MG926922 HEALTH PLUS of LOUISIANA 6-TIER_v4 3/10/09 8:26 AM Page 1 Health Plus of Louisiana Member Guide (6 Level) Please bring this guide with you to your next doctor visit. If you have questions about your prescription drug benefit, visit www.medco.com or call Member Services. Medco is a registered trademark of Medco Health Solutions, Inc. © 2009 Medco Health Solutions, Inc.
The information in this article is notintended as medical advise, but only as aguide in working with your health care Dr. Larry J. Milam H.M.D.,PH.D
Arthritis, Osteoarthritis, Rheumatoid Arthritis,
Bones, Joints and Cartilage Disorders
According to the
Over time these continuing "flare-ups" can How successful have
traditional treatments been?
• One-sixth of the total U.S. population, unnatural positions. Loss of mobility can years) of 112 rheumatoid arthritis patients joints literally frozen in place. Fleshy nod- • 80% of people over the age of 50 will can experience fatigue. Eyes may be-come dry and inflamed, lymph nodes At the end of the study, "over one-third • Arthritis is not exclusively a problem of swell, the appetite is reduced, and sores of the patients were dead and more than half were either dead or severely dis- vascular insufficiency. Cartilage loses its • Under the age of 45, osteoarthritis is integrity, causing uneven joints and bone sicians had been optimistic The patient's In short, the cumulative effects of arthri- initially. After ten years of treatment,
tis wear on us to the point that we reach however, their condition declined con-
"Arthritis" has become the catchall
for a "quick fix" readily offered by hun- siderably and joint destruction pro-
term for over one hundred various
diseases generally referred to as
At the twenty year mark, nineteen per-
"rheumatic diseases". The American
College of Rheumatologists lists ten cat- stronger dose of the most recent arthritis abled. (Apparently none of the remaining Do Perscription Drugs Work
The authors concluded that the concept to alleviate symptoms
that drugs induce a remission in patients and cure Arthritis?
Recent Information Regard-
ing Natural Alternatives
medical profession for Arthritis. In most systemic lupus erythematosus (SLE) cases, their benefit is greatly outweighed "Arthritis" is, in fact, a major symptom
produces significant side effects that can those seeking relief from arthritis without only be suppressed with additional drugs.
The term arthritis is said to be derivedfrom Greek and means "inflammation of Dr. Michael Murray, in his book Arthritis, a joint." Symptoms include swelling, stiff- states that "It is not uncommon for indi- viduals with rheumatoid arthritis to be on function, degradation, deformity and pain 12 or more prescription drugs at one "rheumatic family of diseases. " Move-
ment can be severely impaired and the as-
This information is not intended as medi- sociated pain can be episodic, unpredict- cal advise, but only as a guide when work- ing with your health care practitioner. for an undetermined period of time, only to "flare-up" when least expected.
Natural Alternative Therapies
Pharmaceutical Drugs used in
During the past 16 years, many natural alternatives have been the treatment of Arthritis
employed by those seeking relief from arthritis without longterm side effects.
The primary drugs used by the medical profession in the treat-ment of arthritis, particularly rheumatoid and osteoarthritis, are The following information is presented to help you
nonsteroidal antiinflammatory drugs (NSAIDS) which include
become aware of alternative treatments and to act
as a guide when working with your Health Care
The most common side effects of NSAIDS
Professional or Advisor.
is damage to the intestinal tract and
NSAID-induced peptic ulcer.1
More than a dozen controlled clinical trials in Europe and the Best selling author, Dr. Michael Murray, in his book Arthritis, UK have shown glucosamine sulfate to be as good or better says, "The use of NSAIDS are a significant cause of serious than NSAIDS in treating arthritis. The studies report a positive
gastrointestinal tract reactions, including ulcer hemorrhage and impact on cartilage metabolism without adverse side effects.
perforation, and lead to as many as 20,000 hospitalizations Glucosamine is a naturally occurring simple sugar component which is the building block of larger complex sugars calledglycosaminoglycans. Glycosaminoglycans form the gel-like All NSAIDS are recommended for only short periods of time
ground substance found in connective tissue, mucous secre- since prolonged use carries the risk of significant side effects.
