Pycnogenol for osteoarthritis?

 Pycnogenol (French maritime pine bark extract)

The results of a recent study published in the journal, Phytotherapy Research, suggest that Pycnogenol may help alleviate pain in patients with osteoarthritis of the knee. Additionally, pycnogenol helped to improve functional measures.


Dose: 150 mg Pycnogenol per day at meals.

RESULTS: Following treatment with Pycnogenol patients reported:

• An improvement of WOMAC index (Western Ontario and McMaster osteoarthritis index)
  
• A significant alleviation of pain by visual analogue scale

"CONCLUSION: Results show that Pycnogenol in patients with mild to moderate OA improves symptoms and is able to spare NSAIDs."

Arthritis can be a painful and debilitating medical condition.From this study, it's possible that pycnogenol supplementation may provide some relief. 

For more information about the health benefits of Pycnogenol follow the link.

Reference:

Cisár P, Jány R, Waczulíková I, Sumegová K, Muchová J, Vojtassák J, Duraćková Z, Lisý M, Rohdewald P. Effect of pine bark extract (Pycnogenol) on symptoms of knee osteoarthritis. Phytother Res. 2008 Aug;22(8):1087-92.

Exploring the Mechanisms behind S-Adenosylmethionine (SAMe) in the Treatment of Osteoarthritis.

S-Adenosylmethionine is one of the key ingredients found in Arthroleve (arthroleve.com/). A recent research paper highlights the study of this ingredient in osteoarthritis:

"Osteoarthritis is a chronic joint disease characterized by pain and immobility due to a gradual loss of cartilage. Current treatments are palliative; there is no cure. With a growing interest in alternative therapies, due in part to safety issues regarding pharmacological treatments like Celebrex, safe dietary compounds that help the body regenerate cartilage tissue are of great clinical importance.

The dietary supplement S-adenosylmethionine (SAMe) shows such potential. Clinical trials have shown reduced pain and stiffness while in vitro and animal studies have shown SAMe can stimulate the production of cartilage which is critical in reversing the disease process. The author examines many potential mechanisms of action including: reduction of inflammatory mediators; increasing levels of glutathione; direct or indirect signaling of cartilage synthesis or survival; maintenance of DNA methylation. Research into the mechanisms of supplemental SAMe in osteoarthritis is necessary to evaluate the clinical effectiveness and safety of this dietary supplement."

Reference:

Hosea Blewett HJ. Exploring the Mechanisms behind S-Adenosylmethionine (SAMe) in the Treatment of Osteoarthritis. Crit Rev Food Sci Nutr. 2008 May;48(5):458-63.

Vitamin C and E supplementation and hypertension

 Vitamin C and E supplementation and hypertension...

"BACKGROUND: Essential hypertension is characterized by endothelial dysfunction, arterial stiffness, and increased oxidative stress. We evaluated the effect of short-term combined treatment with the antioxidants vitamins C and E on endothelial function, arterial stiffness, and oxidative stress in untreated essential hypertensive patients."

"CONCLUSIONS: Combined treatment with vitamins C and E has beneficial effects on endothelium-dependent vasodilation and arterial stiffness in untreated, essential hypertensive patients. This effect is associated with changes in plasma markers of oxidative stress."

Reference:


Plantinga Y, Ghiadoni L, Magagna A, Giannarelli C, Franzoni F, Taddei S, Salvetti A. Supplementation with vitamins C and E improves arterial stiffness and endothelial function in essential hypertensive patients. Am J Hypertens. 2007 Apr;20(4):392-7.

Omega 3 fatty acids and blood pressure

Food omega-3 purified fatty acids may help control adverse blood pressure levels according to the results of this recent study:

"In summary, food omega-3 PFA intake related inversely to blood pressure, including in nonhypertensive persons, with small estimated effect size. Food omega-3 PFA may contribute to prevention and control of adverse blood pressure levels."

Reference


Ueshima H, Stamler J, Elliott P, Chan Q, Brown IJ, Carnethon MR, Daviglus ML, He K, Moag-Stahlberg A, Rodriguez BL, Steffen LM, Van Horn L, Yarnell J, Zhou B; INTERMAP Research Group. Food omega-3 fatty acid intake of individuals (total, linolenic acid, long-chain) and their blood pressure: INTERMAP study. Hypertension. 2007 Aug;50(2):313-9. Epub 2007 Jun 4.

Will taking potassium citrate lower your blood pressure?

