Monday, January 12, 2009

Recommended Arthritis Cure #3,275 - Montmorency Cherries

Another day, another natural arthritis cure recommendation.

Another extremely helpful and well-meaning person offering me a haven from my gammy hips (which are pretty good at the moment, thanks for asking). The conversations follow a similar pattern - a recommendation from them, a cursory googling by me, a you-should-really-take-it follow up from them, a there's-no-evidence reply from me, and the obligatory blog post.

In the past, I've dealt with silicon gels, glucosamine, condroitin, rosehips and cod liver oil, and blogged them for posterity. When real medicine can't deliver, there are plenty of 'natural medicine' and quackery companies ready to pounce in with stories of cure and relief from these stubborn diseases.

So, how do you go about finding out if cherries are the wonderfruit we are being lead to believe it is? It's actually quite tough - googling "cherries, arthritis" brings up reams and reams of companies either promoting cherries as an arthritis cure, or publishing press releases on behalf of these companies - no balance, no evidence, no proof, no journalism, just unequivocal breathless fawning.

So I made a few assumptions - the most well-promoted cherry seller will probably have somewhere on their website the strongest possible claims backed up by the strongest possible evidence that cherries can cure arthritis. (Actually, thanks to the work of the MHRA, no self-respecting company would claim a cure, the strongest they can get away with is "alleviation of the pain of arthritis" or similar - this turns the potion from a cure into a painkiller at best). Given that they want to sell me their cherry produce, no doubt they will have done the hard work for me and compiled all the different studies from all over the world to convince me of it's efficacy and encourage me to buy.

Let me introduce to you CherryActive. I should say, that CherryActive aren't touting an arthritis pill per se, their magical cherries will help a whole range of ailments and in various situations, such as:

Healthy Joints
Healthy Muscles
Regular Sleep
Healthy Heart
Lower Cholesterol
Improved Recovery from sport
Anti-Ageing
Frequent Flying
Healthy Children
Brain Health


What a panacea. However, I'll stick to the arthritis section. My cherry advocate kindly sent me "The Montmorency Cherry Nutrition Report", commissioned by the Cherry Marketing Institute (CMI), an organization funded by North American tart cherry growers and processors. A cynic might question the independence of such a brochure, but at least we can be sure it will be thorough, if perhaps over-egged.

(There is good reason to believe it may be over-egged, as the FDA last year announced a permanent injunction against some cherry-sellers for putting medicinal claims on their packaging that were not based in fact. In 2005, the FDA sent a warning letter to a list of cherry manufacturers warning them that their dubious claims could land them with a hefty fine. These are the same cherry growers and processors who fund the CMI).

Straight to page 5, for the heading "Arthritis & Gout".

[First of all, it's important to distinguish between arthritis and gout. Gout is the deposition of uric acid crystals on the cartilage of joints and tendons, which causes inflammation and pain. These crystals can continue to form Tophi, which can go on to cause "gouty arthritis". Arthritis is one of those catch-all words, which means 'joint inflammation' and covers a multitude of different conditions. Gout, however, although an inflammatory disease, is very different from rheumatoid or osteoarthritis.]

Gout seems to have some research in its favour - a paper in the Journal of American Nutrition (Jacob, 2003) indicates that a good dose of cherries of a day can lower the plasma urate level and may give credence to its anti-gout legend. The 10 candidates had to eat 45 cherries in 10 minutes after a overnight fast. The significant (p<0.05) decrease in plasma urate (╬╝mol/l) went from 214±13 to 183±15 - this was compared with other fruit, however strawberries gave a reduction, and given the wonder-components associated with cherries are supposed to be the anthrocyanidins which give them their red colour, it's surprising they didn't compare more red fruit. In any case, they used sweet Bing cherries, not tart Montmorency cherries, and a study with 10 people and huge error bars doesn't carry much weight, but nonetheless, it's a maybe, for mild gout.

