Every doctor should get sick at least once during his or her professional life. Not with a brief, straightforward illness like pneumonia or influenza, but with an ongoing and less well-defined condition such as fibromyalgia, irritable bowel syndrome, chronic fatigue, or osteoarthritis for which there is no standard cure.

I am not wishing ill upon my peers. I am actually hoping that they might be blessed to discover, as I did, that highly effective interventions are available that are not taught in medical school nor at medical meetings and are not published in mainstream medical journals. I am wishing them the joy of learning to listen, really listen, to people rather than asking their chief complaint, quickly writing a prescription to mask the symptom and sending them on their way.

I participated in a continuing education program on fibromyalgia last year. The “fibromyalgia specialist” spoke for nearly an hour but his comments may be summed up in one sentence: “These people can (unnecessarily) eat up a lot of time and resources so get them out of your office as quickly and as cheaply as possible!” It was a sad commentary on how modern medicine approaches chronic (ongoing) illness.

Arthritis, particularly osteoarthritis (a wearing out of joint cartilage), is an extremely common condition in our society. Over half of all Americans over 65 years of age experience pain on a daily basis. Two thirds of these individuals attribute their pain to arthritis. Sadly, the overwhelming majority of them do not seek help because they falsely assume that age associated joint pain is inevitable and irreversible. Neither assumption is correct, for joint deterioration is not inevitable and is, in most cases, reversible.

The experience of living with pain is not a pleasant one. I know. There was a time in my life when the joints of my hands hurt terribly. The slightest increase in activity such as pulling a few weeds in the garden would cause a flare in pain and swelling that would last for weeks or months. I could hold a pen only by keeping my fingers and thumb perfectly straight – and even that was painful. I was exploring the availability of devices that would allow me to avoid writing notes or prescriptions by hand. Those days are but a dim memory now, but what they taught me about the body’s ability to heal itself changed my life forever.

Osteoarthritis is the term generally used to describe the loss of cartilage in joints over time. Cartilage is the smooth, soft, clear substance that is found at the end of bones and that forms the joint surface. The cartilaginous surfaces ensure that joints will be able to move smoothly without friction or pain. Just as tires wear down as they roll mile after mile over roads so the body’s joint cartilage can wear down as we walk, bend, lift or carry items day after day. Injuries can accelerate the breakdown of joint cartilage. Certain activities can also cause a more rapid breakdown. Runners, for example, may experience knee pain at an earlier age and typists commonly develop arthritis at the base of their thumb from repetitively hitting the space key.

There is a major difference between tires and joint cartilage, however. As tires wear down they must be replaced. As cartilage wears down the body can restore it – provided that it has the necessary building materials available.

Suppose for a moment that you owned a factory that was set up to manufacture dactrons, amazing devises containing over 100 different components. If the factory ran out of 1 or 2 or 3 components do you think the dactrons would still work properly? What if the plant ran short on 40 or 50 parts? Would it still be putting out a quality product? Our bodies require over 100 nutrients to function properly. Since most people fail to provide their bodies with optimum levels of a majority of these nutrients is it any wonder that they begin to wear out and break down over time?

Unfortunately, the majority of people suffering from osteoarthritis do not know that they are lacking the building blocks necessary to maintain healthy, smooth-functioning joints. When they seek help for the problem they are typically prescribed a drug from a family called NSAIDs (New Sorts of Aspirin In Disguise). These include over-the-counter medications such as ibuprofen and naproxyn as well as many prescription drugs. According to a prestigious medical publication, the New England Journal of Medicine, 16,500 people in the United States died from properly prescribed NSAIDs in 1998. New drugs such as Vioxx and Celebrex have been introduced, but these are not free of side effects. While they are less likely to trigger stomach ulcers than the older drugs, ulcers can still occur. These drugs are more likely to disrupt intestinal function, they can raise blood pressure and they may induce kidney, liver or heart failure.

Joint protection begins with the basic nutrients – optimum levels of vitamins and minerals as I have discussed in previous newsletters. Trace minerals are of particular importance. Of these, manganese appears to be the most critical. I recommend 5-10 mg. daily.

Essential fatty acids are needed to prevent inflammation and to maintain proper joint function. Fish oils or vegetable oils are excellent sources. If using fish oil be certain that the oil is obtain from the belly fat rather than from the liver. Some fish liver oils, such as shark liver oil, can be high in toxins including mercury and other heavy metals. The desired fish oils are referred to as "Omega 3s" or "Marine Lipids".  Two or three capsules daily are generally sufficient.  My preferred vegetarian source of essential fatty acids is flaxseed oil. A quality flax oil should have a very light flavor that will blend well with other salad oils, juices, cereals like oatmeal, pastas and salsas. One tablespoon per 100 pounds of body weight daily is the proper amount. Flax oil does come in capsule form, but 14 capsules are required to obtain 1 tablespoon of oil.

I have found that many people do well with the basic vitamins and minerals and essential fatty acids, especially if the arthritic condition is mild. Other supplements may be necessary, however. One of the most valuable is glucosamine. I recommend glucosamine sulfate, 500 mg. two or three times daily. Since it is not a pain reliever, but is providing the body the ability to repair the joints, allow at least two months to note improvement.

A substance that is commonly seen in combination with glucosamine is chondroitin. It is not necessary to take both, although this may be done. Chondroitin is broken into glucosamine in the body, so it actually adds very little. It is simply another source of glucosamine. I prefer to add a highly refined extract from a shellfish called the green-lipped mussell. This is a rich source of mucopolysaccharides , such as hyaluronic acid.  Mucopolysaccharides are key constituents of joint cartilage and joint fluid.  They provide flexibility to the cartilage and lubricate the joint.  A properly formulated combination product can bring about pain relief in a much shorter period of time – often within two weeks rather than two months.

Basic vitamins and minerals, flaxseed oil, glucosamine, and mucopolysaccharides will bring about improvement in most individuals. If an adequate response is not seen within two months I would add a source of methyl groups such as dimethylglycine (See Homocysteine, High or systemic enzymes (See Systemic Enzymes). 

SAM-e is a source of methyl groups that is widely marketed for relief of osteoarthritis. The usual schedule is 200 mg. twice daily for 3 days, then 400 mg. twice daily for 7 days, then 400 mg. 3 times daily for 21 days at which point it may be reduced to a maintenance level of 200 mg. twice daily. SAM-e currently costs about $1.00 per 200 mg. capsule. I do not recommend SAM-e as products containing dimethylglycine or trimethylglycine are more efficient providers of methyl groups and cost much less than SAM-e. 

MSM is a supplement with an interesting story. MSM was originally introduced prior to the availability of more effective agents such as glucosamine. When some enthusiastic manufacturers claimed that it would cure arthritis the FDA stepped in and it was taken off of the market. It has been re-introduced, but I have not seen a need to recommend it. I believe that it is less beneficial than other compounds currently available.

As with any condition, the sooner corrective measures are instituted the greater the likelihood of success. It is never too late to begin, however. The widely held belief that joint pain is an inevitable result of aging is a myth. Hopefully the news will spread that much has been learned about the prevention and correction of “wear and tear” arthritis. Each of us should be looking forward to years of vibrant activity not to increasingly painful immobility.