High blood pressure or hypertension is a significant risk factor for cardiovascular disease (CVD). A new study published in the British Journal of Nutrition suggests that taking a daily supplment of potassium citrate lowered volunteers blood pressure by 5 mmHg.

***Many blood pressure lowering drugs called ace inhibitors cause your body to retain potassium. Consult your physician before taking a potassium supplement as many medical conditions as well as some medications can already elevate your potassium levels.


"Blood pressure (BP) shows a continuous relationship with the risk of CVD. There is substantial evidence that dietary potassium exerts an anti-pressor effect. Most clinical trials have used KCl. However, the chloride ion may have a pressor effect and in foods potassium is associated with organic anions. In a double-blind randomized placebo-controlled trial we explored the effect on BP of two salts of potassium, KCl and potassium citrate (K-cit), in predominantly young healthy normotensive volunteers. The primary outcome was the change in mean arterial pressure as measured in a clinic setting. After 6 weeks of supplementation, compared with the placebo group (n 31), 30 mmol K-cit/d (n 28) changed mean arterial pressure by - 5.22 mmHg (95 % CI - 8.85, - 4.53) which did not differ significantly from that induced by KCl (n 26), - 4.70 mmHg ( - 6.56, - 2.84). The changes in systolic and diastolic BP were - 6.69 (95 % CI - 8.85, - 4.43) and - 4.26 (95 % CI - 6.31, - 2.21) mmHg with K-cit and - 5.24 (95 % CI - 7.43, - 3.06) and - 4.30 (95 % CI - 6.39, - 2.20) mmHg with KCl, and did not differ significantly between the two treatments. Changes in BP were not related to baseline urinary electrolytes. A greater treatment-related effect was observed in those with higher systolic BP. Increasing dietary potassium could therefore have a significant impact on the progressive rise in BP in the entire population."

Reference:
Braschi A, Naismith DJ. The effect of a dietary supplement of potassium chloride or potassium citrate on blood pressure in predominantly normotensive volunteers. Br J Nutr. 2007 Dec 6;:1-9

Bromelain for knee osteoarthritis?

Bromelain is an ingredient common in many dietary supplements which are marketed for promoting joint health. Does it actually work?

"BACKGROUND: Osteoarthritis (OA) of the knee is the most prevalent joint disorder. Previous studies suggest that bromelain, a pineapple extract, may be a safer alternative/adjunctive treatment for knee OA than current conventional treatment."

"DISCUSSION: This study suggests that bromelain is not efficacious as an adjunctive treatment of moderate to severe OA, but its limitations support the need for a follow-up study."

Brien S, Lewith G, Walker AF, Middleton R, Prescott P, Bundy R. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM. 2006 Dec;99(12):841-50.

Research studies which highlight natural treatments for arthritis

As I have been writing about osteoarthritis and natural treatment options at this blog, I thought it would be useful to highlight some of the recent posts on this topic.  I wouldn't really call this a "top 10 natural arthritis treatment options" type of post, yet there are ten recent posts about this topic.

Some of the studies on these treatment modalities suggest that the options listed are effective for treating joint pain, yet others are equivocal. 


The following posts contain clinical trial studies on these various forms of natural arthritis treatments.

1. Glucosamine for joint health
2. Willow bark extract as a natural treatment
3. Magnets for treating pain
4. Devil's Claw extract in rheumatic conditions
5. Chondroitin Sulfate for joint pain
6. Exercise as a treatment for arthritis
7. Balneotherapy for osteoarthritis
8. S-adenosylmethionine for osteoarthritis
9. Psychological interventions for arthritis
10. Tai chi for Osteoarthritis

Are you taking the wrong type of glucosamine?

Glucosamine is a ubiquitous and widely studied ingredient in many joint health products. I've written previous articles on the different types of glucosamine used in joint health products (sulfate, hydrochloride, and n-acetyl glucosamine).

A recent article (Vlad et al, 2007) supports my previous conclusions on the ingredient glucosamine hydrochloride. In this recent article, published in the medical journal, Arthritis and Rheumatism, the study others sought to explain the heterogeneity of clinical trial results on glucosamine. Essentially, they endeavored to explain why many randomized clinical trials on glucosamine have found that it works, yet some clinical trials have conflicting results. Essentially, part of the reason for this discrepancy is that the clinical trials on glucosamine products include trials on glucosamine sulfate and glucosamine hydrochloride. Among their explanations was the simple conclusions that "glucosamine hydrochloride is not effective."

