Straight Talk on Supplements

According to a recent survey published by the American Gastroenterological Association, nearly two-thirds of people who have chronic pain have been battling the condition for at least two years. Nearly half of them admitted having taken more than the recommended dose of over-the-counter painkillers, putting themselves at increased risk of harmful side effects like liver damage or stomach bleeding. As the abuse and regulations of prescription painkillers continue to challenge doctors and policy-makers, many people are searching for new solutions to get relief.

Over-the-counter supplements derived from plants or other natural sources can have positive effects on pain and inflammation, but not all supplements are created equally. Recent research questions the usefulness of some supplements for fighting pain, and western scientists are still trying to understand how certain supplements derived from traditional eastern medicine work to reduce pain. Here we present the latest information on four supplements you may have heard about.

Coenzyme Q10 (Ubiquinone)

The human body produces a substance called ubiquinone (also known as coenzyme Q10 or CoQ10) and uses it to carry out several important functions, perhaps the most essential of which is helping cells make energy. The substance is also known for its antioxidant properties and is thought to help neutralize free radicals that cause cellular damage. Scientists know that we produce less CoQ10 as we age, and lately, they have been investigating the effects of ubiquinone on the heart, muscles, and other parts of the body.

CoQ10 supplements may help alleviate muscular dystrophy and periodontal disease, and it might boost energy and speed recovery from exercise.

Certain drugs, like the class of cholesterol drugs called statins, including Crestor (rosuvastatin), Lipitor (atorvastatin), and Mevacor (lovastatin), have received attention in recent years because of the risks of side effects, such as muscle aches and pains. While scientists know that statins reduce the amount of CoQ10 in the body, according to most research, it is unclear whether replacing it by taking it in supplement form can help manage the aches caused by statins. That is because studies often fail to address whether statins are responsible for the muscle discomfort of the patients being evaluated. Therefore, taking a CoQ10 supplement may not benefit patients whose pain stems from a different issue.

In fact, a 2014 study that followed patients who had statin-induced muscle pain found in some people, the CoQ10 supplement taken with simvastatin (Zocor) did not delay the onset of pain. And a 2015 study found that taking a CoQ10 supplement had virtually no effect in improving pain for half the people with statin-induced muscle pain compared to those who took a placebo.

If you take a statin and are experiencing pain, talk to your doctor about your symptoms before buying CoQ10. Once your doctor finds out what is causing your pain, you can work together on treatment options.

And a note about labels: CoQ10 supplements may be sold as “ubiquinone” or as its active form, “ubiquinol.” They may not say “CoQ10” on the front label, but the back of the bottles may read “Ubiquinol (activated CoQ10).”


Although not new to modern medicine, magnesium deficiency can contribute to a variety of heath conditions, and new research suggests that it is a growing problem. According to surveys conducted in the United States and Europe in 2015, people do not get enough magnesium in their diets. Data show that Americans have been steadily consuming less magnesium for the last century, a trend thought to be the result of increased use of fertilizers and eating processed foods.

Magnesium, the eighth most common element and fourth most plentiful mineral on Earth, is vital to human health and well-being. It is involved in more than 300 biochemical reactions that occur in the body, such as muscle contraction, reproduction, protein production, nerve signaling, and muscle-tone maintenance.

Magnesium levels that are either too low or too high can cause a variety of dysfunctions in the body. Low levels of magnesium, or hypomagnesemia, usually occur more often than high levels of magnesium in the blood (hypermagnesemia), and they’re associated with a wide variety of disorders like diabetes, high blood pressure, heart disease, Alzheimer’s disease, menstrual headaches in women, and migraines. Alcoholism, uncontrolled diabetes, an overactive thyroid or parathyroid, and digestive disorders like Crohn’s disease, short bowel syndrome, and celiac disease can lower magnesium levels.

Also, certain drugs, like Nexium (esomeprazole) and Prilosec (omeprazole) for acid reflux, osteoporosis drugs like Aredia (pamidronate), and water pills like hydrochlorothiazide and Lasix (furosemide) can lower the concentration of magnesium in your body, but this becomes more of an issue when the drugs are taken for long periods of time.

Magnesium deficiency can cause pain, including muscle spasms in virtually any part of the body, presenting as Charley horses, backaches, and cramping in the face and on the soles of the feet. And low magnesium can lead to bladder spasms that cause leakage or an overactive bladder.

