Arthritis – A Nutritional Approach to Pain Management

As our patients become older, the wear and tear on their joints begins to take its toll. As joint degeneration progresses, their lives may become restricted to activities which do not cause them pain, and this may limit their ability to exercise. Helping our patients to live the best quality of life possible, to help them to live as independently as possible and play with their grandchildren in the park, is the most motivating goal we can hope to achieve. Providing support to reduce chronic pain and manage joint dysfunction and repair of age-related joint injuries with proven clinical efficacy becomes paramount.

Ow! My Knees! My Back!

Many conditions seen in the clinical setting, including osteoarthritis, rheumatoid arthritis, and other degenerative and inflammatory joint conditions, may benefit from nutritional support. Gelatin has been used in traditional Western medicine for centuries to provide symptomatic relief of painful joints. Gelatin is a heterogeneous mixture of polypeptides produced by the partial hydrolysis of collagen.[1] When given at a dose of 10 g/day, studies show that gelatin is effective for the management of osteoarthritis and may reduce analgesic consumption by up to 50%.[2]  The amino acid monosaccharide, glucosamine, is used in the synthesis of articular cartilage components such as glycosaminoglycans and proteoglycans.  Glucosamine sulphate also provides a source of sulphate ions required for the structural component of cartilage.[3] A systematic review has found that glucosamine, on average, reduced osteoarthritis knee pain by up to 50% and improved physical functioning.[4] Using glucosamine and methylsulfonylmethane (MSM) together has been shown to be superior to either of these ingredients alone for the treatment of osteoarthritis.[5] The combination of nutrients found in Gelatin Complete Joint Restore Powder may be used in the treatment of osteoarthritic conditions and other degenerative joint diseases to improve mobility, decrease inflammation and promote healing.

Creaking Joints

While acute treatment is important to decrease symptoms, increase mobility and improve quality of life, long-term management of degenerative conditions is equally important for patients who have been living with these conditions for long periods of time. Silica is known for its role in the formation and maintenance of bone and cartilage. Within connective tissue, it becomes chemically bonded to glycosaminoglycans within the joint matrix to provide structural integrity to the joint.[6] The trace element manganese forms a part of the enzyme manganese-containing superoxide dismutase (Mn-SOD) which removes damaging free radicals and provides protection of the joints.[7] Connective Tissue Maintenance combines these minerals with zinc, boron and glucosamine in a joint maintenance formula which improves joint mobility and provides long-term protection against joint degeneration.

Fire in the Knees!

As Practitioners, our first goal may be to help our patients get out of bed first thing in the morning without pain, or reduce the pain in their knees from walking up stairs. High Potency Anti-Inflammatory Herbs contains a combination of herbs and nutrients that reduce both acute pain and inflammation, and can be used in combination with Gelatin Complete Joint Restore Powder or Connective Tissue Maintenance to provide acute symptomatic relief of pain and inflammation. Both turmeric and boswellia have been used in traditional herbal medicine to provide relief from pain and inflammation.[8],[9],[10] Combined with ginger, quercetin and capsaicin, High Potency Anti-Inflammatory Herbs reduces inflammation by blocking the activation of nuclear factor kappa B (NFĸB) and other inflammatory enzymes within the downstream section of the inflammatory cascade.

However, if the inflammation is chronic in nature, as experienced in patients with ongoing osteoarthritis, rheumatoid arthritis or long-term pain, BCM-95™ Turmeric & Devil’s Claw to Treat Chronic Inflammation is the combination of choice. Table 1 outlines the results of clinical trials on pain and inflammation using BCM-95™ turmeric, boswellia and devil’s claw, the key ingredients in this formula.

Table 1. Clinical studies on turmeric, boswellia and devil’s claw for pain and inflammatory disorders

Condition Ingredient* Duration Results Ref.
Osteoarthritis 17.5 g/day BCM-95™ Turmeric and 3 g/day BosPure® 12 weeks More effective than COX-2 inhibitor for osteoarthritis symptoms [11]
Rheumatoid arthritis 25 g/day BCM-95™ Turmeric 2 weeks As effective as NSAIDs for reducing pain, stiffness and swelling [12]
Osteoarthritis, knee Boswellia (30 or 75 mg AKBA/day) 3 months Improvement in pain and physical function [13]
Osteoarthritis, knee Boswellia (20 mg AKBA/day) 5-30 days Improvement in pain and physical function [14]
Osteoarthritis, knee Boswellia (20 mg AKBA/day) 8 weeks decrease pain, increased mobility and walking distance [15]
Low back pain Devil’s claw (60  mg harpagosides/day) 6 weeks Pain reduction and less medication required. As effective as NSAIDs [16]
Osteoarthritis and  rheumatic conditions Devil’s claw
1.4-2.9 g/day
8 weeks Reduced pain, stiffness. Improved function and quality of life [17]

