Reviewed By Michael Smith, MD
By presidential proclamation, we're living in the National Bone and Joint Decade, 2002-2011, and that means we should be seeing a surge in research into causes and treatments of arthritis and other diseases.
Meanwhile, many people with osteoarthritis (OA) and rheumatoid arthritis (RA) seek relief by buying the latest book or nutritional supplement claiming to relieve or cure arthritis, or they take advice from a neighbor who swore that eating gin-soaked raisins eased her symptoms.
How do you navigate this gray area of unregulated therapies to know if what you're doing can help or harm? WebMD talked with two experts who provided insight into the claims made for arthritis diets and supplements. Hayes Wilson, MD, is a rheumatologist in Atlanta and medical adviser for the Arthritis Foundation. Christine Gerbstadt, RD, MD, practices in Pittsburgh and is a spokeswoman for the American Dietetic Association.
Here's a guide to help you sort fact from fiction:
- Eliminate nightshades. One of the most common diet claims is that
eliminating nightshades, which include potatoes, tomatoes, eggplants, and
most peppers, relieves arthritis. This diet probably isn't harmful, but
there are no studies to support it.
- Alkaline diet. The alkaline diet presumes both OA and RA are
caused by too much acid. Among the foods it excludes are sugar, coffee, red
meat, most grains, nuts, and citrus fruits. It's meant to be followed for
just one month. It may be that people feel better because they lose weight,
reducing stress on joints, which eases pain. This diet eliminates most
vitamin C sources. There are no studies to support it.
- Dong diet. This restrictive diet relies heavily on vegetables,
except tomatoes, and eliminates many of the same foods as the alkaline diet.
There's no evidence it affects arthritis.
- Vegetarian diet. Some people report improvement in symptoms, but
evidence is mixed. One small study of people with RA showed improvement in
four weeks, and follow-up studies of those who stayed on the diet showed
continued improvement after one and two years.
- Switching fats. One of the known correlations between food and
arthritis is that omega-6 fatty acids increase inflammation, and omega-3
fatty acids reduce it. Limit intake of meat and poultry, and increase your
intake of cold-water fish, such as sardines, mackerel, trout, and salmon.
For salad dressings and cooking, substitute olive, canola, and flaxseed oils
for corn, safflower, and sunflower oils.
- Gin-soaked raisins. Lots of people claim it works, but experts
say there's no evidence. Grapes and raisins do contain anti-inflammatory
compounds, but not in amounts that would be therapeutic. The gin might dull
pain, but drinking to excess sabotages health benefits of nutrients and
vitamins, and introduces a whole new set of problems.
- Green tea. Drinking three to four cups of green tea a day could help people with RA. Studies funded by the Arthritis Foundation showed that giving the polyphenolic compounds in green tea to mice significantly decreased the incidence and severity of RA. Human studies have not yet confirmed the results.
- ASU (avocado-soybean unsaponifiable). French studies of ASU,
derived from avocado and soybean oils, show it can relieve OA pain,
stimulate cartilage repair, and lower a patient's need for nonsteroidal
anti-inflammatory drugs (NSAIDs) to control pain. Jason Theodosakis, MD,
author of The Arthritis Cure and champion of glucosamine chondroitin,
believes ASU will have a major impact on treatment of OA. Sold in France by
prescription under the name Piascledine 300, it's available in the U.S.
without a prescription.
- Black currant oil. See GLA.
- Borage oil. See GLA.
- Boron. Population studies show that people who have high-boron
diets have a very low incidence of arthritis, and there's evidence that
people with OA and RA can benefit. The best sources of boron are fresh
fruits and vegetables and, depending on where you live, drinking water.
- Bovine cartilage. Taken from the windpipe and trachea of cows,
it's supposed to act as an anti-inflammatory agent in the treatment of OA
and RA. A few animal and laboratory studies are promising, but there are no
human studies to support claims. Researchers also think it may promote
regrowth of cartilage.
- Bromelain. This substance found in pineapple is supposed to
relieve pain and swelling in OA and RA and improve mobility. There are no
studies that show it's effective by itself, but one study of a bromelain
supplement containing the enzymes rutin and trypsin relieved pain and
improved function in 73 people with knee OA. The effect was similar to
taking an NSAID.
- CMO. It's touted as an "arthritis cure," but there's no human
clinical evidence to support it.
- Chondroitin sulfate. Used for many years in Europe to relieve OA
pain, it's been shown to stop joint degeneration, improve function, and ease
pain. One study followed patients with OA in finger joints for three years,
and showed fewer patients developed further cartilage damage. It can take
two months or more to realize the effects of chondroitin.
