If you have stiff, painful joints you can help yourself the holistic way with a number of natural remedies and therapies.

The main forms of arthritis are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis is caused when the lining around a joint becomes inflamed. This usually affects the same joint on both sides of the body, such as both hips. Osteoarthritis occurs when cartilage around bones wears thin and their rough edges rub together, causing pain and swelling. Young people, especially those who smoke, are more likely to experience rheumatoid arthritis with osteoarthritis more common in older people, or those who have damaged joints through injury or excessive sports. Both types are usually treated with anti-inflammatory drugs and painkillers, which can have side effects, but you can also ease symptoms naturally:

 

• Exercise: Regular exercise has been shown to increase joint mobility and flexibility in arthritis suffers. It can also help keep weight down as being overweight puts extra pressure on bones and joints. Studies have found that yoga in particular offers pain relief but don’t do a session when your joints are inflamed and inform your teacher of your condition.
• Hydrotherapy: Water exercises a few times a week can help control the amount of pain you have. Exercising in water is non-impact, so this way there is no shock to the joints which cause pain. Also while you are in the water there is less chance to hurt yourself because you won’t fall.
• Physical/Heat/Massage/Relaxation Therapy: Arthritis is pain in the joint area and it can strike in any part of the body where joints exist. This pain isn’t always the result of damaged joints. It can be caused by overworked tendons, a build-up of scar tissue, frayed nerves and tense muscles. These types of therapies are oftentimes effective because they generally are designed to focus on the affected area. Rubbing and kneading, applying heat, or using a walker or other type of device designed to improve mobility and posture can all help to promote improved blood circulation and loosen overly tight areas. The goal of these types of therapies is to work on the root of the pain and hopefully, after repeated treatments if necessary, make the pain disappear permanently.
• Nutrition: Because arthritis is an inflammatory disease you need to eat foods with anti-inflammatory actions such as omega 3 fatty acids. Eat omega 3 rich oily fish or nuts and seeds such as pumpkin and sesame several times a week and up your intake of complex carbohydrates such as grains, fruits, peas and beans and dark green leafy vegetables. You should also eat plenty of red and purple berries as these are packed with antioxidants. It may also help to avoid wheat as this can lead to inflammation and aggravate symptoms. Finally, studies show that vegetarian meals may ease inflammation so cutting out meat, especially red meat, is strongly advised. 
• Supplements: A number of nutrients may be able to ease arthritis. Bromelain, an anti-inflammatory enzyme found in pineapples can help. Ginger has been found to have anti-inflammatory properties as have omega 3 supplements. According to neurologists at the University of Pittsburgh, omega 3 supplements may work just as well as prescription drugs to ease arthritis pain. (I use Omega 3 Plus fatty acid supplement in the clinic as it is a good combination of both EPA and DHA – see the Resources Page). 

 

A recent study from the University of North Carolina at Chapel Hill also found that there appeared to be a clear relationship between selenium and osteoarthritis. A 2001 study of patients with knee arthritis found that an extract of ginger reduced pain while standing and after walking. By using ginger, patients were able to reduce their pain medications after 6 weeks. Glucosamine is an amino sugar found naturally in the body’s cartilage, and may help with joint repair.  

 

Several studies have shown that it may be moderately beneficial for the pain and stiffness of osteoarthritis, particularly of the knee. Other studies suggest that it may be as effective as ibuprofen for pain relief, although the supplements needed to be taken for at least 2 weeks to have an effect. Try to get a glucosamine supplement combined with MSM (methylsulfonylmethane) which occurs naturally in food and helps to maintain healthy connective tissue, keeping the joints flexible and reducing pain.  (See the Resources page for information on MSM Plus).   

 

Finally, vitamin C is one of the key vitamins for joints and bones but its importance is often forgotten. Vitamin C is needed for the manufacture of collagen and collagen is essential for joints, muscles, ligaments and tendons. Use an alkaline form of vitamin C such as magnesium ascorbate rather than the acid form, ascorbic acid, as it is thought that the more alkaline the diet, the less severe the symptoms of arthritis.  (see Vitamin C Plus, an alkaline form, on the Resources Page).