Putting Out the Fire of Pain

Muscle pain frequently coincides with arthritis. Meta Mag®- Magnesium Bisglycinate, Corydalis and California Poppy for Pain contains magnesium alongside the herbs corydalis and California poppy, which possess analgesic actions to assist with pain relief. Magnesium exerts muscle-relaxing actions via multiple mechanisms and is a natural glutamate antagonist. Glutamate is involved in central sensitisation and pain amplification. Corydalis contains the alkaloid compounds dehydrocorybulbine (DHCB) and L-tetrahydropalmatine (1-THP), which mediate its analgesic effects in both inflammatory and neuropathic pain.[18] Corydalis has demonstrated an effect equal to the non-steroidal anti-inflammatory (NSAID) diclofenac sodium in a study of 79 patients with knee osteoarthritis.[19] This formula also contains California poppy, which has been used traditionally in Western herbal medicine for its pain-relieving properties and to promote calm sleep without the disadvantages of potential additive effect.[20] Furthermore, it demonstrates mild sedative and anxiolytic effects with an affinity for GABA receptors.[21]

 

Oiling the Joints

In cases of both acute and chronic inflammation, omega-3 essential fatty acids are indicated. The inflammation process in the body consists of the onset and resolution stage. The transition to resolution, which is mediated by fatty acids known as specialised pro-resolving mediators (SPMs), transforms the pro-inflammatory environment into an anti-inflammatory environment to restore tissue homeostasis.[22] Arachidonic acid is the precursor for one series of SPMs – lipoxins, whilst eicosapentaenoic acid (EPA) provides resolvins and docosahexaenoic acid (DHA) is the source of protectins and maresins.[23] Patients get enough arachidonic acid for lipoxin synthesis but insufficient intake of EPA/DHA for resolvin, protectin and maresin synthesis. As arachidonic acid is also a pro-inflammatory molecule in its own right, correcting this ratio through diet and the supplementation of EPA and DHA is prudent to allow patients the best possible recovery. Studies show that administration of 2.4 g/day EPA/DHA in healthy subjects[24] and 4 g/day EPA/DHA in patients with chronic kidney disease[25] resulted in a significant increase in plasma concentrations of SPMs. If resolution fails to occur, chronic inflammation sets in.

In addition, studies show that supplementation of 2.7 g of combined EPA and DHA over a 3-4 month period significantly reduced reported joint pain intensity, the duration of morning stiffness, the number of painful/tender joints and NSAID usage in patients.[26] High Potency Ultra Pure EPA/DHA Liquid containing 2.7 g of Omega-3 per dose will provide anti-inflammatory support to patients.

 

Keeping Joints Ship Shape!

For large portions of the population, degenerative joints diseases such as osteoarthritis are a part of everyday life. With an ageing population and the rate of osteoarthritis expected to increase, it is vital as Practitioners that we are able to provide treatment options that address acute symptomatic relief as well as also targeting the cause of the problem. Decreasing inflammation, providing nutritional support for joints, and rebuilding the cartilage in worn joints will mean that our patients will suffer from less pain and be able to stay active, walk up stairs without pain, enjoy family life and keep their independence. An integrative approach, incorporating physiotherapists and other healthcare professionals to help combine exercise programs with nutritional and herbal support, will address both diet and lifestyle, and may greatly improve your patients’ symptoms and quality of life. We have many tools available to improve joint health, and the combination of all of them is far better than the sum of their parts.

References

[1] Moskowitz RW. Role of collagen hydrolysate in bone and joint disease. Semin Arthritis Rheum. 2000 Oct;30(2):87-99.

[2] Adam M. Welche Wirkung haben Gelatinepraparate? Ther Osteoarthrose Therapiewoche. 1991;41:2456-61 Cited in: Bello AE,

Oesser S. Collagen hydrolysate for the treatment of osteoarthritis and other joint disorders: a review of the literature. Curr Med Res Opin. 2006 Nov;22(11):2221-2232.

