Safe Alternative Therapies for Arthritis

Podcast Transcript

Hello and welcome to The Bone and Joint Playbook with Dr. John Urse, Tips for Pain-Free Aging. Dr. John Urse is a board-certified orthopedic surgeon with over 35 years of experience in the Dayton Ohio area. He is also a clinical fellowship trained surgeon in total joint replacement from Harvard. Today’s topic is Safe Alternative Therapies for Arthritis You Should Try. Let’s listen in.

Terry: Well, hello everybody and welcome to The Bone and Joint Playbook with Dr. John Urse. Dr. Urse what do we have on topic today?

Dr. Urse: Well Terry, we are going to talk about safe alternative medical therapies for pain and arthritis.

Terry: Pain and arthritis. Well, I have that every single day of my life, so I’m excited about this one. Why are you the expert we should talk to about pain and arthritis.

Dr. Urse: Well, I don’t know if I’m an expert Terry, but I do have about 35 years’ experience as a board-certified orthopedic surgeon in Dayton Ohio. I served on the White House committee for alternative medical therapies in the late 1990’s and I utilize a lot of standard, alternative and complimentary medicine modalities in my orthopedic practice.

Terry: So, before we start this why don’t you describe what arthritis is.

Dr. Urse: Well arthritis is really the breakdown of the cartilage which is the white cushioning substance at the end of our bones and that is where our joints meet in order to glide smoothly. That is how our knees move, our elbows move and when the cartilage breaks down the bone starts to rub on bone and that generates pain much like a brake shoe pad on a car not having the padding that causes the squeaking of the wheels when you stop. So, arthritis pain generates inflammation, it generates redness, swelling and often times these inflammatory mechanisms tell us we need to do something about it, and we start looking for ways to take care of that.

Terry: Got it. Why are alternative medicines important to us, what is it that these can do that a prescription can’t?

Dr. Urse: Well, I always tell people that a few over the counter anti-inflammatories are probably ok for a headache or a day after raking leaves, but you don’t want to be on these medicines long term. When we talk about anti-inflammatories, we’re talking about things that control inflammation, redness, swelling and even pain modalities by using either a true medicine like cortisone or a Medrol Dose Pak. These more what are called remittive agents, they actually are used to treat rheumatoid arthritis or things like ulcerative colitis or Crohn’s disease, these major inflammatory problems. We’re not talking about those things today, we’re talking about what are called non-steroidal anti-inflammatories or NSAIDS are things like Aleve, Motrin, or Advil. They are mostly over the counter, but also come in a prescription form. The problem with those is that they have a considerable amount of side effects. So even though they may help you with your acute inflammation or swelling on the long-term front, taking these medications for a long time has considerable side effects that can be potentially harmful.

Terry: You mean Tylenol? Or is Tylenol, ok?

Dr. Urse: Well Tylenol is not an anti-inflammatory. Tylenol is a pain reliever and also helps with fevers, it’s safe to take up to 4,000mg a day for pain or discomfort and in fact it is probably one of your best options to take for a safety barrier against some of the side effects we’re going to mention.

Terry: Ok so what are patients doing today for arthritis? Say I was going to go visit my doctor, what would they prescribe to me before we would get to the alternatives. What are patients doing today?

Dr. Urse: Well, I think they have already been to their barber shop or beauty salon and heard all the latest ideas from their friends. They will probably get a prescription for one of the anti-inflammatories, you’ve heard of Motrin, Naprosyn, Celebrex or Voltaren. These are well accepted, and FDA approved anti-inflammatory medications or what are called NSAIDS. The problem is 80% of people are already using various alternative and complimentary therapies and they’re trying to control these arthritis and pain symptoms that perhaps they don’t want to be on the prescription medicines that were prescribed by their health providers.

Terry: So, I know we could be talking all day long on this topic. Today we are just going to talk about safe alternatives. Run me down a list of safe alternatives that you would prescribe me as your patient.

Dr. Urse: Well again, what we are going to talk about today is mostly a non-prescription list of over-the-counter remedies or therapies that you could get a health store or some of your online suppliers. We’re going to ask our listeners to do their homework and look up some reputable sources, we’re going to talk about later how do I find a good source of some of the products we’re going to talk about and how do I know have a good product to begin with before I spend the money or figure it’s not helping me with my problem.

