Rheumatoid Arthritis (RA) : Supplements

Dietary sources of omega-3 fatty acids include fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), while some nuts (English walnuts) and vegetable oils (canola, soybean, flaxseed/linseed, olive) contain alpha-linolenic acid (ALA). There is evidence from multiple studies supporting intake of recommended amounts of DHA and EPA in the form of dietary fish or fish oil supplements lowers triglycerides, reduces the risk of death, heart attack, dangerous abnormal heart rhythms, and strokes in people with known cardiovascular disease, slows the buildup of atherosclerotic plaques ("hardening of the arteries"), and lowers blood pressure slightly. However, high doses may have harmful effects, such as an increased risk of bleeding. Although similar benefits are proposed for alpha-linolenic acid, scientific evidence is less compelling, and beneficial effects may be less pronounced. Some species of fish carry a higher risk of environmental contamination, such as with methylmercury.

Omega-6 fatty acids are one of two groups of essential fatty acids (EFAs) that are required in human nutrition . (The other is the omega-3 fatty acid group.) Omega-6 fatty acids include linoleic acid and its derivatives. Essential means that these fatty acids must be consumed in the diet because humans cannot manufacture them from other dietary fats or nutrients, nor can they be stored in the body. They must be consumed daily to meet the body's requirements. They are macronutrients, required in amounts of grams per day (compared to micronutrients such as vitamins, which are required in milligrams per day). EFAs provide energy and are also components of nerve cells, cellular membranes, and are converted to hormone-like substances known as prostaglandins. In the body, prostaglandins and EFAs are necessary for normal physiology, including: producing steroids and synthesizing hormones regulating pressure in the eye, joints, and blood vessels mediating immune response regulating bodily secretions and their viscosity dilating or constricting blood vessels regulating collateral circulation directing endocrine hormones to their target cells regulating smooth muscles and autonomic reflexes being primary constituents of cell membranes regulating the rate of cell division maintaining the fluidity and rigidity of cellular membranes regulating the inflow and out-flux of substances into and out of cells transporting oxygen from red blood cells to the tissues maintaining proper kidney function and fluid balance keeping saturated fats mobile in the blood stream preventing blood cells from clumping together (conglomeration, which is the cause of atherosclerotic plaque, and blood clots , can be a cause of stroke ) mediating the release of inflammatory substances from cells that may trigger allergic conditions regulating nerve transmission and communication being the primary energy source for the heart muscle EFAs are therapeutic, and clinical trials have shown that EFAs protect against such conditions as heart disease ; cancer ; autoimmune diseases, including rheumatoid arthritis and multiple sclerosis ; skin diseases, including acne, atopic eczema , and psoriasis ; and may protect against stroke. The prevalence of heart disease in populations has been shown to be inversely proportional to the relative concentration of linoleic acid in the diet. Both linoleic acid and its derivatives are obtained from plant and animal sources. Plant sources include unprocessed, unheated vegetable oils such as corn, sunflower seed, safflower, soy, sesame, and cottonseed oils. They are also found in plant materials such as evening primrose, black currant seeds, and gooseberry oils as well as in raw nuts and seeds, legumes, and leafy greens. Animal sources of omega-6 fatty acids (although in smaller amounts than in plants) are lean meats, organ meats, and breast milk. Linoleic acid is an 18-carbon long polyunsaturated fatty acid containing two double bonds. Its first double bond occurs at the sixth carbon from the omega end, classifying it as an omega-6 oil. As linoleic acid is absorbed and metabolized in the human body, it is converted into a derivative fatty acid, gamma linoleic acid (GLA), which is converted into di-homo-gamma linoleic acid (DGLA) and arachidonic acid (AA). The DGLA and AA are then converted into two types of prostaglandins by adding two carbon molecules and removing hydrogen molecules. There are three families of prostaglandins, PGE1, PGE2, and PGE3. DGLA is converted to PGE1, while AA is converted into PGE2. PGE3 is made by the conversion of omega-3 fatty acids . Both PGE1 and PGE3, anti-inflammatory agents, protect against coronary disease by keeping blood platelets slippery and flowing, thus preventing blood clotting. PGE2 is inflammatory and increases platelet stickiness and blood clotting. All three forms must be present to ensure a functioning clotting system. There must be enough PGE2 to ensure healthy clotting, but enough PGE1 and PGE3

