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Herbs and Supplements

People living with ankylosing spondylitis (AS) may incorporate herbs and supplements into their diet in an effort to ease the symptoms of AS and boost their overall health. Sometimes referred to as natural remedies, these may come in the form of vitamins, minerals, or herbs. While most herbs and other supplements are generally safe when taken as directed, some can interfere with medications, causing medications to not be as effective or causing worsening side effects. Sometimes herbs and supplements can have side effects including liver or kidney damage. It’s important to talk to your doctor about all herbs, vitamins, and other supplements you are taking.

While the U.S. Food and Drug Administration (FDA) oversees supplements, they do not require the rigorous testing and research-based evidence for supplements as they do for pharmaceutical products. Because the manufacturing companies are responsible for ensuring safety and because the proof of benefit is not required, there is far less evidence on how well these products work. In addition, the quality of the products can vary substantially from one manufacturer to another. It’s best to work with a healthcare provider who has a knowledge of nutritional supplements and who knows all the treatments and medications you are taking.

Omega 3 fatty acids/Fish oil

Fish oil, as the name implies, comes from fish. It contains omega-3 fatty acids, which have been used for centuries for a variety of muscular and skeletal diseases. Research on omega 3 fatty acids has shown that they can have anti-inflammatory effects, and fish and fish oil supplements are recommended by the American Heart Association for their effect on reducing heart disease. While generally safe, fish oil supplements can cause fatty stools or belching if not taken with a meal, and they should not be used by people who take anticoagulant medications because of the increased risk of bleeding.1

Calcium and vitamin D

People with AS have an increased risk of osteoporosis, a condition in which the bones are weakened and more likely to fracture. Adequate intake of calcium and vitamin D are important to bone health and play a role in the prevention and treatment of osteoporosis. These supplements are usually recommended and taken together because vitamin D helps the bones absorb calcium.3

White willow bark

White willow bark contains salicin, a compound similar to aspirin. White willow bark has been used historically for pain and inflammation. Research studies comparing white willow bark to aspirin have demonstrated a comparable efficacy between the two products. White willow bark should not be used in children or in people with peptic ulcer disease, poorly controlled diabetes, or liver or kidney disorders.1

Curcumin/Turmeric

Turmeric is a plant that is related to the ginger plant. Curcumin is the naturally occurring yellow pigment that comes from turmeric. In addition to its use as a spice in Indian cooking, curcumin is used in Ayurvedic and Chinese medicine as an anti-inflammatory, as well as to treat digestive disorders and enhance wound healing. Research has demonstrated the anti-inflammatory effects of curcumin. Caution should be used in people taking certain medications, such as anticoagulants or high doses of nonsteroidal medications.1

Boswellia

Boswellia is a tree that grows in India, Ethiopia, Somalia, and the Arabian Peninsula. The resin from the Boswellia tree is better known as frankincense. Boswellia has anti-inflammatory, anti-arthritic, and analgesic (pain relieving) properties. While most people can tolerate Boswellia, it may cause stomach discomfort, including nausea, acid reflux, or diarrhea, in some people.1

Folic acid

Folic acid is a B vitamin that is important in the formation of healthy cells in the body.4 Research has found that when folic acid is taken with methotrexate, a medication which may be used to treat AS, patients have fewer side effects and are able to take the medication for longer periods of time.5

Written by: Emily Downward | Last reviewed: February 2019
  1. Maroon JC, Bost JW, Maroon A. Natural anti-inflammatory agents for pain relief. Surg Neurol Int. 2010;1:80. Published 2010 Dec 13. doi:10.4103/2152-7806.73804
  2. Omega-3 fats: good for your heart. MedlinePlus, U.S. National Library of Medicine. Available at https://medlineplus.gov/ency/patientinstructions/000767.htm. Accessed 2/19/19.
  3. Hinze AM, Louie GH. Osteoporosis Management in Ankylosing Spondylitis. Curr Treatm Opt Rheumatol. 2016;2(4):271-282
  4. Folic acid. MedlinePlus, U.S. National Library of Medicine. Available at https://medlineplus.gov/folicacid.html. Accessed 2/19/19.
  5. Medication and diet. Spondylitis Association of America. Available at https://www.spondylitis.org/About-Spondylitis/Treatment-Information/Diet-Nutrition/Medication-Diet. Accessed 2/19/19.