Herbs in Rheumatology

[Guest guest]

Herbs in Rheumatology

 

by Jim Duke, PhD

 

This issue of News from the Herbal Village is based, in part, on the

draft of my book, Green Pharmacy, reviewing the so-called

" green alternatives " (GA) or millennial medicines for some 125 modern

ailments from the Herbal Village, stressing aromatherapeutic, herbal,

food farmacy, nutritional and pharmaceutical alternatives.

 

In preparing the book, I developed a GA database, not to encourage self

diagnosis nor self medication, rather to elucidate and enumerate for

intelligent readers some of the alternatives to which an increasingly

large percentage of Americans are exposing themselves.

 

Eisenberg (1993) indicated that Americans visit alternative

practitioners more than conventional physicians. Many of these alternative

therapists are encouraging the " green

alternatives " covered in the GA database and Green Pharmacy.

 

Until America performs unbiased head-on trials comparing the millennial

green alternatives with the centennial synthetic alternatives (standard

pharmaceuticals, some 25-60% ultimately derived from green alternatives,

depending on the accounting system you use), America cannot be sure it

is getting the best medicines.

 

After 60 years as an outdoor botanist, the last 30 years as an

ethnobotanist keenly interested in medical botany, I believe that in

many cases the global green alternative is better than what we are

getting.

 

If I were diagnosed with arthritis, I’d much rather take some of the

herbs listed below than steroids.

I once endured a course of injected

steroids prescribed for bursitis and I really prefer the GA.

In retirement, as I told you in the first two issues, I am campaigning

to get America to give the GA’s fair trial rather than keep them in the

closet.

 

DEFINITIONS:

Rheumatoid arthritis, often called rheumatism or synovitis,

is characterized by inflammation and pain, perhaps more frequently in

the hands - especially the knuckles and second joints - in anyone,

especially older people, often causing deformities as muscles weaken,

tendons shrink, and ends of bones enlarge.

(Time-Life Medical Advisor{TMA}1996).

Infectious arthritis is caused by a bacterial or viral invasion of the

joints, often following such diseases as gonorrhea, Lyme disease, staph

infections and tuberculosis.

Osteoarthritis, or degenerative joint disease, refers to pain and

inflammation resulting from systematic loss of bone tissue in the

joints. Some seem to have a genetic predisposition. (TMA, 1996)

 

CIRCULATING IMMUNE COMPLEXES (CICs)

 

Non-steroidal anti-inflammatory drugs (NSAIDs) *inhibit* cartilage repair

(by inhibiting the production of the collagen matrix).

 

Since osteoarthritis is caused or characterized in part by cartilage

degeneration, the NSAIDs which 'suppress' the symptoms may *worsen* the

target condition by inhibiting cartilage formation and hastening its

'destruction'.

 

Individuals with rheumatoid arthritis may have " leaky guts " (increased

intestinal permeability), especially if heavily dosing with NSAIDs. NSAIDs

increase the leakiness of the gut, so that large dietary and bacterial molecules

are absorbed into the body, leading to formation of complexes which can be

deposited in the joints.

 

Thus, the aspirin may ultimately aggravate more than alleviate.

 

Cichoke (1996) notes that arthritis is associated with increased levels

of immune complexes circulating in the blood.

 

Normal antibodies in our immune system recognize and eliminate antigens

(the enemy), like bacteria, cell wastes, toxins and viruses. Antibodies (shaped

rather like the letter Y) flood the circulatory

system, mopping up antigens (with the forked Y ends), forming aggregated

clumps of antibody and antigen immune complexes (ICs).

 

These IC’s are normally eliminated by the body. But abnormally, the body

does not detect and/or or eliminate the circulating immune complexes

(CICs).

 

In this abnormal case, auto-immune diseases, (even rheumatoid arthritis)

infections and/or malignant ailments can develop. Early breakdown and

dissipation of the CICs (which can penetrate the joint cartilage from

the synovial fluid) can moderate rheumatoid arthritis.

 

ICs may act as antigens and stimulate the production of antibodies,

resulting in the formation of gamma-globulins, which are contained in

the ICs.

 

The resulting antibodies, called rheumatoid factors, can be measured in

the blood thus strengthening, if not positively, confirming the

diagnosis of rheumatic joint disease.

 

(Rheumatoid factors occur in several diseases such as some types of

arthritis, endocarditis and hepatitis). Presence of rheumatoid factors,

in conjunction with rheumatic symptoms, confirm the diagnosis of

rheumatic disease.

 

Several clinical tests confirm the beneficial effects of enzyme

mixtures (including amylase, lipase, bromelain, chymotrypsin,

pancreatin, papain, trypsin) in rheumatoid arthritis.

 

One study helped 23 patients with arthritis of the large extremity

joints, and seven with poly- arthritis of the fingers, using an enzyme

mixture containing bromelain, chymotrypsin, pancreatin, papain, rutin,

and trypsin.

