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Most doctors tend to scratch their heads – or shake them in disbelief – whenever the subject of homeopathy comes up. It’s an alien concept that goes against almost everything understood in modern medicine. While much of homeopathy’s appeal is based on hearsay and anecdotes, nevertheless, a number of studies have shown homeopathic remedies are effective for some conditions. Most doctors write that off to placebo effect – the curious but real phenomenon in which a person’s belief that a substance will make him feel better actually does make him feel better. But there may be more to homeopathy than the placebo effect can explain: Some of the studies were performed on animals and in test tubes, yet still showed positive effects.

The basic premise isn’t so strange: Homeopathy is based on the idea that "like cures like," that diluted amounts of a poison or other disease-causing substance can relieve the same symptoms that the larger dose causes. That concept resembles the desensitizing therapy used to relieve allergy symptoms, or vaccination, in which we are given a mild case of the disease to put our immune system on guard. But the most confounding homeopathic belief of all is that the weaker the dose, the stronger the body’s response. In fact, some of the "most potent" remedies are so diluted that not a single molecule of the original material remains in the solution or tablet.

No one can explain how it works – or how it could work. One homeopathic theory is that the molecules of the remedy substance leave an energy "memory" as they disappear, somewhat like a shadow, and that the body responds to it. To most scientists, that’s nonsense. How, they ask, can a substance that diluted possibly have any effect? And skeptics and foes aren’t the only ones baffled.

"It boggles the mind," agrees Wayne Jonas, MD, a family physician at the Uniformed Services University of the Health Sciences in Bethesda, Md., who uses homeopathy in his practice. George Guess, MD, a family practitioner in Charlottesville, Va., says: "I don’t have the answer, but I know it works." Dr. Guess, who is president of the American Board of Homeotherapeutics and whose practice is "99 percent" homeopathy, was drawn to the field in part because of what he calls "the pleasant paradox: You can get an effect without a side effect," he says. Corey Weinstein, MD, who practices homeopathy in San Francisco, says "There are a lot of things that we use every day and don’t understand. Homeopathy isn’t magic – it’s just a wonderful, natural tool that helps people."

A "Pharmacy" from the 18th Century

Homeopathy is a healing system developed in the 18th century by the German physician Samuel Hahnemann. Looking for a mild therapy that could stimulate the "vital energy" to restore and maintain health, he believed the substances that cause disease could, when administered in tiny amounts, provoke a healing response. Over decades, Hahnemann built a pharmacy of thousands of "remedies" derived from natural substances such as herbs, minerals and animal products. Homeopathy quickly built a great popular appeal: By the mid 1800s, thousands of homeopathic doctors, hospitals, pharmacies and medical schools appeared worldwide.

Homeopathy faded from popularity in the United States in the 1940s with the advent of antibiotics and other effective pharmaceuticals. Today, increased interest in alternative therapies has led to a revival. Now homeopathic remedies are sold at health food and drugstores in the form of tinctures, creams, and most often as tiny tablets that dissolve under the tongue. Today’s homeopaths often use a computer to keep track of the many remedies. Homeopathy is an individualized therapy: A practitioner takes a detailed history of your health, lifestyle, preferences and symptoms and categorizes your "constitutional type." The homeopath then carefully matches this information to a vast data bank of remedies.

Among the most common homeopathic preparations is arnica, used for bruises and injuries. Some common remedies for arthritis pain are Rhus toxicodendron (from poison ivy) Bryonia (wild hops), Apis (from bee venom) and Ledum (from marsh tea). A homeopathic remedy for gout is Colchicum autumnal, the herb from which a prescription drug for gout is made. In so-called "classical homeopathy," the practitioner seeks a single remedy that’s the perfect fit for an individual and his situation, and then prescribes one remedy at a time. If that remedy doesn’t work on all the symptoms, the practitioner may substitute – or add – another remedy. According to Dr. Weinstein, some insist this is the best way to practice homeopathy. On the other hand, many of today’s homeopaths use combination remedies of two or more ingredients at a time.

Many more people self-treat, especially for minor ailments such as muscle aches, a cold or an earache. There are many books on homeopathy that match symptoms to remedies, and remedies are usually labeled with their therapeutic uses. Anyone can buy the substances off-the-shelf in health food stores, pharmacies and even grocery stores. And homeopathic remedies are approved by the U.S. Food and Drug Administration as over-the-counter drugs, unlike herbs and dietary supplements which have not received FDA approval as medications.

But in homeopathic philosophies, self-treating isn’t as effective as a customized treatment for a chronic condition such as arthritis, says Dr. Corey Weinstein. Practitioners say symptoms sometimes worsen briefly before they begin to get better. Acute ailments such as the flu or a stomach upset may clear up with one dose in a few hours or days, says Jennifer Jacobs, MD, who’s on the faculty at the University of Washington and who’s been using homeopathy for 23 years in her family practice. Chronic conditions such as arthritis may take several months of treatments, she says.

I think you will find it difficult to locate rheumatologists who use homeopathy. Neil Kramer ,MD,a rheumatologist at the Arthritis and Rheumatic Disease Centre in Santa Barbara,said,"Despite its growing popularity,the established medical community have not readily embraced Homeopathy. "We can not support Homeopathy,these therapies are expensive and potentially toxic. The incorporation of these treatmens into the therupeutic armanentation of the rheumatologist cannot be recommended until they are shown to be effective,safe,and affordable"

A few family doctors have employed homeopathy in their practise. Some said remedies may even slow or stop the progression of rheumatoid arthritis (RA) or osteoarthritis (OA). But scientific evidence doesn’t prove that. There are acceptable studies that suggest homeopathy eases conditions such as allergies, but the research on homeopathy and arthritis is mixed, says Dr. Jonas. "Many of the studies have problems."

He analyzed a group of six studies: three for rheumatoid arthritis and one each for OA, fibromyalgia and myaglia (or muscle pain). The remedies, which varied, were better than placebo for relieving some symptoms in two of the three RA studies. But the other studies had mixed results, were of poor quality or used small numbers of patients. "Overall, the evidence for the benefit of homeopathy in arthritis is poor," says Dr. Jonas, and rheumatologists emphasized that people should not discontinue or delay taking effective prescription medications to experiment with an unproven therapy.

"I’d probably use other therapies first, or along with homeopathy," says Brian Berman, MD, director of the University of Maryland’s complementary medicine program, who is a family practitioner, a homeopath and an acupuncturist.

A caution: Homeopaths also believe substances such as coffee or prescription drugs may counteract the remedies. But no conscientious homeopath takes patients off prescription drugs abruptly or asks them to stop medications if they have a systemic type of arthritis such as lupus or RA.

"If I have someone with RA who needs methotrexate, I send them to a rheumatologist. But they could be trying homeopathy along with it," says Dr. Jonas, who describes himself as "a 99 percent conventional doctor" who also uses homeopathy. "I have many people taking conventional medicine along with homeopathic remedies," says Dr. Jacobs. "If it’s the right homeopathic remedy, it won’t be nullified by any other medication the person may be taking, but they may need to take the homeopathic remedy more often." Some people might find with homeopathy that they can gradually reduce their medication, she says, but this should be done under a doctor’s care.