Most side effects are the result of high doses that must be Glucosamine sulfate is the preferred form of glucosamine for thera- given in order to suppress the symptoms.
peutic use. It is an effective means of providing glucosamine In addition to gastrointestinal distress, NSAIDS often cause
orally as a building block for the regeneration of cartilage and allergic reactions, easy bleeding and bruising, ringing in the glycosaminoglycans lost during the progression of osteoarthri- ears, fluid retention, heartburn, indigestion, abdominal cramps, gas, nausea, vomiting, diarrhea, constipation, urinary tract in- Glucosamine sulfate plays an important role both in pre-
fection, rashes, headaches, depression, dizziness or fatigue, serving the integrity of the tissue and in restoring this
integrity after tissue injury, inflammation or degenera-
When given in high doses over long periods of time, NSAIDS
An open field physician supervised study was carried out in One serious side effect of aspirin and other NSAIDS that is
Portugal to assess the effectiveness of oral glucosamine sul- often overlooked is the inhibition of cartilage repair and accel- fate administered to treat pain associated with arthritis. A eration of cartilage destruction.3 Some clinical studies have total of 1201 patients received 500 mg. of glucosamine sulfate shown that NSAIDS are associated with acceleration of
three times a day for 50 days. The results of the study showed osteoarthritis and increased joint destruction. The higher the that relief from pain, both at rest and during physical activity, dose and the longer the use of NSAIDS, the greater the joint
improved steadily throughout the treatment period and contin- ued for six to twelve weeks after the supplement was stopped.
The clinical improvement was independent of gender, the age of There is increasing evidence that aspirin and other NSAIDS
the patient and the location of the arthritis. Oral glucosamine appear to suppress the symptoms, but accelerate the pro- sulfate was well tolerated by 86% of the participating patients.8 Glucosamine sulfate appears to be one of nature's best rem- If possible, the use of these drugs should be avoided or
edies for osteoarthritis, addressing the root of the problem severely reduced.
Chondroitin sulfate contains several molecules known as gly- cosaminoglycans (GAGS) or mucopolysaccharides. Chon- Indomethacin (Indocin, Indometh) Meclofenamate (Meclofen, droitin is composed of repeating units of glucosamine sulfate with attached sugar molecules. Because chondroitin is a larger molecule, it is often combined with an enzyme such as brome- lain to help free its glucosamine and make it more absorbable.
Recent studies have shown that glucosamine sulfate and chon-droitin sulfate, two naturally occurring substances normallypresent in the cartilage of the joints, out perform standard ar- Discontinuing any drug should be done gradually over a period of time and thritis drugs in reducing long-term pain, joint tenderness and under the direction of your health care professional. Pharmaceuticals
Chondroitin has also been shown to block or neutralize theenzyme that destroys cartilage. Using chondroitin in combi- These include cortisone hormones and synthetic corticoster- nation with glucosamine sulfate may provide synergistic ben- oids like prednisone and methylprednisone.
efits for halting the progression of osteoarthritis.10 While the synthetics have less extreme side effects, the long
Magnesium & Vitamin B6
term use of synthetic corticosteroids, even at low doses,
Magnesium activates enzymes that help form new calcium crys- can cause serious, sometimes life-threatening problems.
tals which, in turn, are necessary for vitamin D to convert to an Side effects include: the growth of facial hair, acne, fluid re-
active form. It also is a vital catalyst in enzyme activity, espe- tention, weight gain, easy bruising, sleeplessness, muscle wast- cially the activity of those enzymes involved in energy produc- tion. A deficiency of magnesium can interfere with the transmis-sion of nerve and muscle impulses, causing irritability and ner- More serious side effects include:
stomach ulcers, inflammation of the pancreas, and the leach-ing of calcium from the bones (osteoporosis), which makes In addition, magnesium is necessary to prevent the calcifica- tion of soft tissue.12 Recent research indicates that magne-sium may help prevent osteoporosis and certain cardiovascu- • These drugs suppress the immune response and, as a re- lar diseases.13 When magnesium is combined with vitamin B6 sult, increase the risk of bacterial infections.
