While alternative therapies offer much to a sufferer of arthritis in any of its forms, there is a great deal that you can also do for yourself. A radical change of diet, a low-impact exercise regime and the introduction of vitamin and mineral supplements into your daily regime can have an enormous benefit, as they have for many thousands of others before you. It is advisable to work with a qualified nutritional therapist on any major change to your diet, or before beginning supplementation.
Here we look at the key supplements that need to be part of your fight against arthritis.
Glucosamine and chondroitin
These two naturally-occurring compounds are beginning to revolutionise alternative treatments for arthritis. Sold as nutritional supplements, both are recognised to be of major importance in the growth of cartilage, which covers the ends of bones in the joints and protects them from wear.
Glucosamine is the major building block of proteoglycans, large molecules in cartilage that give it elastic and protective properties. Chondroitin is an even larger cartilage molecule. Taken orally, they take only four hours to be absorbed by the joints. In lab tests, they have increased the protective effects of cartilage and may even spur cartilage growth. One theory is that they work by improving the quality of the synovial fluid between the joints.
The evidence for their effect in patients is impressive. So far, there have been over 14 trials, most showing a significant reduction in pain and joint stiffness. Virtually all the research has been done on osteoarthitis, the most common form of the disease.
Bromelain, an enzyme obtained from the pineapple plant (Ananas comosus), can be effective in reducing the amount of inflammation associated with RA and the dose of steroids needed to manage it.
Twenty-five patients with stage II or III RA were able to taper their steroid dosages down to small maintenance doses of enteric-coated bromelain. Joint swelling was also substantially reduced in most patients.
Cetyl myristoleate (CMO)
CMO, or cetyl myristoleate, is one of the great new hopes for most types of arthritis, other than osteoarthritis. It is meant to be particularly beneficial in treating cases of rheumatoid arthritis and in the fairly rare condition, psoriatic arthritis.
CMO is made up of fatty acids and oils, which can be derived from fish or animal fat. Some of the CMO products are derivatives of bovine tallow. CMO is a component of the unsaturated fatty acid cis-9-tetradecanoic acid, more commonly known as myristoleic acid. It is a part of our bodies, present in sebum, the oily secretion of our skin. It even covers our bodies as newborns and so eases our passage out into the world.
Rex Newnham, a nutritionist based in North Yorkshire, has discovered that areas with low soil boron-such as Jamaica, Mauritius and Fiji-have levels of arthritis as high as 70 per cent. But in areas with high soil boron, there is little or no arthritis.
Boron is a little-known trace mineral that could improve-even cure-both rheumatoid and osteoarthritis, osteoporosis and other bone diseases, he maintains.
This controversial view is held by a small group of scientists, mainly in Australia and America, and has been championed by Newnham, a New Zealand-born nutritionist and naturopath.
Both B5 (pantothenic acid) and B3 (niacinamide) have been shown to be beneficial at doses of 25 mg. They should be taken within a balanced B complex and should not be taken at night. Niacinamide has been shown to reduce inflammation and increase joint flexibility, and may help sufferers reduce the amount of first-line anti-inflammatories they need to take.
Niacinamide, taken in large doses, has long been advocated as a treatment for osteoarthritis. In one study, 663 patients receiving niacinamide had a greater range of movement, compared with controls. In another, 72 patients were given either niacinamide or a placebo for 12 weeks. The niacinamide group reported a 29 per cent improvement against a 10 per cent worsening of symptoms among the placebo group. The supplement also reduced the use of NSAIDs by 13 per cent, and joint mobility improved by 4.5 degrees.
Essential fatty acids (EFAs)
Top of the list are fish oil supplements such as cod liver oil, best taken during the winter months, and fish oil during the warmer periods of the year. Although initially sceptical about fish oils, rheumatologists have taken the claims seriously enough to do proper clinical trials. Pooling the data, their unequivocal conclusion was that taking fish oil supplements for three months "significantly" reduced joint pain and stiffness-with no side-effects. Regular consumption of grilled or baked fish seems to have the same effects. The key beneficial ingredient in fish is thought to be the omega-3 fatty acids. However, cod liver oil should not be taken by anyone on blood-thinning medication such as warfarin, or by diabetics as it can raise blood sugar levels.