 

Acute and subacute cases clearly improved. Of patients with activated

arthritis, treated six weeks with a specific enzyme mixture (containing

trypsin, chymotrypsin, bromelain, papain, pancreatin, amylase, lipase,

and the bioflavonoid, rutin), improved with no obvious side effects.

(Cichoke, 1996)

 

BUT, it may take months, and the required dose can be up to 30 tablets

or more per day. That’s nearly a thousand capsules a month, more than

10,000 a year.

 

Papaya and pineapple juice would be more pleasant, and perhaps cheaper,

at least in Latin America. No one apparently knows whether the juice

approach would be more or less effective at controlling CICs, if they

are in fact the culprits that several scientists paint them to be.

Cichoke summarizes: As a conditions of arthritis, CICs are present.

Systematic enzyme therapy decreases the numbers of CICs and, in doing

so, reduces the associated symptoms of the disease. . , without . . .

serious and long-term side effects. Fight rheumatoid conditions without

the serious side effects.

 

I read Cichoke’s 1994 book during a couple of train trips and found it

quite engaging. In the chapter where he talks about the CICs, he

concludes rather emphatically, " Enzymes, through uncooked food and

supplements, can help every system in your body function better. "

 

I like the title for his arthritis chapter no. 12: More Precious than

Gold. (Cichoke, 1994). The arthritis foundation keeps telling us that

diet does not influence rheumatic conditions (except perhaps admitting

that prunes may aggravate that podiatric form of arthritis known as

gout.)

 

Cichoke says, and I paraphrase very lightly: (1) In some people milk and

milk products seem to aggravate the disease,

 

(2) Diets low in saturated fat and high in EPA, help reduce or prevent

the joint inflammation which makes arthritis so painful. EPA probably

interferes with inflammatory prostaglandins,

 

(3) Anti-oxidants can prevent oxidative joint damage, (4) Weight loss

alleviates arthritis, and

 

(5) European researchers have found enzymatic light at the end of the

arthritic tunnel, if not the carpal tunnel.

 

In this case, I side with Cichoke: diet, like exercise and weight loss,

can alleviate many kinds of arthritis.

 

Nature’s Herbs carries several plant-derived enzymes, like bromelain and

papain, and herbs like ginger and turmeric, which also contain

proteolytic enzymes, and may even be synergetic in breaking up CIC’s

 

GREEN ALTERNATIVES

 

Ashwagandha (Withania somnifera): Withaferin A " seems to be more potent

than hydrocortisone in experimental (adjuvant-induced) arthritis in

rats " which rather resembles human rheumatoid arthritis (RA). Most of

the activities fall in dose ranges of 10-25 ppms. At inhibiting edema,

the compound proved useful at 12-25 mg/kg body weight of albino rats

intraperitoneally (ipr). A single dose lasted a long time, effectively

suppressing inflammation after four hours.

 

The effect of the compound called withanolide in suppressing

granulation-tissue formation seemed similar to that of hydrocortisone.

All that sounds good for both osteo- and rheumatoid arthritis. Some data

suggests that it might suppress the immune system, which could be useful

in RA. While some data suggests also that the plant may be poisonous, we

still read that " The tender shoots are used as a vegetable " and " the

seeds are used as a masticatory " (Wealth of India).

 

Shoot extracts were anti-inflammatory in rats implanted with

subcutaneous cotton pellets. 10 mg/kg doses i.p. significantly inhibited

granuloma formation.

 

Inhibition was comparable to 5 mg/kg hydrocortisone.

 

Ashwagandha was also tested, along with Apium graveolens (celery),

Myrtus communis (myrtle), Matricaria chamomilla, (chamomile), Achillea

santolina (santolina), and aspirin on the suppression of

carageenen-induced paw edema in rats.

 

Aerial parts or flowers of plants were used in a water/ethanol

extraction. 1% Carageenen solution was injected into the plantar region

of the hind foot, followed by the various plant extracts at 10 mg/kg i.

p. A treatment dose (at one tenth of a lethal dose (LD50) was used for

each plant extract, and 1/5 (100 mg/kg) and 2/5 LD50 (200 mg/kg) used

for aspirin. Three hour paw volume was measured; inhibition of edema was

greatest in W. somnifera > Apium graveolens > Achillea santolina >

Matricara chamomilla > Myrtus communis.

 

All plant extracts inhibited edema better than 100 mg/kg aspirin, but

only W. somnifera was as effective as 200 mg/kg aspirin. However, the

dose of W. somnifera (like all the herbs studied!) is a smaller

percentage of LD50, and has no reported gastrointestinal irritation side

effects, so this may be a promising alternative to aspirin. (Al- Hindawi

et al. 1992 - abstracted by C. Leigh Broadhurst)

 

Bilberry (Vaccinium myrtillus):

More promoting oligomeric procyanidins (OPCs) like Pycnogenol® or red

wine than bil- or blueberries, Schwitters (1993) notes that OPCs, by

means of their activity against free radicals, can help prevent

alterations of the synovial liquid by depolymerization of

hyaluronic-acid during articular diseases as well as collagen

degradation during so called collagen disease (such as MS).

