Dr. Jacob Teitelbaum's Column
...expert advice on CFS, Fibromyalgia and other Health Topics.
You can benefit from Dr. Teitelbaum's wisdom and experience by visiting us at The Environmental Illness Resource regularly to read articles from his latest newsletter!
Monday, March 3rd, 2008:
Arthritis? A 6 Week Program to Help Heal Your Achy Joints
by Jacob Teitelbaum MD
Joint pain, known as arthritis, affects 1 out of 4 Americans and comes in many forms. Whether you have the most common type (Osteoarthritis or "wear and tear" arthritis) or the red, hot, swollen joints of Rheumatoid Arthritis, a natural program to help decrease inflammation and heal your joints can result in dramatic pain relief. Here's how you can get your joints pain free naturally—now! (For the quick summary, see "Important Points" at the end of this article.)
Some starting points to consider:
1. Do not presume that joint pain is arthritis. It can also come from the muscles, tendons, and ligaments around the joint. This is so even if the x-rays are abnormal.
2. The most common type of arthritis (osteoarthritis) is known as "wear and tear arthritis." The joints mainly affected by osteoarthritis are the finger, knee and hip joints. There may be joint deformities, but there should not be inflammation.
3. If you have psoriasis, or "pitting" in the fingernails, which looks like someone stuck a needle tip into several places in the nails (even without the skin changes/rash), your arthritis may be from the psoriasis.
4. If you have an elevated uric acid blood test and sudden pain and swelling in the joints (especially the big toe) consider gout. The NSAID medications plus colchicine can work well for the acute phase. Allopurinol® can be used to prevent further attacks. Your doctor is very likely familiar with the treatment for gout.
I prefer using natural, rather than prescription, therapies for osteoarthritis. The most common prescription medications in use (NSAIDs like Motrin®) kill over 16,500 Americans yearly and do not slow, and may actually hasten, the progression of the arthritis.
I recommend you begin with a program which will decrease inflammation and help to repair the joints. This has four main components:
2. Reverse inflammation
3. Restore function
4. Rule out and treat infections and food allergies
A. Repair. The joint cartilage can be repaired using a combination of glucosamine sulfate (most important—750 mg 2 times a day for at least 6 weeks), MSM (2-3 grams a day), and if the arthritis is severe Chondroitin (less important—400 mg 3x day). It is also critical that you get the nutrients present in the Energy Revitalization System vitamin powder, which also promote wound healing.
B. Reverse inflammation. Use natural anti-inflammatories to prevent damage and decrease or eliminate pain. I recommend a combination of several natural remedies, many of which can be found in combination. The mix I like the most combines boswellia (also known as Frankincense), willow bark, and cherry (all included in End Pain by Enzymatic Therapy or the Pain Formula by Integrative Therapeutics). Take 2 tablets 3x day for 6 weeks, then you can often lower the dose. It takes 6 weeks to see the full effect.
C. Restore function with stretching, exercise, weight loss, and heat. Exercise at least twenty minutes a day. Swimming, walking, and yoga are good choices. Use a heating pad or moist heat for up to 20 minutes at a time to give relief.
D. Rule out and treat infections and food allergies, which can aggravate arthritis. Most food allergy blood tests (except the ones from Elisa Act Technologies) are not reliable. NAET (see www.NAET.com) is a wonderful way to test for and eliminate food sensitivities. A related technique called JMT (see www.jmt-jafmeltechnique.com) is also an excellent way to treat rheumatoid and osteoarthritis naturally using energy medicine.
Let's look at these treatments in more depth.
The joint cartilage can be repaired using a combination of glucosamine sulfate, Condroitin®, and MSM. It is also critical that you get comprehensive nutritional support, as discussed earlier, to promote wound healing. Glucosamine, a cartilage compound that has been shown to actually heal your joints, is as effective as NSAIDs (e.g. Motrin® and other anti-inflammatory drugs). In addition, a recent animal study showed that glucosamine and the anti-inflammatory drugs work synergistically. This means that when the two are taken together, it is much more effective than simply taking either one alone. Using glucosamine can therefore allow you to stop the anti-inflammatory drugs, or at least lower the needed dose. This can improve the safety, effectiveness, and cost of treatment dramatically.