What’s the bottom line? The half-dozen rheumatologists, consulted say there’s not enough evidence homeopathy helps any arthritis symptoms. "We need more studies," says Arthur Weinstein, MD, director of the Division of Rheumatology at George Washington University Medical Center in Washington, DC. "It is possible to conduct good studies, and alternative remedies such as homeopathy should be subject to the same scrutiny as prescription drugs."

Meanwhile, they agreed the remedies are so diluted that treatments are unlikely to do harm, and many people say they find symptomatic relief. "We have to stay open-minded," says Nancy Lane, MD, who’s an associate professor of medicine at San Francisco General Hospital at the University of California. "These alternatives are important, because people are using them. Therefore, we must consider them important topics to study." Homeopathic remedies can be found in many pharmacies and health food stores.

According to doctors,and the National Center for Homeopathy, fees for treatment range from $100 to $400 for the first consultation and then from $50 to $100 for follow-up visits. Remedies range from $5 to $15, and sometimes are used in one dose. The consultations may be covered by your insurance if the homeopath is also a medical doctor or osteopath.

If you decide to try homeopathic remedies, heed the advice given by the physician homeopaths interviewed:

Get a diagnosis from a medical doctor if you have – or even suspect you have – arthritis. There are more than 100 different types, and your diagnosis will determine the proper treatment. Don’t try to treat yourself if you have a systemic rheumatic disease such as rheumatoid arthritis or lupus. And don’t expect homeopathy alone to be enough. Consult your regular medical doctor as well.

Don’t give up your prescription medications without your doctor’s OK. It can be dangerous to stop some drugs abruptly. Look for a homeopath with years of experience, certification from a national homeopathic organization and, preferably, medical training. Use only products labeled with the words "produced in accord with the U.S. Pharmacopoeia Convention" to be sure you are getting a pure homeopathic product, not one mixed with drugs or other substances.

Read the labels if you have alcohol concerns: Some remedies are diluted with alcohol. Take only one remedy at a time, and keep detailed notes about what you take and any effects you feel. This will help you determine if it appears to help your symptoms or track any adverse effects. Don’t continue a therapy that isn’t working: Homeopaths say remedies show effects for minor ailments in a few days. For a chronic disease such as arthritis, it may take up to two months. If you don’t improve after that period, it’s probably not the right remedy – or homeopathy may not be the right treatment.

Remember, more is not better: The whole philosophy of homeopathy is small doses. Take the remedies as directed, in tiny amounts. Side effects are rare, as homeopathic remedies have little (if any) active ingredients. However, if you develop new symptoms, stop taking the remedy right away and consult your doctor and a homeopath.

Acupuncture has been described in thousands of writings throughout the centuries. Among the many recent studies are several that show it relieves osteoarthritis symptoms –-so well in one Scandinavian study that 25 percent of patients previously scheduled for knee surgery canceled their plans. That same study showed booster treatments once a month sustained the pain relief.

Other studies have shown that acupuncture helps relieve pain from fibromyalgia and osteoarthritis; can decrease the number and severity of Raynaud's phenomenon attacks; helps ease conditions that can accompany arthritis such as depression and irritable bowel syndrome; and enhance conventional treatments for gout, when used in a combined therapy.

However, a 1997 meta-analysis of 17 studies that looked at acupuncture in inflammatory diseases such as rheumatoid arthritis, spondylarthropathy, lupus and local and progressive systemic scleroderma found the studies failed to show the effectiveness of acupuncture for these conditions.

Furthermore, many studies are not published in English and few acupuncture studies meet rigorous scientific standards. A 1999 analysis of studies that looked at acupuncture for fibromyalgia, for example, found seven that suggested it relieves pain, reduces morning stiffness and may improve sleep, but only one of those studies was considered to meet high scientific standards, says Brian Berman, MD, director of the Complementary Medicine Program (CMP) at the University of Maryland in Baltimore.

Dr. Berman, who also practices acupuncture, says more and better studies are needed to measure the effects of acupuncture. The CMP has three NIH-funded studies underway looking at acupuncture and both osteoarthritis and post-operative pain.

Experts says: There's enough research to suggest acupuncture relieves pain for some, and that it is safe when performed by a trained professional using sterile or disposable needles.

Acupuncture appears to work best on fibromyalgia and soft-tissue pain, and to be least effective for rheumatoid arthritis or other systemic inflammatory conditions, doctors say. Relief is often temporary, and treatments can be time-consuming and expensive.

"If asked, I encourage patients to try it and make up their own minds as to its usefulness," says Robert Bennett, MD, professor of medicine and chairman of the division of arthritis and rheumatic diseases at Oregon Health Sciences Center in Portland. "A few patients will integrate it into their treatment, but most patients give up acupuncture because it's so costly, both in dollars and time, to have two or three sessions a week."

Acupuncture may not be covered by your insurance, even if it's given by a medical doctor. Costs vary across the country, but generally a first visit runs $75 to $150, with follow-up visits between $35 and $75. At these rates – for weekly or more often sessions – some rheumatologists say acupuncture isn't cost-effective.

Acupuncture advocates disagree. In the beginning, acupuncture's pain-relieving effects may last a week or less, Dr. Kassan admits. "But after four or five weekly treatments, many patients find they can progressively decrease the frequency and end up with monthly treatments. It may also decrease the need for pain medications."

Other advocates believe acupuncture's effects may go beyond temporary pain relief. "Acupuncture is a stimulus that can help repattern the body and help break the chronic pain syndrome," says Ka-Kit Hui, MD, an internist and clinical pharmacologist who is director of the integrated Center for East-West Medicine at the University of California, Los Angeles. It can also stimulate circulation and people can be taught acupressure massage to help themselves, he says.

One thing experts concur on is that acupuncture won't cure arthritis. "Acupuncture doesn't replace conventional medicine," says Dr. Hatfield. "But it adds another dimension beyond what we have now."

Acupuncture is generally safe, but as with any therapy – conventional or alternative – you should observe some precautions.

Choose a therapist who is licensed and/or a graduate of a respected school of acupuncture, and who is willing to work with your doctor. Some 10,000 acupuncturists currently practice in the United States and most are regulated by the state in which they reside. About 4,000 doctors have completed a recognized acupuncture training program. Get a diagnosis from a medical doctor before undergoing acupuncture, to make sure you don't have a condition requiring prompt medical attention. Don't stop your medications without consulting your doctor. Acupuncture works with, not instead of, conventional medicine.
Tell the acupuncturist about all health conditions, including pregnancy; and list all medications (including herbs and non-steroidal anti-inflammatory drugs that could cause you to bleed, for example). Be sure the acupuncturist uses sterilized or disposable needles. There has been recent cases where patients had contacted serious infection because therapist had used needles used on previous patients. Don't take muscle relaxants, tranquilizers or painkillers right before acupuncture, as acupuncture may intensify the effects of these drugs.

Tell the practitioner right away if you experience pain or bleeding. Acupuncture shouldn't hurt after the initial sting of the needle's insertion; you should not bleed more than a few drops. Don't automatically take herbs offered by traditional Chinese practitioners (they will tell you to use some ). They could interact with prescription drugs. Keep notes about your response to the treatment, and tell your doctor and acupuncturist about any changes. Track your progress. If you have no response at all after four to six sessions, this therapy may not work for you. Or you may want to try another therapist, because, as in any therapy, skill levels vary.

