of reactive oxygen species (ROS) and reactive nitrogen species (RNS) and play a pivotal role in many autoimmune and chronic inflammatory conditions. Mitochondrial dysfunction leading to excessive production of ROS and RNS plays a significant role in the pathogenesis of RA (35, 36).

In rheumatoid arthritis, the cells are under so much stress that there main protective shield, glutathione (GSH) gets worn down and oxidative stress damages the mitochondria and the DNA leading to cell death. Poor blood sugar control and high environmental toxin exposure are known to deplete glutathione levels and impair mitochondrial function (37, 38).

Anti-Inflammatory Diet & Lifestyle

Anti-inflammatory foods help to modulate the immune system and reduce inflammatory activity in the body. Great anti-inflammatory foods include coconut products, avocados, olive oil, berries & phytonutrient rich vegetables. Healthy meat sources such as grass-fed beef, wild game, wild salmon, organic poultry and organic eggs are great if the gut can tolerate them.

It is advisable for anyone with chronic inflammation to include organic vegetable juices, fermented foods and herbal teas in their diet. Homemade sauerkraut, apple cider vinegar, coconut water kefir, and kimchi are great. Begin with small doses of all of these and add more if you tolerate them well.

Organ meats such as grass-fed liver, heart, etc. are rich in mitochondrial support nutrients. Powerful herbs such as turmeric, ginger, garlic, onion, rosemary, thyme, cinnamon, & oregano among others should be used as much as possible to improve immune coordination.

Consuming lots of sulfur based onions, garlic, cruciferous veggies on a daily basis and getting high quality seaweed in the form of kelp can be extremely helpful. Using purified fish oils to boost up omega 3 levels is also very important.

Rebuild the Intestinal Wall:

The best way to rebuild the intestinal wall is to incorporate a daily lifestyle of intermittent fasting. This should be a 16-20 hour liquid diet each day in which only cleansing beverages such as fermented drinks and lemon water are consumed.

Consume high quality shakes with berries, coconut or hemp milk and a hypoallergenic protein powder. No more than one solid food meal a day should be consumed for at least a 3 month period of time to ensure proper healing. One could also incorporate a six week liquid diet to take the stress of the digestive tract and speed up the process of healing the gut lining.

Vegetable juices can and should be consumed throughout the fasting period. Some of the best vegetable juices include wheatgrass & cabbage juice among others. Wheatgrass is known for its incredible chlorophyll content and ability to purify the bloodstream. Cabbage is loaded with the amino acid L-glutamine which is the primary amino acid in the gut wall.

Digestive enzymes and fermented foods should be used before or during the solid food meal to enhance digestion. Heavy duty probiotic supplementation should be used in the evening after the solid food meal to reduce inflammation that would be caused by the solid food of the meal.

Subluxation and Neurological Distortion:

Chronic inflammatory disease processes are influenced by the nervous system which controls the coordination of the immune system. Nerve stimulation is essential for the growth, function and control of inflammatory cells. Researchers have found that abnormal neurological control results in the development of auto-immune based inflammatory conditions such as RA (39, 40).

Subluxation is the term for misalignments of the spine that cause compression and irritation of nerve pathways affecting organ systems of the body. Subluxations are an example of physical nerve stress that affects neuronal control. According to researchers, such stressful conditions lead to altered measures of immune function & increased susceptibility to a variety of diseases (41).

Upper Cervical Spine is the Most Important:

The upper cervical spine is the most important region for immune coordination. Various wellness chiropractors specialize in stabilizing the upper cervical spine which allows the nervous system to control and coordinate the body with greater efficiency.

Many individuals with auto-immune diseases such as rheumatoid arthritis have ligament laxity at the upper cervical spine. It is essential to see a well-trained wellness based chiropractor that specializes in upper cervical care and corrective care and has much experience working with individuals with advanced conditions such as RA (42).

These chiropractors will use a regiment of specific adjustments and corrective exercises to minimize subluxation, restore proper neurological tone and maximize the bodies healing potential.