Glucosamine sulfate is a cartilage building compound that has been found to be helpful in arthritis in many studies. Although its exact mechanism of action is not yet fully understood, it is a major component of the cartilage that is damaged in arthritic joints. Glucosamine taken by mouth is incorporated in the molecules that make up this cartilage, likely contributing to the healing of arthritis. As you may have noted above, I recommend the sulfate form (as opposed to Glucosamine hydrochloride) because the sulfate can also help with wound/joint healing.
Unlike aspirin/Motrin/NSAIDS that do not slow down destruction of joints in arthritis, Glucosamine sulfate has been shown to actually help stabilize, and often heal the joints, as shown on x-ray. Doses of less than 1000 mg a day do not affect symptoms, and the standard dose is 750 mg 2 times a day. It can be taken with or without food, and had no more side effects than placebo.
Chondroitin sulfate is sometimes added to Glucosamine or taken by itself. Its benefits are modest because less than 10 percent of it is absorbed, as opposed to 90 percent for Glucosamine sulfate.7 Because of this, I recommend using the "Low Molecular Weight" forms of chondroitin as these are better absorbed. Using these forms, 1200 mg a day can be helpful in slowing down arthritis and is worth trying if you do not get adequate relief with the other treatments. It can be taken all at once or 400 mg 3 times a day with equal effectiveness.
Research using MSM has also shown it to be helpful in arthritis. One showed an 80 percent decrease in arthritis pain after 6 weeks using 1500 mg in the morning and 750 mg at lunchtime. Another showed that Glucosamine and MSM are synergistic for reducing pain and swelling in arthritic joints. One hundred and eighteen patients with mild to moderate osteoarthritis were treated 3 times daily with either 500 mg of glucosamine, 500 mg of MSM, a combination of both, or placebo. After 12 weeks, the researchers found that the combination treatment had a faster effect on decreasing pain and inflammation compared to Glucosamine or MSM alone. A recent study also showed that MSM decreases the inflammatory chemicals (called "cytokines" which contribute to arthritis pain).
Overall nutritional support is also critical. For example, low concentrations and low intake of vitamin D seems to be associated with an increased risk of progression of osteoarthritis of the knee. In addition, SAM-e can be helpful. Researchers also noted that it improved patients' arthritis as effectively as anti-inflammatory medications (NSAIDS). A major problem with SAM-e products is that they are not stable and break down easily, with many products not really delivering what they claim. In addition, it is quite expensive. A better alternative is to take the nutrients your body needs to make SAM-e. Combining the nutrients found in the Energy Revitalization System vitamin powder and B complex resulted in increased blood levels of SAM-e similar to those found in people taking 400 to 800 mg of SAM-e daily. Dozens of other important nutrients can help arthritis (e.g. niacin, pantothenic acid, B complex, vitamin C, vitamin E, boron, selenium and zinc), and these are all present in the vitamin powder .
If you also have osteoporosis, I would recommend you take strontium along with other key nutrients (all present in a product called Bone Health). This has been shown to also help arthritis, and is almost twice as effective as Fosamax at improving bone strength—without the side effects.
2. Eliminate Inflammation
I recommend a mix of 3 natural remedies, all of which can be found in combination products. The formulation that I like the most is called End Pain. Using these three together can powerfully decrease many kinds of pain while preventing damaging inflammation. Take 2 tablets 3 times a day until your pain subsides (approximately 2 to 6 weeks) and then you can often lower the dose to 1 tablet 2 to 3 times a day, or as needed. Let's look at just some of the research on these 3 herbals.
