Many nutrients have been shown to help alleviate pain and even facilitate joint repair and healing in clinical studies; we discuss several below.

Glucosamine

Glucosamine is a naturally occurring substance in the body, synthesized by special cells in the body (called chondrocytes) for the purpose of producing joint cartilage. In osteoarthritis (OA), this synthesis is defective, and supplementation with glucosamine has proven useful in many scientific studies for osteoarthritis. Supplying an external source of glucosamine provides the body with additional raw materials to rebuild the joint.

Studies indicate that glucosamine is almost totally free of side effects, particularly when compared to NSAIDs. In addition, it has been shown to relieve most symptoms as effectively as the NSAIDs. In one well-designed study of 178 patients with OA of the knee, one group was treated for 4 weeks with glucosamine sulfate (1500 mg daily) and the other group was treated with ibuprofen (1200 mg daily). Glucosamine relieved the symptoms as effectively as ibuprofen and was significantly better tolerated (i.e., fewer side effects) than ibuprofen. The safety and tolerability of glucosamine can easily be explained by the fact that it is a substance normally used by the body.

As with most natural remedies, the therapeutic effect of glucosamine is not immediate. It usually takes 1-8 weeks to appear. Once achieved, it tends to persist for a notable time even after discontinuation glucosamine. The probably reason for this is that glucosamine is incorporated into rebuilding the cartilage itself.

Given the amount of available evidence, the comparisons with NSAIDs, and the number of positive double-blind, placebo-controlled studies (the gold standard in scientific human testing), glucosamine sulfate (used alone or in combination with chondroitin sulfate) should be used as a first natural choice for OA. The evidence shows that at the very least equally effective as NSAIDs and that it has much fewer side effects. Its ability to actually repair and improve joint function in addition to providing pain relief gives it a significant advantage compared to conventional treatments. In most studies, the dose has been 500 mg three times daily.

At least one study suggests that the sulfate salt of glucosamine is also an important component and the other salts, such as glucosamine hydrochloride, may not work as well. Sulfate is an important mineral in building cartilage.

Studies indicate that glucosamine sulfate and chondroitin sulfate work synergistically to provide a greater benefit combined than either does separately. Glucosamine has been shown to increase the production of beneficial joint compounds and chondroitin sulfate has demonstrated ability to inhibit joint deterioration. Thus, used together they have shown a marked ability to improve joint health.

Chondroitin Sulfate

Chondroitin sulfate is a major component of cartilage. It is a very large molecule, composed of repeated units of glucosamine sulfate. Although the absorption of chondroitin sulfate is much lower than that of glucosamine (10-15% versus 90-98%), a few studies have shown very good results from long-term treatment with chondroitin sulfate, reducing pain and increasing range of motion.

Chondroitin sulfate has an excellent safety record, with no known toxicity. In repeated clinical studies oral chondroitin sulfate (1200 mg/day) was consistently effective in reducing OA symptoms, and was very well tolerated (no side effects). In most studies, the dose has been 400 mg three times daily.

Studies indicate that glucosamine sulfate and chondroitin sulfate work synergistically to provide a greater benefit combined than either does separately. Glucosamine has been shown to increase the production of beneficial joint compounds and chondroitin sulfate has demonstrated ability to inhibit joint deterioration. Thus, used together they have shown a marked ability to improve joint health.

Purity and Labeling of Glucosamine and Chondroitin Sulfate Products

Glucosamine and chondroitin sulfate are both obtained from animal tissue sources, and purity can vary widely depending upon the extraction techniques and analysis technology. The studies of glucosamine and chondroitin sulfate referenced in this article were all conducted using carefully assayed, purified compounds. The purity of the compounds used can certainly be expected to affect the outcome.

Furthermore, glucosamine and chondroitin sulfate are considered dietary supplements, and are therefore not regulate by the Food and Drug Administration. Although many brands of chondroitin sulfate and glucosamine are available over the counter, independent laboratory analysis has shown that many products do not actually contain the amounts claimed on the label.