 

Hyaluronidase is involved in inflammation, releasing histamine during

degranulation of mast cells, wherein histamine is contained in blister-

like vesicles.

 

Hyaluronidase breaks down the " blisters " , releasing the histamine.

Bioflavanols (OPCs) block an activator of hyaluronidase, hence exerting

an anti-histamine, anti-allergic, and anti-inflammatory activity.

 

Leukotrienes are 3-4 magnitudes more active than histamine, and are

implicated in allergies, arthritis, asthma, diabetic retinopathy (via

vascular leakage), immune suppressions, inflammations, and insect

stings. (Schwitters, 1993)

 

Boswellia aka Indian Frankincense (Boswellia serrata):

 

I’d not be afraid to try the resin from Boswellia serrata, used for

centuries in Asia in the treatment of arthritic conditions.

 

Boswellic- acid extracts from the gum show anti-arthritic activity in

experimental animals, retarding inflammation, maintaining

glycosaminoglycan synthesis, and improving circulation to the joints.

 

(Reddy et al, 1989) Alpha, beta-boswellic-acid completely inhibits the

complement pathway at only 0.1 æM. Ammon et al (1993) found that

boswellic acids specifically inhibit 5-LO in vitro (IC50=1.5-7.5 æM)

without inhibiting 12-LO or CO.

 

This important mechanism allows boswellic acids to act as

anti-inflammatory agents without the attendant side effects of broad

spectrum NSAIDs which block the cyclooxygenase reaction, or

glucocorticosteroids which interfere with the phospholipase-A2 reaction.

 

Boswellin, (a standardized extract of 60-65% boswellic acids,) improves

the blood supply to the joints and prevents the breakdown of tissues

affected by arthritis (Sabinsa Corp, 1995).

 

In a double-blind, placebo-controlled study of 42 osteoarthritics

(Kulkarni et al. 1991) taking a combination of Boswellia, Curcuma,

Withania and zinc for three months, pain and disability was

significantly reduced, with no significant side effects; 39 patients

preferred the combo to placebo. In a clinical trial (Gupta et al. 1987)

95% of 175 RA patients, reported moderate to excellent improvement after

3-4 weeks of treatment, with reduced morning stiffness, pain, and

swollen joints.

 

Grip strength and physical performance also improved. In a foreword,

James Brady, MD, Boca Raton, Florida, says: " The major use of Boswellia

serrata in contemporary medicine is as an anti-arthritic and

anti-inflammatory plant-derived extract.

 

Its anti-inflammatory actions, supported by solid science, are indicated

in clinical medicine for the treatment of rheumatoid arthritis,

osteoarthritis, juvenile rheumatoid arthritis, soft-tissue rheumatism,

gout, low back pain, myositis, and fibrositis and are attributed

primarily to the presence of boswellic acids.

 

Boswellic acid inhibits leukotriene synthesis via inhibition of 5-

lipoxygenase. Compared to nordihydroguaiaretic acid (NDGA), both inhibit

5-lipoxygenase, but only NDGA also inhibits cyclooxygenase and

12-lipoxygenase. At reducing edema, boswellia, however, is not a whole

lot better than phenylbutazone, IC39-75 = 50-200 mg/kg orl rat, cf IC40-

47 at 50-100 mg/kg phenylabutazione. And, at the molar level, it’s not

clear that beta-boswellic- acid is better than aesculetin. Further 10 mg

boswellic acid ointment was not as effective as 5 mg phenylbutazone

ointment. As Sabinsa puts it, boswellic acids are effective at higher

concentrations than phenylbutazone. "

Translate: it takes less phenylbutazone to do the trick, orally or

topically. " The therapeutic, anti-inflammatory effect of boswellic acids

was comparable in strength to that produced by a topical application of

curcuminoids. " (Majeed et al, 1996.) In his new newsletter, even Dr.

Andy Weil (1996) recommends boswellia and its extract Boswellin to

relieve inflammation of the joints.

 

Burdock (Arctium lappa):

 

I get many inquiries on the Essiac formula (burdock, rhubarb, sheep

sorrel, slippery elm).

 

While I think burdock could have given Jackie Onassis a few extra years

Willix (Health & Longevity {H & L}, May 1995) is more positive,

recommending " Essiac tea, with boiled unfluoridated water, to boost your

immune system and prevent disease, 1 to 2 ounces a day; for arthritis,

asthma, chronic fatigue syndrome, 2 ounces 1 to 2 times a day; for

breast cancer, 2 ounces 3 times a day " .

