To the Editor,
The recent review article “Biological Basis for the Use of Botanicals in
Osteoarthritis and Rheumatoid Arthritis” by Ahmed and colleagues[1] is a truly
remarkable document that will contribute to the understanding and appropriate
clinical utilization of natural and botanical medicines in the treatment of
musculoskeletal disorders. We sincerely congratulate the authors and this
Journal for such a fine publication. In this letter, we would to offer two
addenda to enhance the scope of their review.
First, while providing a thorough review of Curcuma longa, the authors
might have also discussed the issue concerning the systemic bioavailability of
curcumin, the major constituent of turmeric, to humans. In fact, while
curcumin is indeed bioavailable to rats from oral supplementation, it is not
bioavailable to humans from oral dosing as high as 2 grams. Shoba et al[2]
have shown that in humans given 2-gram doses of curcumin alone, the levels of
curcumin in serum were undetectable to very low one hour post-administration.
However, concomitant administration of 20 mg of piperine was found to
significantly increase absorption and bioavailability of curcumin by 2000%, due
the ability of piperine to enhance gastrointestinal absorption and reduce
intestinal and hepatic clearance. Piperine is the major pungent alkaloid
found in the Asian vine Piper nigrum L, commonly known as black pepper.
There are in vitro animal and human studies demonstrating the
bioavailability-enhancing property of piperine for numerous drugs and
nutritional supplements in addition to curcumin, including coenzyme Q10[3,4]
Second, in addition to the five plants reviewed, we feel that the white willow
tree (Salix alba) would be another botanical of interest to be included
in the review. Indeed, the bark of the white willow tree has been used in
China for centuries as a medicine because of its ability to relieve pain and
lower fever, and it is one of the better researched botanical medicines for the
treatment of back pain and osteoarthritis. In a recent double-blind
placebo-controlled clinical trial in 210 patients with moderate/severe low-back
pain (20% of patients had positive straight-leg raising test), extract of willow
bark showed a dose-dependent analgesic effect with benefits beginning in the
first week of treatment.[5] In another head-to-head study of 228 patients
comparing willow bark (standardized for 240 mg salicin) with Vioxx (rofecoxib),
Chrubasik et al [6] showed that treatments were equally effective, yet willow
bark was safer and 40% less expensive. It appears that one of the main
mechanisms of action of willow bark is the inhibition of cyclooxygenase-2
(COX-2) gene transcription following its conversion to salicylates.[7]
Except for possible allergic reactions in patients previously sensitized to
aspirin (one single case report[8]), there is no evidence of aspirin-like
adverse effects with the use of willow bark extracts.[9] Salicylates are
widely present in fruits, vegetables, herbs and spices and are partly
responsible for the anti-cancer, anti-inflammatory, and health-promoting
benefits of plant consumption.[10,11]
Again, we congratulate authors Ahmed, Anuntiyo, Malemud, and Haqqi for their
excellent review. Their paper will clearly contribute to an accurate
understanding of the value of natural and botanical medicines in the clinical
treatment of musculoskeletal disorders.[12]
Alex Vasquez, D.C., N.D.
Researcher
Biotics Research Corporation
6801 Biotics Research Drive
Rosenberg, Texas 77471-5755
fax 281/344-0725
avasquez{at}bioticsresearch.com
Dave N Muanza, Ph.D.
Laboratory Director
Biotics Research Corporation
[1] Ahmed S, Anuntiyo J, Malemud CJ, Haqqi TM. Biological basis for the use of
botanicals in osteoarthritis and rheumatoid arthritis: a review. Evid Based
Complement Alternat Med. 2005 Sep;2(3):301-8
http://ecam.oxfordjournals.org/cgi/content/full/2/3/301
[2] Shoba G, Joy D, Joseph T, Majeed M, Rajendran R, Srinivas PS. Influence of
piperine on the pharmacokinetics of curcumin in animals and human volunteers.
Planta Med. 1998;64:353-6
[3] Badmaev V, Majeed M, Prakash L. Piperine derived from black pepper increases
the plasma levels of coenzyme Q10 following oral supplementation. J Nutr
Biochem. 2000 Feb;11(2):109-13
[4] Bano G, Raina RK, Zutshi U, Bedi KL, Johri RK, Sharma SC. Effect of piperine
on bioavailability and pharmacokinetics of propranolol and theophylline in
healthy volunteers. Eur J Clin Pharmacol. 1991;41(6):615-7
[5] Chrubasik S, Eisenberg E, Balan E, Weinberger T, Luzzati R, Conradt C.
Treatment of low-back pain exacerbations with willow bark extract: a randomized
double-blind study. Am J Med. 2000;109:9-14
[6] Chrubasik S, Kunzel O, Model A, Conradt C, Black A. Treatment of low-back
pain with a herbal or synthetic anti-rheumatic: a randomized controlled study.
Willow bark extract for low-back pain. Rheumatology (Oxford).
2001;40:1388-93
http://rheumatology.oxfordjournals.org/cgi/content/full/40/12/1388
[7] Hare LG, Woodside JV, Young IS. Dietary salicylates. J Clin Pathol
2003;56:649-50
http://jcp.bmjjournals.com/cgi/content/full/56/9/649
[8] Boullata JI, McDonnell PJ, Oliva CD. Anaphylactic reaction to a dietary
supplement containing willow bark. Ann Pharmacother. 2003;37:832-5
[9] Vasquez A, Muanza DN. Comment: evaluation of presence of aspirin-related
warnings with willow bark. Ann Pharmacother. 2005 Oct;39(10):1763. Epub
2005 Aug 30
http://www.theannals.com/cgi/content/full/39/10/1763
[10] Lawrence JR, Peter R, Baxter GJ, Robson J, Graham AB, Paterson JR. Urinary
excretion of salicyluric and salicylic acids by non-vegetarians, vegetarians,
and patients taking low dose aspirin. J Clin Pathol. 2003;56:651-3
http://jcp.bmjjournals.com/cgi/content/full/56/9/651
[11] Paterson JR, Lawrence JR. Salicylic acid: a link between aspirin, diet and
the prevention of colorectal cancer. QJM. 2001 Aug;94(8):445-8
http://qjmed.oxfordjournals.org/cgi/content/full/94/8/445
[12] Vasquez A. Reducing pain and inflammation naturally - Part 3: Improving
overall health while safely and effectively treating musculoskeletal pain.
Nutritional Perspectives 2005; 28: 34-38, 40-42
http://www.optimalhealthresearch.com/part3
Conflict of Interest:
Drs. Vasquez and Muanza are researchers at Biotics Research Corporation, an FDA-licensed drug manufacturing facility in the USA that evaluates and manufactures botanical extracts
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Accolades and Addenda for "Use of Botanicals in Osteoarthritis and Rheumatoid Arthritis"
