What are supplements? Why are they beneficial for autoimmune health?
Dietary or nutritional supplements are products intended to supplement the diet and may include vitamins, minerals, amino acids, enzymes, botanicals or herbal supplements. They are not intended to treat, diagnose, mitigate, prevent, or cure diseases.
Dietary supplements are usually oral either in a pill, capsule, tablet, gummies, drink, powder, or liquid tincture. Some are even packaged as an edible energy bar. Most adults in the United States take at least one or more supplements and three in five adults take supplements regularly.
Supplements however are not intended to replace a healthy eating routine. It is important to try to get as many nutrients from the diet as possible but sometimes those with autoimmune syndromes can have trouble meeting all of those needs.
For example, during an autoimmune flare a patient is in a high inflammatory, even a catabolic state. During this flare it may be difficult to achieve all vitamin and mineral requirements through the diet alone. Specific supplements have anti-inflammatory and anti-oxidant activity that may help support lowering pain and swelling during a flare.
Some rheumatology medications such as corticosteroids, methotrexate, and NSAIDs can interfere with mineral and vitamin pathways or absorption, which can lead to deficiencies. If you think a supplement may be beneficial for you, it is important to work closely with your health care team before implementing.
What do I need to be aware of when taking supplements? Are there any associated risks?
Supplements are generally safe, but they can have associated side effects, especially if taking high doses or if taken with concomitant medications. Many supplements can cause allergic rashes, gastrointestinal upset, and some can increase the risk of bleeding. It is important to stop them if you have an upcoming surgery or procedure planned.
It’s important to request your provider check that there are no drug-supplement interactions or no supplement-supplement interactions. This can be done by checking many resources such as the natural medicine comprehensive database’s interaction checker or HerbMedPRo.
For example, turmeric/curcurmin and fish oil may increase the risk of bleeding and interact with a blood thinning medication called warfarin or coumadin. Caution is advised. Antioxidant supplementation may reduce the effect of some cancer chemotherapy.
Too much iron can cause nausea, constipation, damage in the liver, and increases risk of infections. Some supplements may stimulate the immune system too much, such as Echinacea and Astragalus. Others, such as St. John’s Wort can interfere with many medications. Supplements for nursing, pregnant, or growing children are to be used with caution and usually only prescribed under the direct care of a health care provider.
What are common supplements for RA, AS, PsA? Why is each important, what do they do?
There are some common supplements used to help support inflammatory autoimmune conditions such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. There may be potential health benefits to some supplements, but often robust clinical trial data are lacking and more research is needed.
Multivitamin
It may be difficult for someone with a chronic medical condition or someone on a restricted diet such as elimination diet, gluten free diet, or vegan diet to obtain all the nutrients and antioxidants from food sources.
Some RA patients can be deficient in calcium, iron, folic acid, zinc, Vit D, and B vitamins. A good grade multivitamin will also contain plenty of antioxidants such as VIt A, Vit E, Vit C, selenium, lycopene, lutein, and beta-carotene to help combat inflammation and oxidative stress damage caused by autoimmune diseases.
Vitamin D
Vitamin D is naturally produced in our bodies from sunlight or ingested through foods or supplement sources. Many individuals living at north latitudes may not get enough Vitamin D. Vitamin D absorption in the gastrointestinal tract can be lowered from many medications or medical conditions.
Low vitamin D has been associated with numerous autoimmune diseases and is needed for healthy bones. As we age, our body is less effective at making Vitamin D and many medications can interfere with our body’s absorption such as corticosteroids and proton pump inhibitors. A British Medical Journal (BMJ) study showed that taking Vitamin D supplement can reduce the incidence of autoimmune disease by 22%. It is always best to get your vitamin D level tested in the blood and review an optimal supplemental dose with your provider before consuming.
Too much Vitamin D can harm your body and increase calcium levels in blood and tissues. If you supplement with an extra Vitamin D capsule or liquid, it is imperative to check your multivitamin’s total dose of Vitamin D and your other supplements to make sure you are not taking too much and taking a safe total daily dose.
Omega- 3
Omega-3 fatty acids are polyunsaturated fats that are essential to ingest because they cannot be made in the body. Omega-3s, include ALA (alpha-linolenic acid found in plants such as flaxseeds and nuts, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) found in fatty fish.
These fatty acids have anti-inflammatory activities and are the substrates for specialized pro-resolving lipid mediators (SPMs). These mediators play a role in protection against harmful uncontrolled inflammation.
The intake of fish oil or fish can have an impact on the production of proinflammatory cytokines. EPA and DHA also can be ingested as supplements, such as fish oils, cod liver oil, krill oil, salmon oil, and some algal oils.
If you are vegan, an algal oil may be of some benefit as eating nuts and seeds alone may not be enough to increase one’s omega -3- fatty acid total levels. Studies lean toward benefits from ingesting omega- 3s or fish in those with rheumatoid arthritis but longer duration studies are needed. Doses of 2-3 grams per day were most effective. One study even found that fish oil helped achieve remission in rheumatoid arthritis patients taking disease modifying agents and that those medications were safely lowered.