20 Ways to Beat Rheumatoid Arthritis:

Here are the best action steps to get started with on your journey to prevent and/or beat Rheumatoid Arthritis. You should always consult with your physician before stopping or changing medications or taking on new health strategies.

Additionally, you should be working with a functional health practitioner to help guide you through these strategies. This is not an exhaustive list and there are other natural therapeutic strategies that I and functional health practitioners will utilize to help individuals with Rheumatoid Arthritis.

1) Change Your Diet: Follow an Anti-Inflammatory nutrition plan here and consider the auto-immune diet and/or the low-oxalate diet, both of which you can find here

2) Test For Food Sensitivities: You can do a biofeedback test to determine what foods are causing stress in your system and an elimination diet to test how you are responding to eliminating certain foods for periods of time.

3) Reduce Stress: Find ways to reduce stressful activities and enjoy more peace and calm. Learn to thrive under stress by reading this article here

4) Improve Your Sleep: Sleeping a high quality 8-9 hours each night is key to healing and improving brain function. Follow the steps in this article to improve your sleep.

5) Power Up Your Nrf2 Pathway: This is the key genetic anti-oxidant pathway. Adding in clinical dosages of resveratrol, curcumin, sulfuraphane and Green tea (ECGC) can be extraordinarily beneficial. I use Nrf2 Power here to improve this pathway. I always get my chronic hypertensive patients on Nrf2 Power.

6) Include Magnesium & B Vitamin Rich Foods: Magnesium helps to improve blood sugar signaling patterns and protects the blood-brain barrier. The best magnesium and B vitamin rich foods include dark green leafy veggies, grass-fed dairy, raw cacao and pumpkin seeds. Consume these as tolerated. You can also do Epsom salt baths to boost your magnesium levels.

7) Focus on Deep Breathing: Improving your posture, seeing a high quality chiropractor and optimizing your breathing patterns is highly recommended. Follow these tips here to improve your breathing patterns.

8) Use Anti-Oxidant Rich Herbs: Add turmeric, ginger, oregano, garlic, basil, thyme and rosemary to as many dishes as possible and drink organic herbal teas on a regular basis.

9) Ground Your Body: In our society we are surrounded by toxic electromagnetic frequency’s (EMF’s). These EMF’s increase stress within our body and alter neurotransmitter function. By going outside daily and walking barefoot on grass, dirt or sand you absorb natural EMF’s from the ground that balance your electrical rhythms. Follow the steps in this article here.

10) Supplement With Omega 3’s: Omega 3 fatty acids and in particular the long chain variety EPA and DHA are critical for stabilizing blood sugar, reducing inflammation and pain. Consume grass-fed meat, grass-fed butter, wild-caught fish and spirulina to get it in your diet.

It is also advisable to supplement with 2-5 grams daily of EPA/DHA along with 200 mg of GLA. Clinically, I use ProEFA to boost up omega 3’s.

11) Improve Your Mitochondria: The mitochondria are the energy powerhouses of every cell. When someone has RA it is a clinical sign that they have dysfunctional activity going on in the mitochondria.

Support your mitochondria with clinical doses of CoQ10, L-carnitine, N-acetyl cysteine and Lipoic acid. The supplement I use with my autoimmune clients is Brain Supercharge which has the clinically effective dosages of each of these key nutrients and more.

12) See a Chiropractor: Have a full neurological exam and see a high quality chiropractor to help reduce stress on the nervous system and enhance overall well-being.

13) Juice Your Veggies: Juicing is one of the best ways to get high quality anti-oxidants and powerful phytonutrients into your system. Here is my article on Best Juicing strategies.

14) Intermittent Fasting: Going 16 hours between dinner and breakfast is one of the best ways to improve mitochondrial production. Your body improves energy efficiency by increasing and strengthening the mitochondria during periods of fasting. This is also one of the best ways to reduce oxidative stress and inflammation.

Consume your meals in an 8 hour window such as 11am – 7pm. Read this article for more info on fasting. Research has shown that fasting improves the symptoms of individuals with RA (43)

15) Optimize Your Vitamin D: Be sure to increase your vitamin D through good amounts of regular sun exposure and/or taking a high quality vitamin D3/K2 supplement.