Borage, whose botanical name is Borago officinalis , is an annual herb in the Boraginaceae family. There are as many as 2,500 species in this family of plants. The specific designation officinalis indicates the herb's inclusion in official listings of medicinal plants. Borage is a wild-growing, hardy native of the Mediterranean region, cultivated and naturalized throughout Great Britain and North America. Traditionally associated with courage, borage was used to flavor the wine for soldiers preparing for battle. The English word "borage" may be derived from the word borrach , a Celtic word meaning "a person of courage." In folk tradition throughout its long history of recorded use, borage was believed to dispel melancholy and ease grief and sadness. According to the ancient Greek physician Dioscorides, borage can "cheer the heart and lift the depressed spirits." Common names for the herb include burrage, common bugloss, star flower, tailwort, or beebread. Borage self-seeds freely and flourishes in rich, well-drained soil in full sun. It is a good companion herb in the cottage garden, attracting honey bees and imparting strength and insect resistance to nearby plants, particularly strawberry and tomato. Borage's silvery-green, oblong to ovate, textured leaves form a basal rosette, then grow alternately up a succulent hollow round stem containing a clear mucilage. The leaves and sprawling branches are covered in bristly white hairs that impart a silvery sheen to the herb and are irritating to the skin on contact. Borage can reach a height of 2 ft (0.6 m), with leaves as long as 5 in (13 cm). The five-petaled star-shaped blue flowers, each with five black anthers, grow in loose, downward-turning clusters at the apex of the stems. Borage may bloom continuously from early spring until frost. The large, brownish-black seeds are three-sided. They may be viable for as long as eight years. The roots are shallow and spreading.

Antilipemic agent; combination consisting predominantly of ethyl esters of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Omega-3 fatty acids are one of two groups of fatty acids—the omega-3s and the omega-6s—that are vital to human life. They are called essential fatty acids (EFAs), which the body cannot make but absolutely needs for normal growth and development. These fats must be supplied by diet. People living in industrialized western countries eat up to 30 times more omega-6 than omega-3 fatty acids, resulting in a relative deficiency of omega-3 fats. Omega-6 metabolic products (inflammatory prostaglandins, thromboxanes, and leukotrienes) are formed in excessive amounts causing allergic and inflammatory disorders and making the body more prone to heart attacks, strokes, and cancer . Eating diets rich in omega-3 acids or taking fish oil supplements can restore the balance between the two fatty acids and can possibly reverse these disease processes.

Fatty acids are organic compounds composed of carbon chains of varying lengths, with an acid group on one end and hydrogen bound to all the carbons of the chain. Essential fatty acids (EFAs) are those that are necessary for health, but cannot be synthesized by the body. Therefore, it is important to supply the body with EFAs through one's daily dietary intake. EFAs are also called vitamin F or polyunsaturates. They are important ingredients for the growth and maintenance of cells. The body utilizes essential fatty acids for hormone production, specifically for the production of prostaglandins , which aid in reducing hypertension , migraine headaches, and arthritis . Essential fatty acids offer many positive effects for the body, including the nourishment of skin and hair; reduction of blood pressure , cholesterol , and triglyceride levels; prevention of arthritis and inflammation; and the reduction of the risk of blood clotting . Furthermore, essential fatty acids help protect the body from cardiovascular disease, candidiasis , eczema , and psoriasis , and they play a critical role in brain development and in the transmission of nerve impulses.

Borage ( Borago officinalis ) is an herb native to Syria that has spread throughout the Middle East and Mediterranean. Borage flowers and leaves may be eaten and borage seeds are often pressed to produce oil very high in gamma-linolenic acid (GLA). Borage is popularly used for premenstrual syndrome (PMS) and menopausal symptoms. Borage is also popular among elderly women. Borage is known for its anti-inflammatory properties and has been studied for the treatment of gum disease, rheumatoid arthritis, and asthma. There is currently controversy about the safety of borage. Consumers should use caution when taking borage as there have been cases of poisoning after confusion with foxglove.

Zinc is an important trace mineral. This element is second only to iron in its concentration in the body.

Zinc is a mineral that is essential for a healthy immune system, production of certain hormones, wound healing, bone formation, and clear skin. It is required in very small amounts, and is thus known as a trace mineral. Despite the low requirement, zinc is found in nearly every cell of the body and is a key to the proper function of more than 300 enzymes, including superoxide dismutase. Normal growth and development cannot occur without it.

Zinc is a mineral that is essential for a healthy immune system , production of certain hormones, wound healing, bone formation, and clear skin. It is required in very small amounts, and is thus known as a trace mineral. Despite the low requirement, zinc is found in nearly every cell of the body and is a key to the proper function of over 300 enzymes, including superoxide dismutase. Normal growth and development cannot occur without it.

Glucosamine is a natural compound that is found in healthy cartilage. Glucosamine sulfate is a normal constituent of glycoaminoglycans in cartilage matrix and synovial fluid. Available evidence from randomized controlled trials supports the use of glucosamine sulfate in the treatment of osteoarthritis, particularly of the knee. It is believed that the sulfate moiety provides clinical benefit in the synovial fluid by strengthening cartilage and aiding glycosaminoglycan synthesis. If this hypothesis is confirmed, it would mean that only the glucosamine sulfate form is effective and non-sulfated glucosamine forms are not effective. Glucosamine is commonly taken in combination with chondroitin, a glycosaminoglycan derived from articular cartilage. Use of complementary therapies, including glucosamine, is common in patients with osteoarthritis, and may allow for reduced doses of non-steroidal anti-inflammatory agents.

