Pain-Free Living

5 Supplements to Manage Your Symptoms

By Frieda Wiley, PharmD, CGP, RPh

Many supplements support a healthy immune response, which ultimately can help relieve arthritis symptoms. However, so many products are available, including many different options for the same supplement, that it can be hard to make a decision. Keep reading for some sound information on five common—if not so commonly used—supplements for arthritis and to find out whether they might work for you.

1. Chondroitin and glucosamine

These supplements are available individually but can also be purchased as a single tablet. Many studies show little to no benefit in managing arthritis symptoms with these supplements compared to a placebo; a 2006 study published in The New England Journal of Medicine found that people taking 1500 mg of chondroitin and 1200 mg of glucosamine daily showed no more than 20% improvement in their symptoms compared to their placebo-taking counterparts.

However, while this may not be a significant improvement, it does indicate some benefit, and some people who suffer from severe knee pain swear by it (although this evidence is primarily anecdotal). In fact, while the results of studies vary, those who might benefit most from taking chondroitin and glucosamine supplements are those who have severe osteoarthritis in the knee; those with milder symptoms may not notice improvements while taking these supplements.

As a combination supplement, chondroitin and glucosamine are usually available in doses of 1500 mg and 1200 mg, respectively, taken either once or twice a day. When you begin to take the supplement, your doctor may advise you to take it three times a day for a few months build up the levels of the supplement faster in your bloodstream. The supplement chondroitin is a protein derived either from shark cartilage or the trachea of a cow, so people who are allergic to shellfish should use care to select a product that does not come from a fish-related source.

Glucosamine does not have many reported or known interactions with drugs or other supplements. However, you should be careful if you are taking chitosan, a supplement sometimes sold as a weight-loss drug. Chitosan actually contains glucosamine, so taking chitosan while taking a glucosamine-containing supplement could potentially cause problems for someone with diabetes or other conditions that affect blood sugar. If you are taking chitosan, talk to your doctor before taking glucosamine.

Few side effects have been observed with chondroitin use; most commonly, people may experience stomach discomfort, slight nausea, indigestion, or diarrhea. Glucose is a building block of glucosamine, so people who have diabetes or other illnesses affected by blood sugar (like PCOS) should be mindful.

2. Turmeric

Turmeric has been used as a remedy for arthritis for centuries; in the 5,000-year-old Ayurvedic medical tradition in India, it is also commonly taken for digestive and liver support. Turmeric is helpful not only for managing inflammation and resulting pain from arthritis, but also for promoting healthy inflammatory responses throughout the body: Data from clinical studies primarily upholds its benefit in relieving inflammation caused by arthritis and stomach irritation. In fact, a 2007 study found that when taken in combination with ginger, turmeric’s anti-inflammatory and pain-relieving abilities surpassed those of indomethacin (Indocin) and allowed for greater recovery from arthritis symptoms than the ginger-indomethacin combination.

Depending on the manufacturer and how the supplement is prepared, turmeric can be taken in doses of 500 mg twice a day to up to four times a day for arthritis. In general, turmeric does not appear to have any major drug interactions. However, it may thin the blood, so people who are taking blood thinners like Coumadin (warfarin), Lovenox (enoxaparin), or Pradaxa (dabigatran) should first talk to their doctors or pharmacists before taking this supplement. Additionally, certain pain medications like nonsteroidal anti-inflammatory drugs, or NSAIDS—e.g., Motrin, Advil (ibuprofen), or Aleve (naproxen)—can also thin the blood.

While these interactions are not currently thought to be very common, it is still important to be aware of the possibility they may occur. If you notice bruising, wounds that take longer than usual to clot, or bleeding when brushing your teeth, stop taking turmeric right away and talk to your doctor. Curcumin, turmeric’s active ingredient, can lower blood sugar, so people with diabetes should monitor their blood sugar carefully. Extremely high doses of turmeric may actually cause iron deficiency; people with anemia caused by low iron levels and people with diabetes should first talk to their doctors before taking turmeric.

3. Ginger

If you come from a Latin culture, your grandmother may have told you to chew on ginger when your bones hurt. As it turns out, Grandma was right! Ginger has many anti-inflammatory properties and is also popular for relieving nausea, helping to manage motion sickness, and—with its immune-boosting capabilities—helping to keep the sniffles at bay during flu season.

Ginger can be found in grocery stores as a fresh root, as a tea or a powder, or as capsules. As with many herbal supplements, the exact amount of a single dose of ginger can vary per the manufacturer and the extract; depending on the form of the supplement and manufacturer, ginger can be taken twice a day to four times a day, with doses ranging from 170 mg to 250 mg for people with arthritis.