Willow BarkWillow bark is the original source of aspirin, but when used as the entire herb it has been found to be much safer than aspirin and quite effective. The active ingredient is salicin, and willow bark has been shown to be effective in both osteoarthritis and back pain. People who are severely allergic to aspirin (e.g. those with aspirin-induced asthma or anaphylaxes, which is very unusual) should not use willow bark. Like aspirin and Celebrex®, it acts as a COX (Cyclooxygenase enzyme) inhibitor, decreasing inflammation. There is clearly a combination of other elements in willow bark that markedly enhance its effectiveness and safety—which can be a major benefit over aspirin and NSAIDs (e.g. Motrin®). Unfortunately, aspirin and NSAIDs cause an enormous amount of gastritis and ulcer bleeding to the extent of killing 15,000 to 20,000 Americans yearly! The studies on willow bark are quite consistent in showing its effectiveness in reducing pain. Let's look at some of the research.
In one study, 210 patients with severe chronic low back pain were randomly assigned to receive an oral willow bark extract, with either 120 mg (low-dose) or 240 mg (high-dose) of salicin, or placebo, in a 4-week blinded trial. In the last week of treatment, 39 percent of the group receiving high-dose extract were pain free; 21 percent of the group receiving low-dose extract were pain free; and only 6 percent of the placebo group were pain free (P <0.001). The response in the high-dose group was evident after only 1 week of treatment.2 Researchers then studied 451 patients who came in with low back pain in an open study, using salicin 240 mg, 120 mg, or standard orthopedic/NSAID care for 4 weeks. Forty percent of the patients in the 240 mg group and 19 percent in the 120 mg group were pain free after four weeks. In the standard treatment group, using standard medications, only 18 percent were pain free. The study showed that willow bark was not only far more effective and safer than standard prescription therapies, it also decreased the cost of care by approximately 40 percent!3
Another review found that willow bark extract has comparable anti-inflammatory activities as higher doses of acetylsalicylic acid/aspirin (ASS) and it reduces pain and fever as well. In pharmacologically active doses, no adverse effects on the stomach lining (e.g. indigestion, ulcers, etc) were observed, in contrast to aspirin.
A daily dose of willow bark extract standardized to 240 mg salicin per day was also significantly superior to placebo in patients with osteoarthritis of the hip and the knee. In two open studies against standard active treatments as controls, willow bark extract exhibited advantages compared to NSAIDs and was about as effective as Vioxx 4 (but much safer). Another placebo-controlled study found that willow bark (salicin 240 mg/day) was more effective than placebo in treating arthritis (the normal wear and tear type called osteoarthritis) after only 2 weeks of therapy.5 Other references are also available for those of you who would like more information on willow bark.6-9
All of this makes willow bark a wonderful natural pain medicine. It is safe and effective for arthritis, back pain, and likely many other types of pain. I recommend beginning with enough to get 240 mg of Salicin a day until maximum benefit is seen. At that point, you may be able to lower the dose to 120 mg, or less, a day, or take it as needed.
BoswelliaBoswellia Serrata, also known as Frankincense, has been used in traditional Ayurvedic medicine for centuries. Boswellia has been found to be quite helpful in treating inflammation and pain10-15, and it does this without causing ulcers like aspirin family medications.16 It has been shown in studies to be helpful for both rheumatoid arthritis17 and osteoarthritis.18
In the latter study, 30 patients with osteoarthritis of the knee were given 1000 mg of either an extract of boswellia or a placebo for 8 weeks; the groups were then switched for the next 8 weeks. All of the patients on the boswellia showed significantly decreased pain and improved ability to walk. In fact, the improvement was quite remarkable, with the pain index falling by 90 percent after 8 weeks and a similarly dramatic increase in function. This was recently discussed in more length in the wonderful patient-oriented newsletter Nutrition and Healing by Jonathan Wright, M.D.—a physician that I have great respect for (see www.wrightnewsletter.com). The article was written by Kerry Bone.
