The degeneration of cartilage associated with arthritis, and the concomitant
side effects of pain and stiffness, is facing a larger number of consumers.
According to the National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS), arthritis may be caused by inflammation of the tissue lining
the joints. "The medical community has not definitively linked arthritis to any
particular gene or nutritional deficiency, and the exact cause, to this day, is
very debatable," said Justin Marsh, director of marketing and CEO, Arthur Andrew
Medical. "The disease encompasses a variety of conditions that may trigger an
immune response and, in turn, inflame the joints."
Some signs of inflammation include redness, heat, pain and swelling. Joints,
the places where two bones meet, can become severely damaged by unrestrained
inflammation over time. Arthritis commonly occurs in the hands, knees and
shoulders. There are several types of arthritis, although the two most common
ones are osteoarthritis and rheumatoid arthritis.
Osteoarthritis (OA) usually comes with age and most often affects the
fingers, knees and hips. "Osteoarthritis, commonly known as ‘wear and tear
arthritis,’ typically develops by over-use of the cartilage and, therefore,
usually occurs with increasing age," explained Frank Schonlau, director of
scientific communication, Horphag. He added women are more commonly affected
than men. Risk factors for OA include obesity, as it increases the workload of
articular cartilage, and hereditary factors that may render the cartilage less
resistant to mechanical stress. Osteoarthritis can follow an injury to a joint
in cases such as car accidents or sports. Years after the joint has apparently
healed, the person may develop arthritis.
According to NIAMS, rheumatoid arthritis (RA) occurs when "the body’s own
defense system doesn’t work properly: it affects joints and bones (often of the
hands and feet), and may also affect internal organs and systems."
Because arthritis is such a common ailment, there are a number of
over-the-counter (OTC) and prescription drugs on the market. However, for those
who are leery of taking such medications, there are many topical and internal
natural products that can provide relief and support joint health.
Strong Framework
Calcium and vitamin D have shown to be effective in boosting and
maintaining bone health, which goes hand in hand with healthy joints. "Calcium
and vitamin D are definitely important factors in joint health, because bones
provide the structural framework for the joint," explained Micah Osborne,
president, Membrel LLC. "When this structure begins to break down, you lose the
normal spacing between two bones, thus increasing the frictional forces and
pressure put on the supporting cartilage and ligaments. As the bone continues to
deteriorate, osteophytes form, which can cause soft tissue irritation,
inflammation and further cartilage injury." One popular method for obtaining
these important minerals is from eggshells, such as Membrell’s BoneHealth ESC
(eggshell calcium) which delivers not only calcium and vitamin D, but magnesium
as well.
In an 18-month study, researchers found a daily calcium supplement (555 mg/d)
boosted bone mineral content (BMC) in teenage girls with low habitual calcium
intake (n=96).1 Compared with the control group, the supplemented
group showed significantly greater gains in BMC over the intervention.
Magnesium deficiency has been shown to be a key factor in bone loss.2
One study from the University of Tennessee concluded greater magnesium intake
was significantly related to higher BMD.3 In the trial, 2,038 older,
white men and women aged 70 to 79 had their dietary intake of magnesium assessed
using a semi-quantitative food frequency questionnaire, and supplement data was
collected based on a medication inventory. Researchers found magnesium intake
was positively associated with BMD.
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Have a Fatty (Acid)
There is an overwhelming amount of evidence that healthy fats can help reduce
arthritis-related inflammation. A recent study from the Vascular and
Inflammatory Diseases Research Unit, Ninewells Hospital, Dundee, Scotland,
tested the effectiveness of cod liver oil (containing omega-3 essential
fatty acids) as a non-steroidal anti-inflammatory drug-sparing agent (NSAID).4
Ninety-seven patients with RA were randomized to take either 10 g/d of cod liver
oil containing 2.2 g of omega-3 essential fatty acids (EFAs) or air-filled
identical placebo capsules. At study’s end, 39 percent of the cod-liver patients
(n=49), but only 10 percent (n=48) of the placebo were able to reduce their
daily NSAID requirement by more than 30 percent. This study suggests cod liver
oil supplements containing omega-3 fatty acids can be used as NSAID-sparing
agents in RA patients.
