Ask the Pharmacist
October 18, 2017
Q: You have discussed a number of conventional treatments for arthritis in your last two articles. What do you think about the natural products available?
A: There are a number of reasons people look to the natural or alternative worlds for solutions to their arthritic symptoms.
These can range from fear (sometimes justified) of the potential side effects mainstream medicines may hold, a lack of benefit from the prescription drugs their doctor has prescribed for them, a desire to use products they consider more in tune with their world views toward medicines and the fact that, quite frankly, there is mounting evidence that at least some of these products work pretty well and are very safe.
While the last two articles focused mainly on arthritis of the knees, the options mentioned here can be used to treat arthritis that occurs within any joint within your body.
Probably the best know natural product is glucosamine sulfate which began to make waves in the 1990s and now 20 years later, has been the subject of numerous studies examining both its effectiveness and its safety profile.
Glucosamine is a natural product that is found in the synovial fluid, the thick, gel-like liquid that acts like a cushion between the two main bones of the joint. Most supplements harvest the glucosamine from the shells of shellfish (note that it is considered safe for those with shellfish allergies to take) but it can also be manufactured in a laboratory. While it comes in several forms, the sulfate one has by far the most evidence supporting its use, so it makes sense to go with it.
More than 20 clinical trials, lasting up to three years, support its use. While studies have yielded somewhat conflicting results, experts feel that, on the balance, glucosamine sulfate is at least likely to be effective for osteoarthritis.
What’s more, tests indicate that it has anti-inflammatory properties and may well help cartilage and the synovial fluid to regenerate which offers exciting potential to help, at least partially, reverse the course of this relentless disease.
A study published in the renowned journal , “The Lancet,” showed that those who took glucosamine sulfate showed no decrease in “joint-spacing” over three years which is atypical because most people with osteoarthritis will see a decrease as the bones inevitably come closer together.
Overall, pain tends to decrease between 28-41 per cent for those who try it, while joint stiffness appears to decrease by 21-46 per cent. These sorts of numbers are comparable to the results seen by the usual doses of ibuprofen and acetaminophen with the bonus that the effects seem to last longer with glucosamine.
The downside is that it may take up to two months to yield results and the supplement must be taken regularly as opposed to a “when-needed” approach for the usual pain killers.
It may be tried on its own or combined with other treatment options from either the mainstream of medicines (acetaminophen, the NSAIDs) or the alternative world (chondroitin, MSM). It is also very inexpensive which is not always the case in the “natural” market place. The recommended dose is 1,500 milligrams (mg) per day and it may be taken as a single dose or divided up throughout the day.
The most exciting piece of news regarding glucosamine is a study showed that those people who took the supplement regularly for a one- to three-year time frame had a 57-per-cent decrease in knee replacement surgery relative to a matched group of patients who did not.
Given that it is considered “very safe”, with upset stomach being the most common side effect, there is very little reason for even those with minor arthritis not to try this.
Another supplement that is often tried on its own or in a pill combined with glucosamine, is chondroitin sulfate. It, too, is a naturally-occurring substance found within our healthy joints. The suggested dose is 1,000 to 1,200 mg per day taken in a single or multiple doses.
While the majority of studies seem to indicate that chondroitin works, there are still a large number of studies that suggest it is no more effective than a placebo pill. The products that combine it with glucosamine produce similarly conflicting results in trials, with experts currently thinking that they “probably” work but perhaps no better than taking glucosamine on its own.
Like glucosamine, there may be more than just a pain relief benefit as preliminary evidence shows there may be a lessening in the loss of joint-spacing while taking this.
On a cautious note, it is usually sourced from the trachea of cows or pigs, raising the spectre of one of these animals being affected by “mad cow” disease. While this risk is extremely small, for those who are concerned, look on the label to ensure that the chondroitin was instead taken from marine-derived sources (that is shark’s cartilage which comes with its own ethical dilemmas).
SAMe (s-adenosylmethionine) is another naturally-occurring supplement (it is found in our liver and is involved in the creation of a large number of our neurotransmitters, hormones and other chemicals) that is used frequently for osteoarthritis. It also appears to be involved in the generation and repair of cartilage, and studies show that it works very well for improving the symptoms of osteoarthritis.
Like the other supplements, it is well-tolerated and slow to take effect, with most patients saying it takes days to weeks to start experiencing the benefits.
Its use is hampered by two facts. One, is that it is significantly more expensive than the other options we have highlighted here. The other, is that many of the products on the market appear to be poorly-made, with a number of tests showing that some have little to no SAMe when they were investigated by an independent lab.
If you decide to go the SAMe route, grab the butanedisulfonate form which has the highest bioavailability. One other note is that SAMe also has documented antidepressant effects which can be a good thing for some people but also has the potential to “flip” some bi-polar patients into a manic phase which can have devastating consequences.
A few last quick notes as this article is already way too long. We highly endorse creams/lotions that use capsaicin (an ingredient derived from hot peppers) for the pain of arthritis (such as Menthacin, Zostrix) but you must be willing to apply them three to four times per day every day, and the pain may get worse for up to two weeks before it actually gets better.
Lastly, while MSM (methylsulfonylmethane) has been around for years and been the subject of books and an awesome marketing campaign, the actual independent evidence supporting both its usefulness and long-term safety is still lacking, relative to the other supplements we have discussed.
We would reserve trying this, either on its own or in combination with the others, until we had at least tried the previously-mentioned supplements. It might well be both effective and safe, but we would be more comfortable with a little more evidence supporting both of those claims.
For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts
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