For instance, in a recently published study done at the Pharmacy School at the University of Maryland 32 bottles of chondroitin sulfate were purchased at pharmacies and health food stores. Only 2 of the products met label claims while 14 of the 32 bottles purchased contained 10% or less of the label claim. What were the buyer’s chances of getting a good product when only 2 of 32 products met their label claim?

Purchasers of dietary supplements should be careful to buy from reputable sources that use quality-control programs to validate raw material and finished product purity. See our discussion on Why Quality Matters for more information.

Hydrochloric Acid

Improper digestion is often one of the major factors in rheumatoid arthritis. Proper digestion is dependant on two major classes of compounds: hydrochloric acid and digestive enzymes. Thus, if low hydrochloric acid production is one of your underlying factors, supplementing hydrochloric acid will improve digestion.

The following challenge protocol for hydrochloric acid supplementation was developed by Jonathan Wright, MD:

Begin by taking one tablet… (600 mg) of hydrochloric acid (Metagest) at your next large meal. If this does not produce a warming sensation or abdominal discomfort, at every meal after that of the same size take one more tablet. Continue to increase the dose until you reach seven tablets or when you feel a warmth in your stomach or abdominal discomfort, whichever occurs first. A feeling of warmth in the stomach means that you have taken too many tablets for that meal, and you need to take one less tablet for that meal size. It is a good idea to try the larger does again at another meal to make sure that it was the hydrochloric acid that caused the warmth and not something else.

After you have found the largest does that you can take at your large meals without feeling any warmth, maintain that dose at all meals of similar size. You will need to take less at smaller meals. When taking a number of tablets it is best to take them throughout the meal.

As your stomach begins to regain the ability to produce the amount of hydrochloric acid needed to properly digest your food, you will notice the warm feeling again and will have to cut down the dose level.

Proteases

While starch and fat digestion can be carried out satisfactorily without the help of pancreatic enzymes, the proteases are critical to proper protein digestion. Incomplete digestion of proteins creates a number of problems for the body, including the development of allergies and formation of toxic substances produced during putrefaction. Putrefaction refers to the breakdown of protein material by bacteria.

As well as being necessary for protein digestion, the proteases serve several other important functions. For example, the proteases, as well as other digestive secretions, are largely responsible for keeping the small intestine free from parasites (including bacteria, yeast, protozoa, and intestinal worms). A lack of proteases or other digestive secretions greatly increases an individual’s risk of having an intestinal infection, including an overgrowth of the yeast Candida albicans.

The proteases are also of benefit in treating food allergies. In order for a food molecule to produce an allergic response it must be a fairly large molecule. In studies performed in the 1930s and 1940s, pancreatic proteases were shown to be quite effective in treating food allergies. It appears that many practitioners are not aware of, or they have forgotten about, these early studies. Typically individuals who do not secrete enough proteases will suffer from multiple food allergies. It appears that many individuals with rheumatoid arthritis may secrete insufficient amounts of proteases.

The proteases are also important in preventing tissue damage during inflammation and the formation of fibrin clots. Proteases cause an increase in the breakdown of fibrin, a process known as fibrinolysis. Fibrin’s role in the promotion of inflammation is to form a wall around the area of inflammation that results in the blockage of blood and lymph vessels which leads to swelling. Fibrin can also cause the development of blood clots which can become dislodged and produce strokes or heart attacks. Protease enzymes are often used in the treatment of thrombophlebitis, a disease in which blood clots develop in veins, which become inflamed, and can dislodge and cause strokes or heart attacks.

Pancreatic enzymes and protease enzyme preparations have been shown to be useful in the treatment of many acute and chronic inflammatory conditions that are associated with high levels of circulating immune complexes. Diseases associated with high levels of circulating immune complexes include rheumatoid arthritis, lupus erythematosus, periarteritis nodosa, scleroderma, ulcerative colitis, Crohn’s disease, and multiple sclerosis. The presence of immune complexes are thought to contribute greatly to the disease process in rheumatoid arthritis. Experimental and clinical studies have shown that protease enzyme preparations are extremely effective in reducing circulating immune complex levels with clinical improvements that correspond with decreases in immune complex levels.

