Natural Remedies, Vitamins, and Supplements
A variety of natural remedies including herbs, vitamins, minerals, and other supplements may be taken by people with rheumatoid arthritis (RA) as complementary methods of managing their disease as they seek relief of RA symptoms and help in managing health complications and conditions that commonly affect individuals with RA.
Vitamins and minerals with potential benefit in RA include vitamins D, B6, B9 (folic acid), B12, C, and E and selenium, magnesium, calcium, and zinc.1 Several different herbal supplements may be used by people with RA. They can be classified into the following categories:
- Anti-inflammatory supplements
- Analgesic (pain relieving) supplements
- Sleep aids
Always check with your doctor first
Because herbs and other plant-based products, vitamins, minerals, and other supplements can react with pharmaceutical treatments for RA and may pose a risk when taken at too high a dosage, it is important to discuss your use of these substances with your doctor. Your doctor has the resources and tools to identify potential harmful interactions between treatments, both prescribed and non-prescribed, to ensure your safety. In addition, your doctor can help you determine the proper dosage for supplements that you decide to use.
Dosing is an important factor with vitamin or mineral supplements. Vitamins or minerals taken at a certain dose may be beneficial. However, taken at a higher dose, the same vitamin or mineral may be harmful. So, it is very important to work with your doctor and other members of your care team to determine which supplements you should take and what the proper dose should be.
Basics about vitamins and minerals
Vitamins are chemicals that our bodies need to maintain health. Except for vitamin D, which is produced in our bodies when we’re exposed to sun (we can also get vitamin D from different foods), we typically get our daily requirement of vitamins from dietary sources (foods and drinks). Minerals are inorganic substances.
There is general agreement that consuming the recommended daily allowance (RDA) of basic vitamins and minerals is needed to stay healthy. There is controversy, however, about whether some people should take more than the RDA of certain vitamins and minerals. Getting too much of some vitamins and minerals may be dangerous to general health. This is why it is important to talk to your doctor before you take any vitamin or mineral supplement (or any other type of supplement).
Vitamins and minerals in RA
A variety of vitamins, minerals, and other related supplements have been evaluated for use in people with RA. The most important of these include vitamins D, B6, B9 (folic acid), B12, C and E, and selenium, magnesium, calcium, and zinc.
Vitamin D supplements are potentially important for people with RA for two reasons. Vitamin D is recognized as important in maintaining bone health and people with RA are at significantly increased risk for osteoporosis and bone loss due to RA disease processes and glucocorticoid use. Vitamin D also plays an important role in immune system function, and abnormalities in the way cells use vitamin D have been linked to various autoimmune diseases.2 Your doctor can check your vitamin D level with a simple blood test called 25 hydroxyvitamin D (25(0H)D, for short).
Adequate vitamin D intake also appears to protect against developing RA. One 11-year study that followed approximately 30,000 women who did not have RA at the beginning of the study found that those women who had a low vitamin D intake (less than 200 international units [IU] per day) were 33% more likely to develop RA than those with a higher daily intake of vitamin D.3
Two forms of vitamin D are available in supplements, vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Remember to consult with your doctor before you take any supplement. This is especially important with vitamin D, because taking too much of this vitamin can pose a danger to your health.4
The idea behind taking antioxidant vitamins, which include vitamins C and E, is that these vitamins reduce damage caused by free radicals.1 A free radical (also called an oxidant) is a molecule in the body that has an unpaired electron. These molecules are very unstable because they are constantly trying to pair their unpaired electron. This causes them to react with other substances in the body, causing what is sometimes called oxidative damage. You can get the RDA of antioxidant vitamins by eating 3 to 4 servings of vegetables and 2 to 4 servings of fruits every day. However, you can also take supplements to ensure that you are getting adequate amounts of these vitamins.
