Can I still take vitamin supplements while on methotrexate?
Q) I take plaquenil and methotrexate for my rheumatoid arthritis, and folic acid. My rheumatology clinic has suggested not taking vitamin supplements as it's not known if they'll react with methotrexate and stop it working. What do you think about supplements and methotrexate?
Joyce, York - 2010
A) I presume your clinic was unsure which supplemental vitamins you were taking. From a prescriber’s point of view that's the nightmare – the patient taking a drug or drugs which they have bought themselves and which may interact or counteract with a drug that has been prescribed for their condition. I use the word ‘drug’ loosely, as many food supplements and vitamins can interact with prescribed medication. An example is grapefruit juice and ciclosporin – the one counteracts the other. In the case of methotrexate the concern would largely be folic and folinic acids, which act against the methotrexate. Folic acid is usually prescribed, in small doses, along with methotrexate so that it can minimise the side-effects of the drug. Large doses, particularly taken on the same day as methotrexate, would stop the drug working. Some foods also contain folic acid, particularly green vegetables such as broccoli, Brussels sprouts, asparagus and peas, as well as chickpeas and brown rice.
This answer was provided by Dr Philip Helliwell in 2010, and was correct at the time of publication..
Is there any evidence to support the claims that cider vinegar helps with arthritis conditions?
Q) I'd be interested to know your opinion on the various claims made about the benefits of taking cider vinegar for the relief – and even prevention – of arthritic conditions.
J N, Bognor Regis - 2006
A) This is an interesting question. Some years ago I did a survey of all the books claiming dietary help for arthritis. I bought about 20 books and tried to find a common theme. Cider vinegar and honey was a central theme to Margaret Hills’s Curing Arthritis the Drug-Free Way and appeared in several other books. As far as I can see it was an old New England remedy, unusually adopted ‘in reverse’ by us. There are no controlled trials to support the use of cider vinegar and the reasons for recommending it aren't based on scientific grounds. It is, however, unlikely to do you any harm. By all means try the diet, but remember to maintain a sense of balance and don’t stop your arthritis drugs.
This answer was provided by Dr Philip Helliwell in 2006, and was correct at the time of publication.
How effective is vitamin B5 for osteoarthritis?
Q) My partner and I both find vitamin B5 (pantothenic acid) extremely effective in dealing with the symptoms of osteoarthritis and are puzzled that its use for this isn't more widely known. I understand a Dr Barton-White did research into this back in the 1960s. I wonder why this wasn't followed up. Can you shed any light on this?
Peter, Guildford - 2005
A) Pantothenic acid is available in a variety of foods. Rich sources of pantothenic acid include liver and kidney, yeast, egg yolk, broccoli and whole grains. Fish, shellfish, chicken, milk, yogurt, legumes, mushrooms, avocado and sweet potatoes are also good sources. Deficiency of this vitamin is virtually unknown because it occurs in so many foods. As you state, there were a number of studies in the early 1960s but nothing has been published since. I've as yet been unable to review the early studies so can’t pass on my comments to you but, in the absence of a clear therapeutic reason, you're unlikely to need supplements of this vitamin.
This answer was provided by Dr Philip Helliwell in 2005, and was correct at the time of publication.
If I take vitamins and minerals to ‘boost my immune system’ is this conflicting with the immunosuppressant?
Q) I’m on strong immunosuppressant drugs. If I take vitamins and minerals to ‘boost my immune system’ is this conflicting with the immunosuppressant? In other words, am I back to square one? If you could clarify this I’d be very grateful.
Mary, Hythe - 2012
A) A very good question. The simple answer is that there is no evidence that standard vitamin and mineral therapy does stimulate the immune system but it sounds good! Recently, there has been a lot of interest in vitamin D. Vitamin D is essential for healthy bones. It is called the ‘sunshine’ vitamin because it is made in the skin (but only when exposed to the sun). Unfortunately we don’t have a lot of sun in winter (especially in Yorkshire) and advice to cover up to prevent skin cancer has reduced vitamin D production even in the summer months. So, vitamin D supplements or a diet rich in vitamin D (oily fish) is recommended. Vitamin D may also have a role in our immune systems but it is not a question of ‘boosting’, rather a question of helping everything work normally. So, in short, I doubt you are causing a conflict by taking extra vitamins and minerals along with your immunosuppressants.
