For thousands of years, humans have used products from the natural world around them for food, clothing and shelter. The use of herbs, plants, and other natural products has been developed for many different reasons, one of the most important being for medicinal purposes. Throughout the world many cultures have developed elaborate rituals and rich traditions of treating ailments with natural products and some of these have survived into the modern era. In the contemporary western world, a renewed appreciation for the use of natural products in healing has grown over recent decades. As the new millennium approaches, we are witnessing a continuing explosion of interest in what have come to be termed "alternative therapies."
What Exactly Is an Alternative Therapy?
This article will make use of the term alternative therapies to encompass a broad array of medicinal practices that have generally been considered outside the mainstream of Western medical teaching. Within medical literature terms like "unconventional medicine," "nontraditional medicine" or "complementary medicine" would be synonymous. In general, alternative therapies include those which are not taught primarily in Western medical schools and are not part of standard medical care in the community. This would include the use of vitamins, herbal products and physical manipulations and modalities such as acupuncture. While other therapies, such as meditation and prayer, are certainly within the definition of alternative therapies, they are beyond the scope of this article and will not be considered further.
Popular Use of Alternative Therapies for Musculoskeletal Problems
We know from a series of national surveys that have been conducted by researchers at the Harvard Medical School that a large percentage of Americans use alternative therapies for the treatment of a variety of conditions. Many of the most often cited reasons have to do with musculoskeletal problems, such as arthritis. In 1993, the first national survey showed that over one third of those surveyed used at least one unconventional therapy within the preceding year. The most frequently noted reasons were for back problems, followed by anxiety, headache, sprains and strains, depression, insomnia and arthritis. The types of therapy used were diverse. Prayer and exercise were the most frequently used. They were followed by relaxation techniques, chiropractic, and massage. Patients using alternative therapies were more likely to be between the ages of 25 and 49, have some college education, have higher incomes, and live in the Western United States. In 1998, an updated survey showed that even more Americans were using alternative therapies than they were five years earlier. Again, alternative therapies were used most frequently for chronic conditions including back pain.
Researchers in arthritis throughout the world have confirmed that when arthritis patients themselves are surveyed, between one third and one half have used some form of alternative care. In the United States, one study has shown that a less wealthy, less educated and racially diverse population in North Carolina also used alternative therapies at a high rate. Over 90% used prayer. Over half used liniments and close to half used over-the-counter remedies. Thus, we would do well not to stereotype the user of alternative therapies as coming from a certain social or economic group. Most often, it seems the user of alternative therapies is a patient seeking relief of their symptoms that have not been adequately controlled by conventional medical therapy
Types of Arthritis and Their Painful Symptoms
Arthritis is a rheumatic disease. The rheumatic diseases are diseases of the joints, bones and connective tissues, and may affect other internal organs as well. Arthritis may be primarily non-inflammatory, as in the case of osteoarthritis. Osteoarthritis is the type of arthritis that affects many of us as we age and is sometimes called "degenerative" joint disease. It is, in part, related to biochemical changes in the cartilage as we age and, in part, to "wear and tear". The major symptom from which patients with osteoarthritis seek relief is pain. Therefore, many of the alternative therapies used by patients with osteoarthritis are chosen for their pain-relieving properties and some of these are used for other painful conditions not caused by arthritis.
Other forms of arthritis are classified as inflammatory. The most familiar example is rheumatoid arthritis. This form of arthritis is characterized by the cardinal signs of inflammation; namely, warmth, redness, swelling and pain. It is often accompanied by abnormalities in the immune system. Other forms of inflammatory arthritis include the arthritis that is seen in systemic lupus erythematosus, Reiter's disease, ankylosing spondylitis, psoriatic arthritis and many others. There are over 100 forms of arthritis. In inflammatory arthritis, patients seek relief not just from pain, but from inflammation as well. Therefore, they may seek out a somewhat different spectrum of natural products for the treatment of their symptoms than those with osteoarthritis. In the remainder of this article, I have provided information on several natural treatments, which may help you relieve some, if not all, of your symptoms.
