Supplements That Help Manage Osteoarthritis Symptoms (and RA)
P. Anthony Chapdelaine, Jr., MD, MSPH, Exec. Dir./Sec.*
Improvement should be obvious the first month for most of these supplements, and this improvement should maximize after three months. (Rarely, it may take two months to start working.) It is best to add one supplement at a time for a few weeks to determine whether that supplement provides adequate symptom relief, since each person reacts differently. Some, such as glucosamine (with or without chondroitin) usually help to moderate most people’s symptoms within a few weeks.
qd = once a day, bid = twice a day, tid = three times a day.
- Glucosamine HCl; may take 4 to 5 weeks to work, take on empty stomach if possible although with food is acceptable. 1500 mg/d (750 mg bid or 500 mg tid) or Glucosamine sulfate: 1900 mg daily. (Need to monitor fasting glucose for diabetics taking this due to insulin resistance effect, which should be offset with exercise and diet. )
- Chondroitin sulfate 300 to 400 mg. tid. (Glucosamine and chondroitin are often combined in one capsule.)
- MSM: 1 to 2 grams tid (or more as needed). Capsules or powder. Severe pain: at least 10 g/d. Precaution: if on aspirin, dicumerol, blood thinners like heparin since MSM may increase blood thinning effect. Anti-inflammatory. Analgesic (c-fibers). Increases blood supply. Softens scar tissue. Osteoarthritis/degenerative arthritis (with glucosamine sulfate on empty stomach).
- Polyphenol Flavonoids and Non-flavonoids. These can take up to three months before you notice symptom improvement. Help regenerate Vitamin E, prevent LDL oxidation, improve elasticity of blood vessels and skin, decrease arthritis discomfort, help prevent circulation problems, reduce excess blood clotting, help prevent symptoms of allergy and hay fever.
Resveratrol (suppresses the COX-2 gene and deactivates the COX-2 enzyme). 200 mg capsules 1 or 2 capsule daily (often combined with grapeseed extract or green tea extract). Grape juice, red wine, blueberries.
Anthocyanins from dark berries, apples, etc. Various brands such as LEF.org: follow instructions.
Oligomeric proanthocyanidins (OPCs) 40-120 mg/d: derived from grape seeds. Or pine bark (pycnogenol) 100 mg/d.
Green tea extract. Follow bottle instructions.
Soy Isoflavones. Now Foods 60 mg capsule qd to tid. Other good brands.
- Perna canaliculus (New Zealand green-lipped mussel) food product (lyophilized: freeze dried to remove water); anti-inflammatory (immune modulator: down regulates pro-inflammatory cytokines); chodroprotective, gastroprotective; antihistamine. Dose: 6 (six) 500 mg caps/d (2 caps with each meal tid for two weeks), then 2 to 4 caps/ day maintenance.
- Evening primrose oil (GLA)– balances prostaglandins; fights inflammation; best on RA; 1 teaspoon or 1 to 2 capsules qd.
- Boswellia (frankincense plant from India): contains boswellic acids including acetyl-keto-beta AKBA and is anti-inflammatory and increases joint circulation; Now Foods 500 mg capsules (standardized to 60%). Take 3 to 4 capsules daily, then decrease to 1 or 2 caps daily. 1000 mg daily (up to three 400 mg capsules daily.
- White willow bark extract 240 mg capsule 1 to2 capsules bid to tid.
- Omega 3 fatty acid oils: include (among many others): Life Extension Foundation’s Mega EPA/DHA, Now Foods’ Super Omega EPA, Now Foods’ enteric-coated Ultra Omega-3, or Now Foods’ vegetarian-source High Lignan Flax Seed Oil. 1 capsule bid.
- Red Mineral Algae seaweed extract [extract used in one study—a multi-mineral supplement derived from red algae (Lithothamnion corallioides)—is particularly rich in calcium and magnesium, along with over 70 other trace minerals]. Now Foods 875 mg algae extract per capsule. Take 2 capsules twice a day. (For mobility and flexibility more than for pain).
- Cat’s claw extract (Uncaria tomentosa). Various brands. Follow instructions.