This answer was provided by Dr Philip Helliwell in 2012, and was correct at the time of publication.
Is taking flaxseed/linseed oil the same as taking omega-3 fish oil?
Q) I have rheumatoid arthritis. In your Q&A correspondence, the benefit of omega-3 from fish oil is mentioned. Can the same benefit be gained from flaxseed/linseed oil as a vegetarian alternative, which is claimed to contain omega-3, omega-6 and omega-9, together with palmitic acid and stearic acid? Also, can the immuno-suppressive effect of 10 mg methotrexate daily, together with other drugs, taken for some years, be a reason why my colds this year have dragged on over weeks into months?
Keith, via email - 2013
A) For your first question, the crucial factor is the amount of omega-3 and omega-6 oil in the alternative dietary supplements. I have heard that flaxseed and linseed oil are acceptable alternatives to fish oil but you will have to compare the amounts of the constituents in order to make sure that you are getting the same amount. For your second question, although the weekly dose of methotrexate you take is small, patients taking this medication often say that they seem to suffer more colds and flu, and that they take longer to go away. On another note, if you are taking methotrexate it is recommended that you have an annual flu jab, and a jab for pneumonia every 10 years. You should be able to get these from your GP.
This answer was provided by Dr Philip Helliwell in 2013, and was correct at the time of publication.
Should I take Cal-in for added vitamin D for osteoporosis?
Q) I would be grateful if you could give your view on taking Cal-in daily for added vitamin D. I have severe osteoporosis, and am at present taking Calci-chew-D3 Forte, otherwise I am having a ‘drugs holiday’. I have had many fractures.
J C, Hoddesden - 2014
A) Cal-in is just another way of supplementing your diet with calcium and vitamin D. There is no reason to believe that it is any better at providing these than those sources available on prescription, such as Calcichew D3 forte, but it may be more palatable! In osteoporosis, while it is important to take these supplements, it is also important to take something to ‘strengthen’ your bones, especially if you have had several fractures. I presume you are having a ‘holiday’ from bisphosphonates, as continuous long-term use with these drugs is now not recommended and their use should be re-considered after 5-10 years.
This answer was provided by Dr Philip Helliwell in 2014, and was correct at the time of publication.
Can you take green lipped mussel supplements if you have a seafood allergy?
Q) Can you take green-lipped mussel supplements if you have a seafood allergy?
Sid - 2016
A) I think it’s safer to avoid green-lipped mussel supplements with a seafood allergy. It’s hard to give specific advice for this question as there are different types and severity of allergy and many different types of fish.
A further complication is that supplements may be made in a factory where different types of seafood are being handled so even if you know the specific trigger for your allergy, there's the risk of cross-contamination with other seafood that may cause an allergic reaction.
Allergy UK has very helpful information on seafood allergy.
This answer was provided by Dr Tom Margham in 2016, and was correct at the time of publication.
What is the evidence of using bee venom injections for arthritis pain?
Q) My 37-year-old-daughter has had juvenile idiopathic arthritis (JIA) since she was two. We tried all avenues to help her, including some visits to a homeopath when she was 17–18. The homeopath decided on a course of bee venom injections.
The results were absolutely amazing. Almost overnight she went from being unable to walk short distances without pain to being 'normal' and walking quite a long way.
But the effects seemed short-lived. A combination of leaving for university and one very unpleasant injection, coupled with the miracle wearing off, meant that the injections were no longer pursued.
My daughter now regularly injects herself with an anti-TNF product, which concerns me. Recently she suffered a very nasty streptococcal infection. I’d be very interested to hear of any further developments with bee venom trials.
Glynis, via email - 2015
A) Bee venom therapy has been around for thousands of years. Reference to the treatment can be found in ancient Egypt and Greek medical writings. Also known as apitherapy, the technique is more widely used in Eastern Europe, Asia and South America.
A number of animal studies have shown that bee venom has significant anti-inflammatory and analgesic effects. High-quality trials in humans are needed to define any future role of bee venom for arthritis but I'm not aware of any that are being undertaken.
This answer was provided by Dr Tom Margham in 2015, and was correct at the time of publication.