Vitamins
One of the most commonly used categories of alternative therapies is vitamins. Vitamins have been in use for numerous maladies for decades, both in doses that provide minimum nutritional supplementation for the avoidance of deficiency diseases like scurvy, and in so-called "megadoses" many hundreds, or even thousands, of times higher than what the body needs to simply exist without a deficiency disease.
In recent years, data have accumulated on a relationship between the use of certain vitamins and the prevention of the progression of osteoarthritis. There is no data that suggests that you can avoid osteoarthritis in the first place by taking vitamins. However, there is epidemiological evidence that having higher levels of certain vitamins can slow the worsening of osteoarthritis.
A large study of residents of Framingham, Massachusetts over the last few decades has provided us with many insights into the incidence of cardiovascular disease and its relation to cholesterol, as well as many other health issues. Recent data was published from this ongoing study that looked at vitamin D, vitamin C and beta-carotene. Patients were asked to complete food frequency checklists. The lists assessed the intake of these vitamins; in other words, how often they ate foods containing these vitamins. The study showed that patients who had the highest levels of vitamin D intake and the highest levels of vitamin D in their blood were three times less likely to have progression of their osteoarthritis.
A second study using the Framingham populations showed that patients with the highest levels of vitamin C intake had a three-fold reduction in progression of their osteoarthritis and that those patients with the highest levels of beta-carotene intake had a two-fold reduction. Eating a diet rich in vitamins D and C and beta-carotene might be one of the few truly preventive interventions we can make when it comes to osteoarthritis.
Calcium
The typical American diet is notoriously low in calcium. Calcium intake by children and adults alike often lags behind nutritional requirements. Osteoporosis, a thinning of the bones which makes bones more susceptible to fracture, has reached epidemic proportions and affects millions of American men and women alike.
An adequate calcium intake throughout life seems to help protect bones from osteoporosis. It does not appear to protect against osteoarthritis or any form of inflammatory arthritis. However, calcium intake is important for arthritis patients for many reasons. First, it helps the bones to be as strong as they can be. It is essential that arthritis patients maintain healthy bones and muscles to help compensate for the limitations imposed by their arthritis. Second, immobility due to arthritis contributes to osteoporosis, putting patients at further risk for broken bones. And, finally, rheumatoid arthritis itself increases the risk for osteoporosis, as do the steroid medications often used to help treat it. All arthritis patients should take calcium supplements if the intake of calcium in their diet is inadequate.
The recommended daily dose of calcium is 1000 milligrams per day for adults between the ages of 18 and 65. For children, pregnant women, nursing mothers, women past menopause and everyone older than 65, the recommended daily dose of calcium is 1500 milligrams per day. Some patients may require higher doses but more is not always better when it comes to calcium. Taking too much can increase your risk of kidney stones. You should discuss your risk with your doctor if you or a family member has had kidney stones. A urine test for calcium can be helpful for determining your risk as well.
Vitamin D is recommended in a dose of 400 to 800 international units per day to aid absorption of calcium. Magnesium supplements do not seem to add much to calcium absorption and are not routinely recommended.
Glucosamine Sulfate and Chondroitin Sulfate
There has been considerable interest in, and even more advertising about, the benefits of glucosamine sulfate and chondroitin sulfate for the treatment of osteoarthritis. These two compounds are naturally present in the joints and are two of the building blocks of normal cartilage. They have been used in Europe for many years as an alternative, as well as an adjunctive, therapy for degenerative joint disease. While you might think that supplying these two building blocks could help build cartilage, it is not yet clear how glucosamine sulfate and chondroitin sulfate work in human beings.
Research on the use of glucosamine sulfate and chondroitin sulfate has been extensive in the European literature and some studies in English have been published as well. When compared head to head with one of the common medications used to treat arthritis, glucosamine and chondroitin are about as effective as those medications in treating pain. However, they do not start acting as quickly as the nonsteroidal anti-inflammatory drugs (NSAIDs) that physicians usually prescribe for arthritis pain. It may take several weeks for patients to see a benefit.
