Positive Health Online

Osteoarthritis (OA) is the most common form of arthritis, especially among older people. It is a joint disease caused by the breakdown of cartilage – the firm, rubbery tissue that cushions bones at joints. Healthy cartilage allows bones to glide over one another and absorbs energy from the shock of physical movement. In OA cartilage breaks down and wears away. As a result, the bones rub together, causing pain, swelling, and stiffness. OA may also limit the range of motion in affected joints. Symptoms tend to appear when individuals are in their 50s and 60s.

Ayurveda suggests that primarily an excess of ama (toxic waste) and lack of agni (digestive fire power) causes osteoarthritis. Osteoarthritis is a type of arthritis that is associated with wear and tear. Poor digestion and a weakened colon, resulting in accumulation of undigested food and the build-up of waste matter, can cause this. Poor digestion allows toxins to accumulate in the body and problems with the colon allow the toxins to reach the joints. One way, therefore, to treat arthritis is to stimulate the digestive fire (agni) and suppress the ama.

It is vital to diagnose which type of arthritis you have as Ayurveda distinguishes three categories corresponding to vata, pitta and kapha.

Depending on a person's lifestyle, diet and emotional constitution, vata, pitta or kapha goes out of balance. Then that particular dosha slows down agni resulting in the toxic, sticky by-product of inadequate digestion known as ama.

Arthritis differs in people depending on their body types.

Signs and Symptoms of OA

Signs and symptoms of OA may include the following:
• Joint pain (often a deep, aching pain) that is worsened by movement and improved with rest (in more severe cases, a person may experience constant pain);
• Stiffness in the morning or after being inactive for more than 15 minutes;
• Joint swelling;
• Joints that are warm to the touch;
• Crunching or crackling noise when the joint moves (crepitation);
• Limited range of motion;
• Muscle weakness;
• Abnormal growth of bony knobs near joints causing deformities (such as Heberden's nodes, in which bumps appear on the outermost finger joints).

Preventive Care

The following measures may reduce the risk of developing OA, Ayurvedically:
• Protecting an injured joint from further damage;
• Exercising;
• Losing weight;
• Avoiding excessive repetitive motions;
• Correct diet;
• Using appropriate herbs;
• Hospital treatment as a last resort.

Ayurvedic Herbs and Osteoarthritis

All these lie under the control of mental, emotional, physical, nutritional, environmental and even spiritual conditions. Ayurveda is the science of balance and teaches how to create mental, emotional and spiritual balancing with the assistance of nutrition, yoga, meditation, breathing exercises, herbs and supplements, according to our individual constitution (prakriti) and pathology (vikriti) or a person who has balance in his physiology (doshas), balanced digestive abilities (agni), balanced tissues (dhatus), balanced excretion (malas) and the person whose soul, senses and mind are content, is considered healthy. Technically speaking, inflammation represents a major source of oxidation or free radical damage and Ayurvedic medicine is blessed with an arsenal of wonderful herbs to control inflammations at different levels.

A few recent trials comparing Ayurvedic herbal remedies with placebo found that participants who consumed the Ayurvedic herbs experienced significant improvement (with only mild side-effects) compared to those in the placebo group.

Ayurvedic herbs, particularly involving Boswellia (Boswellia serrata), have shown promising results in OA. Patrick Holford, from the Institute of Optimum Nutrition, calls it the "ultimate gift to an arthritic" in his book Say No to Arthritis. The other two herbs that may be worth considering are winter cherry (Withania somnifera) and turmeric (Curcuma longa). In a study of 436 people taking Boswellia and Commiphora Mukul capsule combination over 12 weeks 86% of the people with OA showed a significant improvement.

Boswellia, also known as Frankincense, grows in India, Northern Africa and the Middle East. Extract of Boswellia has been used to treat arthritis, asthma, ulcerative colitis, Crohn's disease and skin conditions.

Osteoarthritis and Boswellia: In combination form with Ashwagandha, turmeric and zinc – studies have shown positive effects in the treatment of osteoarthritis. In a double blind placebo-controlled study, patients showed a significant improvement in pain severity and disability score. In an animal study, the dogs showed improvement in intermittent lameness, localized pain and stiff gait. All external factors that aggravate lameness, such as 'lameness when moving' and 'lameness after a long rest' diminished gradually.

A pair of placebo-controlled trials involving a total of 81 patients with arthritis found a significant reduction in swelling and pain over the course of three months. Further more a comparative study in 60 people over six months found the boswellia extract produced symptomatic benefits comparable to oral gold therapy.

