Part 3: NSAID damage: Help your arthritis patients undo it

Many arthritis patients have NSAID damage from regularly taking these drugs.

They may present with gastrointestinal (GI) issues such as epigastric burning or irritable bowel syndrome symptoms, among other issues. As suggested in part two of this article series, substituting MSM, pancreatic enzymes and nicainamide for NSAIDs should handle patients’ pain and stop further damage, but the GI symptoms will not go away unless you do something about them.Many companies make products to help heal the GI lining. Look for three ingredients in these products: S-Methylmethionine, deglycyrrhizinated licorice (DGL) and Aloe vera. All three have been shown to help heal the GI mucosa.

NSAID damage repair trio: Methylmethionine, DGL and aloe

Methylmethionine is sometimes called “vitamin U” and is an extract from cabbage. It is not an actual vitamin; the term vitamin U was coined in 1950 by Garnett Cheney for uncharacterized anti-ulcerogenic factors in raw cabbage juice that may help speed healing of peptic ulcers.

Studies have shown it to heal the mucosa and treat ulcers.^1-7

Studies have shown DGL also heals the mucosa. It increases mucus production, prolongs the life of mucosal cells and increases circulation to the mucosal cells.^8-13

Aloe vera has been used to successfully treat both ulcers and GERD.^14,15 It also reduces inflammatory markers.¹⁶

Other products to try for NSAID damage

When you think cellular repair, think of phosphatidylcholine (PC). Inflammatory bowel disease is all about damage to the cells lining the intestine, and patients can benefit from PC supplementation. Studies have shown PC supplementation is extremely helpful to patients with ulcerative colitis.^17-19

One double-blind, randomized, placebo-controlled study involved 60 patients with chronic active, non-steroid-dependent, ulcerative colitis. Researchers saw clinical improvement in 90% of the patients given PC, with 53% of them going into remission.

Studies show PC can reduce the NSAID damage to the GI tract.^20,21 One study compared the use of ibuprofen to the use of ibuprofen fortified with PC in osteoarthritis (OA) patients. The authors of the study concluded, “Ibuprofen-PC is an effective osteoarthritic agent with an improved GI safety profile compared with ibuprofen in older OA patients, who are most susceptible to NSAID-induced gastroduodenal injury.”²²

If GI symptoms are particularly severe, add two phosphatidylcholine three times a day.

Don’t forget diet and lifestyle modifications

Remember, motion is lotion. Many patients with arthritis protect the affected joint and avoid movement; this makes things worse. Get them to exercise and strengthen the muscles of the affected joint.

Diet is a factor, too. Many of the foods in arthritis patients’ diets may cause inflammation that aggravates their condition. Get a copy of Roadmap to Health (email me), an anti-inflammatory diet that includes meal plans and recipes.

Final thoughts on undoing NSAID damage

When it comes to chronic complaints, medicine does not necessarily find the best solution. It finds the best patentable solution. The typical medical solution for joint pain is to give NSAID drugs, leaving patients with NSAID damage. The typical medical solution for epigastric burning is to shut down stomach acid production, creating a whole host of other problems. You can do a better job than this with the natural, holistic tools at your disposal.

PAUL VARNAS, DC, DACBN, is a graduate of the National College of Chiropractic and has had a functional medicine practice for 34 years. He is the author of several books and has taught nutrition at the National University of Health Sciences. For a free PDF of “Instantly Have a Functional Medicine Practice” or a patient handout on the anti-inflammatory diet, email him at paulgvarnas@gmail.com.

