Anti-Inflammatory Botanicals, Enzymes

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Anti-Inflammatory Botanicals, Enzymes

When joints are damaged due to Osteoarthritis (OA) and rheumatoid arthritis (RA) progression, the resulting inflammation is the root of pain and decreased function. Numerous herbs have scientifically supported anti-inflammatory properties that have proven useful to consumers managing joint pain.

Boswellia serrata affects a couple of the inflammatory cascades tied to enzymes such as COX and LOX. In one study, boswellia extract (WOKVEL® from Verdure Sciences Corp.) decreased arthritis pain and inflammation scores compared to the non-steroidal anti-inflammatory drugs NSAID valdecoxib during a seven-month period. Ohio State University scientists studying another specialty boswellia compound (5-LOXIN from Laila Nutraceuticals and P.L. Thomas) discovered the herb affected 113 of 522 induced genes related to inflammation, cell adhesion and proteolysis (protein breakdown).¹ They noted 5-LOXIN also acted on several inflammatory mediators, including matrix metalloproteinases (MMPs) that contribute to cartilage breakdown.

Turmeric and its anti-inflammatory active constituent curcumin also inhibit MMPs and other inflammatory mediators.² Further, curcumin was found to affect the COX-2 enzyme, which affects inflammation, but not the COX-1 enzyme that affects gastrointestinal (GI) tract health.³ This is important, because non-selective drugs can affect both forms of COX enzymes, and cause GI problems. This is behind the finding that curcumin works synergistically with COX-2 inhibitor celecoxib, possibly decreasing the drug dosage required for arthritis patients.⁴

Devil's claw is another herb that works against MMPs and assorted inflammatory mediators.⁵ It can provide an analgesic action in acute and subacute inflammation, and has been shown to reduce pain and improve mobility in OA patients.^6,7 In a U.K. trial, 259 patients with arthritis and other rheumatoid problems were able to improve global pain, stiffness and function, as well as various quality of life measurements, after taking devil's claw.⁸ In patients with knee or hip OA, cryoground devil's claw powder (Harpadol from Arkopharma) supplementation was as effective as the arthritis drug diacerhein, suggesting the herb could decrease the amount of drugs required by OA patients.⁹

French maritime pine bark might also help OA patients need less pharmaceutical medication. One study on pine bark extract (Pycnogenol® from Natural Health Sciences) found 100 patients with stage I or II OA had significant improvement in joint pain, stiffness and function after taking 150 mg/d of Pycnogenol for three months.¹⁰ The benefits persisted as much as two weeks after the supplementation ended. These results on pain, stiffness and function were equaled in another study that featured OA patients taking Pycnogenol with smaller non-steroidal anti-inflammatory drugs (NSAID) dosages and a placebo group that took increasing amounts of NSAIDs.¹¹

While maritime pine trees are found commonly near the sea, a supplement made from a plant found in the sea, red seaweed (Aquamin™ distributed by GTC Nutrition), has generated recent buzz for also improving pain and mobility while relieving OA patients of the need for NSAID use.¹² Another study produced some mixed results, as Aquamin compared favorably to glucosamine on pain and mobility in patients with moderate to severe knee OA, but the two supplements in combination did not produce the same benefit, compared to placebo.¹³

Mixed results also mark the use of Arnica montana on OA. One study found topical arnica (Arnica Rub from Bioforce USA) was as effective as ibuprofen in improving pain and function parameters in 204 patients with OA of interphalangeal joints of hands.¹⁴However, a systematic review of placebo-controlled clinical trials on homeopathic arnica found no evidence of efficacy beyond a placebo effect.¹⁵

Still, some experts such as Ellen Kamhi, Ph.D., R.N., who is known as the Natural Nurse, recommend various homeopathic remedies for joint pain, soreness and various arthritis symptoms. Specifically, Kamhi advocated Arnica, Rhus toxicodendron (Rhus Tox),Dulcamara, Colocynthis and Bryonia.

Lou Paradise, chief of research at Topical BioMedics Inc., agreed homeopathic products can help manage pain in inflammatory health problems such as arthritis. Topricin has a synergy of homeopathic medicines—Arnica, Rhus Tox, Belladonna, Lachesis Muta and Crotalus—and is designed to help balance the body’s molecular chemistry for optimum healing. "The body’s challenge when there is an inflammatory response is to drain the toxins from the cells, and provide a restoration of oxygen-rich blood to all cells for repair," Paradise said. "Topricin’s medicines stimulate the lymphatic system to drain allowing a relaxing of constriction of the capillaries returning blood flow back to normal." He noted Topricin has succeeded in pain relief performance, from pediatric to geriatric care, where the vast majority of other pain management products and/or OTC medicines have failed.

Gobbling Up Inflammation

Enzymes like COX and LOX contribute to the metabolism of fatty acids and the resultant production of prostaglandins that can be either pro- or anti-inflammatory. Many arthritis and joint pain treatments, whether natural or conventional, target the production of these prostaglandins. How selective these remedies are can determine their effectiveness and/or side effects. However systemic enzyme supplements can actually digest, or break down, certain prostaglandins responsible for inflammation, avoiding the question of side effects due to lack of proper selectivity.