Make sure that your joint health product includes glucosamine sulfate. Glucosamine sulfate is found in the Arthroleve formulation. Visit http://www.arthroleve.com/ for information on our latest offers! We now offer free shipping for our Home Delivery Plan customers.


References:
Vlad SC, LaValley MP, McAlindon TE, Felson DT. Glucosamine for pain in osteoarthritis: why do trial results differ? Arthritis Rheum. 2007 Jul;56(7):2267-77.

Arthroleve contains glucosamine sulfate. Visit: www.arthroleve.com today for a free trial!

Which type of exercise is best for knee osteoarthritis?

The results of a very recent study concluded that water-based exercises were superior to land based exercises for patients with osteoarthritis (OA) of the knee. If you suffer from OA of the knee, you may want to talk your healthcare provider about appropriate water-based exercises.

"Both water-based and land-based exercises reduced knee pain and increased knee function in participants with OA of the knee. Hydrotherapy was superior to land-based exercise in relieving pain before and after walking during the last follow-up. Water-based exercises are a suitable and effective alternative for the management of OA of the knee" (Silva et al, 2007).


References:
1. Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, Natour J. Hydrotherapy Versus Conventional Land-Based Exercise for the Management of Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial. Phys Ther. 2007 Nov 6;

Glucosamine and Diabetes

Many joint health products (including Arthroleve) which contain glucosamine caution use in people who have diabetes as glucosamine is type of sugar which could theoretically affect blood sugar levels. However, a recent study concluded, "oral glucosamine at standard doses for 6 weeks does not cause or significantly worsen insulin resistance or endothelial dysfunction in lean or obese subjects" (Muniyappa et al, 2006).


References

1. Muniyappa R, Karne RJ, Hall G, Crandon SK, Bronstein JA, Ver MR, Hortin GL, Quon MJ. Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects. Diabetes. 2006 Nov;55(11):3142-50.

Different Types of Glucosamine

I recently came across an interesting article which was published in the medical journal, Osteoarthritis and Cartilage, in 2006 (Hopman et al). The authors of the study had noted that glucosamine use was increasing dramatically in Canada and they sought to find our which factors were associated with glucosamine use. The noted that glucosamine is often used by people that suffer from arthritis, back pain, or simply seek to maintain their joint health.

Not surprisingly, they found that glucosamine use was higher among the elderly. The incidence of arthritis increases dramatically with age. The also noted that glucosamine use was higher among people who take calcium supplements, engage in physical activity, and who have a prior history of glucosamine use. Many of these factors seem to fit the pattern of people who are taking proactive measures to maintain their joint health.


How many types of glucosamine are commonly taken by consumers?

There are three main types of glucosamine currently on the market:

1. Glucosamine Sulfate--This is the most researched type of glucosamine and has the largest amount of clicinical trial data supporting its efficacy.

2. Glucosamine Hydrocholoride--Many suppliers of this ingredient tout it as having a "lower molecular weight" and concluced that it is therefore "better absorbed" than glucosamine sulfate. However, in the largest study on glucosamine hydrochloride, which was independently funded by the NIH, glucosamine hydrochoride failed to show any benefits over placebo (Clegg et al, 2006). Many researchers have hypothesized that the sulfate moiety or component plays an important role in the activity of glucosamine.

3. N-acetyl glucosamine--there is sparse clinical trial data on this type of glucosamine and it is not commonly used by manufacturers.


In addition to the different types of glucosamine used in joint health product, there are also different grades of quality and different sources of glucosamine sulfate. Dietary supplements are also manufactured under different quality control regulations. For example, is your glucosamine supplement made in a GMP approved facility in the USA, or in a unregulated facility in China?

Arthroleve ULT(TM) is made with glucosamine sulfate and is manufactured in a GMP approved environment in the United States. http://www.arthroleve.com/.


References:

1. Hopman WM, Towheed TE, Gao Y, Berger C, Joseph L, Vik SA, Hanley DA, Carran J, Anastassiades T. Prevalence of and factors associated with glucosamine use in Canada. Osteoarthritis Cartilage. 2006 Dec;14(12):1288-93. Epub 2006 Jul 10

2. Clegg DO, Reda DJ, Harris CL, Klein MA, O'Dell JR, Hooper MM, Bradley JD, Bingham CO 3rd, Weisman MH, Jackson CG, Lane NE, Cush JJ, Moreland LW, Schumacher HR Jr, Oddis CV, Wolfe F, Molitor JA, Yocum DE, Schnitzer TJ, Furst DE, Sawitzke AD, Shi H, Brandt KD, Moskowitz RW, Williams HJ. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med. 2006 Feb 23;354(8):795-808.

