Supplement and Herb Guide for Arthritis Symptoms

Origin: A natural vegetable extract made from one-third avocado oil and two-thirds soybean oil.

Claims: Slows the progression of osteoarthritis (OA).

What we know: ASU blocks pro-inflammatory chemicals, prevents deterioration of synovial cells (which line the joints) and may help regenerate normal connective tissue.

Studies: ASU has been studied extensively studied in Europe, where it is routinely used to treat OA. A 2003 study published in the Journal of Rheumatology reported ASU inhibited the breakdown of cartilage and promoted repair. A 2008 meta-analysis found that ASU improved symptoms of hip and knee OA and reduced or eliminated use of nonsteroidal anti-inflammatory drugs (NSAIDs). A large, three-year study published in 2013 in the BMJ showed that ASU significantly reduced progression of hip OA compared with placebo.

Dosage: Softgel; take 300 mg daily.

*The French government has tracked ASU’s safety record for more than 15 years and has yet to find any significant problems.

Ribes nigrum; see GLA

Origin: Black currant seed oil is obtained from seeds of the black currant. Black currant seed oil contains 15 to 20 percent gamma-linolenic acid (GLA). Do not confuse with black currant berry.

Dosage: Liquid and capsules; typical dosage ranges from 360 mg to 3,000 mg daily.

*Black currant oil may increase immune response in the elderly.

Borago officinalis; see GLA

Origin: Oil from the seeds of the borage plant. Borage seed oil contains about 20 to 26 percent GLA.

Dosage: Liquid and capsules; take 1,300 mg (oil) daily.

Frankincense, Boswellia, Boswellin, Salai Guggal; also known as Indian Frankincense

Origin: Gum resin from the bark of the Boswellia tree found in India.

Claims: Reduces inflammation and treats rheumatoid arthritis (RA), osteoarthritis (OA) and bursitis symptoms. It’s also used to treat symptoms of ulcerative colitis and Crohn’s disease.

What we know: Boswellic acids, especially one called AKBA, are powerful anti-inflammatories. They block an enzyme called 5-lipoxygenase (5-LOX) that breaks down polyunsaturated fatty acids in foods into leukotrienes, inflammatory molecules that attack joints and other tissues. Boswellia may also help reduce cartilage damage in arthritis. It also shows promise as a cancer treatment.

Studies: A 2014 Cochrane Review found that a three-month course of 100 mg a day of enriched (AKBA) Boswellia reduced OA pain by nearly 20 points and improved function by eight points (on 100-point scales) without serious side effects. In a 2018 systematic review of 20 OA supplements, Boswellia extract was among the standouts, providing significant short-term relief for knee, hip and hand pain. The Natural and Alternative Treatments database, which contains over 12,000 clinical studies, also gives Boswellia high marks for OA pain relief.

Dosage: Capsule or tablet; 100 mg daily for OA; between 1200 to 3600 mg for RA. Look for 5-Loxin and AKBA-enriched Boswellia and for products with ingredients that enhance absorption like black pepper (piperine) or lecithin.

*Boswellia may increase side effects of other drugs, including antidepressants, anti-anxiety medications, ibuprofen and immunosuppressants.

*There’s also some concern that Boswellia may stimulate the immune system, so use caution if you have RA or lupus.

Pineapple, Ananas comosus

Origin: A group of enzymes found in pineapple that break down protein.

Claims: Decreases pain and swelling of rheumatoid arthritis (RA) and osteoarthritis (OA) and increases mobility.

What we know: There is some evidence that enzymes like bromelain have pain-relieving and anti-inflammatory effects comparable to NSAIDs.

Studies: A 2005 German study showed that bromelain activated immune cells that fight infection. A 2004 review published in Evidence-Based Complementary and Alternative Medicine found that bromelain showed promise as a treatment for OA but said more studies were needed.

Dosage: Capsules and tablets; take 500 mg to 2,000 mg three times a day between meals.

*Bromelain can cause stomach upset and diarrhea and should be avoided if you are allergic to pineapples.

* It can also increase the effect of blood-thinning medicine.

Capsicum frutescens

Origin: The highly purified, heat-producing component in chili peppers.

What we know: Applied as a topical cream, gel or patch, capsaicin activates specific nerve receptors causing local heat, stinging and/or itching sensations. Prolonged activation of these receptors causes them to lose their ability to function properly (and process pain signals) for extended periods of time. Capsaicin must be used regularly to keep the nerve receptors from working properly and processing pain signals.

Studies: Many studies have shown that capsaicin effectively reduces pain from osteoarthritis (OA), rheumatoid arthritis (RA) and fibromyalgia. In a 2010 German study, joint pain decreased nearly 50 percent after three weeks' use of 0.05 percent capsaicin cream.

