Turmeric
Turmeric, a traditional herb, contains the active ingredient curcumin, which may have anti-inflammatory effects via the nuclear factor kappa B pathway. Some data have shown potential effectiveness in RA, for example, although consumers take the popular supplement for a variety of concerns.12
As a supplement, turmeric is often sold with piperine, the active component of black pepper. Although this might enhance absorption, the science on this isn’t clear. Piperine may cause gastrointestinal upset in some patients, so some may prefer versions without this added ingredient.
Fish Oil
Years of research show that fish oil may help decrease symptoms of such inflammatory diseases as RA, but supplement quality and quantity may be key.13 For example, Dr. Manek has concerns about many common fish oil products with questionable additives. Patients should look at the labels of fish oil available in pharmacies to verify sources of the omega-3 oils.
For patients who want to try it, Dr. Manek recommends a trial of three months, with a dose of at least 2.6 g total of eicosapentaenoic acid and docosahexaenoic acid. Patients should also cut open the capsule and smell to make sure it is not rancid—a very common issue; fish oil can become too oxidized to exert positive health effects.14
Stress Management
In addition to the key role of sleep, Dr. Manek emphasized the importance of stress management for controlling inflammation. “The medications for inflammatory arthritis and connective tissue diseases do not address the stress pathways that are so fundamental to these conditions,” she said.
The nervous system and immune system are in close communication, in real time, through multiple pathways.15 Comparatively lower vagal tone (e.g., decreased parasympathetic activation) has been found in many immune-mediated inflammatory disorders. This has generated interest in vagal nerve stimulation as a potential anti-inflammatory intervention, with some promising early data.16
Dr. Manek shared results from an interesting exploratory study in RA and psoriatic arthritis that analyzed various parasympathetic and sympathetic measures, including heart rate variability. Patients who responded poorly to anti-tumor necrosis factor therapy initially had lower parasympathetic tone and higher sympathetic activation compared with responders. This underscores a potential role for autonomic effects in inflammatory autoimmune disease.17
A popular breathing technique to increase the parasympathetic tone naturally, according to Dr. Manek, is to breathe in through the nose for four seconds, hold the breath for seven, then exhale through the mouth for eight seconds. It doesn’t take long to share with patients, she said, and they quickly notice a calming effect as the parasympathetic nervous system is stimulated.