16) Practice Oil Pulling: Oil pulling helps to reduce the microbial load in your mouth. This takes stress off of the immune system and reduces inflammation levels throughout the body. Read more about oil pulling here and practice this 2x daily.

17) Get a Home Water Filtration System: Very important to avoid the chloride, fluoride, pesticides, heavy metals, etc. that are found in tap water. Use a good whole home water filtration system as discussed in this article here

18) Use Essential Oils: The anti-oxidant content and aromatherapy benefits of essential oils help to improve oxygenation and reduce the harmful effects of oxidative stress throughout the body. Some of my favorites include lavendar, peppermint, chamomile and sweet orange among others.

Put a drop on your hands and mix together and then cover your nose and inhale the healing vapors. This will stimulate your brain and increase blood flow to your cranium.

19) Low Intensity Movement: A sedentary lifestyle reduces synovial fluid flow in the joints and can lead to increased oxidative stress throughout the body. Throughout the day, get a lot of low-intensity movement such as walking, light cycling, playing, etc. Regular movement will help reduce inflammation in the body and help stabilize the joints boost the development of new neurons in the brain.

20) Improve Your Gut Motility: Improving bowel movement frequency and consistency is a key detoxification concept. Consuming an anti-inflammatory diet with good fiber sources such as chia seed and flax seed, using bone broths, fermented foods and probiotics will improve bowel motility.

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Natural remedies for rheumatoid arthritis

Share on PinterestA plant-based diet can boost overall health and may have special benefits for people with RA.

Inflammation is a main characteristic of RA, and following an anti-inflammatory diet can help reduce symptoms.

Research published in 2015 studied the effects of a plant-based diet on levels of a protein known to cause inflammation.

The researchers concluded that a vegan diet rich in fresh fruits and vegetables, whole grains, legumes, nuts, and seeds significantly reduced systemic inflammation in participants.

In people with RA, a similar diet aimed to reduce inflammation may ease pain and promote overall wellbeing.

Supplements

Fish oil from cold-water fish, such as salmon, mackerel, tuna, cod, and herring, contain high amounts of omega-3 fatty acids. These acids help combat inflammation by blocking inflammatory receptors.

In 2010, researchers published a meta-analysis of investigations into the effects of fish oil on RA.

They found that a combination of fish oil supplementation and non-steroidal anti-inflammatory drugs resulted in less joint tenderness in people who had long-standing symptoms of RA.

The researchers concluded that fish oil may be a beneficial supplemental therapy.

Fish oil supplements are available for purchase online and in many health stores.

Indian frankincense, or Boswellia serrata, also has powerful anti-inflammatory properties, and supplements may help relieve symptoms of RA.

Tumeric and curcumin supplements have shown promise in the treatment of arthritis, according to some research.

Results of multiple studies suggest that turmeric and curcumin can prevent and combat inflammation.

However, use supplements that contain turmeric with care. People who take blood thinners, such as warfarin, should avoid turmeric.

Share on PinterestProbiotics are present in yogurt and pickles, and they may help reduce inflammation.

Probiotics may also benefit people with RA. A 2014 study found that administering the Lactobacillus casei 01 probiotic to people with RA for 8 weeks resulted in improved disease activity and inflammation.

Foods such as some yogurts and pickles are rich sources of probiotics, which are also available as supplements.

Anyone planning to start taking supplements should consult a doctor. Some can have side effects or interfere with other treatments.

The U.S. Food and Drug Administration (FDA) do not regulate herbs and supplements. As a result, the doses can be irregular, and there have been some reports of contamination.

by Steffany Haaz, MFA, CYT

Updated: 12/19/2008

Rheumatoid Arthritis (RA) is a chronic, inflammatory, autoimmune disease that impacts joints and connective tissue. It is often painful and disabling, and usually requires lifelong pharmacological management. Patients are usually diagnosed between the ages of thirty and fifty, although RA affects all ages. Common co-morbidities include cardiovascular disease, cachexia (muscle wasting), depression and impairments to quality of life (1;2). Although they have greatly improved the general course of RA, drugs that are commonly used to manage the disease carry some notable side effects as well.

