Herbal COX-2 Inhibitors: A Natural Alternative

n Sept. 30, 2004, the pharmaceutical giant Merck & Co. Inc. announced a voluntary worldwide withdrawal of VIOXX (rofecoxib), its arthritis and acute pain COX-2 inhibiting medication. The company’s decision was based on data from a new, three-year prospective, randomized, placebo-controlled clinical trial, which showed that after 18 months of use, VIOXX increased relative risk for confirmed cardiovascular events, such as heart attack and stroke. Almost immediately commentary began about the potential for natural COX-2 inhibitors to fill the VIOXX void. Undoubtedly, you’ve had customers asking about this issue. But do natural COX-2 inhibitors really offer a viable alternative to VIOXX? It is our position that they do. To understand why this might be so, it’s important to understand the role of the COX-2 enzyme. There are two cyclo-oxygenase (COX) enzymes at work in the body, COX-1 and COX-2. The COX-1 enzyme is expressed in most tissues, and is necessary for a variety of important internal housekeeping functions, such as protecting the stomach lining, maintaining renovascular function and platelet aggregation. The COX-2 enzyme is necessary for inflammation, a normal, healthy attempt by the body to heal itself. However, when inflammation gets out of control (such as in the case of arthritis, or other chronic inflammatory disorders) ongoing pain and discomfort is the result. That’s where botanical COX-2 inhibitors can help. Botanical COX-2 inhibitors block the action of the COX-2 enzyme, which helps reduce inflammation and pain. Turmeric, ginger, boswellia, hops and salicin all have demonstrated anti-inflammatory properties through their role as botanical COX-2 inhibitors. Bromelain also has antiinflammatory activity, but not as a COX-2 inhibitor. A reduction of inflammation also results in a reduction of pain. White willow bark and meadowsweet are sources of salicin, which has analgesic (pain-relieving) properties as well as antiinflammatory properties. Turmeric is a bright yellow, ancient spice and a traditional remedy that has been used as a medicine, condiment and flavoring based on records dating back to 600 B.C. Its medicinal value is essentially due to its curcuminoid content. The curcuminoids inhibit 5-lipooxygenase (LOX) and COX, resulting in a well-established antiinflammatory action. Treatment with curcuminoids was found to be as effective as cortisone or phenylbutazone in instances of acute inflammation, and about half as effective as these drugs for chronic inflammation. In research on people with rheumatoid arthritis, curcuminoids were found to be useful for reducing inflammation, pain and stiffness. In a double blind study, curcuminoids were found to be superior to a placebo or the non-steroidal anti-inflammatory drug phenylbutazone for alleviating postsurgical inflammation. Bromelain is a proteolytic enzyme found in pineapples that breaks down protein into smaller peptides and amino acids. Beyond its protein digesting capacity, research has shown bromelain has anti-inflammatory activity. At least four studies using O