Terry: So, what are the safe alternatives? Go ahead and take me through some of these therapies you might suggest.

Dr. Urse: I’d like to start with one of the simple ones and that’s Boswellia. Boswellia actually comes from a tree bark from trees that are in India, Ethiopia, Somalia, and the Arabian Peninsula. They produce a gum resin called Frankincense, that resin reduces what’s called inflammation, helps with arthritic symptoms, helps with pain, and actually lowers white blood cell counts in your joint fluid. Remember, in the joints is where the cartilage breakdown or arthritis is going to start and then progress over time and become more of a problem for the patient. There are studies that show Boswellia is comparable to the number one world selling anti-inflammatory Voltaren in double blind studies when treating knee arthritis.

Terry: Wow, so is there a recommended dosage for Boswellia? You actually told me to go out and get this and it has actually helped. I don’t remember if there is a certain milligram that I should be taking.

Dr. Urse: The doses recommended are usually between 200 and 350mg, two to three times a day. You always want to take those with some fatty foods or with some food to help with absorption, because it can reduce nausea, or some upset stomach issues you might get on an empty stomach.

Terry: Ok, so what else is on that list?

Dr. Urse: Well curcumin is derived from the ginger plant family, we have all seen that spice and orange flavoring we put in some of our foods, some is from our Asian counterparts. It’s also derived from the same plant that turmeric is known as. It has tremendous anti-inflammatory, antioxidant, and some anti-cancer benefits. The problem with turmeric is that form is not taken up by our gut very well, so only about 3% is taken up in the gut, so a more active form of the turmeric is curcumin. If you take it with a black pepper extract, there is a name for that, bioperine, that will increase the uptake of curcumin in your gut by 2,000%. What you really want to do is absorb it, because it’s what is called a fat-soluble substance and it gets taken up by the gut when it’s with a pepper or fatty food environment.

Terry: So how long should I be taking these before I notice something?

Dr. Urse: Thats a good question Terry. We like to tell people that after about six weeks, if you haven’t seen an effect, it’s either a bad brand with poor quality in the supplements you purchased. Or it’s perhaps not the right thing for you. We know nothing is 100% for the things we recommend or try, so we tell people to move onto a better product, different company or a different one on our list today.

Terry: So is it safe to say if I buy it on Amazon, I am going to get a great product or are the chances are that I’m not going to get something that is a true product.

Dr. Urse: So, you know I am not going to throw anyone down the alley here, but without getting in the weeds too much on what’s good and what’s bad, we are going to spend a little time at the end going over what the red flags are to look for with what to buy and where to get it.

Terry: So, curcumin sounds like a great one I need to try, what should I notice when I take curcumin and what effects should I notice?

Dr. Urse: Well, it should help with things like arthritis, but also inflammation. Some of these have benefits for things like bursitis, we’ve talked about hip bursitis, shoulder bursitis, tendinitis where a tendon is inflamed. Again, the anti-inflammatory properties in these things we talked about today decrease swelling, redness and inflammation which are all signs of things that lead to discomfort that we are looking to get relief from.

Terry: Ok, what else is on that list?

Dr. Urse: Well green tea made the list, it’s a long-recognized compound that’s been known for historically for anticancer and cardiovascular benefits, but more recently for treating arthritis. It has what are called polyphenols and polyphenol compounds have tremendous anti-inflammatory but something we’re interested in with arthritis, they have what are called cartilage protective or chondroprotective qualities. We talked about chondromalacia which means soft cartilage, chondro means cartilage. So, when we talk about what causes arthritis in the beginning and you asked me what happens. Well, that firm white glistening layer at the end of bones is cartilage and we see it on the end of a chicken bone. When that gets soft and breaks down that is called chondromalacia and when the cartilage wears down further there is no cushioning layer, there is a raw bone area and when that rubs against the other part of your knee or shoulder, or other body part that is what causes a lot of inflammation and discomfort that leads to the things we are trying to treat with arthritis. The neat thing about green tea is that it inhibits or blocks an enzyme that breaks down cartilage. So having three or four cups of green tea a day will actually be very beneficial for inflammation and maybe protective to some of your cartilage issues.

Terry: Is there any green tea you can take by a tablet instead of drinking four to five cups, which would be a pain for me. How do I get it into my system?

