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Natural Foods Merchandiser

Joint ventures: 7 supplements for arthritis

No matter what type of joint troubles your customers have, aches and pain and loss of function are the result. The debilitating conditions literally stop people in their tracks because healthy joints are at the core of every physical movement, from walking up stairs to picking flowers.

While glucosamine and chondroitin have been the go-to remedies for joint health for some time, other supplements may work just as well. They can relieve pain and improve mobility without the unwelcome side effects of cyclooxygenase II inhibitors, which up the risk of heart attack, or nonsteroidal anti-inflammatory drugs, which may lead to liver toxicity. That should be welcome news to the nearly 21 million Americans who suffer from osteoarthritis, the disease that causes the cushioning between bone and joints to wear away over time. It'll also please those who have the less common rheumatoid arthritis, an inflammatory disease that triggers the body's immune system to attack healthy tissues.

This supplemental help takes a variety of forms. "Anyone in all [arthritic] categories can benefit from taking similar things," says Nicole Barreda, N.M.D., a naturopath in Scottsdale, Ariz. "You can get all the benefits without any side effects." Here, the experts share their latest favorites to try.

Boswellia (Boswellia serrata)

Also known as frankincense, boswellia has a long history of use in Ayurvedic medicine for treatment of inflammation and arthritis. In a study published this summer in Arthritis Research and Therapy, researchers found that a type of boswellia extract called 5-Loxin decreased pain and improved performance for those suffering osteoarthritis of the knee. Earlier studies showed that boswellia relieved osteoarthritis of the knee better than a placebo and some other drugs. The herb may relieve pain by controlling inflammation, though perhaps through a different pathway than COX-2 inhibitors, and it may improve joint health by decreasing enzymes that degrade cartilage. "For osteoarthritis patients and people with pain, there are many causes of inflammation," says Dr. Jason Theodosakis, assistant professor at the University of Arizona College of Medicine and author of The Arthritis Cure (St. Martins, 2004). "Boswellia works on a different pathway than over-the-counter prescription drugs. Because of that, I think there's better safety."

Dose: Theodosakis suggests 100 milligrams per day of 5-Loxin, which is standardized to 30 percent acetyl-keto-beta.

Avocado-soybean unsaponifiable

"Saponified means ‘to make soap,'" says Theodosakis. "Unsaponifiable means ‘you can't make soap' with this oil." But you can wash away arthritis pain by taking in this fat from avocados and soybeans. ASU works by beneficially modifying bone cells that are undergoing osteoarthritic changes. "In osteoarthritis, it's not just cartilage degeneration, but a degeneration of the whole joint, including bone," Theodosakis says. "Many people believe the underlying pain occurs because the bone changes." The studies have been so convincing that The Cochrane Database of Systematic Reviews recommends ASU as the herbal derivative with the most positive evidence as an arthritis treatment. Even more, Theodosakis' patients who take ASU end up decreasing or stopping their anti-inflammatory drugs. But don't just point customers to the produce and bulk aisles for pain relief. You can eat all the avocadoes and soybeans in the world, and you still won't relieve joint pain. ASU is bound to certain plant fibers called lignans. It must be mechanically removed from the lignans in order for the body to readily absorb it—which explains why the supplement works and the food doesn't, according to Theodosakis.

Dose: Theodosakis suggests 300 milligrams once a day.

Turmeric (Curcuma domestica, Curcuma longa) and ginger (Zingiberaceae) An ancient Asian spice that gives curry its yellow color, turmeric prevents both rheumatoid arthritis and osteoporosis, according to recent studies. An in-vivo study published in Arthritis and Rheumatism in 2006 revealed that the curcuminoid extracts of turmeric switch off the protein that triggers joint swelling and destruction. Turmeric is a member of the ginger family, and ginger, too, seems to reduce arthritis pain, though the effects in one study were small and somewhat inconsistent.

Dose: Barreda suggests 500 milligrams of turmeric/curcumin three times a day; 2,000 milligrams of ginger a day.

Hyaluronic acid

Osteoarthritis signals low concentrations of hyaluronic acid in the joint's synovial fluid. "Hyaluronic acid acts as a shock absorber and as a lubricant," Theodosakis says. "Grinding and crunching in the knee is a sign of low hyaluronic acid." What started as a U.S. Food and Drug Administration-approved prescription injection of hyaluronic acid is now being transformed into an oral supplement ingredient—with positive results. Initial research of proprietary hyaluronic acid products (for example, made from either rooster combs into Hyal-Joint or through bacteria fermentation into Baxyl) show that the supplement relieves pain and inflammation and improves range of motion—in essence, quality of life improves. Theodosakis is a fan of Hyal-Joint. "It's twice as active as the fermented product," he says.

Dose: Theodosakis suggests 80 milligrams a day of Hyal-Joint. Ask your healthcare practitioner for appropriate doses of other hyaluronic acid supplements.


Bromelain comes from pineapple and is one of several proteolytic enzymes—others include papain from papaya and pancreatin from hog pancreas. These enzymes digest proteins and are natural anti-inflammatories. Joint pain is inflammation of the joint capsule itself. "Inflammation is the body's attempt to heal," naturopath Barreda says. "When you injure a part of your body, it swells up. Sometimes the inflammation goes on excessively or for too long, and it becomes a chronic state. You want to decrease that inflammation, which has now become a problem." Nonsteroidal anti-inflammatory drugs all have side effects and can potentially harm the kidney and liver. "Instead, you can take natural anti-inflammatories because they're basic components of food and so they don't have the side effects of drugs," Barreda says. In studies, enzymes like bromelain seem to calm knee and hip pain that results from inflammation, according to Clinical Rheumatology and Clinical and Experimental Rheumatology.

Dose: 500 milligrams three times a day, according to Barreda.

Omega-3 fatty acids

The omega-3 fatty acids EPA and DHA found in fish encourage the production of anti-inflammatory prostaglandins and have been shown to improve rheumatoid arthritis in many studies. In a recent investigation, scientists found that participants taking cod liver oil, containing 2.2 grams of omega-3 essential fatty acids, had such good results that they were able to gradually cut back on NSAIDs, according to Rheumatology 2008. "Fish oil is a great and easy thing to take," Barreda says. "You can also take it in different forms, such as flaxseed oil or coconut oils. They're all natural anti-inflammatories."

Dose: 2,000 milligrams a day of fish oil, suggests Barreda.

Shea triterpenes

Shea triterpenes come from the pit of the fruit of the karite tree, which grows wild in Africa. The same tree fruit is used to make skin-smoothing shea butter. Unpublished proprietary clinical trials testing FlexNow joint formula, which contains shea triterpenes as the active ingredient, showed that the supplement reduced the breakdown of type II collagen, which is the most abundant part of cartilage. It also eased pain and inflammation in joints. According to Len Smith, CEO and president of BSP Pharma, the makers of FlexNow, the joint formula works synergistically with glucosamine and chondroitin to curb cartilage destruction. "We strongly suggest taking them together," Smith says. Dose: Follow label instructions.

Pamela Bond is a freelance writer in Eldorado Springs, Colo.

Natural Foods Merchandiser volume XXVIII/number 10/p. 94,98

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