Perhaps you have read about the exciting results of still another clinical trial with Pycnogenol and arthritis (1). As the baby boomers age, more and more find themselves hampered by various aches and pains, especially knee pain. This month, I have called upon Frank Schönlau, Ph.D., to discuss this research with us and to get his recommendations for the best help for knee pain.
The idea is to stop the damage and then rebuild the cartilage with the appropriate nutrients, rather than merely take pain medication that allows the damage to continue and does not restore the cartilage, as well as causing undesirable side effects with prolonged use.
I introduced Pycnogenol to our readers in May 1991 in my column “Pycnogenol: Powerful New Antioxidant.” I have had the pleasure of watching the body of scientific literature on Pycnogenol steadily grow through the years to uncover more and more health benefits. As this research has grown, I have felt the need to keep you informed. Along the way, I have discussed Pycnogenol in this column seven additional times and written six books on Pycnogenol (2–7). Pycnogenol research is expanding so rapidly that I couldn’t describe it all in my latest book, Live Better Longer (2). Now, more exciting research has been published on Pycnogenol and the time has come to report it here. I have again called upon Dr. Schönlau to discuss the importance of this research with us. You may remember Dr. Schönlau from his last visit to our column in August 2003 when we chatted about “The Science of Pycnogenol.”
Passwater: Dr. Schönlau, what stimulated your interest in studying Pycnogenol?
Schönlau: My interest in chemistry and eventually biochemistry began in school. I was very interested in the phenonenon of chemical reactions and how chemical substances can readily react with each other to form completely different new substances. It all looked like a miracle. I soon realized that the real miracles were happening in living beings: hundreds of complex biochemical pathways interconnected with each other. I studied chemistry and biochemistry at the University of Münster in Germany. For many years, I did basic research comprising immune responses, cancer, vascular disorders and inflammatory processes.
Coincidentally, I met Dr. Peter Rohdewald at the University and I learned that he was doing research on Pycnogenol. I was excited about the enormous potential of this substance, and Dr. Rohdewald suggested that we join our efforts to conduct research on Pycnogenol. To date, I have published several scientific articles on Pycnogenol research and I am convinced that this unique substance continues to bear fruit.
Passwater: What causes joint pain and who is typically affected by joint pain?
Schönlau: Joint pain typically develops gradually as we grow older. An occasionally painful joint will be taken care of with an acetaminophen tablet and after a while, we find ourselves slowly but surely consuming an ever-increasing amount of them. There are many cases in which sports injuries trigger a lasting problem to the cartilage. For most of us, however, the wear and tear confronts us with damaged joint cartilage at a later time in our lives. According to statistics, overweight people are much more commonly diagnosed with so-called osteoarthritis and, interestingly, women are at higher risk for joint pain than men.
Passwater: A recent study on Pycnogenol refers to osteoarthritis. Isn’t this what we commonly call arthritis of the knee or simply knee pain? Can you explain this condition in terms that a person on the street will understand?
Schönlau: You are absolutely right, this is all about arthritis, and typically this will result in painful knees and, in less common cases, pain in the back or hips. And, it’s not just the pain; mobility in general gets affected with joint stiffness and a grating sensation during movement. It affects interactions with family and friends and the whole community. Some people would rather stay home than take on the burden of moving about.
Passwater: How does Pycnogenol work in regards to inflammation, one of the root causes of arthritis and osteoarthritis?
Schönlau: Pycnogenol acts on the master-switch, which triggers inflammation; it has a rather peculiar scientific name, “Nuclear Factor kappa B” which is written as “NF-kappa B” in scientific discussions. This switch rules over all the dozens of different molecules generated during inflammation, among them the cyclooxygenase (COX) enzymes, which are responsible for the pain.
The NF-kappa B switch is at the core of deciding “go” or “no go” for immune cells to be deployed to take care of suffering tissue such as in the case of harmed cartilage. The immune cells can only contribute to harmed tissue when the cause of the damage is an infection.
Inflammation is a two-edged sword, without which we would succumb to every virus and bacteria. When, however, inflammation occurs in the absence of an infection, it turns against the body’s own tissue, taking it under “friendly fire” and this is what happens in arthritis. Pycnogenol turns down the inflammatory master switch and hence fewer immune cells are deployed to the joints. They are less aggressive, too.