Dr. Urse: There is, and you actually led me into this, and we didn’t even practice this. There is what is called a green tea extract and you can take it in a pill form and that extract is in about a 3-400 mg per day range. The one thing you need to know is there is also caffeine in green tea, and we also think the polyphenols, the thing that we thought was really useful for inflammation, may not be in decaffeinated forms of green tea, we don’t know that. There are decaffeinated green teas, but we don’t know if they have the polyphenol content, and you might hear a lot of people reporting how polyphenols are the things that help olive oil get its good anti-inflammatory effects. We are going to talk about some of those oils coming up with the Omega-3 oils. I’ll leave you with a little curiosity called the Asian paradox and that has stated that by increasing your consumption of green tea you may be improving your cardiovascular, which is your heart and vessels and your nerves called neuroprotective and even cancer preventing properties. So, you get a little extra bonus on the parts away from joints too with the green tea.

Terry: That’s interesting because I buy Milo’s tea at Kroger all the time, so maybe I need to go buy Milos green tea, I think they might have it.

Dr. Urse: Well, you need to those people about sponsoring our podcast.

Terry: Great idea. So, is there anything else on the list that you would like to cover?

Dr. Urse: Well, we talked about what are called Omega-3 oils and these are commonly called fish oils. These are called EFA’s or essential fatty acids and what they do, they’re actually traced back to the 18th century when cod liver oil unfortunately would go rancid when exposed to air, now they have oxygen free encapsulation which provides an odorless, colorless, and tasteless product that you can take in 1-3 grams a day range. So, Omega-3 oils are very, not only anti-inflammatory protective in musculoskeletal problems, but they’re also good for your cardiovascular system. You may have had your cardiologist recommend some of the Omega-3 oils for that reason. We know that the Omega-6 oils are the bad actors, those have some of the long chains of the fatty acids, those are in some of the harmful oils that we cook with such as the vegetable oils and some of the deep fryer things. You don’t want the Omega-6’s the Omega-3’s are the things you should look for. We will talk more about where to look for these a little more towards the end of the podcast.

Terry: So far, I feel like I’m taking seven pills out of this whole thing. How many pills do you think you should be taking a day? Someone once told me that vitamins are only creating a very expensive urine.

Dr. Urse: Well, there is certainly something to be said about taking too much of something, because the excess that your body doesn’t use will go out in your urine. What I want people to do is know that these all have potential benefits, and they may have a few side effects. We talked about some of the nausea with the Boswellia perhaps. So, you may find that one does not suit you well and therefore you might want to have some safe alternatives. The reason I bring this up is the things we are conventionally taking these non-steroidals have side effects. We talked about things that can be bad and they can cause ulcers in your stomach, bleeding that could be so bad that some people die. In fact, in one year over 100,000 people went to the emergency rooms with serious GI bleeds, and that’s GI for gastrointestinal and those were from anti-inflammatory medications, things like Naproxen, Ibuprofen, the things they were eating like candy. Not only can they effect a GI bleed there were probably in the upper 17,000 range of people who died and 80% of those people that went to the emergency rooms had no premonitory symptoms that they even had a problem taking their anti-inflammatories. The biggest issues are that 10-15% of people are actually taking three of these pills a day for three months at a time which is almost a 40% increase from the previous five years. So, people are taking a lot of these medicines sometimes it’s a little higher dose than they want because they have either have headaches or joint pains. The over-the-counter doses are smaller, that’s why they sell them over the counter because they figure people will eat more than they should, so they lower the dose. Unfortunately, the National Kidney Foundation even estimates 10% of kidney failure per year is directly related to substantial overuse of anti-inflammatories. So, when you say, why am I looking for safe alternatives, the standard mediations have a lot of side effects, these GI bleeds, these kidney issues, these issues related to what’s called gastritis which is stomach upset and even salt retention. A lot of the medications like Naproxen is called Sodium Naproxen, sodium is salt so if you’re taking a lot of anti-inflammatories, you’re getting an increase salt load which can make fluid retention a problem, you could get swelling in your ankles, it may raise your blood pressure. It has problems on top of the things you’re trying to treat so we go through these lists and say pick one that will help you and maybe not harm you as much as more of the conventional prescription medications.

Terry: I take a lot of Naproxen, not a lot but maybe three a day after my neck injury.

Dr. Urse: Again, in short term use these can be safe and shouldn’t be a big worry. If Advil relieves your headache, take an Advil. If you’ve taken it before and you don’t have a known bleeding ulcer or kidney issues, those things are things you will want to discuss with your healthcare provider.