 

• Herbs: A number of herbs and spices can help ease arthritis. Devil’s claw is renowned for its anti-inflammatory and painkilling properties as is white willow bark, although you should avoid this if you are allergic to aspirin. Turmeric strengthens connective tissues, while nettle cleans the body and prevents a build up of uric acid which can cause pain and inflammation. Apple cider vinegar is often is recommended for patients who suffer from rheumatoid arthritis.  (A good anti-inflammatory supplement combination I use is Boswellia Plus which contains a number of anti-inflammatory herbs including ginger and turmeric see the Resources Page).
• Aromatherapy: For osteoarthritis you may want to try a warming aromatherapy blend to ease muscle spasm, stiffness and poor circulation. Try blending three drops of ginger, three of lavender and four drops of black pepper in 20 ml of carrier oil. For rheumatoid arthritis go for gentle, soothing anti inflammatory oils: Blend two drops rose otto, two yarrow and six drops palmarosa oils in 20 ml carrier oil. Do not massage on the joints if there is pain, apply gently to the surrounding tissues instead.
• Acupressure: Both acupuncture and acupressure may be able to ease the pain and swelling of arthritis. Try these exercises: Press the fleshy part below the web between your thumb and forefinger for one minute. This may help relieve pain and can be used as a relaxant if stress triggers your arthritis. You could also locate the point in the web between your big and second toes and exert medium pressure for a minute on both feet.
• Homeopathy: The homeopathic remedy bryonia is often recommended if you feel fine in the morning and find that your symptoms get worse as the day goes on. If you wake up stiff but find that movement eases the stiffness try rhus tox. For both cases use the 6c potency in the morning and evening for a few days and stop taking once symptoms improve.

With age most women have a tendency to lose bone mass density increasing the likelihood of both developing osteoporosis and breaking a bone. One way to help keep bones healthy, of course, is to know and avoid the risk factors that can undermine bone mass density long before we reach our golden years.

What’s your risk?

 

Tick any of the following that apply to you:

 

• Do you have a family history of osteoporosis?
• Have you ever yo-yo dieted or suffered from an eating disorder such as anorexia or bulimia?
• Have you been prone to irregular cycles or did you have long gaps between periods when younger?
• Are you post-menopausal?
• Did you have an early menopause (before the age of 40)?
• Have you had a hysterectomy and also your ovaries removed?
• Have you taken certain medications – steroids, heparin, anticonvulsants, diuretics, long-term laxatives or antacids?
• Have you had a thyroid problem or a hyperparathyroid problem?
• Are you a smoker?
• Have you already broken any bones?
• Are you inactive?
• Have you got shorter with age?
• Do you have a heavy alcohol (more than 7 units per week) or caffeine (more than 2 cups of coffee or tea per day) intake?
• Are you of European or Asian descent?
• Do you have a digestive problem, Crohn’s, ulcerative colitis or Coeliac’s disease?
• Are you slim or small boned?
• Have you never had children?
• Do you exercise too much?

 

If you ticked just one you have a higher than average risk of low bone density which increases your risk of osteoporosis. It’s a good idea to reduce alcohol and caffeine and to stop smoking and to watch your diet and start taking exercise. If you ticked more than two you should take action now to reduce your risk of osteoporosis in the future.

 

You are what you eat and digest

 

Diet is crucial in preventing osteoporosis but calcium, found in dairy products, tofu, fish with bones and green leafy vegetables, is not enough to prevent it – research shows that other minerals are needed, especially magnesium as it helps your bones retain calcium. According to a study published in the Journal of the American Geriatrics Society, a high intake of magnesium either from food (sources include whole grains, green leafy vegetables, soya and nuts) or supplements (100-300 mg daily) may keep bones healthy as people age. Researchers concluded that ‘Higher magnesium intake through dietary change or supplementation may provide an additional strategy for the prevention of osteoporosis.’

 

Boron also works with calcium and magnesium and is an important mineral for osteoporosis prevention. It can be found in small amounts in fruits and vegetables but you may need to supplement.  (see OsteoPlus on the Resources page  which contains the important bone nutrients magnesium, calcium, boron and vitamin D and also digestive enzymes to make sure that you are absorbing as well as possible).

 

A lack of vitamins can also cause problems. The main ones are lack of vitamin D, found in oily fish and formed in sunlight and vitamin K found in fresh vegetables, such as broccoli and cabbage.