Dosage: Most capsaicin products – such as Zostrix, Zostrix HP, Capzasin-P and others – contain between 0.025 to 0.075 percent concentrations. Apply regularly three times daily.

*Capsaicin can cause burning and irritation. Avoid applying it near your eyes or on sensitive skin.

Uncaria tomentosa

Origin: The bark and root of a woody vine that grows in parts of South and Central America.

Claims: Believed to have anti-inflammatory properties; may stimulate the immune system.

What we know: Cat's claw is an anti-inflammatory that inhibits tumor necrosis factor (TNF), a target of powerful rheumatoid arthritis (RA) drugs. It also contains compounds that may benefit the immune system.

Studies: In 2002, the Journal of Rheumatology published a randomized double-blind study of cat’s claw for the treatment of RA. Researchers found that in 40 people with RA, the supplement reduced joint swelling and pain by more than 50 percent compared to placebo.

Dosage: Capsules, tablets, liquid and tea bags; 250 mg to 350 mg capsule daily for immune support. Buy only products that contain uncaria tomentosa; at least a dozen unrelated plants are also called “cat’s claw.” Look for a brand that is free of tetracyclic oxindole alkaloids (TOAs).

*Cat’s claw can cause headache, dizziness and vomiting, and can lower blood pressure, so don’t use if taking an anti-hypertensive medication or blood thinner. *Do not use if you have tuberculosis or are taking drugs that suppress the immune system.

Cannabidiol

Origin: One of numerous compounds known as cannabinoids in the cannabis plant. Unlike THC, it does not have an intoxicating effect.

Claims: Reduces pain and inflammation; eases anxiety and depression; aids sleep

What we know: Evidence is promising that CBD may have pain-relieving properties and that it may help ease anxiety and help sleep, but more research is needed.

Studies: Animal studies indicate that CBD may help temporary reduction in pain and inflammation, but these findings have not been validated in human studies. One study showed that a synthetically derived CBD product was effective for osteoarthritis knee pain.

Dosage: CBD products come in topical, edible and inhalable forms, with pros and cons to each. Many products are derived from hemp, a form of cannabis containing 0.3% or less of THC, the psychoactive compound in cannabis. While there are no established clinical guidelines, experts advise starting with a product containing a few milligrams of CBD in a sublingual form (under the tongue) twice a day. If needed, increase in small increments over several weeks, and depending on the laws in your state, discuss with your doctor whether to try a form containing small amounts of THC. It may interact with some arthritis drugs. Learn more in the Arthritis Foundation’s CBD Guidance for Adults With Arthritis .

Origin: Chondroitin is a component of human connective tissues found in cartilage and bone. In supplements, chondroitin sulfate usually comes from animal cartilage.

Claims: Reduces pain and inflammation, improves joint function and slows progression of osteoarthritis (OA).

What we know: Believed to enhance the shock-absorbing properties of collagen and block enzymes that break down cartilage. Helps cartilage retain water and may reverse cartilage loss when used with glucosamine.

Studies: In 2016, a large multinational trial found combined glucosamine and chondroitin to be as effective at reducing pain, stiffness and swelling in knee OA as the NSAID celecoxib, without the cardiovascular and GI side effects of celecoxib. But another 2016 analysis of eight trials of glucosamine and chondroitin found equal numbers of studies showing positive effects and neutral effects. A 2011 study showed a significant improvement in pain and function in patients with hand OA using chondroitin alone. Benefits of chondroitin and glucosamine remain controversial, but the supplements appear extremely safe.

Dosage: Capsules, tablets and powder. Often combined with glucosamine. Phillip Barr, MD, a physician at Duke Integrative Medicine in North Carolina recommends 500 mg to 3 grams of glucosamine and chondroitin a day in divided doses. He also advises patients to stay on the

supplements for at least a month to see if they take effect. After a month, they may stop taking them if they don’t see any improvement.

*Some chondroitin tablets may contain high levels of manganese, which could be problematic with long-term use.

*Chondroitin taken with blood-thinning medication like NSAIDs may increase the risk of bleeding.

* If you are allergic to sulfonamides, start with a low dose of chondroitin sulfate and watch for any side effects. Other side effects include diarrhea, constipation and abdominal pain.

*Because chondroitin is made from bovine products, there is the remote possibility of contamination associated with mad cow disease.

Curcuma longa; also known as Turmeric

Origin: The main chemical in turmeric, the root of a plant related to ginger. Turmeric is a staple of traditional Chinese and Indian (Ayurvedic) medicine and a prime ingredient in curries.

Claims: Reduces pain, inflammation and stiffness related to rheumatoid arthritis (RA) and osteoarthritis (OA); treats bursitis.