It has been shown in humans that with Pycnogenol, inflammatory cells release fewer enzymes that are harmful to the cartilage and also less of the COX enzymes responsible for the pain. Thus, cartilage experiences much less “friendly fire” from immune cells and has the opportunity to recover and rebuild. This process, of course, takes time and that’s why the pain lowering and improved flexibility with Pycnogenol requires a little patience.
Passwater: Our readers will agree that Pycnogenol’s role in switching down NF-kappa B to reduce the enzymes that cause pain is very important, but they may also wonder if this action of Pycnogenol on NF-kappa B impairs immune defenses in any way.
Schönlau: This inflammatory switch NF-kappa B is not all evil; we depend on it for every kind of infection. Shutting off this switch completely would cause immune-suppression, something we know from people with organ transplants who take such drugs to prevent tissue rejection. In studies carried out with students who took Pycnogenol, the sensitivity of NF-kappa B in their immune cells was decreased by 15%. This may at first thought not sound like an impressive effect, but it does indeed efficiently moderate immune responses. With Pycnogenol, immune cells can better distinguish between a desirable inflammation such as when we catch flu and a superfluous inflammation such as in the case of arthritis.
Passwater: Please explain the progression of past and present research that led to the discovery that Pycnogenol is a viable natural option for joint health.
Schönlau: During past years, several investigations have been carried out with healthy people to understand Pycnogenol’s effects on the immune system. This research has pointed to considerable anti-inflammatory potency of Pycnogenol and this sparked the interest for potential benefits in joint health. It was then decided to carry out a first pilot trial to see if Pycnogenol does really have an effect on arthritis.
Dr. Ronald Watson at the University of Arizona in Tucson then showed for the first time that Pycnogenol really does work and he already pointed out that his patients required significantly less painkillers for their joint pain. Dr. Watson’s findings encouraged us to carry out two much larger studies on Pycnogenol for joint health. Only recently, another study showed that Pycnogenol lowers the inflammatory marker CRP in patients with arthritis (8). This finding serves as direct evidence for Pycnogenol decreasing inflammation in the body.
Schönlau: The more severe the joint pain gets, the more people depend on powerful pain killers. The most potent medications were the COX-2 specific inhibitors, which, unfortunately, cannot be taken continuously because of serious cardiovascular side-effect risks. Pycnogenol is not meant to replace a painkiller and it doesn’t work in the same way as they do. With painkillers, you may expect significant pain alleviation within 30–60 minutes. But beyond the pain reduction, the analgesic medication does nothing to improve your joints. On the contrary, the disrupted pain sensation may cause people to further over-use the joints and this leads to an ever-increasing reliance on pain medication.
Passwater: Excuse me for interrupting you, but there are often undesired side effects from long-term medication with acetaminophen (e.g., decreased levels of the master antioxidant glutathione) and aspirin (e.g., internal bleeding). Being able to wean off medication and take a healthy nutrient instead has double benefit.
Schönlau: Pycnogenol may take weeks to set in with noticeable pain relief, however, here the pain relief results from a better joint cartilage condition. Pycnogenol aims at the inflammatory processes prevailing in the joint and calms down the immune cells, stopping them from taking the cartilage under “friendly fire.” This is the prerequisite for having the cartilage recover and this process takes time. The three clinical trials done with Pycnogenol so far all show that patients gradually require fewer painkillers to live with their arthritic joints. The most recent study actually showed that patients then also experienced much less stomach problems, a result of years of chronic painkiller usage.
Passwater: Dr. Schönlau, we have been talking about knee pain that mostly results from wear and tear on cartilage. But, other joint pain can result from minor muscle tears (rather than cartilage) due to sports injuries or just everyday activities (such as working around the house or yard). These minor muscle tears (not requiring surgery) take a long time to heal and are painful. They also involve inflammation. Would Pycnogenol be of help to this type of inflammation?