So what about arthritis, either osteo or rheumatoid? The brochure gives two papers that "suggest that consumption of cherries may be beneficial for the management and prevention of inflammatory diseases". (We all enjoy woolly modifying words like 'suggest' and 'may'). The first, van Acker (1995) is a research communication connecting flavenoids (such as anthrocyanidins) as scavengers of Nitric Oxide radical, however this molecule is ubiquitous in the body and very beneficial - it helps gentleman stand to attention when required. It has nothing to do with cherries and nothing directly to do with arthritis - to put this research in the category of "Cherries help with Arthritis" is really cloud cuckooland and another example of the nonsense surrounding 'antioxidants'.

The second is by Kelley et al, published in 2006 in Journal of Nutrition. It was a follow on from the Jacobs study above involving more people (18) and again involved the consumption of a daily amount of 45 sweet Bing cherries (not a pill nor a syrup but the cherries themselves). This study was longer term, looking at some inflammation markers after 0, 7, 14 and 28 days and 28 days after the discontinuation of the study. There was also a reading taken 8 days before the study began. The study found that C-Reactive protein, a protein found in the blood as a response to inflammation, decreased during the intervention period with the cherries. The researchers admit that it was a small study, with no placebo and that the difference seen could have been something other than the cherries, but it still warrants more research:
These should be confirmed in studies with larger number of subjects and also in subjects with preexisting inflammatory conditions such as CVD, arthritis, smokers, and older subjects.

There is a third paper (Tall 2004), but it involves heating rat's paws and measuring the inflammation - to be honest I want to know if a human with arthritis will benefit from eating cherries; this paper talks about anthrocyanins (present in many different fruit) in treating inflammatory pain in rats. Those two statements are very, very far apart.

And there you have it. That is the weighty mass of evidence that the Cherry Marketing Institute has helped fund, and my goodness it is unimpressive - to the point where I'm annoyed I won't get the three hours back again it has taken me to research it all.

To recap, a company called CherryActive, which sells Montmorency cherry cordial & pills has presented as the strongest evidence it has on arthritis the following:

1. A paper on a surrogate endpoint for gout using sweet Bing Cherries based on 10 people.
2. A paper based on 18 people eating sweet Bing cherries looking at general inflammation markers
3. A paper on rats with no cherries but anthrocyanins, present in loads of fruit.

You can see for yourself that the evidence is weak to non-existent. Of course, that doesn't mean the evidence won't be there in the future, the point is they don't need it. They have people willing to be duped in to believing it works (placebo-effect alone), with the press as their willing conduits - it seems churlish not to put yet another fawning, uncritical Daily Mail link in time-honoured fashion, so here it is, from Sept 2008. Cut&paste-tastic.

You may be amazed, given my incredible tabloid headline writing skill that I didn't stoop to use a gag on 'cherry-picking the evidence'. That's because CherryActive have caught the eye of other dietary-minded bloggers such as HolfordWatch, who used it with conviction. An nutri-nonsense product that has Patrick Holford and Food for the Brain endorsing it, is almost guaranteed to be pimping pills to a gullible public in Holford's happy evidence-bending way.

It turns out they can't do maths either - have a look at the nutritional information on CherryActive's website. Show me someone who can put 21g of natural sugars (81 kCal) into 10kCal, and I'll show you someone who has done their sums wrong. Let's hope not too many dieters or diabetics rely on those numbers.

EDIT: May09: CherryActive, having been made aware of their mistake, have amended it to read 110 kcal, not 10.

Perhaps I should tell the CMI to go back and try again, give them another bite of the cherry, if you will.

BPSDB

Thanks to Chris Preston & Gadgeezer from Bad Science for their help.

26 comments:

  1. Good to read the follow-up on your cherry-thoughts. I found this to be a very interesting observation:
    "googling "cherries, arthritis" brings up reams and reams of companies either promoting cherries as an arthritis cure, or publishing press releases on behalf of these companies - no balance, no evidence, no proof, no journalism, just unequivocal breathless fawning."

