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PRx Host : |
We're fortunate to have Judith Horstman with us tonight. Judith is an award-winning journalist and Fulbright scholar who has written a new book,  The Arthritis Foundation's Guide to Alternative Therapies. Welcome, Judith!
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Judith Horstman : |
Hi! I'm happy to be here.
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PRx Host : |
Judith, your book covers so many alternative remedies, and I'm eager to learn more about them. Before we start, I'm curious : do you have a personal interest in arthritis and/or alternative remedies?
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Judith Horstman : |
Yes, I've been interested in alternative therapies for almost 30 years. I've been meditating and practicing yoga for that long and writing about alternatives for the past 10 years or so. I have osteoarthritis myself.
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PRx Host : |
Do you believe the alternative practices you've done have helped your arthritis?
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Judith Horstman : |
Definitely. Meditation is a wonderful way to quiet your mind and your body and help with pain. Yoga keeps you limber and strong, but you have to be careful that you learn and practice yoga with a teacher who knows something about your kind of arthritis. Actually, the alternative therapy I've found most helpful for my arthritis pain is deep relaxation, the kind taught by Jon Kabat-Zinn in his stress-reduction courses.
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PRx Host : |
Is deep relaxation something anyone can do? I know that some people become uptight about not doing relaxation and meditation "right."
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Judith Horstman : |
Deep relaxation is one of those things that's so simple it can be hard for some people, especially people who think too much! You can read about how to do it or use a tape, but it's useful to go to a stress-reduction course and learn how to do it from a good teacher. Can I say something about people getting uptight about relaxing?
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PRx Host : |
Please do!
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Judith Horstman : |
I think sometimes we tend to blame ourselves for not being "good patients" or for not being able to do things people say that are good for us. We try too hard, and there's always someone who "blames" the victim, who's going to tell you it's your fault that you aren't getting better or managing your pain better. People with fibromyalgia (a kind of arthritis that's really a chronic pain syndrome) often hear that.
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PRx Host : |
Thanks, Judith. You've addressed an important issue. I'd like now to turn to the use of supplements.
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Judith Horstman : |
That's a big subject! And it's one that appeals to a lot of people. That's because they think they can make their arthritis better by taking an herb or a dietary supplement and because we hear so much about herbs and supplements in the media as "cures."
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PRx Host : |
Are herbs effective for arthritis?
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Judith Horstman : |
There are many herbs that are effective for some arthritis symptoms such as pain and inflammation, but these aren't cures. And you have to be very careful that you get your herbs or supplements from a reliable source. Some of thge supplements that research is showing can help with arthritis pains include ginger, which helps for inflammation, fish oil, which helps with rheumatoid arthritis inflammation (and also helps prevent heart disease), and glucosamine. Also, many people with chronic illnesses, such as arthritis, find that they are often depressed. It's hard not to be depressed when you hurt all the time.
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PRx Host : |
Of course.
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Judith Horstman : |
The herb St. John's wort has been used in Europe for a long time to treat depression. In fact, it's an approved medication (and not an "alternative") in Germany. You'll see it sold here and it can be effective for mild depression. But (and this is a big BUT), herbs and supplements can have side effects, just like drugs. People seem to think that just because something is natural, it's safe, but the fact is that anything that's strong enough to help you is strong enough to hurt you.
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PRx Host : |
Is there any danger in combining herbs?
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Judith Horstman : |
That's an excellent question. And one that many people don't think about. They tend to think that more is better and they may be taking several dietary supplements or herbs. For example, they may be taking ginger and fish oil, or they may be taking borage oil, and maybe some ginkgo for memory. All of these supplements have blood-thinning effects. So, if you're taking NSAIDs (which are nonsteroidal anti-inflammatory drugs like aspirin or ibuprofen, which are also blood-thinners) along with these supplements, you could have a bleeding problem.
And many people are also taking Coumadin, which is a blood-thinner. So, if you decide to dose yourself with a couple of supplements and then you take your NSAIDs for pain and your Coumadin for heart health, you could find that you might have a bleeding problem.