A first acupuncture session typically lasts about an hour and a half, with follow-up sessions taking 30 minutes to an hour. You'll be asked to lie or sit on a padded table, and to remove or loosen just enough clothing to get comfortable and to uncover areas to be treated.

A therapist will take a detailed health history, and a practitioner of traditional Chinese medicine will also examine your tongue and take your pulse in several different places.

The treatment can involve from two to 15 hair-thin sterile needles (most acupuncturists today use disposable needles) inserted just under the skin, or deeper.

Acupuncture shouldn't hurt much. You may feel a "pinch" or sting and some warmth or tingling for a few seconds. If pain persists, tell the therapist right away.

The therapist will leave the needles in place for a few minutes to an hour (20 minutes is typical), checking to make sure you are comfortable or to remove or manipulate some needles to stimulate the acupoints. Sometimes tiny amounts of an herb called mugwort (or moxa in China) are burned and held – painlessly – over the stimulation points. After the treatment, you'll be asked to rest quietly for a while and then get up slowly, noticing any changes. You may feel a bit lightheaded from the treatment.

People have widely different responses to acupuncture – even people with the same disease or symptoms. Some feel an immediate and strong effect. It may take several sessions for others to feel anything – and perhaps 20 percent of those who try acupuncture get no effect.

If you can't stand needling, you might want to try acupressure: It stimulates the same points, but without the needles and without breaking the skin. The practitioner uses hands and fingers – and sometimes tools such as rollers, balls or pointers – to apply pressure at the acupoints.

You can learn to use some acupressure techniques yourself: Ask the acupuncturist to show you. It's also taught through some health-care providers, or at community and senior centers, and in books and on videos.

Long practiced in Asia, meditation became well known in the West in the 1960s when celebrities like the Beatles began studying transcendental meditation with the Indian guru Maharishi Mahesh. Around the same time, scientists began to study the seemingly supernatural abilities of Asian monks to control what had been believed to be automatic body functions. These studies confirmed that long-time meditators could indeed affect many autonomous physical functions, such as heart rate, blood pressure and the production of stress chemicals like cortisol.

One of those researchers, Harvard University professor Herbert O. Benson, MD, showed that religious belief wasn't necessary to reap the benefits of meditation. It is the repetitive practice, and not a specific technique or intent, that brings about what he called the relaxation response. The relaxation response is an antidote to stress and the many conditions caused by stress, says Dr. Benson, who is president of the Mind/Body Medical Institute at Beth Israel Deaconess Medical Center in Boston.

By the 1990s, meditation was becoming accepted as medicine, especially through the stress reduction program at Harvard and at the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School. Today, more than 240 programs around the country are modeled on the University of Massachusetts program.

Meditation and Arthritis So far, few of the hundreds of studies on meditation look specifically at arthritis or related conditions. However, stress is believed to be associated with flares in many kinds of arthritis, including rheumatoid arthritis, lupus and fibromyalgia. Many studies have shown meditation can significantly lower stress, chronic pain and anxiety.

Scientists now know meditation changes the way our brain works, and shows that thoughts can influence the brain and the body, says Dr. Benson. When his research team used MRI imaging to study the brains of four people meditating, he says the team found increased activity in specific areas involved in attention and control of the autonomic nervous system.

Meditation has also been shown to slow heart and breathing rates, lower blood pressure and cortisol levels, and increase alpha brain wave activity. It may also increase the body's production of melatonin, which is needed for healthy sleep (a problem for many with fibromyalgia and chronic pain). And a startling study last spring found twice-daily TM meditation actually reduced fatty buildup in artery walls as effectively as heart medications.

There's also evidence that meditation moderates the immune response, says Richard Kradin, MD, an immunologist and psychiatrist at Harvard University. Meditation may affect the nervous and vascular systems, as well as the immune system, which in turn would affect joint function and inflammation."There are clearly beneficial effects [from meditation] in people with arthritis. I've seen it in my patients," says Dr. Kradin. "But we need more and better research." There are many unanswered questions. Not all people benefit from meditation. Why is that? Does meditation make people feel better, but not affect underlying disease? Can it actually modify disease progression? What is the correct "dose" to get an effect? Does it matter which technique is used, or how intense the practice is?

Researchers say many techniques work. "Certainly there's evidence that the relaxation response developed by Dr. Benson and mindfulness meditation as used in the Stress Reduction Clinic have positive effects as well," says Santorelli."There are scores of techniques that evoke the relaxation response," agrees Dr. Benson, listing yoga, tai chi, qi gong, as well as praying the rosary. "No one is better than another."

And while meditation doesn't appear to have any side effects, several rheumatologists were concerned some people may put too much faith in it. "If you give too much credence to mind-body therapies, people who get sick and don't get better could feel themselves a failure, and that they are too weak to turn things around," says Dr. Benson. There is also concern people will give up conventional treatments in favor of meditation. Don Goldenberg, MD, a rheumatologist in Wellesley, Mass., who co-authored a study on meditation and fibromyalgia, says meditation can improve symptoms. However, he cautions against thinking you can meditate your illness away.

"Meditation sounds like a good idea, and I recommend it to my patients," says Frederick Wolfe, MD, a rheumatologist and director of the National Data Bank for Rheumatic Diseases in Wichita, Kan. "But I don't know if any of them ever do it, or what percentage who do find it helpful. It's one thing to show it works in a clinic with highly motivated people, and another to show it works in the real world," Dr. Wolfe adds.

But Singh says people who completed an eight-week training program demonstrated that treatment effects lasted long after the program ended. "They learned to think differently and behave differently and continued to improve," she says. "People who are miserable from chronic pain and have not been given much hope for change, and then they feel better from a treatment are smart enough to continue what makes them feel better."

Meanwhile, many health professionals practice what they prescribe. "A meditation practice can change the quality of your life," says Singh, who meditates daily. "It offers each person a few moments to quietly refocus and just be in a moment of peace." Dr. Goldenberg, a fibromyalgia expert who has struggled with chronic ailments himself, practices yoga and meditation. Santorelli's expertise in stress reduction has its roots in his long-time meditation and yoga practice.Dr. Benson says he resisted using mind-body therapy for 15 years after he first described the relaxation response because he thought people would question his scientific objectivity. Getting older made him reconsider his stance. "Now I evoke the relaxation response every morning," says Dr. Benson.

You can learn how to meditate from a book or an audio tape , but it may be helpful to have some personal instruction. Look for a course or instructor certified by a medical program or a spiritual organization. Check out the stress reduction program offered at a nearby hospital, health or community center. The costs vary from free to a $1,200 fee charged by the Transcendental Meditation Organization. Stress reduction workshops that teach meditation may be covered all or in part by your insurer.

Herbs And Supplements:

Here’s an overview of the oil supplements most-used for rheumatoid arthritis and other forms of inflammatory arthritis. Fish oil is perhaps best known for its heart-saving abilities, but the same qualities help reduce RA and Raynaud’s symptoms. In some studies, those with RA using fish oil were able to significantly reduce their use of NSAIDs, or even discontinue them without increased pain and inflammation. In a study of 32 people with Raynaud’s who took fish oil, researchers found that the oil improved the tolerance to cold exposure among those who had primary but not secondary Raynaud’s.

