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withdrawn due to an unacceptably increased risk of heart attack and stroke.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
"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
GREEN LIPPED MUSSEL EXTRACTS
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.
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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
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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)
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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.
HOW TO TAKE SUPPLEMENTS?
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
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
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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