Positive Health Online

The Arthroses

The arthroses is a collective term for ALL forms of arthritis, whatever their source of origin and cause. There are many various forms of arthritis with many different causes. The word "arthritis" simply means inflammation of a joint. Any and all joints in the body can be afflicted with arthritis. There are some joints that are likely to be more commonly affected by certain forms of arthritis, than others. For instance, weight-bearing joints are more likely to be involved in post-traumatic forms of arthritis.

Although the word "arthritis" means inflammation of the joint, not all arthroses are inflammation in the joint. Many forms are inflammatory processes affecting the tissues around the joint. Of those forms of arthritis that actually affect the joint, the inflammation is of the synovial membrane of the joint, the periosteal membrane or the bone itself. Those forms of arthritis that affect the soft tissues in and around the joint involve the cartilage, the intra-articular ligaments, the peri-articular ligaments, the capsular ligament, the tendons, the muscles or even the nerves. It will be obvious that dependent upon which tissues are involved will depend the symptom picture. In general when mainly soft tissues are involved, the symptom picture is of severe swelling and painful movement. Where the articular tissues themselves are involved, the predominant symptoms will be restricted movement, not necessarily extremely painful, and eventual deformity. Also, in general, those forms involving the articular tissues will be more chronic and slower in response to treatment, mainly because of a relatively poor blood supply, at least compared to the soft tissue varieties.

The various forms of arthritis are detailed below.

Osteo-arthritis

Osteo-arthritis affects all the classical intra-articular structures, bone tissue, periosteal membrane and synovial membrane. Sometimes the intra-articular cartilages are also destroyed in the process. Osteo-arthritis develops as an inflammatory response to damage, usually as a result of major trauma, or repeated episodic minor traumatic events. The first damage is usually to the synovial membrane which becomes, as a result, inflamed. This inflammatory process is passed on to the underlying periosteal membrane which finally wears through revealing the bone tissue itself and allowing two bony surfaces to rub together, creating inflammation and the growing of small spicules of bone (osteophytes) from the otherwise smooth surface thus preventing the smooth movement of one bone over another. The final stage is often fusion of these two areas of exposed bones with consequent loss of movement of the joint and rigidity. The condition is finally self-limiting as, at this stage, no further movement is possible, therefore, no further damage can be done and, usually by this time, there is little pain unless the joint is forcibly moved.

Treatment

In the earlier stages of inflammatory change, reducing the recurrent trauma; using measures that reduce the inflammatory process; keeping the joint gently mobile, reducing weight bearing loads and preventing secondary damage by support and any of the therapies that balance the energy fields will have a decided improving effect. Leaving out any of these measures will considerable reduce the effectiveness of treatment.

In the later stages, when bone fusion has started to occur, very little is to be done as, by then, the condition has gone into the self-limiting phase. Mobility can be maintained, at the expense of pain, for a considerable period, by persistent, regular gentle manipulation and mobility exercises.

Several mineral deficiencies have been implicated as, if not causing the condition, at least, aggravating it. Boron seems to be a particularly important mineral as it forms part of the enzyme activity responsible for proper laying down of bone in the collagen matrix. Alongside this, Vitamin C (not ascorbic acid) is also an essential ingredient for proper bone construction in the collagen matrix.

Rheumatoid Arthritis

Rheumatoid arthritis mainly affects the tissues surrounding the joint, at least initially. After a very short while the synovial membrane becomes involved.

The name comes from the Latin word "rheumatismus" derived from the root word "rheum" and from the Greek word "rheumatismos" derived from the root word "rheumatizesthai". Both derivations mean "suffering from rheum". Rheum is a thin watery discharge, originally from the eyes, but now more commonly from anywhere, including joint fluid overproduction.

There are many contributory factors, not all of which are fully understood. There is certainly, often, a genetically inherited tendency and there is certainly an auto-immune basis. Often it is part of another syndrome (see Sjörgren's Syndrome).

Treatment

Because of the complex nature and origin of rheumatoid arthritis, it is not an easy condition to treat and yet, despite this many of the complementary forms of medicine produce valuable relief of symptoms. Like most forms of auto-immune disease, early diagnosis and treatment yields the best responses, whatever the therapy employed.

Sjörgren's Syndrome

This is a chronic inflammatory condition of the lachrymal and salivary glands, often accompanied by rheumatoid arthritis. It is almost certainly, like rheumatoid arthritis itself, an auto-immune disease response (named after Henrik Samuel Conrad Sjörgren, a Swedish ophthalmologist who described it in 1899).