Anti-inflammatory Turmeric

Turmeric (Curcuma longa) is the spice that gives curries their yellow color. It is traditionally used in Ayurvedic and Chinese medicine. Current research has found turmeric to be a powerful antioxidant, anti-inflammatory, anticarcinogenic, antimicrobial and hepatoprotective. It has also demonstrated positive results in cardiovascular and gastrointestinal diseases. The active principals in turmeric are the flavonoid curcuminoids along with various volatile oils, resins, proteins and sugars.

Anti-inflammatory Properties

Turmeric is a potent anti-inflammatory. Various laboratory studies have identified a number of different molecules involved in inflammation that are inhibited by curcumin. These include phospholipase, lipoxygenase, cyclooxygenase 2 (Cox-2), leukotrienes, thromboxane, prostaglandins, nitric oxide, collagenase, elastase, hyaluronidase, monocyte chemoattractant protein-1 (MCP-1), interferon-inducible protein, tumor necrosis factor (TNF) and interleukin-12 (IL-12). Cox-2 inhibitors, such as Celebrex and Vioxx, had been prominent as nonsteroidal anti-inflammatory drugs. Recently, Vioxx showed an increase in heart disease, and was recalled from the market. Turmeric, on the other hand, covers almost every aspect of inflammation and has a much broader spectrum than the current drug regimen available. In animal and in vivo studies, turmeric extract has been shown to decrease chronic and acute inflammation.

Oral administration of curcuminoids in instances of acute inflammation was found to be as effective as cortisone or phenylbutazone. In animal studies, oral administration of the turmeric extract reduced the inflammation of adjuvant induced arthritis. In monkeys, turmeric extract inhibited the inflammation due to neutrophil aggregation.

Anti-inflammatory Effects on Skin Diseases and Wound Regeneration

Turmeric extract applied to the skin topically has been shown to reduce inflammation and irritation associated with inflammatory conditions and allergies. In acne conditions, a bacterium called Propionibacterium acnes plays a role in inducing inflammation and acne. Turmeric extract along with Neem extract and Rubia cardifolia extract has been shown to stop the growth of Propionibacterium acnes. In other studies turmeric extract has been shown to regenerate skin and help repair wounds faster.

Doses

Typically 5-10 grams of turmeric is used per day. Standardized extract in the doses of 500 mg to 2,000 mg, two to three times per day.

Toxicity and side-effects

No toxicity has been reported in acute or chronic administration of turmeric extract. Turmeric extract caused ulcer as evident in one rat study only at a very high dosage (100mg/kg of body weight).

Antioxidant vitamins C and E may provide some protection.

Vitamin D and calcium are also recommended from around the age of 40 for strong bones.

A good source of minerals is also important. Research from The American Arthritic Research Foundation completed a study in November 2005 showing that lack of chromium aggravates the symptoms of osteoarthritis. A high protein food which contains a vast array of vitamins and minerals as well as amino acids, Omega 3 and 6 oils is Spirulina. This Spirulina is available from salty lakes, such as those found in Hawaii and South India.

Foods and How they Affect the Three Humours

The food that should be eaten are those which are beneficial in alleviating the type of arthritis one has – e.g. for a pitta type of arthritis use foods which reduce pitta. The following are examples of foods which affect the three doshas:
• Wheat reduces pitta;
• Rice promotes vata and kapha very slightly and reduces pitta;
• Chickpeas reduce pitta;
• Moong lentils (a green gram or moong bean) is considered the best of all lentils as it is easy to digest and brings all three humours in harmony;
• Aubergines increase kapha and pitta;
• Karela (bitter gourd) is a preventative against pitta disorders;
• Cabbage reduces pitta and promotes vata;
• Carrots bring balance to all three humours;
• Cauliflower is pitta-promoting and brings balance to an excess of vata and kapha;
• Potatoes are vata- and pitta-promoting;
• Spinach is considered a 'cold food' and so reduces pitta and kapha;
• Tomatoes increase kapha and pitta slightly;
• Apples reduce vata and pitta but increase kapha;
• Oranges reduce vata and slightly enhance pitta'
• Milk reduces vata and pitta;
• Garlic reduces vata and kapha but enhances pitta;
• Ginger reduces vata and kapha;
• Coriander reduces pitta.

The vast majority of the vitamins and minerals we need come from vegetables and fruit, so these food groups should make up to 50% of the food we eat. Most vegetables are best eaten raw or steamed.

