WHAT IS THE CLINICAL USEFULNESS OF NUTRITIONAL SUPPLEMENTS
- Unlike pain-killers, nutritional supplements fight the inflammation that causes pain. They help block substances such as TNF-alpha and inflammatory cytokines.
- Unlike NSAID drugs such as motrin, advil, aleve, ibuprofen, meloxicam, diclofenac and celebrex they do not interfere with healing.
OTHER HEALTH BENEFITS
Many of the supplements we recommend for arthritis have had studies suggesting other benefits, such as helping to prevent cancer and helping high blood pressure.
FEW IF ANY SIDE EFFECTS
These substances are all generally safe without the side effects that all pharmaceutical drugs have (regular glucosamine should not be taken by those with a shellfish allergy although we have a vegetarian glucosamine that is ok)
FINDING THE RIGHT SUPPLEMENT: PURITY, DOSE AND GMP CERTIFICATION
- Nutritional supplements are not tested and regulated as pharmaceutical drugs are. Studies have shown that many commonly sold supplements have far different doses in the tablet than what is listed on the label.
- In some cases the substances listed on the label are not present in the tablet at all.
- In some cases toxic substances such as mercury have been found.
- The least expensive products are often the worst offenders. Be careful: you get what you pay for!
- The tablets we list on our website are all GMP (good manufacturing practice) certified – recognizable by the blue label on the bottle – or are otherwise tested and certified by the manufacturer. They are usually a little more expensive than the cheapest products available – but it is very important to make sure you know what is in what you are taking.
- Some supplements are best taken in certain forms. For example curcumin is a great supplement that is found also in turmeric. However turmeric has oxalates which can cause kidney stones, whereas curcumin does not. Curcumin is also more concentrated. For this and other reasons we recommend curcumin supplements rather than tumeric.
WHAT ABOUT GETTING THE SUPPLEMENT FROM DIET AND NOT TABLETS
We think this is a great idea. Tumeric, aged garlic, ginger and cinammon are examples of great spices which can be used in cooking and provide health benefits.
WHAT ABOUT TOPICALS
- Topicals can be a great idea either by themselves or in addition to oral substances. For example substances such as Frankincense and Arnica are often very effective. Be careful though because Arnica can be poisonous if taken orally.
- Frankincense is used to make Boswellic acid which is a great oral supplement and is used to make the 5-Lox oral supplement on our website. (5-lox is short for 5-lipo-oxygenase which is an enzyme that Boswellia/Frankincense block)
- Be aware that topicals such as diclofenac cream are actually NSAID drugs which have a potential for toxicity not found in nutritional supplements
- Be aware of substances that are just liniments which are designed to inflame the skin and “distract” the nervous system from the joint pain. Icy hot and Bengay are examples. While they do give a sensation of pain relief (via the “gait control” theory of pain) they do not treat the underlyng problem. They can also cause burns to the skin, which I have seen in my office, if they are used excessively.
MAKING SURE THE DOSE ON THE BOTTLE MATCHES THE DOSE IN STUDIES
- I have spent a great deal of time researching the scientific literature to find substances that are efficacious, and have recorded the doses used in these studies in my database.
- However manufacturers will often market an effective substance but in a dose that has not been proven effective, usually a much smaller dose.
- One of the best examples of this is MSM. Many studies have shown efficacy but generally the dose used is 5000mg/day. However many products include MSM in a far lower dose, often only a few hundred mg, a tenth of the proven dose. I have taken steps to recommend the proven substance also in a proven dose. So for MSM, which is usually sold in 1000mg tablets when it is sold by itself this would require 5 tablets daily. For this reason I searched and found a 1500mg tablet and recommend 3 tablets daily, providing 4500mg which is very close to the 5000mg dose used in most studies.
- BEWARE MIXED DOSES FORMULATIONS: Many of these have useful substances but in inadequate doses because there is not room in a tablet for an adequate dose. One reason this is done is because the substances themselves cannot be patented, but the proprietary mixtures can be. For this reason all the products we recommend (excepting glucosaimine and chondroitin) are single substance tablets. This allows the proper dosage – in accordance with clinical studies – and also makes it easier to start and stop individual substances to see which was the effective product.
