Osteoarthritis Diet & Nutrition Discussion
Many years ago Dr. Max Warmbrand developed a since somewhat controvesial diet which was free of poultry, meat, dairy, sugar, processed foods, chemicals, and eggs for people with OA and rheumatoid arthritis. He claimed marked success anecdotally1 indicating that positive results required 6 months on the diet. The diet remains untested and while it is a healthy diet and may reduce disease risk, it's not easy for most patients. For that reason it is generally tried when all other avenues have failed.
Solanine - nightshade family
Nightshade plants - tomatoes, white potatoes, peppers, eggplant - contain solanine. Solanine is a toxin but is usually destroyed through the natural digestive process. One unproven theory is that some people may be unable to digest solanine and render it harmless. Such resulting absorption into the physiology could aggrevate OA. However, removing solanine from one's diet reportedly brought relief to some patients with arthritis.2 3
One survey reported that 28% of patients who avoid nightshade plants have a "marked positive reponse" and 44% more, a "positive response."
Interestingly, a study demonstrated that solanine damaged the membrane of mitochondria (cellular power plants) in liver cells.106 It is an angle of possible investigation.
There may be a link between food allergies and sensitivities and OA, although past studies have been aimed at rheumatoid arthritis.4 Food allergy testing and elimination should be considered if other therapies are not helpful.
The linings of joints contain a significant amount of chondroitin sulfate (CS), whose molecular structure is similar to glucosamine sulfate. It has been reported that there are lower levels of CS in cartilage of patients with osteoarthritis, and therefore, supplementing with CS might help to revive joint functioning.20 Although it was once felt that CS consumed orally was not absorbable,21 early administration of CS in research was accomplished with injections which reported benefits.22 23 It is now known that orally administered CS is absorbable24 and that pre-dissolving it in water and drinking the water is better than taking pills orally.25
There is now good evidence that oral supplementation is effective. It has been demonstrated that it consistently improves mobility of joints, reduces pain, and heals joint tissues, as, in part, evidenced by x-ray examination.26-35 The amount of 400mg 2 to 3 times daily is most often tested, but it has also been reported that taking 1200mg once/daily is just as efficient.36 Supplementation needs to continue for several months to see results.
S-adenosyl methionine (SAMe) is a nutrient that reduces inflammation and pain and heals damaged tissue. It may support joint health,37, 38 An no-placebo study found that it was helpful for 71% of more than 20,000 patients with osteoarthritis.39 Additionally, a number of double-blind studies have found that it lessens stiffness, pain and swelling as well as drugs (ie, ibuprofen, naproxen) and better than placebo40-47, 108 using 1200mg daily.
Smaller amounts of SAMe were also helpful. A 2 year trial (no control) suggested marked improvement using 600mg daily for 2 weeks and then 400mg thereafter48 It was also tested successfully in patients receiving intravenous SAMe.49 It generally appears that it is as effective as conventional medicines but there were fewer side effects50 (which appear to be reported at approximately the same rates for OA patients taking placebos).
Glucosamine sulfate (GS), a seashell-sourced nutrient, is used by the body to synthesize and repair cartilage of joints. Non-controlled, single-blind research as well as a number of double-blind studies have demonstrated its effectiveness in lowering OA symptoms.8-16 One trial, however, found no such reduction.17 Most trials used 500mg, 3 times a day but one long-term (3-year) double-blind study reported that 1500mg once daily brought about marked symptom reductions and stopped degeneration as viewed by x-rays.18Results generally are noticed after 3-8 weeks. Note that GS is not a cure and patients who find that it brings relief may need to continue their entire lives.
While side effects are not generally reported, it should be noted that those with seafood allergies should consult their physician (even though the product is extracted from shells, not tissue of shellfish. In addition, some patients take GS beyond the recommended dosages, with negative results to the functioning of the pancreas and increased diabetes risk.107
Glucosamine hydrocloride (GH), another type of glucosamine, was found to bring only small benefits in patients with knee osteoarthritis over an 8 week period.19 They were also receiving as much as 4,000mg daily acetaminophen for their pain, so future research should exclude these people. Yet another type of glucosamine occasionally combined with other ingredients is N-acetyl-glucosamine (NAG), which has not been researched for this purpose.
Early on it was reported that niacinamide (not niacine) supplementation was helpful. Niacinamide is a type of vitamin B3 and reportedly improved joint movement, strength of muscles and reduced fatigue in OA patients.55-57 A 1990s double-blind study reported reduction in symptoms within 3 months.58 The general recommended dosage by medical providers is 250-500mg at least 4 times daily depending on severity of the arthritis.