 

One of the most useful foods for preventing osteoporosis is the phytoestrogens.  Research shows that diets rich in phytoestrogens – naturally occurring oestrogen like substances also known as phytoestrogens could prevent osteoporosis. Phytoestrogens can be found in soya, chickpeas,

 

Get moving

 

One of the best ways to prevent age related bone loss is to get moving but for exercise to boost healthy bones it must involve weight bearing so walking, jumping, skipping and trampolining instead of cycling and swimming where your weight is supported externally are recommended. Weight training is also a good choice. One study published in the Journal of the American Medical Association looked at postmenopausal women on a strength training programme and osteoporosis was reversed as the women’s bone density was increased by the exercises. Whatever exercise you choose aim for five sessions of at least 30 minutes a week.

 

Get scanned

 

The gold standard for bone scanning is DEXA (Dual Energy X-ray Absorptiometry) scan.  An ordinary X-ray only shows osteoporosis when you have lost 30-50% bone density, by which time it is almost too late.

 

A DEXA scan is a machine that uses two X-ray energy beams simultaneously – one high energy and the other low energy.  The low energy beam passes through soft tissue but not bone, the high energy passes through both so your bone density can be calculated by working out the difference between the two readings. 

 

A DEXA scan does have some drawbacks.  One is that it exposes you to X-rays, at the same intensity as a chest X-ray, and X-rays are best avoided where possible.  The other problem is the machine has to be operated by a radiologist and is only available in too few specialised units.  Another disadvantage is that although both hip and spine are measured during a DEXA scan, there can be difficulties estimating the strength of your spine.  This is because conditions such as osteoarthritis and scoliosis, which is curvature of the spine, can give falsely high readings of bone mineral density.  It is now accepted that the most accurate measurements are those from the hip.

 

The alternative to using X rays for bone scanning is to use ultrasound.  The technology for using ultrasound to measure bone health has been developing rapidly over the last few years.  In an ultrasound scan (also known as quantitative ultrasound scan or QUS) scan, sound waves are passed through the heel (calcaneus) bone which, like the hip and spine, is rich in trabecular bone. Recent research has shown that the QUS scans can predict those patients who subsequently go on to have a fracture as well as DEXA scans and an article quoted in the journal Osteoporosis International in 2004 said that QUS scans can ‘predict early postmenopausal fractures as well or even better’ than X rays. 

  

The advantages of using QUS are that the scanners are easily portable, inexpensive compared to DEXA and QCT and completely avoid any exposure to X rays. 

 

There are a number of QUS machines available and some are more accurate and reliable than others.  There is now a new generation of QUS scanners, which incorporate the same, reference image than is normally seen in a DEXA scan.  This image confirms that the person is positioned correctly.  Concerns for accuracy and repeatability had been targeted at the first generation QUS machines because the technology performed a ‘blind’ measurement with no image to guide the practitioner.

 

QUS measurements are also temperature dependent, so some machines are susceptible to cold and can give variable readings.  Thermally-controlled water is the gold standard for ultrasound scans as they give consistency and precision.  The accuracy of the scan using ultrasound is dependent on the type of machine that is used and it took me a long time to find one that I felt was accurate and reliable. 

 

The NOS is suggesting that ultrasound, because it is portable and less expensive than DEXA scanning, could be used to decide which women should go for a DEXA scan.

 

I see ultrasound being used increasingly as a screening tool to help women of all ages to know whether they are at risk of osteoporosis. Ultrasound is safe, it avoids unnecessary exposure to X rays, and it is quick, convenient and relatively inexpensive.   It means that from one simple scan, either you are know your bones are healthy or you know that you need to have a DEXA scan and are having an X-ray because you are at some sort of risk if you don’t. In other words, it’s worth it.  (We have a bone ultrasound machine in the Tunbridge Wells clinic so if you would like a scan then call the clinic on 0870 5329244, a consultation with one of my nutritionists is included in the cost of the scan)

 

Another way of assessing bone health is to measure microscopic “clues” (or biochemical markers) in blood or urine.  Some of these show the rate at which bone is broken down (bone resorption) and others gauge the speed at which it is replaced (bone formation).  Two of the markers that monitor the rate at which bone is broken down, N-telopeptide (NTx) and deoxypryridinoline, can be measured in a simple urine sample.  At the moment NTx seems to be the more sensitive and specific, especially in women.  Higher levels of these bone resorption markers, indicating higher bone turnover and higher bone loss, have been found to be associated with a two fold increased risk of osteoporotic fracture. 