A similar study found fish oil rich in n-3 polyunsaturated fatty
acids—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA),
specifically—could reduce inflammation and inflammation-induced bone loss in
chronic inflammatory diseases like RA, periodontitis and osteoporosis.5
The fruit from the silver vine plant (Actinidia polygama; AP)
has long been used as a folk medicine in Korea for the treatment of pain, RA and
inflammation. A study from Kyung Hee University, Korea, looked at the
anti-inflammatory effects of ALA, using acetic acid or carrageenan-induced
inflammation models, were investigated in mice or rats, respectively.6
Results suggested that the anti-inflammatory activity of ALA might be due to the
suppression of the enzymes responsible for the prostanoid biosynthesis involved
in inflammation. Further evidence that fatty acids are beneficial for
inflammation can be seen in a meta-analysis from York University, Toronto,
Ontario.7 Researchers examined 17 randomized, controlled trials
assessing the pain relieving effects of omega-3 polyunsaturated fatty acids (PUFAs)
in patients with RA or joint pain secondary to inflammatory bowel disease (IBD)
and dysmenorrhea. Supplementation with omega-3 PUFAs reduced patient-reported
joint pain intensity, minutes of morning stiffness, number of painful and/or
tender joints, and NSAID consumption.
One popular topical remedy is the use of cetylated fatty acids (CFAs) as
Celadrin, from Proprietary Nutritionals. In 2004, a study from Hesslink
Ventures of San Diego, Calif., was conducted to determine the benefit of CFAs on
knee range of motion and function in patients with OA.8 Sixty-four
patients with chronic knee OA were evaluated at baseline and at 30 and 68 days
after consuming either placebo or Celadrin (n=33). After 68 days, patients
treated with Celadrin exhibited improved knee range of motion and overall
function, compared to placebo. A similar study was conducted at the University
of California in Oakland.9 Forty patients with knee pain received
either Celadrin topical cream or a placebo. All of the patients who used
Celadrin showed significant improvement in knee range-of-motion, ability to
ascend/descend stairs, ability to rise from sitting, walk and sit down, and
unilateral balance.
A Spoonful of Amino Sugars and Glycosaminoglycans
Natural eggshell membrane is useful in joint supplements, as it contains
naturally occurring glycosaminoglycans (GAGs)—chondroitin and hyaluronic acid
(HA)—as well as collagen and other proteins.
Schonlau noted, "A long tradition for rebuilding cartilage lost by
biomechanical overuse are the amino sugars, such as glucosamine and chondroitin,
which are believed to represent nutritional building blocks for cartilage
renewal. While the evidence from clinical trials isn’t entirely consistent,
these dietary building blocks are safe and not harmful, and thus are widely used
for improving joint function."
In a review on dietary supplements and their effectiveness in OA from
Creighton University, Omaha, Neb., it was suggested that glucosamine sulfate
can improve symptoms of pain related to OA, as well as slow disease progression
in patients with knee OA.10 Chondroitin sulfate also appears
to reduce OA symptoms and is often combined with glucosamine; however, according
to the study, there is no reliable evidence that the combination is more
effective than either agent alone. One study from Hospital del Mar, Spain, found
chondroitin sulfate interferes with the progression of structural changes in
joint tissues and can be used in the management of patients with OA.11
Another study, conducted at University of Calgary, Alberta, examined the effects
of chondroitin sulfate (CS) alone and CS plus glucosamine sulfate (GS) in a
dietary bar formulation on inflammatory parameters of adjuvant-induced arthritis
and on the synthesis of interleukin-1beta (IL-1beta) and matrix
metalloprotease-9 (MMP-9).12 Following 25 days pretreatment with
dietary bars containing either CS alone, CS plus GS, or neither CS nor GS, rats
were either sham injected or injected with Freund’s complete adjuvant into the
tail vein. Rats were fed the respective bars for another 17 days after
inoculation. Researchers found treatment with CS plus GS, but not CS alone,
significantly reduced clinical scores, incidences of disease, joint
temperatures, and joint and serum IL-1beta levels. Treatment with CS alone and
CS plus GS inhibited the production of edema and prevented raised levels of
joint MMP-9 associated with arthritis. Similarly, CS alone and CS plus GS
treatment also prevented the development of cartilage damage associated with
arthritis.
A recent study from Erasmus Medical Center, Rotterdam, Netherlands,
questioned the effective-ness of glucosamine sulfate as a symptom and disease
modifier for OA.13 A total of 222 patients with hip OA took 1,500
mg/d of oral glucosamine sulfate or placebo once daily for two years.
Researchers found that glucosamine sulfate was no better than placebo in
reducing symptoms and progression of hip OA.
"While research has shown that glucosamine is beneficial in reducing pain,
some people are unable to take glucosamine orally due to stomach irritability,"
said Lynn Schrum, president, Better Living Distributors. "The Better Living Pain
Relief Patch™ is a natural patch with glucosamine, chondroitin, cetyl
myristoleate, willow bark extract and meadowsweet, which provides time-released
consistency, so there is no need to take multiple oral doses throughout the day,
eliminating possible stomach irritability."
