Here are substances safer than NSAIDs and pharmaceuticals.

Food [I know, this part isn't Supplements, but I wanted to keep all the information together, and couldn't figure out where to put the resulting page.]

• One of the most promising general methods of treating inflammation is through balancing the micro-hormones called eicosanoids (for example prostaglandins) by
  • Using protein instead of carbohydrate as your main energy source; see
    • Low Carbohydrate diets
  • Reducing consumption of meat, dairy and poultry and getting more protein instead from fish and soy
  • Eating the right fatty acids (see Omega 3 Fatty acids)
• Eliminating consumption of the nightshade plant family (including potatoes, tomatoes, peppers, eggplant, and tobacco)
• Celery is anti-inflammatory. (See Reference 4)
• Identifying food sensitivities and avoiding those foods. This prevents incompletely-digested particles from getting into tissues where white blood cells attack them as foreign bodies (creating inflammation, and possible permanent damage).
• Gus J. Prosch's experimental Anti-Amoebic Treatment for Rheumatoid Disease. This has long been used in Germany for the treatment of OA. It contains a variety of compounds that actively reduce inflammation and promote healing.
• Red wine. See Resveratrol (below).

Vitamins and Minerals

• Pantothenic acid (vitamin B5) —a necessary co-factor in the biosynthesis of the anti-inflammatory adrenal glucocorticoid hormones.
• Vitamin C
  • reduces free radicals and histamine levels
  • reduces the activity of pro-inflammatory adhesion molecules
  • also necessary for synthesis of collagen and other joint components.
  • Competes with blood sugar to enter cells (the two molecules require the same transporter protein); this is useful in improving glucose metabolism and combating diabetes (which increases inflammation)
  • Raffelock recommends 1,000 mg 3 times a day
• Manganese
  • required in synthesis of the antioxidant superoxide dismutase (SOD)
  • Raffelock recommends 5 to 15 mg [check!] per day.
• Vitamin B3,
• Vitamin E
• Selenium
  • synergistic with Vitamin E
  • Raffelock recommends 50 to 400 mcg per day.
• Vitamin K, calcium regulator
• Zinc

Other Nutritional Supplements

• Superoxide Dismutase (SOD)
• Glutathione
• Plant sterols
  • Pygeum africanum
    • "Contains sterols that inhibit the production of inflammatory prostaglandins and reduce edema." (Whitaker, p. 2)
    • This herb has mainly been used for prostate problems, like the other plant sterols, perhaps it's also useful for other inflammatory conditions.
    • Interesting collection of studies at the HerbMed Pygeum page.
    • Pharmacology info better at the Pygeum page at the Body Wise International site.
  • Others: Whitaker cites Bouic PJ. Sterols/sterolins, the natural, non-toxic immunomodulators and their role in the control of rheumatoid arthritis. Newsletter of the Arthritis Trust of America 1998: Summer edition: "sterols have anti-inflammatory capabilities similar to that of the steroid drug cortisone — but with none of its negative effects."
  • Products (these are ones Whitaker recommends):
    • Source Naturals has two:
      • Phytosterol Complex with Beta Sitosterol — contains soy
      • Beta-Sitosterol — no soy, higher dose
    • Cholesterol Essentials from Healthy Directions
    • Moducare, at natural food stores or from Thorne Research
• Methylsulfonylmethane (MSM)
  • necessary for cartilage synthesis and repair
  • alone or with glucosamine.
  • With the problems I have making use of ingested sulfur, I've avoided this but had good results with Aloe Vera applied topically. A lot of it — not the commercial products, but raw leaf.
• Methionine/SAMe: in addition to fighting inflammation, methionine (a sulfur-bearing amino acid) is necessary for building cartilage.
• Omega 3 fatty acids (EPA/DHA/GLA): Fish oils and medicinal seed oils (eg black currant, evening primrose, borage) contribute to anti-inflammatory prostaglandin PGE 1 and PGE3 pathways, and inhibit the inflammatory PGE2 pathway.
  • Gus J. Prosch, Jr. prescribes
    • 100-1500 mg EPA and
    • 700-1000 mg DHA per day
  • [...need a lot more on EFAs and fat metabolism]
• Lyprinol
• Quercetin - but not if you have a COMT SNP: Inhibition of Catechol O-Methyltransferase-catalyzed O-Methylation of 2- and 4-Hydroxyestradiol by Quercetin.
• Resveratrol
• Glycosaminoglycans (synthesis requires sulfur):
  • Glucosamine
    • Boiling bones in water releases glucosamine.
    • improves wound healing, reduces headaches, eases inflammatory bowel disease. (Challem p. 132)
    • Glucosamine Choride
    • Glucosamine Sulfate
      • (I'm steering clear of this because of the sulfur)
      • Raffelock:
        • 500 mg twice daily. More can cause rapid cell aging.
        • take it continuously
  • Other Glycosaminoglycans:
    • Chondroitin sulfate (available in soup made from boiling bones in water)
    • bovine and shark cartilage,
    • sea cucumber.
    • Raffelock says "all these are less effective than glucosamine sulfate because of poorer absorption."
• CoEnzyme Q10, for its anti-inflammatory properties

