Arthritis Supplements Don't Work

Researchers are patting themselves on the back for finally proving that the popular arthritis supplements glucosamine and chondroitin don't work. Too bad physicians don't have much else that eases pain without causing serious side effects.

The latest analysis is from the British journal BMJ (online, Sept. 16, 2010). Investigators reviewed 10 studies that covered 3,800 subjects. They concluded, "Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space."

This comes on the heels of a Norwegian study that investigated the benefits of glucosamine for lower back pain due to spinal osteoarthritis (Journal of the American Medical Association, July 7, 2010). Six months of glucosamine was no more helpful than placebo in that study either.

Many health professionals get a certain amount of pleasure from studies that show an alternative therapy is ineffective. They may feel vindicated when a pill that was not FDA-approved turns out to be no more helpful than an inactive placebo.

Even FDA-approved treatments for osteoarthritis are not above question, however. Doctors have prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for decades. The assumption is that they are effective for joint pain and relatively benign. The data on many of these drugs are not as convincing as many health professionals assume.

For one thing, there are surprisingly few long-term trials of NSAIDs. That's a disappointment for drugs that may be taken for months or years. A meta-analysis of 23 studies involving more than 10,000 patients concluded, "NSAIDs can reduce short-term pain in osteoarthritis of the knee slightly better than placebo, but the current analysis does not support prolonged use of NSAIDs for this condition. As serious adverse effects are associated with oral NSAIDs, only limited use can be recommended" (BMJ, Dec. 4, 2004).

There is growing recognition that NSAIDs such as ibuprofen, naproxen and diclofenac carry substantial risk, including digestive distress such as heartburn, nausea or even life-threatening bleeding ulcers. Other NSAID complications may include elevated blood pressure, irregular heart rhythms, dizziness, fluid retention, ringing in the ears, kidney and liver damage.

A recent report from Denmark suggests that high doses of ibuprofen and diclofenac are associated with an increased risk of heart attacks and other cardiovascular problems (Expert Opinion on Drug Safety, online, June 23, 2010).

With such questionable benefits and serious side effects, it is not surprising that people are looking for alternatives. That's why home remedies are so popular. They are generally affordable and far less risky. Readers of this column report that fruit juices such as cherry, grape, pineapple or pomegranate can be helpful. Spices like cayenne, turmeric and ginger may also give relief.

For those who like such approaches, we offer our book, Favorite Home Remedies, at www.peoplespharmacy.com. None are likely to be studied in double-blind trials, but they're also unlikely to cause the kinds of complications associated with NSAIDs.

Death by Rubber Duck

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Many of the products we use every day, from non-stick frying pans to plastic toys like rubber ducks, expose us to chemicals. How safe are they? Phthalates and BPA are endocrine disruptors. Do we get enough in day-to-day life to make a difference?

Two Canadian environmentalists decided to find out. They ran the experiment on themselves, and what they discovered is disconcerting.

Guests: Rick Smith, PhD, is executive director of Environmental Defense. He's one of Canada's leading environmentalists and has a doctorate in biology from the University of Guelph.

Bruce Lourie started one of Canada's largest environmental consultancies. He is president of the Ivey Foundation.

Their book is Slow Death by Rubber Duck: The Secret Danger of Everyday Things. The

Does Funding Influence Study Outcomes?

Political reporters know they need to follow the money to get the story. It turns out that doctors and medical reporters should, too. Investigators analyzed the outcomes of more than 500 drug trials. Studies funded by the federal government showed benefit about half the time. Those sponsored by the pharmaceutical industry demonstrated a positive response to the drug 85 percent of the time. Studies supported by drug company money were published less often than government funded trials. The investigators speculate that bias can be introduced in subtle ways including the design of the study, the selection of subjects, and the analysis of data.

[Annals of Internal Medicine, August 3, 2010]

Healthy Heart Boosts Brain

Exercise has been shown to be good for the heart and also the brain. Now researchers may have come up with a possible explanation. They measured something called cardiac index, which is a marker for how much blood the heart pumps relative to body size. People with a lower cardiac index score also had demonstrable brain shrinkage. Roughly 1500 people were studied. The relationship was seen even for people in their thirties with no obvious heart disease. The investigators were quick to point out that smaller brain volume was not necessarily linked to cognitive decline, but it is associated with aging. They hypothesize that the pumping power of the heart could influence the amount of blood, oxygen and nutrients that get to brain cells.

[Circulation, online, August 2, 2010]

Can Resveratrol Reverse Inflammation?

A dietary supplement that is gaining in popularity has new evidence to support its potential benefits. Resveratrol is a compound found in many plants, but peanut and grape skins are particularly rich in this antioxidant. In a small placebo-controlled study, 40 mg of resveratrol daily for six weeks significantly reduced the levels of several markers for inflammation. A number of chronic diseases have been linked to inflammation, including diabetes and heart disease. It is still too early to conclude that resveratrol could prevent these conditions, but the evidence is tantalizing.

[Journal of Clinical Endocrinology & Metabolism, online June 9, 2010]

Health Hazards from Dietary Supplements

Some ingredients in dietary supplements may pose health hazards. That's the conclusion of a review by Consumer Reports working in collaboration with the Natural Medicines Comprehensive Database. The so-called "dirty dozen" include herbs and minerals. For example, bitter orange has replaced a banned herb called ephedra in many natural weight loss and energy supplements. But bitter orange may itself be associated with heart rhythm problems, heart attacks and strokes, the same sorts of cardiovascular problems that got ephedra banned. Another perennial problem is the herb comfrey, which is popular for a range of problems such as cough, joint pain and excessive menstrual flow. But comfrey can damage the liver when taken internally. Some of the other herbs to be wary of include coltsfoot, lobelia and yohimbe.

[Consumer Reports, September, 2010]

Nitrates and Bladder Cancer

Common ingredients in processed meat like salami, bologna, hot dogs and ham may increase the risk of bladder cancer. Nitrates and nitrites are frequently used to preserve lunch meats and hot dogs. They also add the familiar pink color and add to the flavor of such foods. But researchers have raised concerns about the safety of such compounds for decades. A joint National Institutes of Health-AARP study of more than 300,000 older Americans lasted seven years. The investigators found that those people who consumed the most dietary nitrite in processed red meat were 30 percent more likely to be diagnosed with bladder cancer than those who ate the least. Beef, chicken and turkey were not linked to a higher risk of bladder cancer.

[Cancer, published online Aug 2, 2010]