These ancient Indian remedies are
said to ease aches and inflammation. A new study prompted us to take a
closer look.
We don't usually think of ginger, turmeric and
frankincense as medicinals. Instead the names conjure up images of a
kitchen spice shelf, a tasty curry or an exotic incense.
But these herbs do have a
venerable therapeutic lineage. For thousands of years they have been
used in Ayurveda (pronounced ay-yur-vay-duh), the traditional medicine
of India, to treat arthritis and other ailments. Sometimes, they are
combined with ashwagandha, another Indian herb.
Research reported at the American College of
Rheumatology (ACR) annual scientific meeting last fall looked at a
combination remedy incorporating these four plant extracts. In a
randomized, double-blinded trial of 90 people with osteoarthritis
(OA), those patients who took the combination experienced significant
and sustained pain relief: Fifty percent improved, compared to 20
percent of those who took placebo.
An earlier double-blinded study of the same
formula, presented at the ACR meeting two years prior, looked at 182
patients with active rheumatoid arthritis (RA). Again, those who took
the herbs experienced a reduction in the number and severity of
swollen joints and noted a statistically significant improvement in
pain, stiffness and function compared to those taking placebo. Tests
also showed disease-modifying activity such as a drop in the amount of
both rheumatoid factor and interleukins, the biological markers that
show RA disease activity.
In both studies, participants had no significant
side effects or interactions with other drugs, even those taken over a
four-year period.
East vs. West
Given such promising results, are these herbs worth a try? The answer
depends on whom you ask.
If you ask a Western-trained medical doctor, you're likely to
meet with skepticism. Many doubt the effectiveness of herbs in
general. Others feel they don't know enough about herbs and other
botanical therapies to give an opinion. "If I were an expert, I'd
comment. But most of us are just guessing," says rheumatologist Justus
Fiechtner MD, of East Lansing, Mich.
Some skeptics question how the same formula could help both OA
and RA - two conditions with different causes and different symptoms.
That's a Western bias, says Scott Gerson, MD, founder and
medical director of the National Institute of Ayurvedic Medicine in
Brewster, N.Y. Dr. Gerson is a Western-trained medical doctor as well
as an Ayurvedic physician.
"We're conditioned to think of drugs as having only one effect,
but that's not true," he says. "Though given for one symptom or
disease, all drugs actually have many actions in your body. Herbs,
which are complex, have many active ingredients and can affect many
body systems."
Western experts also have a problem with the multi-herb formula.
When so many ingredients are used, it's hard to scientifically
evaluate a remedy to determine which one (or ones) are the active
ingredients, or even how they act together, says Pharmacist Donald R.
Miller, chairman of the department of pharmacy practice at North
Dakota State University in Fargo.
While Miller says the studies presented at ACR were well done
and may very well be objective and accurate, they were sponsored by
San Jose, Calif.-based AyurCore, a company making and selling a
patented product called Artrex, which is made of the
four-herb combination. "I'd like to see studies done by an independent
group," he says.
Moreover, medical doctors point out that these studies have not
been published in peer-reviewed journals.
Ancient Healing Tradition
For Ayurvedic practitioners, these studies confirm tradition. "These
herbs have been used for thousands of years," says Dr. Gerson, who has
no financial interest in the Artrex product. "I've used all
of these for osteoarthritis and rheumatoid arthritis."
While these herbs are often used in combination, each has its
own history of study and/or therapeutic use.
Ginger (Zingiber officinale) may be
among the best-studied of the four. Research suggests ginger root
inhibits production of prostaglandins and leukotrienes, which are
involved in pain and inflammation. In an uncontrolled 1992 Danish
study, 56 patients who had either RA, OA or muscular discomfort took
powdered ginger. All of those with musculoskeletal pain and
three-fourths of those with OA or RA reported varying degrees of pain
relief and no side effects, even among those who took the ginger for
more than two years.
Turmeric (Curcumin longa) is used
lavishly for color and flavor in Indian cuisine. Studies show it
inhibits prostaglandin production and stimulates the creation of
cortisol, which relieves inflammation. It seems to act like capsaicin,
an active ingredient in cayenne pepper, by depleting nerve endings of
the neurotransmitter substance P. When turmeric was taken internally
along with cayenne pepper in an animal study, it significantly lowered
inflammation. Capsaicin is usually used in ointments that are applied
externally to aching joints. One researcher suggests turmeric might
also work applied externally, but there are no studies to show this.
Frankincense, also known as boswellia (Boswellia
serrata), comes from a tree that yields gum when its bark is
peeled away. In animal and test tube studies, it inhibited the
production of leukotrienes, which cause inflammation.
Ashwagandha (Withania somniferum) is
an Asian plant of the potato family. Its roots have long been used to
treat "rheumatism," high blood pressure, immune dysfunctions, erection
problems and also to ease inflammation. Because of all this, it's
sometimes called the "Indian ginseng."
Strength in Numbers
Although each herb may have some action on its own, Ayurvedic
medicine traditionally combines herbs for greater effect. A 1991 study
conducted in India looked at another combination formula - of
Boswellia, ashwagandha, turmeric and zinc. In a double-blinded,
placebo-controlled trial of 42 patients with OA, those receiving the
test formula showed a significant drop in pain
and disability. Moreover, the combination appeared to only affect the
symptoms: X-rays didn't show any changes in the joints of the test
group. Again, there were no significant side effects.
While researchers report that the herbs require up to a month to
take effect, they say they retain their therapeutic punch over several
years without a need to increase the dosage.
And don't look to herbs to fully solve your health problems.
Ayurvedic practitioners and Western doctors agree it takes a
well-rounded treatment plan to control arthritis. "Yes, these herbs
work," says D. Edwards Smith, MD, a rheumatologist and Ayurvedic
practitioner who is now dean of the Maharishi College of Vedic
Medicine in Albuquerque, N.M., "but herbs are just one part of
therapy." Treating and preventing disease requires daily healthy
living that includes rest, relaxation, exercise and a well-balanced
diet.
Good Advice
If you are thinking of using these herbs, keep this advice in mind:
- Make sure you have an accurate diagnosis. There are more than
100 different types of arthritis and related conditions.
- As always, before you take botanicals or other supplements,
be sure to tell your doctor what you are taking and how much so you
can be monitored for any side effects or changes.
- Don't discontinue any prescription drugs - especially
glucocorticoids - without first consulting your doctor. It can be
dangerous to suddenly stop some medications.
- Remember that these botanicals act as chemicals in the body:
Anything powerful enough to help can also hurt. Botanicals may also
interact with prescription and other drugs. For example, ashwagandha
in very large doses may increase the effects of barbiturates.
- Follow directions on the package or from a health
professional trained in herbal or Ayurvedic therapy. More is not
better, and large doses can cause problems.
- Use ginger with care if you are taking blood pressure or
blood thinning medication, as large doses can multiply the effects
of these drugs and cause bleeding. For the same reason, don't use
large amounts of ginger if you are scheduled for surgery or dental
work.
- After about two or three months, check in with your doctor,
as you would when taking any medication long-term.
- Keep up with your full treatment plan. Be sure to exercise,
get appropriate rest, practice joint protection, keep your weight
down and your spirits up.
Judith Horstman writes frequently about alternative medicine
in Arthritis Today. Her book on alternative
and complementary therapies for arthritis was published by the
Arthritis Foundation. |