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PRx Host : |
A question from our audience that relates to herbs, Judith.
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Joely : |
Have you heard of eating flaxseed or flax oil to help reduce inflammation?
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Judith Horstman : |
That's a great question! Flaxseed and flax oil aren't as well-known as fish oil, but flaxseed products have great promise for helping with inflammation. They contain omega-3 oils, and while studies haven't proven that they actually reduce inflammation, they suggest that they can raise the levels of good anti-inflammatory oils in your body.
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PRx Host : |
How do you know how much to take of flaxseed products? Can you take too much?
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Judith Horstman : |
It's possible to take too much of anything. You can tell that you're taking too much flaxseed oil when you have diarrhea. My sources at the Flax Institute recommend taking 1-3 tablespoons per day of the oil or about 1/4 of a cup of the meal, ground up, and mixed with your food. You can also use it in cooking. I sometimes use flaxseed oil with fresh lemon juice as a salad dressing.
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PRx Host : |
Another good question from our audience, Judith.
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Jai67 : |
What about the "nightshade diet"? Does avoiding potatoes and eggplant really help?
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Judith Horstman : |
That's an old myth. Some years ago, a man named Childers proposed the theory that plants of the nightshade family such as tomatoes, potatoes, bell peppers, and eggplants can increase inflammation. However, that hasn't proven to be true in studies. Childers did conduct one uncontrolled study in which people with arthritis were asked to avoid nightshade foods. These people said their symptoms improved, but that's hardly a scientific study. In fact, there are no controlled scientific studies that show that any one kind of food affects your arthritis symptoms.
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PRx Host : |
Back to flaxseed … another audience question.
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Patricia_King : |
Aren't the good qualities of flaxseed oil destroyed by cooking?
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Judith Horstman : |
Yes, in the case of the oil. If you heat the oil, you will destroy its valuable properties. But the flaxseed meal can be used in cooking without losing its potency. Some people mix it into muffins. By the way, you have to be careful buying these oil supplements. You should find them in the refrigerated section of a health food store, and check the dates to make sure they aren't old, because they can lose their potency easily.
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PRx Host : |
Should they be organic?
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Judith Horstman : |
In the best of worlds, indeed! And many are.
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PRx Host : |
Do you find that taking supplements really has helped you?
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Judith Horstman : |
Yes, I've found that some help and some don't. I take vitamins every day. I've been really good about that for the past year or so, and it's nothing very earth-shaking. I take vitamin C, E, B-12, and folic acid. And, of course, calcium. These are the vitamins that are recommended by most rheumatologists and by Dr. Andrew Weil, too. As for supplements, there's such a variety of them and not everybody responds to the same ones.
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Knoonan : |
For tendinitis (wrist), should I take glucosamine and/or chondroitin with the oils mentioned above?
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Judith Horstman : |
Hmmm. the evidence, so far, for glucosamine and chondroitin is that they help with osteoarthritis, or joint pain, by working on the cartilage. Tendinitis doesn't seem to me like it would be much helped by these two supplements, and they're not cheap. I don't really see that the oils would particularly help with tendinitis either.
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DolS : |
What is your opinion of DMSO for pain relief?
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Judith Horstman : |
That's a blast from the past! DMSO first showed up about 40 years ago as a new miracle treatment for many kinds of joint and muscle pain. Actually, it's a very useful solvent used in many laboratories. It's used to preserve human tissue and human embryos in freezing. But, the FDA got nervous about DMSO for human use as a treatment when there were some bad results from an animal test. Therefore, all of the DMSO available on the market to consumers is industrial grade, not medical grade. And some people had some bad effects from contaminated products.
Today, DMSO is showing promise again -- as a transdermal agent. It has the ability to transport other substances across cell membranes. A Canadian firm has developed a new treatment that uses DMSO and a prescription NSAID called diclofenac [brand name Cataflam]. The DMSO carries the NSAID exactly to the spot you want, so you can just "paint" it on a sore joint. This could be available soon, and it's a vindication for many people who've long believed that DMSO has many medical uses.