(pyridoxine), it helps reduce and dissolve calcium phosphateand calcium oxalate kidney stones.14 • They can promote narrowing of the blood vessels by fatty deposits and calcification (atherosclerosis).
Vitamin B effects both physical and mental health. Antide- pressants, estrogen therapy, and oral contraceptives increase • They can cause cataracts and glaucoma.5 the need for vitamin B . Cortisone drugs, often used by many arthritis suffers, block the adsorption of this vitamin by the body.15 • Some studies indicate that they can suppress the normal Vitamin D
functioning of the adrenal glands, suppressing the produc- Vitamin D acts to increase the absorption, utilization and trans- port of calcium, and distributes calcium to the bones and teeth.
• High doses of corticosteroids can spread previously limited It is necessary for growth, especially for the normal growth and infections to all parts of the body and can actually kill the living parts of bone, ultimately causing bone collapse.6 It is also an important factor in the prevention and treatment of SAARDS & DMARDS
osteoporosis and hypocalcemia, and enhances immunity, thy- A third class of drugs are known by two names: Slow Acting roid function and normal blood clotting.
Anti-Rheumatic Drugs or SAARDS, and Disease Modifying Anti-
Intestinal disorders and liver and gall bladder malfunctions in- Rheumatic Drugs or DMARDS. As the first name implies,
these drugs take a long time to begin working, but eventually
terfere with the absorption of vitamin D. Some cholesterol low- have an effect. They are used primarily in the treatment of ering drugs, antacids, mineral oil and steroid hormones (corti- inflammatory kinds of arthritis, especially rheumatoid arthritis, sone) also interfere with the absorption of vitamin D. Supple- ankylosing spondylitis and arthritis associated with systemic The first group are antimalarials such as chloroquine (Aralen) Pantothenic Acid
and hydroxy-chloroquine (Plaquenil).
Probably the least known of the B vitamins is pantothenic acid.
Side effects include: indigestion, nausea, vomiting, head-
It is used by the body's adrenal glands to manufacture steroid aches, nervousness, diarrhea, abdominal cramps, psoriasis, hormones. One such hormone, cortisone, is essential in times ringing in the ear and blurred vision.
Because the risk of eye damage is great, most doctors recom- Several researchers have pointed out that, because pantothenic mend an eye examination every six months.
acid is essential to the formulation of two important compo-nents of connective tissue, a deficiency of the vitamin would D-penicillamine
lead to a shortage of those substances.
More than twenty-five percent of people taking D-penicillamine Why is it possible to have a shortage of this important vitamin (Cuprimine) quit within the first year due to its unwanted side that is found in small amounts in most foods? The answer is simple. In the processing of most of our food, a major part ofthe pantothenic acid content is stripped away. In processing Side effects include: nausea, vomiting, diarrhea, rashes, kid-
all purpose white flour, about half of the pantothenic acid con- ney damage, blood abnormalities, drug-induced lupus and my- tent is lost. White rice has also lost half its pantothenic acid asthenia gravis (where muscles gradually become weaker and through milling. Losses of pantothenic acid in canning green vegetables average about 56%; in canning root vegetables, Pharmaceuticals
Anyone taking this drug is advised to have regular blood
46%; in canning peas and beans, 78%; in canning fruit juices, and urine tests to determine whether they should continue
50%. Losses to freezing are around 50% in all vegetables, its use.
though only about 7% is lost in fruits and juices (which arealready naturally low in pantothenic acid). Losses in cooking Sulfasalazine
any of these foods, run as high as 44%.16 50% of the patients who take sulfasalazine (Azulfidine) de-velop side effects within the first four (4) months of use.
How much do we really get in our diet? Most experts think weare getting about 50% of what we need and that additional Side effects include: rashes, nausea, vomiting, abdominal
pain, headaches and blood and liver abnormalities. Patients A 1966 study of people with rheumatoid arthritis showed ab- are advised to have regular blood and liver tests.
normally high levels of pantothenic acid excreted in their urine.
