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Part 4 - Supplements
How and when to use supplements?
Your essential guide to joint-care

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed to treat acute and chronic pain in people with rheumatism and arthritis. (By Dr Sarah Brewer)

Although they are effective analgesics, NSAIDs are associated with a number of potentially serious side effects, including kidney damage, exacerbation of asthma and gastric ulceration. More recently, some of the newer NSAIDs which were introduced because they were less likely to cause intestinal bleeding were withdrawn due to an unacceptably increased risk of heart attack and stroke. Most guidelines therefore recommend that doctors first prescribe simple analgesics, such as paracetamol, before moving on to NSAIDs. Even so, it is estimated that around 25 million NSAID prescriptions are issued in the UK each year, resulting in 12,000 admissions to hospital to treat serious side effects and as many as 2,600 deaths. If you prefer not to take an NSAID or are advised to avoid them by your doctor, a number of alternative remedies are available that have a useful anti-inflammatory action and a much lower risk of adverse events.


The Ayurvedic spice, turmeric, contains curcumin, a powerful antioxidant that lowers inflammation by reducing formation of inflammatory substances. Like aspirin, it helps to reduce abnormal blood clotting. Unlike aspirin and other NSAIDs, however, far from causing peptic ulcers, turmeric has been used to successfully treat gastric and duodenal ulcers, gastric erosions, gastritis and dyspepsia.


"Bromelain is widely used to reduce the pain, swelling and inflammation associated with arthritis..."

This is a digestive enzyme derived from the stem of pineapples. It has a powerful anti-inflammatory action by reducing the migration of white blood cells and damping down their release of inflammatory chemicals. It is widely used to reduce the pain, swelling and inflammation associated with sinusitis, bruising, sprains, wounds, minor operations, burns and arthritis. Like turmeric, bromelain also has a blood-thinning action due to its ability to stop blood platelets clumping together.


New Zealand green lipped mussel extract contains a number of glycoproteins that damp down inflammation in arthritic joints. Preliminary research suggests it is also helpful for inflammatory bowel disease, asthma and peptic ulcers. Like bromelain, it prevents white blood cells from moving into the inflamed joints, where they would have released powerful chemicals making pain and swelling worse. Green lipped mussel extract can significantly reduce pain and stiffness and has been shown to outperform NSAIDs such as ibuprofen and indometacin. In a trial involving 60 people with osteoarthritis of the knee and hip, green lipped mussel extract significantly improved all signs and symptoms within eight weeks, with 80% experiencing significant pain relief and improved joint function with no adverse effects.


This is helpful for low-back pain, osteoarthritis, rheumatoid arthritis, gout and sports injuries. It contains harpagoside and harpagide, substances that can reduce the production of white cell inflammatory chemicals known as leukotrienes. A systematic review of 12 clinical trials investigating its effects against osteoarthritis, low-back pain and mixed-pain conditions found strong evidence for its effectiveness at higher doses. Do not take if you have peptic ulcers or indigestion, however, as it promotes secretion of digestive juices.

GLUCOSAMINE (recommended) click here for more information

Essential for the production of new cartilage, glucosamine can reduce joint inflammation by making synovial fluid the joints oil thicker and more cushioning. A systematic review of 20 randomised controlled trials found that, in people with osteoarthritis, it was more effective than placebo with a 28% improvement in pain and a 21% improvement in joint function. In the four trials in which glucosamine was compared to an NSAID, glucosamine was superior in two and equivalent in two. Although the analgesic effects of glucosamine took longer to develop, the risk of side effects was considerably lower and similar to placebo.

CHONDROITIN (recommended) click here for more information

Chondroitin sulphate becomes concentrated in knee tissues, especially cartilage, and has anti-inflammatory actions by damping down the migration of white blood cells and their release of inflammatory chemicals. It may also modify the structure of cartilage to make it stronger. Compared with NSAIDs, chondroitin appears to be more effective at inhibiting these cell-related inflammatory actions than in reducing swelling and has no damaging effects on the stomach or kidneys. A clinical trial involving 120 people with osteoarthritis of the knee found that taking chondroitin for three months twice a year significantly improved pain and joint function, Importantly, X-rays showed significant decrease in joint space width in those taking placebo, while those on chondroitin showed no deterioration.

MSM (METHYL-SULPHONYL-METHANE) (recommended) click here for more information

MSM is a natural sulphur compound that reduces the formation of free radicals by white blood cells. This is especially helpful for reducing inflammation associated with hay fever. In a small, double-blind, placebo controlled trial involving 16 patients with osteoarthritis, those taking MSM experienced an 80% reduction in joint pain after six weeks compared with an average improvement of only 20% in those on placebo.


A number of food supplements have proven anti-inflammatory actions which are at least as effective as those of non-steroidal drugs, but with significantly less risk of serious side effects. Combining these with physiotherapy and regular exercise can help to reduce pain and improve your mobility if you are unable or unwilling to take prescribed treatments. In some studies, supplements were given together with prescribed painkillers and helped to reduce the dose of drug needed. Always tell your doctor/pharmacist if you intend to combine supplements with prescribed medication, however, and check there are no known interactions.

Start the day right (By Dr Sarah Brewer)

When do you take your supplements? With breakfast or your evening meal? Do you wash them down with water, juice or coffee? Does it matter? Dr Sarah Brewer explains how to take supplements for optimum health.


If you have not eaten for more than 20 minutes, don't take your supplements. Wait until you have a snack/juice and take them then. If taken on an empty stomach, some can make you feel sick or cause indigestion.

Wash supplements down with water or orange juice. Don't take them with coffee or tea, as these may interfere with absorption.

Fat-soluble substances (e.g. co-enzyme Q10, evening primrose oil, fish oils and vitamins A, D, E, K) should ideally be taken with food containing some fat (eg. milk). If taking a fish oil supplement that produces fishy burps, try emulsifying the oil by shaking your dose with a little milk to increase absorption and reduce aftertaste.

If taking two or more capsules of the same preparation a day, spread these out over the day, if possible, to maximise absorption and obtain more-even blood levels.

If you take a one-a-day vitamin and mineral supplement, it is usually best after your evening meal rather than with breakfast. This is because repair processes and mineral movements in your body are greatest at night when growth hormone is secreted.

A days dose is better taken at the time you are most likely to remember, however. Don't feel you have to follow any strict regime if you find difficulty remembering to take supplements at a certain time, or if they do not fit in with your particular lifestyle.

Its easier to remember to take supplements if you get into a routine and take them at the same time each day. Keep them by your toothbrush, for example, or by your keyboard if this helps you remember.

If taking capsules, look down at the floor as you swallow to help them go down more easily. For heavier tablets, put your head back as you swallow to help the action of gravity.

Donít swallow supplements in a hurry if you take your time, your throat muscle will be more relaxed and tablets are less likely to lodge in the gullet.

If taking vitamin and mineral supplements makes you feel nauseated, hereís a possible solution: whiz up all the supplements you would normally take during the day in a food blender, or pulverize them in a pestle and mortar. Divide the powder into two to four equal portions. Take each portion (mixed with milk, soup or juice) at regular intervals during the day, part-way through each meal, when your stomach juices are in full flow.

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