 

Willix says that " it appears there are no adverse side effects to

Essiac. I’m sure it contains dozens of useful phytochemicals, and a few

immune boosters.

Remember, we might not want to boost the immune system in auto-immune

rheumatics. (Essiac’s oxalic acid might be undesirable in some

conditions).

 

Chamomile (Chamomilla recutita):

Even in a book with an ominous title like Adverse Effects of Herbal

Drugs (De Smet, et al. 1992) we read that chamomile is reportedly

anti-convulsant, anti- fungal, anti-herpetic, anti-inflammatory,

antiseptic, anti-viral (herpes, polio), immunostimulant, sedative and

spasmolytic.

 

If true, that means it could serve in dermatology, ear-nose-throat

disease, gastroenterology, gynecology, pediatrics, pulmonology, and

stomatology as an anthelmintic, anti-spasmodic, carminative, diuretic,

expectorant, sedative, stimulant, and tonic.

 

Externally it is applied as a counter-irritant liniment for bruises,

hemorrhoids, inflammation and sores.

 

Local anti-inflammatory activity is considered due to apigenin,

apigenin-7-D-glucoside, luteolin and quercetin. Hydroalcoholic extracts

of dried chamomile flowers have repeatedly demonstrated mild but

significant anti-inflammatory activity (AIA), while extracts from fresh

flowers were found to be 40% more active.

The AIA for isolated apigenin was 10 times greater than that of

matricin, which was in turn 10 times greater than that of chamazulene.

Essential oils are not as active as the hydroalcoholic extracts.

 

Matricin is characteristic of extracts from fresh chamomile, and

differences in the content of this constituent may account for variable

AIA results (Bingol and Sener 1995 CLB). Reports of asthmatic and

contact allergenic problems may be exaggerated or due in many cases to

misidentifications. Neither apigenin, apigenin-D- glucoside, bisabolol,

cis-en-yn-dicycloether, farnesene, luteolin, nor matricin had any

allergenic potency in the absence of anthecotulide. (De Smet 1992).

 

A topical compress of chamomile or arnica is worth the try, if you’re

not having any luck with a pepper or peppermint (or spearmint) compress.

 

 

Cayenne (Capsicum annuum): Capsaicin, the hot principle of the hot

pepper, was the only herbal approach mentioned (barely), besides

steroids (once herbally derived), in Newsweek’s, " Living with Arthritis "

(March 20, 1989).

 

Here again we were reminded of iatrogenic perils: " Nearly 9 million

arthritis sufferers take large doses of such " NSAIDs " daily. Some 10,000

of them die every year from gastrointestinal complications - many of

them " silent ulcers " that show no symptoms until they become life

threatening. "

 

Arthritic rats have been injected with capsaicin " that blocks

pain-transmitting neurons and succeeded in reducing the inflammation in

their joints. "

 

So Dr. Levine, of whom Newsweek spoke, was injecting the active

ingredient from hot peppers, seeking " a whole new class of drugs to

combat rheumatoid arthritis. " ... Numerous studies (some dramatically,

some slightly encouraging) report the success of capsaicin, the hot

ingredient in red pepper, for pains. Substance P, thought to be the

mediator of peripheral pain pulses, is apparently depleted by capsaicin.

(Cordell and Araujo, 1993)

 

Researchers are also finding significant pain relief applying a

capsaicin cream externally to painful arthritic knees four times daily.

For rheumatoid arthritis, the treatment reduced pain by more than half

while osteoarthritis pain was reduced some one-third.

 

Deal et al. (1991) conclude " Capsaicin cream is a safe and effective

treatment for arthritis. " Not only reducing pain, capsaicin also

increases the production of the enzyme collagenase and prostaglandins,

reducing both pain and inflammation (pages from Herbalgram No. 27,

1992).

 

If you’re not having any luck with capsaicin pepper or the Jamu capsicum

pads (pepper pain pads or PPP), then you might try peppermint (or

spearmint) compresses.

 

Celery Seed (Apium graveolens):

 

The maker of one celery seed extract got into the business because it

had done his arthritis so much good. When I saw his ad claiming that

celery seed was also hypouricemic, I didn’t believe it. So I replaced my

allopurinol with celery seed extract. Six months later, after several

traumatic injuries, and a couple of minor overdoses of ethanol, any of

which normally would have triggered a gout crisis, I was still gout

free.

 

I would not have believed this anecdote if anyone told it but me. After

the second month on celery seed, I then tried celery stalks, whole or

juiced, for a couple weeks with the same results, a little messier and

more trouble but food farmacy at its best.

 

Bisset (1994) says only that " Celery seed is now only occasionally used

in folk medicine, chiefly as a diuretic in bladder and kidney

complaints, and an adjuvant in arthritic and rheumatic conditions. The

effect is ascribed primarily to the essential oil. . . described as

having sedative activity.