Later, studies by British researcher Dr. Annand confirmed that The side effects of gold therapy are the reason most people 20 of 26 patients with osteoarthritis showed significant im- provement after 14 days of supplementation of pantothenicacid.17 Almost half of those treated with gold compounds experience Bromelain
diarrhea, indigestion, gas, nausea, abdominal pain, loss of ap- Bromelain refers to a mixture of enzymes found in pineapple.
petite, ulcers in the mouth, rashes, itching, conjunctivitis, kid- Since its introduction as a medicinal agent in 1957, over two ney problems, blood abnormalities and upper respiratory in- hundred scientific papers about its therapeutic applications flammation. Regular monitoring of blood and kidneys is ad- have appeared in medical literature.
Various studies report that bromelain exerts a wide variety of Methotrexate
beneficial effects, including the reduction of inflammation in Methotrexate (Rheumatrex) seems to be the fastest acting of the SAARDS.
Bromelain is a protease-containing enzyme, which may account forits antiinflammatory effects which include the inhibition of pro in- Side effects include: nausea, loss of appetite, abdominal
flammatory compounds. Bromelain has been shown to prevent pain, rashes, anemia, ulcers, headaches, drowsiness, blurred swelling by activating compounds that break down fibrin.19 By de- vision, lung damage, fibrosis or cirrhosis of the liver, urinary creasing fibrin, bromelain helps promote circulation and posttrau- tract irritation and kidney damage. Regular blood and liver matic resorption of inflammatorily by-products. This allows a Cyclosporin
Bromelain also blocks the production of kinins.21 Kinins are com- The majority of people who use cyclosporin (Sandimmune) re- pounds produced during inflammation that increase swelling and port decreased kidney function and elevated blood pressure.
Other side effects include: headaches, gum swelling, trem-
Bromelain is often combined in formulas with other antiinflamma- ors and convulsions. Regular blood and blood pressure tests tory ingredients such as curcumin to help enhance its absorption.
Conditions in which the clinical efficacy of bromelain has been Azathioprine
documented, in addition to arthritis, include angina, bronchitis, ath-letic injury, bruises, maldigestion, menstrual cramps, pancreatic in- Azathioprine (Imuran) is reported to produce slightly more side sufficiency, pneumonia, scleroderma, sinusitis, surgical trauma and effects than other SAARDS.
Side effects include: nausea, vomiting, diarrhea, bone mar-
Yucca (Yucca glauca)
row suppression and hepatitis. Long term use may increase Native American Indians used the root of the yucca as a poultice on breaks and sprains and for rheumatism. Yucca contains a highcontent of steroid saponins which are precursors to cortisone andprovide relief for symptoms of arthritis and rheumatism. Some re-searchers feel that yucca saponins improve the body's ability toproduce its own cortisone by supplying materials needed for thehormone to be manufactured by the adrenal glands. Yucca is natu-rally rich in vitamin A, B complex vitamins and contains some vita-min C. It is high in calcium, potassium, phosphorus, iron, manga-nese and copper. 23 Alfalfa (Medicago sativa)
Fennel (Foeniculum valgare)
Celery (Apium graveolens).
In many cases of osteoarthritis, plant based remedies can help ad-
dress the underlying factors responsible for the degeneration.
Ginger is derived from the plant Zingiber officinale. Folk medicinehas long touted ginger as an effective aid for proper digestion, and Some plants that show great promise are those rich in substances for relief of indigestion and nausea. Now scientists are discovering known as phytoestrogens. These plant compounds have been other potential uses including relief from the pain and inflammation shown to be capable of binding to estrogen receptors and cartilage of rheumatoid arthritis. Dr. Krishna C. Srivastva, of the Institute of cells, thereby preventing the bindings of the body's own estrogen Odense in Denmark, states that arthritis patients reported "signifi- to the receptor.24 Since there is a higher incidence of osteoarthritis cant relief" from pain after taking less than a tablespoon of ginger in women, it suggests that estrogens may play a role in this disease.