Terry: Ok, so what’s funny is that these are alternatives to alternatives. So, if we’re taking an alternative, but if that doesn’t work out there might be an alternative to that alternative.

Dr. Urse: Sure. You have different sodas you drink or different drinks at a restaurant, some people like tea, some like sodas, water, or coffee. There are a lot of different things to choose from and when you go to your pharmacy or your health food store it’s a little overwhelming isn’t it? So, I am trying to zero you in on a couple different areas of things that we have seen and literature. I have a blog I just completed on DrJohnUrse.com and I have some references written for some of these statements I’ve made about which products work better, where they work and how to test them properly or at least look for a good product for you.

Terry: Thats a great idea, so if someone is looking for more information or more detail, just go to DrJohnUrse.com and they can find that somewhere on that webpage, correct?

Dr. Urse: That’s correct under the blog article for Safe Alternative Medical Therapies.

Terry: Great, so I had a question down here, we may have covered this. What should we avoid? I know we don’t want to take those medications long term, is there something else we should be avoiding doing if we’re having arthritis pain?

Dr. Urse: What you want to do is make sure you’re discussing things with your healthcare provider. We talked about the number of people taking these medications is substantial, but there are also a lot of people taking alternative therapies. What you don’t want is to be in that 2/3 of people that don’t mention any of these things to their healthcare provider. Your doctor may need to know that you take ginkgo biloba for memory, because that may affect a blood thinner you’re taking. So, these medicines all have interactions even if they’re prescription or over the counter alternative therapies. So the key is to get your healthcare provider to coordinate the best remedies for you and again a lot of the healthcare providers aren’t probably interested in talking about some of these safe alternatives, but that doesn’t mean you can’t look around for someone who is well versed in that area or have your own ability to search the internet and come up with a good game plan for you and your family.

Terry: So, if my general practitioner or my family doctor doesn’t seem have a good handle on arthritis, I don’t know if mine does or not because I’ve never talked to him about it. Is there a specialist I should go see, is there someone who specializes in arthritis?

Dr. Urse: Well, a rheumatologist is a specialist for arthritic conditions. One of our first podcasts was on arthritis and we talked about what cause joint unhappiness and we were talking about mostly osteoarthritis which is the wear and tear degenerative arthritis of just living longer. Unfortunately, there are other types of arthritis, rheumatoid arthritis, gout, things that effect our joints from an immune problem like ulcerative colitis or Crohn’s disease, psoriasis, or psoriatic arthritis. So, there are other places we would go for an arthritis specialist. Then you may need a remitive agent which is something actually arrests or slows down that aggressive immune process like rheumatoid arthritis has or psoriasis, and they have medicines that are much stronger than anything we’re talking about here. You also should get a pretty good bit of information from an arthritis specialist, but I think your doctors in orthopedic medicine like what I do also have a good handle on that, as would a physiatrist who is a physical therapy specialist or some of your family doctors that are more versed in some of the nutrition aspects of healthcare.

Terry: So, in this conversation we had, I know there is a ton of things we didn’t talk about and we’re probably going to do another podcast on those down the road. Have I left off something that we should have covered today before we talk about what we’re going to cover in a future episode.

Dr. Urse: Well, I’m going to do one more thing, because people have heard of this. It’s called glucosamine and chondroitin and what’s called MSN which is mercifully an abbreviation for methylsulfonylmethane. Glucosamine chondroitin and MSM are frequently combined together because they have a benefit for arthritis. One study in Belgium actually showed taking a prescription grade glucosamine chondroitin supplement may delay arthritis progression on weight bearing x-rays of your knee. So, let’s assume we talked about the cartilage wearing down in your knee and getting softer, we talked about chondromamcia. On weight bearing standing x-ray you may see the joint space is half what is should be on the other side of the knee. If you look at this study in Belgium showed it basically said that if you took a placebo and didn’t do anything except took a water pill for three years and took an x-ray later you would see arthritis progression and narrowing of the joint space to where it may be bone on bone, we talked about that. A good prescription grade glucosamine actually did not show any of the arthritis progression three years later on the people that took a good brand for three years. Now it didn’t make your knee look normal, but it slowed progression. That is a pretty good study, but there are also a lot of lousy studies that may or may not be useful. I tried to put some references in of some of the better studies that were double blinded or had a placebo where you had a control group and a little better information than having a manufacturer saying our things are great. In answer to your other topics that we may bring up in a future blog, I think we’re going to put a little time into CBD oils, some of the cannabinoid products, we will talk a little about ashwagandha, collagen, white willow bark, pycnogenol, tart cherry juice, resveratrol which is derived from the skins of red grapes, that’s why wine is supposedly good for anti-inflammatory purposes. We will talk about cats’ claw and capsaicin in future blogs perhaps.