How it’s used: Fish oil comes as a liquid and in softgel capsules. The usual dose is about three grams, or 3,000 milligrams (mg), total of EPA/DHA (the key ingredient in fish oil) per day. Be sure to check the labels: the capsules may say "1,000 mg of fish oil," but will have varying percentages of EPA and DHA. If they contain 300 mg, you’ll need to take 10 capsules a day. Look for high potency capsules so you don’t have to take so many. A month’s supply costs about $45.

Evening primrose seed oil and borage seed oil also eased RA symptoms in studies – some say better than fish oil in terms of relieving joint tenderness. Evening primrose oil is better known, but borage oil has a higher percentage the beneficial acid GLA. Some folklore recommends rubbing these oils on your aching joints, or on the hands for those with Raynaud’s, but there is no evidence that this helps.

How it’s used: These oils are available as liquids but are most often taken in softgel capsules. The usual dosage for RA is about 1.8 grams (1,800 mg) of GLA a day. Again, check the ingredients on the label and see how much GLA is in each capsule, then do the math. If the capsules have 300 mg of GLA, you will need to take six a day. Evening primrose oil may contain 130 mg of GLA, so you’ll need 14 capsules per day. A month’s supply of borage oil is about $60; evening primrose oil is about $100 a month.

Flaxseed oil is believed by some to help arthritis, but so far there aren’t any good studies that prove this. The belief it may reduce inflammation in RA comes from its composition, and from studies that show it increases levels of the beneficial fatty acid EPA. In a study of healthy men who limited "bad" fats in the diet, researchers found flaxseed oil worked as well as fish oil. It’s also possible flaxseed might help with lupus. In a small study of nine people with lupus nephritis (kidney inflammation), 30 grams of flaxseed a day significantly lowered cholesterol, thinned blood, reduced inflammation and improved kidney function.

How it’s used: Flaxseed is sold as a liquid, whole seeds and a meal or flour for baking. Some sources recommend taking 1 to 3 tablespoons a day of the oil or about 30 grams (one-fourth of a cup) of the meal or flour. You can use the meal or flour, which costs about $1 a pound, in bread, pancake and waffle recipes: One quick-bread recipe uses 2 cups of flaxseed flour with 4 cups of regular flour. It has a nutty flavor and the oil, which costs about $15 for 16 ounces, is used in salad dressings.

These medicinal oils can become rancid after exposure to heat, light and oxygen. To prevent this: Read supplement labels carefully. Buy only plant oils that are certified organic (or grown without pesticides); that are packaged in opaque plastic containers; and that have an expiration date. Look for products that have been "expeller-pressed;" expeller pressing means no heat or chemicals were used in the process of squeezing the oil out of the seeds. Look for liquid oils displayed in a refrigerated case; store oils and capsules in the refrigerator. Remember: The products are not pure GLA or EPA/DHA. Check to see how much of the active ingredients you are getting. Look for high dosage capsules, and be prepared to do some calculations to figure out how many you need to take. If you aren’t sure, ask a pharmacist.

In spite of the evidence for these oil supplements, they aren’t routinely recommended. That may be because they are not FDA approved or covered by insurance, says Robert B. Zurier, MD, chief of rheumatology at the University of Massachusetts and a leading researcher in GLA oils. According to Dr. Leventhal, who has also conducted research on GLA oils, "Physicians are naturally skeptical about a diet therapy."

There are also some unanswered questions: Which type of oil is better? Would it help to take more than one? And what’s the best dosage? "Both GLA and fish oil have been shown to help, and they might be good together," says Kremer. "But we don’t know – it hasn’t been studied enough." Until more is known, proceed with caution. "I don’t want my patients to think this is the way to go, and give up conventional treatments," says Dr. Leventhal. "People who want to try this should talk to their doctor."

If you decide to try oil supplements, tell your doctor and keep a daily diary to note any changes. Fish oil and the GLA oils thin the blood, which means they could increase your risk of bleeding if you are also taking NSAIDs, blood thinning medication, or herbs such as ginger or turmeric that also slow clotting. Although no one has had a bleeding incident in any of the studies, it’s best to be cautious. Check with your doctor. If you use the old fish oil standby, cod liver oil, be sure it has been stripped of vitamins A and D: These vitamins are toxic in large doses. Allow three months for the oil supplements to take effect. If you don’t see any changes by then, the supplements may not be working for you.

It’s rare, but some people may get intestinal upsets or gas when they start taking oils. Start with a one-third dosage and increase it gradually to reduce the chances of stomach upsets or gas. Fish oil capsules are tasteless, but burping may bring up a fishy taste or odor, so take them right before meals. Some people who take high doses of fish oil have reported that their body odor takes on a fishy smell. Fish that Give Good Fat=Mackerel ,Herring ,Sardines ,Anchovies ,Albacore tuna ,Salmon

The colder the water they live in, the more omega-3 oil in the fish: A half a pound of salmon yields 3 to 4 grams of omega-3 oil. Frozen and canned fish are fine. However, be sure the fish is wild: Farm-raised fish (such as salmon) are fed commercial products resulting in lower omega-3 levels.

Consider changing the balance of oils in your diet to improve your whole health picture. Here’s what some experts suggest.

Toss the cooking and salad oils in your house except for those high in beneficial fatty acids such as flaxseed, olive and canola oils. Cut your meat and other animal product consumption to no more than 4 to 6 ounces per day (about the size of two decks of playing cards). Eat cold water fish two or three times a week (see list above). Add flaxseed products to your diet. The oil can be used in salad dressings and the flour can be cooked into muffins or pancakes for breakfast.
Watch your overall fat intake: no more than 30 percent of your daily calories should come from any kind of fat

We don't usually think of ginger, turmeric and frankincense as medicinals. Instead the names conjure up images of a kitchen spice shelf, a tasty curry or an exotic incense. But these herbs do have a venerable therapeutic lineage. For thousands of years they have been used in Ayurveda , the traditional medicine of India, to treat arthritis and other ailments. Sometimes, they are combined with ashwagandha, another Indian herb.

Research reported at the American College of Rheumatology (ACR) annual scientific meeting last fall looked at a combination remedy incorporating these four plant extracts. In a randomized, double-blinded trial of 90 people with osteoarthritis (OA), those patients who took the combination experienced significant and sustained pain relief: Fifty percent improved, compared to 20 percent of those who took placebo.

An earlier double-blinded study of the same formula, presented at the ACR meeting two years prior, looked at 182 patients with active rheumatoid arthritis (RA). Again, those who took the herbs experienced a reduction in the number and severity of swollen joints and noted a statistically significant improvement in pain, stiffness and function compared to those taking placebo. Tests also showed disease-modifying activity such as a drop in the amount of both rheumatoid factor and interleukins, the biological markers that show RA disease activity.

In both studies, participants had no significant side effects or interactions with other drugs, even those taken over a four-year period. Given such promising results, are these herbs worth a try? The answer depends on whom you ask. If you ask a Western-trained medical doctor, you're likely to meet with skepticism. Many doubt the effectiveness of herbs in general. Others feel they don't know enough about herbs and other botanical therapies to give an opinion. "If I were an expert, I'd comment. But most of us are just guessing," says rheumatologist Justus Fiechtner MD, of East Lansing, Mich.