On the other hand, glucosamine and chondroitin appear to be very safe. They do not have many of the side effects of NSAIDs. In fact, they are a good alternative for patients with pain due to osteoarthritis who have had an ulcer or who get stomach upset that prevents them from taking NSAIDs. They can also be used in addition to prescription medication, especially in patients who get some, but not complete, pain relief from their arthritis drugs. Most manufacturers recommend 500 milligrams of glucosamine and 400 milligrams of chondroitin three times a day. These preparations are of no known benefit for inflammatory arthritis.
Acupuncture
Acupuncture is an ancient practice, originally from China, with a history going back more than 2000 years. As currently practiced in the United States, it usually involves the use of sterilized stainless steel needles, which are placed along the lines of so-called meridians. According to traditional teachings, the meridians are pathways throughout the body along which chi, or life energy, flows. The meridians determine where the needles should be placed depending on the patient's symptoms.
There are many different types of practitioners of acupuncture. Some are physicians; many are trained at accredited schools. Many states have licensing requirements and it is best to ensure that a practitioner has a valid license.
Herbal Preparations
A great deal has been written in the lay press about the use of herbal medications for the treatment of diseases and conditions. Many herbs, especially in the Chinese and Indian traditions, have been used to treat pain and inflammation. By Western medical standards, most herbs have not been adequately studied for effectiveness or safety. The type of clinical trials that help doctors make medical decisions "based on the evidence" are simply lacking for these preparations. And some have been found to interact badly with certain prescription medications and cause serious side effects on their own. Natural does not always mean safe.
Nonetheless, interest remains high in herbal medicine and laboratory studies are ongoing to investigate the anti-inflammatory properties of many herbs. Some of these have not yet been tested on humans or are in early clinical studies but show promise for their anti-inflammatory effects. These include extracts derived from the Indian herbs Semecarpus anacardium and Boswellia serrata. A Chinese herb commonly known as "thunder god vine," Tripterygium wilfordii, is being actively studied in this country as a possible treatment for rheumatoid arthritis. Studies of an extract of avocado and soybean oils available in France are further along. This product, known as avocado/soybean unsaponifiables (ASU), has been shown to be effective in the treatment of osteoarthritis. ASU not only reduced pain, but it permitted patients to decrease their reliance on prescription NSAIDS.
Many herbal medications remain to be adequately tested, but a trip to the local health food store will reveal that numerous plant products, including those containing combinations of products, are readily available. Some of these contain plant extracts used in folk medicine traditions. Some examples are alfalfa, celery seed, feverfew, and yucca:
- Alfalfa, (whose name comes from the Arabic for the "father of all foods") was fed to horses as fodder and thought to make them swift and strong. It is easy to see how such a plant could be thought to help arthritis given this tradition.
- Celery seed was used in Greek times to make wine and as an award at early athletic games. Herbalists subsequently adopted it for the treatment of arthritis, as well as other disorders.
- Feverfew also has a long history of use in Greek and early European cultures and has numerous effects on the body. As its name implies, it was found to fight fever and to have anti-inflammatory effects. However, the one study that has looked at the use of feverfew in the treatment of rheumatoid arthritis has found that it was no better than placebo. In addition, feverfew can have side effects on the heart and nervous system.
- Yucca has been widely used in Native American traditional medicine for a variety of ailments. It was studied in one trial for the treatment of arthritis, but the study was flawed and the results were inconclusive.
Summary
In summary, herbal medications as a group have not been well studied by Western standards. Physicians do not yet have the information they need to make the kind of recommendations they can about prescription drugs. For most herbal preparations that you might choose from the neighborhood retail outlet, the scientific data does not yet exist to support their effectiveness or safety. And, in fact, over-the-counter preparations can vary a great deal in the content and purity of the intended plant extracts. Therefore, physicians cannot assure patients, as they can with prescription drugs, of the purity of the product the consumer is buying. Nonetheless, just as the public is increasingly interested in herbal preparations, so, too, are many members of the medical community. A great deal of research is now underway and the next few years are likely to show a vast increase in our scientific understanding of how best to use many of these products.
