Osteoarthritis and Nutritional Supplements
Many people come to our practices having experienced the symptoms of osteoarthritis, or degenerative joint disease (DJD), as it is more correctly called. DJD is the most common joint disease in the world and it is one of the most common causes of pain, loss of function and disability in adults.
Nutritional supplements that promise to help with DJD/osteoarthritis are heavily promoted in the media – fish oils, glucosamine, krill oil, topical gels and creams, pharmaceutical pain relievers – the list is long and varied. People with DJD commonly ask what they can take to help with their symptoms. Do these things actually work? Can they reverse the disease process?
This article discusses some of the nutritional supplements that research has shown to be effective, and other lifestyle changes that people can consider to improve their quality of life.
DJD can be thought of as “wear and tear” of joints. It is caused when there is damage to the articular cartilage of joints – the material that keeps joints moving smoothly. This usually happens in joints that bear the weight of the body – hips, knees and the low back. Common signs and symptoms of DJD are a deep, aching pain and stiffness that is generally worse after a period of rest, such as first thing in the morning. People with DJD report that it “takes a while to get going” in the mornings, but they are generally fine with some movement and perhaps a warm shower. They also report feeling some “crunching and creaking” in affected joints, and they usually know when it is going to rain!
Glucosamine
Glucosamine sufate has been shown to improve mobility in patients with DJD (less stiffness and better movement) as well as reducing pain.
When choosing a supplement, look for the glucosamine sulfate form, not glucosamine hydrochloride. Glucosamine sulfate has been shown to be more effective. Bioceuticals-ArthroGuard
In severe DJD, especially in the knee, a glucosamine/chondroitin combination supplement is more effective than glucosamine on its own.
The usual dose of glucosamine sulfate is 1500mg 1-2 times daily, and 1200mg per day for chondroitin sulfate. It can take a long time to see changes, at least 4-6 weeks. Take the supplement for at least two months before deciding if you notice any difference.
A couple of warnings with glucosamine – it is usually made from seafood products so avoid it if you have an allergy to shellfish. It can also interact with some drugs, including warfarin and NSAIDs (anti-inflammatory medications). It may aggravate asthma in some people. Always tell your prescribing doctor and pharmacist about any supplements that you are taking.
Fish oils
Fish oils have been shown to reduce the pain associated with DJD. In addition, taking fish oils can also help prevent heart disease. Bioceuticals EPA DPA
The usual dose is 3-7g per day. Some pain relief should be seen after about a week of taking fish oils. There are few side effects; fish oils are generally well tolerated especially if taken with meals.
Beware if you take anti-coagulant/blood thinning medications such as Warfarin – high doses of fish oils can be dangerous in these cases. Always mention to your prescribing doctor that you wish to take fish oils and they can advise you. Also avoid fish oils if you have an allergy to seafood.
SAMe
S-Adenosyl Methionine or SAMe has been shown to be as effective as NSAIDs (anti-inflammatory medication) in reducing the side effects of DJD, with significantly fewer side effects. SAMe might be worth a try if you experience troubling side effects from NSAIDs, or can’t take them due to ulcers.
The usual dose for SAMe is 400mg 2-3 times per day, and people usually see changes within 1-2 weeks. Side effects are mild and rare, but avoid use with anti-depressants and bipolar (SAMe may interact with anti-depressant medications). Do not use during pregnancy or lactation.
What else can I do?
DIET – your dietary choices can have a major impact on DJD symptoms. Obesity is a well recognised risk factor for DJD so keeping your weight at an appropriate level is important. While there is no evidence recommending any particular diet or eating plan, some patients find great benefit from a primarily vegetarian or Mediterranean-style diet – that is one composed mostly of vegetables and fruits, fish, wholegrain cereals, beans, nuts and seeds. There is limited red meat and dairy in this type of diet. Extra virgin olive oil, a staple of Mediterranean diets, contains oleocanthol, which acts as a natural anti-inflammatory and may help reduce arthritic pain.
Some small research studies have shown that a diet rich in vitamins C and D – citrus fruits, blackcurrant, capsicum, kiwifruit, eggs – can slow the progression of DJD in some people.
Some foods are also good sources of fish oils – try adding herring, salmon, sardines or mackerel into your diet as these are the best sources of omega-3 EPA and DHA essential fatty acids.
In addition, avoid highly processed foods, hydrogenated fats, salt, fast foods, coffee and chemical additives.
EXERCISE – physical activity is one of the best things you can do to alleviate the symptoms of DJD. Many research studies have shown improvement in patients who undertake almost any form of exercise – so do something you enjoy. Water-based activities are particularly good – swimming, water aerobics – as the water provides some buoyancy and improves the range of motion of joints.
If you want to try a nutritional supplement, choose a good quality product in consultation with your chiropractor and prescribing GP. Give it a try for a couple of months and see if it makes a difference for you. Also try some dietary modifications and get moving!
References
Kotsirilos V, Vitetta L, Sali A. A guide to integrative and complementary medicine. Churchill Livingstone; 2011.
Sarris J, Wardle J. Clinical naturopathy: An evidence-based guide to practice. Churchill Livingstone; 2010.
Yochum TR, Rowe LJ. Essentials of Skeletal Radiology. 3rd ed. Lippincott Williams & Wilkins; 2005.
Braun L, Cohen M. Herbs & natural supplements: an evidence-based guide. 3rd ed. Churchill Livingstone; 2010
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