Some skeptics question how the same formula could help both OA and RA - two conditions with different causes and different symptoms. That's a Western bias, says Scott Gerson, MD, founder and medical director of the National Institute of Ayurvedic Medicine in Brewster, N.Y. Dr. Gerson is a Western-trained medical doctor as well as an Ayurvedic physician.

"We're conditioned to think of drugs as having only one effect, but that's not true," he says. "Though given for one symptom or disease, all drugs actually have many actions in your body. Herbs, which are complex, have many active ingredients and can affect many body systems."

Western experts also have a problem with the multi-herb formula. When so many ingredients are used, it's hard to scientifically evaluate a remedy to determine which one (or ones) are the active ingredients, or even how they act together, says Pharmacist Donald R. Miller, chairman of the department of pharmacy practice at North Dakota State University in Fargo. While Miller says the studies presented at ACR were well done and may very well be objective and accurate, they were sponsored by San Jose, Calif.-based AyurCore, a company making and selling a patented product called Artrex, which is made of the four-herb combination. "I'd like to see studies done by an independent group," he says. Moreover, medical doctors point out that these studies have not been published in peer-reviewed journals.

For Ayurvedic practitioners, these studies confirm tradition. "These herbs have been used for thousands of years," says Dr. Gerson, who has no financial interest in the Artrex product. "I've used all of these for osteoarthritis and rheumatoid arthritis.

While these herbs are often used in combination, each has its own history of study and/or therapeutic use. Ginger (Zingiber officinale) may be among the best-studied of the four. Research suggests ginger root inhibits production of prostaglandins and leukotrienes, which are involved in pain and inflammation. In an uncontrolled 1992 Danish study, 56 patients who had either RA, OA or muscular discomfort took powdered ginger. All of those with musculoskeletal pain and three-fourths of those with OA or RA reported varying degrees of pain relief and no side effects, even among those who took the ginger for more than two years.

Turmeric (Curcumin longa) is used lavishly for color and flavor in Indian cuisine. Studies show it inhibits prostaglandin production and stimulates the creation of cortisol, which relieves inflammation. It seems to act like capsaicin, an active ingredient in cayenne pepper, by depleting nerve endings of the neurotransmitter substance P. When turmeric was taken internally along with cayenne pepper in an animal study, it significantly lowered inflammation. Capsaicin is usually used in ointments that are applied externally to aching joints. One researcher suggests turmeric might also work applied externally, but there are no studies to show this.

Frankincense, also known as boswellia (Boswellia serrata), comes from a tree that yields gum when its bark is peeled away. In animal and test tube studies, it inhibited the production of leukotrienes, which cause inflammation.

Ashwagandha (Withania somniferum) is an Asian plant of the potato family. Its roots have long been used to treat "rheumatism," high blood pressure, immune dysfunctions, erection problems and also to ease inflammation. Because of all this, it's sometimes called the "Indian ginseng.

Although each herb may have some action on its own, Ayurvedic medicine traditionally combines herbs for greater effect. A 1991 study conducted in India looked at another combination formula - of Boswellia, ashwagandha, turmeric and zinc. In a double-blinded, placebo-controlled trial of 42 patients with OA, those receiving the test formula showed a significant drop in pain and disability. Moreover, the combination appeared to only affect the symptoms: X-rays didn't show any changes in the joints of the test group. Again, there were no significant side effects.

While researchers report that the herbs require up to a month to take effect, they say they retain their therapeutic punch over several years without a need to increase the dosage.

And don't look to herbs to fully solve your health problems. Ayurvedic practitioners and Western doctors agree it takes a well-rounded treatment plan to control arthritis. "Yes, these herbs work," says D. Edwards Smith, MD, a rheumatologist and Ayurvedic practitioner who is now dean of the Maharishi College of Vedic Medicine in Albuquerque, N.M., "but herbs are just one part of therapy." Treating and preventing disease requires daily healthy living that includes rest, relaxation, exercise and a well-balanced diet.

If you are thinking of using these herbs, keep this advice in mind: Make sure you have an accurate diagnosis. There are more than 100 different types of arthritis and related conditions. As always, before you take botanicals or other supplements, be sure to tell your doctor what you are taking and how much so you can be monitored for any side effects or changes. Don't discontinue any prescription drugs - especially glucocorticoids - without first consulting your doctor. It can be dangerous to suddenly stop some medications.

Remember that these botanicals act as chemicals in the body: Anything powerful enough to help can also hurt. Botanicals may also interact with prescription and other drugs. For example, ashwagandha in very large doses may increase the effects of barbiturates. Follow directions on the package or from a health professional trained in herbal or Ayurvedic therapy. More is not better, and large doses can cause problems.

Use ginger with care if you are taking blood pressure or blood thinning medication, as large doses can multiply the effects of these drugs and cause bleeding. For the same reason, don't use large amounts of ginger if you are scheduled for surgery or dental work. After about two or three months, check in with your doctor, as you would when taking any medication long-term.

Keep up with your full,conventional, treatment plan. Be sure to exercise, get appropriate rest, practice joint protection, keep your weight down and your spirits up.

North Americans spend millions of dollars each year on nontraditional treatments for arthritis. Some people eat shark cartilage. Others swear by chick cartilage or white raisins soaked in gin. Still others send for products that promise miracle cures or secret ingredients. You might seek out such treatments for several reasons. You may find that conventional arthritis medications offer little relief, or you may not be able to tolerate the side effects that occur with such treatments, especially after long-term use.

Some people believe that natural substances must be safe because they're natural, but this is not always the case. Arsenic and nightshade are two natural substances that people have used to improve health, but both can kill you. Just because medications are available without a prescription does not mean they are free of side effects.

Acupuncture involves the insertion of thin needles under your skin to stimulate the free flow of chi (chee), the Chinese word for life force. The National Institutes of Health found that acupuncture may be a reasonable pain management option for OA. More recently, the American College of Rheumatology reported that acupuncture works no better than a placebo. Future research may help define which people or types of arthritis can benefit from acupuncture. There are people with RA who have tried acupuncture,but the results are mixed,some benefit,others do not.

Some research suggests that omega-3 fatty acids from cold-water fish, such as salmon, mackerel and herring, may give modest, temporary relief from inflammation. Soybean and avocado oils also may offer relief from OA. Eating salmon 3 times a week may be a safer and wiser option then supplements,since they are unregulated,the exact safety dose is unsure-even by experts. The subject has been promoted widely by the media.

There is no scientific data to support the popular belief that swallowing cod liver oil will lubricate stiff joints There was a trial done by a British Scientist on cod liver oil and he felt it might be of benefit if administered properly,but it wasn't simply,swallowing cod liver oil . He applied for publication in the Lancet,but nothing,widely, was heard about the full details. I believe if there was some strength in his claims we would hear about it.

Some evidence suggested that glucosamine and chondroitin sulfate supplements can help you maintain existing cartilage and stimulate new cartilage to grow. Glucosamine is found naturally in your body. It helps give cartilage its strength and rigidity. The supplements sold in stores are a synthetic version of this substance. An article published in the Journal of the American Medical Association by the Arthritis Center at the Boston University School of Medicine evaluated several previously published trials. The researchers concluded that trials of glucosamine and chondroitin sulfate preparations showed some positive effects for OA.