Schönlau: This is indeed a very interesting thought you bring up. We have found in a previous study that Pycnogenol can lower the frequency of muscle cramps and pain during sports and also afterwards during recovery periods. This benefit has been in part attributed to the anti-inflammatory activity of Pycnogenol. There hasn’t been a clinical investigation. Personally, I’m curious if Pycnogenol can also speed-up the recovery of tendons burdened by competitive sports.
Passwater: Personally, how long have you studied and been working with the extract?
Schönlau: I have now been involved in the research on Pycnogenol for almost 10 years and I get more and more excited about it with every year I spend on it. This extract from a French maritime pine tree is surely the most versatile food supplement I have ever come across. There’s hardly anything else available that has been investigated in so many clinical tests with now more than 7,000 patients in total. The benefits we found with Pycnogenol for joints can be translated to other painful problems such as women’s menstrual periods. We have shown that Pycnogenol is very helpful for soothing the pain women experience during their period. And likewise, women were found to require fewer painkillers when they supplement with Pycnogenol. The anti-inflammatory activity of Pycnogenol is amazing!
Schönlau: The vast majority of supplements for joint health on the market deliver building blocks for allowing faster recovery of the cartilage. Think of glucosamine and chondroitin and similar substances that have been shown to gradually improve cartilage over periods of half a year or longer. These ingredients are very supportive, however, the situation is a bit like you are trying to rebuild your house while it is still on fire. In fact, from our current knowledge, it would be good to take Pycnogenol for a while and then take supplements such as glucosamine in addition to further aid the recovery of the cartilage.
Passwater: What is the recommended amount of Pycnogenol and what types of formula options are available today?
Schönlau: In the most recent and largest study on arthritis, patients took 50 mg Pycnogenol twice a day, once in the morning after breakfast and during the evening after dinner. Pycnogenol is available in capsules and tablets in various dosage forms, which allows people to choose a product for their individual needs.
Passwater: How long can Pycnogenol be safely taken?
Schönlau: Pycnogenol is a very safe substance. For this reason, it has been awarded GRAS status, which indicates that it safe for consumption as a component from fortified foods for indefinite periods of time. Safety tests have shown that there are no unfavorable long-terms effects of Pycnogenol. Possible side effects can be reported on www.pycnogenol.com and to date, no serious side effects have been reported.
Passwater: How do you see the joint health application growing for Pycnogenol in the future?
Schönlau: Personally, I am convinced that in the future, we will see products in which Pycnogenol will be combined with cartilage “building blocks” such as glucosamine. Such a combination would make a lot of sense as explained before. People will always resort to painkillers when their joints just hurt too much. Supplementation with Pycnogenol and nutrients that help rebuild the cartilage should aim at the recovery of arthritic joints. Only this will truly improve people’s quality of life. WF
1. P. Cisar et al., “Effect of Pine Bark Extract (Pycnogenol®) on Symptoms of Knee Osteoarthritis,” Phytother. Res. 22 (8), 1087–1092 (2008).
2. R.A. Passwater, “Live Better Longer: The Science Behind the Amazing Health Benefits of OPC,” (Basic Health Publications, Laguna Beach, CA, 2008).
3. R.A. Passwater, User’s Guide to Pycnogenol: Nature’s Most Versatile Supplement (Basic Health Publications, Laguna Beach, CA, 2005).
4. R.A. Passwater, Pycnogenol for Superior Health (McCleery & Sons, Fargo, ND, 2001).
5. R.A. Passwater, All About Pycnogenol (Avery, New York, NY, 1998).
6. R.A. Passwater, Pycnogenol: The Super “Protector” Nutrient (Keats, New Canaan, CT, 1994).
7. R.A. Passwater, The New Superantioxidant—Plus (Keats, New Canaan, CT, 1992).
8. G. Belcaro, et al., “Variations in C-Reactive Protein, Plasma Free Radicals and Fibrinogen Values in Patients with Osteoarthritis Treat with Pycnogenol” Redox Report (2008).
Dr. Richard Passwater is the author of more than 40 books and 500 articles on nutrition. He is the director of research and development for Solgar Vitamin and Herb, Inc. Dr. Passwater has been WholeFoods Magazine’s science editor and author of this column since 1985. More information is available on his Web site, www.drpasswater.com.
Published in WholeFoods Magazine, November 2008