Vitamins B6 and B12 are commonly found to be at deficient levels in people with RA.1 There is some evidence that B vitamins provide benefits in people with RA. For instance, vitamin B6 has been shown to reduce levels of inflammatory markers, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), in patients with RA.5
Food sources of B6 and B12 include fish, meat, poultry, and fortified cereals.6,7
Adequate intake of calcium, which is the most abundant mineral in the body, is important to maintain the health of bones, teeth, and the regulation of vital body processes. Dietary sources of calcium include dairy products, leafy vegetables, and fortified foods (like cereal). People with RA are at increased risk for bone loss, so adequate calcium intake is crucial (RDA for adults: 1,000 to 1,200 mg). However, calcium taken in excess may result in toxic effects.8
Sources of the mineral selenium, which has antioxidant properties potentially useful in RA, include seafood, whole grains, lean meats, and dairy products. Selenium is one of the minerals that is frequently seen at low levels in people with RA. Talk to your doctor about if you should take selenium supplements and at what recommended dose.1,9
Magnesium is another mineral that is often found in low levels in people with RA. Magnesium is important in many functions in the body, including the production of protein, management of blood sugar, regulation of blood pressure, and the normal function of muscles, nerves and the rhythm of the heart. Magnesium is found in leafy green vegetables, legumes, nuts, seeds, and whole grains. Magnesium is also available in a supplement as powder or tablets.1,10
Zinc is used in many different processes in the body and is essential for good health (RDA for men: 11 mg; women: 8 mg). Dietary sources of zinc include poultry, meat, beans, and nuts. Although no study has implicated low levels of zinc as a cause of RA, results from studies have shown that some people with RA have low levels of zinc and that the metabolism of zinc may be impaired in individuals with RA.1,11
Herbal supplements and RA
There are a variety of herbal supplements and preparations that may be touted as potential RA treatments. These supplements and preparations are available in different formulations, including as raw herbs freshly harvested, extracts in liquid or powder form, infusions made by steeping an herb or plant in boiling water (like a tea), tinctures made by steeping an herb in alcohol, and topical preparations. Herbal supplements and preparations listed below are categorized by their main effects, including anti-inflammatory, analgesic, and sleep-promoting effects.
Anti-inflammatory herbal supplements
- Alfalfa - Although alfalfa has shown anti-inflammatory properties, there is insufficient evidence to recommend it for RA. In addition, some research suggests it may increase symptoms of auto-immune diseases like RA.12
- Angelica sinensis - Angelica sinensis, also known as Dang-gui or Dong quai, is an herb used in traditional Chinese medicine. Data from laboratory research suggests that some of the compounds in Angelica sinensis may have anti-inflammatory and anti-rheumatic properties. However, additional studies are needed to confirm these effects in people with RA.13
- Bladderwrack - Bladderwrack is a type of brown seaweed (Fucus vesiculosus) used as a complementary or alternative medicine for many different conditions. However, there is insufficient evidence to recommend using bladderwrack for RA or any other condition. In addition, it contains significant amounts of iodine, which may be harmful to certain people, and may contain heavy metals, which can lead to heavy metal poisoning.14
- Bromelain - Bromelain is an extract from the pineapple plant and has been studied for its anti-inflammatory properties in nasal and sinus inflammation. There is conflicting evidence on whether it is effective for osteoarthritis, and there is no evidence to show it has any benefit in RA.15
- Cat's claw - Cat's claw is an herbal supplement used for a variety of conditions. There have been few high-quality clinical trials on cat's claw, but data from some research suggests it may have a benefit in osteoarthritis (not RA).16,17
- Devil's claw - Research suggests that Devil's claw, an herb named for the appearance of its fruit, may possibly be effective for osteoarthritis, but there is not enough evidence to support its use in RA.18
- Curcumin - Curcumin is a compound found in turmeric, which is often used as a spice in Indian dishes and used in traditional Chinese and Ayurvedic medicine for its anti-inflammatory properties. Curcumin has been studied in several clinical trials, and data suggests it may be beneficial in reducing pain and inflammation in people with RA.19
- Chondroitin - The natural chemical compound chondroitin sulfate is a key part of cartilage and other connective tissue. A synthesized form of chondroitin given as an oral supplement (often combined with glucosamine, another component of cartilage) is used in patients with osteoarthritis where it has resulted in moderate to major improvements in joint symptoms, including decreased pain and improved function. However, there is no evidence to show it benefits people with RA.20
- Glucosamine - Glucosamine sulfate is a naturally occurring substance in the fluid around joints. It has shown to be beneficial for people with osteoarthritis; however, there is no research to prove its use in people with RA.21
- Feverfew - Feverfew is an herbal supplement that has been traditionally used to treat RA, along with other conditions like migraine. It has demonstrated anti-inflammatory and pain relieving characteristics, and some research suggests it may help prevent migraine attacks. However, there is insufficient evidence for its recommended use in RA.22,23
