By Judith Horstman
These ancient Indian remedies are said to ease aches and inflammation. A new study prompted us to take a closer look.
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 (pronounced ay-yur-vay-duh), the traditional medicine of India, to treat arthritis and other ailments. Sometimes, they are combined with Ashwaganda, 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.
East vs. West
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.
Ancient Healing Tradition
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."
Strength in Numbers
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, Ashwaganda, 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.
Judith Horstman writes frequently about alternative medicine in Arthritis Today. Her book on alternative and complementary therapies for arthritis was published by the Arthritis Foundation.