Patients who consume lots of antioxidants reportedly experience far lower rates of deteriorating joint tissues, especially knee problems, than those who consume fewer antioxidants in their diets.51
Vitamin E. Of single antioxidants, vitamin E is the most researched and fewer symptoms have been found in both single-blind52 and double-blind studies53 54 wherein 400IU -1,600IU daily was tested. Beneficial resulted occurred within several weeks. However a 2010 literature review contradicted this finding.109
An early double-blind study reported that 2,250mg daily oral MSM for 6 weeks lessened osteoarthritis.67 Later research has reported significant improvement in pain symptoms110-111 although there was some concern over best dosages and duration of treatment.112 Note, like DMSO, there was a reduction in pain but not apparently a general reduction in inflammation. Reported side effects included upset stomach, headache and diarrhea. Until there is more research into best dosages and treatment periods, this should be taken under the supervision of your health care provider.
Both preliminary and double-blind research reports effectiveness of this supplement, but the evidence is somewhat weak. It may be helpful for some patients. In one trial OA patients were given an extract (210mg daily) or freeze-dried powder (1,150mg daily) and reported reductions in morning stiffness, joint pain, and joint functioning.59 In another trial 45% of OA patients taking 350mg 3 times daily for 3 months reported a good response.60 Yet another trial where 2100mg daily for 6 months was tested reported "excellent" results for pain of knee arthritis.61 There have been side effects reported in some people such as upset stomach, gout, rashes, and in one case, hepatitis.62
Dimethyl sulfoxide (DMSO)
While use DMSO is controversial (the FDA has approved it for symptom relief of bladder pain disease) research has demonstrated that it is helpful, used topically, for reducing inflammation and relieving pain, including osteoarthritis pain.63 64 One trial reported that diluted (25% concentration) of DMSO as a gel helped reduce pain from OA after 3 weeks much better than a placebo.65 It appears to do so by inhibiting pain messages through the nervous system -- lessening the pain, 66 but not healing the joint tissues. Because it is sold in a variety of forms, strengths and purity, it should be used only when monitored by your medical professional.
Cetyl myristoleate (CMO)
Some of CMO's properties include reducing inflammation and pain and modulating the immune system. Wikipedia reports that while it is not as well known as glucosamine and chondroitin, it is increasingly being used for conditions such as osteoarthritis. Some research has reported that 65.5% OA patients who had not responded to NSAIDs and who took 540mg CMO daily for a month found it effective compared to those who took a placebo (14.5%).68 They also used it topically as they felt it was needed. No side effects have been reported to date.
A connection has been suggested between low boron levels and arthritis due to its effect on metabolism of calcium.69 (The US Dept. Agriculture found in an experiment that taking boron reduced excretion of calcium, thus possibly also tying it to osteoporosis.) In addition to other deficient mineral stores in the bones of OA patients, boron is reported also lower in people with OA.70 One double-blind study of 10 OA patients reported supplementing with 6mg daily for 2 months relieved symptoms in half of the people (compared to 1:10 for placebo.71 This is promising but needs validation through additional research.
Omega-3 fatty acids
Omega-3 fatty acids (found in fish oil, DHA and EPA), reduce inflammation and have mostly been researched with respect to rheumatoid arthritis, a condition marked by inflammation. Inflammation is a somewhat less marked feature of osteoarthritis.72 Researchers found in a 6 month controlled trial that OA patients given EPA had "strikingly lower" reports of pain that those receiving placebo.73 But they also found that supplementing with cod liver oil was not better placebo.74
Some trials have suggested and confirmed that DPA (250mg 3-4 times daily) reduced chronic pain.75,76, 113 but others contradicted those findings.77 DPA apparently blocks functioning of an enzyme destroy's natural painkillers, enkephalins, in the body. They are similar to endorphins. Higher levels of enkephalins might explain the pain reducing results. A related product D,L-phenylalanine (DLPA) with recommended dosages of 1,500-2,000mg daily. Intake of these supplements should be between meals as protein may reduce its effect.78
Some early trials have indicated that OA patients may find bovine cartilage supplements helpful79. They contain a combination of molecules similar to chondroitin sulfate and protein and have been found to reduce inflammation. Additionally, ten-year study substantiated reduced symptoms through bovine cartilage supplementation80 but the dosage is not known.