Still's Disease

Still's Disease is the juvenile form of rheumatoid arthritis. It commonly has its onset in pre-pubertal childhood, or even earlier, and like rheumatoid arthritis burns itself out within a few years (by mid 20s) leaving only the deformities behind.

Gout

This is a specific form of arthritis due to faulty metabolism of purines, partial breakdown products of proteins. The production of purines is particularly associated with the breakdown of proteins from animal cells and yeast cells. The purines, from protein catabolism, are incompletely broken down and lead to the formation of uric acid. Normally, uric acid is further catabolised into urea, in humans. In birds, the production and excretion of uric acid is the normal course of events. In other words avian protein catabolism ends with the excretion of uric acid. Uric acid is not normally excretable by humans although small amounts can be converted into the various urate salts and passed through the kidneys. Once produced it has to be "hidden" until it can once again be broken down into urea and thus excreted. The uric acid is laid down, temporarily, especially in and around joints, particularly in association with connective tissue and collagen. Other sites are also chosen, such as the cartilage of ear and nose.

It appears that there is an inherited enzyme defect that results, from time to time, in inadequate production of the enzyme responsible for the final conversion of uric acid into urea. Gout can also occur as a non-inherited effect when excessive animal or yeast protein is taken in. This is as a result of "relative deficiency" of the enzyme required, being produced in insufficient amounts to cope with the overload. There is usually a very definite "periodicity" of the episodes in gout.

Treatment

Probably the most useful single support that one can suggest for gout sufferers is that they reduce their general protein intake to levels that are more appropriate for adults – around 2-3 ozs.(40-60g) daily – instead of the 100-150g that seems to be the norm in the western civilization. Especially helpful is reduction of animal and yeast protein. It is important to maintain an adequate but minimal protein intake, if this is not done, the body will digest its own proteins and produce the same problems.

More long term, anti-inflammatory measures, at the appropriate time, by such regimes as acupuncture and homoeopathy can be most helpful. Particularly valuable, over a good length of time, is the practice of Shiatsu.

Various detoxification techniques are almost essential – as they are in most of the arthroses.

The use of moderate amounts of Vitamin C (not ascorbic acid) in a natural food form is also of great help. This needs to be permanently taken as we all are Vitamin C deficient and Vitamin C is essential for proper collagen formation and repair (this also applies to most forms of arthroses).

Infective Arthritis

Infective arthritis is the damage done as a result of specific infections affecting the joint space. Resultant damage occurs to the synovial membrane, the periosteum and even the bone itself. The commonest causal organism is the Tubercle Bacillus although any infection that becomes established in the joint space can do the same damage, eventually.

Lyme Disease [pronounced lim] named after a town in south-east Connecticut, U.S.A., where it was first described, is a specific form of infective arthritis that follows on from an intra-articular infection of a spirochaete called Borrelia burgdorfi. It is a disease transmitted by ticks and is usually characterised by a rash, followed by 'flu-like symptoms including fever, joint pains and headaches. If untreated it results in chronic arthritis with nerve and heart dysfunction.

Treatment

Treatment of these infective arthroses consists of eradicating the causative organism at an early stage, before too much damage has been done to the tissues. Resting of the joint during this phase, with gentle mobility of the affected joint and little or no weight bearing is essential. A variety of other treatments may be helpful at this stage and later. Such aids as hydrotherapy, hot and cold compresses, oil packs and aromatherapy have all proved equally as useful as most orthodox medical treatments, and often more so.

Arthroses of associated diseases

Various specific disease states have associated arthroses. Nearly all of these conditions are auto-immune diseases or have an auto-immune faction.

Psoriasis

Many cases of psoriasis are accompanied by an acute rheumatoid type of arthritis. Dealing with only this aspect of the problem is unlikely to deal with the psoriasis as a whole.

Irritable Bowel Syndrome/Malabsorption Syndrome

Both of these conditions often lead to a gouty type of arthritis developing. It would appear that it is the poor absorption of food materials, probably minerals of one sort or another, that leads to incomplete metabolic defects occurring, resulting in toxic overload and temporary deposition of waste materials in and around joint spaces.

Systemic Lupus Erythematosus (S.L.E.)

Nearly all cases of S.L.E. develop a rheumatoid type of arthritis at some stage during the course of the disease. It is almost certainly because of the auto-immune aspect of the disease.

Cancer

Many cases of cancer appear to develop various forms of arthritis. This is particularly so in cases of lung cancer. It does not appear to be a direct association but more likely a metabolic defect situation and it is more usual in the terminal stages.