References

1. Cheney G. Anti-peptic ulcer dietary factor (vitamin “U”) in the treatment of peptic ulcer. J Am Diet Assoc. 1950;26(9):668-672. PubMed. https://pubmed.ncbi.nlm.nih.gov/15436263/. Accessed October 24, 2024.
2. Cheney G, et al. Vitamin U therapy of peptic ulcer; experience at San Quentin Prison. Calif Med. 1956;84(1):39-42. PubMed. https://pubmed.ncbi.nlm.nih.gov/13276831/. Accessed October 24, 2024.
3. Cheney G. Rapid healing of peptic ulcers in patients receiving fresh cabbage juice. Calif Med. 1949;70(1):10-15. PubMed. https://pubmed.ncbi.nlm.nih.gov/18104715/. Accessed October 24, 2024.
4. Salim AS. Sulphydryl-containing agents stimulate the healing of duodenal ulceration in man. Pharmacology. 1992;45(3):170-180. PubMed. https://pubmed.ncbi.nlm.nih.gov/1438525/. Accessed October 24, 2024.
5. Salim AS. Sulfhydryl-containing agents in the treatment of gastric bleeding induced by nonsteroidal anti-inflammatory drugs. Can J Surg. 1993;36(1):53-58. PubMed. https://pubmed.ncbi.nlm.nih.gov/8443719/. Accessed October 24, 2024.
6. Kruchinina TV, et al. S-methylmethionin (vitamin U): Experimental studies and clinical perspective. Vopr Pitan. 2018;87(5):70-76. Russian. PubMed. https://pubmed.ncbi.nlm.nih.gov/30592892/. Accessed October 24, 2024.
7. Salim AS. Role of sulphydryl-containing agents in the management of recurrent attacks of ulcerative colitis. A new approach. Pharmacology. 1992;45(6):307-18. PubMed. https://pubmed.ncbi.nlm.nih.gov/1362613/. Accessed October 24, 2024.
8. van Marle J, et al. Deglycyrrhizinised liquorice (DGL) and the renewal of rat stomach epithelium. Eur J Pharmacol. 1981;72(2-3):219-25. PubMed. https://pubmed.ncbi.nlm.nih.gov/7250207/. Accessed October 24, 2024.
9. Goso Y, et al. Effects of traditional herbal medicine on gastric mucin against ethanol-induced gastric injury in rats. Comp Biochem Physiol C Pharmacol Toxicol Endocrinol. 1996;113(1):17-21. PubMed. https://pubmed.ncbi.nlm.nih.gov/8665398/. Accessed October 24, 2024.
10. Rees WD, et al. Effect of deglycyrrhizinated liquorice on gastric mucosal damage by aspirin. Scand J Gastroenterol. 1979;14(5):605-607. PubMed. https://pubmed.ncbi.nlm.nih.gov/493863/. Accessed October 24, 2024.
11. Tewari SN, Trembalowicz FC. Some experience with deglycyrrhizinated liquorice in the treatment of gastric and duodenal ulcers with special reference to its spasmolytic effect. Gut. 1968;9(1):48-51. PubMed. https://pubmed.ncbi.nlm.nih.gov/5640926/. Accessed October 24, 2024.
12. Turpie AG, et al. Clinical trial of deglycyrrhizinized liquorice in gastric ulcer. Gut. 1969;10(4):299-302. PubMed. https://pmc.ncbi.nlm.nih.gov/articles/PMC1552833/. Accessed October 24, 2024.
13. Tewari SN, Wilson AK. Deglycyrrhizinated liquorice in duodenal ulcer. Practitioner. 1973;210(260):820-823. PubMed. https://pubmed.ncbi.nlm.nih.gov/4581313/. Accessed October 24, 2024.
14. Eamlamnam K, et al. Effects of Aloe vera and sucralfate on gastric microcirculatory changes, cytokine levels and gastric ulcer healing in rats. World J Gastroenterol. 2006;12(13):2034-9. PubMed. https://pubmed.ncbi.nlm.nih.gov/16610053/. Accessed October 24, 2024.
15. Park CH, et al. Low molecular-weight gel fraction of Aloe vera exhibits gastroprotection by inducing matrix metalloproteinase-9 inhibitory activity in alcohol-induced acute gastric lesion tissues. Pharm Biol. 2017;55(1):2110-2115. PubMed. https://pubmed.ncbi.nlm.nih.gov/28874080/. Accessed October 24, 2024.
16. Panahi Y, et al. Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial. J Tradit Chin Med. 2015;35(6):632-6. PubMed. https://pubmed.ncbi.nlm.nih.gov/26742306/. Accessed October 24, 2024.
17. Stremmel W, et al. Retarded release phosphatidylcholine benefits patients with chronic active ulcerative colitis, Gut. 2005;54(7):966-971. PubMed. https://pubmed.ncbi.nlm.nih.gov/15951544/ . Accessed October 24, 2024.
18. Stremmel W, et al. Delayed Release Phosphatidylcholine is Effective for Treatment of Ulcerative Colitis: A Meta-Analysis. Dig Dis. 2021;39(5):508-515. Europe PMC. https://europepmc.org/article/MED/33440385. Accessed October 24, 2024.
19. Karner M, et al. First multicenter study of modified release phosphatidylcholine “LT-02” in ulcerative colitis: a randomized, placebo-controlled trial in mesalazine-refractory courses. Am J Gastroenterol. 2014;109(7):1041-1051. PubMed. https://pubmed.ncbi.nlm.nih.gov/24796768/. Accessed October 24, 2024.
20. Cryer B, et al. Low-dose aspirin-induced ulceration is attenuated by aspirin-phosphatidylcholine: a randomized clinical trial. Am J Gastroenterol. 2011;106(2):272-277. PubMed. https://pubmed.ncbi.nlm.nih.gov/21081908/. Accessed October 24, 2024.
21. Lanza FL, et al. Clinical trial: comparison of ibuprofen-phosphatidylcholine and ibuprofen on the gastrointestinal safety and analgesic efficacy in osteoarthritic patients. Aliment Pharmacol Ther. 2008;28(4):431-442. PubMed. https://pubmed.ncbi.nlm.nih.gov/18549459/. Accessed October 24, 2024.
22. Lisitsa AV, et al. Experience with the use of phospholipid preparations in the combined treatment of bronchial asthma. Klin Med (Mosk). 2012;90(12):16-21. PubMed. https://pubmed.ncbi.nlm.nih.gov/23516864/. Accessed October 24, 2024.