Pining for Pine
Pycnogenol, an antioxidant found in French maritime pine bark extract, is
thought to have a positive effect on reducing inflammation. "Pycnogenol inhibits
the pro-inflammatory master switch (NF-kappaB), which orchestrates the whole
inflammatory machinery," said Schonlau. A double blind, placebo-controlled study
evaluated the efficacy of 100 mg/d of Pycnogenol in a three-month study in OA
patients.14 OA symptoms were evaluated by Western Ontario and
McMaster Universities (WOMAC) scores, mobility by recording walking performance
(treadmill). Treatment (n=77) and placebo groups (n=79) were comparable for age,
sex distribution, WOMAC and OA index scores, walking distances and use of NSAIDs.
The global WOMAC score decreased by 56 percent in the treatment group; walking
distance in the treadmill test was prolonged from 68 minutes at the start to 198
minutes after three months treatment. The use of drugs decreased by 58 percent
in the treatment group; gastrointestinal complications decreased by 63 percent
in the treatment group; and treatment costs were reduced significantly compared
with placebo. Researchers concluded, "Pycnogenol offers an option for reduction
of treatment costs and side effects by sparing anti-inflammatory drugs."
A similar study, conducted by Horphag, involved 37 patients with OA who
received either a placebo or Pycnogenol (50 mg, tid) for three months.15
There was a significant improvement in total WOMAC score and WOMAC subscale
score of pain and physical function at 60 and 90 days of treatment. There was
significant reduction in pain, stiffness, physical function and decreased usage
of NSAIDs in the Pycnogenol supplement group. An additional study aimed to
determine whether oral intake of Pycnogenol contains sufficient concentrations
of active principles to inhibit key mediators of inflammation.16
Blood samples from seven healthy volunteers were obtained before and after five
days administration of 200 mg/d Pycnogenol. It was found that Pycnogenol
effectively prevented inflammation disorders in patients by moderation the
immune system response.
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Break Down, Shake Down
Arthur Andrew Medical has focused its attempts on pinpointing digestive
abnormalities as the most common cause of arthritis. "A normal digestive tract
is permeable enough to allow nutrients to pass into the bloodstream. For
patients who have Leaky Gut Syndrome (LGS) or an abnormally high percentage of
permeability undigested food, particles such as fats, proteins, starches,
bacteria and even yeast can enter the bloodstream," Marsh said. As the
particulates ferment, they can cause the immune system to respond with
inflammation, the body’s way of trying to heal itself. "Unfortunately joint
material is dense and tends to resist expansion. When these areas become
inflamed, they can be extremely tender," he added.
In order to combat this inflammation, Arthur Andrew Medical has been studying
the efficacy of using enzymes. "A digestive enzyme can help to completely
assimilate food into usable nutrients. … The next step is to repair the small
intestine by using strong doses of probiotics and select enzymes, such as
chitin, protease and cellulose to eliminate yeast. Once the
yeast is eliminated, the probiotics can repair the micro-tears in the gut. …
Systemic enzymes can digest undigested food particles in the blood before they
can trigger an autoimmune response," he continued. Systemic enzymes help quickly
eliminate inflammation and modulate the immune system.
One study evaluated the effects of intra-articular injection of
carboxymethylated chitosan (produced by deacetylation of chitin) and tissue
inhibitor of metalloproteinase-1 (TIMP-1) on osteoarthritis.17 White
rabbits (n=32) underwent unilateral anterior cruciate ligament transection (ACLT)
and were randomly divided into groups, recieveing either injections of CMCTS of
varying levels or a placebo. According to the study, CMCTS may have a protective
effect on articular cartilage of OA.
A similar study with different enzymes assessed the efficacy of
poly(lactide-co-glycolide) (PLGA), poly(L-lactic acid) (PLA) and
poly(caprolactone) (PCL) on inflammation.18 Results showed
injection of 20 percent paclitaxel-loaded PLA microspheres significantly reduced
all measures of inflammation in the antigen arthritis rabbit model.
Neprinol®, an enzyme supplement from TMN Health, is purported to be an
anti-inflammatory. Its main ingredient, serrapeptase (Serratio
peptidase), is a proteolytic enzyme. In a study from researchers at the
University of Naples, Italy, the efficacy and tolerability of Serratio
peptidase were evaluated in a multicentre, double blind, placebo-controlled
study of 193 subjects suffering from acute or chronic ear, nose or throat
disorders.19 It was concluded that Serratio peptidase, among
other things, has anti-inflammatory activity and acts rapidly on localized
inflammation.