Glucosamine is an amino sugar that occurs naturally in the body. This one-molecule substance consists of glucose and a hydrogen and nitrogen amine. Amino sugars are different from other body sugars, as they form part of carbohydrates. Their function is also different as they are not a source of energy, but rather are included in body tissue structure. Therefore, glucosamine plays a role in forming and maintaining the body's tissues—for example, constructing nails, skin, eyes, bones, ligaments, tendons, heart valves, discharging mucus from the respiratory system, digestive system, and urinary tract. Glucosamine helps blend sulfur into the cartilage. When people grow older, their bodies may lose the capacity to make enough glucosamine, so the cartilage in such weight-bearing joints as the hips, knees, and hands is destroyed. The remaining cartilage then hardens and forms bone spurs , causing pain , deformed joints, and limited joint movement. Glucosamine is not readily available from any primary food source. Commercial preparations of glucosamine are derived from chitin, which is a substance found in the outer covering of such shellfish as lobster, crab, and shrimp, as well as in such animal connective tissues as the marrow of chicken bones. Commercially prepared glucosamine comes in three formats: glucosamine sulfate, glucosamine hydrochloride, and N-acetyl-glucosamine (NAG).

Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Selenium deficiency can occur in areas where soil content of selenium is low, and may affect thyroid function and cause conditions such as Keshan disease. Selenium deficiency is also commonly seen in patients on total parenteral nutrition (TPN) as their sole source of nutrition. Gastrointestinal disorders may decrease the absorption of selenium resulting in depletion or deficiency. Selenium may be destroyed when foods are refined or processed. Specific dietary sources of selenium include brewer's yeast, wheat germ, butter, garlic, grains, sunflower seeds, Brazil nuts, walnuts, raisins, liver, kidney, shellfish (lobster, oyster, shrimp, scallops), fresh-water and salt-water fish (red snapper, salmon, swordfish, tuna, mackerel, halibut, flounder, herring, smelts). Selenium is also found in alfalfa, burdock root, catnip, fennel seed, ginseng, raspberry leaf, radish, horseradish, onion, chives, medicinal mushrooms (reishi, shiitake), and yarrow. The role of selenium in cancer prevention has been the subject of recent study and debate. Initial evidence from the Nutritional Prevention of Cancer (NPC) trial suggests that selenium supplementation reduces the risk of prostate cancer among men with normal baseline PSA (prostate specific antigen) levels, and low selenium blood levels. However, in this study selenium did not reduce the risk of lung, colorectal, or basal cell carcinoma of the skin, and actually increased the risk of squamous cell skin carcinoma. The ongoing Selenium and Vitamin E Cancer Prevention Trial (SELECT) aims to definitively address the role of selenium in prostate cancer prevention.

Selenium is an essential trace mineral. Small amounts of selenium are good for your health.

Selenium is a nonmetallic element with an atomic number of 34 and an atomic weight of 78.96. Its chemical symbol is Se. Selenium is most commonly found in nature in its inorganic form, sodium selenite. An organic form of selenium, selenomethionine, is found in foods.

The rhizomes (underground stem) and stems of ginger have assumed significant roles in Chinese, Japanese and Indian medicine since the 1500s. The oleoresin of ginger is often contained in digestive, antitussive, antiflatulent, laxative, and antacid compounds. There is supportive evidence from one randomized controlled trial and an open-label study that ginger reduces the severity and duration of chemotherapy-induced nausea/emesis. Effects appear to be additive to prochlorperazine (Compazine®). The optimal dose remains unclear. Ginger's effects on other types of nausea/emesis, such as postoperative nausea or motion sickness remain indeterminate. Ginger is used orally, topically, and intramuscularly for a wide array of other conditions, without scientific evidence of benefit. Ginger may inhibit platelet aggregation/decrease platelet thromboxane production, thus theoretically increasing bleeding risk.

The rhizome (root) of turmeric ( Curcuma longa Linn.) has long been used in traditional Asian medicine to treat gastrointestinal upset, arthritic pain, and "low energy." Laboratory and animal research has demonstrated anti-inflammatory, antioxidant, and anti-cancer properties of turmeric and its constituent curcumin. Preliminary human evidence, albeit poor quality, suggests possible efficacy in the management of dyspepsia (heartburn), hyperlipidemia (high cholesterol), and scabies (when used on the skin).