Herbs

• Alfalfa
• Ashwagandha (Withania somniferum)
• Black Elderberry (Sambucus nigra L.)
• Boswellia Serrata [all the following are from an ad; need to look for better info]
  • James Braly, MD says it produces
    • reduction of joint swelling
    • restoration and improvement of blood supply to inflamed joints
    • pain relief
    • increased mobility
    • amelioration of morning stiffness
    • steroid-sparing
  • in addition it slows down the leukotriene cycle
• Bromelain (next to last paragraph)
  • pineapple enzymes.
  • blocks production of kinin (which contributes to inflammation)
• Celery seed extract (See Reference 4).
• Cucurmin
  • essential ingredient of the spice turmeric
  • antioxidant
  • no known toxicity.
• Devil's claw
• Ginger Root
  • [according to the same ad...]
    • increases circulation
    • reduces inflammation
  • Studies on ginger oil show it specifically inhibiting enzymes contributing to OA (Raffelock).
• Horse Chestnut (Aesculus Hippocastanum)
• Nettle Leaf (Urtica dioica).
  • Much used in Germany
  • contains phytoestrogen that I think gave me a liver attack
• Pygeum (see plant sterols, above)
• Yucca leaves
  • Extract
  • Holisticonline's database entry describes studies, but does not document them
  • don't eat it unprocessed! — the saponins are poisonous
• Wow! I just did a search at Purple Sage for "anti-inflammartory" — and got 33 herbs, most of which aren't on this list yet.

Hormones

Keeping in mind the need to balance hormones, increasing the levels of these may be indicated:

• Natural Progesterone. Excess estradiol and lack of progesterone worsens OA.
• Thyroid hormone. People with hypothyroidism (low thyroid) have an increased risk of OA.
• Anabolic hormones like testosterone, DHEA, and growth hormone

References

1. "Alternatives to NSAIDs for Osteoarthritis" by Dean Raffelock, in the November, 2001 issue of the John R. Lee, MD Medical Letter (pp5-6).
2. Dr. Julian Whitaker's Health & Healing; Your Definitive Guide to Alternative Health and Anti-Aging Medicine, Vol. 12, No. 8 (Aug 02) "The Many Benefits of Plant Sterols," pp.1-3.
3. Mediators of Inflammation, on the site of the Pathology Department of the University of Western Ontario in London, Ontario, Canada.
4. Herbs in Rheumatology, by Jim Duke, PhD, on the site of Willner Pharmacy, "the oldest and largest nutritionally oriented Pharmacy in North America"

For More information

• ILAR (International League of Associations for Rheumatology)
• The Inflammation Syndrome, by Jack Challem. John Wiley & Sons, Hoboken NJ, 2003.
• My pages
  • Arthritis
  • Histamine
  • Inflammation
  • Histidine