Vascuzyme is a wonderful combination of proteases along with other nutritional factors to help reduce inflammation and pain.

Dietary Fats

Fatty acids are important mediators of allergy and inflammation through their ability to form inflammatory prostaglandins, thromboxanes, and leukotrienes. Altering dietary oil intake can significantly increase or decrease inflammation depending on the type of oil being increased.

By altering the type of dietary oils consumed and stored in cell membranes, prostaglandin metabolism can be manipulated. Prostaglandin manipulation can be extremely powerful in the treatment of inflammation, allergies, high blood pressure, and many other health conditions. The basic goal in most situations is twofold: (1) reduce the level of arachidonic acid, and (2) increase the level of EFA. Vegetarian diets are often beneficial in the treatment of many chronic allergic and inflammatory conditions including rheumatoid arthritis, presumably as a result of decreasing the availability of arachidonic acid for conversion to inflammatory prostaglandins and leukotrienes while simultaneously supplying linoleic and linolenic acids. In addition, many nutrition-oriented physicians recommend GLA, flaxseed oil, or fish oil supplements to further modify prostaglandin synthesis.

Fish (especially deep sea fatty fish including salmon, tuna, halibut, mackerel and trout) and flaxseed oil are good dietary sources of essential fatty acids.

Omega-3 Fatty Acids

The studies of fish oil supplementation in arthritis have demonstrated excellent, consistent results in regards to relieving tender joints and morning stiffness and reducing inflammation, in some cases eliminating the need for NSAID medication.. The first double blind, placebo-controlled study of rheumatoid arthritis patients using 1.8 grams of EFA a day showed less morning stiffness and tender joints. These results led to considerable scientific interest as well as numerous popular press accounts of the possible benefits of fish oil for allergic and inflammatory condition.

Over a dozen follow-up studies have consistently demonstrated positive benefits. As well as improvements in symptoms (morning stiffness and joint tenderness), fish oil supplementation has produced favorable changes in suppressing the production of inflammatory compounds secreted by white blood cells.

While the results of these studies are impressive, all of these studies were relatively short-term (less than one year). In order to properly assess the beneficial effect of any treatment of rheumatoid arthritis, it is extremely important to evaluate patients over an extended period of time (ideally, at least one year) as the condition is associated with ups and downs in symptom severity. Recently, a one-year study of fish oil supplementation in rheumatoid arthritis was completed. The results clearly indicated that supplementation with 2.6 g per day of omega-3 oil (six 1 gram capsules of fish oil per day) resulted in significant clinical benefit and led to significant reductions in the need for drug therapy. The results of this long-term study provide further validation of the short-term studies.

The results of the studies suggest that the effective dose of fish oil is 3-6 grams a day. As drug toxicity is estimated to contribute 60% of the total cost of treating RA patients in the United States. Use of omega-3 oils in the diet would appear to offer a simple, safe, and inexpensive way to reduce toxicity and side effects from OA and RA medications.

EPA-DHA Complex and Omega EFA are two great supplemental sources of omega-3 fatty acids.

Dietary Antioxidants

Oxidative stress or free-radical damage is a factor of importance in the development of OA, just as it is a major cause of most chronic degenerative disease as well as aging. There is also strong evidence that oxidative damage occurs in RA patients. In order to counteract free-radical damage, antioxidants are needed.

The importance of consuming a diet rich in fresh fruits and vegetables cannot be overstated in the dietary treatment of arthritis. These foods are the best sources of dietary antioxidants. However, this may not always be enough, and supplementation is often necessary.

While the benefits of vitamin C, beta carotene, vitamin F, selenium, and zinc as antioxidant nutrients are becoming well-recognized and well-accepted, there are still other plant compounds which promote healthy joints. Of particular benefit in rheumatoid arthritis are flavonoids.