Turmeric is a member of the Curcuma botanical group, which is part of the ginger family of herbs, the Zingiberaceae. Its botanical name is Curcuma longa . Turmeric is widely grown both as a kitchen spice and for its medicinal uses. Two closely related plants, Curcuma petolata and Curcuma roscoeana , are natives of Cambodia and are grown for their decorative foliage and blossoms. All curcumas are perennial plants native to southern Asia. They grow in warm, humid climates and thrive only in temperatures above 60°F (29.8°C). India, Sri Lanka, the East Indies, Fiji, and Queensland (Australia) all have climates that are conducive to growing turmeric. The turmeric plant is identifiable by both its characteristic tuberous root and the leaves that extend upward from erect, thick stems arising from the root. Turmeric root is actually a fleshy oblong tuber 2–3 in (5–10 cm) in length, and close to 1 in (2.54 cm) wide. It is tapered at each end, and its exterior can be yellow, tan, or olive-green in color. The interior of the root is hard, firm, and either orange-brown or deeply rust-colored, with transverse resinous parallel rings. M. Grieve, in A Modern Herbal , states that the root is dense and breaks into a powder that is lemon yellow in color. Turmeric root has a fragrant aroma and a somewhat bitter, peppery, biting taste reminiscent of ginger. When eaten, it colors the saliva yellow and leaves a warm sensation in the mouth. The root contains a bitter volatile oil, brown coloring matter, gum, starch, calcium chloride, woody fiber and a yellowish coloring material that is known as cucurmin. In addition to the root, the turmeric plant produces rhizomes, which are underground stems growing parallel to the ground that produce roots below and new shoots from their upper surface. Turmeric rhizomes have also been used for medicinal purposes. The plant's leaves are divided, lance-shaped and narrower at each end. They are close to 2 ft (61 cm), lustrous and deep green. The flowers arise from those leaves, and are a pale yellow color, growing in groupings of three to five.

Black cohosh is popular as an alternative to hormonal therapy in the treatment of menopausal (climacteric) symptoms such as hot flashes, mood disturbances, diaphoresis, palpitations, and vaginal dryness. Several studies have reported black cohosh to improve menopausal symptoms for up to six months, although the current evidence is mixed. The mechanism of action of black cohosh remains unclear and the effects on estrogen receptors or hormonal levels (if any) are not definitively known. Recent publications suggest that there may be no direct effects on estrogen receptors, although this is an area of active controversy. Safety and efficacy beyond six months have not been proven, although recent reports suggest safety of short-term use, including in women experiencing menopausal symptoms for whom estrogen replacement therapy is contraindicated. Nonetheless, caution is advisable until better-quality safety data are available. Use of black cohosh in high-risk populations (such as in women with a history of breast cancer) should be under the supervision of a licensed healthcare professional.

Black cohosh ( Cimicufuga racemosa ) is a member of the Ranunculaceae family. Its nicknames of squawroot and snakeroot denote its Algonquian heritage and differentiate it from the common snake root plant ( Aristolochia serpentaria ). It should also not be confused Black cohosh plants. (© PlantaPhile , Germany. Reproduced by permission. ) with blue cohosh ( Caulophyllum thalictroides ); their only similarity is that both are roots. Black cohosh grows from a gnarled black root, hence its name; it has a smooth stem and big multiple leaves with jagged edges. In summer, white flowers develop from what are called racemes. These flowers emit a stinky odor. The plant, which can grow to 9 ft (1 m) tall, is a native North American plant found on hills and in forests located at high levels. It is found from Ontario, Canada to Maine to the southern states of Georgia and Missouri. Black cohosh contains several components, as outlined by James F. Balch, MD and Phyllis A. Balch, CNC in their book Prescription for Nutritional Healing, Second Edition : actaeine cimicifugin estrogenic substances isoferulic acid oleic acid palmitic acid pantothenic acid phosphorus racemosin tannins triterpenes vitamin A

Feverfew is an herb that has been used traditionally for fevers, as its name denotes, although this effect has not been well studied. Feverfew is most commonly taken by mouth for the prevention of migraine headache. Several human trials have been conducted with mixed results. Overall, these studies suggest that feverfew taken daily as dried leaf capsules may reduce the incidence of headache attacks in patients who experience chronic migraines. However, this research has been poorly designed and reported. There is currently inconclusive evidence regarding the use of feverfew for symptoms associated with rheumatoid arthritis. Feverfew appears to be well tolerated in clinical trials, with a mild and reversible side effects profile. The most common adverse effect appears to be mouth ulceration and inflammation with direct exposure to leaves. In theory, there may be an increased risk of bleeding.

