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Osteoarthritis sufferers, rejoice! If there has ever been a time when relief from this crippling disease was more than just a promise, it is now. During the last few years, scientists have made impressive discoveries in treatments -- especially when it comes to alternative health solutions -- including everything from glucosamine and chondroitin supplements to vitamins and minerals. Before looking at these in detail, though, let's quickly review some of the basic facts about osteoarthritis.

Arthritis 101

Swollen joints. Morning stiffness. Painful movements. These are daily facts of life for the more than 35 million Americans who live with osteoarthritis. This disease, also known as degenerative joint disease or osteoarthrosis, is the leading cause of disability in older people. Osteoarthritis is not a killer, like heart disease and cancer, but, as the millions of Americans who suffer from it know, osteoarthritis can rob otherwise healthy people of their quality of life, by making even the simplest of movements painful.

The exact cause of osteoarthritis is not known, so prevention is difficult.

In general, though, since osteoarthritis affects the joints, anything you can do to relieve stress on the joints is recommended. This includes losing excess weight, avoiding repetitive motions, and choosing low-impact sports (e.g. bicycling, swimming) over grueling, joint-punishing activities.

Here's why: Osteoarthritis breaks down cartilage, the spongy, protective cushion between joint bones. As the cartilage wears away, bones begin to rub against one another, causing pain, inflammation, and stiffness. Knees, hips, fingers, and the spine are the areas most often affected by the disease, but any joint is vulnerable, especially if it has been injured or overused.

When a joint becomes painful, many people avoid movement, including exercise. This is a major mistake. The stronger the muscles around the joint are, the more support they provide. thereby reducing pain. In addition, strong muscles keep joints properly aligned, cutting down on further cartilage wear and tear.

Once osteoarthritis has been diagnosed, physicians often recommend non-steroidal anti-inflammatory drugs (NSAIDs) for relief. These include over-the-counter NSAIDs such as Advil, Motrin, aspirin, and others, as well as NSAIDs available by prescription, like Naprosyn, Relafen, and Daypro, to name a few. While they do lessen pain, NSAIDs often have adverse side effects By contrast, many of the alternative therapies are side-effect free. Better yet, as millions of arthritis sufferers know, these alternative therapies are very effective. Even if it takes a few tries to find the right treatment for you, in the long run, it is definitely a worthwhile endeavor.

Glucosamine and chondroitin: a hard-working team

Four years ago, when The Arthritis Cure was first published (a book I co-authored with Jason Theodosakis and Barry Fox), arthritis sufferers learned about two naturally occurring substances -- glucosamine and chondroitin sulfates -- that had been shown in international studies to relieve osteoarthritis symptoms, and in some cases, even reverse the condition. In spite of extensive, existing research, though, many American doctors were reluctant to prescribe glucosamine and chondroitin until studies were done in the United States. Now, the glowing reports from many patients are being supported by rigorous new studies, both in the U.S. and abroad.

In North Carolina, orthopedic surgeon Amal K. Das, Jr., M.D., conducted a study with 93 patients suffering from osteoarthritis of the knee. After taking glucosamine, more than half of the participants reported significant improvements in both mobility and pain. "At first I only recommended these supplements to patients who had tried everything else and were still in pain," notes Das. "But now I think everyone should know about them."

But even more impressive findings were announced recently at meetings of the American College of Rheumatology, when a 3-year-long European study of 212 patients found glucosamine actually protected cartilage in arthritic joints from deteriorating. Using before and after X-rays, researchers found that 40 percent of the group taking a placebo suffered cartilage deterioration during the 3 years, compared with only 22 percent of the group taking glucosamine.

Is chondroitin necessary?

Given the fact that glucosamine seems to do the job nicely on its own, is chondroitin, the supplement it's often paired with, necessary? In earlier years, when studies were often conducted using injectable chondroitin that wasn't available to the general public, that was a viable question. But several recent studies using oral chondroitin have shown it has potent healing powers of its own.

A year-long clinical trial at the University Hospital in Geneva, Switzerland, looked at the effects of 800 mg of oral chondroitin vs. a placebo on 42 patients with osteoarthritis in the knee. Researchers discovered something remarkable -- chondroitin not only eased symptoms, but it also regulated bone and joint metabolism, halting cartilage degeneration, and stabilized joint width, a key indicator that osteoarthritis did not worsen while patients were taking chondroitin.