For all of these reasons, patients with RA often look to Complementary and Alternative Medicine (CAM) for additional sources of relief. In fact, joint pain and arthritis are among the top five most common reasons that Americans seek CAM (3). Usually, CAM is sought in addition to allopathic (standard medical) treatment to ease symptoms of the disease and side effects of drug therapy. Below is an outline of the currently available research for treatments that are commonly used by RA patients, as well as a synopsis of what may be recommended as safe and possibly effective for this population.

Dietary and Botanical Supplements

Fish oil.

When working with an RA population, fish oil is probably the most frequently mentioned supplement. The standard western diet contains a low proportion of omega-3 type essential fatty acids (EFAs), which are said to have anti-inflammatory properties. Two EFAs in fish oil are eicosapentaenoic acide (EPA) and docosahexanoic acid (DHA). The body can actually convert EPA to DHA, but individuals vary with regard to the efficiency of that conversion. EPA and DHA can also be found in vegetable sources, such as flax and algae, respectively. In a report by the National Center for Complementary and Alternative Medicine (NCCAM) within the National Institutes of Health (NIH), it was concluded that evidence for the use of fish oil (or other omega-3 supplements) for the treatment of RA is promising, as a result of several laboratory, animal and clinical studies (4). Some effect has been noted for symptoms such as tender joints, morning stiffness and use of non-steroidal anti-inflammatory drugs (NSAIDs). What is uncertain, however, is how much of this effect is placebo, as results from randomized controlled trials (RCTs) are inconsistent.

Patients must be prudent with the use of fish oil, however, as it can reduce the ability for some individuals to clot, leading to a greater risk of bleeding. This is particularly important if patients are on other blood thinners, blood pressure medication, or if they might undergo surgery. Because the risk of mercury contamination in fish is high, a concentrated extract from fish also carries some risk. Unfortunately, dietary and herbal supplements are not regulated by the FDA for content, so without diligent research into a particular manufacturer, it is difficult to know what mercury levels are present. For this same reason, label accuracy cannot be guaranteed, and patients should be wary about whether the supplement contains the desired ingredients, without any unknown additives.
Gamma Linolenic Acid (GLA). Unlike EPA and DHA, GLA is an omega-6 fatty acid. The standard western diet has a higher proportion of omega-6 fats, and they are often associated with higher levels of inflammation. However, evidence for anti-inflammatory properties of GLA, in particular, seems to be strong. It is not naturally occurring in the diet, but can be found in several plant seeds, including borage, evening primrose and black currant. A 2000 review by the diligent and reputable Cochrane Collaboration investigated several RCTs that suggested a beneficial effect for pain, joint tenderness and morning stiffness (5).

As with many supplements, however, the risk for drug interaction should be considered. Borage oil may contain pyrrolizidine alkaloids, which can be harmful for patients at risk of liver damage. The risks of bleeding with GLA are similar to those noted for fish oil. Evening primrose should not be taken along with some psychiatric drugs (phenothiazines), and there is some risk of minor GI side effects (nausea, gas, bloating, etc.) with large quantities of these supplements.

Glucosamine and chondroitin.

These are two different substances that are often combined in supplement form. Both are usually isolated from shellfish, but are naturally found in human joint tissue. Both are commonly used for osteoarthritis (OA), which is a degenerative form of arthritis with a very different etiology from RA. While these supplements have shown anti-inflammatory effects in animals, clinical trials have only been conducted in OA. These have been quite inconsistent and controversial, with some finding improvements on X-ray, others finding improvements in symptoms only, and still others finding no effect (6;7). There is no evidence at all, however, that these supplements would be helpful for RA patients.