Feverfew ( Chrysanthemum parthenium or Tanacetum parthenium ) is named for one of the herb's traditional medicinal uses as a febrifuge, from the Latin febrifugia , indicating its fever-reducing action. This European native of the Compositae (Asteraceae) or aster family has naturalized throughout North and South America, escaping from cultivation. It can be found along roadsides and along the borders of wooded areas. Other common names include featherfew, febrifuge plant, featherfoil, mid-summer daisy, and wild chamomile . Feverfew is a bushy and herbaceous perennial that grows from a branched and tapering root to produce erect, round and slightly grooved stems. The feathery, aromatic and bitter-tasting leaves are arranged alternately along the length of the many-branched stem. They are a yellow-green, stalked, and bipinnate with deeply cut, toothed segments in an oval shape. Flowers bloom in mid to late-summer in flat-topped clusters at the end of stems that may reach to a height of three feet. Smaller than daisies, and without the protruding central disk of chamomile, feverfew blossoms have yellow centers consisting of tightly-bunched tubular florets surrounded by creamy white rays. Bees seem to avoid feverfew, deterred by its pungent aroma. The plant self-seeds freely, and thrives in full sun or partial shade in most soil.

DHEA (dehydroepiandrosterone) is an endogenous hormone (made in the human body), and secreted by the adrenal gland. DHEA serves as precursor to male and female sex hormones (androgens and estrogens). DHEA levels in the body begin to decrease after age 30, and are reported to be low in some people with anorexia, end-stage kidney disease, type 2 diabetes (non-insulin dependent diabetes), AIDS, adrenal insufficiency, and in the critically ill. DHEA levels may also be depleted by a number of drugs, including insulin, corticosteroids, opiates, and danazol. There is sufficient evidence supporting the use of DHEA in the treatment of adrenal insufficiency, depression, induction of labor, and systemic lupus erythematosus. No studies on the long-term effects of DHEA have been conducted. DHEA can cause higher than normal levels of androgens and estrogens in the body, and theoretically may increase the risk of prostate, breast, ovarian, and other hormone-sensitive cancers. Therefore, it is not recommended for regular use without supervision by a licensed health professional.

DHEA is the acronym for dehydroepiandrosterone, a hormone produced naturally from cholesterol in the adrenal glands of males and females. It is a precursor to the male sex hormone testosterone. It is also sold as an over-the-counter dietary supplement. The human body produces very little DHEA until about the age of seven, when production soars. It peaks in the mid-20s and starts to decline in the early 30s. By the mid-70s, DHEA production has dropped by about 80-90%. At all ages, DHEA levels are slightly higher in men than women. The optimum DHEA level in a healthy adult is 750-1,250 milligrams per deciliter of blood (mg/dL) for men and 550-980 mg/dL for women. DHEA was first identified in 1934 and was sold over the counter mainly as a weight loss aid until the late 1980s. Then the federal Food and Drug Administration (FDA) classified DHEA as a drug, making it available by prescription only. The FDA reversed itself in 1994, reclassifying DHEA as a dietary supplement obtainable without a prescription. A 1994 study by researchers at the University of California, San Diego looked at 30 middle-age men and women who took 50 mg of DHEA a day for three months. The test subjects generally reported an improved sense of well-being, increased energy, enhanced sex drive, and an improved ability to deal with stress . The results were widely reported by the mass media, with several referring to DHEA as the "fountain of youth hormone." Despite hundreds of studies of DHEA over the past three decades, researchers are still unclear on how the hormone works or exactly what it does in the body. Although it is know DHEA decreases with age, it is not known whether this constitutes a deficiency or is because the body needs less DHEA as it ages. The main reason so little is known about DHEA is because the hormone is not patentable, so drug companies are unwilling to spend money doing further research on it. Much of the research today in funded through universities and the National Institute on Aging that maintains a skeptical philosophy about DHEA supplementation.

Dimethyl sulfoxide (C 2 H 6 OS), or DMSO, is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO was first synthesized in 1866 as a byproduct of paper manufacturing. Therapeutic interest began in 1963. DMSO was reported to penetrate through the skin and produce analgesia, decrease pain, and promote tissue healing. DMSO is available for both non-medicinal and medicinal uses. The major clinical use of DMSO is to relieve symptoms of interstitial cystitis. Potential toxic effects to the lens of the eye have been reported in animals but no effects have been noted in humans. Topical application has been associated with redness and inflammation of skin, and a garlic-like taste and odor on the breath have been reported. DMSO has been used to treat amyloidosis ( 1 ; 2 ; 3 ; 4 ; 5 ; 6 ), diabetic ulcers ( 7 ), extravasation ( 8 ), erosive gastritis ( 9 ), and ischemia prevention in surgical flaps ( 10 ), but well designed clinical trials are lacking. Because of the limited scientific evidence, whether DMSO provides effective treatment of patients with closed head trauma ( 11 ), herpes zoster ( 12 ; 13 ), tendopathies ( 14 ), and complex regional pain syndrome ( 15 ) will require more research.