Conclusions

It is difficult to deal with all the different forms of arthritis under the same heading as they have such a range of causative factors and accompanying problems. This, however, is a cardinal point when treating arthritis. Whereas orthodox medicine makes very little attempt to differentiate the various forms and tends to treat symptomatically, most complementary forms of medicine and therapy automatically deal with the different arthroses in different ways and, probably more importantly, deal with the sufferer as an individual. In this latter lies the key to the relative success of various therapies in dealing with arthroses.

There are some key treatments that appear necessary depending on the type of arthritis. These have been mentioned after each section. Otherwise the most important help that can be given to sufferers of arthroses is to deal with them as individuals with individual responses specific, as much to them as individuals, as to the disease process itself.

Where possible early diagnosis and treatment produces the best results, but the earlier the disease can be diagnosed, the less individualistic are the symptoms and the more the symptoms are dependent on the causal factors. The individual has not had the time necessary to develop their own characteristic symptom picture.

Treating arthroses, whatever the cause, when a full blown picture has emerged is only ever going to be partially successful.

Osteo-Arthritis Nutrient Applications: 1)     Calcium and magnesium – essential for bone/ligament and muscle health. 2)     Glucosamine sulfate – glucosamine plus sulfur; glucosamine works differently than NSAIDS: NSAIDS inhibit proteoglycan synthesis (cartilage is made from proteoglycans), whereas glucosamine prevents proteoglycan degradation, thus enhancing cartilage production. 3)     Antioxidants:     1.    Vitamin C – high potency vitamin C aids in collagen formation and cartilage growth; supplementation in guinea pigs was shown to inhibit osteoarthritis progression (Schwartz, E.R. The Modulation of Osteoarthritic Development by Vitamin C and E. Int J Vit Nutr Res. Supple 26: 141-46, 1984).     2.    Vitamin E – may work like Vitamin C to inhibit osteoarthritis progression. Also acts as antioxidant and inhibits the prostaglandins that promote inflammation.     3.    Selenium and zinc. 4)     Proteolytic enzymes (Bromelaine) – catalyze oxidative reactions and decrease inflammation. 5)     Boron – osteo-arthritis patients have shown improvement when supplemented with boron; boron decreases urinary excretion of calcium and magnesium and increases estradiol levels. NOTE: The parathyroid gland contains more boron than any other tissue. Boron enhances parahormone activity and the parathyroid gland is the primary organ controlling mineralization of bone. (Burton Goldberg Group,  Alternative Medicine: The Definitive Guide. Future Medicine Publishing, Inc. WA. p. 533). 6)     Superoxide Dismutase (SOD) – effective antioxidant, especially in combination with catalase. Manganese enhances SOD activity because it is part of the SOD enzyme. 7)     Yucca and Devil’s Claw – anti-inflammatory herbs. 8)     Shark Cartilage – aids in decreasing joint inflammation and pain. Shark cartilage contains mucopolysaccharides which are carbohydrates that combine with water to stimulate immune function. Supplementation with shark cartilage is thought to repair damaged cartilage. It is also known to have properties that inhibit angiogenesis, which is invasion of new blood vessels in cartilage.     NOTE: Cartilage does not have a blood supply. 9)    Niacinamide – shown to improve joint flexibility. 10)    Bee pollen (propolis) and black currant seed oil may also be helpful. 11)    Feverfew – decreases inflammation by inhibiting compounds that cause inflammation. 12)    Pantothenic Acid – deficiency in rats caused osteo-arthritis lesions. 13)    Green lipped Mussel Extract – in a New England study green lipped mussel extract was shown to be beneficial for severe osteo-arthritis patients who did not respond to medication (Werbach M., M.D., Healing Through Nutrition, Harper Collins Publishers. NY, p. 286). 14)    Proanthocyanidins – aid in collagen metabolism and decreasing joint inflammation.  Dietary and Lifestyle Applications: 1)    A detoxification program is beneficial. 2)    Stress reduction is essential. 3)    Proper diet is important. A vegetarian diet is best.     A.     Avoid dairy products, refined foods, meat, citrus fruits and nightshade foods (tomatoes, white potatoes, eggplant, peppers (not black pepper) and margarine. NOTE: The nightshade foods are alkaloids that increase inflammation and inhibit collagen repair. They also contain a toxic substance called solanine that triggers reactions in people.     B.    Increase complex carbohydrates, dietary fiber, fruits, vegetables and nuts. Increase cold water fish for an essential fatty acid source (Omega-3) including salmon, mackerel, sardines and herring. Avoid saturated fats and follow a low-fat diet proportionately rich in polyunsaturated fatty acids (PUFA’s).     C.    Increase boron-rich foods including alfalfa, lettuce, peas, cabbage, apples, dates, prunes, raisins, almonds and hazelnuts.     D.    Sulfur and methionine-containing foods such as legumes, cabbage, brussel sprouts, garlic and onions are also beneficial. NOTE: Sulfur is an important mineral needed by cartilage tissue. Methionine has shown positive results against rheumatoid arthritis (di Padova, C. S-adenosylmethionine in the treatment of osteoarthritis. Review of the clinical studies. Am J Med. 1987; 83(5A): 60-65) 4)    Avoid caffeine, alcohol and tobacco. 5)   It is important to avoid allergy foods, since these foods have been associated with osteo-arthritis. An elimination/rotation diet is recommended. Avoid environmental toxins as much as possible. 6)   Regular chiropractic care is beneficial to address structural/postural problems. 7)    Maintain normal weight to avoid added weight bearing stress to the joints. 8)    Supplemental cod liver oil may be helpful to decrease inflammation. 9)    Drink 6-8 8-ounce glasses of filtered water per day to flush toxins and avoid dehydration. Chronic pain is often associated with chronic dehydration. 10)    A half pound of fresh cherries or blueberries per day may be beneficial. They contain proanthocyanidins that aid in collagen metabolism and decrease joint inflammation. 11)    Hot baths and hot pads may provide some relief. 12    Avoid smoking. 13)    Juicing is good. Pineapple juice, due to its bromelain content, may be helpful. Ginger is also beneficial as an anti-inflammatory agent. 14)    Do not take an iron supplement. It may be involved in joint destruction in arthritis due to pro-oxidant effect. 15)    Deep massage, such as rolfing, has been shown to be beneficial. Extracted with permission from: TOOHEY L and KREUTLE S. Nutritional Physiology: Clinical Applications and Scientific Research. HealthQuest Publishing. 1995