What we know: A potent anti-inflammatory, curcumin blocks inflammatory cytokines and enzymes, including 5-LOX and cyclooxygenase-2 (COX-2), the target of the drug celecoxib.

Studies: In 2016, an industry-sponsored systematic review of randomized controlled trials found that 1,000 mg a day of curcumin reduced OA pain and inflammation as well as nonsteroidal anti-inflammatory drugs (NSAIDs) like diclofenac and ibuprofen. Another 2016 study suggests curcumin might help prevent bone breakdown in people with RA.

Dosage: Choose curcumin extract – whole turmeric is often contaminated with led. 500 mg capsules twice daily. Curcumin makes up only a small percentage of turmeric and can be hard to absorb. Be sure to check the standardized amount of curcumin when looking for a supplement, and choose brands that use phospholipids (Meriva, BCM-95), antioxidants (CircuWin) or nanoparticles (Theracurmin) for better absorption.

*High doses of turmeric can act as a blood thinner and cause upset stomach.

*Avoid turmeric/curcumin if you take blood thinners such as warfarin (Coumadin), are about to have surgery, are pregnant or have gallbladder disease.

Harpagophytum procumbens; also known as Devil’s Claw Root, Grapple Plant or Wood Spider

Origin: A traditional herb used in South Africa.

Claims: Relieves pain and inflammation. May help lower uric acid levels in people with gout. Acts as a digestive aid and appetite stimulant.

What we know: Harpagoside, the active ingredient in devil’s claw, appears to reduce pain and inflammation in joints. Some studies suggest stomach acid may counteract benefits, so take the supplement between meals when less stomach acid is released.

Studies: In 2002, Phytomedicine published a study of 227 people with non-specific low back pain or osteoarthritis (OA) of the knee or hip treated with devil’s claw extract. After eight weeks of taking 60 mg daily, between 50 and 70 percent of people reported improvement in pain, mobility and flexibility.

Dosage: Capsules, tincture, powder and liquid; take 750 mg to 1,000 mg three times a day.

*Do not take devil’s claw if you are pregnant, have gallstones or ulcers, or are taking an antacid or blood thinners.

*It can affect heart rate and may interfere with cardiac, blood-thinning and diabetes medication.

*It may also cause diarrhea.

Dehydroepiandrosterone

Origin: An androgen steroid hormone naturally produced in the body by the adrenal glands. Do not confuse 7-Keto DHEA with DHEA.

Claims: Helps control lupus flares; increases the blood level of DHEA.

What we know: Natural DHEA levels have been found to be low in people with rheumatoid arthritis (RA) and lupus, particularly in postmenopausal women, as well as men with ankylosing spondylitis, perhaps due to corticosteroid use. DHEA may help regulate the immune system and control inflammation.

Studies: In people with lupus, DHEA treatment may reduce disease activity and flares. Studies found it allowed doctors to lower women’s corticosteroid dosages. DHEA also appeared to counteract bone loss caused by medication and increase bone density. Long-term safety, overall effectiveness and appropriate dosages have not been established.

Dosage: Capsule and tablets available both as prescription (200 mg) and non-prescription (10-, 15- or 25-mg) products; typically 200 mg for lupus. Do not take doses higher than 25 mg without advice from a physician. Effects of long-term use are unknown.

*DHEA side effects include stomach upset, abdominal pain and high blood pressure, as well as acne, facial hair growth, voice deepening, and changes in menstrual pattern.

*It also decreases levels of “good” cholesterol (high-density lipoprotein, or HDL).

*DHEA can also increase insulin resistance for people with diabetes and exacerbate liver disease.

*Use is contraindicated in men with prostate cancer and women with uterine fibroids.

Dimethyl Sulfoxide; see MSM

Origin: A colorless, sulfur-containing organic by-product of wood pulp processing.

Claims: Relieves pain and inflammation, improves joint mobility in osteoarthritis (OA), rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA) and scleroderma, and manages amyloidosis (excessive build-up of protein in organs as seen in RA). Increases blood flow to skin.

What we know: Topically, appears to be an anti-inflammatory.

Studies: Controlled studies as a topical application for DMSO and OA have yielded conflicting results. Few human studies.

Dosage: Cream, gel; topically, 25 percent DMSO solution; take internally, only if prescribed by a physician.

*Side effects of DMSO taken internally include headache, dizziness, drowsiness, nausea, vomiting, diarrhea, constipation and anorexia.

*Topical DMSO also can cause skin irritation and dermatitis.

*Do not use DMSO if you have diabetes, asthma or liver, kidney or heart conditions.

*Never take industrial-grade DMSO. Wash off any lotions or skin products before applying DMSO.

Oenothera biennis and other Oenothera species; also known as Primrose; see GLA

Origin: The seeds of a native American wildflower, containing 7 to 10 percent gamma-linolenic acid (GLA).