In one multi-centre, double blind, placebo-controlled trial, the clinical
efficacy of the anti-inflammatory enzyme serrapeptase was studied.20
Out of 174 patients who underwent Caldwell-Luc antrotomy for chronic abscesses,
88 received 10 mg of serrapeptase three times on the day before the operation,
once on the night of the operation and three times daily for five days after
operation; the other 86 received placebo. The degree of swelling in the
serrapeptase-treated patients. Maximal swelling throughout all the
post-operative points of observation was also significantly smaller in size in
the serrapeptase-treated group than in the placebo-treated group.
Herb is the Word
Popular in topical creams, herbs have been shown to provide temporary relief
of joint pain. One popular topical pain reliever, Stopain® by DRJ Group
Inc., contains peppermint oil and eucalyptus oil. "Peppermint and
eucalyptus are popular in topical creams due to their analgesic properties,"
explained Bob Miller, president and CEO, DRJ Group Inc. "In addition, Stopain’s
extra-strength spray and roll-on formulas contain glucosamine and
dimethylsulfone (MSM), essential nutrients that support joint health and
mobility." A study from Pharmaceutical Research, Utah, compared the efficacy of
an herbal ointment to a placebo ointment in relieving the pain and stiffness of
osteoarthritis.21 The herbal preparation contained substances
believed by alternative practitioners to be helpful in treating osteoarthritis.
Subjects were randomized to an active (n = 11) or a placebo (n = 8) group.
Herbal ointment and control contained small amounts of capsaicin and menthol and
were similar when applied. Significant differences between the active and
placebo groups for pain (P < 0.05) and stiffness (P < 0.05) were found when the
baseline phase was compared with the fourth week. An herbal ointment was shown
to be effective in relieving the pain and stiffness of osteoarthritis without
adverse effects. Another study added menthol to Celadrin and tested its
effectiveness.22 Individuals diagnosed with knee OA (n=10; age, 66.4
+/- 11.5 years) and severe pain of the elbow and wrist were tested for pain and
functional performance before and after one week of treatment with a topical
cream consisting of Celadrin and menthol applied twice per day. One week of
treatment with a topical cream consisting of Celadrin and menthol was effective
for reducing pain and improving functional performance in individuals with
arthritis of the knee, elbow and wrist. However, the study states that further
work is needed to determine the impact of menthol in such a cream.
Arnica (Arnica montana L), a flowering plant found predominantly
in Europe, is popular due to its anti-inflammatory effect. "Arnica has been
known for years for its healing abilities," Eileen Sheets, managing director,
Bioforce USA, said. "In order to really heal joints, you must get the
inflammation down. Arnica rub can pave the way for better results with
glucosamine and chondroitin," she continued. According to a recent study, the
sesquiterpene lactones (SL), secondary plant metabolites from the flowers of the
arnica plant, exert anti-inflammatory effects mainly by preventing nuclear
factor (NF)-kappaB activation because of alkylation of the p65 subunit.23
Unfortunately, the same study also found arnica has been classified as a plant
with strong potency to induce allergic contact dermatitis. However, another
study supported the use of arnica as a homeopathic remedy as an
anti-inflammatory.24 The anti-inflammatory effect of Arnica
montana 6cH was evaluated using acute and chronic inflammation models. In
the acute model, carrageenin-induced rat paw edema, the group treated with
Arnica montana 6cH showed 30 percent inhibition compared to control (P <
0.05). In the chronic model, Nystatin-induced oedema, the group treated three
days previously with Arnica montana 6cH had reduced inflammation six
hours after the inflammatory agent was applied.
There are numerous options for those suffering from arthritis. As a retailer,
adequate education on each specific option is a must, as well as educating
consumers. This will enable them to choose the most effective treatment for
their pain.
1. Lambert HL et al. "Calcium supplementation and bone mineral accretion in
adolescent girls: an 18-mo randomized controlled trial with 2-y follow-up."
Am J Clin Nutr. 2008; 87.2: 455-62.
2. Rude RK et al. “Magnesium deficiency and osteoporosis: animal and human
observations.” J Nutr Biochem. 2004;15(12):710-6.
3. Ryder KM et al. “Magnesium intake from food and supplements is associated
with bone mineral density in healthy older white subjects.” J Am Geriatr Soc.
2005; 53.11: 1875-80.