    Whoever thought the internet would end up full of fluff pieces and rubbish to the point where it drowns out the actual, sensible, critical commentary on this stuff? And that it would so starkly show up the lack of adequate journalism on this topic (never mind decent).

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  2. Ho hum.

    So at the end of all that, we're back to

    "Eat fresh fruit and veg - it's good for you and it might just possibly benefit arthritis.. though there's no evidence, really... err...".

    Remarkable.

    Mrs Dr Aust sometimes jokes about people she sees who attribute their arthritis and the consequent pain to "workplace stress", rather than to the extra 20 kg in weight they are carrying.

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  3. Your parenting skills and your ability to parent may have been tested if you live with arthritis pain. Physical limitations can interfere with your energy level and ability to share certain activities with your kids, for example. Not only that -- your patience, ability to discipline, and ability to cope with issues such as sibling conflict may be shortchanged.

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  4. This was a real eye opener. Thanks because this takes the field of rheumatology into an altogether different level. In a country like India, many with joint pain go for alternative medicine , some even go to quacks who offer steroids mixed with some pain killers. the actual differential diagnosis doesnt seem to bother even many of the general practitioners of Allopathy who prescribe some painkillers and placebos for symptomatic relief. This revelation makes it all the more important that we practitioners of allopathy medicine investigate the patient thoroughly and classify them accordingly . this will help identify those who can benefit from lifestyle modification.
    Thanks for this important bit of information. I will make sure I spread this as far and wide as I can.

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  5. I have to say, though, that eating cherries (just two days)has made it possible for me to sleep without taking tylenol and ibuprofen for the first time in months. My knees have felt much better during the day, as well. Not scientific, but I guess I'll keep the little red globes on my menu for as long as it works!

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  6. I had arthritis joint pain in my knees and someone recommended cherries. I exercise a lot. I was in pain for 6 months at a time. Then about 6 months with no exercise. Then 6 months of pain. The cherries took 2 weeks to work but all the pain in my knees went a way. I still eat a hnadful of dried cherries every day. The arhtritis has never come back.

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  7. Very glad to hear it Kent!

    May or may not have been the cherries - the data from lots of people when tempered for biases suggests that these type of interventions don't work. You have put it down to the cherries, but essentially that's non-conclusive and anecdotal.

    Good that you're pain free though, whatever caused it!

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  8. Wow Dr. T,
    Do you work for the pharmaceutical companies? I read in a mens health article that cherries area natural inflammatory and tried them for myself. I have found that a handful of dried cherries will give almost immediate relief ( not total) from muscle tightness. I do not have arthritis however, it is reasonable that it would relive these symptoms as well. As far as I know there is no cure for arthritis and all medicines provided simply alleviate symptoms. So why is that not enough for cherries. Also you seem to disparage the idea because other fruit like strawberries may work as well. Maybe that is why we all should be eating more fruits and vegetables, not that cherries don't have valuable properties. On that note people with arthritis should eat less meat and eliminate heavily processed food from there diets, and so should anyone who doesn't have arthritis. The drug companies have wayy to much influence over our government that being said perhaps we should not ignorantly assume that unless big brother does a study saying it works, that it won't. Maybe they do not want the profits from products like ibuprofen diminished. Let us all remember that the medical industry is just that, an industry. Where is the profit in a healthy population? Who will they sell their artificial hips to if people did yoga and ate healthy food? I for one believe the testimonies posted here and elsewhere and mostly my own experience before the FDA.

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  9. Wait, because you don't agree with the evidence I present, you reckon I'm a pharma shill?

    Well, I'm not, sorry to disappoint. Pretty shallow accusation (ad hom and logically backrupt).

    The evidence is pretty clear at the moment (no effect). Who knows what will happen in the future? Why do you not treat the cherry growers with the same weight as the pharma companies? Both are selling a product and trying to hang a cure on it.

    You *have* heard of evidence and trials, haven't you?