[3] Usha PR, Naidu MU. Randomised, double-blind, parallel, placebo-controlled study of oral glucosamine, methylsulfonylmethane and their combination in osteoarthritis. Clin Drug Investig. 2004;24(6):353-363.

[4] Poolsup N, Suthisisang C, Channark P, et al. Glucosamine long-term treatment and the progression of knee osteoarthritis:

systematic review of randomized controlled trials. Ann Pharmacother. 2005 Jun;39(6):1080-1087.

[5] Usha PR, Naidu MU. Randomised, double-blind, parallel, placebo-controlled study of oral glucosamine, methylsulfonylmethane and their combination in osteoarthritis. Clin Drug Investig. 2004;24(6):353-363.

[6] Carlisle EM. Silica as a trace nutrient. Sci Tot Environ. 1988;73:95-106.

[7] Herrero-Beaumont G, Ivorra JA, Trabado M, et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, doubleblind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum. 2007 Feb;56(2):555-567.

[8] Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Revised edition. Seattle, Washington: Eastland Press. 1993:272-273.

[9] Kuang L, Zhang K, editors. Chinese Pharmacopoeia Commission. Pharmacopoeia of the People’s Republic of China. Vol 1. Beijing: People’s Medical Publishing House. 2005:260-261.

[10] Pole S. Ayurvedic Medicine: The Principles of Traditional Practice. Philadelphia: Elsevier/Churchill Livingstone. 2006:179-180,228-233.

[11] Kizhakkedath R. Clinical evaluation of a formulation containing Curcuma longa and Boswellia serrata extracts in the management of knee osteoarthritis. Molecular Medicine Reports. 2013;8:1542-1548.

[12] Chandran B, Goel A.  A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytotherapy research. 2012;26.11:1719-1725.

[13] Sengupta K, Alluri KV, Sathis AR, et al. A double blind, randomised, placebo controlled study of the efficacy and safety of 5-Loxin® for treatment of osteoarthritis of the knee. Arthritis Research and Therapy. 2008;10(4):R85.doi: 10.1186/ar2461.

[14] Vishal AA, Mishra A, Raychaudhuri SP, et al. A double blind, randomised, placebo controlled clinical study evaluates the early efficacy of Aflapin® in subjects with osteoarthritis of knee. International Journal of Medical Sciences. 2011;8(7):615-622.

[15] Kimmatkar N, Thawani V, Hingorani L, et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double blind placebo controlled trial. Phytomedicine. 2003 Jan;10(1):3-7.

[16] Chrubasik S, Model A, Black A, et al. A randomised double-blind pilot study comparing Doloteffin® and Vioxx® in the treatment of low back pain. Rheumatology. 2003;42:141-148.

[17] Warnock M, McBean D, Suter A, et al. Effectiveness and safety of devil’s claw tablets in patients with general rheumatic disorders. Phytotherapy Research. 2007;21:1228-1233.

[18] Ingram SL. Pain: novel analgesics from traditional Chinese medicines. Current Biology. 2013;24(3):R114-R116.

[19] Zuo C, Yin G, Cen XM, et al. Controlled clinical study on compound Decumbent Corydalis Rhizome and diclofenac in treatment of knee osteoarthritis. Zhongguo Zhong Yao Za Zhi. 2015;40(1):149-153.

[20] Bone K. California poppy. In: A Clinical Guide to Blending Liquid Herbs. Warwick: Elsevier/Churchill Livingstone. 2003;124-126.

[21] Rolland A, Fleurentin J, Lanhers, MC, et al. Neurophysiological effects of an extract of Eschscholzia californica Cham. (Papaveraceae). Phytotherapy Research. 2001;15:377-381.

[22] Ortega-Gomez A, Perretti M, Soehnlein O. Resolution of inflammation: an integrated view. EMBO Mol Med. 2013;5:661–674.

[23] Buckley CD, Gilroy DW, Serhan CN. Proresolving Lipid Mediators and Mechanisms in the Resolution of Acute Inflammation. Immunity 2014;40:315-327.

[24] Barden A, Mas E, Croft KD, et al. Short-term n-3 fatty acid supplementation but not aspirin increases plasma proresolving mediators of inflammation. J Lipid Res. 2014 Nov;55(11):2401-2407.

[25] Mas E, Barden A, Burke V, et al. A randomised controlled trial of the effects of n-3 fatty acids on resolvins in chronic kidney disease. Clin Nutr. 2015 Apr;35:331-336.

[26] Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain 2007;129(1-2):210-223.

Comments are closed.