Cherries, blueberries and hawthorn berries and their juice are good for gout because they contain anthocyanidins and proanthocyanadins. They have also been found to help enhance collagen strength and to have anti-inflammatory effects. Quercin found in onions, broccoli, squash, and red grapes is another example of a naturally occurring flavonoid with good anti-inflammatory properties.

Onions and garlic are rich in the sulphur-containing amino acids cysteine and methionine. These amino acids are essential constituents in both cartilage and anti-oxidant enzymes.

Eggs are rich in sulphur containing amino acids, although too many are not recommended in the diet due to their high fat content.

Crucificous foods, e.g. cabbage, Brussels sprouts and broccoli are highly beneficial as they are rich in glucosinolates, which improve detoxification and hence help prevent inflammation.

Seeds and nuts are important sources of vitamins, minerals and essential fatty acids.

Always use plenty of herbs and spices to balance the doshas.

Massage

Massaging with oils such as sesame oil helps. Mixing in 20% Mahanarayan oil fortifies the massaging oil.

Vata arthritis is the most common type of arthritis and is seen when there is an excess of vata, usually from the colon.

This settles in the joints accompanied by ama or toxins. The auto-immune system is triggered off and this attacks the joint surfaces. This results in pain, dryness and stiffness.

Treatment: Take hot baths and massage yourself or have an Abyhanga (body) Ayurvedic massage.

Pitta arthritis is seen when there is heat, swelling or a burning sensation. It starts with excess pitta or heat in the body and the accumulation of acid by-products of metabolism overflow from the intestine. These have moved through circulation to the joints.

Treatment: Take baths with luke warm/cold water and massage yourself or have an Abyhanga massage with cool oils, such as coconut oil. Follow a pitta pacifying diet. Boswellia-based herbs should help.

Kapha arthritis starts with a build-up in the lungs and sinuses causing a slow down of digestion and metabolism and blockage of the elimination of ama.

Treatment: Cool compresses and massaging yourself or having an Abyhanga Ayurvedic massage with oils such as coconut oil helps reduce symptoms. To strengthen the oil add 20% Khsheerbala oil to the coconut oil. A five to seven days detoxification diet and an anti-pitta diet is recommended. If cool compresses aggravate the pain, the arthritis may be either a vata or kapha type. Herbs such as Boswellia and Commiphora Mukul should help. Use ice-bag for cooling.

Abyhanga Ayurvedic massage with massage oils such as almond oil. A 20% solution of Sahacharadi oil can be added for a stronger oil. Dry heat such as sauna helps. A one to two week detoxification diet would also help. An anti-kapha diet, foods that are light, dry and warm, would be recommended. Hot herbs, such as dry ginger, turmeric and cinnamon, would be helpful. As with other types of arthritis, herbs such as Boswellia and Commiphora Mukul should help.

Case Study

Peggy Magson is 77 and has been suffering from Osteoarthritis in both her knees and elbows. She had been to her doctor on many occasions and had gone through the array of NSaids. Some gave her relief but she feared the side-effects. Without medication she struggled to move her elbows and walking was a problem. At this stage she decided to try the alternative route. She came to see us at the Ayurveda Institute of Europe's Clinic in Green Lane, Ilford. She was given some Boswellia with Commiphora Mukul combination capsules and told to take one in the morning and one at night.

Peggy's morning stiffness drastically improved such that she could wake up in the morning without pain. She was also able to walk without pain. She is now on a maintenance dose of Boswellia capsules and is enjoying a more 'normal' life.

Further Information

To check whether your body is adequately mineralized or alkaline one can do a pH test advised by Dr Robert Young. This simple test gives an indication whether you have enough reserves in the body. Research shows that people suffering from degenerative health conditions have too acidic bodies. For a free test, a diet sheet or for more information or learn about the Ayurvedic massages or herbs mentioned, please send a S.A.E to The Ayurveda Institute of Europe, 386 Green Lane, Ilford, Essex IG3 9JU. You can also Tel: 020-8270 0533; info@ayurvedainstitute.org; www.ayurvedainstitute.org

References and Further Reading

Sodhi V. Inflammatory Conditions and Ayurvedic Medicine. Townsend letter for Doctors and Patients. Feb-March 2005.
Vinod Verma. Ayurveda for Life. Motilal Banarsidass. 2001.
Thompson Dennis. The Ayurvedic Zone Diet. Lotus Press. 1999.
Frawley David. Ayurvedic Healing. Morson Publ. 1990