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.
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