Osteoarthritis (also known as degenerative joint disease) is a form of arhtritis (inflammation of a joint) caused by degeneration of cartilage. Cartilage serves an important role in joint function. Its gel-like nature provides protection to the ends of joints by acting as a shock absorber. Without the cartilage in the joint, bone literally rubs against bone leading to pain, deformity, inflammation, and limitation of motion in the joint.
The onset of osteoarthritis can be subtle. Morning joint stiffness is often the first symptom. As the disease progresses, there is pain on motion of the involved joint that is made worse by prolonged activity and relieved by rest. There is usually local tenderness, soft tissue swelling, joint crepitus (cracking sounds), bony swelling, restricted mobility, and bony nodules. X-ray findings show narrowing of the joint space (the area between the bones taken up by cartilage). The weight-bearing joints such as the knees, hips, and spine as well as the hands are the joints most often affected with the degenerative changes of osteoarthritis. These joints are under greater stress because of weight and use.
What causes Osteoarthritis?
Osteoarthritis is divided into two categories, primary and secondary. In primary osteoarthritis, the degenerative “wear-and-tear” process occurs after a person turns forty years of age. The cumulative effects of decades of use leads to the degenerative changes by stressing the collagen matrix of the cartilage. Stress on the cartilage results in the release of enzymes which destroy cartilage components. With aging, the ability to restore and manufacture normal cartilage structures decreases. So, what I am saying is that aging is the primary cause of osteoarthritis. But, just because you may be getting older doesn’t mean that you have to suffer from the pain of osteoarthritis.
Secondary osteoarthritis is associated with some predisposing factor which is responsible for the degenerative changes. Predisposing factors in secondary osteoarthritis include: inherited abnormalities in joint structure or function; trauma (fractures along joint surfaces, surgery, etc.); presence of abnormal cartilage; and previous inflammatory disease of joint (rheumatoid arthritis, gout, etc.).
What dietary factors are important in Osteoarthritis?
Perhaps the most important dietary recommendation for individuals suffering from osteoarthritis is that they achieve normal body weight. Being overweight means increased stress on weight-bearing joints affected with osteoarthritis. Beyond that, it is critical that the diet be rich in fruits and vegetables because their natural plant compounds can protect against cellular damage, including damage to the joints. Foods especially beneficial for osteoarthritis are flavonoid-rich fruits, such as cherries, blueberries, blackberries and strawberries. Also important are sulfur-containing foods, such as garlic, onions, Brussels sprouts, and cabbage. The sulfur content in fingernails of arthritis sufferers is lower than that of healthy subjects without arthritis.
Ginger contains anti-inflammatory compounds called gingerols. These substances are believed to explain why so many people with osteoarthritis experience reductions in their pain levels and improvements in their mobility when they consume ginger regularly. Although most scientific studies have used powdered ginger root, fresh ginger root at an equivalent dosage is believed to yield even better results because it contains active enzymes. Most studies utilized 1 gram of powdered ginger root. This would be equivalent to approximately 10 grams or one-third of an ounce of fresh ginger root, roughly 1/4″ inch slice.
People with osteoarthritis may want to avoid foods from the nightshade family. It appears that in genetically susceptible individuals, long-term, low-level consumption of alkaloids found in tomatoes, potatoes, eggplant, peppers, and tobacco can worsen osteoarthritis. Presumably these alkaloids inhibit normal collagen repair in the joints or promote the inflammatory degeneration of the joint. Although remaining to be proved, elimination of nightshade vegetables from the diet may offer some benefit to certain individuals and is certainly worth a try.
What nutritional supplements should I take for Osteoarthritis?
Foundation Supplements. There are three products from Natural Factors that I think are critical in supporting good health:
- MultiStart (age and gender specific multiple vitamin and mineral formulas). Follow label instructions.
- Enriching Greens – a great tasting “greens drink” containing highly concentrated “greens” like chlorella, spirulina, wheat grass juice, barley grass juice, etc., and herbal extracts. Take one serving (one tablespoon) in 8 ounces of water daily.
- RxOmega-3 Factors – A true pharmaceutical grade fish oil supplement. Take two capsules twice daily if you have osteoarthritis.
Glucosamine sulfate has been the subject of over 300 scientific investigations and over 3 double-blind studies. It has also been used by millions of people worldwide and is registered as a drug in the treatment of osteoarthritis in over 70 countries. Glucosamine is a simple molecule that can be manufactured in the body. The main function of glucosamine in joints is to stimulate the manufacture of molecules known as glycosaminoglycans (GAGs), which are the key structural components of cartilage. It appears that as some people age, they lose the ability to manufacture sufficient levels of glucosamine. The result is that cartilage loses its ability to act as a shock absorber. The inability to manufacture glucosamine has been suggested to be the major factor leading to osteoarthritis. The more than 20 published clinical trials with glucosamine sulfate have demonstrated an overall success rate of 72-to-95% in various forms of osteoarthritis. In osteoarthritis of the knee, the success rate is over 80%. In addition to being shown to be more effective than a placebo, in head-to-head, double-blind studies comparing glucosamine sulfate to nonsteroidal anti-inflammatory drugs (NSAIDs), glucosamine sulfate was shown to produce better results than NSAIDs in relieving the pain and inflammation of osteoarthritis, despite the fact that glucosamine sulfate exhibits very little direct anti-inflammatory effect and no direct analgesic or pain-relieving effects. Glucosamine sulfate appears to address the cause of osteoarthritis. By treating the root of the problem through the promotion of cartilage synthesis, glucosamine sulfate not only improves the symptoms, including pain, but also helps the body to repair damaged joints. The typical dosage for glucosamine sulfate is 1,500 mg per day.