 

Extensive animal experiments have demonstrated that the at most very

slightly toxic alkaloid fraction has depressant, tranquilizing effects

on the CNS. . .The drug is contraindicated in inflammation of the

kidneys, since the essential oil (like other apiaceous oils) may

increase the inflammation as a result of epithelial irritation. "

 

Still in the UK, celery seed is found in some 60 anti-inflammatory

preparations.

 

And in my database, I found at least 25 anti-inflammatory compounds

including: alpha-pinene, apigenin, ascorbic-acid, bergapten,

butylidene-phthalide, caffeic-acid, chlorogenic-acid, cnidilide, copper,

coumarin, eugenol, ferulic-acid, gentisic-acid, isopimpinellin,

linoleic-acid, luteolin, magnesium, mannitol, myristicin,

protocatechuic-acid, quercetin-3-galactoside, rutin, scopoletin, thymol,

umbelliferone, and xanthotoxin. Is this combination of natural chemicals

synergetically preventing my gout as well as my allopurinol? Stay tuned.

 

 

Evening Primrose (Oenothera biennis):

 

Horrobin (1992), advocate of evening primrose oil (EPO) and

gamma-linolenic-acid (GLA), has an interesting point or two about PGE1

(prostaglandin E1). GLA can be administered, orally, as a precursor of

PGE1, dihomogammalinolenic-acid (DGLA) and

15-hydroxy-dihomogamma-linolenic acid (15-OH-DGLA) which can block the

arachidonic cascade and production of inflammatory compounds.

 

This has been shown effective, in in vivo and in vitro models of

arthritis. Horrobin concludes that anyone reviewing this literature

should be convinced that GLA is a potent treatment for experimental

inflammatory and auto-immune disorders. (Horrobin, 1992).

 

Leventhal et al. (1993) worked with 37 rheumatoid arthritic patients

giving them 1.4 gm GLA/day (from borage oil) or placebo.

 

GLA patients had a 36 to 45% reduction in tenderness and 28 to 41%

reduction in swollen joints. Patients given a placebo showed no

improvement.

 

There was significant reduction in synovitis in as early as 6 weeks.

Nutritionists advise me that the balance between omega-3’s and omega-6’s

is important, one suggested ratio being 1 part EPO with one part

flaxseed oil and one part fish oil.

 

Fenugreek (Trigonella foenum-graecum):

 

I had doubted that wild yam would be effective as a transdermal

estrogenic without spiking with progesterone. However, several

clinically practicing herbalists (such as Susan Weed) argued that point

with me at the 1995 fall outings in the Catskills. They said that they,

themselves, had made salves out of wild yam, adding no progesterone, and

that their clients were having the desired progesteronic effects.

 

If they are right, I speculate that fenugreek would have similar

effects, because the seed can contain more diosgenin (to 1.9%) than the

roots of many wild yams (0.45% in Dioscorea bulbifera). Diosgenin itself

is said to be useful in inflammation. Fenugreek seed contains two

steroidal saponins which on hydrolysis give diosgenin and gitogenin,

with traces of neotigogenin, tigogenin and yamogenin.

Steroid hormones derived from diosgenin have many applications. Lydia

Pinkham’s Compound contained 12 ounces fenugreek seed, 8 ounces unicorn

root (Aletris), and 6 ounces each of life root (Senecio), black cohosh

(Cimicifuga), and pleurisy root (Asclepias) in enough alcohol to make

100 pints of compound.

 

The fenugreek and cohosh both contain diosgenin, the precursor for

steroids.

 

I have to agree with the author who suggests that Lydia Pinkham was a

few years ahead of ERT (Estrogen Replacement Therapy). I might even try

it for sciatica.

 

Even Commission E approves fenugreek externally as a poultice for

inflammation.

 

Garlic (Allium sativum): As a gout sufferer I was interested to read

that the enzyme xanthine oxidase from the liver was inhibited by garlic;

more so with boiled garlic than with fresh garlic juice, showing that

something other than allicin is responsible.

 

Anti-arthritic activity was found for steam-distilled garlic oil fed at

2.5 mg/kg in rats, decreasing the arthritis 26%. Garlic’s effects were

synergistically increased by dietary boron (Koch & Lawson, 1996), well

represented in stinging nettle (also recommended for arthritis).

 

The effects of aqueous extracts of raw and boiled garlic on

cyclooxygenase (CO) activity were studied in rabbit platelets, lung, and

aortic tissues.

 

Raw garlic inhibited CO by 50% in these tissues at 0.35, 1.10, and 0.90

mg respectively.

 

Boiled garlic extract had little effect on CO in these tissues as

compared to raw. Platelets in particular were very sensitive to the

effect of raw garlic extract, and therefore raw garlic preparations may

be required in order to exert significant anti-thrombotic effects. (Ali,

1995 CLB) That’s why there are two cloves of garlic in the celery juice

I am taking today in lieu of allopurinol. And one in my celery soup.