Balneotherapy for osteoarthritis.

Balneotherapy for osteoarthritis.

I certainly hope that the first question that you are asking yourself is the very same question that I asked myself when I came across this very recent study... The question that came to my mind was, "what on earth is balneotherapy?"

Balneotherapy, to my recent understanding is a broadly defined term encompassing the various types of therapy pertaining to spas. In this recent cochrane review, they attempted to review various clinical trials which were conducted on varying forms of mineral bath treatments for arthritis.

One challenge with randomized clinical trials that evaluate unconventional treatment forms is that it is often difficult to create an adequate placebo. For example, with a clinical trial involving tablet type medication, you can make a placebo tablet that looks, tastes, and feels exactly the same as the medication tablet. However, whether the clinical trial is attempting to evaluate a treatment method such as tai chi, spa baths, or meditation, these types of treatment options do not fit into the conventional evaluation methods preferred by physicians.

Just try to imagine what type of placebo comparision one would actually use for a randomized clinical trial for tai chi. A group of people engaged in fake tai chi? Well, actually no. Current comparison methods include people that are on a waiting list for a treatment who do not receive any treatment interventions. The problem with using a waiting list of patients as a comparison group is that the trial is no longer blinded. The people who are conducting the clinical trial know exactly which group received the intervention and which group did not. As well, the people that are in the trial themselves also know that they are receiving an intervention. Further, many of these types of trials have the additional problem that people who enroll in the study will simply drop out if they are not randomized to the tai chi group, for example. All of these problems as well as others create bias in evaluating these types of treatments.

When I think back to my childhood, I can recall playing with a toy which I believe is made by Fisher-Price. It was a spherical piece of plastic with various shaped holes built into the hollow sphere. The toy came with correspondingly shaped objects with the ultimate goal of fitting these little pieces of plastic into the sphere. Though the attempt to evaluate unconventional treatment options with our current type of clinical trials is noble, much like trying to place the star shaped object into the square hole of the toy that I played with when I was a toddler, it simply just doesn't fit and the efforts to make it fit are fruitless. Here is an example of the fruitless efforts of the esteemed cochrane collaboration in evaluating several clinical trials on balneotherapy:

"AUTHORS' CONCLUSIONS: We found silver level evidence (www.cochranemsk.org) concerning the beneficial effects of mineral baths compared to no treatment. Of all other balneological treatments no clear effects were found. However, the scientific evidence is weak because of the poor methodological quality and the absence of an adequate statistical analysis and data presentation. Therefore, the noted "positive findings" should be viewed with caution." (Verhagen et al, 2007).

What is the alternative method for evaluating alternative treatments? Common sense! Provided that the alternative treatment is safe, has no contraindications, you have no medical reason for not trying it, and that it isn't excessively expensive, give it a try and if it works for you, keep doing it--if it doesn't work, then stop.

So if you are one of my blog readers who suffers from arthritis, you can consider many options--sign up for a tai chi class, throw some mineral salts into a warm hot bath, if you find that helps to relieve your arthritic pain, maybe keep doing it, if it doesn't then stop. It's that simple!


Reference:
Verhagen A, Bierma-Zeinstra S, Boers M, Cardoso J, Lambeck J, de Bie R, de Vet H. Balneotherapy for osteoarthritis. Cochrane Database Syst Rev. 2007 Oct 17;4:CD006864.

S-adenosylmethionine for osteoarthritis

S-adenosylmethionine for osteoarthritis?

A recent study published in the journal, BMC Musculoskeletal Disorders, compared the efficacy of SAMe to Celexocib for the management of knee osteoarthritis.  The study authors concluded that SAMe was as effective as celexocib for treating patients with this medical condition.


From the study authors: 

"CONCLUSION: SAMe has a slower onset of action but is as effective as celecoxib in the management of symptoms of knee osteoarthritis. Longer studies are needed to evaluate the long-term effectiveness of SAMe and the optimal dose to be used" (Najm et al, 2004).

Reference:

Najm WI, Reinsch S, Hoehler F, Tobis JS, Harvey PW. S-adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: a double-blind cross-over trial. [ISRCTN36233495]. BMC Musculoskelet Disord. 2004 Feb 26;5:6.