Dosage: Capsules, oil and softgel; generally five 500-mg capsules per day. For rheumatoid arthritis (RA), 540 mg daily to 2.8 g daily in divided doses. Evening primrose oil may take up to six months to work.

Origin: Oil from cold-water fish such as mackerel, salmon, herring, tuna, halibut and cod, which are all rich sources of the omega-3 fatty acids, EPA and DHA. Your body can’t make them, so you need to get them from fatty fish or supplements.

Claims: Reduces inflammation and morning stiffness. Treats rheumatoid arthritis (RA), lupus, psoriasis, depression and Raynaud’s phenomenon. Important for brain function and may inhibit RA development.

What we know: Omega-3s block many sources of inflammation, including prostaglandins (pro-inflammatory cytokines) and inflammation-causing leukotrienes. They’re also converted by the body into powerful anti-inflammatory chemicals.

Studies: Fish oil has been extensively studied for dozens of inflammatory and autoimmune disorders. A 2017 systematic review looked at the benefits of fish oil for RA, lupus and osteoarthritis (OA). Of 20 trials involving RA, almost all found that fish oil – in daily doses ranging from 0.2 to nearly 5 grams of EPA and 0.2 to 2.1 grams of DHA – significantly reduced joint pain, stiffness and swelling, and reduced or eliminated patients’ use of NSAIDs. Five of seven studies found fish oil improved lupus disease activity in the short-term. Four studies for OA were inconclusive, but other research has found fish oil helps reduce OA pain. It’s also an effective treatment for gout and may even help prevent gout flares. Some dermatologists recommend fish oil for their patients with psoriatic arthritis because it may help both skin and joint symptoms.

Dosage: Fish, capsules, softgels, chewable tablets or liquid. For general health, two 3-ounce servings of fish a week are recommended, but supplements are the best source to get a therapeutic dose of fish oil. Plus, fish is more likely to be contaminated with mercury and PCBs, which are less common in high-quality supplements. Use fish oil capsules with at least 30 percent EPA/ DHA, the active ingredients. For lupus and psoriasis, 2 g EPA/DHA three times a day. For RA and OA, up to 2.6 g, twice a day. For depression, 6.6 g daily. For psoriasis, at least 1,000 mg a day. Prescription fish oils contain high doses of EPA and DHA; you can get the same amounts over the counter, just look for “high potency.” Philip Barr, MD, a physician at Duke Integrative Medicine in North Carolina, recommends the Nordic Naturals brand for potency and purity.

* Check with your doctor if you’re taking blood-thinners because fish oil could increase their effect.

* Due to potentially dangerous levels of mercury, women who are pregnant or hoping to conceive should avoid eating shark, swordfish, king mackerel and tilefish and should eat no more than 8 ounces of albacore tuna each month.

Linum usitatissimum; also known as Flax, Flaxseed Oil, Linseed Oil

Origin: Seed of the flax plant, containing omega-3 and omega-6 fatty acids and lignans (beneficial plant compounds, similar to fiber).

Claims: Eases symptoms of rheumatoid arthritis (RA), lupus and Raynaud’s phenomenon. Lubricates joints and lessens stiffness and joint pain. Lowers total cholesterol and reduces risk of heart disease and some types of cancer. Improves hot flashes and dry skin.

What we know: Flaxseed is high in alpha-linolenic acid (ALA), a type of omega-3 fatty acid that can be converted to EPA and DHA (the active ingredients in fish oil). Flaxseed is a good source of fiber.

Studies: Lack of studies on whether flaxseed improves symptoms of RA, but omega-3 fatty acids are known anti-inflammatories. Mixed results about whether flaxseed or flaxseed oil can accelerate or slow progression of prostate cancer.

Dosage: Whole seeds, ground meal or flour, capsules or oil. Whole seeds must be ground into meal or flour; 30 g (1 ounce) daily. Capsules, available in 1,000 mg to 1,300 mg, no typical dosage. Oil, 1 to 3 tablespoons daily.

*Fiber in flaxseed can impair absorption of some medications.

*Flaxseed acts as a blood thinner, so beware when taking blood thinners, aspirin or other NSAIDs.

*Avoid flaxseed if you have hormone-sensitive breast or uterine cancer.

* Use with caution if you have high cholesterol and are taking cholesterol-lowering drugs.

Zingiber officinale

Origin: The dried or fresh root of the ginger plant.

Claims: Decreases joint pain and reduces inflammation in people with osteoarthritis (OA) and rheumatoid arthritis (RA). Increases circulation in people with Raynaud’s phenomenon.

What we know: Ginger has been shown to have anti-inflammatory properties similar to ibuprofen, the COX-2 inhibitor celecoxib and even TNF blockers. It also switches off certain inflammatory genes, which may make it an effective pain reliever and a potential treatment for autoimmune disorders and cancer.