    T

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  10. http://www.northumbria.ac.uk/browse/ne/uninews/marathoncherries

    I like cherry juice so I thought I'd have some at breakfast every day just as a juice starter.
    To my amazement my chronic sinus infections and various other aches and pains have all gone. Not saying it is the cherry juice but I think it too much of a co incidence that although it has been a hard cold spell I have had no colds, no aches and feel on top of everything....

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  11. Also check out that NU web link

    http://www.northumbria.ac.uk/browse/ne/uninews/marathoncherries

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  12. Thanks Graciegranny.

    " Not saying it is the cherry juice but I think it too much of a co incidence that although it has been a hard cold spell I have had no colds, no aches and feel on top of everything...."

    Actually, you *are* saying it's the cherry juice even though you say you aren't! I'm glad things have cleared up for you. Personal anecdotes can at bet give an idea to study, but by themselves are pretty useless. We humans are particularly rubbish at identifying cause/effect and are extremely easily duped. That's just the way our hardwiring evolved.

    Interesting article about the bing cherries - I couldn't find it published in a scientific journal, do you happen to have the link?

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  13. The link you seek is:
    6. Howatson, G., McHugh, M.P., Hill, J., Brouner, J., Jewell, A., van Someren, K.A., and Shave, R. Howatson, S.A. (2010). The effects of a tart cherry juice supplement on muscle damage, inflammation, oxidative stress and recovery following Marathon running. Scandinavian Journal of Medicine and Science in Sports, 20, 843-52.

    Although the web page revealing it (http://www.northumbria.ac.uk/sd/academic/lifesciences/ad/ses/sportstaff/glyn_howatson/ )does show research funding coming from Cherryactive, a company marketing a montmarency cherry juice supplement.
    Nevertheless, I'm giving it a try! Along with Rosehip tea. Can't hurt as far as I can see and there's at least that 'evidence' that I can hope is affirmed.

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  14. It is worth noting that, even where there is strong evidence to support the effectiveness of complimentary medicines (e.g. herbal / food vitamins and supplements), online companies are often hesitant to publish these (even where they are supported by proper clinical studies) as they are under constant pressure from trading standards not to make ANY medical claims, i.e. even if they can be verified. There are extremely tight controls on what can and cannot be said by online retailers in this industry. Therefore, if you are interested in the potential health benefits of an alternative therapy, you may have to do some of the "leg work" yourself, to find out what those might be. Of course, exercise due caution, but do not be disuaded from trying something that could be extremely effective, simply because the website in question does not make a long list of claims.

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  15. My goodness, anonymous. What utter BULLSHIT!

    You can make a medical claim if you have:
    a) evidence.

    Everything follows from that. Don't just make up nonsense.

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  16. I had carpel tunnel syndrome during my pregnancy and the cherries helped ease the pain. However I had been a pianist for 15 years and my finger joints are becoming sensitive and starting to ache, when I eat cherries (a handful or so a day) it helps to ease the pain. Drugs created by the pharmaceuticals are created from natural sources so if I can get the chemical from a plant rather than a pill that is good enough for me.

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  17. I'm sorry but reading all this, Dr T, it seems you are the one who doesn't even want to acknowledge that these cherries might actually work. Why don't you just try them and see. You are so cynical.

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  18. Why? IF the evidence says it doesn't work then why not try something else.

    Have you tried squeezing lemon juice in your eye if you have a sore knee? Why not?

    It seems you are the one who doesn't even want to acknowledge that lemon juice in the eye might actually work. Why don't you just try it and see. You are so cynical

    ;)

    T

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  19. With this many claims over this period of time one wonders why more studies have not been conducted since 2004/5? I agree that reading all the spurious claims is quite tedious, but statistically three small trials don't prove something, but equally it also means they don't disprove it. Of course one is not entitled to make any claims unless they are proven, otherwise it is false "snake oil" advertising. However this still does not mean that it's proven or unproven.

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  20. Things aren't proved until their proved. Saying "it has't been disproved either" as if this gives it some weight is nonsense.

    e.g. If I put a lemon up my bum, will I be able to fly? I haven't disproved it so there might be something in it.

