Tuesday night I was lucky enough to catch a lecture by a functional medicine physician on the importance of supplements in the healing process.  One of the more underserved things we do have in our arsenal is the recommendation of certain supplements that can aide healing, decrease pain and inflammation, and help overall mood.  I would like to take a bit to share what I learned.

For those who are TL;DR

3 Tbsp olive oil is good for RA and other auto-immune inflammation, but it can’t be cooked.

Curcumin is amazing for joint pain and inflammation (has research) but needs pepper to help absorption into the body.

Boswellia is amazing for management of OA associated knee pain.

Ginger does not really do anything for pain or inflammation.

Strawberries have been shown to help decrease constant and intermittent pain in obese adults with knee OA.

Glucosamine/Chondrotin/MSM has been shown to reduce cartilage surface degeneration in mice and has evidence it reduces pain, stiffness, and swelling.  It has also been shown to increase tendon to bone healing.

Antioxidants help healing of long bones such as Zinc and Vitamin C

DO NOT recommend Turmeric or Boswella if someone is on Zoloft or Toprol or Crestor

For those who want to dive in, let’s take a look at how some of this works and the studies behind it. The lecture primarily focused on supplements for the treatment of knee OA, so the studies do surround this topic. You can extrapolate this data to general arthritic or joint related pain as you feel comfortable. 

Curcumin for Knee OA:

A meta-analysis of randomized controlled trials supports the efficacy of 1000mg of Curcumin in the treatment of arthritis. CuraMed 500mg capsule and Cramin 500mg capsules orally 3 times a day for 12 weeks in 201 patients found decreased pain with OA.

How does it do this? Curcumin decreases pro-inflammatory mediators, inhibits oxidative stress and Cox-2, inhibits JAK2/STAT3 signaling pathway, and activates the opioid system.  Big take away is that Curcumin inhibits Nf Kappa B.

So what is Nf Kappa B? well, NF for short cause I don’t feel like typing it our a bunch more times, is frequently observed in many diseases including arthritis, cancer, and autoimmune disease.  Studies have found that NF is involved in chondrocyte catabolism, survival, and synovial inflammation. Disruption of the cartilage matrix is caused by enhanced chondrocyte catabolism with reduced chondrocyte anabolism in the articular cartilage.

NF is activated by inflammatory cytokines and excessive mechanical stress, both of which induce catabolic gene transcription.  NF is stimulated by IL-1b, TNF-a, and IL-6 through a positive feedback loop.

So here is a good summary on Curcumin:

Inflammation Proliferation Remodeling
*Inhibition of NF-Kb activity *Enhancement of fibroblast *Increase in production of
*Reduction of TNF-a and IL-1 Migration, granulation tissue TGF-b
*ROS scavenging Formation, and collagen *Increase in fibroblast
*Modulation of antioxidant Deposition Proliferation
enzymes *Elimination of inflammatory *Improvement of wound
  Cells from wound site in early contraction
  Phase of wound healing  

Olive Oil for RA:

A randomized trial of 43 patients found that fish oil and fish oil with olive oil improved pain and function in patients with RA. The fish oil and olive oil groups had the most improvement. Soy was not found to be of benefit. This is because IL-1 and TNF-a induce Cox-2 and are overexpressed in RA. Oleocanthal, found in Olive Oil, can reduce IL-1 and TNF-a. Oleocanthal also inhibits production of IL-6, which is a cytokine that is linked to cartilage destruction. There is also in vitro proof of Cox-1 and Cox-2 inhibition.

Pound for pound, Oleocanthal in Olive Oil is a more effective Cox inhibitor than Ibuprofen reducing Cox activity by 41-57% compared to 13-18% with Ibuprofen; however, 3 Tbsp of olive oil is about 10% of a typical Ibuprofen dose, so there is not enough in a typical serving to have that amazing effect. Unfortunately, cooking kills this antioxidant so it must be ingested raw.

Use of antioxidants after long bone surgery:

We know that osteocalcin and alkaline phosphatase play a big role in healing of bone fractures and that oxidative stress can delay healing times.  One study looked at an antioxidant tablet that had vitamin A, E, C, and selenium and concluded that administering these antioxidants could accelerate bone healing after fixation surgery!

Glucosamine-Chondroitin tendon to bone healing:

One study in rabbits found that this supplement enhanced tendon to bone healing by increasing hyaline cartilage formation and decreasing formation of capillary vessels.  While this study was done on rabbits, the same chemical properties may be used to think the same healing effects could be found in humans.

Zinc to assist in bone fracture healing:

A trial was done on 60 patients in a randomized, double-blind, placebo controlled clinical trial. The experimental group received 50mg of zinc sulfate for 60 days compared to placebo.  The study concluded that zinc caused a significant elevation of serum zinc and alkaline phosphate activity as well as significant growth of bone callus formation. 

Vitamin C to assist in bone fracture healing:

There is no clinical evidence that Vitamin C helps with healing in humans; however, there is a study using animal models.  We do know that Vitamin C acts to neutralize Reactive Oxygen Species (ROS) responsible for cell apoptosis during the inflammatory phase.  Cell culture studies have also shown that Vitamin C can induce tendon-derived stem cell mobilization, osteoblast growth and differentiation, and fibroblast stimulation.  Due to these factors Vitamin C has the potential to accelerate bone healing after a fracture, increase type I collagen, and reduce oxidative stress parameters.

Even though this blog is all about supplements, it is important to know that these supplements can interact with commonly prescribed medications, so you should ask a health care provider about any supplements you may want to take.  Here is a great chart of common medications and potential adverse reactions.  

I hope this blog helps some of you see how natural supplements absolutely have a place in health care and taking them has been shown by research to aide in healing.

Written by: Dr. Travis Stoner PT, DPT, OCS, COMT, FAAOMPT

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