Studies: Studies have confirmed that a daily dose of 500 to 1,000 mg of ginger extract can modestly reduce pain and disability in hip and knee OA. In animal models, larger daily doses of ginger extract – the equivalent of up to 4 grams in humans – had strong anti-inflammatory effects in RA. Recent research suggests that ginger extract containing both gingerols – the active part of ginger – and ginger essential oils may be more effective for chronic inflammation than gingerols alone.

Dosage: Powder, extract, tincture, capsules and oils, up to 2 g in three divided doses per day or up to 4 cups of tea daily. In studies, 255 mg of Eurovita Extract 77 (equivalent to 3,000 mg dried ginger) twice daily. ConsumerLab recently found that only half of reviewed ginger products met quality standards. Philip Barr, MD, a physician at Duke Integrative Medicine in North Carolina suggests medical-grade supplements by Thorne Research and Pure Encapsulations.

* Ginger can interfere with medications for blood thinning.

* It should not be used if you have gallstones.

Ginkgo biloba

Origin: Leaf of the ginkgo biloba tree, native to East Asia.

Claims: Increases blood flow and circulation in Raynaud’s phenomenon and claudication (pain in legs or arms caused by reduced circulation due to blocked arteries).

What we know: There is no strong evidence that ginkgo improves mood, menopause symptoms, memory or fatigue.

Studies: Results from a 2002 double-blind, placebo-controlled trial of ginkgo for the treatment of Raynaud’s phenomenon showed that the supplements could reduce the number of disease flares by 56 percent.

Dosage: Liquid, tablet, softgel and capsule and extract; typically 120 mg to 240 mg extract daily. Choose supplements standardized to 5- to 7-percent terpene lactones and 24-percent flavonol glycosides, the active ingredients in ginkgo.

*Ginkgo’s side effects include stomach upset, dizziness or headaches.

*Do not take ginkgo if you are taking blood-thinning medication like aspirin, have epilepsy or experience seizures, have diabetes or are scheduled for surgery.

Gamma-Linolenic Acid (GLA)

Origin: A type of omega-6 fatty acid found in evening primrose oil, black currant oil and borage oil.

Claims: Lessens joint pain, stiffness and swelling associated with rheumatoid arthritis (RA). Eases symptoms of Raynaud’s phenomenon and Sjögren’s syndromes.

What we know: Unlike other omega-6 oils, GLA is a potent anti-inflammatory. It blocks enzymes that convert substances from food into leukotrienes (inflammatory molecules) and may stop the body from switching on pro-inflammatory genes.

Studies: In a small 2017 study, RA patients were randomized to receive fish oil supplements, fish oil plus evening primrose oil or no supplements. Disease activity and joint tenderness decreased significantly in the first two groups but not the third. Another trial compared fish oil, borage oil and a combination of

the two in RA patients. All three groups showed significant reductions in disease activity after nine months. In 2011, Australian researchers updated a Cochrane Review of potentially useful herbal therapies for RA. Of 22 studies of different supplements, seven found that GLA from evening primrose, borage or black current seed oil showed potential for relieving pain and disability.

Dosage: Capsules or oil; 2 g to 3 g daily in divided doses. Consumer Lab reports that many of the seed oil supplements it tests are rancid. Be sure to check the expiration date.

* May increase bleeding risk; avoid if you use blood thinners such as warfarin (Coumadin).

Glucosamine sulfate, glucosamine hydrochloride, N-acetyl glucosamine

Origin: Major component of joint cartilage. Supplements are derived from the shells of shellfish (such as shrimp, lobster and crab) or from vegetable sources.

Claims: Slows deterioration of cartilage, relieve osteoarthritis (OA) pain and improves joint mobility.

What we know: Glucosamine produced in the body provides natural building blocks for growth, repair and maintenance of cartilage. Like chondroitin, glucosamine may lubricate joints, help cartilage retain water and prevent its breakdown.

Studies: In 2016, a large multinational trial found combined glucosamine and chondroitin to be as effective at reducing pain, stiffness and swelling in knee OA as the NSAID celecoxib, without the cardiovascular and GI side effects of celecoxib. But another 2016 analysis of eight trials of glucosamine and chondroitin found equal numbers of studies showing positive effects and neutral effects. Mayo clinic researchers say evidence supports trying glucosamine sulfate – not glucosamine hydrochloride – with or without chondroitin sulfate for knee OA, especially because the supplements are “inexpensive and side effects are few and far between.”