In a report published in the medical journal The Lancet, a group from Belgium found that symptoms improved for patients with osteoarthritis of the knees who took 1,500 milligrams of glucosamine daily for 3 years. X-rays of those taking the drug showed less joint space narrowing than did X-rays of patients who received a placebo — a pill with no therapeutic value. Many of the reported "trials" have been on small studues that were not designed effectively to determine its validity. Recently the NIH did a long testing of Glucosime and they concluded it may help some people with osteoarthritis.

Scientists don't know if the results from one study looking at the effects on a specific joint area can be applied to other joints or to all types of arthritis. Larger, longer studies are needed before any positive effects from the supplements can be proved. If you have an allergy to shellfish, you should not take glucosamine. If you take blood thinners such as warfarin (Coumadin, Panwarfin), chondroitin sulfate may affect the levels. Also, glucosamine may raise blood insulin levels in people with diabetes.

The evidence that glucosamine builds up cartilage is meagre. And even in the studies that show that it might, the amount of cartilage built up is miniscule. The studies have been done in osteoarthritis, not in rheumatoid arthritis where the damage to cartilage is much more aggressive. Any potential benefit of cartilage repair would be outweighed by the destructive inflammatory process of rheumatoid arthritis. Glucosamine might reduce some of the pain in the knee but it needs to be taken for 2-3 months to determine such a benefit.

The degree of cartilage loss in your knee and the prescence of rheumatoid arthritis make it very unlikely that glucosamine sulfate would restore any meaningful amount of cartilage, if any at all. However, glucosamine may be useful for some osteoarthritis patients,it is not recommended for RA..

Devil's claw has not been shown to help rheumatoid arthritis and it may have some hormonal side effects such as abortion. Some persons believe that liquid cod liver oil helps their arthritis by lubricating their joints. However there is no real evidence to support such claims. In fact, joints are lubricated by mucus like hyaluronic acid not by oils such as the fatty oils in cod liver oil. Cod liver oil contains vitamins A and D and omega-3 polyunsaturated fatty acids.

Vitamins A and D are not known to help arthritis but vitamin D is important for normal bone growth and maintenance.
There is a danger in taking too much cod liver oil and developing vitamin A and D toxicity. The omega-3 fatty acids include EPA (eicosapentenoic acid) and DHA (docosahexanoic acid) which have been shown to have a mild anti-inflammatory effect on arthritic joints. However, these fatty acids can be purchased in a pure form with an exact dosage and without the danger of developing vitamin A and D toxicity.

S-adenosyl-methionine (SAM-e) is another supplement that has gained a lot of attention as a possible therapy for OA. SAM-e, pronounced "Sam-ee," occurs naturally in all human tissue and organs. It helps produce and regulate hormones and cell membranes. Europeans have used SAM-e for years as a prescription medication for arthritis and depression. It became available in the United States as an over-the-counter supplement in 1999.

Unlike many dietary supplements, researchers have studied SAM-e in numerous clinical trials. The studies indicate that SAM-e may relieve osteoarthritic pain ( some recommend it for fibromyalgia)just as well as nonsteroidal anti-inflammatory drugs (NSAIDs), but with fewer side effects. The manufacturers of SAM-e also say that it helps regenerate cartilage and improve joint disease, but no scientific evidence supports this claim. It is expensive and would the benefit support the expense? Studies I have seen said it is like a NSAID-effective-wise.

More studies are needed to determine whether these or any other supplements offer effective ways to treat arthritis. If you take a supplement, talk with your doctor first. Exceeding recommended doses of any vitamin, mineral or other supplement might harm you. According to some alternative practitioners, bee venom has enzymes that relieve the symptoms of rheumatoid arthritis. Others think that bee venom stimulates your body to produce more steroids, which may help relieve symptoms. More large studies are needed to shed light on the value of bee venom. Ten percent to 15 percent of the population has mild to fatal allergic reactions to insect venom, so this treatment is risky for some people.

Currently, the Food and Drug Administration (FDA) has not approved any arthritis medications derived from snake venom. Little scientific data supports its use in treating arthritis. Snake venom is toxic, so arthritis experts warn against this treatment until more research has been done.

Injections of gold salts long have been thought to reduce inflammation and are an accepted form of treatment for rheumatoid and psoriatic arthritis. But as other more effective and better-tolerated treatments have come along, the use of gold injections has declined, and they can be difficult to obtain. Gold compounds can be injected into the buttock muscle or taken in capsule form. People usually take a small test dose to be sure their bodies will tolerate the compound before they start therapy, which may last several months. Rashes, mouth sores, kidney damage, diarrhea and changes in blood counts are the most common side effects of gold therapy. If you take gold you should have regular blood and urine tests to identify health problems.

According to folk wisdom, when you wear copper bracelets small amounts of copper pass through your skin and neutralize free radicals, which are toxic molecules that damage cells. Wearing copper jewelry is probably harmless, but most doctors find little scientific basis on which to recommend them.

Researchers are starting to look at magnets as a possible therapy for pain associated with arthritis. Some studies suggest benefits, but more research is needed. Some researchers believe that inappropriate use of magnet therapy actually could lead to health problems. You should not bring a magnet within 6 inches of a pacemaker.

Aromatherapy practitioners believe that oils derived from plant extracts and resins can help treat various illnesses when massaged into your skin or inhaled. Medical professionals acknowledge that therapeutic massage can help relieve pain and promote relaxation. More study is needed to determine whether plant oils used in aromatherapy deliver any medical benefits.

Dimethyl sulfoxide (DMSO) is an industrial solvent similar to turpentine. Some people believe that DMSO can relieve pain and reduce swelling when rubbed on the skin. Research into DMSO has yielded mixed results. Industrial-grade DMSO, sold in hardware stores, may contain poisonous contaminants, so arthritis experts don't recommend using this solvent.

Homeopathic treatments involve extremely diluted preparations of natural substances, such as plants and minerals. Because most homeopathic medicines contain virtually no molecules of the active substances, many scientists are skeptical about their effectiveness.

Joint manipulation is practiced by chiropractors and osteopaths. They claim that the treatment can relax the tissues surrounding joints, improve circulation and make joints more mobile. However, it's unclear whether joint manipulation or realignment of the spine also helps relieve joint pain caused by OA. If you have rheumatoid arthritis, avoid neck manipulations.

Elimination diets require you to stop eating certain foods. One such diet forbids nightshade vegetables, such as potatoes, eggplants, bell peppers and tomatoes.

According to the Arthritis Foundation, food sensitivities may play a role in arthritis. However, scientists disagree on how common the problem is and what foods, if any, to avoid. Before you alter your diet, consult with your doctor. Some people are naturally allergic to certain foods.

If you dig into the medical literature for studies about complementary and alternative treatments, you’ll see several terms that describe different types of research. These may include:

Clinical studies. These studies involve human beings as subjects — not animals. They’re usually preceded by studies that demonstrate the safety and effectiveness of the treatment in animals.

Randomized, controlled trials. Participants in these trials usually are divided into two groups. The first group receives the treatment under investigation. The second is a control group — they receive standard treatment, no treatment or an inactive substance called a placebo. Participants are assigned to these groups on a random basis. This helps to ensure that the groups will be similar.