But, don't, don't, don't buy DMSO and treat yourself! There really is no safe over-the-counter source for it. If you're interested in trying it, ask your doctor to find you a source.
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PRx Host : |
Another question from our audience in another area.
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DolS : |
Is acupuncture effective for pain relief from arthritis?
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Judith Horstman : |
Now, acupuncture is a five-star treatment in my book! I have had acupuncture for my osteoarthritis. In fact, Kaiser Permanente (my HMO in San Francisco) uses acupuncture. I went right to the clinic -- like an ordinary outpatient clinic -- and had my acupuncture treatments! I found it really eased the pain I had in my neck, which was muscle pain as well as joint pain.
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PRx Host : |
Why is it helpful?
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Judith Horstman : |
Nobody really knows. It's one of the key therapies used in Chinese medicine. So, millions of people have had acupuncture for thousands of years. It's based on the principle that everybody has a vital life energy called "chi" that runs through our bodies, along invisible channels called meridians. In acupuncture, hair-thin needles are placed at precise points along these meridians to balance your "chi."
Now, Western scientists are still uncertain how it works. It's believed that the needling in acupuncture may stimulate the release of endorphins which are nature's natural pain-killers. Whatever the theory, the National Institutes of Health has endorsed acupuncture as a useful therapy for many kinds of pain. In Chinese medicine, acupuncture is also used as a way to maintain health.
Now, as in every therapy, some people say it doesn't do a thing for them. But I've found it extremely effective. And many doctors in chronic pain clinics, especially, are beginning to include acupuncture as a standard treatment.
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PRx Host : |
What about magnet therapy? Can that reduce pain?
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Judith Horstman : |
Well, I know magnets are a very popular therapy. In fact, a multibillion-dollar-a-year therapy. You see lots of articles about athletes who claim they work, but there's no really good scientific evidence that magnets do anything. There are only two very small studies in which people said it seemed to work better than a placebo. But, most experts think it's a waste of money.
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PRx Host : |
What about copper bracelets?
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Judith Horstman : |
I think they can be a nice jewelry accessory. But, there's not convincing evidence they do anything for arthritis. There is one study in which half of the people wore copper bracelets and the other half wore a different metal bracelet painted to look like copper. Those with the copper bracelets said they did have less pain. But scientists don't understand how this could have any effect. It is possible, I suppose, that small amounts of copper could be absorbed through the skin from the bracelet, thought his hasn't been proven. But if the copper is shiny, it has a lacquer finish and isn't touching your skin at all.
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PRx Host : |
Another acupuncture question, Judith.
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EdeeTX : |
Could acupuncture help someone who has had several vertebrae in her neck fused and is in constant pain?
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Judith Horstman : |
Well, I really don't know -- I'm not a doctor -- but I think it's worth exploring because acupuncture does seem to help so many kinds of pain. Also, acupuncture is safe. There are no known side effects, so you really don't have anything to lose. I would suggest consulting a doctor who uses acupuncture and other alternative therapies for chronic pain. And I really feel for you.
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Whitt12770 : |
My mother is in her early 50s and has recently found out she has osteoarthritis. Isn't that very young to be afflicted with arthritis? What can she do to combat this … and is it hereditary?
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Judith Horstman : |
A very good question! No one knows why some people get osteoarthritis and others don't. There may be a hereditary component that would tend to put you more at risk, and it's true that the longer you live, the more likely you are to have "wear and tear" on your joints that will erode away the cartilage. People who have had accidents or injuries to their joints, such as athletes or people who work at jobs that stress certain kinds of joints, tend to develop osteoarthritis as a result of these repetitive injuries.
About combating it? There's plenty you can do for your arthritis. The first thing is to keep moving. I know you won't want to when you're in pain, but your joints need to be exercised and so does the rest of your body. By strengthening the muscles around your joints, you relieve some of the stress on the joints. Also, if you're overweight, lose weight! Just think of that extra 10 pounds as a 10-pound weight you're carrying on your sore knee joint or hip joint.