Boswellia has also been demonstrated to have significant anti-inflammatory properties, inhibiting leukotriene synthesis by inhibiting 5-lipooxygenase activity. It also decreases the activity of human leukocyte elastase (HLE). Unique to Boswellia is that it blocks two inflammatory chemicals that are increased simultaneously in a variety of human diseases.19 This results in its being helpful in asthma and colitis, as well as pain. In one study of asthmatics, 40 patients were treated with 300 mg 3 times day for 6 weeks. Seventy percent of the asthma patients showed improvement in symptoms and lung function and a decrease in allergic blood cells (eosinophils).20 Boswellia also helped in the treatment of ulcerative colitis. In one study of 20 patients in which Boswellia, 300 mg 3 times a day, was given for 6 weeks, 14 went into remission, while with sulfasalazine (the standard prescription treatment), the remission rate was 4 out of 10.21 Test tube studies suggest that Boswellia also markedly inhibits cancer.22-23
Boswellia does not appear to have any major side effects that resulted in people withdrawing from the studies and it rarely causes minor gastrointestinal disturbances or rash. A common dose is 150 to 350 mg 3 times a day.
Cherry Fruit (Prunus Cerasus)Although there are not as many human studies on the use of tart cherries, they also contain compounds that inhibit COX (inflammation) as effectively as ibuprofen.24 Tart cherries also possess both antioxidant and anti-inflammatory properties. In addition, research suggests that tart cherries may also inhibit colon and perhaps other cancers.25 Cherries and other colored berries are very high in many antioxidants. As with eating cherries, taking cherry fruit extract is quite safe. Many people find that eating 10 to 20 cherries a day helps their arthritis considerably. 2000 mg of cherry fruit extract (present in 6 tablets of the End Pain formula) contains the active components present in 10 cherries or 32 oz of cherry juice. Early research, as well as how many people come back for more after they have tried it, which to me is a significant indicator of effectiveness, suggests that cherry fruit extract holds a lot of promise!26-28
Fish oil, ½ to 1 Tbsp daily, also has strong anti-inflammatory properties, and is especially helpful in Rheumatoid Arthritis.
3. Restore Function
Restore function with stretching, exercise, and heat. Exercise at least 20 minutes a day. Swimming, walking, and yoga are good choices. Use a heating pad or moist heat for up to 20 minutes at a time to give relief.
Diet, exercise, and lifestyle can be important in the treatment and prevention of osteoarthritis. For example, losing 11 pounds will reduce a woman's risk of developing arthritis of the knee by 50 percent over a 10 year period. Adding exercise will usually further decrease arthritis pain. If the arthritis makes it too painful to walk, do walking and swimnastics in a (preferably warm) pool. The buoyancy of the water makes it easier and water exercises have been shown to be even more effective than walking. For hand arthritis, use heating pads (I like the herbal filled ones that can be micro waved) that you keep your hands in for up to 20 minutes at a time. Stretch your fingers while in the heating pad to restore range of motion and function. Remember though—Pain is your way of saying "don't do that," so do not push through significant pain.
4. Rule Out and Treat Infections and Food Allergies
These can aggravate arthritis. New techniques that combine acupressure and applied kinesiology can be a very powerful way to eliminate allergies and sensitivities. I recommend using a brilliant technique called NAET. It was developed by Dr. Devi Nambudripad (see www.NAET.com for more information). If you also have osteoarthritis or rheumatoid arthritis, I recommend using a spin off of this technique called JMT (see www.jmt-jafmeltechnique.com for more information). For rheumatoid arthritis, I also use long-term antibiotics (Minocycline) because I feel this is an infectious disease in many cases, and research has shown antibiotics to be effective. One type of food sensitivity to be aware of in arthritis that has not responded well to other treatments is reactivity to foods in the nightshade family. These include tomatoes, potatoes, eggplant, peppers, paprika, cayenne and tobacco. If you do not experience relief after one month of being off these foods, reintroduce them to see if they affect your symptoms. Also avoid the artificial sweetener Aspartame (NutraSweet®).