Another good report comes from France, where scientists conducted a randomized, double-blind, controlled study to measure a placebo against the effectiveness and tolerability of 1,200 mg oral chondroitin gel taken once a day as opposed to 400 mg capsules taken three times daily. After 3 months, they concluded that both gel and capsules were equally effective at reducing symptoms of osteoarthritis of the knee, something that did not happen in the placebo group.

Synergy of glucosamine + chondroitin: a one-two punch

Given the fact that glucosamine is essential for creating the proteins that make up cartilage, while chondroitin attracts fluid to these tissues, experts have speculated that taking the two supplements together would produce even more dramatic results. Until recently, there were no studies to back up the theory, but now there are.

The synergistic effects of glucosamine and chondroitin, when taken together, were demonstrated in a recent U.S. Navy study involving 34 Navy Seals with osteoarthritis. Researchers divided the group in two, then gave one half a proprietary formulation of glucosamine, chondroitin, and manganese ascorbate, while the other half received a placebo. After eight weeks, knee arthritis sufferers in the glucosamine group reported significant pain relief, while those in the placebo group did not.

Meanwhile, more studies are underway to determine glucosamine's and chondroitin's effects on osteoarthritis. Last year, the National Institutes of Health launched a $6.6 million study of the supplements with 1,000 patients, and another clinical trial with 350 patients is underway at Johns Hopkins. In the meantime, glucosamine and chondroitin have repeatedly been proven to be safe, with only abdominal upset a rarely reported side effect.

Here are some other supplements which may help keep arthritis pain at bay:

Something about Sulfur

MSM (short for methylsulfonylmethane) is a naturally occurring, organic sulfur compound that is essential for healthy skin, hair, muscles, and other tissues. It is also reported to be a potent arthritis pain reliever. In fact, its cousin, DMSO, has been used for years on arthritic and lame animals. Although this supplement is becoming increasingly popular, research is scarce. But MSM supplements of 2,000 to 4,000 mg a day appear to be safe and side-effect free.

Super Silicon

This macromineral is present throughout our bodies, and is especially important to the development of strong bones and tissues, such as arteries, tendons, and cartilage. While no studies have been done examining the effects of silicon on osteoarthritis, deficiencies have been linked to the bone-thinning disease, osteoporosis. And researchers do know that silicon is an essential element in chondroitin, as well as a requirement for proper growth of cartilage.

While our ancestors obtained silicon from a diet rich in bone marrow, cartilage, tendons, and raw root vegetables, it is difficult to do so on a diet of modern processed foods, which contain almost none of this mineral.

The richest sources of silicon available in today's supermarket are beer and pork rinds, notes C. Leigh Broadhurst, Ph.D., a geochemist with a government nutrition research lab, which is why most men are not generally deficient in silicon, but women are. While Broadhurst believes silicon supplements of stabilized orthosilicic acid are better absorbed, other, vegetable-based silicon supplements are also available. As for dosage, follow the directions on the product you choose.

Boning up on Calcium

Like silicon, calcium deficiencies have been linked to osteoporosis. Indirectly, though, calcium is connected to osteoarthritis, because easily fractured bones only add to the discomfort and pain of arthritis. Calcium is easily obtained with three or four daily servings of dairy. Dark-green leafy vegetables, such as collard greens and kale, and fortified foods, such as enriched soy milk, are also excellent calcium sources. Typically, depending on the stage of life, women should get 1,200 to 1,500 mg of calcium daily, and men need about 900 mg. Few people meet these basic requirements. Consult your physician for exact recommendations.

Mighty Magnesium

Strong bones require more than calcium alone. Magnesium plays an essential role in the production of strong bones, muscles, and other tissues, and it enhances the body's absorption and ability to use calcium. Once you have determined the amount of calcium you should be getting daily, factor in about one-third that amount of magnesium, too.

More Manganese, please

The enzymes that produce cartilage need manganese, a mineral that may be more difficult to utilize as we grow older. To make certain you are getting an adequate supply, supplements of 10 to 30 mg daily are recommended.

Don't forget the Vitamin C

Although it's more famous as a fighter of the common cold, vitamin C is actually very important in the production of cartilage. Since our bodies can't store this essential nutrient, doses between 500 and 4,000 mg are recommended on a daily basis.