One of the easiest ways to increase magnesium levels is to eat foods rich in the mineral, and luckily, such foods are easy to find: Nuts, beans, seafood, whole grains, bananas, and leafy, green vegetables like kale and spinach are all excellent sources of magnesium. A second option is to take magnesium supplements. While they are generally considered safe, they may cause nausea, vomiting, and diarrhea. Taking a magnesium supplement with food can help ease stomach discomfort. Soaking in a bath of Epsom salts (magnesium sulfate) may provide relief for people who have muscle cramps.

Determining how much magnesium your body needs and what form would be best for you can be challenging. Experts have varying opinions on how much magnesium a person should take. The amount may vary based on a person’s weight, the dosage form, or the type of magnesium (magnesium oxide, magnesium chloride, magnesium citrate, etc.). However, before trying any new supplement or product, your best bet is to work with your doctor or other qualified health-care professional to determine the dose and type of magnesium supplement that’s right for your body.

Also, magnesium interacts with several drugs, including antibiotics like levofloxacin (Levaquin), moxifloxacin (Avelox), and doxycycline (Vibramycin); water pills like spironolactone (Aldactone); and calcium-channel blockers like nifedipine (Adalat, Adalat CC, Afeditab CR, and Procardia). So if you’re taking other medications or supplements, ask your doctor or pharmacist about magnesium.

Gastrodia elata Blume

Traditional Chinese medicine has used the dried rhizome of Gastrodia elata Blume, a member of the orchid family, for centuries to treat disorders involving the brain such as vertigo, general paralysis, tetany, epilepsy, and pain. Still, despite being an old remedy, researchers do not yet fully understand how the extract works. In recent years, scientists have been studying the plant more closely to identify its active ingredients and the pathways by which they work.

According to various studies, the active ingredients and their activity may depend on how the gastrodia was extracted. Still, research shows that gastrodia contains antioxidants and chemicals that help support healthy inflammatory responses in the brain, but less research is available detailing how the supplement can decrease pain. Data show that certain gastrodia extracts decrease the expression of inflammatory proteins and markers involved in neurological disorders like cyclooxygenase-2 (COX-2), tumor necrosis factor-alpha (TNF-α, vanillin), and NF-kB defects. A 2011 study of rats with diabetic nerve pain found that bathing nerve cells in gastrodin makes the cells less responsive to pain.

So far, the research does not offer information about how gastrodin interacts with prescription drugs, nonprescription medications, and other over-the-counter products. That may change as scientists continue their investigations. Still, the fact that gastrodin appears to have antioxidant properties and several active components may give pain sufferers hope for options in the future.


The precious oil frankincense is derived from the gum resin of Boswellia sacra, a tree native to the Arabian Peninsula and northeastern Africa. Its use dates back to biblical times. Various species of Boswellia extracts (including Boswellia serrata and Boswellia sacra) have been used for centuries in Ayurvedic medicine, which originated in India, and in parts of the Middle East. Today, boswellia supplements are becoming easier to find in the United States.

Most over-the-counter supplements containing boswellia, however, are not sold with it as the only active ingredient. Instead, the product is most commonly found in combination with other herbs or ingredients known to support a healthy inflammatory response, like turmeric, or the isolated form of turmeric’s active ingredient, curcumin.

Research shows that boswellia contains acids that inhibit the lipoxygyenase pathway, which scientists believe may contribute to the supplement’s anti-inflammatory properties. Yet, because boswellia is normally sold as an herbal blend, the majority of studies about it tend to explore its effects on inflammation or pain in conjunction with other herbal supplements. This makes it difficult to know exactly how boswellia works by itself in the body to support healthy inflammatory responses.

Most studies support the idea that boswellia helps provide some relief from pain. The most promising research explores its effects on reducing pain associated with osteoarthritis. However, a 2014 animal study comparing the herbs neem, licorice, boswellia, and guggul against ibuprofen found that bowsellia had no significant anti-inflammatory benefit.

Currently, research exploring potential drug interactions with boswellia is lacking. As with any new product, it’s important to ask your doctor or pharmacist before giving supplements that contain boswellia a try.

Remember, it is always a good idea to talk to your doctor before trying any supplement or new drug. It is important to recognize that, with any product that’s ingested — whether a prescription drug, over-the-counter drug, nutritional supplement, herb, or a product that does not require prescriptions — there are always risks. If you and your doctor decide that a supplement is safe to take, be sure to take it exactly as your doctor tells you, and never take more than the recommended amount unless your doctor tells you otherwise.

Want to learn more about supplements and pain? Read “5 Pain-Fighting Supplements” and “5 Pain Supplements to Manage Your Symptoms.”

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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