28 March 2011
Can Diet or Supplements Relieve Your Arthritis Aches and Inflammation?
Compared to the majority of lay articles discussed in this class, this article was very well written. The author did a great job of simplifying the information to a point where a person with no medical background could easily understand it. The definitions were especially easy to understand and not overly simplified. They explained how arthritis is a group of diseases and conditions that share common symptoms including pain, aches, stiffness and swelling in or around the joints. There are more than 100 types (which I definitely did not know!). The two most common are obviously osteoarthritis and rheumatoid arthritis. They then go into discussing how a lot of arthritis sufferers seek herbal supplements and diets to complement their medication. They talk about 13 double-blind, placebo-controlled studies in which about 3.3 grams of omega-3 fatty acids a day significantly reduce rheumatoid arthritis symptoms. They also mention another study where vitamins A, C and selenium were not noted to be effective in relieving symptoms. They pretty much summed it up by saying that some supplements work, some have no effects, and others can harm you. Towards the end the article started to go all over the place stating a series of "myths" that may or may not work and explaining that they have no scientific evidence behind them. They also stressed not to cut out an entire food group when dieting, which seems obvious to us but may not no others, so I really like that they threw that in there! However, at the end in "EN's Bottom Line" was not very specific. The article didn't really end up saying anything of great significant importance to arthritis. It was just kind of how to live healthy. "Eat a well balanced diet and take a multivitamin" was the overall message which is not very specific to arthritis, more just how to lead a healthy lifestyle.
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I thought the author Sharon Palmer did a great job in this article to get her information across and remained unbiased. After reading this article and the discussion in class I wanted to see what other work she has done and what I found was that she has her own website and that there is a link to all her other work. I just wanted to share this in case anyone else was interested!
ReplyDeletehttp://www.mediaartgraphics.com/sharon/index.php
The short mention of vitamin D stood out to me in this article. I was researching vitamin D and found the Institute of Medicine's Dietary Reference Intakes for vitamin D, which is the source that establishes the Recommended Dietary Allowance that Sharon Palmer talks about. The IOM article brought up an interesting point that although most North Americans do not reach their recommended daily intake of vitamin D, which Palmer also mentioned, the average blood concentration of vitamin D is above the suggested 20 nanograms per milliliter regarded by the IOM to be sufficient for bone health. That level is equivalent to an intake of 600 IU's daily for people under 71 years of age or 800 IU's daily for those over 71 years old, which is higher than the value Palmer includes from Dr. Gagne of the University of Saskatchewan.
ReplyDeleteYes I definitely changed my view of this paper after the discussion in class. People brought up very good points about how the author did a good job of explaining many common ways to deal with arthritis without being bias. I guess it's just fact that very few outrageous diets, herbal supplements and remedies work at relieving arthritis symptoms. A good diet and exercise is the best secondary "treatment" to medicine. The only thing I still think the author could have improved on separating osteoarthritis and rheumatoid arthritis more in the paper.
ReplyDeletePart 1
ReplyDeleteWhen going over the lay articles we went over last class session, the issue of taking supplements to alleviate arthritis symptoms was brought up frequently. So, I decided to take look for studies that addressed this issue until I came across a study entitled:
"Fish oil supplementation increases cyclooxygenase inhibitory activity in rheumatoid arthritis patients".
The authors in the paper sought to investigate the benefits of combining fish oil and paracetamol (acetaminophen) to alleviate rheumatoid arthritis symptoms. They claim that commonly used drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) to alleviate rheumatoid pain symptoms increase the risk of GI and CV complications (1). A few examples of NSAIDs are ibuprofen and aspirin (WebMD).
Eicosapentaenoic acid (EPA) (contained within fish oil), NSAIDs, and Paracetamol decrease prostaglandin production via inhibition of cyclooxygenase’s (COX). They claim that reducing prostaglandins ultimately results in a reduction of pain. The ways in which EPA, NSAIDs, and paracetamol inhibits COX production of prostaglandins is explained in the figure below from the paper. EPA acts as a competitive inhibitor for COX, NSAIDs manipulate the active sit to inhibit COX activity, and paracetamol acts as an anti-oxidant to diminish the amount of oxidants, which are important for COX activation. Here is the link to the paper; look for figure 1 which sums up what I said schematically:
http://www.sciencedirect.com.ezproxy1.library.arizona.edu/science?_ob=MiamiCaptionURL&_method=retrieve&_udi=B6WCS-50G0F01-1&_image=fig1&_ba=1&_user=9555371&_coverDate=08%2F31%2F2010&_rdoc=8&_fmt=full&_orig=browse&_srch=doc-info(%23toc%236746%232010%23999819996%232245767%23FLA%23display%23Volume)&_cdi=6746&_issn=09652299&_pii=S0965229910000695&_acct=C000055186&_version=1&_urlVersion=0&_userid=9555371&md5=c7e17ec44b6e732c2bc595caae5e3782 )
The study included 19 human subjects who suffer from rheumatoid arthritis. All were instructed to take an “anti-inflammatory dose” of fish oil containing EPA (270 mg EPA) daily. After an unspecified amount of time a blood sample was taken from the 19 subjects to classify subjects as either having high EPA or low EPA levels (“>3.5% or < 2% respectively of total plasma phospholipids”). Thereafter all subjects ingested 1 g of paracetamol. Blood samples were taken just before paracetamol was administered and one hour after consumed.
