Many doctors dismiss natural remedies out of hand, but some solutions may be effective at treating patients with rheumatology conditions.
Studying the available research on natural remedies for osteoarthritis,we discover that some formulations 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 treatment guidelines for 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, it’s compelling that the national arthritis organization doesn’t list any medications at the top of the list of standard treatments. Most medications have not been shown to alter the natural history of the disease. There may be more evidence for alternative therapies than there are for the medicines.
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.
Based on scientific evidence, a Cochrane review found that a brand name product called Pycnogenol, a pine bark derivative, showed no benefit for osteoarthritis patients.
Also, Omega-3 fatty acids don’t seem to have an anti-inflammatory effect in clinical studies, at least not for osteoarthritis.
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 seem to stimulate chondrocytes, and therefore could stimulate cartilage repair and cartilage growth. The data for this is moderate scientific evidence as opposed to strong evidence, but they 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.
Taking the native (whole) collagen 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.
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, PEA is a good mast cell inhibitor. Mast cells are part of the immune system, but 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 decrease allergy symptoms.
PEA has been studied in humans. People improved by the standard measures of both pain relief and swelling and signs of inflammation, and the result is a stronger effect than some prescription medications.
Antioxidants
The third category – antioxidants – has been studied the most. Oxygen free radicals are made as part of an inflammatory reaction, and normally the body has mechanisms to scavenge these. Oxygen free radicals are created during the inflammatory process, and the body removes them, creating balance.
But if the balance changes – which happens in inflammatory diseases – individuals produce more of this reactive oxygen than the immune system can remove, so taking antioxidants can be helpful.
Anytime that there’s an overproduction of inflammatory compounds in the body, there’s likely some antioxidant that could help decrease the inflammation.
A variety of antioxidants have been found to be useful for cancer prevention, Alzheimer’s, Parkinson’s, asthma, allergies, and many types of arthritis. Some of these are:
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.
Taking a pill is often easier than trying to get the equivalent amount of antioxidants from food.
However, for general health, it’s recommended for people to eat the rainbow. Meaning, eat a variety of healthy foods because you get different antioxidants from different plant sources.
Making sure you include plants in your diet, plus taking one or two supplemental antioxidants (in tablet or capsule form) can be beneficial to your health.
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 controls. Take a buyer beware approach to supplements: the company that advertises the most isn’t necessarily the best. And the cheapest product may not be the best either.
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 label that says phytosome – for example, curcumin phytosome – because a phytosome is now the most common commercial way of making a nanoparticle. If the supplement label doesn’t say phytosome, the antioxidant may have limited to no effectiveness.
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.
Supplements and Drug Interactions
For the most part, the supplements rheumatologists prescribe 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.
Keep in mind that supplements are drugs too, in a sense. They are powerful chemicals that have evolved over millions of years in plants.
Even if you aren’t receiving cancer treatment or being treated for a heart condition, follow safety measures before taking any supplement. Do a Google search pairing the supplement with each of your regular medications to learn if there’s any potential interaction. 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 we recommend 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 objectively observe whether you hurt less and notice less tenderness and less swelling in your joints. That’s how drug effectiveness is measured in clinical trials, so it makes sense to apply the same approach to supplements.
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.