 

Ginger (Zingiber officinale):

 

Srivastava and Mustafa (1992) gave 3-7 gm powdered ginger a day to 56

patients with rheumatoid arthritis (n=2, osteoarthritis (n=1 or

myalgia (n=10).

 

More than 75% of the arthritics experienced varying degrees of relief

from pain and swelling. None reported adverse effects from the high

levels of ginger, from 3 to 30 months. Perhaps that’s why Jean Carper

drinks ginger tea for her own osteoarthritis as reported in Parade

Magazine (July 31, 1994. p. 4).

 

If 10 gm ginger gives some relief to more than 75% of arthritics, naive

arthritics should give ginger a try.

 

Ginkgo (Ginkgo biloba):

 

Recently ginkgo extracts have been promoted as a topical agent (or

cosmetic) to improve peripheral circulation, hence useful as slimming

and moisturizing agents due to their microvasculokinetic activity.

Della Loggia et al. (1996) demonstrated anti- inflammatory activity of

some Ginkgo biloba constituents and their phospholipid complexes.

Ginkgolides, bilobalides, a bioflavonic fraction, and some pure

bioflavonones (especially when mixed synergistically) were comparable to

indomethacin as anti-inflammatories. Ginkgolides inhibit the

pro-inflammatory PAF (platelet aggregating factor).

 

Its bioflavones inhibit histamine release from mast cells and cAMP

phosphodiesterases. The extract also reduces production of oxygen

species by activated neutrophils. Complexes with

distearoylphosphatidylcholine, more soluble in non-polar solvents than

the parent compounds, are still even more strongly lipophilic, resulting

in increased bioavailability and activity. For example the complex shows

some 5 times more anti-edemic activity than the free compounds.

 

The complex of a mix of ginkgolides A and B was more potent than

indomethacin while the free mixture was not quite as effective. But

phospholipid itself, alone, was inactive, merely increasing the activity

of ginkgolides by making them more bioavailable. Of pure bioflavones,

amentoflavone was strongest with anti-edemic (IC45=2 æM/ear), followed

by ginkgetin (IC25=2 æM/ear) and sciadopitysin (IC19=2 æM/ear) as

compared with an IC60=2 æM/ear for indomethacin.

 

The mix of the bioflavonic fraction (corresponding to ca 0.2æM of

bioflavones) inhibited 73% of the edema, compared with 45% for

amentoflavone, the strongest competitor. Thus the pure flavones exhibit

additive or even synergetic activity when mixed. (Della Loggia, R., et

al. 1996)

 

Horse Chestnut (Aesculus hippocastanum): Borrowing data from Chang et

al. (1996) on Fraxinus bungeana DC, I see good rationale also for the

horse chestnut. Containing esculetin, esculin, fraxetin and fraxin,

bunge’s ash has been used folklorically as an anti-inflammatory

analgesic uricosuric for gout and rheumatism, and as an anti-aggregant,

anti-bronchitic, anti-diarrheal, and antipyretic, as well as a screen.

Chang et al. (1996) speculate that these chemicals act synergistically

for treatment of these diseases, and the glucosides esculin and fraxin

are hydrolized in the body to the aglycones esculetin and fraxetin, the

much more potent superoxide scavengers. Since these scavengers are

implicated in many clinical disorders, scavengers can reasonably be

expected to increase the span of health in preventive and therapeutic

medicine.

 

Licorice (Glycyrrhiza glabra):

 

Your doctor might recommend a steroid. Some herbal alternatives to the

steroids (which themselves contain steroids or steroid precursors), are

fenugreek (Trigonella), licorice (Glycyrrhiza), sarsaparilla (Smilax),

and wild yam (Disocorea).

 

The licorice has a lot going for it, including ulcer prevention, but it

can raise the blood pressure and lower potassium levels. In their survey

of anti-inflammatory phytochemicals, Handa et al. (1992) state that

glycyrrhizin potentiates the anti-arthritic activity of hydrocortisone

in rats.

 

The aglycone is about 1/8th as effective as cortisol in some tests.

Derivatives of these and the flavonoids liquiritogenin, liquiritin,

quercetin and rutin have also demonstrated anti-inflammatory activity.

Duwiejua and Zeitlin (1993) enumerate several triterpenes with

significant anti-inflammatory activities, one licorice compound equaling

in intensity alpha, beta-boswellic acid (from Boswellia serrata) which

completely inhibits the complement pathway (100% at 0.1 æM).

 

Moreover glycyrrhetinic acid mimics corticosteroid activity. Licorice

needs be watched, but for me, with moderate blood pressure and potassium

levels, the licorice looks good. Diabetics might prefer the fenugreek,

which has at least 5 hypoglycemic compounds.