Guggul (gum guggul) is a resin produced by the mukul mirth tree. Guggulipid is extracted from guggul, and contains plant sterols (guggulsterones E and Z), which are believed to be its bioactive compounds. Prior to 2003, the majority of scientific evidence suggested that guggulipid elicits significant reductions in serum total cholesterol, low-density lipoprotein (LDL), and triglycerides, as well as elevations in high-density lipoprotein (HDL). Although recent evidence provides preliminary evidence against the efficacy of guggul for hypercholesterolemia, and thus, further study is necessary before a definitive conclusion can be reached. Initial research reports that guggulsterones are antagonists of the farsenoid X receptor (FXR) and the bile acid receptor (BAR), nuclear hormones that are involved with cholesterol metabolism and bile acid regulation.

The mukul myrrh tree, or Commiphora mukul , is small, thorny, and usually devoid of foliage. It grows naturally throughout India and Arabia. Guggul is the gum resin that comes from this tree, which belongs to the same genus as myrrh and has some similar components and actions. Guggul resin contains steroids, diterpenoids, alipathic esters, and carbohydrates. These factors appear to work together to exert the beneficial effects of this botanical. Guggul has been traditionally used in Ayurvedic medicine to treat arthritis, inflammation, bone fractures , overweight, and disorders of lipid metabolism. One ancient Ayurvedic reference describes the power of guggul to treat "coating and obstruction of channels." This description stimulated further research into the properties of this botanical medicine for preventing and treating atherosclerosis , as well as other conditions resulting from high levels of lipids in the body.

Gamma linolenic acid (GLA) is a dietary omega-6 fatty acid found in many plant oil extracts. Commercial products are typically made from seed extracts from evening primrose (average oil content 7-14%), blackcurrant (15-20%), borage oil (20-27%) and fungal oil (25%). GLA is not found in high levels in the diet. It has been suggested that some individuals may not convert the omega-6 fatty acid linoleic acid to longer chain derivatives, such as GLA, efficiently. Thus, supplementation with GLA-containing oils, such as borage oil and evening primrose oil, is occasionally recommended to increase GLA levels in the body. GLA is available commonly as a dietary supplement and is sold over the counter in capsules or oil to treat a variety of conditions such as eczema, oral mucoceles (mucus polyps), hyperlipidemia (high cholesterol), depression, postpartum depression, chronic fatigue syndrome (CFS), psoriasis (chronic skin disease), muscle aches, and menopausal flushing. There is currently good evidence for GLA treatment in rheumatoid arthritis, acute respiratory distress syndrome, and diabetic neuropathy (nerve damage). Little or no effect has been found in treatment of atopic dermatitis, attention deficit hyperactivity disorder (ADHD), cancer prevention, menopausal flushing, systemic sclerosis, and hypertension (high blood pressure). GLA has also been used to help with the body's response to tamoxifen in breast cancer patients. Today, production and extraction of oil from evening primrose and borage is done by companies primarily in China, New Zealand, and England. Pharmaceutical licensing for GLA oil products has had only limited success worldwide.

Pantothenic acid (vitamin B5) is essential to all life, and is a component of coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. The name pantothenic acid comes from the Greek word pantos, meaning "everywhere," referring to its wide distribution in most plants and animals. Rich food sources include meats, liver, kidney, fish/shellfish, chicken, vegetables, legumes, yeast, eggs, and milk. However, freezing and canning may lead to a loss of much of the pantothenic acid content. Whole grains are also a good source, although refining may degrade much of the pantothenic acid content. In commercial supplement products, vitamin B5 is available as D-pantothenic acid and as the synthetic products dexpanthenol (converted in the body to pantothenic acid) or calcium pantothenate. Pantothenic acid is frequently used in combination with other B vitamins in vitamin B complex formulations. Only the dextrorotatory (D) isomer of pantothenic acid possesses biologic activity. Pantothenic acid deficiency is exceedingly rare, and likely only occurs only in cases of the most severe life-threatening malnutrition. Most individuals likely obtain sufficient amounts from dietary sources. Pantothenic acid has been used or studied for numerous health conditions, but has not been clearly demonstrated as beneficial for any. Oral, topical (on the skin), or injected forms have been used.

Pantothenic acid and biotin are types of B vitamins. They are water-soluble, which means that the body can't store them. If the body can't use all of the vitamin, the extra leaves the body through the urine. Therefore, these vitamins must be replaced every day.

Pantothenic acid, also known as vitamin B 5 , is a member of the water-soluble B vitamin family. It is an essential ingredient of two substances, coenzyme A and acyl carrier protein, which are needed to metabolize carbohydrates and fats. The same coenzymes play a part in production of certain hormones, vitamin D , red blood cells, and the neurotransmitter acetylcholine. Pantothenic acid is necessary for proper growth and development. Studies of Mexican infants whose diets are deficient in micronutrients have shown that those who receive dietary supplements containing pantothenic acid do not show the growth retardation that appears in control groups.