Dosage: Capsules, tablets, liquid or powder (to be mixed into a drink). Often combined with chondroitin.  Phillip Barr, MD, a physician at Duke Integrative Medicine in North Carolina recommends 500 mg to 3 grams of glucosamine and chondroitin a day in divided doses. He also advises patients to stay on the

supplements for at least a month to see if they take effect. After a month, they may stop taking them if they don’t see any improvement.

*Glucosamine may cause mild upset stomach, nausea, heartburn, diarrhea and constipation, as well as increased blood glucose, cholesterol, triglyceride and blood pressure.

*Don’t use glucosamine if you are allergic to shellfish.

*People with glaucoma or intraocular hypertension may also have worsening eye pressure if they take a glucosamine supplement.

Perna canaliliculus

Origin: Extract from a New Zealand mussel.

What we know: Mussels are rich in omega-3 fatty acids, and because they reduce the production of prostaglandins (pro-inflammatory cytokines) and inflammation-causing leukotrienes, may have the same anti-inflammatory effects as fish oil.

Studies: Results of both human and animal studies have been mixed. A 2006 Clinical Rheumatology review found benefit for both osteoarthritis (OA) and rheumatoid arthritis (RA) in two of five clinical trials. A 2008 review of trials for OA found benefit when green-lipped mussels were added to conventional therapies. Unlike NSAIDs, which can harm the stomach, green-lipped mussel extract may help heal ulcers.

Dosage: Capsules, extract: 300-350 mg three times daily of extract for RA; 900-1200 mg daily for OA.

See Boswellia serrata

Origin: A hormone produced by the pineal gland, which is located at the base of the brain.

Claims: Aids sleep and treats jet lag.

What we know: A potent antioxidant, melatonin regulates sleep/wake cycles. It appears to treat insomnia and sleep disturbances related to conditions like fibromyalgia and depression. Aspirin and other NSAIDs can decrease melatonin levels.

Studies: A systematic review of studies shows no evidence that melatonin effectively treats sleep disorders or is useful for altered sleep patterns, such as from shift work or jet lag. However, there is evidence that it is safe with short-term use. Another review of studies showed that melatonin reduced the onset of sleep by four minutes and increased the duration of sleep by nearly 13 minutes; another showed that people taking melatonin slept almost 30 minutes longer than people taking placebo.

Dosage: Capsules or tablets; 1 mg to 5 mg at bedtime for insomnia, for no longer than two weeks.

*Higher doses or long-term usage require doctor supervision.

*Certain medications interact with it, including NSAIDs, beta-blockers, antidepressants, diuretics and vitamin B-12 supplements.

*Do not take melatonin with alcohol or caffeine.

*Do not use if you have an autoimmune disease or if you have depression, kidney disease, epilepsy, heart disease or leukemia.

Methylsulfonylmethane

Origin: Organic sulfur compound found naturally in fruits, vegetables, grains, animals and humans.

Claims: Reduces pain and inflammation.

What we know: MSM is an organic sulfur compound. Sulfur is needed to form connective tissue. MSM also seems to act as an analgesic by lessening nerve impulses that transmit pain.

Studies: A 2006 pilot study of 50 men and women with knee OA showed that 6,000 mg of MSM improved symptoms of pain and physical function without major side effects. No large, well-controlled human studies have been performed.

Dosage: Tablets, liquid, capsule or powder, topical and oral. Typically 1,000 mg to 3,000 mg daily with meals.

*MSM may cause stomach upset or diarrhea. Don’t use MSM if you are taking blood thinners.

Pycnogenol

Origin: An extract from the bark of the French maritime pine tree

What we know: Pycnogenol contains procyandin, a powerful antioxidant, and also seems to inhibit pro-inflammatory enzymes, including COX 1 and COX 2.

Studies: A small 2007 University of Arizona study found pycnogenol reduced osteoarthritis (OA) pain by 43 percent and stiffness by 25 percent. Two 2008 studies showed significant improvements in joint pain, stiffness and function that persisted after the supplement was stopped. But a 2012 review concluded that these studies were poorly designed and underpowered.

Dosage: Capsules, tablets: In studies, 100 to 150 mg daily.

Origin: Live bacteria and yeasts that may help prevent and treat disease by keeping your digestive tract and immune system healthy.

What we know: Microbes – bacteria, yeast and viruses – living in your gut, collectively called the microbiome, influence health and disease through complex interactions with your immune system. When these microbial communities get out of whack – through poor diet, antibiotic use, stress or illness – the result can be immune, metabolic and even mental health problems. Probiotics (the live microbes and yeast in supplements) or prebiotics (foods that promote the growth of good microbes, including yogurt, sauerkraut, miso and other fermented foods) may help restore a healthy microbiome and normalize immune function. Scientists believe some types of probiotics are effective for diseases like rheumatoid arthritis (RA), but no one is exactly sure what those are (or even what a healthy microbiome looks like). However, it’s believed that, for most people, consuming a probiotic supplement may have a beneficial effect on health.