Oxitrol contains a broad spectrum of potent anti-oxidants that can prove very useful in obtaining and maintaining joint health.

Flavonoids

The flavonoids are a group of plant pigments largely responsible for the colors of fruits and flowers. However, they serve more than aesthetic functions. In plants, flavonoids serve as protection against environmental stress. In humans, flavonoids appear to function as “biological response modifiers.” Flavonoids appear to modify the body’s reaction to other compounds such as allergens, viruses, and carcinogens as evidenced by their anti-inflammatory, anti-allergic, antiviral, and anticancer properties. Flavonoid molecules are quite unique in that they are active against a wide variety of oxidants and free radicals.

Recent research suggests that flavonoids may be useful in the support of many health conditions. In fact, many of the medicinal actions of foods, juices, herbs, pollens, and propolis are now known to be directly related to their flavonoid content. Over 4,000 flavonoid compounds have been characterized and classified according to chemical structure.

Different foods will provide different flavonoids and different benefits. For example, the flavonoids responsible for the red to blue colors of blueberries, blackberries, cherries, grapes, hawthorn berries, and many flowers are termed “anthocyanidins” and “proanthocyanidins.” These flavonoids are found in the flesh of the fruit as well as the skin and possess very strong “vitamin P” activity. Among their effects is an ability to increase vitamin C levels within our cells, decrease the leakiness and breakage of small blood vessels, protect against free radical damage, and support our joint structures.

These flavonoids have a very beneficial effect on collagen. Collagen is the most abundant protein of the body and is responsible for maintaining the integrity of “ground substance.”

Ground substance is responsible for holding together the tissues of the body. Collagen is also found in tendon, ligaments, and cartilage. Collagen is destroyed during inflammatory processes that occur in rheumatoid arthritis, gout, and other inflammatory conditions involving bones, joints, cartilage, and other connective tissue. Anthocyanidins and other flavonoids affect collagen metabolism in many ways:

• They have the unique ability to actually cross-link collagen fibers resulting in reinforcement of the natural cross-linking of collagen that forms the so-called collagen matrix of connective tissue (ground substance, cartilage, tendon, etc.).


• They prevent free radical damage with their antioxidant and free radical scavenging action.


• They inhibit destruction to collagen structures by enzymes secreted by our own white blood cells during inflammation.


• They prevent the release and synthesis of compounds that promote inflammation such as histamine.

These remarkable effects on collagen structures and their potent antioxidant activity make flavonoid components of berries extremely important in any form of arthritis.

Perimine is a flavonoid rich supplement that has demonstrated benefits for immune regulation that can be particularly beneficial in rheumatoid arthritis.

Selenium and vitamin E

Selenium levels are low in patients with rheumatoid arthritis. Low selenium levels may be a significant nutritional factor as selenium plays an important role as an antioxidant and serves as the mineral cofactor in the free radical scavenging enzyme glutathione peroxidase. This enzyme is especially important in reducing the production of inflammatory prostaglandins and leukotrienes.

Clinical studies have not yet clearly demonstrated that selenium supplementation alone improves the signs and symptoms of rheumatoid arthritis, however, one clinical study indicated that selenium combined with vitamin F had a positive effect. Vitamin F is an important antioxidant, working synergistically with selenium.

The selenium content of foods varies widely. The best sources are fish and grains. However, the amount of selenium in grains and other plant foods is directly related to the amount of selenium available in the soil.

Zinc

Zinc has antioxidant effects and functions in the antioxidant enzyme superoxide dismutase (copper-zinc SOD). Zinc levels are typically reduced in patients with rheumatoid arthritis, and several studies have used zinc in the treatment of rheumatoid arthritis, with some of the studies demonstrating a slight therapeutic effect. Most of the studies utilized zinc in the form of sulfate. Better results may be produced by using a form of zinc with a higher absorption rate such as zinc picolinate, zinc monomethionine, or zinc citrate. In addition to eating foods rich in zinc, like whole grains, nuts, and seeds, individuals with rheumatoid arthritis should supplement their diet with an additional 30 to 45 mg of zinc daily, preferably by using one of the more absorbable forms of zinc.