The black currant shrub is native to Europe and parts of Asia and is particularly popular in Eastern Europe and Russia. Traditional herbalists uphold that black currant has diuretic (increases urine flow), diaphoretic (promotes sweating), and antipyretic (fever reducer) properties. In Europe, it has been used topically (applied to the skin) to treat skin disorders, such as atopic dermatitis, and as part of gargles to treat sore throats. Black currant juice has been boiled down into a sugary extract, called Rob, to treat sore throat inflammation, colds, the flu, and febrile (fever) illness. A mixture made from black currant bark has been used to treat calculus (hardened plaque), edema (swelling), and hemorrhoids. With a vitamin C content estimated to be five times that of oranges (2,000 milligrams/kilogram), black currant has potential dietary benefits. Black currant is also rich in rutin and other flavonoids, which are known antioxidants. Because of black currant's high essential fatty acid content, researchers believe that it may be effective in the treatment of inflammatory conditions and pain management, as well as in regulating the circulatory system and increasing immunity. As a medicinal treatment, black currant seed oil is the most commonly used part of the plant and is available in capsule form. The effectiveness of black currant seed oil is mixed and safety concerns seem to be minor in non-allergic people.

Podophyllum gets its name from the Greek words podos and phyllon , meaning foot shaped leaves. Podophyllum rhizomes have a long medicinal history among native North American tribes who used a rhizome powder as a laxative or an agent that expels worms (anthelmintic). A poultice of the powder was also used to treat warts and tumorous growths on the skin. Podophyllotoxin is a plant-derived compound used to produce two cytostatic drugs, etoposide and teniposide. The substance has been primarily obtained from the American mayapple ( Podophyllum peltatum ). The Himalayan mayapple ( Podophyllum hexandrum or Podophyllum emodi ) contains this constituent in a much greater quantity, but is endangered in the wild. Currently, extracts of the podophyllum plant are used in topical medications for genital warts, HIV-related oral hairy leukoplakia, and some skin cancers. Preliminary research also shows that CPH 82, an oral form of Podophyllum emodi composed of two purified semisynthetic lignan glycosides, may be useful in treating rheumatoid arthritis. However, when used orally, podophyllum can be lethal and should be avoided. The drug etoposide (VePesid®) is the semisynthetic derivative of podophyllotoxin, and is approved by the U.S. Food and Drug Administration (FDA) for various types of cancer.

Chlorophyll is a chemoprotein commonly known for its contribution to the green pigmentation in plants, and is related to protoheme, the red pigment of blood. It can be obtained from green leafy vegetables (broccoli, Brussel sprouts, cabbage, lettuce, and spinach), algae ( Chlorella and Spirulina ), wheat grass, and numerous herbs (alfalfa, damiana, nettle, and parsley). Chlorophyll has been used traditionally to improve bad breath and other forms of body odor including odors of the urine, feces, and infected wounds. More recently chlorophyll has been used to aid in the removal of various toxins via the liver and remains a key compound for improving the function of essential detoxification pathways. Supportive evidence suggests it may be used as an anti-inflammatory agent for conditions, such as pancreatitis as well as exhibiting potent antioxidant and chemoprotective activities. Scientific research has demonstrated it may be an effective therapeutic agent in the treatment of herpes simplex, benign breast disease, chemoprevention, tuberculosis, and rheumatoid arthritis. Type 2 diabetes and obesity are also being explored as areas where chlorophyll can also be used.

Classified as an herb, bromelain is a sulfur-containing proteolytic digestive enzyme that is extracted from the stem and the fruit of the pineapple plant ( Ananas comosus , family Bromeliaceae) . When taken with meals, bromelain is believed to assist in the digestion of proteins. When taken on an empty stomach, it is believed to act medicinally as an anti-inflammatory agent. The expert panel, the German Commission E approved bromelain for the treatment of swelling/inflammation of the nose and sinuses caused by injuries and surgery in 1993.

Bromelain, also known as bromelin, is a protein-digesting enzyme extracted from the flesh and stem of the pineapple plant, Ananas comosus . Although the people of Guadeloupe introduced Christopher Columbus to the fruit in 1493, Europeans did not recognize the pineapple's beneficial attributes until later. Pineapple had a long history of traditional use among the native peoples of Central and South America. They applied pineapple dressings to wounds and skin injuries to reduce inflammation, and eased stomachaches and indigestion by drinking the juice of the fruit. Bromelain was first isolated from pineapple juice in 1891 and introduced as a therapeutic supplement in 1957. The active ingredients of bromelain are found in the juice and stem of the pineapple plant, but the stem contains more bromelain than the fruit.