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PRx Host : |
Judith, what about informing your doctor, assuming he/she is a traditional medical doctor, about herbs and acupuncture and other alternative remedies you may be doing? Many people won't do this because they fear being ridiculed or treated as doing something "useless."
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Judith Horstman : |
I think your doctor should know everything you're taking or doing, even if your doctor doesn't seem like he or she wants to know. Many doctors today may act scornful or warn you against using alternatives. Part of the reason is that they may not know much about them, and they don't want you using something that might hurt you. But, more and more, as patients demand information from their doctors, doctors are beginning to educate themselves about alternatives.
It's also important that your doctor note in your medical record any herbs, supplements or other therapies you are trying. This could be a life-saver, particularly if you need surgery suddenly and you've been taking a lot of anti-inflammatory herbs or supplements that could increase your chances of bleeding. All good relationships are built on trust. By keeping information from your doctor, you aren't giving him or her the best information about your health. And you could be setting yourself up for a medical emergency.
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Brudy : |
Are there any vitamins or herbs that should be avoided when taking NSAIDs for rheumatoid arthritis?
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Judith Horstman : |
That's a very good question. Remember that balance is important. The problem with taking supplements and NSAIDs is that you might be taking too much of a good thing. As we said, some herbs and supplements contribute to blood thinning, and so do NSAIDs. WARNING: However, you should NEVER stop any drugs your doctor has prescribed without consulting your doctor. This is especially important if you have RA inflammation because, if the inflammation isn't checked, it can cause permanent and disabling deformities in your joints. By the way, I'd like to say here again that I am NOT a doctor. So, be sure to consult a doctor or other health professional.
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PRx Host : |
Another audience question, Judith. You're being so helpful!
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PRx_julie : |
What do you know about micro-dosing prednisone?
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Judith Horstman : |
Prednisone is a prescription drug, not an alternative therapy. So, I'm afraid I really don't know much about this. Sorry I can't help you!
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PRx Host : |
Judith, it's terrific that your book is published by the Arthritis Foundation. Great to have such support from a national organization. The book is called The Arthritis Foundation's Guide to Alternative Therapies.
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Judith Horstman : |
And, you're right, it IS terrific that the Arthritis Foundation is supporting and publishing this book. It will help people make informed decisions about alternatives and it is endorsed by the nation's experts on arthritis and is truly an unbiased source.
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PRx Host : |
The book can be found in bookstores everywhere, including online. It's the best source I've seen for giving the studies that support the alternative remedies -- or do not support them. Judith, thanks so very much for a superb chat, I know you're helping so many people who are dealing with the pain of arthritis.
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Judith Horstman : |
Thank you! It was a pleasure to be here.
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PRx Host : |
We hope you'll return in the future!
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Judith Horstman : |
I'd love to! Ask me back again.
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PRx Host : |
Also, to our viewers -- Judith is a columnist for Arthritis.com.
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Judith Horstman : |
Thanks again! You make me feel great!
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PRx Host : |
Many thanks, again, Judith, and now good night!
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More About Judith Horstman
Judith Horstman is an award-winning journalist with 30 years' experience writing and editing for newspapers, national magazines, books, new media, and special-interest publications. She has won two Fulbright Scholar grants, aVannevar Bush Fellowship for the Public Understanding of Science from MIT, and numerous awards from the Associated Press and the Best of Gannett for feature writing. Horstman has taught at Keene College, Oregon State University, and Santa Clara University.
Currently she is the editor of the World Federation of Neurology Amyotrophic Lateral Sclerosis website, devoted to Lou Gehrig's disease, at www.wfnals.org. She has also published The Arthritis Foundation's Guide to Alternative Therapies, a thoroughly researched review of alternative and complementary arthritis treatments, including herbs, magnets, acupuncture, and acupressure, as well as tai chi, yoga, and meditation.
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