Curcumin (Tumeric)
Curcumin is the active component of the spice turmeric and has anti-inflammatory and anti-oxidant properties. A recent meta-analysis found that curcumin is beneficial for RA and can improve inflammation.
Curcumin blocks inflammation, the same way that cyclooxygenase-2 (COX-2) inhibitor drug celecoxib (Celebrex) blocks. It may help to balance the immune system not only in our systemic system but in the gut too. Curcumin may not be absorbed very well so look for brands with black pepper, phospholipids, or nanoparticles for better absorption and ingest with food.
Probiotics
Probiotics may improve inflammation in several autoimmune conditions, but long term large trials are needed. Poor oral health, gut microbiota imbalances, and Western diets promoting gut dysbiosis may be a contributing factor in many autoimmune conditions such as rheumatoid arthritis.
Improving gastrointestinal health may aid in reducing systemic inflammation. Strains such as Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus rhamnosus or reuteri and Bifidobacterium bifidum may be particularly helpful for rheumatoid arthritis and other inflammatory arthritis.
Magnesium
Magnesium is an important nutrient for health, but many individuals do not get enough in their diet. Nuts, seeds, avocados, bananas and beans are high in magnesium. This mineral may aid in sleep, muscle discomfort, gastrointestinal mobility and immunity. One study showed that lower magnesium levels were associated with an increased prevalence of rheumatoid arthritis. Optimal doses and which type of magnesium to supplement with should be reviewed in detail with your provider.
How do I know if I should take supplements?
If you are suffering from a chronic autoimmune disease, having persistent inflammation, or experiencing side effects from medications, consult with your health care team to see if there is a role for certain supplements. Supplements cannot claim to cure diseases. If you have problems obtaining essential supplements from the diet due to restrictions, malabsorption, or medication effects speak with your health care team as certain supplements may be medically necessary. Review all doses, brands, and interactions with the team. Healthcare teams trained in Integrative, Lifestyle, or Functional medicine are experienced in recommending supplements judiciously to optimize your health.
What are safe sources to purchase supplements from?
Sources to purchase supplements can vary from Amazon to boutique websites. It is important to obtain your supplements from a reputable source where storage, vetting, and shipment are up to standards. Fullscript is an online platform that works with patients and providers to deliver supplements up to best practices.
It is important to understand that supplements are not regulated for effectiveness and safety by the FDA the same way food and pharmaceuticals are. Look that the supplements you are taking have seals and verifications on the label. The NIH has several independent organizations that offer quality testing to ensure the supplements are safe, free of contaminants, and contain the appropriate ingredients.
Look for these seals: NSF, GMP, U.S.P. on the supplement bottle, which means that the product has been essentially vetted. Consumer Lab is an independent organization that tests products for potency, purity, and quality and they recall products. The NIH also has a free Dietary Supplements Fact Sheets that reviews supplement’s ingredients, claims, and warnings. It is always best to review starting a new supplement with your entire health care team.
What should people be cautious of when purchasing supplements, such as filler ingredients, added sugars, etc. ?
Generally, supplements are safe, but there can be concerns over quality, contamination, and adulteration. The Office of Dietary Supplements, a branch of the NIH, has trusted information on what you need to know before consuming supplements.
Always look for a Supplement Facts label on the product. This should include a descriptive name of the product, name of manufacturer, a complete list of ingredients and the amount of each ingredient, directions for use, nutrition labeling, serving size, amount, and active ingredients. Talk with your health care team to find the best source for purchasing supplements.
To learn more about our Rheumission approach to care, please visit the Approach section of our site, or book a 15-minute intro call with one of our providers. The Rheumission Way helps you get back to being you, with more joy and less pain. We will listen to you and co-create a plan that works for where you are now, and where you want to be. We are always here for you.
About the Author
Dr. Beth Biggee is an Integrative Lifestyle Rheumatologist at Rheumission, bridging the gap between traditional and complementary medicine. With over two decades of expertise in Rheumatology, her distinguished career is marked by triple board certifications in Rheumatology, Integrative Medicine, and Lifestyle Medicine. She earned her medical degree from SUNY Upstate Medical Center in Syracuse, NY, and completed her Internal Medicine residency at the Yale New Haven Hospital. Dr. Biggee specialized in Rheumatology through a fellowship at Tufts Medical School in Boston. Her holistic vision of health was further enriched by completing Andrew Weil's renowned Integrative Medicine fellowship at the University of Arizona and by becoming a Certified Lifestyle Physician through the American Board of Lifestyle Medicine.
Beyond her medical training, Dr. Biggee has deepened her expertise in healing modalities such as learning HeartMath, a cutting-edge neurofeedback technique for stress management, and practicing Usui Holy Fire Reiki. She also holds a certification in Auricular Acupuncture from the Helms Medical Institute. Her passion for plant-based therapies led her to enroll in the Herbal Medicine Foundations Program at Medicine Lodge Academy, and she has pursued extensive hands-on training in Ayurvedic medicine for physicians.
Note: This information is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.