Get to know Boswellia seratta

A resin (Salai guggal or gum guggul) taken from the B. serrata trees that grow in the mountains of India has anti-inflammatory properties that rival those of over-the-counter painkillers. In fact, research points to benefits in the treatment of osteoarthritis, soft-tissue rheumatism, and rheumatoid arthritis. Better yet, Boswellia, a favorite in Ayurvedic medicine, does not wreak havoc on the digestive system. Typically, three 200 mg doses per day is recommended.

Capsaicin, a `hot" new pain remedy

Repeatedly, researchers have found that creams containing capsaicin, a derivative of hot chili peppers, relieves pain in osteoarthritis of the hands. In one study, capsaicin applied four times daily noticeably decreased joint tenderness and pain, with a localized burning sensation the only side effect. Previous and later studies have had similar results.

As you can see, when it comes to beating arthritis, there is a wide range of alternative remedies on the market. Take the time to determine which one is right for you, and let the healing begin.

REFERENCES

Bourgeois, P., et al., "Efficacy and tolerability of chondroitin sulfate 1200 mg/day vs. chondroitin sulfate 3 x 400 mg/day vs. placebo." Osteoarthritis Cartilage, Suppl A:25-30, May 6, 1998.

Das, A.K., Eitel, J., Hammad, T.A. Paper #180, 66th Annual Meeting, American Academy of Orthopedic Surgeons, Anaheim, CA, Feb. 6, 1999.

Jones, M.K., et al. "Inhibition of angiogenesis by non-steroidal, anti-inflammatory drugs: insight into mechanisms and implications for cancer growth and ulcer healing." Nature Medicine 5:1418-1423, 1999.

Leffler, C.T., et al. "Glucosamine, chondroitin and Manganese Ascorbate for degenerative joint disease of the knee or low back. A randomized, double-blind, placebo-controlled pilot study." Military Medicine, 164:2:85-01, Feb. 1999.

McCarthy G.M., McCarthy, D.J. "Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands." Journal of Rheumatology, 19(4):604-7, Apr. 1992.

Uebelhart, D., et al. "Effects of oral chondroitin sulfate on the progression of knee osteoarthritis: a pilot study," Osteoarthritis Cartilage, Suppl A:39-46, May 6, 1998.

RELATED ARTICLE: Rheumatoid Arthritis: the other arthritis

Although it falls under the umbrella category of arthritis, rheumatoid arthritis (RA) really bears very little similarity to osteoarthritis. Both involve joint destruction, but RA is actually an auto-immune disorder. There are about 2.5 million RA sufferers in this country, far fewer than the number of people with osteoarthritis. For these people, joint deterioration commonly occurs on both sides of the body simultaneously and suddenly, and can worsen rapidly.

Since the cause of RA is unknown, there is no one treatment that is effective for everyone. The options include everything from NSAIDs and the newer COX-II inhibitors to steroids, physical therapy, and/or surgery. One of the more promising treatments is enzyme therapy, which involves a combination of such substances as bromelain (a pineapple extract), rutin (a bioflavonoid), papain (derived from papayas), trypsin, and chymotrypsin (extracted from pigs). Oral enzyme mixtures have been widely studied and their anti-inflammatory properties clearly determined to be at least as effective as NSAIDs, with far fewer and less serious side effects.

In addition, two groups of essential fatty acids (EFAs) are known for their anti-inflammatory properties. Both gamma-linolenic acid (GLA) and eicosapentaenoic acid (EPA) can help alleviate symptoms of RA without undesirable side effects. GLAs are found in borage seed oil, primrose oil, and black currant seed. A minimum of 1.4 grams of GLAs should be taken daily for three months to maximize the effects. Meanwhile, in a year-long, double-blind, controlled study, the group of RA patients who received a daily dose of 2.6 grams of EPAs, an omega-3 fatty acid common in flaxseeds, fish, and marine plants, experienced significant symptom relief.

Last, but not least, animal studies at Case Western Reserve University show that the antioxidants in green tea decreased the likelihood of mice developing RA symptoms, and those that did had less severe cases of the condition.

One caution: If you are being treated for RA, please discuss these or any other alternative methods with your healthcare practitioner before making changes. You are on the same team and should work as partners toward improving your health.

Brenda Adderly is the author of 13 books about health. She may be reached by e-mail at brendaadderly@stayhealthy.com if you have questions.

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