Musculoskeletal Pain Relief for People with Arthritis, Lupus, and Fibromyalgia

Robert Thiel, Ph.D., Naturopath Director of Research, Center for Natural Health Research

Key words: arthritis, fibromyalgia, lupus, muscloskeletal pain, reflex nutrition assessment

Thiel, R.J. Musculoskeletal Pain Relief for People with Arthritis, Lupus, and Fibromyalgia. ANMA Monitor 1 (1): 8-10, 1997
Thiel, R.J. Musculoskeletal Pain Relief for People with Arthritis, Lupus, and Fibromyalgia. Townsend Letter 172:91-92, 1997

Abstract: The purpose of this trial was to determine how often nutrition-based interventions could result in musculoskeletal pain relief for people with various forms of arthritis, lupus, and fibromyalgia. Of the 81 participants, all of whom were given nutritional supplementation, 85.2% reported pain reduction within 30 days and 98.8% reported pain reduction within 60 days (P < 0.001). 70.4% reported substantial reduction in pain, while 28.4% reported minimal reduction in pain. Possible food intolerances were found in 77.8% of the participants.

INTRODUCTION
Many people have musculoskeletal pain which is frequently caused by inflammation. Some of the most common types are from osteoarthritis, rheumatoid arthritis, gout, non-specific arthritis, lupus, and fibromyalgia [1]. Arthritis can afflict people of either sex or any age, although most with lupus or fibromyalgia are women [1].

This report includes the results of a pretest-posttest trial involving 81 people who suffered from arthritic pain, lupus, and/or fibromyalgia. The purpose of this trial was to measure how often nutrition-based recommendations could help reduce the pain associated with these conditions and to identify dietary factors that may be involved.

SELECTION CRITERIA
Adults were eligible for inclusion in this trial if they resided in California, came to our office, agreed to provide (and did provide) feedback, signed a consent agreement, and indicated that they suffered from musculoskeletal pain of an arthritic nature or who had systemic lupus erythematosis or fibromyalgia.

This report includes everyone of our active clients who met these criteria. 88 people were eligible, but seven either failed to follow the recommendations or provide the required feedback. Of the 81 actual participants, four had systemic lupus erythematosis, twelve had fibromyalgia, and sixty-five had some form of arthritis. The ages of the participants ranged from 20-86; the mean age was 54.2 years. 21 of the participants were male and 60 were female.

METHOD
After completing the selection documentation, all subjects were interviewed for approximately 45 minutes. All subjects were then assessed using Reflex Nutrition Assessment (RNA). RNA is a non-invasive technique used to assess nutrition status by observing the response of muscles under externally provided human-force (it is similar to other forms of muscle testing [2]). Performing RNA for people with musculoskeletal pain normally consists of performing three assessments. The first assessment is to determine if a reflex directly over the area of pain indicates a nutritional need (by observing a reduction in muscular strength); the second is to determine which nutritional intervention can help fit that need (by observing an increase in muscular strength). The third is to assess for possible food sensititivities--a weakness when exposed to the food is considered an indication of a possible sensitivity. Many have reported success in using it and similar techniques [2-4].

Participants who appeared to have (through the interview process combined with reflex assessment) a sensitivity to one or more foods were advised to discontinue consumption of them. Participants were also advised to consume an average of three tablets (per day) of one or more nutritional supplement for each pain-related reflex concern. Although the supplements varied, items included non-isolated chondroitin-sulfate-A with antioxidants, soluble calcium with magnesium, acidifying calcium, glucosamine with synergists, fortified enzymes, fish oils, yucca with other herbs, and cherry with other herbs. To assist with fatigue, participants with fibromyalgia (and some others) also consumed various glandular formulas. Actual products used instead were those that reflex checked as best. Subjects were interviewed at approximately 30 day intervals to determine any change in pain levels.