Rheumatoid Arthritis Nutrient Applications: 1)    Proteolytic enzymes – anti-inflammatory enzymes; shown to decrease swelling and improve joint mobility. 2)    Omega-3 fatty acids (i.e. EPA. DHA) – fish oil source shown to decrease inflammation 3)    Antioxidants – free radical scavengers     1.     Proanthocyanidins (flavonoids) – grape seed and pine bark extract – powerful antioxidants and collagen protectors.     2.     Vitamin C with bioflavonoids – Rheumatoid arthritis patients have decreased vitamin C levels; deficiency can cause spontaneous bruising.     3.     Vitamin E and Selenium – the two together have been shown to improve rheumatoid arthritis (Munthe,  E. and Aseth, J. Treatment of Rheumatoid Arthritis with Selenium and Vitamin E. Scandinavian Journal of Rheumatology, 1984. 53: 103),     4.     Zinc – zinc is decreased in rheumatoid patients. 4)     Copper – copper in the serum and in the joints is increased in rheumatoid arthritis, but decreased in the liver. Copper supplementation has been shown to be beneficial for inflammation. 5)     Green lipped Mussel Extract – in a New England study, green lipped mussel was shown to be beneficial for severe osteoarthritis patients who did not respond to medication. It may also be helpful in rheumatoid arthritis. (Werbach, M., Healing Through Nutrition. Harper Collins Publishers. NY, 286). 6)     Herbs such as feverfew and devil’s claw may be beneficial. Dietary and Lifestyle Applications: 1)     A detoxification program is beneficial 2)     Stress reduction is essential. 3)    Proper diet is important. A vegetarian diet is best.     A.    Avoid dairy products, refined foods, meat, citrus fruits, nightshade foods (tomatoes, white potatoes, eggplant, peppers (not black pepper) and margarine.         NOTE: The nightshade foods are alkaloids that increase inflammation and inhibit collagen repair.         They also contain a toxic substance called solanine that triggers reactions in people.     B.    Increase complex carbohydrates, dietary fiber, fruits, vegetables and nuts. Increase cold water fish for an essential fatty acid source (Omega-3) including salmon, mackerel, sardines and herring. Avoid saturated fats and follow a low-fat diet rich in PUFAs.     C.    Increase boron-rich foods including alfalfa, lettuce, peas, cabbage, apples, dates, prunes, raisins, almonds and hazelnuts.     D.    Sulfur and methionine-containing foods such as legumes, cabbage, brussel sprouts, garlic and onions are also beneficial.         NOTE: Sulfur is an important mineral needed by cartilage tissue. Methionine has shown positive results against rheumatoid arthritis. (di Padova, C. S-adenosylmethionine in the treatment of osteo-arthritis. Review of the clinical studies. Am J Med 1987: 83(5A): 60-65). 4)    Avoid caffeine, alcohol and tobacco. 5)     It is important to avoid allergy foods, since these foods have been associated with osteoarthritis. An elimination/rotation diet is recommended. Avoid environmental toxins as much as possible. 6)     Regular chiropractic care is beneficial to address structural/ postural problems. 7)     Maintain normal weight to avoid added weight bearing stress on the joints. 8)     Supplemental cod liver oil may be helpful to decrease inflammation. 9)     Drink 6-8 8-ounce glasses of filtered water per day to flush toxins and avoid dehydration. Chronic pain is often associated with chronic dehydration. 10)     A half pound of fresh cherries or blueberries per day may be beneficial. They contain proanthocyanidins that aid in collagen metabolism and decrease joint inflammation. 11)     Hot baths and hot pads may provide some relief 12)     Avoid smoking 13)     Juicing is good. Pineapple juice, due to its bromelain content, may be helpful. Ginger is also beneficial as an anti-inflammatory agent. 14)     Do not take an iron supplement. It may be involved in joint destruction in arthritis due to pro-oxidant effect. 15)     Deep massage, such as rolfing, has been shown to be beneficial. Extracted with permission from: TOOHEY L and KREUTLE S. Nutritional Physiology: Clinical Applications and Scientific Research. HealthQuest Publishing. 1995.