MSM (methyl-sulfonyl-methane) is the major form of sulfur in the human body. Sulfur is an important element for all cells and body tissues. It is especially important nutrient for joint tissue where it functions in the stabilization of the connective tissue matrix of cartilage, tendons, and ligaments. As far back as the 1930s, researchers demonstrated that individuals with arthritis are commonly deficient in this essential nutrient. Restoring sulfur levels brought about significant benefit to these patients. More recent studies have validated the benefits of MSM in osteoarthritis. The standard dosage of MSM is 1,200 to 2,000 mg per day.
Celadrin® is an all-natural matrix of special cetylated, esterifed fatty acids that reduce inflammation. The unique features of Celadrin® as a natural product include an ability to reduce inflammation and pain quickly with no side effects as demonstrated in clinical trials published in the internationally acclaimed Journal of Rheumatology. Available in cream and capsule form, Celadrin® is clinically proven to produce results. Celadrin® cream can be applied to affected areas on an as needed basis. The dosage with oral preparations is three soft gelatin capsules daily.
Other natural products often used in osteoarthritis. The products listed above tend to more effective, but due to the popularity of some of these other products they are briefly discussed below.
Chondroitin sulfate is composed of repeating units of derivatives of glucosamine with attached sugar molecules. The clinical studies that have been done using orally administered chondroitin sulfate demonstrate that it is less effective than glucosamine sulfate. Far more impressive results have been achieved using glucosamine sulfate; glucosamine sulfate is faster-acting and provides much greater overall benefit. My feeling has been that there is no added benefit by taking glucosamine sulfate and chondroitin sulfate together. The recommended dosage for chondroitin sulfate is 1,200 mg daily.
S-adenosylmethionine (SAMe) deficiency in the joint tissue leads to loss of the gel-like nature and shock-absorbing qualities of cartilage. SAMe supplementation appears to be useful in the treatment of osteoarthritis. A total of 21,524 patients with osteoarthritis have been treated with SAMe in published clinical trials. In double-blind trials, SAMe (400 mg three times per day) has demonstrated reductions in pain scores and clinical symptoms similar to NSAIDs.
Boswellia serrata has been historically used in the treatment of osteoarthritis in India. Boswellia yields an exudative gum resin known as salai guggul. Although salai guggul has been used for centuries, newer preparations concentrated for the active components (boswellic acids) are giving better results. Boswellic acid extracts have demonstrated anti-arthritic effects in a variety of animal models. There are several mechanisms of action, including inhibition of inflammatory mediators, prevention of decreased cartilage synthesis, and improved blood supply to joint tissues. Clinical studies using herbal formulas with Boswellia have yielded good results in osteoarthritis as well as rheumatoid arthritis. The standard dosage for boswellic acids in treating arthritis is 400 mg three times per day.
One class of drugs that I encourage people with osteoarthritis to stay away from are so-called “nonsteroidal anti-inflammatory drugs or NSAIDs” which includes aspirin and ibuprofen as well as the newer Cox-2 inhibitors like Vioxx and Celebrex. Although these drugs are extensively used in the United States despite their well-known side effects, research is indicating that in the treatment of osteoarthritis these drugs may be producing short-term benefit, but actually accelerating the progression of the joint destruction and causing more problems down the road. The way in which these drugs work is to inhibit enzymes involved in the production of inflammatory compounds. Enzymes are molecules involved in speeding up chemical reactions. Enzymes to either join molecules together or split them apart by making or breaking the chemical bonds that join molecules together. With NSAIDs, they not only suppress the enzymes that produce inflammatory compounds, they also inhibit enzymes that manufacture cartilage components. A person may feel free from pain while on the NSAID, but there arthritis is silently getting worse as noted in several clinical studies that have shown that NSAID use is associated with acceleration of osteoarthritis and increased joint destruction. If you need immediate pain relief due to osteoarthritis, give Celadrin® a try (both orally and topically).
How do I know if the recommendations are working?
Celadrin® seems to be very fast acting, especially the cream. Glucosamine sulfate and MSM take some time to work, usually 2-4 weeks, but do not forego their use- they still are very important in supporting the manufacture of cartilage.
[quote]“Dr. Murray, I am just amazed at how effective your recommendations for osteoarthritis are without the side effects of the drugs. I could barely walk unless I was taking Vioxx, but after all of the concern about its safety I started taking Glucosamine sulfate and MSM. The relief was almost immediate and was even more complete than the relief I got from Vioxx. Why would any doctor prescribed drugs like Vioxx and Celebrex when there are such effective and safer natural products?” EH[/quote]