Metabolic Pathways
The connection between metabolic pathways and joint health
Normal joint function and structural integrity rely on the
satisfactory performance of various
metabolic pathways —
intestinal, liver, and kidney. Conversely, abnormal changes in these
metabolic pathways can cause joint diseases.
Gout, one of the most common metabolic joint diseases, results from the abnormal metabolism of uric acid. Elevation of uric acid concentration in the bloodstream (hyperuricemia) can lead to the formation of monosodium urate crystals which collect in the joints, tendons and surrounding tissues. This provokes an inflammatory response in the joints which clinically manifests as the sudden onset of pain, swelling, redness, heat and stiffness. Patients with longstanding blood elevation of uric acid can also develop deposits of uric acid crystal under the skin (tophi) and kidney stones.
Uric acid is the product of purine metabolism. Purine bases are converted first into xanthine and then into urate. Xanthine oxidase is a key enzyme catalyzing two critical steps in this process. Uric acid, formed primarily in the liver and released into the bloodstream, is eliminated from the body through urine (being excreted by the kidneys and accounting for about two thirds of the body’s uric acid) and through the gastro-intestinal tract.
But what causes the abnormal accumulation of uric acid in the bloodstream? It may result from one or more of the following processes:
- increased body load of purines
- increased production of uric acid by the liver
- inefficient elimination of uric acid by kidneys
- failed elimination of uric acid by the gastrointestinal tract
Natural remedies for normalizing uric acid metabolism typically focus on:
- inhibiting xanthine oxidase, the key enzyme responsible for uric acid formation
- stimulating the excretion of uric acid by the kidneys
- stimulating elimination of uric acid via gastrointestinal tract
The side bar (above) shows a list of natural ingredients that have long been associated with supporting health in the metabolic pathways.
BLACK CURRANT OIL
Source and Chemical Composition
Black currant oil is produced from the black currant seeds. The oil was shown to contain fatty acids: gamma- and alpha-linolenic acids, and stearidonic acid, as well as anthocyanins, flavonoids, and 2 nitrile-containing compounds.
Mechanism of Action
It has been shown that black currant oil inhibits xanthine oxidase activity. Furthermore, the oil also possesses an anti-inflammatory activity.
Human Experience
Although black currant oil has been broadly used in humans for various conditions, the published data is mainly focused on the use of the oil in patients with rheumatoid arthritis. No formal clinical trials have been conducted to assess the role of black currant oil in uric acid metabolism.
Pregnancy and Lactation
The remedy should not be taken by individuals who are pregnant or lactating.
Interactions
Black currant oil contains gamma-linolenic acid which was demonstrated to suppress platelet aggregation and increase bleeding time. Therefore, a potential interaction exists between black currant oil and anticoagulants, such as warfarin.
Adverse Reactions
No adverse reactions have been reported. Black currant oil should be used with caution in epileptic patients because of reports that gamma-linoleic acid containing supplements can lower seizure threshold.
Toxicology
No toxicity, carcinogenicity, or teratogenicity has been reported.
MORUS ALBUS
Source and Chemical Composition
Morus albus (Chinese name Sang Shen Zi) is a concentrated extract of a mulberry fruit. The active ingredient of morus albus is 3,5,7,2',4'-pentahydroxyflavone (morin).
Mechanism of Action
3,5,7,2',4'-pentahydroxyflavone is shown to inhibit uric acid reabsorption by kidneys, therefore enhancing kidney clearance of urates. The identified molecular target for morin is human urate anion transporter hURAT1. It has been demonstrated that morin is 25 times more efficient than prescription drug probenecid in enhancing uric acid clearance via kidneys.
Human Experience
Morus albus has been used for centuries to relieve symptoms of gout by Traditional Chinese Medicine. However, no formal clinical trials regarding the efficacy of morus albus in patients with impaired uric acid metabolism was published.
Pregnancy and Lactation
The remedy should be avoided during pregnancy and lactation.
Interactions
Based on the Morus albus mechanism of action, the remedy can potentially interact with metabolism of beta-lactam antibiotics, acetaminophen, aspirin and other NSAIDs, rifampin, benzodiazepins and methotrexate. Therefore, morus albus should be avoided in patients taking aforementioned medications.
Adverse Reactions
Morus albus extract contains a tyrosinanse inhibitor. Therefore, prolong use of morus albus can cause skin whitening / hypopigmentation. People with known history of kidney stones should avoid morus albus.
Toxicology
No toxicity, carcinogenicity, or teratogenicity has been reported.
CELERY SEED EXTRACT
Source and Chemical Composition
CELERY SEED EXTRACT contains alpha-linoleic acid, flavonoids, coumarins, 3-N-butyl phthalide, beta-eudesmol as well as varios vitamins and microelements.
Mechanism of Action
CELERY SEED EXTRACT normalizes gastrointestinal microflora responsible for uric acid degradation and facilitate uric acid elimination via kidneys.
Human Experience
All three remedies have been used in complementary medicine as anti-inflammatory, anti-arthritic and anti-gouty products for a long time. However, the focused clinical trials on the effects of these remedies on uric acid metabolism have not been performed.
Pregnancy and Lactation
The remedy should not be taken by individuals who are pregnant or lactating.
Interactions
The ingredients can potentially interact with anti-hypertensive agents, diuretics, warfarin, antibiotics and prevent absorption of lipid soluble vitamins (A, D, E and K).
Adverse Reactions
The reported adverse reactions include increased photosensitivity, occasional diarrhea and nausea.
YUCCA EXTRACT
Source and Chemical Composition
YUCCA EXTRACT is an extract of Yucca schidigera containing steroidal saponins, resveratrol and a number stilbenes
Mechanism of Action
YUCCA EXTRACT was shown to normalize gastrointestinal microflora and facilitate intestinal elimination of uric acid.
Human Experience
All three remedies have been used in complementary medicine as anti-inflammatory, anti-arthritic and anti-gouty products for a long time. However, the focused clinical trials on the effects of these remedies on uric acid metabolism have not been performed.
Pregnancy and Lactation
The remedy should be avoided during pregnancy and lactation.
Interactions
The ingredients can potentially interact with anti-hypertensive agents, diuretics, warfarin, antibiotics and prevent absorption of lipid soluble vitamins (A, D, E and K).
Adverse Reactions
The reported adverse reactions include increased photosensitivity, occasional diarrhea and nausea.
Toxicology
No toxicity, carcinogenicity, or teratogenicity has been reported.
SILYMARIN
Source and Chemical Composition
SILYMARIN is a mixture of at least 4 closely related flavonolignans from seeds of Milk Thistle.
Mechanism of Action
SILYMARIN possesses hepatoprotective activity, it also inhibits xanthine oxidase and stimulates bile flow therefore facilitating the traffic of the synthesized uric acid via gastrointestinal tract.
Human Experience
All three remedies have been used in complementary medicine as anti-inflammatory, anti-arthritic and anti-gouty products for a long time. However, the focused clinical trials on the effects of these remedies on uric acid metabolism have not been performed.
Pregnancy and Lactation
The remedy should be avoided during pregnancy and lactation.
Interactions
The ingredients can potentially interact with anti-hypertensive agents, diuretics, warfarin, antibiotics and prevent absorption of lipid soluble vitamins (A, D, E and K).
Adverse Reactions
The reported adverse reactions include increased photosensitivity, occasional diarrhea and nausea.
Toxicology
No toxicity, carcinogenicity, or teratogenicity has been reported.