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Natural Therapies for Rheumatoid Arthritis and Other Chronic Inflammatory Conditions: A Summary

Natural Therapies for Rheumatoid Arthritis and Other Chronic Inflammatory Conditions: A Summary

By Frederick T. Sutter, M.D., FAAPMR

Rheumatoid arthritis (RA) and other chronic inflammatory conditions, such as osteoarthritis, are affecting increasing numbers of Americans. The most prevalent theory regarding the cause of RA is a combination of factors including genetic susceptibility, infection, and an abnormal immune response.1-9

RA occurs when the body's immune system attacks and destroys the tissues that make up the joints. Immune cells travel to the joint tissue, causing reactions (the inflammatory process) that result in warmth, redness, swelling, and pain. During this inflammation process joint tissue cells grow abnormally, resulting in a joint that is swollen and puffy to the touch. Growing research indicates that the underlying cause for this process may well be reactions to antigens originating from the intestinal tract.1-4,9-17 Antigens are molecules that activate an immune response; they can be microbes, proteins, or allergenic substances. Exposure to these antigens can markedly increase the activity of the intestinal immune system and inflammatory pathways. These reactions can also perpetuate systemic inflammatory messages that are associated with a variety of chronic diseases.1,3,4,11,12

In some patients with RA, an elimination diet or detoxification program may reduce immune reactions to antigens and improve symptoms. Additionally, many natural substances can help to protect joint tissues and relieve RA symptoms by controlling inflammation, reducing the associated free radical damage, and supporting the integrity of the intestinal tract.

Modulating the Inflammatory Response Naturally

Essential Fatty Acids—Omega-6 and omega-3 fatty acids are essential nutrients as well as precursors to both inflammatory and anti-inflammatory molecules. A balanced consumption of each group helps maintain a healthy balance of these molecules. Unfortunately, the consumption of omega-6 fatty acids far outweighs that of omega-3 in the standard American diet, which can result in an overproduction of inflammatory molecules. In RA patients, supplementation with fish oils (omega-3) has resulted in a reduction of pro-inflammatory molecules approaching 90%, and at least 11 double-blind, placebo-controlled studies have shown beneficial clinical effects.18 In fact, some RA patients who take fish oil are able to discontinue anti-inflammatory drugs without experiencing a disease flare.19

Herbs—Phytochemicals (chemical compounds) that demonstrate pain and inflammation-reducing properties are found in herbs including ginger (Zingiber officinale), turmeric (Curcuma longa), cayenne (Capsicum annuum), and boswellia (Boswellia serrata).20-32 Human studies using these herbs have shown relief of muscle discomfort and pain, reduced morning stiffness, and reduced joint swelling comparable to patients receiving anti-inflammatory drugs.21,29,30 Bioflavonoids, a broad class of phytochemicals found largely in citrus fruits, tea, and wine, reduce inflammation as well.24 These compounds work primarily through inhibiting the formation of pro-inflammatory molecules.

Niacinamide & N-acetylcysteine (NAC)—Niacinamide has been shown to be effective in relieving symptoms of RA and osteoarthritis in both human and animal models.33-36 Furthermore, niacinamide inhibits the synthesis of a pro-inflammatory molecule that plays a decisive role during the development of RA. NAC also stimulates the synthesis of glutathione, a principal defense within the body against free radicals.37 Preliminary animal research has shown that combining NAC with niacinamide results in improvements of their individual effects on the suppression of arthritis.38

The Role of Free Radicals and Antioxidants

The excessive free radical production associated with immune overreaction and inflammation is an area of concern in RA and similar conditions.39 In fact, research findings support the hypothesis that free radical damage is responsible for the accelerated degradation in the rheumatoid joint.40 Therefore, free radical scavengers such as vitamins E and C and superoxide dismutase may be beneficial in reducing free radical injury to joint tissues.40-42 In fact, vitamin E supplementation at levels from 200-600 IU per day can also provide significant pain relief in RA patients, and vitamin C supplementation increases cartilage weight and appears to protect against erosion of joint cartilage in animals.41,43,44

In addition to gaining control of inflammation and reducing the associated free radical production, supplying nutritional factors that directly influence the health and integrity of the intestinal tract serves to promote intestinal health as well as overall well being.

Nutritional Support of Gut Ecology

Small intestine bacterial overgrowth, or dysbiosis, has a negative effect on the condition of the intestinal lining and is thought to be an initiating factor in some immune-related disorders; furthermore, it is associated with a more pronounced disease activity in RA patients.9,17 The integrity of the intestinal lining is critical because it acts as a barrier separating the contents of the intestine from general circulation. Substances that support a balanced bacterial ecology of the gut, and therefore enhance the health and proper function of the intestinal lining, include:

Probiotics—Bifidobacterium lactis and Lactobacillus acidophilus are two common species of "friendly" bacteria that reside in the intestinal tract. However, levels of these healthy bacteria are often low due to poor diet and other factors. Supplementation with these friendly bacteria may support healthy gut ecology and keep undesirable bacteria in check.45-47

Prebiotics—Fructooligosaccharides (FOS) are fiber-like carbohydrates that cannot be digested by humans, but act as a food supply for friendly bacteria.47,48 FOS have been shown to increase the number of beneficial organisms in the intestinal tract.48 Lactoferrin, lactoperoxidase, and immunoglobulins are another class of supportive substances that beneficially affect intestinal microbial balance by directly inhibiting the growth of harmful bacteria and supporting immunity.50,51

Nutritional Support of Gut Integrity

Above and beyond sustaining healthy gut ecology, supporting the structure and function of the intestinal lining is critical for proper barrier function and intestinal health.

L-Glutamine—L-glutamine enhances barrier function of the intestinal tract and serves as a primary fuel for the rapidly dividing cells of the intestinal lining and immune system.52-54 These properties make glutamine essential for maintaining the integrity of intestinal tissue and for promoting an optimal immune response.52,54,55

Deglycyrrhizinized Licorice (DGL)—DGL is an extract of licorice (Glycyrrhiza glabra) from which glycyrrhizinic acid has been removed to prevent potential adverse side effects associated with fluid and electrolyte balance. DGL enhances the resistance of the gastric mucosa against the eroding action of bile, promotes growth of cells that line the stomach, and enhances protective mucus production and secretion.56

Aloe Vera (Aloe barbadensis)—Aloe works in two ways to support gut integrity: it promotes faster healing of the epithelial tissues that line the intestinal tract and it promotes balanced immune system function.57 Furthermore, aloe has been shown to reduce inflammation.58,59

Conclusion

Poor health and function of intestinal tissue may play a significant role in RA and other chronic inflammatory conditions. By taking the steps discussed above to: 1) reduce the antigenic load and support detoxification, 2) utilize safe and natural substances to control pain and inflammation, 3) reduce free radical production and damage, 4) support a healthy intestinal microbial environment, and 5) support the health of intestinal tissues, those suffering from chronic inflammatory conditions may finally be able to attain a new level of well being and enjoy an enhanced quality of life.

References

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Advanced Nutrition Publications ©2002

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