- Flaxseed - Flaxseed has many health benefits, including anti-inflammatory and anti-oxidant properties. Flaxseed contains alpha-linoleic acid (ALA), an omega-3 fatty acid. The highest amount of ALA is found in flaxseed oil. Research indicates that flaxseed may provide a benefit to those with RA, easing symptoms like pain and inflammation.24
- Gamma-linolenic acid (GLA) - Dietary supplements containing GLA may benefit people with RA by relieving symptoms like pain and inflammation.25,26 There are different types of GLA supplements, including:
- Borage seed oil
- Evening primrose oil
- Blackcurrant seed oil
- H15, or Boswellia serrata - H15 is an extract of Boswellia serrata and has been used in Ayurvedic medicine for many years. Research suggests that the anti-inflammatory properties of Boswellia serrata may help relieve symptoms of RA.27
- Dimethyl sulfoxide (DMSO) - DMSO appears to have anti-inflammatory properties and is used by people with RA and osteoarthritis to relieve joint pain. However, there is a lack of evidence on its efficacy and safety.28
Analgesic herbal supplements
- Capsaicin - Capsaicin is a chemical component of chili peppers that has analgesic (pain relieving) properties. It is available in a variety of topical applications (lotions, creams, gels, and patches) and may be used to help relieve minor pain from RA, as well as pain from muscle strains or neuralgia.29
- Ginger - Ginger is used as both a spice and an herbal supplement. As an herbal supplement, its use for nausea and vomiting are well-documented, but there is not enough evidence to support its use for RA or other conditions.30
- Methylsulfonylmethane (MSM) - MSM is a naturally occurring compound in humans, animals, and plants, and it has analgesic properties. MSM supplements have demonstrated possible benefit in osteoarthritis, but there is not evidence to support the use of MSM in RA.31
- Thunder god vine - Herbal supplements containing thunder god vine may benefit people with RA by relieving symptoms like pain.25
- Willow bark - Willow bark contains salicin, which acts like aspirin and may be used for pain relief for various conditions. Some research has shown it may possibly be beneficial for low back pain, but research in RA suggests it is not effective for pain from RA.32
Sleep aid herbal supplements
- Melatonin - Melatonin is a hormone secreted by the pineal gland (a small gland located near the center of the brain) that plays an important role in regulating our sleep-wake cycle, among other body functions. Data from clinical trials suggests melatonin supplements may be helpful in treating sleep disorders, such as jet lag, delayed sleep disorder, and sleep problems related to shift work.33
- L-tryptophan and 5-hydroxytryptophan (5-HTP) - L-tryptophan and 5-HTP are precursors to serotonin, which can then be converted to melatonin. Research has been limited on these compounds, with clinical trials of small or limited quality, and no recommendations can be made on their efficacy.33 Increasing levels of serotonin may interact with several anti-depressant medications, so it's important to talk to your healthcare provider first.
- Kava - Kava (also called kava kava or ava pepper) comes from the plant Piper methysticum. It has been used traditionally in the South Pacific to promote relaxation. Research has shown that kava may have a small effect on reducing anxiety, but there are safety concerns: Kava has been linked to an increased risk of severe liver disease, and heavy use is linked with heart problems and eye irritation.34
- Valerian - Valerian comes from a plant (Valeriana officinalis). There is limited research on valerian as a sleep aid, and results from clinical trials have been inconsistent.35
Other herbal supplements
- Dehydroepiandrosterone (DHEA) - DHEA is an endogenous (this means produced in the body) steroid produced by the adrenal gland which plays a role in a broad range of biological functions in the body. DHEA is used within the body to produce male and female sex hormones (androgens and estrogens, respectively). A limited number of studies have evaluated DHEA as a treatment for RA, but results indicate that DHEA is possibly ineffective for RA.36
- SAM-e (S-Adenosyl-L-methionine) - SAM-e is a chemical that occurs naturally throughout the entire body. SAM-e has been shown to have anti-inflammatory and analgesic properties and is commonly used as a supplement to treat musculoskeletal disorders, such as osteoarthritis, and other health conditions, including heart disease and depression. Results from studies on SAM-e in osteoarthritis are mixed, and there is not evidence to support its use in RA.37
- Probiotics - Probiotics are supplements of "good bacteria" that are found in the gut. There are different strains of probiotics available. Some research suggests probiotics may be helpful in people with RA. In one trial, participants who received a probiotic supplement containing Lactobacillus casei had a significant reduction in disease activity and inflammation. Additional trials are needed to confirm these findings, but probiotics may be a helpful adjunct to other treatment for RA.38
Dietary and herbal supplements are often perceived to be safe and without possible side effects. Unfortunately, this is not the case. Some supplements can cause side effects, including serious side effects. Many supplements can also interfere with other medications a person may be taking, causing unwanted side effects or making the medication less effective. It's important to discuss all vitamins, supplements, and medications (prescription and over-the-counter) with a healthcare professional to understand any risks or safety precautions.