- DMSO. Once widely used to relieve joint and tissue inflammation,
it fell out of favor when animal studies showed high doses damaged the lens
of the eye. Don't use it without consulting your doctor.
- Evening primrose oil. See GLA.
- Fish oil. Studies show it relieves the pain of RA.
- Flaxseed. There are many good nutritional reasons to add it to
your diet, but studies of its effect on arthritis have shown mixed results.
Its anti-inflammatory properties work best if other vegetable-based oils are
- GLA. Gamma linolenic acid (GLA) is an omega-6 fatty acid the body
uses to make anti-inflammatory agents, unlike other omega-6 fatty acids that
actually increase inflammation. It's found in evening primrose oil, black
currant oil, and borage oil supplements. Several studies show it relieves
the stiffness and pain of RA. In one study, some patients were able to quit
- Ginger. It's known to have painkilling and anti-inflammatory
agents. Ginger is believed to reduce joint pain and inflammation in people
with OA and RA, and protect the stomach from gastrointestinal effects of
NSAIDs. A clinical study showed ginger reduced knee OA pain.
- Glucosamine. As glucosamine hydrochloride or glucosamine sulfate,
this supplement relieves symptoms for many, but not all, people with OA. It
helps the body build and repair cartilage. In a double-blind study,
glucosamine sulfate was as effective in relieving symptoms in patients with
knee OA as ibuprofen and had fewer side effects. It takes about two months
to realize the effectiveness of this supplement. Although it's derived from
crab, lobster, or shrimp shells, it seems not to cause problems for people
with shellfish allergies.
- Glucosamine chondroitin. Many OA patients get relief by taking
glucosamine and chondroitin together, but it's not known whether the
combination is more effective than taking them alone. That's the subject of
a National Institutes of Health (NIH) study called GAIT (glucosamine/chondroitin
arthritis intervention trial) now under way. The research shows how
effective the supplements are in terms of improving functional ability and
reducing pain in people with knee OA. Results are expected to be published
- MSM. It's widely touted for relief of pain and inflammation. Its
safety and effectiveness have yet to be determined.
- SAM-e. Many European studies over the last 20 years show SAM-e is
as effective as anti-inflammatory painkillers in treating OA but with fewer
side effects. It works in conjunction with vitamin B-12, B-6, and folate.
Claims that SAM-e repairs and rebuilds cartilage lack evidence, as studies
have been done only in the lab and in animals.
- Shark cartilage. Ground-up cartilage from Pacific Ocean sharks is
supposed to relieve the inflammation and pain of arthritis. Animal and lab
studies are promising, but there are no human studies to support claims.
Researchers also think it may promote regrowth of cartilage.
- Stinging nettle. Taken orally or applied to the skin, stinging
nettle is supposed to reduce the pain and inflammation of OA. Some studies
show that patients can lower their dosages of NSAIDs by taking stinging
nettle in extract form. Two small studies showed stinging nettle applied
topically reduced pain for people with hip OA and thumb joint pain.
- Turmeric. This supplement is used in traditional Chinese and
Indian Aruyvedic medicine to relieve pain, stiffness, and inflammation of OA
and RA. A small study that combined turmeric, boswellia, and zinc showed
decreased pain in OA. Two studies using a combination of turmeric, boswellia,
ginger, and aswangandha relieved pain and inflammation in RA. Its
effectiveness alone is unknown.
- Wild yam. Although it contains natural anti-inflammatory steroids, they're not in a form the body can use.
Experimenting with foods and supplements is not without risks. "I know people get desperate enough to try anything, but I would not feel comfortable eliminating whole groups of food," says Gerbstadt. "Before you eliminate any foods or modify your diet, check with a nutritionist."
"The best advice is to eat a healthy, well balanced diet and stay close to your ideal body weight so affected joints have less extra weight to carry around," says Wilson. "Also get plenty of rest and exercise and decrease stress."
Be aware that many supplements interfere with or enhance effects of medications you're already taking. For example, a number of supplements increase the effects of blood-thinning medication. Check with your doctor.
Published Aug. 6, 2004.
SOURCES: Archives of Internal Medicine, July 14, 2003. The Arthritis Foundation's Guide to Alternative Therapies, by Judith Horstman. Hayes Wilson, MD, medical advisor, Arthritis Foundation. Christine Gerbstadt, RD, MD, spokeswoman, American Dietetic Association. Arthritis Foundation. Web site of Jason Theodosakis , MD.
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