RESULTS
Possible food sensitivities were found in 63 (77.8%) of the participants; 33.3% had multiple sensititivies. Those foods by occurrence were bovine dairy products 42.0%, caffeine products 30.9%, refined carbohydrates (sucrose, white sugar, white rice) 14.8%, wheat 9.9%, oats 8.6%, high purine foods 2.5%, and others 4.8%.

85.2% of participants (69 of 81) reported pain reduction within 30 days. 98.8% (80 of 81) reported pain reduction within 60 days; the P value of this result was < 0.001. 70.4% reported significant or complete pain reduction, while 28.4% reported only minimal reductions in pain. All participants with systemic lupus erythematosis or fibromyalgia reported reductions in pain. The one participant that did not report pain reduction, did report increased energy within 60 days and within 30 additional days did report a reduction in pain. Gender did not appear to play any role in determining pain reduction.

DISCUSSION
Osteoarthritis may be the most preventable form of arthritis. A panel convened by the National Institutes of Health stated that 1/2 of American diets are deficient in calcium [5]. My experience is that people who do not consume dairy products or who are unknowingly sensitive (or allergic) to bovine dairy products are the most likely to develop osteoarthritis. Non-bovine dairy sources of calcium include goats' milk, bok choy cabbage, turnip greens, spinach, sardines, and brocolli [6]. I am cautious about calcium supplementation since not all forms of calcium are absorbed well (food calciums are the best; for those who use mineral salts, using multiple calcium forms can be effective).

People with osteoarthritis appear to benefit greatly from nutritional approaches due to the physiology of the joints. The bony surfaces are covered by a thin layer of articular cartridge which is actually two layers of cartilage that slide past each other during motion [7]. In osteoarthritis this cartilage deteriorates. Polysulfated glycosaminoglycan has been reported to induce articular cartilage matrix synthesis and to decrease matrix degeneration [8]. Polysulfated glycosaminoglycan is a mixture of highly sulfated glycosaminoglycans, a major source being chondroitin sulfate extracted from bovine tracheal cartilage [8]. Since there is an increased turnover rate of articular cartilage matrix (joint tissues) in osteoarthritic joints [8], it appears logical that ingesting nutrients that the joints need would be helpful for people with this problem. Chondroitin sulfate compounds have been used in Europe for decades to decrease matrix degeneration in the joints of persons with osteoarthritis [8]. In a recent study involving 700 subjects with osteoporosis, 85% reported having good (26%) to excellent (59%) results in pain reduction [9]. Bovine tracheal cartilage has also been reported to reduce the need for anti-inflammatory medications for some people with arthritis [10].

Technically, rheumatoid arthritis is believed to be a T cell mediated reaction against an unknown antigen which causes joint inflammation [1]. Reducing arachidonic acid (such as going off of dairy) and increasing consumption of omega-3 fatty acids (as is found in fish or flax oils) has been reported to help people with rheumatoid arthritis [11]. This trial did not confirm the notion that people with rheumatoid arthritis uniformly benefit from avoiding plants in the nightshade family such as potatoes, tomatoes, eggplant, and red pepper (although some few will). It appears that many dietary factors are specific to the individual.

People with gouty arthritis have a problem which is almost always helped by natural methods. People with gout need to avoid foods high in purines. These purines cause painful uric acid crystals to form, many of which settle in the lower extermities [1]. Commonly consumed high purine foods appear to be whole wheat, organ meats, fowl, and shellfish.

In my opinion, non-specific arthritis is similar to rheumatoid arthritis in that avoiding certain foods can be helpful. My experience also suggests that the liver is involved in people with non-specific arthritis. It is has be speculated that people with rheumatoid or non-specific arthritis sometimes have their problems worsened by free radical activity and can benefit from antioxidants [11]. Free radicals can damage joint tissues [12]. Free radical reactions continue to damage cell constituents until they are neutralized. They can be neutralized by antioxidant nutrients [13]. Proanthocyanidins are powerful antioxidants extracted from grape seeds, soy beans or pine bark; Passwater claims their ability to bond to collagen promotes renewed youthfulness, flexibility, and body integrity [14]. For best results, I personally like products which combine antioxidants (including proathocyanidins) and chondroitin sulfate (like Derma-Lyph, which is especially good when knees or hips are issues).

