Many doctors dismiss natural remedies out of hand, but WWMG Rheumatologist Richard Jimenez is open to anything that’s effective in treating his patients.
Dr. Jimenez has studied the available research on natural remedies for osteoarthritis and found that some of them are backed by science, with results that compare favorably to prescription medications.
Standard Guidelines for Osteoarthritis Treatment
Osteoarthritis is the most common form of arthritis. The American College of Rheumatology’s most recent guidelines for treating osteoarthritis call for:
- Exercise – so that muscles can better support the joints
- Weight loss – to avoid strain on weight-bearing joints
- Self-management – activity modification and mindfulness to avoid aggravating affected joints, and
- Braces – to provide stability and reduce joint pressure
Medication is only recommended after these priorities.
Although they did not conduct a review of natural medicines or alternative therapies, Jimenez said, “I think it’s interesting that the national arthritis organization doesn’t list any medications at the top of the list of standard treatments. Our medications have not been shown to alter the natural history of the disease. And I think there’s actually more evidence for alternative therapies than there are for the medicines that have been tried.”
Natural Medicines that Do – and Don’t – Help Osteoarthritis
Natural medicines are not automatically superior, however. And a lot of claims being made about a wide variety of natural substances don’t have much evidence to support them.
“I pay more attention to what has scientific evidence that it works as opposed to what doesn’t work. But I will mention a brand name product called Pycnogenol, a pine bark derivative that a Cochrane review found no benefit for any of the claims,” said Jimenez.
Jimenez also doesn’t recommend Omega-3 fatty acids – at least not for osteoarthritis. Whatever other health benefits they may have, he said, “They don’t seem to have an anti-inflammatory effect in clinical studies.”
That said, there are three categories of naturally-derived remedies that have scientific evidence of effectiveness. These are:
- Cartilage collagens
- Palmitoylethanolamide, and
- Antioxidants
Their effectiveness has been shown through successful lab tests, animal studies, or human clinical trials. Let’s examine each category.
Cartilage Collagens
Glucosamine sulfate and chondroitin sulfate are building blocks of cartilage, the material that lines joints. Osteoarthritis occurs when cartilage breaks down and the joint becomes inflamed.
Glucosamine and chondroitin sulfate “do seem to stimulate chondrocytes, and therefore could stimulate cartilage repair and cartilage growth,” said Jimenez.
“I will say the data for this is medium scientific evidence as opposed to strong evidence, but you can alter the metabolism of the cartilage cells.”
Glucosamine sulfate and chondroitin sulfate are sold as supplements, as are whole collagen and collagen peptides. These substances are primarily produced from animal sources, but there are vegan alternatives for glucosamine and chondroitin.
“If you take the native [whole] collagen, it does seem to stimulate immune pathways that have an anti-inflammatory effect. That’s different from breaking up the collagen into individual small pieces called collagen peptides. Collagen peptides seem to stimulate chondrocytes to be more active and make more cartilage,” said Jimenez.
Palmitoylethanolamide
Palmitoylethanolamide, or PEA, (pronounced like the vegetable) is an endocannabinoid. Unlike the more familiar cannabinoid compounds THC and CBD, PEA is manufactured by the body and can be found in a wide variety of edible plants including nuts, soybeans, and many vegetables.
So far, there is not much research on the therapeutic value of dietary quantities of PEA, but it is available as a concentrated supplement.
“In higher concentrations, it is a good mast cell inhibitor,” said Jimenez. Mast cells are part of the immune system, but they are involved in arthritis inflammation as well. PEA not only decreases inflammation, but it also decreases pain nerve activity, with the added bonus that it can improve allergies.
“This has been studied in humans. People improved by the standard measures of both pain relief and also swelling and signs of inflammation, and it’s a stronger effect than some of our other prescription medications,” said Jimenez.
Antioxidants
“The third category is kind of the biggest, and it’s been studied the most. Those are your antioxidants,” said Jimenez. “Oxygen free radicals are made as part of an inflammatory reaction and normally we have mechanisms to scavenge these. So they’re made and then they’re removed and there’s this balance.
But if the balance changes – and that happens in inflammatory diseases – you produce more of this reactive oxygen than your immune system can remove, so taking antioxidants can be helpful.”
