NMU 299 – White Willow Extract Effective in Arthritis: 2022 Update

Nutrition/Natural Medicine Update No 299 (August 15, 2023)

with Dr. James Meschino

Topic: White Willow Extract Effective in Arthritis: 2022 Update

Source: Drugs.com (2022)

The original Aspirin or salicylic acid (salicin) was first discovered in the herbal product known as white willow bark extract (white willow extract). Once it was identified scientists manipulated this compound to form acetylsalicylic acid (ASA), which we know today as the synthetic drug, aspirin (ASA). But the original medicinal constituent in white willow extract (salicin) was used over many centuries to treat pain and inflammation in many civilizations, and some recent studies show that it is quite effective in treating various joint inflammatory conditions as well as painful menstrual cramps (dysmenorrhea). And unlike ASA and other synthetic anti-inflammatory drugs, it does not cause stomach irritation, intestinal bleeding or significantly inhibit blood clotting. Therefore, it has fewer, if any, side effects.

Many people are looking for an alternative to ASA and other non—steroidal anti-inflammatory drugs because of their damaging side effects on the stomach, intestinal tract, risk of bleeding disorders, liver, and kidney damage, as well as their documented effects on promoting high blood pressure and congestive heart failure. In 2022, Drugs.com provided an update on all relevant research related to white willow extract. They state that the medicinal use of willow dates back 6,000 years. Ancient civilizations used willow tree extracts to treat pain, inflammation, and musculoskeletal conditions.  Although salicin is considered the major active constituent, there is research showing anti-cancer activity of the polyphenols and flavonoids, which are also found in white willow bark extract products. Regarding its anti-arthritic properties salicin, from white willow extract, inhibits inflammation by blocking a key enzyme involved in the inflammatory process (COX-2 enzymes, which convert arachidonic acid into inflammation-promoting PG-2).  In white blood cells it also blocks the release and activity of inflammation-promoting cytokines (tumor necrosis factor [TNF]), COX-2 enzymes, and mediators (nuclear factor kappa B), which is great importance in the management of many autoimmune conditions that affect the joints (i.e., Rheumatoid Arthritis)

Experimental cancer studies have shown that salcin inhibits the growth of various human-derived cancer cells in a dose-dependent manner – meaning the higher the dosage of salicin the great the cancer growth inhibition effect. But, regarding arthritis specifically, animal models show that white willow extract slowed the development of osteoarthritis by reducing the release of important inflammatory cytokines (TNF-alpha, IL-1 beta, IL-6) and nitric oxide. Several human clinical trials involving osteoarthritis patients has shown that white willow extract is effective in reducing pain and inflammation when tested against standard anti-inflammatory drugs (i.e., diclofenac). Not only did the arthritic patients realize the same pain relief as the group receiving standard anti-inflammatory drugs, but the white willow extract group reported fewer side effects (i.e., stomach irritation and intestinal pain). A 2013 study looked at the effectiveness of white willow extract in rheumatoid arthritis and showed reductions in mean pain intensity within the first 3 week of treatment, according to both patient and physician ratings. The pain reduction remained in effect at the 6-month mark, with a 45.6% reduction in pain intensity compared to the original baseline measurement. The researchers noted that during the 6-month treatment course the white willow extract supplement was well-tolerated, and no adverse effects were reported in this study of 436 patients suffering from rheumatoid arthritis.  Another double-blind study showed that white willow extract was more effective in treating dysmenorrhea (menstrual cramps) than a commonly prescribed non-steroidal anti-inflammatory medication (mesfenamic). Women taking the white willow extract experienced less abdominal and pelvic pain and less pain intensity overall, compared to the mesfenamic drug group. Other studies in patients who had chronic low back pain flare-ups showed that treatment with white willow extract was effective in reducing pain, inflammation, and shortened the length of the flare-up episode.

Regarding dosage, clinical studies evaluating the painkilling (analgesic) effects of white willow (e.g., for lower back pain, dysmenorrhea) used white willow extract supplements providing 120 to 240 mg per capsule (standardized to 15% salacin content). Patients typically take 1-3 times capsules daily.  Peak blood levels of salicin typically occur about 2-hours after oral administration. As white willow extract has little or no effect on platelet clotting and does not irritate or erode the stomach or gut lining, it is considered to be safer to take than aspirin, ibuprofen, diclofenac (Voltaren), indomethacin, celebrix etc. However, there are some precautionary measures to heed just to be on the safe side, and they are as follows:

• Do not take white willow extract if you are using the drug warfarin or coumadin.
• Do not take white willow extract if you are allergic to aspirin.
• Do not take white willow extract if you have severe asthma, a history of peptic ulcers, gout, hemophilia or a bleeding disorder of any kind.
• Children under 16 should not take white willow extract to guard against developing Reye’s syndrome, just like in the case of aspirin.
• Do not take white willow extract during pregnancy and lactation.

In patients with joint inflammatory problems (OA, RA, etc.) I prefer for them to take a natural anti-inflammatory supplement that combines the synergistic activity of four effective natural-anti-inflammatory compounds. Namely, White Willow Extract, Curcumin, Ginger and Boswellia. These four natural compounds work synergistically to help suppress the inflammatory reactions that give rise to much of the pain seen in various arthritic conditions and joint inflammatory problems.

I have included the reference for white willow extract from the drugs.com update in the text below.

Reference:
https://www.drugs.com/npp/willow-bark.html

Eat Smart, Live Well, Look Great,
Dr. Meschino