 

The major benefit of bone turnover analysis compared to scans (either DEXA or QUS) is that it can be used to monitor the effectiveness of treatment.  If you decide to take HRT or osteoporosis medication and/or start exercising and/or take supplements, this test can tell you whether your treatment is working.  Bone turnover can be measured every three months and if what you are doing is effective, the bone turnover markers WILL go down. 

 

Bone turnover analysis is being used to predict the effectiveness of one form of osteoporosis drugs called bisphosphonates. Changes in the “clues” associated with bone turnover caused by the bisphosphonate drugs are not only linked with subsequent changes in bone density but can also predict the likelihood of future fractures.  One study showed that patients treated with risedronate (a popular bisphosphonate) who showed a reduction in bone turnover markers at 3 months had a significant reduction in vertebral fracture risk.  In fact, the analysis showed that the effects of risedronate on bone turnover were more important than the effects on bone density.  The changes in bone turnover accounted for 66% of the reduction in fracture risk whereas the changes in bone density only accounted for 26%.  

 

There are some women who do not respond to HRT or drugs for osteoporosis and if this is picked up by a simple urine bone turnover test then another course of treatment could be suggested and time is not wasted taking something that isn’t working for you.

 

Also if you have been making changes in your diet and starting exercising, it is helpful to see if your measures are working. It could give you important motivation to keep going with your hard work. 

 

The other benefit of bone turnover analysis is to monitor bone loss.  In general, women lose about 1% of spinal bone density per year during and after the menopause.  But there is a group of women – around 35% – who are known as ‘rapid or fast losers’ in that they can lose 3-5% of bone per year.  This could be picked up by doing a bone turnover analysis because the markers would be fairly high.

 

Having a bone turnover analysis is important because bone density is not the be all and end all of bone health.  Post-menopausal Chinese women, for example, have significantly lower hip bone mineral density than Caucasian women and are in theory at higher risk of osteoporosis.  Yet they have fewer fractures, probably because they have a lower rate of bone loss, which suggests that their rate of turnover is lower.

 

In my opinion, the bone turnover test is not used frequently enough in the diagnosis and treatment of osteoporosis. I think you can only get the full picture by looking at your current rate of bone loss together with your bone scan results.  It is also crucial in monitoring the effectiveness of treatment. Without it, you might have to wait two years for another bone density scan, only to find you might have wasted those years (and lost bone density) on the wrong drug for you.  (see Resources page X for details on how to do a bone turnover test by post.)

To protect your heart, bones and health in the years approaching the menopause a good quality multivitamin and mineral containing vitamins A, D, E, C, B1, B2, B3, B5, B6, B12, folic acid, calcium, magnesium, iron, zinc, chromium, selenium, boron and manganese should form the foundation of your supplement programme. (The one I use in the clinic is MenoPlus). 

You can then, if you feel you need an extra helping hand, add in other supplements which have been shown to be beneficial in connection with the menopause.

For best results take these additional supplements for the short term, say a period of three to four months. After that re-assess them for improvements in your health and work with your healthcare practitioner to adjust your supplement programme accordingly.