Manganese and superoxide dismutase

Manganese functions in a different form of the antioxidant enzyme superoxide dismutase (manganese SOD). Manganese-containing SOD is deficient in patients with rheumatoid arthritis. The injectable form of this enzyme (available in Europe) has been shown to be effective in the treatment of rheumatoid arthritis, however, it is not clear if any orally administered SOD can escape digestion in the intestinal tract and exert a therapeutic effect. In one study, oral SOD was shown not to affect tissue SOD levels.

Perhaps a better and more economical method of raising SOD is to supplement the diet with additional manganese. Manganese supplementation has been shown to increase SOD activity, indicating increased antioxidant activity. Although no clinical studies have been conducted to determine the effectiveness of manganese supplementation in rheumatoid arthritis, it appears to be indicated, based on the low levels seen in patients with rheumatoid arthritis as well as its biochemical functions. The standard recommendation for patients with rheumatoid arthritis is to supplement their diet with an additional 5 to 15 mg of manganese per day. Good dietary sources include nuts, whole grains, dried fruits, and green leafy vegetables. Meats, dairy products, poultry, and seafood are considered poor sources of manganese.

Vitamin C

Vitamin C functions as an important antioxidant. The white blood cell and plasma concentrations of vitamin C are significantly decreased in rheumatoid arthritis patients. Supplementation with vitamin C increases SOD activity, decreases histamine levels, and provides some anti-inflammatory action. In addition to consuming foods rich in vitamin C, such as broccoli, Brussels sprouts, cabbage, citrus fruits, tomatoes, and berries, it is recommended that patients with rheumatoid arthritis supplement their diet with an additional 1,000 to 3,000 mg of vitamin C daily in divided doses.

Ultra Potent C Powder or Ultra Potent C Tablets provide high doses of buffered vitamin C that are essential for proper joint repair and function.

Curcumin (Curcuma longa) - Turmeric

Curcumin, the yellow pigment of Curcuma longa (turmeric), appears to be one of nature’s most potent anti-inflammatory agents. Turmeric is extensively used in foods both for its color and flavor. In addition, it is used in both the Chinese and Indian (Ayurvedic) systems of medicine as an anti-inflammatory agent.

Turmeric and its derivatives have a great deal of pharmacological activity. Although a number of components have exerted activity, curcumin is the most potent compound. Curcumin is a powerful antioxidant and has greater effects in preventing free radical damage compared to vitamin C, vitamin F, and superoxide dismutase. However, the protective effects curcumin has against inflammation and joint damage is only partially explained by its direct antioxidant and free radical scavenging effects. Additional mechanisms include enhancement of the body’s natural antioxidant system; increasing the activity of the body’s own anti-inflammatory mechanisms; and exerting direct anti-inflammatory action, acting directly on several enzymes and gene loci.

Numerous experimental studies have demonstrated curcumin produces exceptional anti-inflammatory effects. Curcumin is as effective as cortisone or the potent anti-inflammatory drug phenylbutazone in models of acute inflammation. However, while phenylbutazone and cortisone are associated with significant toxicity, curcumin is without side effects.

Curcumin exhibits many direct anti-inflammatory effects including the formation of leukotrienes and other mediators of inflammation. However, curcumin also appears to exert some indirect effects. In models of chronic inflammation, curcumin is much less active in animals that have had their adrenal glands removed. This observation means that curcumin works to enhance the body’s own anti-inflammatory mechanisms. Possible mechanisms of action include: (1) stimulation of the release of adrenal corticosteroids; (2) “sensitizing” or priming cortisone receptor sites, thereby potentiating cortisone action; and (3) preventing the breakdown of cortisone.