Glucosamine and chondroitin are generally safe, however, they might pose risk for those with asthma, diabetes, blood clotting disorders, or shellfish allergies. Some mild GI symptoms may occur as well.
Tumeric, ginger, valerian. These are three supplements that are thought to have anti-inflammatory properties. Tumeric, which contains circumin, has been associated with decreased inflammation in animals, and one small, double-blind crossover trial found improvements in walking time, swelling and morning stiffness in RA (8). One small trial found that a ginger supplement was associated with decreased pain and discomfort for patients with RA (9). Valerian root is commonly used as a sleep aid, due to its relaxing properties. Because poor sleep is common among RA patients, valerian may be helpful. However, there is no research evidence of its efficacy for this population. Valerian should not be combined with sedatives or other sleep aids (4).

Special Diets

The composition of an individual’s diet can be an important aspect of health promotion, barring the complications of a chronic condition. For those with a diagnosis of RA, dietary choices may have added significance for a variety of reasons:

  • it may be more difficult to eat a well-balanced diet
  • drug therapy may change nutrient absorption
  • foods perceived as allergens may contribute to inflammation. All individuals, and especially those with RA, should make efforts to consume a well-balanced diet, full of nutrient-dense foods and limited in additives and processed foods. However, some special diets have been investigated specifically for their potential to aid patients with RA.

Fasting/Elimination

Fasting for a brief period may bring some relief of symptoms for patients with RA, possibly due to the elimination of some foods that are perceived as allergens (10). These effects are not necessarily long lasting, however, and symptoms may return when patients return to a normal diet (11). Fasting may be dangerous for some patients, and should certainly not be done without close medical supervision. If a normal diet is not resumed, but sensitive foods are eliminated, effects may be longer lasting. There appears to be a subset of RA patients who are highly sensitive to certain foods, and for whom eliminating these foods can have beneficial effects (12). It should be noted, however, that there are no scientific data supporting the concept that RA is caused by allergies to foods or to other substances.

Vegetarian/Vegan

Several European trials have examined the efficacy of vegan (no animal products at all) or vegetarian (includes eggs and dairy) diets for RA patients, sometimes following a period of fasting. These trials have shown some benefits, including less inflammation, lower disease activity, reduced pain and stiffness. These diets are not always well-tolerated, however, resulting in a high drop-out rate (13).

Mediterranean

One RCT of a Mediterranean diet found improvements to clinical and psychological parameters in patients with RA (14). Two other observational trials are underway, and will hopefully lead to more investigation in this area.

Acupuncture

In a Cochrane review, only one clinical trial of acupuncture met inclusion criteria for rigor of study design (15). There were no statistically significant differences found between intervention and control groups. A prior review of published studies was broader in its inclusion criteria, but due to mixed results, the review still concluded that nothing can be determined from the trials conducted so far in this area (6). There may be some improvement in symptoms, but further research will be necessary to provide a clearer picture of acupuncture’s efficacy for RA.

Magnets

Many patients with arthritis use magnets as a complementary treatment for pain. A review of the use of magnets for pain cites one trial in RA patients with unremitting knee pain (16), in which significant pain reduction was found with two different types of magnetic treatment. There was not a third group without magnet treatment for comparison. Magnets have been effective for treating other types of pain (17), but further research is needed to ensure safety and efficacy for the RA population.

Hydrotherapy

A 2008 Cochrane review by Verhagen et al(18) found seven trials of hydrotherapy (also called balneotherapy) for RA patients, which generally included mineral baths using varying minerals and concentrations. (This is to be distinguished from water aerobics or therapies in the field of physical therapy that involve the use of water, which are not considered CAM.) Positive findings were reported by most studies, but flaws in the methodology hindered conclusiveness. Results were mixed for pain and quality of life (QOL), while some improvements were noted in morning stiffness and grip strength. Often, studies were poorly powered and/or did not include sufficient data to determine statistically significant differences. Although hydrotherapy may be beneficial for RA patients, a large and well-conducted trial is in order.

Homeopathy

Homeopathy is based on the tenant that “like cures like.” Substances that would produce a certain symptom in larger quantities (such as swelling) are diluted to such an extreme that they may actually relieve such symptoms. Two recent trials have been conducted using homeopathy compared to a placebo for RA patients(19;20). Neither found evidence of an effect. An RCT in 1980 found improvements in pain, stiffness and grip strength for the treatment group, but not for controls (21), while a pilot two years prior was unable to make conclusions based on the confounding effects of pharmaceuticals and/or non-specific aspects of physician interaction. (22).