SAMe is found in the patent-pending Arthroleve formulation. For a free sample box, visit: www.arthroleve.com

Glucoamine Sulfate for Knee Osteoarthritis

•In this study, 318 patients were enrolled in this randomized control trial for patients with Knee osteoarthritis (OA) during a six month treatment course.
•Findings: glucosamine sulfate is more effective than placebo in treating knee OA symptoms. Reached the level of statistical significance over 6 month period.
•What’s interesting about this study is that Acetaminophen actually failed to show a statistically significant effect compared to placebo for treating OA pain.

Reference:

Herrero-Beaumont G, Ivorra JA, Del Carmen Trabado M, Blanco FJ, Benito P, Martín-Mola E, Paulino J, Marenco JL, Porto A, Laffon A, Araújo D, Figueroa M, Branco J. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum. 2007 Feb;56(2):555-67.

Clinical Trial recruiting participants--Yoga for Rheumatoid Arthritis

If you suffer from rheumatoid or an inflammatory type of arthritis, you may be interested in participating in this study.

Study sponsors: National Center for Complementary and Alternative Medicine (NCCAM)
National Institute of Neurological Disorders and Stroke (NINDS)

Primary outcome measure: Quality of Life

Link for further information:

http://clinicaltrials.gov/ct/show/NCT00349869;jsessionid=A0D67642B7E386977DCC0A637186F2D4?order=4

Efficacy and safety of willow bark extract?

"OBJECTIVE: To investigate the efficacy and safety of a standardized willow bark extract in patients with osteoarthritis (OA) and rheumatoid arthritis (RA). "


"CONCLUSION: The OA study suggested that the willow bark extract showed no relevant efficacy in patients with OA. Similarly, the RA trial did not indicate efficacy of this extract in patients with RA."


Biegert C, Wagner I, Lüdtke R, Kötter I, Lohmüller C, Günaydin I, Taxis K, Heide L.
Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind controlled trials. J Rheumatol. 2004 Nov;31(11):2121-30.

Devils claw extract for rheumatic conditions

A recent study on Devil's Claw (Harpagphytum procumbens) extract has just been published on September 20, 2007 in the medical journal, Phyotherapy Reserach. Devil’s claw is a plant which is native to south and central Africa. It’s medicinal value lies in its fleshy roots or the secondary tubers. The vernacular name, Devil’s Claw is dervied from the fact that the fruits of the plant are covered in small claw-like protrusions. Harpago itself translates from greek which literally means 'grappling hook.'

Here are some of the conclusions of this recent study:

“There were statistically significant improvements in patient assessment of global pain, stiffness and function. There were also statistically significant reductions in mean pain scores for hand, wrist, elbow, shoulder, hip, knee and back pain. Quality of life measurements were significantly increased from baseline and 60% patients either reduced or stopped concomitant pain medication. Harpagophytum is an effective and well-tolerated serious treatment option for mild to moderate degenerative rheumatic disorders providing improved quality of life measure.”

Devil's claw extract is found in our Arthroleve product formulation. Our HP extract is standardized to 3% harpagoside content which is the active ingredient in the extract.


Arthroleve ULT(TM) is available at: http://www.arthroleve.com/

Reference:

Warnock M, McBean D, Suter A, Tan J, Whittaker P. Effectiveness and safety of Devil's Claw tablets in patients with general rheumatic disorders. Phytother Res. 2007 Sep 20.

Chondroitin Sulfate for osteoarthritis?

 

Does Chondroitin Sulfate work to relieve arthritis symptoms?

Millions of Americans suffer from the debilitating symptoms of osteoarthritis.  To relieve their suffering and to promote joint health, many have turned to alternative therapies including dietary supplements.

Based on the current available evidence, for those that are spending their money on chondroitin sulfate, are they wasting their money?

"Large-scale, methodologically sound trials indicate that the symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged"(Reichenbach et al, 2007).

Reference:
Reichenbach S, Sterchi R, Scherer M, Trelle S, Bürgi E, Bürgi U, Dieppe PA, Jüni P. Meta-analysis: chondroitin for osteoarthritis of the knee or hip. Ann Intern Med. 2007 Apr 17;146(8):580-90.

According to the results of this recent publication in the medical journal, Annals of Internal Medicine, people who take dietary supplements which include chondroitin sulfate may be wasting their time and their money on these products.


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