Publix GreenWise Market Magazine - May 2008
All-Natural Guide to Osteoarthritis
Cope with the degenerative effects of arthritis by taking a joint approach that combines supplements, diet and exercise.
Today's active adults are unwilling to simply accept that getting older can be a pain. They want relief now, and they're increasingly looking for natural approaches to treat the osteoarthritis (OA) that threatens to slow them down.
While medical treatments may be the cornerstone of OA management, natural approaches can augment conventional therapies. Supplements, diet, and exercise all may have a place in managing OA symptoms or, better yet, helping to minimize joint damage in the first place.
Add on a Supplement
Yusuf Yazici, M.D., a rheumatologist and assistant professor at the New York University Hospital for Joint Diseases, counts himself among the many physicians who believe that people with OA may benefit from combining complementary approaches with conventional medical care. Some patients show up eager to talk about dietary supplements they've heard about from family and friends or in media reports. Among the supplements with the best word of mouth are glucosamine and chondroitin, two compounds found naturally in human cartilage.
If you're considering glucosamine and chondroitin, you may be wondering about differences among the various products on the market. Glucosamine exists in two chemical structures: glucosamine hydrochloride and glucosamine sulfate. Several studies have shown a beneficial effect from glucosamine sulfate, says Alan Gaby, M.D., editor of The Natural Pharmacy (3rd ed.; Three Rivers, 2006). In one recent European study (Arthritis & Rheumatism, February 2007), 318 people with OA of the knee were randomly assigned to receive glucosamine sulfate (1,500 mg daily), acetaminophen (the pain reliever in Tylenol) or a placebo for six months. The study showed that glucosamine sulfate was more effective than the placebo at reducing the symptoms of knee OA.
However, another large, six-month study that used the other form of glucosamine—glucosamine hydrochloride—found less clear-cut results (New England Journal of Medicine, February 2006). Funded by the National Institutes of Health and conducted at 16 research centers across the United States, the study included 1,583 people with OA of the knee. Participants were randomly assigned to one of five groups: glucosamine hydrochloride alone (1,500 mg daily), chondroitin sulfate alone (1,200 mg daily), both supplements, celecoxib (a prescription pain reliever) or a placebo. The study found that supplements, singly or in combination, did not reduce pain overall. In the subgroup of participants with moderate to severe pain, it seemed the combination might have been helpful. But that subgroup was small, and researchers cautioned that this finding needs to be confirmed in additional research.
In general, the evidence of effectiveness is stronger for glucosamine sulfate than for glucosamine hydrochloride, says Gaby. Taking chondroitin sulfate along with glucosamine might have added benefits. In fact, many supplement companies make a combination product called simply "glucosamine chondroitin." If you buy the combo version, check the label to determine which form of glucosamine the supplement contains. If cost is a factor, Gaby says you might want to choose a supplement that contains glucosamine sulfate alone, since chondroitin is typically the more expensive substance of the two.
How much should you take? As a rule of thumb, orthopedic surgeon Nicholas A. DiNubile, M.D., author of FrameWork: Your 7-Step Program for Healthy Muscles, Bones and Joints (Rodale, 2005), suggests a daily dose of 1,500 mg of glucosamine and 1,200 mg of chondroitin. After two months, he advises cutting back to 1,000 mg and 800 mg, respectively. Also check with your doctor before starting any supplement. That way, your doctor can help you ensure that all your treatments work together to give you the maximum benefit.
Another dietary supplement called SAM or SAMe (pronounced "sammy") also has been shown to be as effective as prescription and nonprescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs) in reducing pain and improving functional limitations in patients with OA (Journal of Family Practice, May 2002). A typical dose is 200 to 400 mg twice a day. SAMe needs vitamin B12 and folic acid to work, so make sure you're getting enough of these vitamins. Folic acid (also known as folate) is found in enriched breads, cereals and pastas as well as leafy green vegetables, citrus fruits and dried beans. Vitamin B12 is found in fortified cereals, fish, meat, poultry, eggs, milk and milk products.