Collectively, this evidence does not support the use of homeopathy for RA, although larger and better designed studies would be useful to crystallize that conclusion.

T’ai Chi

A 2007 systematic review reported on 5 trials using t’ai chi for RA patients (23). Some measures, such as disability, mood and vitality showed improvement. No change was seen for any markers of pain or functional assessment, and results were mixed for fatigue and swollen joints. Only two of these trials were randomized. T’ai chi may offer some benefits for RA patients, but clarity regarding its effects will require further review.

Yoga

Two trials have shown significant improvements in grip strength for yoga as compared to non-active controls (24;25). Unfortunately, broader outcomes were not assessed. A more comprehensive RCT is currently underway, and has only assessed preliminary data for changes in quality of life (QOL) and tender/swollen joints (26). Improvements were seen in a variety of QOL areas, as well as both joint measures. A full examination of these data will be important for helping to determine the efficacy of yoga for this population.

Overall Recommendations

Complementary and alternative medicine is a very broad category, including mind-body therapies, herbs, energy medicine, and any other modalities that are not considered part of standard allopathic care. In fact, some treatments that were formerly considered CAM have moved into the realm of standard care (ie. some vitamin and mineral supplementation). Due to its heterogeneous nature, it is not appropriate to make broad conclusions about CAM’s efficacy as a whole. As expected, some CAM modalities seem to show more promise for patients living with RA. Some natural supplements have been known for their anti-inflammatory properties, and when side effects are of little concern, they may be beneficial for this population. Special diets, if acceptable to the patient and sufficient in nutrient content, may also provide some relief. CAM forms of physical activity may be the most promising, as this population would benefit from anything that increases their activity levels safely. Overall, CAM methods that help patients to relax and balance physical/emotional stress can be beneficial by a variety of mechanisms. As is generally the case in this emerging field of scientific inquiry, more research is necessary to bolster such findings.

A variety of lifestyle recommendations are generally accepted for ongoing management of rheumatoid arthritis. These include: 1) eating a healthy, balanced diet for adequate nutrition; 2) participating in regular physical activity; 3) reducing sources of stress and finding ways to better manage stress; 4) relying on sources of social support; 5) openly communicating with care providers; and 6) taking an active role in disease management. The complexities of a systemic autoimmune disease, such as RA, require an approach that addresses all aspects of the individual’s wellbeing, beyond pharmacotherapy alone. Psychoneuroimmunology suggests that immune function is impacted by a variety of factors that must all be considered.

While these aspects of lifestyle may not seem like CAM, they all involve taking an active role in disease management, and many address stress, involve social support, or increase patient’s attention to healthful choices, such as diet and exercise. For those that do no harm, there may be benefits on a variety of levels that are not measured, or are inadequately assessed by objective measurement criteria. In many cases, too little research has been done to allow for recommendations regarding participation or avoidance. It is important for patients and providers to be informed about the nature of these modalities, and for researchers and funders to continue the search for more information about their safety, efficacy and mechanisms.