Curcumin has demonstrated some beneficial effects in human studies comparable to standard drugs. In one double-blind clinical trial in patients with rheumatoid arthritis, curcumin at 1,200 mg per day was compared to phenylbutazone at 300 mg per day. The improvements in the duration of morning stiffness, walking time, and joint swelling were comparable in both groups. However, it must be pointed out that while phenylbutazone is associated with significant adverse effects, curcumin has not been shown to produce any side effects at the recommended dosage level.

In another study that used a new human model for evaluating NSAIDs, the postoperative inflammation model, curcumin was again shown to exert comparable anti-inflammatory action to phenylbutazone. It must be pointed out that while curcumin has an anti-inflammatory effect similar to phenylbutazone and various NSAIDs, it does not possess direct analgesic action.

The results of these studies indicate that turmeric or curcumin may provide benefit in the treatment of flare-ups of inflammation in rheumatoid arthritis. Furthermore, the safety and excellent tolerability of curcumin compared to standard drug treatment is a major advantage. Toxicity reactions to curcumin have not been reported. Animals fed very high levels of curcumin (3 g/kg body weight) have not exhibited any significant adverse effects. The recommended dosage for curcumin as an anti-inflammatory agent is 400 to 500 mg three times a day.

High doses of curcumin can be found in Inflavanoid Intensive Care and UltraInflamX; these products also include many other beneficial vitamins, minerals and nutritional support (including ginger) to reduce pain and inflammation and speed the healing process.

Ginger (Zingiber officinalis)

Ginger has been used for thousands of years in China for medicinal purposes. Chinese records dating from the 4th century B.C. indicate that it was used to treat numerous conditions including “rheumatism.” Ginger possesses numerous pharmacological properties. The most relevant in rheumatoid arthritis are its antioxidant effects—inhibition of prostaglandin, thromboxane, and leukotriene synthesis, and anti-inflammatory effects.

Ginger’s ability to inhibit the formation of inflammatory mediators along with its strong anti-oxidant activities and protease component suggest a possible benefit in inflammatory conditions. To test this hypothesis, a preliminary clinical study was conducted on seven patients with rheumatoid arthritis, in whom conventional drugs had provided only temporary or partial relief. All patients were treated with ginger. One patient took 50 grams per day of lightly cooked ginger while the remaining six took either 5 grams of fresh or 0.1 to 1 gram of powdered ginger daily. Despite the difference in dosage, all patients reported substantial improvement, including pain relief, joint mobility, and decrease in swelling and morning stiffness.

In the follow-up to this study, 28 patients with rheumatoid arthritis, 18 with osteoarthritis, and 10 with muscular discomfort who had been taking powdered ginger for periods ranging from three months to 2.5 years were evaluated. Based on clinical observation, it was reported that 75% of the arthritis patients and 100% of the patients with muscular discomfort experienced relief in pain or swelling. The recommended dosage was 500 to 1,000 mg per day, but many patients took three to four times this amount. Patients taking the higher dosages also reported quicker and better relief.

High doses of ginger can be found in Inflavanoid Intensive Care and UltraInflamX; these products also include many other beneficial vitamins, minerals and nutritional support (including curcumin) to reduce pain and inflammation and speed the healing process.

Boswellia Gum (Boswellia serrata)

Boswellia is a large branching tree found in India, Northern Africa, and the Middle East. Strips of the bark are peeled away, yielding a gummy resin that contains oils, terpenoids, and gum. Boswellic acids are the major constituents of the gum resin and are thought to be the important active components. Extracts of this gum resin have been traditionally used for centuries in the Ayurvedic system of herbalism for relief of minor pain and to support healthy joint function. Boswellic acids have been found in vitro to be potent, selective inhibitors of 5-lipoxygenase, the key enzyme of leukotriene synthesis.

High doses of boswellia can be found in Inflavanoid Intensive Care; this product also includes many other beneficial vitamins, minerals and nutritional support (including curcumin and ginger) to reduce pain and inflammation and speed the healing process.