Nutritional values in treating the arthroses

My own personal experience over thirty years in clinical practice is that there are a few general food factors associated with arthritis which can help and one or two specific factors. Otherwise, much of the value of ‘food therapy’ is related around the individual and what seems right for them.

The general factors that may help are:

Reducing red meat intake

Immediately following the death of an animal, the muscle tissue starts to self-digest. This is the process involved when we ‘hang’ meat. Often, this self digestion has progressed partially along the way and the chemical products that are produced can be quite toxic and certainly are very acidic. This very acidity can be an aggravant to many sufferers of various forms of arthritis. Reducing the red meat intake in arthritis sufferers often improves the symptom picture. Another good reason for reducing animal lipid intake is that they are the starting source for the prostaglandins that promote inflammatory processes, a very definite aggravation to the inflammatory process already under way due to the condition.

Increasing the water intake

For most of us, we do not take an adequate through-put of water. This becomes a problem when we have a destructive or invasive activity going on within us, as are most of the arthroses. Because we are breaking down our own tissues in the attempted process of repair, and creating a lot of toxic waste, we have a greater need to maintain good excretory systems. A good flow-through of water is essential to help clear this waste. Many of the symptoms from which we suffer, in these circumstances, are due to internal intoxication.

Reducing sugar intake

There are several reasons for reducing sugar intake in cases of arthroses. The simplest is that sugar creates a high body acidity and in most cases of all types of arthroses high body acidity increase the inflammatory process and aggravates the condition. The other important reason for minimising sugar intake in these situations is because high sugar levels are a major contributory factor in reducing body calcium. This occurs as the result of dephosphorylation of bone in these circumstances. Along with the removal of phosphorus from the bone, calcium is also removed. The phosphorus is used and taken out of the equation, leaving the calcium to be excreted.

Improving the essential fatty acid intakes.

There are several reasons for improving the essential fatty acid intakes. We have already mentioned one – inappropriate essential fatty acids such as those associated with land animals only add to the inflammatory process by creating the pro-inflammatory prostaglandins. The essential fatty acids from both fish and vegetables grown in temperate zones increase the body production of anti-inflammatory prostaglandins. Another reason is that good quality fatty acids, as opposed to trans-fatty acids, are required for maintenance of proper cell membrane activity. A properly functional cell membrane is essential for cell repair and support. The correct essential fatty acids are also required for the adequate production of synovial fluid of the correct density and viscosity being very necessary for the prevention of further damage to the joint and its surroundings.

These measures may not always produce results and may have to be introduced as a permanent change in life-style but they are certainly worth trying and definitely worth using for people with a family history or other propensity to develop one of the arthroses.