Further experimental studies have demonstrated that estrogen pro-motes osteoarthritis.25 Plants such as alfalfa, celery and fennel are The Medical Tribune (30,18:16) reported one study of arthritis pa- all natural sources of phytoestrogens, and their regular consump- tients who took daily servings of ginger powder. All patients re- tion in the diet is encouraged. Other food sources of phytoestrogens ported that "they were able to move around better and had less include parsley, soy, nuts, whole grains and apples.
swelling and morning stiffness after eating the spice".33 In traditional Chinese medicine, fennel is classed as an antispas- Oriental Medicine attributes the stiffness, slowness and pain that modic which helps regulate the chi (vital energy of the body) and results from rheumatic conditions to the entrance of cold and damp- remove congestion. In many Indian restaurants, one often finds a ness in the body, an observation that is not lost to those who suffer bowl of fennel seeds at the cash register. Diners are supposed to from rheumatic symptoms that are intensified by inclement weather.
chew a few of these seeds to remove the effects of dietary sins, such The whole process of the joints losing their lubrication, function as overeating, wrong food combining and eating excessive amounts and warmth is seen as a "cooling of the body", referred to as atro-
of rich spicy foods. Because of its ability to influence the nerves, it phy in the West. Ginger is regarded as one of the classic remedies
for these conditions and is used internally and externally.
Alfalfa's antirheumatic effect is probably due to its extremely high Since ginger has been shown to protect the stomach against dam- nutritive value which includes vitamins A, B, B6, B , C, D, E, niacin, age, it is an excellent ingredient in arthritic formulas to counter stom- pantothenic acid, biotin, folic acid, minerals, proteins, saponins, ach problems resulting from the over use of aspirin and other amino acids, and trace elements. Alfalfa has proven to have a cho- lesterol lowering effect and it generally helps to improve overall B o s w e l l i n
health, vigor and vitality. Due to its saponin content, many believe The antiinflammatory phytonutrient. Boswellia serrata (Indian Frank- it has some natural steroid properties. Although the treatment of incense) is a large, branching deciduous tree that grows in the dry, arthritis is difficult at best, many herbalists feel that the use of alfalfa hilly parts of India. The gum resin of Boswellin serrata, known in the over the long term could significantly help many people deal with vernacular, is "salai guggul", has been used in the Ayurvedic sys- tem of medicine for the treatment of rheumatism, respiratory and Hydrangea
liver disorders. Boswellin 12R is a selectively fractionated principle (Hydrangea arborecens)
obtained from the gummy exudate of the tree. In Ayurvedic medi- Hydrangea is a remarkable herb. Its curative properties are second cine, the gum is described as being sweet, bitter, hot, antipyretic, to no other plant. It contains alkaloids that act like cortisone and is antidysenteric and is attributed to lowering blood glucose levels.34 noted for its cleansing power. It helps prevent deposits in joints It has also been used to improve appetite and alleviate general weak- and is rich in minerals to help build joints. It is often recommended ness and debility.35 Each tree yields about one kilogram of resin per by herbalists for arthritis, gout and rheumatism.27 The major use of this resin in contemporary medicine is as an antiar- thritic and antiinflammatory pharmacological agent.36 The antiin- (Arctostaphylus uva-ursi)
flammatory and antiarthritic properties of the resin are attributed to Uva ursi leaf is recognized by medical authorities as a diuretic, as- the presence of B-boswellic acid and other related pentacyclic tringent and antiseptic. It also contains anesthetic properties ca- pable of numbing pain. Today it is often recommended by herbal-ists as a tonic.