 

Pineapple (Ananas comosus):

 

Naturopaths now suggest a dose of 150-450 mg bromelain, thrice daily,

on an empty stomach. Early studies had been on enteric-coated pills of

only 20 mg. Bromelain, a proteolytic enzyme, at low levels in pineapple,

is suggested to help inflammation in several ways: inhibiting the

formation of an inflammatory prostaglandin (E-2) while selectively

stimulating the production of an anti-inflammatory prostaglandin (E-1);

reducing edema and inflammation by inhibiting kinin formation, and

activating the production of plasmin from plasminogen.

 

In one study (Lotz-Winter, 1990), bromelain lowered kininogen and

bradykinin levels up to 60%, decreased prostaglandin E-2 and thromboxane

B-2 levels, and reduced the symptoms of inflammation. Bromelain can

reduce inflammation in arthritis, sports injury or trauma, and can be

useful in thrombophlebitis (Taussig and Batkin, 1988).

 

Nonetheless, Commisson E suggests bromelain at 80-320 mg (in 2 or 3

doses) only for " acute postoperative and post-traumatic conditions of

swelling, especially of the nasal and paranasal sinuses. " Bromelain has

both proteolytic and lipolytic attributes, and is fairly well endowed

with glutamine, reportedly catabolic. Lipolytic and catabolic activities

might help you lose weight, almost always useful in arthritis.

 

One might mix the pineapple with richer sources of glutamine for a

lipolytic. I had assumed that the bromelain, if ingested, would itself

be digested. But Boik (1995) says that a substantial percentage appears

to be absorbed into the blood, up to 40% absorbed unchanged in animal

models.

 

Stinging Nettle (Urtica dioica):

 

If I had arthritis, I might replace some nightshade foods with

non-nightshade foods that have folk reputations for arthritis, like

dandelion and nettle (more promising in gout than in rheumatoid

arthritis).

 

Analyses of my stinging nettle provided me by USDA scientists showed

that on a dry weight basis it contained 47 ppm boron. A hundred gm

serving would then contain more than the 3 mg boron the USDA scientists

suggested could help in osteoporosis.

 

According to Alternative Medicine, the Definitive Guide, (Goldberg,

1993) the Rheumatoid Disease Foundation suggests the use of boron to

treat osteoarthritis and rheumatoid arthritis.

 

" Boron apparently plays a role in the retention of calcium and also

positively stimulates hormonal factors for both men and women,

contributing to healthy bones. "

 

(Goldberg, 1993) Stinging nettle can give you numbing microinjections,

presumably of acetylcholine, histamine and 5-hydroxytryptamine, as well

as a histamine-liberating enzyme (according to the Wealth of India).

 

One M.D. told me that injections like these might stimulate the

production of mast cells which might cause anti-inflammatory reactions

elsewhere in the body. (Remember that the urtication for arthritis is

often done remote from the site).

 

Like bee stings, nettle stings have evolved in the antiarthritic

folklore of every continent where they occur. Maybe both, like

acupuncture and capsaicin, induce tingling and endorphins.

 

Commission E suggests internal and external application as supportive

therapy for rheumatic ailments (Blumenthal et al., 1997). In a letter to

a medical journal, C. F. Randall (1994) recounts the story of an

81-year-old male osteoarthritic (with radiographically confirmed

unilateral hip osteoarthritis) who found great relief from topical

nettle where ibuprofen had offered none. (He had to apply the leaves

(sting himself only once every few days to maintain the effect). Randall

also mentioned an elderly woman who had used it to help her inflamed

arthritic fingers. (Randall, 1994).

 

One German study (Obertreis et al. 1996), undertaken to study the

anti-rheumatic activities of Urtica dioica, showed that nettle extracts

inhibit both detrimental eicosanoid and cytokine metabolism. Tumor

necrosis factor-a and interleukin-1B are cytokines both suspect in

pathogenesis of osteo- and rheumatoid arthritis. Concentrations of

nettle extracts from 1.25-5 mg/ml inhibited their secretion

dose-dependently and significantly, 5 mg/ml 51% and 100% respectively,

after 24 hours.

 

Since none of the flavonoids tested alone inhibited, other factors or

synergy must be involved. The nettle extract also stimulated the

production of interleukin-6, potentially useful for inhibiting

interleukin-1B’s deleterious effects.

 

Turmeric (Curcuma longa):

 

Curcumin is used widely in India and Indonesia for inflammation. A

pleiotropic cytokine, Tumor Necrosis Factor-alpha (TNF), induces

production of beta- Interleukin-1 (Il-1). Together they cause both acute

and chronic inflammation, and have been implicated in auto-immune

disorders. At 5 æM, curcumin inhibits lipopolysaccharide-induced

production of TNF and Il-1. Could that be good for arthritics yet bad

for oncophobes? (Chan, 1995).