Terry: This is a very interesting conversation; I have learned a lot. Tell me what else we should be talking about.

Dr. Urse: Well I wanted to finish up with what the best thing to get would be and how do you find what you should purchase, because this part is really the part that we don’t know much about and we think that the Food and Drug Administration the FDA is going to help with this, but unfortunately the FDA does not regulate the vitamin or herbal remedy industry. In fact, they are so busy with our mess with COVID and all the vaccines, medicines, and things that have higher priority, the vitamin industry falls pretty low on their list of things they’re interested in. In fact, the FDA only requires that the contents of whatever you’re buying on a shelf has 15% of what the label says, so there are a few red flags that we want to watch for when we buy herbal remedies, supplements and vitamins. So, I want you to be wary of the following things, products that say proprietary blends or formulas as they may contain very little of the primary ingredient you want and a lot of less useful contents. Things that say, contains clinically tested ingredients, that’s fairly meaningless, that doesn’t really mean it’s proven to work or has any proper dose worth using. If it says it claims to cure or treat a disease, supplements are not legally considered drugs and cannot claim to cure or treat a disease. It is ok for them to claim that they may reduce the risk of a disease, so if you say I am going to take calcium and vitamin D to prevent osteoporosis or weakening of my bones which is ok because it’s a supplement that helps support bone health. Don’t fall for things that say uncertain certification. The FDA doesn’t confer ratings on pharmacies or supplement companies. The word quality tested, or third party tested basically doesn’t mean much at all. The things you should look for, there are two sources on the internet, one is called USP.org which is United States Pharmaceuticals .org and they will actually tell you what is in the pill is actually what the label says.

Terry: Will it tell me what brand, like if it’s a brand?

Dr. Urse: It will tell you which brands have 200mg of iron in the pill, they won’t tell you which one to buy, but they at least tell you they’ve tested these. The other is consumerlab.com and you can look up various products and see what the quality might be of the things you’re interested in purchasing.

Terry: When I was on Amazon to purchase Boswellia, right there were 50….

Dr. Urse: You can look at the brands by using those other sources. Finally high prices do not mean better quality. There was a newspaper investigation into a popular mall nutritional store a few years ago and they found the majority of the pills had a large amount of saw dust in the bottles that were labeled expensive supplements. So, I’ll leave you with what you asked before, whatever brand you do pick if you don’t see the desired results in six weeks, you should consider it’s a poor-quality therapy or perhaps it not the optimal product for your problem. I think I will never end my podcast without plugging another podcast, we talked a little about PRP and stem cells and these are called orthobiologic’s and they use your own cells as natural remedies. PRP which comes from your blood in your arm is a product of your platelets that literally have 1,100 anti-inflammatory and growth factors in their substance and stem cells that come from your bone marrow, there are some good and bad stem cell products out there, those can have almost twenty times the anti-inflammatory and growth factors that platelet rich plasma or PRP have. So, there are a lot of alternative therapies out there, today these were mostly some of the herbal and alternative medical therapies we talked about. I think that people have to do some of their own homework and become consumer warriors to find the right things for them.

Terry: Well, I will tell you that this has so far probably been my favorite podcast, because of the fact that we have talked about all of the kinds of things that I am dealing with personally and it’s like a free doctors visit right here in my own pod studio, so it’s been great.

Dr. Urse: Well, I would encourage people to keep liking the podcast on Spotify, Apple or on my website, DrJohnUrse.com and I thank you again Terry for doing a great job producing this.

Terry: Alright, well thanks folks. We will see you on the next Dr. John Urse Bone and Joint Playbook.

Thank you for joining us today on this episode of The Bone and Joint Playbook with Dr. John Urse, Tips for Pain Free Aging. Please join us again for another episode. This has been a production of Doctors Unmasked produced by Terry O’Brien.