Reference List

  1. Walsmith J, Roubenoff R. Cachexia in rheumatoid arthritis. Int J Cardiol 2002; 85(1):89-99.
  2. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med 2003; 163(20):2433-2445.
  3. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. Adv Data 2004;(343):1-19.
  4. National Center for Complementary and Alternative Medicine. Research Report: Rheumatoid Arthritis and Complementary and Alternative Medicine. http://nccam.nih.gov/health/RA/ ;
  5. Little C, Parsons T. Herbal therapy for treating rheumatoid arthritis. Cochrane Database Syst Rev 2001;(1):CD002948.
  6. Soeken KL. Selected CAM therapies for arthritis-related pain: the evidence from systematic reviews. Clin J Pain 2004; 20(1):13-18.
  7. Distler J, Anguelouch A. Evidence-based practice: review of clinical evidence on the efficacy of glucosamine and chondroitin in the treatment of osteoarthritis. J Am Acad Nurse Pract 2006; 18(10):487-493.
  8. Ahmed S, Anuntiyo J, Malemud CJ, Haqqi TM. Biological basis for the use of botanicals in osteoarthritis and rheumatoid arthritis: a review. Evid Based Complement Alternat Med 2005; 2(3):301-308.
  9. Srivastava KC, Mustafa T. Ginger (Zingiber officinale) in rheumatism and musculoskeletal disorders. Med Hypotheses 1992; 39(4):342-348.
  10. Palmblad J, Hafstrom I, Ringertz B. Antirheumatic effects of fasting. Rheum Dis Clin North Am 1991; 17(2):351-362.
  11. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991; 338(8772):899-902.
  12. Darlington LG, Ramsey NW. Review of dietary therapy for rheumatoid arthritis. Br J Rheumatol 1993; 32(6):507-514.
  13. Stamp LK, James MJ, Cleland LG. Diet and rheumatoid arthritis: a review of the literature. Semin Arthritis Rheum 2005; 35(2):77-94.
  14. Skoldstam L, Hagfors L, Johansson G. An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Ann Rheum Dis 2003; 62(3):208-214.
  15. Casimiro L, Barnsley L, Brosseau L, Milne S, Robinson VA, Tugwell P et al. Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis. Cochrane Database Syst Rev 2005;(4):CD003788.
  16. Segal NA, Toda Y, Huston J, Saeki Y, Shimizu M, Fuchs H et al. Two configurations of static magnetic fields for treating rheumatoid arthritis of the knee: a double-blind clinical trial. Arch Phys Med Rehabil 2001; 82(10):1453-1460.
  17. Eccles NK. A critical review of randomized controlled trials of static magnets for pain relief. J Altern Complement Med 2005; 11(3):495-509.
  18. Verhagen AP, Bierma-Zeinstra SM, Boers M, Cardoso JR, Lambeck J, de Bie RA et al. Balneotherapy for osteoarthritis. Cochrane Database Syst Rev 2007;(4):CD006864.
  19. Andrade LE, Ferraz MB, Atra E, Castro A, Silva MS. A randomized controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis. Scand J Rheumatol 1991; 20(3):204-208.
  20. Fisher P, Scott DL. A randomized controlled trial of homeopathy in rheumatoid arthritis. Rheumatology (Oxford) 2001; 40(9):1052-1055.
  21. Gibson RG, Gibson SL, MacNeill AD, Buchanan WW. Homoeopathic therapy in rheumatoid arthritis: evaluation by double-blind clinical therapeutic trial. Br J Clin Pharmacol 1980; 9(5):453-459.
  22. Gibson RG, Gibson SL, MacNeill AD, Gray GH, Dick WC, Buchanan WW. Salicylates and homoeopathy in rheumatoid arthritis: preliminary observations. Br J Clin Pharmacol 1978; 6(5):391-395.
  23. Lee MS, Pittler MH, Ernst E. Tai chi for rheumatoid arthritis: systematic review. Rheumatology (Oxford) 2007; 46(11):1648-1651.
  24. Dash M, Telles S. Improvement in hand grip strength in normal volunteers and rheumatoid arthritis patients following yoga training. Indian J Physiol Pharmacol 2001; 45(3):355-360.
  25. Haslock I, Monro R, Nagarathna R, Nagendra HR, Raghuram NV. Measuring the effects of yoga in rheumatoid arthritis. Br J Rheumatol 1994; 33(8):787-788.
  26. Haaz S, Bathon J, Bartlett S. Initial Findings of an RCT of Yoga on Physical and Psychological Functioning in RA and OA. Arthritis and Rheumatism Supplement. 2007.
    Ref Type: Abstract

Top 4 Supplements to Treat Arthritis Pain

Choosing the right supplement to ease your arthritis pain and inflammation can be confusing. Which supplements are most effective? Of the many types of supplements available in stores and online, the following 4 have been well-studied for their ability to treat arthritis pain:

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Research suggests curcumin, found in the spice turmeric, has anti-inflammatory properties and has the potential to reduce arthritis pain.