Discussion: Botanical Treatment Options
Double-blind studies have suggested that cayenne extract cream (used topically) with 0.025-0.075% capsaicin reduces tenderness and pain due to OA81-84 used 4 times daily for 2-4 weeks, and then twice a day.85 Products with capsicum oleoresin instead of purified capsaicin may not be as effective.86
Willow is known to reduce inflammation and pain. Such pain relief develops slowly, but reportedly lasts longer than pain killers such as aspirin. One double-blind study reported that a product with willow combined with guaiac, black cohosh, aspen bark, and sarsaparilla effectively lowered pain from OA compared to placebo.87 Similarily, it was reported that that 1,360mg daily willow bark extract (with 240mg salicin) was somewhat helpful for pain connected with knee and/or hip osteoarthritis.88
Stinging nettle has been used traditionally for joint pain. Nettle applied to the skin (yes, stings) was tested in preliminary89 and double-blind90 trials and reported that deliberate nettle stings to be safe and effective for OA pain relief. The adverse effect is the sometimes painful or numbing rash that lasts 6 to 24 hours.
Traditionally, ginger has been used as a remedy for rheumatism and arthritis, but not many studies have looked at its usefulness for oasteoarthritis. One small trial suggested relief from arthrtis swelling and pain with powdered ginger supplements.91 Another double-blind study found that ginger extract, with dosage of 170mg 3 times daily for 3 weeks to be a little more effective than placebo for hip or knee OA pain relief.92
- Devil's Claw One trial did find that devil's claw (another traditional remedy) was as effective as diacerhein93 using 2,610mg daily - but both are slow-acting and there was no placebo group.
- Boswellia reduces inflammation and has been compared to NSAIDs to reduce same.94 It hasn't been tested alone, but in combination with ashwagandha, zinc, and turmeric did remedy OA pain and stiffness but didn't improve the health of joint tissue..95 However, unlike NSAIDs, long-term use does not contribute to stomach ulceration or irritation.
- Horsetail is rich in the trace mineral silicon, which helps generate and maintain connective tissue. Traditional herbal medicine practitioners feel that this silicon content is probably responsible for its reduction of arthritis symptoms. It hasn't been evaluated for OA.
- Yucca Some research suggests that its saponins appear to block toxin release from the intestines inhibiting proper cartilage formation. One trial found that yucca might reduce symptoms of OA 96, but beyond that there is limited evidence.
- Cat's claw is another traditional remedy but there is not any scientific evidence.
- Meadowsweet has traditionally been a remedy for a number of conditions including joint and muscle problems.97 It contains aspirin-like salicylates that may bring about pain relief of OA.
- Colchicine, coming from autumn crocus is a traditional rememdy used for chronic back pain, muscle spasm and spinal disc disease pain98 and reportedly brings relief in about 40% of disc disease patients. In studies it is usually administered via IV99 but may be effective orally. An herbal expert practitioner should monitor its use
106. Study of Solanine on Mitochondrion in HepG2 Cell, Shiyong Gao, Yubin Ji, Chenfeng Ji, Xiang Zou, Postdoctoral Research Station, The Institute of Materia Medica, Harbin University
107. Lafontaine-Lacasse M, Dore M, Picard, F (January 2011). "Hexosamines stimulate apoptosis by altering Sirt1 action and levelsin rodent pancreatic beta-cells". Journal of Endocrinology 208 (1): 41-9.
108. Mary Hardy; MD, Principal Investigator, Ian Coulter, PhD, Sally C Morton, PhD, Joya Favreau, MD, Swamy Venuturupalli, MD, Francesco Chiappelli, PhD, Frederico Rossi, MD, Greg Orshansky, MD, Lara K Jungvig, BA, Elizabeth A Roth, MA, Marika J Suttorp, MS, and Paul Shekelle, MD, PhD. (2002-10). ?S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease.
109. Rosenbaum CC, O'Mathuna DP, Chavez M, Shields K (2010). "Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis". Altern Ther Health Med 16 (2): 32-40
110. Kim, LS; Axelrod, LJ; Howard, P; Buratovich, N; Waters, RF (2006). "Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: A pilot clinical trial". Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 14 (3): 286-94
111. Usha, PR; Naidu, MU (2004). "Randomised, Double-Blind, Parallel, Placebo-Controlled Study of Oral Glucosamine, Methylsulfonylmethane and their Combination in Osteoarthritis". Clinical drug investigation 24 (6): 353-63
112. Brien, S; Prescott, P; Bashir, N; Lewith, H; Lewith, G (2008). "Systematic review of the nutritional supplements dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM) in the treatment of osteoarthritis". Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 16 (11): 1277-88
113. Gibbs, R. A. et al. (2007). "Evolutionary and Biomedical Insights from the Rhesus Macaque Genome" (pdf). Science 316 (5822): 222-234.