Zinc formulations have been used since Ancient Egyptian times to enhance wound healing, although the usefulness of this approach is only partially confirmed by clinical data of today. Zinc is necessary for the functioning of over 300 different enzymes and plays a vital role in an enormous number of biological processes. Zinc is a cofactor for the antioxidant enzyme superoxide dismutase (SOD) and is in a number of enzymatic reactions involved in carbohydrate and protein metabolism. Its immunologic activities include regulation of T lymphocytes, CD4, natural killer cells, and interleukin II. In addition, zinc has been claimed to possess antiviral activity. It has been shown to play a role in wound healing, especially following burns or surgical incisions. Zinc is necessary for the maturation of sperm and normal fetal development. It is involved in sensory perception (taste, smell, and vision) and controls the release of stored vitamin A from the liver. Within the endocrine system, zinc has been shown to regulate insulin activity and promote the conversion thyroid hormones thyroxine to triiodothyronine. Based on available scientific evidence, zinc may be efficacious in the treatment of (childhood) malnutrition, acne vulgaris, peptic ulcers, leg ulcers, infertility, Wilson's disease, herpes, and taste or smell disorders. Zinc has also gained popularity for its use in prevention of the common cold. The role for zinc is controversial in some cases, as the results of published studies provide either contradictory information, and/or the methodological quality of the studies do not allow for a confident conclusion regarding the role of zinc in those diseases.

Resin extracts from the Boswellia serrata tree have been found to have anti-inflammatory effects. Animal and laboratory studies suggest possible efficacy for inflammatory conditions such as inflammatory bowel disease, rheumatoid arthritis, and osteoarthritis, although high-quality human data are lacking. Initial human evidence suggests the efficacy of boswellia as a chronic therapy for asthma (but not for the relief of acute asthma exacerbations). Further studies are warranted in this area. As opposed to non-steroidal anti-inflammatory drugs (NSAIDs), long-term use of boswellia has not been shown to cause gastrointestinal irritation or ulceration, although adverse effects have not been well studied in humans.

Astaxanthin is classified as a xanthophyll, which is a carotenoid pigment, and can be found in microalgae, yeast, salmon, trout, krill, shrimp, crayfish, crustaceans, and the feathers of some birds. Haematococcus pluvialis , a green microalga and one of the richest sources of natural astaxanthin, was reviewed and cleared for marketing by the United States Food and Drug Administration (FDA) in August 1999 as a new dietary ingredient by means of the Dietary Supplement Health and Education Act (DSHEA) (21 CRF part 190.6). Astaxanthin is most commonly used as an antioxidant and may be beneficial in decreasing the risks of certain chronic diseases, such as cancer and cardiovascular diseases. Astaxanthin may also be effective in carpal tunnel syndrome, rheumatoid arthritis, muscle strength and endurance, high cholesterol (LDL oxidation), musculoskeletal injuries, and male infertility. Astaxanthin has been used as a feed supplement and food coloring additive for salmon, crabs, shrimp, chickens, and egg production. According to the Code of Federal Regulations, astaxanthin is generally recognized as safe (GRAS) when used as a color additive in salmon foods to obtain the desired pink to orange-red color.

In the United States, willow bark is used by herbalists as an antipyretic (fever reducer), a mild analgesic (pain reliever), and an anti-inflammatory. There is currently strong scientific evidence that willow bark is effective for osteoarthritis and lower back pain. Early study suggests that willow bark extracts may not be helpful for rheumatoid arthritis, but further study is warranted to confirm these recommendations. Taking willow bark may increase the risk of bleeding; however, this risk may be less than taking aspirin. Several countries in Europe have approved willow bark for pain and inflammatory disorders. The German Commission E has approved willow bark for fever, rheumatic ailments, and headaches. The British Herbal Compendium indicates that willow bark can be used for rheumatic and arthritic conditions, and fever associated with cold and influenza. In France, willow bark has been approved as an analgesic to treat headache and toothache pain, as well as painful articular (joint) conditions, tendonitis, and sprains. The European Scientific Cooperative on Phytotherapy (ESCOP) has approved willow bark extract for the treatment of fever, pain, and mild rheumatic complaints.

Evening primrose oil (EPO) contains an omega-6 essential fatty acid, gamma-linolenic acid (GLA), which is believed to be the active ingredient. EPO has been studied in a wide variety of disorders, particularly those affected by metabolic products of essential fatty acids. However, high-quality evidence for its use in most conditions is still lacking.

Evening primrose oil is a dietary supplement derived from the seeds of the evening primrose plant, Oenothera biennis . Its Latin name is derived from the Greek word for wine, reflecting the folk belief that the plant could relieve the symptoms of a hangover. Other names for the plant are tree primrose and sundrop. Native Americans used the leaves and bark of evening primrose as a sedative and astringent; it was given for stomach and liver complaints as well as disorders of the female reproductive system. More recently, the discovery of antioxidant and other properties of the seed oil has focused attention on its usefulness in treating a range of diseases and disorders, including as an anti-inflammatory, and for premenstrual syndrome (PMS), rheumatoid arthritis, diabetes, osteoporosis, ulcerative colitis, menopausal problems, and heart disease.