Studies: The human microbiome – and by association, probiotics – has been widely studied, but there is still much to learn. One meta-analysis of more than 150 studies involving more than 10,000 people concluded that probiotics successfully treat and prevent a wide range of GI problems, including irritable bowel syndrome (IBS), antibiotic-associated diarrhea, C. difficile infection and H. pylori infection. The most effective probiotic in the analysis was VSL#3, which is

commonly used in clinical trials. Many animal trials, including a Canadian study using VSL#3, have shown that probiotics can quell inflammation in RA. But human studies have been inconsistent, says Veena Taneja, PhD, a researcher at Mayo Clinic in Rochester, Minnesota. Many studies have used a single Lactobacillus or Bifidobacterium species, with only modest success. “Supplementation with multistrain synbiotic [probiotics plus prebiotics] bacteria in RA patients have shown some benefit,” she says. In the future, successful probiotic treatments will likely use patients’ own microbes, she adds.

Dosage: Many probiotic bacteria are sensitive to heat and moisture. Refrigerate those that need it, and have online orders shipped overnight with ice. Or look for freeze-dried capsules or tablets in blister packs; they don’t need refrigeration.  Phillip Barr, MD, a physician at Duke Integrative Medicine in North Carolina, suggests trying a generic probiotic that contains both Lactobacillus and Bifidobacterium along with a probiotic yeast called Saccharomyces boulardii, which has been shown to reduce inflammation and help regulate immune function.

*The latest research shows that the fastest route to a healthier gut may be through your diet. You can shift your microbiome in as little as 24 hours by eating more plants and less meat, sugar and processed food.

Rosa canina

Origin: The seed pods of roses.

What we know: Rose hips powder – a rich source of vitamin C – appears to decrease inflammation by inhibiting production of inflammatory proteins and enzymes, including COX-1 and COX-2.

Studies: Animal and in vitro studies have shown that rose hips have anti-inflammatory, disease-modifying and antioxidant properties, but results of human trials are preliminary. A 2008 meta-analysis of three clinical trials showed rose hips powder reduced hip, knee and wrist pain by about one-third in nearly 300 osteoarthritis patients and a 2013 trial found that conventional rose hips powder relieved joint pain almost as effectively as an enhanced version. In a 2010 trial of 89 patients, rose hips improved rheumatoid arthritis (RA) symptoms better than a placebo.

Dosage: Capsules, powder: up to 5 g daily in divided doses for capsules. Most research used a standardized form of rose hips from Denmark sold under the names Litozin and Hyben Vital.`

S-adenosyl-L-methionine

Origin: A naturally occurring chemical in the body.

Claims: Treats pain, stiffness and joint swelling; improves mobility; rebuilds cartilage and eases symptoms of osteoarthritis (OA), fibromyalgia, bursitis, tendinitis, chronic low back pain and depression.

What we know: SAM-e is an effective anti-inflammatory and analgesic for people with OA. Results may be felt in just one week but could take more than a month. SAM-e works closely with vitamins B-12, B-6 and folate, so it is important to get enough of the B vitamins when taking this supplement.

Studies: Over the last two decades, multiple clinical trials involving thousands of people have shown SAM-e to improve joint health and help with the symptoms of OA. A 2002 analysis of 14 SAM-e studies showed it is effective for reducing pain and improving mobility in people with OA. A 2004 University of California, Irvine study found SAM-e equal to the prescription drug celecoxib (Celebrex) and a 2009 study found it comparable to the NSAID nabumetone. Fibromyalgia findings have been mixed, but in two European trials (where it is sold as a drug, not a supplement), SAM-e improved symptoms better than placebo. Extensive research has also found SAM-e effective for depression. In a 2010 Massachusetts General Hospital study, SAM-e combined with antidepressants significantly increased remission rates in patients with major depression who failed conventional therapy.

Dosage: Capsules (preferably in blister pack): 600 to 1,200 mg daily in three divided doses for OA; 200 to 800 mg twice daily for fibromyalgia; 800 to 1,600 mg twice daily for depression. Because of possible interactions, SAM-e should not be taken without doctor’s supervision.

*High doses of SAM-e can cause flatulence, vomiting, diarrhea, headache and nausea.

*SAM-e may interact with antidepressant medications and should be avoided if you have bipolar disorder or are taking monoamine oxidase inhibitors (MAOIs).

*It may also worsen Parkinson’s disease.

Hypericum perforatum

Origin: The yellow flower, leaves and stem of the St. John’s wort plant, is native to Europe and grows wild in the U.S.

Claims: Acts as an antidepressant drug and reduces inflammation and pain.