The most common potential interaction ginger may have with medications can happen with blood thinners, because ginger also can thin the blood. As with turmeric, people who are taking blood thinners or other medications and/or supplements that can thin the blood such as aspirin, garlic pills, gingko biloba, and ginseng should watch carefully for any signs that their blood may have become too thin. Ginger may also lower blood sugar, so people with diabetes should use caution. High doses of ginger could be dangerous for people with heart conditions, so people with heart disease should consume ginger in moderation and discuss any concerns they may have about taking the supplement with their doctors.

Although ginger can help relieve symptoms of nausea, medical professionals still cannot agree upon whether it is safe to take during pregnancy. If you’re pregnant or planning to become pregnant, please talk to your doctor before using ginger. Ginger may irritate the esophagus or stomachs of people who have heartburn and/or sensitive stomachs, and some people with these conditions report feeling burning sensations while drinking ginger tea or eating foods that contain ginger. However, each patient is different, so listen to your body.

4. Omega-3 fatty acids

By now, we have all heard something about omega-3 fatty acid supplements and arthritis. An imbalance in the ratio of omega-3 fatty acids to omega-6 fatty acids in the body can indicate that you may either have or will develop inflammatory diseases like arthritis. Most Americans, who eat a lot of red meat, fried foods, and processed foods, and few vegetables—a diet that is low in anti-inflammatory omega-3 fatty acids but high in inflammatory omega-6 fatty acids—are likely to have an imbalance.

The easiest way to help correct this imbalance? Eat more foods that are high in omega-3 fatty acids. For example, fish like salmon, herring, sardine, and trout are excellent choices because they contain more omega-3s than other types of fish, such as catfish or tilapia. If you would rather not eat fish, there are other options like flax seed, hemp seeds, and chia seeds. If you opt for whole flax seeds, get the best results by grinding them just before eating them. (Be sure to properly seal and refrigerate store-bought ground flax seed to prevent oxidation.) Additionally, seaweed and green leafy vegetables such as brussels sprouts and kale are good sources of omega-3 fatty acids.

Fish oil and fish oil pills are another common source for omega-3s. Some people who take fish oil find themselves burping a fishy smell. To avoid these “fish burps,” you can try taking your fish oil at night, finding a “burpless” brand, or switching to krill oil.

Ideally, people with rheumatoid arthritis should examine the amount of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the omega-3 supplement they choose. Look for sources that provide 3.8 grams per day of EPA and 2 grams per day of DHA. Taking omega-3 supplements may cause blood to thin, especially if taken with other medications or supplements that thin the blood. And while omega-3 supplements are found to help support healthy cholesterol functioning, they also can raise low-density lipoprotein (LDL) levels, so if you have high cholesterol or high LDL levels, talk to your doctor first before taking any supplement that contains omega-3.

5. Devil’s claw

Originally from South Africa, this herb has been used for centuries as a remedy for joint pain caused by arthritis and gout and to help manage symptoms of maladies such as migraines and bladder problems. Studies show that devil’s claw is beneficial taken either alone or in combination with NSAIDs and that it can also relieve pain from osteoarthritis and lower back problems.

Doses of harposide, the active ingredient in devil’s claw, can vary greatly, from as low to 2.6 mg to 2400 mg per day, depending on the manufacturer, the method of preparation, and the ratio of harposide to other active ingredients. To make the most informed decision, read the label on the back of the package or consult your herbalist. The most common side effect of devil’s claw is diarrhea, but people taking devil’s claw can feel nauseated, throw up, or have stomach pain. Some people also may notice a ringing in the ears and changes in appetite.

Devil’s claw may affect the way your liver breaks down certain drugs, so people taking proton pump inhibitors—Prilosec (omeprazole), Protonix (pantoprazole), Aciphex (rabeprazole), Nexium (esomeprazole), the muscle relaxant Soma (carisoprodol), and/or most antidepressants—should be careful while taking it. Devil’s claw can slow the liver’s breakdown of the blood thinner warfarin (Coumadin), which can cause levels of warfarin to increase in the blood and increase the risk of bleeding. If you are taking warfarin, be sure to see your doctor before taking devil’s claw. If you are taking warfarin and are approved to begin taking devil’s claw, have your blood checked to make sure the warfarin is working the way your doctor intended.

Whenever you use herbs and herbal supplements, make sure to purchase high-quality herbs from a reliable source. Discuss the pros and cons of herbal products with an herbalist, naturopathic doctor (ND), or other qualified health-care professional—and always, whenever you’re taking these or any supplements or herbs, talk your pharmacist or doctor. Be sure to share with them any changes you’re thinking about making, and let them know about all the medications, over-the-counter products, supplements, and herbs you’re already taking so they can make sure that these supplements are right for you.

Last Reviewed January 7, 2015

Frieda Wiley, PharmD, CGP, RPh, is a freelance medical writer and consultant pharmacist based in the Piney Woods of East Texas.

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