More specific nutrient requirements

More specific nutrients are also worth considering. They may be obtained from food providing all the requisite, growing, harvesting and storing procedures have been followed. Unfortunately, however, this is often not the case and the food we take in lacks these essential nutrients in adequate amounts. In this case we need to supplement, but the ordinary isolated chemical supplements are usually of very little or limited value. Only fully food matrix conjugated supplements are likely to be helpful, as they are found in nature. Some of the essential nutrients are outlined below:

Vitamin C

Most of us are vitamin C deficient. Most other animals can manufacture vitamin C at will. We are lacking in the last enzyme of three that allows the conversion of sugar into vitamin C. We, therefore, rely on dietary intake to provide our needs. This is invariably inadequate. Vitamin C is essential for the manufacture of good quality collagen, the precursor of bone matrix. Without the production of proper collagen, bone cannot be laid down and bone repair cannot occur. A probable daily requirement for these purposes is in excess of 3g of ascorbic acid (although, as mentioned before, isolated ascorbic acid does not an adequate substitute for vitamin C).

Boron

The element, boron, is an essential material for the proper production of new bone and, hence, repair of old bone damage. With magnesium, another essential element for bone repair and formation, boron works at the site of calcium deposition. Boron is involved in one of the enzymes that inserts calcium into the collagen matrix, whereas magnesium is required on site to facilitate the release of energy required for this operation. Boron is also a fluoride inhibitor. The presence of fluorides in bone enhance the release of calcium from bone and, therefore, boron appears to act in two ways, suppressing the calcium release from bone and enhancing the calcium deposition. Normally, plant life contains adequate amounts of boron, but, for the boron to be available, in the soil, there has to be good amounts of humus (inorganic farming techniques deny this) and the rainfall in the growing area needs to be adequate. Excess rainfall and drought both deny the retention of boron in the soil, for different reasons. Therefore, many soils in Britain are boron deficient. We appear to need in excess of 2mg per day for prevention of arthritic changes.

Magnesium

Magnesium we have already mentioned in association with boron. This is only one of its many functions, nearly all of which are around energy release mechanisms. Our daily requirements of magnesium are around 400mg but this is to maintain the status quo. We probably need at least twice this amount daily when repairing damaged tissue and expending a lot of energy.

Calcium

Calcium is obviously necessary for bone replacement but, probably, in much less quantity than is usually believed to be the case, provided the other nutrients are available to conserve the calcium deposits.

Pantothenic acid

Pantothenic acid is the isolate form of the vitamin B5. The active form of pantothenic acid is phosphopantetheine, which is how it is found in nature. This vitamin is essential for the repair of cell damage and must be present in adequate amounts whenever repair to cells is being carried out. Such a state exists in all forms of arthroses and, therefore, adequate intake of vitamin B5 is essential. It is probable that our diet contains enough vitamin B5 for normal repair purposes but inadequate amounts for the extra stress and repair required in cases of arthroses. Many times the daily requirement of 6mg is suggested in these cases (I use up to 200mg per day when indicated).

Vitamin B6

Vitamin B6 is another member of the B group of vitamins. There are at least three active different chemical forms that the body employs. Each of these have their own specific activities within the cell and are often not transferable. Pyridoxal-5-phosphate is the particularly active form associated with the activities of bone repair and production. The standard pyridoxine hydrochloride supplement is of little or no value and is not converted into this form in any great quantity. Therefore, if supplementation is to be used, it must be natural vitamin B6 or pyridoxal-5-phosphate that is used (in these instances I use 40-60mg daily).

These are not the only nutrients that are helpful, but are the major ones. Mention must also be made of P.A.B.A., biotin and cod liver oil. In practice, the cod liver oil is best taken as the oil. A tablespoonful in apple cider vinegar in the morning and a repeat dose in milk, in the evening.

I am aware that this review can, of necessity, only cover some of the aspects of dealing with the arthroses. A book of several hundred pages would otherwise be necessary.

On the whole, I have been disappointed with the nutritional treatment of the various forms of arthritis, when used alone and, certainly, the immune deficiency types of arthrosis seem much less responsive to dietary change alone.

A final word of advice is that the origin must be considered when dealing with the prognosis, commence treatment at the earliest opportunity and when dealing with only  possible arthroses, advise the life-style changes even if no firm diagnosis has been made and, finally, persevere with the treatment – it may take quite a long while to reverse any process that has been under way for some time.

Compiled by Dr D.F. Smallbone
M.B., CH.B., L.R.C.P., M.R.C.S., M.F.Hom., F.C.O.H. Senior Medical Advisor and Senior Lecturer in Medical Sciences to the College of Natural Nutrition