To measure the activity of COX, serum samples were taken just before and 1 hour after paracetamol ingestion. Blood samples were taken to measure the products of COX which are eicosanoid prostaglandin (PGE2) and thromboxane B2 (TXB2) as a means of measuring COX activity.
Part 2
ReplyDeleteResults
When comparing blood serum levels of prostaglandin and thrombaxane B2 before and after paracetomal consumption, there are lower levels of prostaglandins and thromboxane B2 in both the Low and High EPA groups. However individuals who were considered to have had high EPA levels, had at zero hour, lower initial levels of PGE2 and TXB2 respectively.
Individuals with low EPA levels had 31 % lower serum PGE2 levels (~8 ng/mL to ~5.5 ng/mL) 1 hr after paracetamol ingestion. They also had 22% lower TXB2 serum levels (~31 ng/mL to ~23 ng/mL) 1 hour after paracetamol consumption as well.
Individuals with high EPA levels had a 62 % lower PGE2 serum levels (~6 ng/mL to ~2 ng/mL) 1 hr after paracetamol consumption. They also had 52% lower TXB2 serum levels 1 hr after paracetamol consumption (~22.5 ng/mL to ~10 ng/mL).
Figure 2 sums up the results:
http://www.sciencedirect.com.ezproxy1.library.arizona.edu/science?_ob=MiamiCaptionURL&_method=retrieve&_udi=B6WCS-50G0F01-1&_image=fig2&_ba=2&_user=9555371&_coverDate=08%2F31%2F2010&_rdoc=8&_fmt=full&_orig=browse&_srch=doc-info(%23toc%236746%232010%23999819996%232245767%23FLA%23display%23Volume)&_cdi=6746&_issn=09652299&_pii=S0965229910000695&_acct=C000055186&_version=1&_urlVersion=0&_userid=9555371&md5=c3c788e6a92741d330ed66302e18b626
Discussion
Because of the GI and CV risks associated with prolong use of NSAIDs it is important to limit the amount of NSAIDs. Thus, the combined use of fish oil containing EPA and taking paracetamol may lessen the dependence of RA patients taking NSAIDs.
Works cited.
1) van, der L. M. W, der B. S. van, P Welsing, EJ Kuipers, and RM Herings. "The Balance between Severe Cardiovascular and Gastrointestinal Events Among Users of Selective and Non-Selective Non-Steroidal Anti-Inflammatory Drugs." Annals of the Rheumatic Diseases. 68.5 (2009): 668. Print.
(The actual article itself) Caughey, Gillian E, Michael J. James, Susanna M. Proudman, and Leslie G. Cleland. "Fish Oil Supplementation Increases the Cyclooxygenase Inhibitory Activity of Paracetamol in Rheumatoid Arthritis Patients." Complementary Therapies in Medicine. 18.3 (2010): 171. Print.
"Pain Management Health Center: Nonsteroidal anti-inflammatory drugs (NSAIDs)." WebMD. WebMD, 02 feb 2010. Web. 1 Apr 2011.
I also thought that this article did a good job of trying to give an unbiased opinion of a lot of the supplements that are out there. They were not pushing one thing in particular, just overall better diet and exercise, which is healthy anyways. They were not always very specific to arthritis though, as mentioned, and they did not distinguish between the different types.
ReplyDeleteI was particularly interested in Chondroitin sulfate that they mentioned as being 'possibly effective' against the development of arthritis, especially since I've heard a lot about it before, so I did more research on the topic. First, I simply looked up what Chondroitin sulfate (CS) is and discovered that it is just a glycosaminoglycan (GAG) composed of a chain of alternating sugars. In terms of uptake, I would think that a supplement mainly formed of sugars would most definitely be broken down before it even reaches its intended target. Also, I found a very recent paper titled "The human pharmacokinetics of oral ingestion of glucosamine and chondroitin sulfate taken separately or in combination" by Jackson et al looking at the uptake of chondroitin sulfate after ingestion. The results of the paper confirmed my hypothesis when their findings showed that circulating levels of CS were not affected by ingesting a supplement. In the paper, the authors stated that any improvement suspected from ingestion of CS is probably not from any excess CS (there is a normal circulating concentration) reaching the joint space, but by differing cellular activity in the gut lining or liver, where concentrations of CS would be increased after taking a supplement. Overall, I think that chondroitin sulfate may have more of a placebo effect than provide an actual improvement in joint health. If anyone is interested in looking at the article, here is a link:
http://www.sciencedirect.com.ezproxy1.library.arizona.edu/science?_ob=ArticleURL&_udi=B6WP3-4XNF47B-1&_user=9555371&_coverDate=03%2F31%2F2010&_rdoc=3&_fmt=high&_orig=browse&_origin=browse&_zone=rslt_list_item&_srch=doc-info(%23toc%236979%232010%23999819996%231723131%23FLA%23display%23Volume)&_cdi=6979&_sort=d&_docanchor=&_ct=26&_acct=C000055186&_version=1&_urlVersion=0&_userid=9555371&md5=6e83157aa4547e03191039b0ab6ccde0&searchtype=a