DSSORDERS.COM AND WHERE TO PURCHASE
- You many find all the substances my research has shown to be effective on this website. (Ordering instructions are found at the “purchase supplements” link at ismoc.net). Many can be hard to find and patients asked me for years to help them find them before I began using this website. I have aggregated them here as a matter of patient convenience in finding them.
- You may purchase from this website but I have listed the proper dosage and product brand so that you may also use this information to purchase them elsewhere.
- Other brands may be ok, but make sure the dosages match and make sure, if you use another brand that the product is GMP certified or otherwise tested by an independent agency and certified. This last gets tricky because you can have a GMP certified manufacturer who produces a product where that product itself is not GMP certified, even though the manufacturing facility is.
OUR CLINICAL STUDIES DATABASE SHOWING EFICACY
Several years ago I set out to research all the commonly advertised supplements to see which actually worked. I had several criteria
- I looked for studies from good medical journals which are indexed on “pubmed.” This is the national library of medicine database and includes only high quality peer reviewed journals.
- I looked for clinical studies in human beings, not animals, that showed efficacy. Many substances that are effective in animals are not effective in humans.
- I mostly ignored studies that only showed improvement in laboratory markers without clinical data. While improving lab tests may correlate with improving health, many substances that improve lab tests do nothing to improve health
- I looked for studies that tested supplements in comparison to other drugs such as ibuprofen or other NSAIDs, or against placebo. These are controlled studies.
- I gave less weight to studies that included proprietary branded products where the manufacturer was also funding the study. These studies have been shown to be sometimes tainted since there is an obvious financial incentive to bias the results to help sell product.
- When I first began this research 4 years ago I found nine substances that had shown good efficacy. Since that time studies have shown good efficacy in two more so that there are now 11 that I recommend (the most recent is aged garlic by the way).
- When I recommend these supplements to patients I indicate a rank order based on the quality and volume of research showing efficacy.
- I research these substances for the benefit of my patients because these studies are often technical and difficult to understand for most people. However just because a substance has not been shown to be effective in good studies doesn’t mean that it is not effective for you. So if you try a safe supplement and it works for you, by all means keep using it even if it not on my list of scientifically validates supplements.
HOW TO KNOW WHAT TO TAKE
- When I see a patient I recommend supplements based on their particular condition.
- Some substances have only been shown to be effective for arthritis so I would not recommend them for tendinitis for example. Some have anti-inflammatory properties for almost any condition.
- Some supplements have been shown to be better for osteoaerthritis. Some have been shown to be better for inflammatory arthritides, such as rheumatoid arthritis, and I base my recommendations accordingly.
- Some patients can be expected to do well without any supplememts, for example younger people (who often have PRP injections) with partial tears of the rotator cuff or chondromalacia of the patella, so I do not recommend any supplements to avoid bother and expense. However I can recommend supplements for these and other conditions if the patient requests.
- The best candidates for supplements are generally older people with more severe arthritis.
- I recommend anywhere from 1 to 5 supplements daily initially depending on the patient’s individual clinical condition. Supplements can be added or subtracted subsequently based on our hierarchy of effectiveness on a trial basis.
WHAT ABOUT CBD
- At this writing (June 2019) I have identified no good studies showing efficacy for CBD for musculoskeletal conditions.
- However I have had many patients tell me anecdotally that CBD is quite helpful, and have read many anecdotal reports of efficacy.
- Because the anecdotal evidence is so strong I have researched CBD formulations and put both a topical and oral high quality formulation on DSSorders.com. This is the only substance on that website that has not yet been validated by good studies. However, it is safe and therefore there is no reason not to try it
- Oral or topical CBD: Benefit has been seen with both, therefore it is OK to try only topical, only oral, or the two together.
- Is CBD psychoactive? There have been more than 100 substances isolated from marijuana. Contrary to what you may have read, CBD is indeed somewhat psychoactive. Some studies have shown anti-anxiety and mild sedating properties. However, unlike THC it will not make you “high.”