Give Joints a Food Boost
Eating foods with anti-inflammatory activity also may help protect your joints, says Larry Bergstrom, M.D., director, complementary and integrative medicine program at the Mayo Clinic in Scottsdale, Arizona. You may associate inflammation with rheumatoid arthritis rather than OA. However, Bergstrom points out that people with OA also can experience inflammation when insufficiently cushioned bone ends rub against each other.
Research has shown that healthful omega-3 fatty acids may have an anti-inflammatory effect. To get more omega-3s in your diet, eat such fatty fish as mackerel, lake trout, herring, sardines, albacore tuna and salmon at least twice a week. These fish are rich in two types of omega-3s: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Other foods to include in your diet are soybeans (including tofu), canola, walnut and flaxseed as well as their oils. These plant foods contain alpha-linolenic acid, which is also an omega-3 fatty acid. If you choose to take an omega-3 supplement, Bergstrom recommends 1 gram a day of combined EPA and DHA.
Exercise Your Options
It may be instinctive not to exercise if movement is painful. But for a person with OA, remaining sedentary is the worst thing to do. "It's important, even if it does hurt, to get with [an exercise] program," says Miriam Nelson, Ph.D., director of the John Hancock Center for Physical Activity and Nutrition at Tufts University and lead author of Strong Women and Men Beat Arthritis (Aurum Press, 2003). "With exercise, you can improve function and sustain more movement with less pain."
Many people with OA avoid exercise because of fear of injuring themselves, says Timothy McCall, M.D., author of Yoga as Medicine: The Yogic Prescription for Health and Healing (Bantam, 2007). Easy does it is fine; just make sure you keep moving. "Don't think you're not helping yourself by doing gentle stuff," he says. "A gentle yoga class can help you move your joints through a wider range of motion than you would tend to do in everyday life."
Whatever natural approach you try, you could be benefiting not only your joints but your whole body. Staying active is important for your overall health, for example, and consuming plenty of omega-3s helps protect your heart. So by keeping close tabs on OA, says McCall, you may be helping ward off other illnesses too.
LEARN MORE: Visit the Arthritis Foundation at arthritis.org.
Minimize Your Risk
Some risk factors for OA, such as age and heredity, are out of your hands. But you can control other risk factors for the disease. Addressing these factors while you're younger may decrease your chances of developing OA later on.
- Maintain a healthy weight
"Weight gain has a really debilitating effect on the joints, especially at the knee," says Nelson. Studies show that every pound of weight you gain translates into three pounds of pressure at the knee, with pressure on your hips increasing as much as six times. Nelson underscores the importance of long-term weight management. "The negative effects of excess weight on the joints may not be evident for years," she says. But when it comes to OA, it may be a case of overeat now, pay later.
- Keep strong muscles
Muscle shortening and lengthening is what moves the joints. In addition, muscles hold the joints in alignment. Why is this so important? "If a joint is out of alignment, there's going to be more wear and tear," Nelson says. She notes that older women, in particular, tend to have rather weak muscles surrounding the joints. Nelson says the best strategy is prevention. Regular strength training will help keep your joints working properly, and it even helps if your joints have already deteriorated.
- Watch out for injuries or overuse
If you participate in sports or have a job or hobby that involves repetitive motion, you may be at higher risk for OA. And even if you no longer play competitive sports, it's possible that down the line the site of an old injury or surgery on a joint may be fertile ground for OA to develop. Nelson cautions that while it's important to maintain muscle strength, you need a day of rest between each strength training session. As a preventive measure, avoid overdoing. Make moderation a goal.
A Pain in the Joint
Osteoarthritis is caused by the wearing away of cartilage that cushions the ends of the bones in joints. As the cushioning between the bones deteriorates, any type of weight-bearing activity—such as walking, standing or even sitting—can become painful. Other symptoms, such as stiffness and loss of flexibility, also may develop and gradually worsen over time.