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Arthritis diets and supplements: Do they work?

Pain from arthritis might lead you to try anything to relieve it, including a change in diet or taking supplements. Make sure you know what works first.

Nutritional supplements

  • ASU (avocado-soyabean unsaponifiable). French studies of ASU, derived from avocado and soyabean oils, show it can relieve OA pain, stimulate cartilage repair, and lower a patient's need for non-steroidal anti-inflammatory drugs (NSAIDs) to control pain. Dr Jason Theodosakis, author of The Arthritis Cure and champion of glucosamine-chondroitin, believes ASU will have a major impact on treatment of OA. It is not readily available in the UK, but a recent study of four pieces of research show that it might have some healing properties.
  • Black currant oil. See GLA.
  • Borage oil. See GLA.
  • Boron. Population studies show that people who have high-boron diets have a very low incidence of arthritis, and there's evidence that people with OA and RA can benefit. The best sources of boron are fresh fruits and vegetables and, depending on where you live, drinking water.
  • Bovine cartilage. Taken from the windpipe and trachea of cows, it's supposed to act as an anti-inflammatory agent in the treatment of OA and RA. A few animal and laboratory studies are promising, but there are no human studies to support claims. Researchers also think it may promote re-growth of cartilage.
  • Bromelain. This substance found in pineapple is supposed to relieve pain and swelling in OA and RA and improve mobility. There are no studies that show it's effective by itself, but one study of a bromelain supplement containing the enzymes rutin and trypsin relieved pain and improved function in 73 people with knee OA. The effect was similar to taking an NSAID.
  • CMO. It's touted as an "arthritis cure", but there's no human clinical evidence to support it.
  • Chondroitin sulphate. Used for many years to relieve OA pain, it's been shown to stop joint degeneration, improve function and ease pain, but results are mixed. One study followed patients with OA in finger joints for three years, and showed fewer patients developed further cartilage damage. It can take two months or more to realise the effects of chondroitin.
  • DMSO. Once widely used to relieve joint and tissue inflammation, it fell out of favour when animal studies showed high doses damaged the lens of the eye. Don't use it without consulting your GP.
  • Evening primrose oil. See Gamma linolenic acid (GLA)
  • Fish oil. Studies show it relieves the pain of RA.
  • Flaxseed. There are many good nutritional reasons to add it to your diet, but studies of its effect on arthritis have shown mixed results. Its anti-inflammatory properties work best if other vegetable-based oils are restricted.
  • GLA. Gamma linolenic acid (GLA) is an omega-6 fatty acid the body uses to make anti-inflammatory agents, unlike other omega-6 fatty acids that actually increase inflammation. It's found in evening primrose oil, black currant oil and borage oil supplements. Several studies show it relieves the stiffness and pain of RA. In one study, some patients were able to stop taking NSAIDs.
  • Ginger. It's known to have painkilling and anti-inflammatory agents. Ginger is believed to reduce joint pain and inflammation in people with OA and RA, and protect the stomach from gastrointestinal effects of NSAIDs. A clinical study showed ginger reduced knee OA pain.
  • Glucosamine. As glucosamine hydrochloride or glucosamine sulphate, this supplement relieves symptoms for many, but not all, people with OA. It helps the body build and repair cartilage. In a double-blind study, glucosamine sulphate was as effective in relieving symptoms in patients with knee OA as ibuprofen and had fewer side effects. It takes about two months to realise the effectiveness of this supplement. It's derived from crab, lobster, or shrimp shells, so check with your GP before taking any kind of glucosamine if you are allergic to shellfish.
  • Glucosamine chondroitin. Many OA patients get relief by taking glucosamine and chondroitin together, but it's not known whether the combination is more effective than taking them alone. That was the subject of a US National Institutes of Health (NIH) study called GAIT (glucosamine/chondroitin arthritis intervention trial). The research showed how effective the supplements are in reducing pain in people with knee OA. For patients with moderate to severe pain the combination of glucosamine and chondroitin provided significant pain relief compared to placebo. However they also showed that for those with mild pain the supplements either in combination or taken alone did not provide significant pain relief.
  • MSM. It's widely touted for relief of pain and inflammation. Its safety and effectiveness have yet to be determined.
  • SAM-e. Many European studies over the last 20 years show SAM-e is as effective as anti-inflammatory painkillers in treating OA but with fewer side effects. It works in conjunction with vitamin B-12, B-6, and folate. Claims that SAM-e repairs and rebuilds cartilage lack evidence, as studies have been done only in the lab and in animals.
  • Shark cartilage. Ground-up cartilage from Pacific Ocean sharks is supposed to relieve the inflammation and pain of osteoarthritis. Animal and lab studies are promising, but there are no human studies to support claims. Researchers also think it may promote re-growth of cartilage.
  • Stinging nettle. Taken orally or applied to the skin, stinging nettle is supposed to reduce the pain and inflammation of OA. Some studies show that patients can lower their dosages of NSAIDs by taking stinging nettle in extract form. Two small studies showed stinging nettle applied topically reduced pain for people with hip OA and thumb joint pain.
  • Turmeric. This supplement is used in traditional Chinese and Indian Aruyvedic medicine to relieve pain, stiffness and inflammation of OA and RA. A small study that combined turmeric, boswellia and zinc showed decreased pain in OA. Two studies using a combination of turmeric, boswellia, ginger and aswangandha relieved pain and inflammation in RA. Its effectiveness alone is unknown.
  • Wild yam. Although it contains natural anti-inflammatory steroids, it is likely they're not in a form the body can use.

Use caution

Experimenting with foods and supplements is not without risks. "I know people get desperate enough to try anything, but I would not feel comfortable eliminating whole groups of food", says Gerbstadt. "Before you eliminate any foods or modify your diet, check with a nutritionist."

"The best advice is to eat a healthy, well-balanced diet and stay close to your ideal body weight so affected joints have less extra weight to carry around", says Wilson. "Also get plenty of rest and exercise and decrease stress."

Be aware that many supplements interfere with or enhance effects of medications you're already taking. For example, a number of supplements increase the effects of blood-thinning medication. Check with your GP.

Reviewed on March 24, 2008

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