Double-blind studies. In these studies, neither the researchers nor the human subjects know who will receive the active treatment and who will receive the placebo.

Prospective studies. In these forward-looking studies, researchers establish criteria for study participants to follow and then measure or describe the results. Information from these studies is usually more reliable than retrospective studies. Retrospective studies involve looking at past data — for example, asking participants to recall information — which leaves more room for errors in interpretation.

Peer-reviewed journals. These journals only publish articles that have been reviewed by an independent panel of medical experts.

Prospective double-blind studies that have been carefully controlled, randomized and published in peer-reviewed journals provide the “gold standard.” When these involve large numbers of people — several hundred or more — studied over several years, they gain even more credibility. Doctors also like to see studies that are replicated, which means they've been repeated by different investigators with generally the same results.

To date, few complementary and alternative treatments have been researched according to rigorous standards. For the majority of unconventional treatments, the jury is still out on whether they’re helpful

Today, you can't health book or website without being promised that some vitamin or 'natural' pill will help your arthritis. Just which of these claims can you swallow? In part, that depends on who you ask, the type of arthritis you have, your nutritional status and even your age. But there is some evidence that certain vitamins and other supplements may help reduce pain, lower the risk of associated diseases and offset the effects of certain medications.

Just as with any medications, these substances may interact with drugs or be contraindicated in certain conditions-not to mention the fact that large amounts of certain vitamins can be toxic. For recommendations pertinent to your situation, check with your doctor and don't exceed doses suggested on the bottle.

Calcium Since the bone-thinning disease osteoporosis is sometimes associated both with arthritis and the use of steroid medications, supplemental calcium (together with vitamin D) may help maintain bone strength. 'The best evidence for vitamins affecting musculoskeletal health is that taking vitamin D and calcium helps prevent osteoporosis,' notes Dr. Howard Stein, a Vancouver rheumatologist.

The Osteoporosis Society of Canada currently recommends between 1,000 and 1,500 mg of calcium daily, depending on bone density and risk of bone loss. Shouldn't you get this from your diet? Ideally, yes, but many adults don't drink much milk, our best dietary source of calcium, and 1,500 mg equals five cups. Firm cheeses, canned salmon or sardines with bones, yogurt and tofu are also good sources. If you can't or don't consume enough of these foods, a calcium supplement may be worthwhile. However, extra calcium may contribute to kidney stones in susceptible people.

Vitamin D Vitamin D goes hand-in-hand with calcium to create healthy bones, but unfortunately a large segment of the population isn't getting enough. Our skin manufactures vitamin D when exposed to the sun but during Canadian winters we don't receive sufficiently strong sunlight to do the job. In fact, a biochemist at Toronto's Mount Sinai Hospital notes, nearly one-third of 800 women aged 18 to 35 were vitamin D deficient over the winter months.

And for people with lupus, sunlight is often out of the question because of photosensitivity. This is one possible reason people with the disease may have low levels of the nutrient compared to control subjects with RA and OA.

Unfortunately, there are very few dietary sources other than in vitamin fish oil and fortified milk. The newly boosted recommended intake of vitamin D is 400 IU after 50, and 600 IU for people 70 and older.

Some physicians recommends even larger amounts during winter months: 1,000 units daily, particularly for the elderly and people with dark skin, since both groups produce comparatively low levels of the vitamin.

There are only about 90 IUs in a cup of milk. And milk it must be, since yogurt and cheese are seldom made with fortified milk. However, some soy beverages are now fortified with both vitamin D and calcium.

Other benefits? Low vitamin D intake may correlate with the progression of osteoarthritis of the knee. At least one preliminary study from Boston found people with low blood levels of 25-hydroxyvitamin D (a product of D) and low dietary intake of the vitamin ran three times the risk of disease progression than those who consumed more. This doesn't necessarily mean vitamin D lowers your risk (a higher intake may be associated with other healthy behaviours that make the difference), but it's one more reason to ensure you're getting enough.

Folic Acid While folic acid has received a great deal of attention because it prevents certain birth defects, this B vitamin may be just as important to people with lupus and RA. Methotrexate interferes with folic acid metabolism, sometimes resulting in anemia in people who take the drug for RA. Folic acid may also ease the gastrointestinal symptoms that can result from this therapy.

For those with lupus,(NIH-study ) an extra supply of the vitamin may pay

dividends over the longer term. Increasing evidence suggests high blood levels of a substance called homocysteine is an independent risk factor for atherosclerosis, which may be behind the earlier-than-expected heart disease associated with lupus. While all of the evidence isnÕt yet in, it appears a combination of vitamins, including folic acid, lowers homocysteine levels, at least theoretically reducing the risk of heart disease.

Vitamin C Touted as everything from an anti-inflammatory to an antioxidant, vitamin C has received more scrutiny than many other nutrients, but there are surprisingly few studies of how it may affect arthritis. One preliminary study from Boston University linked a relatively high intake of vitamin C to a three-fold reduction in the risk of osteoarthritis of the knee. In fact, low intake of the vitamin correlated predictably with the risk of cartilage loss. Vitamin C also appeared to reduce the risk of knee pain.

So should you take supplemental C? Not on the strength of this single study, but the antioxidant appears to have other better-researched benefits, such as possibly reducing the risk of developing cataracts.

Vitamin E Like C, mention of vitamin E is almost non-existent in arthritis research. However, Dr. Stein a rheumatologist,notes a single study suggesting vitamin E reduces pain. Of course, you can't base an informed decision on one study. But vitamin E may have other benefits; some research suggests it reduces the risk of cataracts and heart disease. Although even this research isn't conclusive since a recent study of 9,000 people found supplemental vitamin E didn't affect heart attack and stroke risk. However, some scientists, at the Stroke Prevention and Atherosclerosis Research Centre based at The John P. Robarts Research Institute in London, Ontario, suggest vitamin E may need to be taken with C to be effective and many studies have only examined E alone.

Omega-3 fatty acids These nutrients are found predominantly in cold-water fish and, according to some studies, the fish themselves provide the best source of omega-3 fatty acids. Generally,rheumatologists recommend fish first (two to three times weekly) because there are other benefits from eating fish. The omega-3s in fish are also in the active form, while those in flaxseed and canola must be converted to this form in the body.

However,most researchers agree that it may be difficult to eat enough fish to produce a therapeutic effect. "You have to take high amounts (two to three grams a day) to receive this benefit," says most of the researchers. "Most North Americans could not eat a diet high enough in cold water fish." says another.

Do omega-3s work? 'There is some evidence for symptom relief,' says Joe Schwarcz, PhD, director of McGillÕs Office for Chemistry and Society. 'Although, the studies I've looked at are not great studies.' Reported to be most effective in RA, omega-3s contain precursors to molecules called prostaglandins. As anyone who has read about the new COX-2 inhibitors knows, there are two types of prostaglandins: those that mediate pain and inflammation and those that don't.

'Omega-3s may shift production of prostaglandins to the non-inflammatory type from the inflammatory ones,' explains Schwartz. Omega-3s may also be responsible for the symptomatic relief .Some people with arthritis gain from a vegetarian diet. A vegetarian diet may somehow change the fat profile. Another potential benefit? Increasing evidence suggests these nutrients also reduce the risk of heart disease.