- Ginger extract 250 mg 2 to 4 times a day of a standardized (concentrated) extract of ginger (Zingiber officinale). May take up to six months to notice significant changes.
- SAMe S-adenosyl methionine. Must be enteric coated. Used for depression, osteoarthritis, demyelinating diseases like multiple sclerosis, liver disease, cardiovascular disease, schizophrenia, dementia, peripheral neuropathy, Attention Deficit Disorder (ADD), migraine headaches, and other conditions. Increases number of cartilage cells, (2) Increases proteoglycan synthesis by cartilage cells, (3) decreases cartilage loss (4) blocks enzymes that damage cartilage, (5) protects synovial lining from destruction by tumor necrosing factor (TNF), and (6) helps to relieve pain and inflammation. Take 400 mg enteric coated tablet twice a day for ten days, then increase to three times a day (1200 mg total). After 3 weeks of 1200 mg daily, reduce dose to maintenance of 200 to 400 mg daily. (Whatever dose in needed to control symptoms.)
- Ashwaganda 250 mg capsule tid with meals.
- Sulforaphane (from broccoli sprout powder). Antioxidant with anticancer properties. Used for many problems such as autism. Thorne’s Crucera-SGS or Nutramax Avmacol are good sources. 1 capsule qd to bid.
- Avocado Soy Unsaponifiables (ASU) 300 to 600 mg daily. (ASU is not the same as avocado and soy oil. It is specially extracted from the fiber of avocados and soy)
- Selenomethionine. 200 mcg (micrograms) capsule daily.
- Angelica (Dong quai). Approximately 550 mg capsule. Take 1 to 2 capsules tid.
- Black Cohosh (Cimicifuga racemosa). 500 mg capsule. Take 1 capsule tid.
- Devil’s claw (Harpogophytum procumbens) 500 mg capsule. Take 1 to 2 caps bid for 8 weeks, then stop two weeks, and then take again for eight weeks, etc.
- Feverfew 250 mg once or twice a day.
- Oregano (Origanum vulgare) (Like others in the mint family it contains rosmarinic acid). Follow bottle directions.
- Rosemary (Rosemarinus officinalis): Drinking rosemary tea to treat arthritis is an American folk medicine practice. Leaves contain four anti-inflammatory substances-earnosol, oleanolic acid, rosmarinic acid, and ursolic acid. Carnosol is anti-inflammatory using same pathways as steroids and aspirin. Rosmarinic acid acts as an anti-inflammatory, and ursolic acid, (about four percent of the plant) has been shown to have anti-arthritic effects in animal trials. Approximately 400 mg/capsule (standardized to 20%). One cap daily.
- Yucca (saponin extract of yucca with multiple uses). Now Foods 500 mg 4:1 extract. 2 caps qd to bid. Other brands available.
- Pantothenic acid 500 mg capsule. Take 3 to 6 capsules daily for three week trial.
- Vitamin E complex. Vitamin E complex, containing mixed tocopherols and tocotrienols. Life Extension Foundation’s Gamma E Mixed Tocopherols and Tocotrienols. Others available. 1 capsule qd to bid.
- CMO (cetyl myrisotleate) 500 mg standardized to 20%. 2 capsules tid with meals for two to three months trial. If working then continue.
- Curcumin (extract from root of tumeric spice plant). Get the “bioavailable” form such as LEF’s Super Bio-Curcumin and other brands. Powerful antioxidant (especially effective versus nitric oxide free radicals). Protects liver, helps with inflammation of bronchitis and asthma, deters blood clots, suppresses gases from gas-causing foods. Take 1 to 2 capsules bid.
- Bromelain (lowers inflammation). Multiple uses. Arthritis, muscle and back pain. Now Foods 500 mg capsule (2400 GDU/g) and other brands. Try 1 capsule tid with meals. Enzymes like bromelain often work better on empty stomach, so try that if taking with meals doesn’t help.
- Niacinamide 1,000 mg tid.
- Hyaluronic acid (Now Foods brand and others.) 100 mg capsule bid with food.
- Boron gluconate. Take 3 mg bid.
- Undenatured Type II collagen known as UC-II. Take 40 mg daily.