ARE NUTRITION SUPPLEMENTS FOR ARTHRITIS SAFE?? (Article by Ms Nishat consultant dietitian in OARC)
These days most store shelves are adorned with various supplements in the form of pills, powders or drinks which make enticing claims regarding their efficacy. But do they really work? Do patients really need them? Which ones are the best?
Below are the bare facts about SEVEN common supplements which are sold to patients with arthritis
- Glucosamine: It is a protein naturally found in bone marrow, cartilage .Supplementation of glucosamine at higher doses has been tried in treating osteoarthritis.(one of the more than 100 different types of arthritis) The beneficial effect of supplementation is questionable and has not been considered useful even in the latest studies. Glucosamine in general is safe but it should be avoided by individuals suffering from shell-fish allergy as it is extracted from exoskeleton (chitin) of shellfishes. As glucosamine sulphate is administered in combination of NaCl as a salt, it must be avoided by individuals suffering from hypertension and renal issues. It can worsen diabetes and glaucoma.
- Chondroitin sulphate: chondroitin is found naturally in cartilages of animals such as sharks and is commonly supplemented as chondroitin sulphate to help reduce pain and swelling in osteoarthritis. Chondroitin sulphate consumption can cause mild problems like heart burn, upset stomach and nausea. It must be avoided by pregnant and lactating mothers and those on warfarin (blood thinners).
- Vitamin C: vitamin C is a water-soluble vitamin with antioxidant properties which is found to have anti-inflammatory effect and essential for collagen synthesis. It is found naturally in mala, guava, oranges, lime and green vegetables like cabbage, capsicum, drumstick leaves and agathi (Agase). Hence, supplementation may worsen pain in osteoarthritis and hence is not recommended.
- Calcium and vitamin D: Calcium is a macro-mineral found in milk, green leafy vegetables like amaranth, fenugreek, drumstick leaves and ragi. Vitamin D is a fat soluble vitamin found in marine fishes, egg yolks, milk and butter. Vitamin D helps in absorption of calcium in the body. These nutrients are essential for preventing bone loss. Calcium and vitamin D from natural sources are better absorbed than supplements. Also, dietary intake of these nutrients doesn’t cause toxicity but taking supplements without deficiency can cause hypercalcemia which can cause renal calculi (kidney stones).
- Fish oil tablets: fish oil tablets originate from oil of fishes like salmon, mackerel, tuna, herring and cod. They are mainly composed of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These omega -3 fatty acids are essential for brain function, reducing LDL (“bad”) cholesterol and inflammation in the joints. Supplementation of around (2.7g/day) of fish oil containing both EPA and DHA has an anti-inflammatory effect and can reduce the severity of rheumatoid arthritis (a type f arthritis different from osteoarthritis). In addition no major harms have been seen with Fish oil.
- Collagen: Collagen is a protein found abundantly in animal bones, skin and organs. Collagen supplementation was thought decreased pain, swelling and morning stiffness. However this was NOT found to be true. Although collagen supplementation (20-40mg/day) is safe but its necessity in arthritis treatment is debatable.
- Curcumin: Curcumin is the chemical in turmeric that is thought to reduce joint pain and swelling by reducing inflammation. Curcumin is an antioxidant as well. Therefore daily consumption of 10g of turmeric is equivalent to curcumin dosage of 1500mg/day. This can possibily help reduce inflammation (swelling) in both rheumatoid arthritis and osteoarthritis. However the same is unproven at present
Always remember. Nutrition supplements are those which are intended to supplement the diet of a person. Most research is conclusive that the best supplement is a healthy diet.
Warning: Supplements must be taken under the guidance of doctor/dietitian. Unsupervised supplementation can result in adverse health effects and unnecessary strain on pocket.
R.K. Chaganti, I. Tolstykh, M.K. Javaid, T. Neogi, J. Torner, J. Curtis, P. Jacques, D. Felson, N.E. Lane, M.C. Nevitt, and the Multicenter Osteoarthritis Study Group (MOST) (2014). High Plasma Levels of Vitamin C and E Are Associated with Incident Radiographic Knee Osteoarthritis
Leslie G Cleland, Michael J James and Susanna M Proudman (2005) Fish oil: what the prescriber needs to know
Bagchi D, Misner B, Bagchi M, Kothari SC, Downs BW, Fafard RD, Preuss HG. (2002). Effects of orally administered undenatured type II collagen against arthritic inflammatory diseases: a mechanistic exploration.
James P. Lugo, Zainulabedin M. Saiyed and Nancy E. Lane (2016) Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study