There is positive evidence that boswellic acids reduce the synovialfluid leucocyte count and lower the elevated serum transaminaselevels, as well as erythrocyte sedimentation rates.38 Inflammatory Cornsilk (Stigmata maidis)
conditions such as rheumatoid arthritis are characterized by a marked Cornsilk has long been used by physicians as a diuretic and for increase in the above mentioned parameters. Boswellic acids func- bladder complaints because it has a cleansing effect on urea as it tion as potent antiinflammatory agents in rheumatic conditions, and circulates. It has been shown to be a valuable natural remedy in the are especially effective in shrinking inflamed tissues.39 This action treatment of renal and cystic inflammations.28 In China, the herb is is thought to be mediated through a vascular phenomenon. Boswellic also used to treat diabetes and hypertenion.29 In cases where edema acids improve blood supply to the joints and restore the integrity of is indicated, most herbalists around the world agree that cornsilk blood vessels obliterated by spasm. They may, in turn, also open directly reduces painful symptoms and swelling due to inflamma- up collateral blood circulation to provide adequate blood supply to tory conditions.30 Some herbalists feel that it may be useful in help- ing to decrease swelling associated with enlarged prostate.31 One of the most remarkable qualities of boswellic acids is their absence of side effects which are all too often experienced by those who use Natural Alternatives
the regularly prescribed NSAIDS (Non-Steroidal Anti-Inflammatory
Nutritional and Preventative Therapy
Nutritional therapy, as opposed to drugs, is the cornerstone of al- ternative treatment and prevention. The body's biochemistry iscomplicated (and endlessly fascinating). This is justification for (Standardized Extract - 95% Curcuma longa)
seeking advise from a professional trained in the nutritional sci- Curcuma longa, also known as turmeric (pronounced too-muh-rik), ences and familiar with natural nutritional alternatives.
is a member of the ginger family and has been highly esteemed byIndo European people for its golden yellow color and as a culinary For best results (in the absence of a complete nutritional analysis), the following program of nutritional supplements is recommended Tumeric, best known as Haridra in Sanskrit, has been used in the
for those seeking to mitigate the symptoms of arthritis or those Ayurvedic system of medicine for tens of centuries as an external tonic for the stomach, a blood purifier, for flatulence (gas) and dys-pepsia (indigestion) and urinary tract diseases.41 Daily Recommendations:
The significance of tumeric in medicine changed considerably whenit was discovered to have antioxidant properties due to its naturallyoccurring phenolic compounds. These phenolic compounds are Wellness Pack PLUS
collectively termed curcuminoids, since their principal ingredient is OsteoFlextm*
Continuing laboratory and clinical research has indicated that these curcuminoids in tumeric have antiinflammatory activity, which iscomparable in strength to steroidal drugs and nonsteroidal drugs such as indomethacin and phenylbutazone.42 In addition, Liver Enhancer
curcuminoids inhibit enzymes (derived from arachidonic acid) which Kidney Enhancer
participate in the synthesis of inflammatory substances in the body.43 Therapeuticatm
Curcuminoids have been shown to prevent the synthesis of severalinflammatory prostaglandins and leukotrienes.44 When the antiinflammatory properties of curcumin were tested in adouble-blind clinical trial in patients with rheumatoid arthritis,curcumin produced significant improvement in all patients. The * OsteoFlextm is a broadspectrum supplement specially therapeutic effects were comparable to those obtained with phe- formulated with key nutrients to provide nutritional nylbutazone, a prescription drug known for its analgesic and antiin-flammatory properties.45 support for the mitigation of the symptoms of Arthritis.
White Willow Bark
Though weaker in its activity, white willow bark was the original
source of salicin, the forerunner of aspirin. It is mentioned in ancient
Egyptian, Assyrian and Greek manuscripts and was used to combat
pain and fevers by physicians such as Galen, Hippocrates and
Interestingly, salicin is converted through oxidation to salicylic acidwithin the body.46 References
Doctor Won't Tell You." Harper Additional sources
Reference Guide. 4th Edition.
Nutrition, June, 1977, p. 24.
The information in this paper is intended as a reference guide,providing education and information. It is not intended as medi-cal advise or as a guide to self-treatment; nor is it intended tosubstitute for medical treatment. People with medical questionsshould consult with a qualified Health Care Professional. Thoserequiring nutritional information should consult a nutritional pro-fessional. No part of this paper may be copied or reproduced in any formwithout the written permission of the publisher.
January 2011/Ed. 1 When Linda Molnar developed pain in her legs that got worse when she walked even a short distance, doctors initially attributed it to an old back injury. But three years and many doctor visits later, a vascular specialist finally gave her the correct diagnosis last fall: peripheral artery disease. you feel productive, wheth-er or not you get paid for Often referred to as