Systemic lupus erythamatosis (SLE) is an autoimmune disorder with similarities to rheumatoid arthritis, though it has many additional symptoms [1]. Approximately 90% of people with SLE complain of intermittent arthralgias, polyarthritis, and similar articular problems [1]. Fibromyalgia is another autoimmune disorder. It similar to rheumatoid arthritis combined with chronic fatigue [15]. I have found that most people with fibromyalgia or SLE are bothered by bovine dairy products. Nutrition-based interventions can be quite effective for people with either of these conditions. Thus far, I have helped every person who has come to my office with fibromyalgia who has followed my recommendations as well as most with SLE.

Be cautious about how you discuss pain and nutritional supplementation as the FDA has not yet accepted much of the scientific research as a basis of making claims (even though true). Having said that, it is my strong opinion (based on years of successful clinical experience) that people with musculoskeketal pain can be helped from nutrition-based interventions.

REFERENCES
[1] Berkow, R. The Merck Manual of Diagnosis and Treatment, 14th ed. Merck & Co. Rahway (NJ), 1982
[2] Thiel, Robert J. Serious Nutrition for Health Professionals. Arroyo Grande (CA): California Health Group, 1995
[3] Burr-Madsen, Angela. Body Polarity Reflex Analysis and the Nutritional Connection. Carson City: Thoth, Inc., 1992
[4] Rosen, Marc S. and Williams, Louisa. The research status of applied kinesiology, part II: An annotated bibliography of applied kinesiological research. In: A.K. Review, Vol. 1, No. 2: 34-47, 1991
[5] Many American diets deficient in calcium: NIH Committee. Nutrition Week 22: 7, June 10, 1994
[6] Whitney, Eleanor Noss, and Nunnelley, Eva May. Understanding Nutrition. 4th ed. West
Publishing, New York, 1987
[7] Luciano, D., et al. Articulations. In: Human Anatomy and Physiology, 2nd ed. McGraw-Hill: New York: 170-182, 1978
[8] Todhunter, Rory J. and Lust, George. Polysulfated glycosaminoglycan in the treatment of osteoartritis. Journal of the American Veterinary Medical Assocation 204 (8): 1245-1250, April 15, 1994
[9] Kriegel, Henry. Bovine tracheal cartilage. Health Supplement Retailer 1 (3): 34-37, December 1995
[10] Nicolini, Emilio. Studies in cartilage. Presentation at the 12th Annual Convention of
the American Naturopathic Medical Association, Las Vegas, September 8, 1995
[11] Darlington, L.G. and Ramsey, S.W. Clinical Reveiw of Dietary Therapy for Rheumatoid Arthritis. British Journal of Rheumatology 32: 507-514, 1993
[12] Emerit, Ingrid. Free radicals and ageing of the skin. Free Radicals and Ageing: 328-340, 1992
[13] Burger, Steve. Vitamins and Minerals for Health. Wild Rose College of Natural Healing, Calgary, Circa 1988
[14] Passwater, Richard A. The New Superoxidant-Plus. Keats Publishing: New Canaan (Conn.), 1992
[15] Clauw, D.J. The pathogenesis of chronic pain and fatigue syndromes with special
reference to fibromyalgia. Medical Hypotheses 44 (5): 369-378, May 1995

The Center for Natural Health Research supplies research and other items for health care professionals interested in natural interventions.

For additional information check out http://www.healthresearch.com. This research is for doctors and other health care professionals. Thiel is not a medical doctor. None of this research is medical advice, nor should it be construed as medical advice; nor is any of this information specific for any individual.

Copyright 1999/2000 by Robert Thiel, Ph.D., Naturopath All rights reserved.