Omega-3 fatty acids may help to reduce morning stiffness, as can a diet that is high in polyunsaturated fats and low in saturated fat.
Unlike diet and vitamins, fish oil has been scientifically tested against drug therapy. One study, carried out by L Skoldtsam at Kalmar Hospital in Sweden, concluded that 10 g of fish oil a day had similar anti-inflammatory qualities to NSAIDs. Another, by C S Lau of Ninewells Hospital, Dundee, discovered in a double-blind placebo study that patients on the fish oil could reduce their NSAID requirements without suffering any deterioration.
Evening primose oil (gamma-linolenic acid) is another dietary oil found by most studies to be helpful in arthritis. The optimal dose is about 500 mg/day of GLA (equal to 6 g of evening primrose oil). There's evidence that olive oil, too, relieves pain. It may also prevent arthritis if consumed regularly.
Blackcurrant seed oil, rich in gamma-linolenic acid (GLA) and alpha-linolenic acid (ALA), can help alleviate inflammation in patients with rheumatoid arthritis1. But the problem is that sufferers need to take several large capsules a day of whatever supplement they choose, and this puts some off the regime.
Zinc has proven beneficial in a research trial at the Division of Rheumatology, University of Washington. Twenty-four patients with chronic rheumatoid arthritis were given 50 mg of zinc three times a day or a placebo for 12 weeks. Those who took zinc had less joint swelling, less morning stiffness and could walk further than those after placebo. The trial was also repeated for psoriatic arthritis and again showed positive results. The Institute for Optimum Nutrition recommends supplementing 10 to 15 mg of zinc every day, as well as eating a zinc-rich diet.
Vitamins A, C and E
The Institute of Optimum Nutrition recommends that arthritis sufferers should consider taking combined antioxidants, vitamins C, E and selenium. Daily doses of vitamin C can be as high as 3000 mg, and 400 IUs of Vitamin E and 200 mcg of selenium could also be taken every day for optimum effect, the Institute recommends.
Vitamin C, which is necessary for collagen synthesis, is often deficient in the elderly. In one study, comparing osteoarthritus patients given vitamin C, beta carotene and vitamin E against controls, those taking high doses of vitamin C reduced the rate in which cartilage was lost by 70 per cent.
Vitamin E is also essential to collagen repair. Studies have shown that vitamin E inhibits the enzymes which break down collagen; in one clinical trial, osteoarthritis patients given 600 IU of vitamin E significantly improved.
For those of us living in northern Europe with its shorter summers and grayer climes, vitamin D supplements could be an important, and overlooked, part of the anti-arthritis regime.
Normally we would expect to get sufficient vitamin D from the sun when it reacts with our skin. But poor weather plus scares about skin cancer mean that many of us get too little of it.
Sometimes a vitamin D deficiency mirrors typical arthritis symptoms, such as knee aches and pains, aching legs, bone tenderness, weakness of muscles, and an inability to walk properly. Sometimes, believes nutritionist Rex Newnham, a vitamin D deficiency is mistaken for arthritis, particularly among old people in nursing homes, who see the sun too infrequently, and among vegetarians, whose diet can be deficient in vitamin D. Interestingly, dark-skinned people living in northern Europe are also more likely to suffer a vitamin D deficiency.
Benefits of vitamin D include muscle strengthening, and creation of healthy bone. Apart from sunlight, which is the best source of vitamin D, you can also get the vitamin from oily fish, or from cod liver oil, from eggs and dairy produce.
MSM and sulphur tablets had the late Hollywood film star James Coburn as its greatest advocate. He claimed that his rheumatoid arthritis, which had him crippled in pain and unable to work, was cured by taking MSM sulphur tablets.
Methylsulphonyl-methane, or MSM, is a source of bioavailable sulphur, which is found in the tissues and fluids of all plants, animals and humans.