1. Curcumin (from turmeric root)

Evidence suggests the turmeric root has anti-inflammatory properties.1 The active component of turmeric, called curcumin, makes up only about 3% of turmeric, so you may need to eat a lot of turmeric to get noticeable benefits. An alternative to eating turmeric every day is to take a supplement.

Limited research indicates curcumin may inhibit the body’s ability to absorb iron,2,3 so if you have iron deficiency, you may want to raise this concern with your doctor.

See Turmeric and Curcumin for Arthritis

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2. Vitamin D

If you have arthritis pain or are at high risk for arthritis, your doctor may recommend a vitamin D supplement. (I prefer vitamin D3.) A blood test can determine whether you have a vitamin D deficiency.

Vitamin D deficiency is associated with the development of osteoarthritis4 as well as autoimmune arthritis, such as psoriatic arthritis5 and rheumatoid arthritis (RA).6 Low vitamin D levels are also associated with more and/or worse rheumatoid arthritis symptoms.7,8 Other medical conditions, such as osteoporosis, muscle weakness, hip fractures, diabetes, cancer, and heart disease, are also associated with low vitamin D levels.

It’s not yet clear whether vitamin D supplementation can prevent arthritis from developing or alleviate arthritis symptoms.4,9,10 People who have kidney disease, bone disease, certain cancers, or calcium disorders should talk to their doctors before taking a vitamin D supplement.11

3. Omega-3 fatty acids

Research suggests omega-3 fatty acids have anti-inflammatory properties. Unless you eat fatty fish like salmon and mackerel two or more days a week, it can be challenging to get a therapeutic amount of omega 3 through food. Taking a supplement may help.

Most omega 3 supplements come in the form of fish oil. However, I recommend an omega 3 supplement derived from plants, such as flax seeds. A plant-based supplement helps avoid the risk of mercury contamination found in some poorly manufactured fish oil supplements. A plant-based omega-3 supplement may also be preferable if you follow a vegetarian or vegan diet. Keep in mind that omega 3 fatty acids in fish oil can be different than those in plant-based sources. (Fish oil contains eicosapentaenoic acid and docosahexaenoic acid while flax seeds, for example, contain alpha-linolenic acid .) This difference may affect the dosage.

See The Difference Between Omega-3 and Omega-6 and Knee Arthritis Pain

A daily intake of omega 3 may increase your risk of bleeding and may not be appropriate if you take a blood thinner, such as warfarin.12 Not all physicians agree this risk is supported by evidence.13

4. Glucosamine and chondroitin sulfate

Many supplement products aiming to treat arthritis contain both glucosamine and chondroitin sulfate. These substances are found naturally in human cartilage. Research regarding glucosamine and chondroitin sulfate supplements is mixed,14-16 and doctors’ opinions of them vary. Positive clinical studies suggest they may provide modest pain relief by helping to rebuild worn-out cartilage in your arthritic joints.

See Glucosamine and Chondroitin Sulfate Supplements for Osteoarthritis

Glucosamine should be avoided by anyone allergic to shellfish since it is derived from shrimp, crab, and other crustaceans.

See How Glucosamine and Chondroitin Help with Osteoarthritis

In general, if you take any supplement for 2 to 6 months and don’t notice any relief from arthritis symptoms, check with your doctor for other options.

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Opinions about the recommended doses for supplements can vary. Before starting a new one, talk to your doctor or pharmacist to make sure the supplement’s contents and the dosage is right for your condition and won’t interact with any other medications and supplements you take. Some supplements can cause serious health problems if they are taken at high doses or combined with other supplements and medications.17

Also, keep in mind that supplements are not a quick fix for your arthritis pain. They may take effect gradually—over weeks or months–and provide only a modest decrease in pain. When you combine supplements with other treatments, such as an anti-inflammatory diet and exercise, there may be more significant pain relief.

Learn more:

The Ins and Outs of an Anti-Inflammatory Diet

Glucosamine and Chondroitin Sulfate Side Effects

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