 

Turmeric’s curcumin inhibits prostaglandin synthesis (weaker than

ibuprofen). At high doses, it stimulates the adrenals leading to the

release of endogenous cortisone.

 

(Srivastava and Srimal, 1985) A relatively non-toxic nutraceutical,

curcumin inhibits inflammation as well as cortisone or phenylbutazone in

acute models, but only half as well in chronic models. (Srimal and

Dhawan, 1973) Patacchini et al (1990) say that both curcumin and

capsaicin deplete nerve endings of the neurotransmitter of pain,

substance P.

 

In one study, the activity of 1,200 mg/day curcumin was comparable to

300 mg phenylbutazone. But some compounds, perhaps synergetic with

curcumin, are more potent. In a survey of anti-inflammatory

phytochemicals, Handa, Chawla, and Sharma (1992) ranked them this way

for experimental anti-edemic activity: sodium curcuminate >

tetrahydrocurcumin > curcumin > phenylbutazone > triethylcurcumin. Still

the triethylecurcumin was best at inhibiting granulomatous tissue

formation. Two other natural analogues,

feruloyl-4-hydroxycinnamoylmethane and bis-(4-hydroxycinnamoyl)-methane

were actively anti-inflammatory while diacetylcurcumin and ferulic-acid

were inactive. (WARNING: Though it has a lower ulcerogenic index than

phenylbutazone, curcumin at 2 x ED50, administered for 6 days, can

produce ulceration in rats). (Handa, Chawla, and Sharma, 1992). I now

assume that beta-sitosterol occurs in all plants. Handa et al. say that

beta-sitosterol (from nutsedge) has potent anti-inflammatory activity

against carrageenan and cotton pellet induced edema in rats (comparable

to hydrocortisone and phenylbutazone ipr).

 

It showed a wide safety margin with the ipr LD 50 about 3,000 mg/kg in

mice and the minimum ulcerogenic dose 500 mg/kg. Anecdotally, a friend

of mine was very impressed with the anti-arthritic activity of turmeric

(with cayenne) in DMSO, as was I. It was messy though.

 

Willow (Salix spp):

 

Weissmann (1991) says that 4-8 gm aspirin a day can reduce the redness

and swelling of the joints in rheumatoid arthritis (but might be

ulcerogenic). Raskin notes the effects of salicylic acid (salicin,

o-hydroxybenzoic-acid), which is ubiquitous in plants, is the same in

plants (and presumably animals) as aspirin, which undergoes spontaneous

hydrolysis to salicylic acid. Exogenously applied, aspirin is " rapidly

converted to salicylic acid. " All poplars and willows contain

salicylates, in that sense being NSAIDs. The first herbal remedy

mentioned by the Time-Life Medical Advisor is a 5 ml tincture made of 2

parts willow and one part each of black cohosh and nettle, taken three

times a day. (TMA, 1996) There is a popular anti-arthritic remedy called

Phytodolor N, (tincture of Fraxinus excelsior, Populus tremula and

Solidago virgaurea). Individual tinctures alone, or combined, exhibit

anti-edemic and anti-inflammatory activities, dose-dependently,

comparable to diclofenac. (Ghazaly et al. 1992).

 

BOTTOM LINE: I’d rather have high-bromelain pineapple or

papaya/pineapple juice fortified with 10 gm ginger and 1 gm turmeric,

and spiced up with a bit of licorice and capsaicin, to down after

nibbling on sunflower seeds and brazil nuts, and chased with antioxidant

tea, than what the doctors are prescribing for osteoarthritis or

rheumatoid arthritis.

 

 

I believe that’s the double " hippocrazic " (Freudian slip for

Hippocratic) alternative, doing less harm, and letting food be medicine.

 

 

I also think Gobo Gumbo might be useful, following exercise, along with

some topical capsaicin/curcumin, and ingested proteolade, a mixture of

fruits rich in proteolytic enzymes.

 

I’m retired now, and have enough time to concoct these time-consuming

" recipes " .

 

But even today, in retirement, I find it easier to take these herbs as

standardized extracts and tinctures.

 

And on the road, of course, I won’t be taking my gobo gumbo or my

anti-arthritic soups or salads, but I can pack my ABC’s for arthritis:

ashwagandha, bromelain, boswellia, cayenne, and my spice capsules like

ginger and turmeric.

 

 

http://www.willner.com/References/webref21.htm

 

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Ammon HPT, Safayhi H, Mack T, Sabieraj J. Mechanism of anti-inflammatory

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Ammon, H. P. T., et al, {Tubingen, Germany} Use of preparations of

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Deal, C. L. et al, 1991. Treatment of Arthritis with Topical Capsaicin:

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Goldberg, B (et al.including hundreds of alternative specialists, even

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Houghton, P. J., Zarka, R., De Las Heras, B. and Hoult, J.R.S. 1995.

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