• Antioxidants: If you are eating a healthy diet and taking a multivitamin and mineral supplement you may not need to take additional antioxidants unless you have a strong family history of cancer. Antioxidants are abundant in fruits, vegetables and sprouted grains so make sure you get plenty of these foods in your diet. If, however, you exercise a lot and are exposed to a great deal of stress and chemical pollutants it might be wise to add an antioxidant complex to your supplement programme.  (The antioxidant formula I use in the clinic is called Nutriguard).
• Boron: A study published in the British Journal of Nutrition in 1993 showed that increasing dietary intake of the mineral boron  in postmenopausal women decreased the amount of calcium excreted in the urine. That means less risk of bone loss. U.S. Department of Agriculture studies found similar benefits for a high boron diet. Make sure that your multivitamin and mineral contains enough boron. (The MenoPlus multivitamin and mineral contains boron as does the OsteoPlus supplement I use in the clinic.) Three and a half ounces of almonds, prunes, or raisins each contain at least 2 mg of boron. Asparagus, cabbage, figs, peaches, and strawberries are good sources as well.
• B vitamin complex: B vitamins are incredibly helpful during times of stress and symptoms of B vitamin deficiency include anxiety, tension, irritability and poor concentration. If this sounds familiar or if you are under a great deal of stress it might be a good idea to supplement with additional B vitamins for a few months to get your health and energy back. You should be getting about 50 mg of most of the B vitamins a day so if your multivitamin isn’t giving you enough add a B complex to your supplement plan.
• Calcium: This mineral helps guard against osteoporosis. Calcium also appears to improve blood sugar balance and recent studies have shown that extra calcium can help with weight loss. Good source of calcium other than dairy products include brazil nuts, almonds, sesame seeds, salmon with bones and green leafy vegetables.  When choosing a supplement containing calcium, read the label, and choose calcium citrate rather than calcium carbonate.  Unfortunately, calcium carbonate is one of the cheapest forms of calcium, which is otherwise known as chalk.  It is one of the most difficult forms of calcium to absorb, and you need a highly efficient digestive system to order to manage it.  On the other hand, calcium citrate is almost 30% more absorbable than calcium carbonate.  (The MenoPlus and OsteoPlus supplements contain calcium citrate and also magnesium in the citrate form for maximum absorption.)
• C Vitamin: Vitamin C is a powerful immune booster but it is particularly helpful at the menopause. Giving women vitamin C with bioflavonoids has been shown to reduce hot flushes. Vitamin C helps to build up collagen which gives your skin and tissues elasticity and can therefore be useful in the treatment of vaginal dryness and stress incontinence. Collagen is also important for strong bones. Vitamin C is abundant in fruit and vegetables but you may also want to supplement your diet with 1000 mg per day of vitamin C and bioflavonoids. When choosing vitamin C, choose the alkaline form, ascorbate, rather than ascorbic acid as we know that the more acid the diet the greater the bone loss.  (Vitamin C Plus – an alkaline form of vitamin C).
• D Vitamin: This vitamin is crucial for the absorption of calcium so important for bone health and has now been found to be important in cancer prevention.  Dietary intake of vitamin D has decreased over recent years and may be linked to rising cases of osteoporosis. Vitamin D can be toxic in high doses so just take the amount that is your multi-vitamin and mineral and do not add in a separate vitamin D supplement unless you have been tested and found to be deficient. (This is done with a simple blood test).  Get plenty of exposure to sunlight. Fatty fish, such as halibut, mackerel and salmon are rich sources of vitamin D and also egg yolks.
• Essential fatty acids: Dry skin, cracked nails, lifeless hair, depression, aching joint, lack of energy, weight management problems, forgetfulness, vaginal dryness and breast pain are all symptoms of deficiencies in essential fatty acids but can also be part and parcel of the menopause. Components of these fatty acids may protect you from heart disease because they’re believed to increase HDL (‘good’) cholesterol while lowering triglyceride levels and blood pressure. That’s why supplementing with EFAs during the menopause may be able to help not just with your symptoms but also help to decrease your increased risk of heart disease around this time.  In addition to making sure your diet is rich in EFAs from oily fish, nuts and seeds take a good fish oil supplement.  (I use one called Omega 3 Plus in the clinic as you only need to take two capsules a day to get a good dose see Resources)  If you are vegetarian or vegan and prefer not to take fish oil then linseed (flax) or hempseed oils are fine.
• E Vitamin: This vitamin is helpful for the relief of hot flushes, breast tenderness, and vaginal dryness. It can also be used topically for vaginal dryness by piercing the capsule and rubbing the oil into the skin. A dose around 400ius per day is considered beneficial. Asparagus, avocados, brown rice, egg yolks, lima beans, peas and sweet potatoes are the best food sources.
• Magnesium: This mineral has a calming effect, so it eases symptoms like irritability, anxiety, mood swings, and insomnia. It also helps your bones absorb calcium, raises levels of HDL (“good”) cholesterol while lowering LDL (“bad”) cholesterol, and helps muscles–including your heart–to relax. Good sources are almonds, cashews, whole grains and most green leafy vegetables. 

Note: See next months issue for an A to Z of natural herbal supplements for the menopause.