Managing Osteoarthritis

Let’s start to look at the various products that are commonly used as effective alternatives in helping the patient with osteoarthritis (OA). My favorite two herbal complexes from the MediHerb line are called Boswellia Complex and Gotu Kola. Boswellia Complex is a combination of Boswellia, celery seed, ginger and turmeric. Gotu Kola is commonly called Penneywort. The MediHerb complex contains Gotu Kola, Gingko leaf and Grape Seed Extract.  When we explore the various actions that these herbs have on the human system it will take into account much of the discussion that we have had in the previous blogs.

Part I

Part II

Part III

Boswellia Serrata (Frankincense)

Boswellia is very closely related to Frankincense and Myrrh. Young Living Essential Oils of course makes many of these essentials available in their superior product line and I recommend these oils as they support a healthy musculoskeletal system and healthy skin. These resins and essential oils have been used really since antiquity in incense, embalming fluids and in Ayurvedic Medicine.  Boswellia has had a long and rich history of therapeutic use for a wide range of inflammatory conditions, not just OA, but inflammatory bowel conditions and psoriasis for example.

Gotu Kola (Indian Pennywort)

Gotu Kola Complex is a synergistic combination of Gotu Kola herb and concentrated extract of Grape Seed and Ginkgo leaf. These potent ingredients work effectively to help promote, maintain and support connective tissue and the body’s natural repair process. This unique formula can also assist normal circulation and maintain the elasticity of our veins and arteries. Clinical trials have shown that Grape Seed can support blood vessels. Its powerful antioxidant properties can help protect against free radical damage. Ginkgo also provides antioxidant protection and supports healthy circulation.

How they Help Osteoarthritis

In looking at what it is that Boswellia does, there is quite of lot of science that shows the use of Boswellia as a very rational approach for OA. Boswellia has the ability to inhibit 5-lipoxygenase but it only has minor activity on prostaglandin production and the leukotrienes that are inhibited by this aspect which is more important in OA. Boswellia downregulates tumor necrosis factor by inhibiting nuclear factor kappa b.  Nuclear factor kappa b is quite an important target because it is kind of a master regulator of the inflammation and the degradation at the joint. Boswellia is also a significant cytokine inhibitor and it inhibits interleukin 1 beta, which is a very important cytokine as we discussed in part 2 and it is a key initiating cytokine for the changes that takes place that allows the disfunction to take hold in the articular cartilage.

In looking at what it is that Gotu Kola does, there is some science to show that this herbal improve capillary permeability back into the boney matrix of the epiphysis of the bones within a joint which have been damaged by trauma. This is the important factor in actually turning around the arthritic process.

Treating and Modifying Osteoarthritis

There is quite a lot of clinical evidence for Boswellia Complex and Gotu Kola  therapy being supportive in OA and these herbals don’t just treat the disease but they are also disease modifying. There are five significant clinical trials that this article is drawn from that are worth mentioning and give us a lot of confidence in using products that have the right levels of Boswellia  and Gotu Kola in them that are going to be truly effective. In the early 2000’s  there was a study done with Boswellia over an eight week period and the Boswellia was significantly effective at reducing the symptoms of OA using the equivalent of three MediHerb Boswellia tablets per day. When scientist look at significance they talk about probability and the probability that the good result was just some chance event was <.001 which is an outstanding result. When Boswellia is compared to conventional drugs Boswellia typically has a slightly slower onset of  action but when Boswellia therapy is stopped but then the patients are still monitored, what is observed is that Boswellia has a disease modifier effect and the patients have improvement even when they stop taking the Boswellia.  So, Boswellia is doing significant work in modifying the disease process so that if the patient stops taking Boswellia it may take weeks or months for them to observe the symptoms coming back and their ability to stand, ability to walk long distances, the pain walking up a stairs and many other tests commonly used to determine longevity of results all show improvement.

Another study of significance shows increased availability of blood in the sclerosed epiphysis of joints damaged by OA. Imaging of of the poorly vascularized epiphysis showed decreased density and enhanced fluid signals after trials of the herbal were completed.

Reducing Matrix Metalloproteinase in Synovial Fluid

Some of the more recent studies not only show  improvements in OA but they are looking inside the joint to see what may be changing the matrix metalloproteinase. Boswellia has been shown in clinical studies to  reduce the production of matrix metalloproteinase in synovial fluid, which is a very important and a very significant finding.

Increasing Bioavailability of Boswellia.

In a much more recent study 2010 that shows if you enhance the bioavailability of the Boswellia then you get an even better result. In terms of bioavailability it is very important to recommend that Boswellia be taken with a meal. Boswellia is more bioavailable in the presence of dietary fats and oils. The study showed that patients taking the Boswellia on an empty stomach had 5X less boswellic acid in their system than patients who took the same amount of Boswellia with a meal that has a fatty component.  So if you forget to take your 1 tablet with a meal you can easily make up the difference by taking 5 tablets on an empty stomach. Not! A better thing to do would be to hold your next dose over until your next meal and take 2 instead of 1. This same study showed that Boswellia stayed in the system for up to 60 days after stopping the dosage. This also explains why the patient needs to have some patience during the first five days as the boswellic acid builds up and understand that the full effect may not occur but for eight weeks.

This is a revisited discussion of these two important herbal complexes. Please check out these follow up blogs that are relevant to this subject. These herbal formulations are an extremely important part of the recommendations at the Seaside Wellness Center and I think play a significant role in our ability to help our patients reach their healthcare goals.

Gouty Arthritis

Joint Inflammation

Bursitis

Until we blog again,

Dr. John Weisberg