“Anytime [in the body] that there’s an overproduction of inflammatory compounds, probably there is some antioxidant that might help decrease the inflammation you’re seeing in that disease,” said Jimenez.
A variety of antioxidants have been found useful for cancer prevention, Alzheimer’s, Parkinson’s, asthma, allergies, and many types of arthritis.
Curcumin & Quercetin
The two antioxidants that are most important for osteoarthritis are:
- curcumin and
- quercetin
Curcumin is the primary antioxidant in turmeric and yellow onions.
Quercetin is found in onions, apples, berries, and green tea (which contains another useful antioxidant, EGCG).
Superfoods
Plant flavonoids are a class of antioxidants that evolved as defense mechanisms in plants. They are found in high quantities in most of the plants known as “superfoods,” and in many others as well.
Olive oil contains high levels of antioxidants that make it a good anti-inflammatory food.
Supplements
Similar to PEA studies, research on antioxidants focused on high concentrations of purified substances (like you would find in a supplement) rather than lower concentrations from dietary sources.
“You could probably eat about 10 uncooked onions a day, but sometimes taking a pill is easier than trying to eat the equivalent and that way you know what you’re getting,” said Jimenez.
However, he warns, “You could end up not ever wanting to eat again and just take your supplements. So for general health, eat the rainbow. You want a variety of healthy foods. You’re getting different antioxidants from different plant sources.
“Concentrate on plants in your diet, and then taking one or two supplemental antioxidants can make sense in tablet or capsule form.”
Quality of Supplements Can Vary
Unfortunately, supplements are poorly regulated in the U.S. and products are often manufactured in countries with even fewer rules and no quality control.
“There should be a buyer beware approach; the [company] that advertises the most isn’t necessarily the best. And the cheapest product may not be the best,” said Jimenez.
Besides questions of purity and quality, the specific formulation of a supplement is important for absorption. That’s one of the reasons it’s so hard to identify effective dietary doses.
In the case of antioxidants, the active chemical must not only be absorbed in the GI tract to be effective, but it must also be able to penetrate cell walls. To do that, the antioxidant must be a nanoparticle.
“Look for a product that says phytosome, for example, curcumin phytosome. Because a phytosome is now the most common commercial way of making a nanoparticle. And if it doesn’t say that you may be wasting your money completely when you’re looking at antioxidants,” warned Jimenez.
He recommends a well-studied preparation of boswellia extract by the English company FutureYou Cambridge.
For other supplements, look for third party certification. Two reliable certifications are NSF, a nonprofit certification that originated from the University of Michigan and the for-profit but still independent USP.
One company Jimenez recommends is Theralogix, which makes US-made and certified products, but there are many other companies that also meet high standards.
Supplements and Drug Interactions
For the most part, the supplements Dr. Jimenez has described are very low risk for most patients. But in a few cases, supplements— especially antioxidants— can interfere with other medications.
Cardiac and cancer patients should talk with their prescribing doctor before taking any new supplements. A rheumatologist can also be a valuable resource.
Regarding supplements, Jimenez says, “These too are drugs in a sense. These are powerful chemicals that just happened to have evolved over millions of years by plants.”
Even if you aren’t receiving cancer treatment or being treated for a heart condition, Jimenez recommends a safety measure before taking any supplement: do a Google search pairing the supplement with each of your regular medications.
“If you’re going to take a full dose of curcumin, as an example, just plug in your medicine + curcumin [in the search bar] and see if there’s any interaction,” said Jimenez. If any results come up showing a negative drug interaction, wait before trying the new supplement until you talk with your prescribing doctor.
Take an Intentional Approach
When you’re suffering from osteoarthritis pain, it may be tempting to throw everything at it, but Jimenez suggests a more intentional approach to supplements.
“Test it like you would any other medicine, one new supplement at a time to see if it makes a difference. Try to be an honest judge of whether you hurt less and whether you notice less tenderness and less swelling. That’s how we measure drug effectiveness in clinical trials.”
Where to Seek Help
If you’ve been diagnosed with osteoarthritis, request an appointment with a WWMG Rheumatologist to discuss which natural treatments are most appropriate for you. In addition to working with our primary care providers, they can also provide a referral to a naturopath outside of WWMG if you want to explore complementary medicine options.
Whatever your treatment preference, we look forward to supporting you in good health.