What we know: St. John’s wort’s mood-elevating properties were believed to be from active ingredients hypericin and hyperforin, chemicals that raise levels of serotonin, a chemical found in the brain. Serotonin levels may be low in people who are depressed and possibly in those who have fibromyalgia. New research, however, suggests the whole preparation (not just the two active ingredients) is more effective.

Studies: No scientific evidence shows that St. John’s wort is effective for reducing inflammation. A Cochrane Review of studies on St. John’s wort for depression showed that current evidence is inconsistent. A study also found that the herb is not effective for social anxiety disorder.

Dosage: Extract in the form of powder (dried), liquid (10 to 60 drops one to four times per day) or tablet, capsules and tea; extract, typically 900 mg daily.

*Although St. John’s wort taken alone is considered safe, it is potentially dangerous if taken with prescription antidepressants.

*St. John’s wort can cause insomnia, restlessness, anxiety, irritability, stomach upset, fatigue, dry mouth, dizziness or increased sensitivity to sunlight.

*Consult your physician before taking St. John’s wort if you are already taking any kind of prescription medications.

*Do not take it if you have Alzheimer’s disease, HIV, depression, schizophrenia, infertility or bipolar disorder.

*It may also reduce effectiveness of oral contraceptives.

Urtica dioica

Origin: The leaves and stem of the stinging nettle plant, a stalk-like plant found in the U.S., Canada and Europe.

Claims: Reduces inflammation, aches and pains of osteoarthritis (OA).

What we know: The antimicrobial, antioxidant, analgesic and anti-ulcer properties of stinging nettle have been studied in Germany and Turkey. Stinging nettle is high in potassium, calcium and magnesium and may be helpful for gout.

Studies: A German study shows that hox alpha, a new extract of stinging nettle leaf, contains an anti-inflammatory substance that suppressed several cytokines in inflammatory joint diseases. In a Turkish study, stinging nettle extract showed antimicrobial effects against nine microorganisms, as well as anti-ulcer and analgesic activity. Stinging nettle root extract combined with sabal fruit extract was shown to be superior to placebo for treating prostate hyperplasia (a precancerous condition) and was well tolerated.

Dosage: Tea, capsule, tablet, tincture, extract or whole leaf; capsules, up to 1,300 mg daily; tea, 1 cup, three times a day; tincture, 1 ml to 4 ml three times a day; nettle leaf applied directly to the skin.

*Nettle may interfere with blood thinners, diabetes and heart medications, and lower blood pressure

Tripterygium wilfordii

Origin: Root of a vine-like plant from Asia.

Claims: Reduces pain and inflammation and treats symptoms of RA, lupus and other autoimmune diseases.

What we know: Used in Chinese medicine for years, thunder god vine shows evidence of suppressing the immune system.

Studies: A 2006 review of randomized clinical trials shows that thunder god vine improved symptoms of rheumatoid arthritis (RA) but serious side effects occurred. A 2009 study of 121 RA patients conducted in the United States found that those who received 60 mg three times a day of thunder god vine had better response than those who received 1 g twice a day of sulfasalazine. And a 2014 Chinese study of 207 RA patients found that those who received 20 mg pills three times a day of thunder god vine did not do worse those receiving 12.5 mg per week of methotrexate. Patients who received both the thunder god vine and the methotrexate had the best response of all.

Dosage: Extract; up to 60 mg three times a day.

*This root can cause stomach upset, skin reactions, temporary infertility in men and amenorrhea (lack of menstruation) in women.

*It should not be used if you are taking immunosuppressive drugs, like prednisone.

*The leaves and flowers of this plant are highly toxic and can cause death, so preparation should only be made from the root.

see Curcumin

Valeriana officianalis

Origin: The dried root of the perennial herb valerian.

Claims: Treats insomnia and eases pain; has antispasmodic and sedative effects.

What we know: Valerian works as a mild sedative and sleep agent, but it takes two to three weeks to see effect. No known effects on muscle or joint pain and arthritis.

Studies: A randomized, placebo-controlled trial of 184 adults showed two tablets per night for 28 nights produced significant improvements in sleep and quality of life.

Dosage: Capsules, tablets, tincture, softgel or tea; 300 mg to 500 mg of valerian extract daily (maximum dose is 15 g of root per day). For insomnia and muscle soreness, take 1 teaspoon of liquid extract diluted in water or a 400 mg to 450 mg capsule, tablet or softgel 30 to 45 minutes before bedtime or as needed. For a milder effect, drink a cup of valerian tea before bed. Avoid powdered valerian root.

*Valerian may cause headache, excitability, uneasiness and insomnia.

*Do not drive or operate machinery while taking it, and do not take with alcohol, barbiturates, tranquilizers or other sedative-type drugs or herbs.

*Do not use valerian longer than one month, or if you have liver disease.