For example, protease enzymes can help remove excess fibrin that causes inflammation and joint pain. "Inflammation is especially tender in moving joints where denser tissues rub against each other and fibrin increases blood viscosity and blood pressure," said Daniel Curtin, Arthur Andrew Medical. He explained enzymes in his company's Neprinol supplement digest fibrin and pro-inflammatory prostaglandins leaving the blood purified, quelling the immune response and retuning inflammatory levels to normal. In published research, a combination of the enzymes rutosid, bromelain and trypsin in patients with knee OA improved functionality and decreased pain at rest and on motion.¹⁶ In other studies, this combination of protease enzymes (Phlogenzym® from Mucos Pharma) decreased pain and stiffness measures in patients with a high level of pain from hip OA, and reduced pain and joint tenderness and swelling in knee OA patients after three weeks of supplementation.^17,18

Mike Smith, Specialty Enzymes, called systemic enzyme supplementation the cutting edge in enzyme research, although practitioners and people in general think of digestion when they think of enzymes. "Certainly, the research is there, but getting the word out is more problematic," he said. "Fortunately, more and more health care providers are utilizing systemic enzymes for inflammation and cardiovascular issues. This is especially true given the concerns over NSAIDs." He added practitioners and patients are looking for natural alternatives, and systemic enzymes fit the bill nicely. "This is especially true since the positive results are both rapid and dramatic." He noted growth in this area of enzymes has been very consistent over the last 10 years. "One can associate this with a low noise level about systemic enzymes combined with a high positive result for patients," he explained. "Word of mouth can be very effective."

1. Roy S et al. “Human Genome Screen to Identify the Genetic Basis of the Anti-inflammatory Effects of Boswellia in Microvascular Endothelial Cells.” DNA Cell Biol. 24, 4:244-55, 2005.

2. Shakibaei M et al. “Suppression of NF-kappaB activation by curcumin leads to inhibition of expression of cyclo-oxygenase-2 and matrix metalloproteinase-9 in human articular chondrocytes: Implications for the treatment of osteoarthritis.” Biochem Pharmacol. 2007 May 1;73(9):1434-45.

3. Park C et al. “Curcumin induces apoptosis and inhibits prostaglandin E(2) production in synovial fibroblasts of patients with rheumatoid arthritis.” Int J Mol Med. 2007 Sep;20(3):365-72.

4. Lev-Ari S et al. “Curcumin synergistically potentiates the growth-inhibitory and pro-apoptotic effects of celecoxib in osteoarthritis synovial adherent cells.” Rheumatology (Oxford). 2006 Feb;45(2):171-7.

5. Schulze-Tanzil G, Hansen C, Shakibaei M. “[Effect of a Harpagophytum procumbens DC extract on matrix metalloproteinases in human chondrocytes in vitro][Article in German].” Arzneimittelforschung. 2004;54(4):213-20.

6. Grant L et al. “A review of the biological and potential therapeutic actions of Harpagophytum procumbens.” Phytother Res. 2007 Mar;21(3):199-209.

7. Wegener T, Lüpke NP. “Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil's claw (Harpagophytum procumbens DC.).” Phytother Res. 2003 Dec;17(10):1165-72.

8. Warnock M et al. "Effectiveness and safety of Devil's Claw tablets in patients with general rheumatic disorders." Phytother Res. 2007 Dec;21(12):1228-33.

9. Chantre P et al. “Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis” Phytomedicine. 2000;7(3):177-83

10. Peter Cisár et al. “Effect of pine bark extract (Pycnogenol®) on symptoms of knee osteoarthritis” Phytother Res. 2008;22(8):1087-92.

11. Reza Farid et al. “Pycnogenol supplementation reduces pain and stiffness and improves physical function in adults with knee osteoarthritis” Nutr. Res. 2007;27(11):692-97.

12. Frestedt JL et al. "A natural seaweed derived mineral supplement (Aquamin F) for knee osteoarthritis: A randomised, placebo controlled pilot study." Nutrition. 2009, 8:7.

13. Joy L Frestedt et al. “A natural mineral supplement provides relief from knee osteoarthritis symptoms: a randomized controlled pilot trial” Nutr J 2008;7:9 DOI:10.1186/1475-2891-7-9

14. Reto Widrig et al. “Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomized, double-blind study” Rheumatol Int. 2007;27:585-91

15.Ernst E, Pittler MH. “Efficacy of homeopathic arnica: a systematic review of placebo-controlled clinical trials” Arch Surg. 1998;133(11):1187-1190.

16. Akhtar NM et al. “Oral enzyme combination versus diclofenac in the treatment of osteoarthritis of the knee--a double-blind prospective randomized study.” Clin Rheumatol. 2004 Oct;23(5):410-5.

17. Klein G et al. “Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs.” Clin Exp Rheumatol. 2006 Jan-Feb;24(1):25-30.

18. Tilwe GH et al. “Efficacy and tolerability of oral enzyme therapy as compared to diclofenac in active osteoarthrosis of knee joint: an open randomized controlled clinical trial.” J Assoc Physicians India. 2001 Jun;49:617-21.