Omega-6 fatty acids, in supplements like evening primrose oil, may have a similar effect but there is less research available than on the omega-3s.

"For RA, the fish oils and the evening primrose are probably worth a try," concludes Dr. Schwarz.

Other Supplements,rheumatologist I.Tsan points out that all bets are off when you buy herbal remedies and supplements like glucosamine. While vitamins are regulated, these products are not: there's no guarantee that what's on the label is in the bottle. "There's all kinds of stuff out there and there's no regulation. Anybody who takes anything is on their own," states Dr. Tsan. When tested, he adds, some glucosamine supplements contain no glucosamine whatsoever; while in others, there's more than what's listed on the bottle.

Bearing that in mind. Glucosamine and chrondroitin According to Schwarz, there is some evidence that glucosamine, a simple sugar extracted from the exoskeletons of shellfish, may alleviate the pain of osteoarthritis. In 13 studies he reviewed, glucosamine preparations were more effective than a placebo. But, not much better. In another study of 118 patients, glucosamine hydrochloride alleviated pain in osteoarthritis of the knee for 49% of patients, compared to 40% for the placebo. And, notes a reearcher on the study that, relief can be some time in coming, since it can take up to three months to see an effect.

According to the study: "The glucosamine hydrochloride didn't work for everyone, but in the people it helped, it seemed to work as well as NSAIDs."
However, the study adds, most existing studies are very small, meaning the results can't be generalized to a larger population.

Note: Recently the NIH did a extensive study ( 2001-2002 )and it concluded that Glucosamine might help some people with osteoarthritis,but cartridge rebuilding is a complicated affair and more study was needed and further suggested that cartridge regeneration by the substance may be highly unlikely.

While some practitioners assert glucosamine preparations provide the 'building blocks' of both the cartilage and synovial fluid that cushion joints, thereby 'rebuilding' them, there is little evidence to back this claim. And, many experts don't believe this is possible, since glucosamine is already present in large amounts throughout the body. "Just from the chemical point of view, it's hard to imagine,' says Dr. Schwarz. "And there really is no evidence that it helps rebuild cartilage."

Should you take glucosamine nonetheless? "Glucosamine either does nothing or may help,' notes a metropolitan hospital rheumatologist. "It certainly appears to be safe. Every year, 1,900 people die of complications from NSAIDs, whereas as far as I know, there have been no deaths from glucosamine." So if you can't take NSAIDS for your osteoarthritis or prefer to try something which appears to have fewer side-effects before switching to other drugs, glucosamine may be worth exploring. It is not used for RA treatment.

Chondroitin sulphate, another component of cartilage, is sometimes combined with glucosamine in arthritis preparations. "There's less evidence of any sort for chrondroitin," states Swartz. "But some people believe it takes up to nine months to work." It, too, appears to be relatively safe.

SAM-e This chemical, just lately promoted in North America as a remedy for "joint health" and "emotional well-being," has a longer history in Europe. Some studies have suggested the benefits may be equal to a standard NSAID,but it is expensive,over $ 200/monthly. Is it worth the cost ?

Like glucosamine and chondroitin, S-adenosyl-methionine (SAM-e) is a molecule our bodies already make. SAM-e is involved in a host of processes, from the production of mood-boosting chemical messengers in the brain to the maintenance of cell membranes. And, once again, the studies are few and not always well-designed.

A rheumatologist notes he has had no personal experience with SAM-e, has examined some of the research. "It may be promising for pain relief," he concludes. "And there have been studies that suggest SAM-e may be beneficial for depression." The latter is a potential benefit for people with fibromyalgia with co-existing depression.

DHEA Not long ago, this hormone, which is illegal in Canada, was trumpeted as a cure for lupus. Some people still flout the law because they still believe it may help their arthritis.

Is taking DHEA wise? Dr. Schwartz doesn't think so. "There have been some short-term studies that I don't find satisfactory," he notes, adding that because DHEA is a hormone, only long-term studies can determine whether it's safe.

"Hormones are very powerful things." He cites the case of DES, a hormone found to be dangerous a generation too late when daughters of women who took the drug began developing a rare form of vaginal cancer.

What's right for you? This is a question only you and your doctor can answer. It may be worth consulting a dietitian to assess whether you're getting enough of these nutrients from your diet and which vitamin supplements, if any, may be necessary to make up the difference.

The jury is still out on the benefits of many nutritional supplements, so no one can tell whether or not they're going to work for you. "As physicians, we have to advise people what to do now." He tries to help his patients make informed decisions based on the current state of research. While in cases like DHEA, it's probably best to wait for definitive studies, Swartz says some of these apparently safer compounds may give patients another option when conventional remedies fail.

"You don't want to go to your doctor, and have the doctor say, "There's nothing more I can do". That does two things. The patient leaves the office and doesn't come back, and the patient feels hopeless. Part of keeping people well, apart from treating the disease, is hope."

Think about something funny. Keep searching your mind until you hit something -a comedy routine, a scene from a sitcom or a line from your life -that causes you to chuckle. Guffawing is even better. Go ahead, let her rip.

Now then, don't you feel better? You've quite possibly just boosted your immune system, eased any pain you may have felt, relaxed your body and reduced your stress hormones. And the treatment was painless, free and fun.

The first studies of the effect of humor on the body were conducted in the United States in the 1930s. But it wasn't until 1979 that humor research got a real boost. That's when Saturday Review editor Norman Cousins countered a diagnosis of ankylosing spondylitis, a painful and potentially crippling arthritis, with a combination of mainstream medicine and large doses of humor.

Cousins watched videos of Candid Camera , as well as Marx Brothers and Three Stooges films. Although his doctors had given him little chance of recovery, within 8 days his pain began to subside, and he returned to work. He documented his recovery in the book Anatomy of an Illness and founded the Humor Research Task Force.

Cousins' experience spawned a wealth of humor research. Some of the most intriguing findings include those of studies conducted at Loma Linda University School of Medicine in California, which found that laughter stimulates the immune system. Students who watched funny videos had a significant increase in T cells and natural killer cells, both of which fight off diseases. They also had lower levels of the stress hormone cortisol in their blood.

There's more. A yearlong study by the Oakhurst Health Research Institute of 240 people who had had heart attacks found that those who spent 30 minutes a day chortling at comedy videos were less likely to have a second heart attack. In another study, 67 college students were made to give speeches to their peers. Those who watched an episode of Seinfeld beforehand had lower heart rates during their speeches, a result comparable to receiving biofeedback.

Other studies have found that laughter relaxes the skeletal muscles of your arms and legs, exercises your heart by raising your heart rate, releases pent-up feelings like frustration and anger, lessens pain and aids breathing.

Patch Adams, the doctor portrayed in the movie of the same name who bucked tradition and made humor a part of his bedside manner, was onto something. Although more studies are needed, it seems clear that laughter promotes wellness and healing. Some hospitals are so convinced of the benefits of humor that they provide patients with humor libraries, clowns and joke-cracking nurses who wear funny noses. Remember, it's not always jokes or slapstick comedy that makes us laugh. Sometimes unplanned situations or ironic observations can give you a humorous high.

No one knows why laughter has the effects it does, but one theory is that it boosts the release of endorphins, those same feel-good brain chemicals that account for the so-called runner's high.