Other Natural Therapies
As noted above, I recommend that you begin with the End Pain formula and glucosamine/MSM/ chondroitin. You may also want to try this popular home remedy:
Purple Pectin for Pain. Purchase Certo® in the canning section of your local grocery. It is the thickening agent used to make jams and jellies. Certo contains pectin, a natural ingredient found in plants. Take 1 to 3 Tbsp of Certo in 8 ounces of grape juice 1 to 2 times a day (1 to 2 Tbsp a day is enough for most people, but you can try more). If it's going to help, you'll likely know in 7 to 14 days. As the pain disappears, the dose can be reduced to 1 tsp in grape juice once or twice a day as needed. Many people have found this simple, safe, and cheap treatment to be effective.
In addition to these four treatment areas, although it may seem silly, copper bracelets have actually been shown in a blinded crossover study to be helpful in relieving arthritis, and I have also seen patients get better using them.
If red, swollen, tender joints are present, consider rheumatoid or infectious arthritis. In either of these situations, in addition to standard treatments, I recommend adding the antibiotic minocycline 100 mg twice daily, and an anti-inflammatory diet low in meat and high in fish oil. It is a good idea to take fish oil, 1 to 2 Tbsp daily. Many other nutrients are also helpful and are present in the Energy Revitalization System vitamin powder.
Although I have been using natural cortisol (Cortef®—by prescription) in doses of up to 20 mg daily for decades, some recently touted techniques have been adapting the protocol to use low-dose pulse therapies. The main concern with cortisol is that too high a dose can be toxic and it also suppresses the adrenal glands. Doses of up to 20 mg daily (approximately equal to 4 to 5 mg of prednisone but safer) have been shown to be safe even when used for extended periods. In severe cases, it is reasonable to add it in in this safe and often helpful dose.
If inflammatory arthritis is present (and in severe cases even if it is not), consider Minocycline, 100 mg twice a day (an antibiotic), long-term as discussed above.
Natural remedies can dramatically decrease most kinds of arthritis pain and improve function. I recommend that those with arthritis pain begin with the following program to heal your joints:
1. Nourish your joints by taking:
A. The Energy Revitalization System vitamin powder (1/2 to 1 scoop a day with the B complex vitamin that comes with it).
B. Glucosamine Sulfate 750 mg 2x day.
C. MSM 2500 mg/day.
D. If osteoporosis is present, add Bone Health.
2. Turn off inflammation with:
A. A mix of Willow bark, Boswellia (frankincense) and cherry. I recommend the End Pain or Pain Formula products (either is excellent). Take 2 tabs 3 times a day.
B. If you have inflammatory arthritis (red, swollen joints, as in rheumatoid arthritis) add fish oil as well (1 teaspoon or 3 capsules 2-3 times a day for 6 weeks then once a day).
Do the above for 6 weeks (they can be taken with your prescription pain medications. If you are on the blood thinner Coumadin, however, consult with a holistic physician before taking these or any herbals). After 6 weeks, you will be amazed at how much better you feel, and though I would stay on the vitamin powder forever, you can lower the dose of the other treatments as able if you'd like.
3. Add exercise:
Walking (in a pool if it is too painful) is good exercise for arthritis below your waist. If you have decreased flexibility, put heat (I like herbal "beanbags" that can be heated in the microwave) on the affected joints. After 5-10 minutes in the heat, slowly and gently move the joints as able to reclaim your full range of motion. Do this 2-3 times a day till your joints are limber.
4. Look for and treat food allergies:
If symptoms persist, look for and treat food allergies with a special form of acupressure called NAET (see www.NAET.com).
This program is like a 6 week spa for your joints. You'll love how the pain goes away, and you get your life back!
More information (as well as the scientific references for the studies cited in this article) can be found in my book "Pain Free 1-2-3" (McGraw Hill,2006).
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
Learn more from Dr. Teitelbaum's books:
Home Testing & Sanitizer: