`Alternative' approaches in arthritis relief

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Somewhere in America is a woman whose arthritis is much better because she bought a new car. There are other women whose arthritis has notably improved because they're taking a new vitamin combination that almost no one has even heard of yet.

Alternative approaches to arthritis is a tricky topic, though. How do you sort out the ones that are just old (or new) myths from those that have a decent chance of doing the job for you?

Well, this may surprise you, but I believe the best place to go for alternative arthritis treatment is to really good doctors. That's what we did.

USING YOUR HEAD
Funny thing, but perhaps the most important alternative we got from a doctor is something that happens in your head. An alternative attitude.

What many people need to get past is the notion that "it's just arthritis." Everyone has it; what's the big deal?

The big deal, says arthritis specialist Cody Wasner, M.D., is that "arthritic conditions cause more disability and financial loss than any other chronic illness. There's no illness of this severity that is considered so minor by so many people."

Once you have the right attitude and you're determined to lick arthritis, you can begin considering some other alternatives.

But again, you must use your head.

Dr. Wasner (a spokesperson for the Arthritis Foundation) gives a case in point, one that occurred just a few weeks ago.

A woman who was desperate came in with osteoarthritis of the thumb and wanted to take a complex nutritional mixture with some unknown (maybe dangerous) ingredients.

Dr. Wasner proposed his own alternative treatment, after learning what seemed to make her thumb really ache. "She's a real-estate person and has to get into and out of her car about 40 times a day. The car she had was an older model with one of those buttons you have to push on the handle to open the door. So 40 times a day she was pushing, and that really aggravated her thumb."

He showed her how to open the car door using her unaffected fingers and both hands, and "that helped her so much she went out and bought a new car with different door handles. No more thumb problems."

That was a much safer, simpler alternative to her alternative, which is why we say that doctors and "alternatives" are not mutually exclusive.

Actually, there are dozens of simple alternative movements you can use to quiet arthritis. An occupational therapist can point them out. (Ask your physician to recommend one.)

A NUTRIENT CONNECTION?
Now to be honest, not all alternatives are so clear cut and medically pristine. Some are new and not yet verified through replicated studies. Others are just plain controversial.

The one I want to mention now is certainly new, published just months ago, and as for controversial--well, it's bound to be because it involves the "V" word--vitamins.

The new research pairing two vita-mins--B12 and folate--tested them vigorously in 26 patients with osteoarthritis of the hands. All the patients had previously been taking prescription nonsteroidal anti-inflammatory drugs (NSAIDs) to control their pain. Each patient quit taking all medications (and vitamins) for 10 days. Then each patient tried three different treatments (B12-folate combination, folate alone or an inactive placebo) for two months at a time. To ease any pain, they were permitted to take acetaminophen, an OTC drug that is milder than NSAIDs. After each two-month period, various tests were made to determine pain levels, grip strength, the number of acetaminophen pills taken and other parameters.

To rule out the power of suggestion, neither the patients nor the doctors knew which preparation was being taken. (Only the hospital pharmacist knew, and he wasn't talking till the whole trial was over.)

When it was over, the B12-folate combination was the clear winner, showing apparent improvement that was equal to or better than the relief obtained in the powerful medications being taken before the study began (Journal of the American College of Nutrition, August 1994).

But if the relief is no better than with drugs, is there really a benefit? "With NSAIDs, there were many side effects; with vitamins there were none," lead author Margaret A. Flynn, Ph.D., R.D., of the University of Missouri-Columbia Medical School, told us.

The dose of B12 was 20 micro-grams, which is not especially high, even though it's more than three times the Daily Value (DV). The folate dose was 6,400 mcg., which is 16 times the DV. Why so high on folate?

"An earlier pilot study we did showed no effect at lower doses, so in this study we went with a higher dose that is generally believed to be safe," Dr. Flynn added.

More work needs to be done to confirm these results. Meanwhile, you need to ask your doctor about taking so much folate and if a folate-B12 prescription makes any sense for you.

There is some intriguing evidence that perhaps one elderly person in eight is metabolically deficient in B12. Not so deficient to develop pernicious anemia, but low enough to have metabolic problems that may lead to circulatory and neurological problems (American Journal of Clinical Nutrition, July 1994). Perhaps arthritis is also connected to low B12, even when blood tests come up normal.

OTHER POSSIBILITIES
Here is a quick look at some other arthritis research in alternatives.

Put this one into your talk-to-the-doctor file, too. It involves a natural oil fraction called gammalinolenic acid (or GLA for short), and you may have seen it on the shelf of your health-food store. The bad news is that the dosage used is--again--really high. The typical GLA tablet has about 45 milligrams of active ingredient, but the study I'll mention used 1.4 grams--which is 1,400 mg. Whoa! And more unhappy news--GLA is not approved for treatment of anything, so the average doctor will probably not leap at the chance to prescribe it. That said, here's the good news about this natural treatment, derived from oil of either borage seed or evening primrose.

In patients with rheumatoid arthritis and painful synovitis, those taking GLA had--after 24 weeks--reduced the number and severity of tender and swollen joints all told by about 30 to 40 percent when compared with those patients given look-alike placebos. Those receiving the placebo reduced nothing. And while 7 out of 14 patients improved on GLA, only 1 in 12 of the other group got better.

That preliminary research was done at several medical centers and reported by Lawrence J. Leventhal, M.D., and colleagues in Annals of Internal Medicine, November 1,1993.

It's being followed up with a controlled trial (under FDA auspices) of even higher GLA doses.

Now if all these high-dose supplements leave you feeling--well, overdosed--you might want to try something as familiar as a tuna sandwich.

At the University of Washington in Seattle, researchers noted that when they compared hundreds of women affected by rheumatoid arthritis (RA) with those without the disease, there seemed to be a "thing" between RA and eating baked or broiled fish. A good "thing," assuming you like fish. Compared with women who, before developing RA, ate fish less than once a week, women who ate it once oF twice a week were about one-quarter less likely to have RA. Eating fish twice or more often a week was linked to even less chance of having RA--down to just 57 percent compared to non-fish lovers.

Now, is this a cause-and-effect deal, or just a blip on someone's health sonar? Actually, since fish oils are similar to the plant oils we mentioned earlier, in that both are believed to interfere with the body's ability to crank out chemicals that cause inflammation, maybe it's not a blip but, well, the Tuna Fish of Truth.

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By Mark Bricklein

with Michele Stanten, Research Associate

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