4. Galarraga B, et al. "Cod liver oil (n-3 fatty acids) as an non-steroidal
anti-inflammatory drug sparing agent in rheumatoid arthritis." Rheumatology
(Oxford). 2008 Mar 24 [Epub ahead of print].
5. Rahman MM et al. "Docosahexaenoic acid is more potent inhibitor of
osteoclast differentiation in RAW 264.7 cells than eicosapentaenoic acid." J
Cell Physiol. 2008 Jan;214(1):201-9.
6. Ren J et al. "In vivo and in vitro anti-inflammatory activities of alpha-linolenic
acid isolated from Actinidia polygama fruits." Arch Pharm Res. 2007
Jun;30(6):708-14.
7. Goldberg RJ et al. "A meta-analysis of the analgesic effects of omega-3
polyunsaturated fatty acid supplementation for inflammatory joint pain."
Pain. 2007 May;129(1-2):210-23.
8. Hesslink R et al. "Cetylated fatty acids improve knee function in patients
with osteoarthritis." J Rheumatol. 2002 Aug;29(8):1708-12.
9. Kraemer WJ et al. "Effect of a cetylated fatty acid topical cream on
functional mobility and quality of life of patients with osteoarthritis." J
Rheumatol. 2004 Apr;31(4):767-74.
10. Gregory PJ et al. "Dietary supplements for osteoarthritis." Am Fam
Physician. 2008 Jan 15;77(2):177-84.
11. Monfort J et al. "Biochemical basis of the effect of chondroitin sulfate
on osteoarthritis articular tissues." Ann Rheum Dis. 2007 Jul 20 [Epub
ahead of print]
12. Chou MM et al. "Effects of chondroitin and glucosamine sulfate in a
dietary bar formulation on inflammation, interleukin-1beta, matrix
metalloprotease-9, and cartilage damage in arthritis." Exp Biol Med
(Maywood). 2005 Apr;230(4):255-62.
13. Rozendaal RM et al. "Effect of glucosamine sulfate on hip osteoarthritis:
a randomized trial." Ann Intern Med. 2008 Feb 19;148(4):268-77.
14. Belcaro G et al. "Treatment of osteoarthritis with Pycnogenol((R)). The
SVOS (San Valentino osteo-arthrosis study). evaluation of signs, symptoms,
physical performance and vascular aspects." Phytother Res. 2008
Apr;22(4):518-23.
15. Farid R. et al. "Pycnogenol supplementation reduces pain and stiffness
and improves physical function in adults with knee osteoarthritis." Nutrition
Research. 2007 Nov; 27(11):692-697.
16. Grimm T et al. "Inhibition of NF-kappaB activation and MMP-9 secretion by
plasma of human volunteers after ingestion of maritime pine bark extract (Pycnogenol)."
J Inflamm (Lond). 2006 Jan 27;3:1.
17. Liu SQ "The effects of carboxymethylated chitosan on metalloproteinase-1,
-3 and tissue inhibitor of metalloproteinase-1 gene expression in cartilage of
experimental osteoarthritis." Rheumatol Int. 2005 Nov;26(1):52-7.
18. Liggins RT et al. "Intra-articular treatment of arthritis with
microsphere formulations of paclitaxel: biocompatibility and efficacy
determinations in rabbits." Inflamm Res. 2004 Aug;53(8):363-72.
19. Mazzone A et al. "Evaluation of Serratia peptidase in acute or chronic
inflammation of otorhinolaryngology pathology: a multicentre, double-blind,
randomized trial versus placebo." J Int Med Res. 1990
Sep-Oct;18(5):379-88.
20. Tachibana M et al. "A multi-centre, double-blind study of serrapeptase
versus placebo in post-antrotomy buccal swelling." Pharmatherapeutica.
1984;3(8):526-30.
21. McKay L et al. "Effect of a topical herbal cream on the pain and
stiffness of osteoarthritis: a randomized double-blind, placebo-controlled
clinical trial." J Clin Rheumatol. 2003 Jun;9(3):164-9.
22. Kraemer WJ. "A cetylated fatty acid topical cream with menthol reduces
pain and improves functional performance in individuals with arthritis." J
Strength Cond Res. 2005 May;19(2):475-80.
23. Lass C et al. "Anti-inflammatory and immune-regulatory mechanisms prevent
contact hypersensitivity to Arnica montana L." Exp Dermatol. 2008 Mar 12
[Epub ahead of print]
24. Macêdo SB et al. "Anti-inflammatory activity of Arnica montana 6cH:
preclinical study in animals." Homeopathy. 2004 Apr;93(2):84-7.
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