    T

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  21. Hello, I have been taking monmorency cherry active for 2 weeks and have found amazing changes to my quality of sleep. I have stopped yawning and napping during the day and feel altogether far sharper. I have recommended them to a mate who was having long standing sleeping issues and he has reported great results. My wife hasnt noticed any difference to her, and neither has my father. I have ankylosing spondilitis and have noticed no benefit at all from the cherries in the pain department. For sleep problems I have to say im a convert. I have takes all sorts of sleep aids over the last 20 years and none have worked like cherry active.

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  22. I have to say that Cherry Activ cured my pseudo gout and was recommended by a south african doctor. He was totally right. And no, I am not in anyone's pay except that of my own body. So I wouldnt be so quick to dismiss, my friend.

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  23. I've had osteoarthritis for the last 12 years as determined by my first arthritis doctor. I've went to 3 other arthritis doctors for some help other than the expensive pain medications with side effects offered. I was told the meds was all they could do. I was eating OTC Nsaids to deal with the unending pain. 8 months ago, I searched the internet and found the claims concerning the effectiveness of tart cherries in helping with arthritis pain. I sent off for some 600 MG capsules. 3 days after I started taking them, I started getting relief with the stiffness and joint pain in my fingers. Within 6 weeks my arthritis pain was approximately 95 percent gone and I have not taken any Nsaids since I started taking the cherry capsules. I can stop taking the cherry pills for 2 - 3 days and the pain begins to get unbearable. 2 more days taking the pills starts the relief again.

    I'm convinced that the tart cherry pills help me and I've found a source of 1000 MG capsules that end up costing me $5.60 per month by ordering several bottles and getting free shipping. The company selling these at this price aren't getting rich off me and I've given out bottles to family and friends who suffer from the same affliction. Approximately 80% of the people who have used the cherry product have become believers. Approximatley 20% say that it has not helped them.

    Regardless of "proof" required by some people, this inexpensive relief without damaging side effects that I have found should be considered by other who suffer like I did. There is nothing to be lost by trying. I can see some people who will say they are not going to try them because there is no scientific studies proving this is going to work. I believe that these are not the people suffering from the pain just looking for something that might work for them. For those with arthritis pain, consider this: They are cheap, healthy and for many that I know very effective. what do you have to lose but maybe the pain? For those with doubts and won't even try, I suggest you should continue with your existing treatment since it seems to be work well for you.

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  24. Hello, Dr* T,

    I know this article's old, now, but I'm hoping you still check up on posts, as I just came across this blog while looking for information on the cherries.

    I'm skeptical of the claims regarding Montmorency cherries myself. As someone who has a mild form of arthritis, I like the idea of eating some cherries or drinking some cherry juice as a way to relieve some of the pain. That doesn't mean, of course, that doing so will relieve the pain, just that I would like it to do so.

    I will admit, out of curiosity, I did buy a container of Montmorency cherry juice (I got it on clearance for $5, so not a big waste of money). I've drank two tablespoons in a 20 oz. bottle of water over the course of the day, every day, for the past week. I've noticed SOME relief, but I'm not ready to credit the cherry juice just yet. There can be any number of factors causing the momentary reduction in pain, and singling out what I'd like it to be does me a disservice, as I may be chasing something up the wrong tree.

    Now, that said, I did come across this article, and I'm curious what you think about it. Yes, it's only one study, but I'd like to think it could spur on more studies to see if there really is something to cherry juice. Here's the article: http://www.ncbi.nlm.nih.gov/pubmed/21233776

    Hopefully something good does come of it. I'll likely finish the jar of cherry juice and then be done with it, but until then, if nothing else, the cherry juice is rather tasty. ;)

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  25. Dr T, whoever you are, I read all of this carefully and didn't see the studies you referred to that discounted any benefit to arthritis sufferers from cherries. You coma across as a bit of a dimwit. Learn to understand the studies you quote. Eating cherries hasn't killed anyone, but over the counter pain relievers are responsible for thousands of deaths a year. There isn't a study to prove the effectiveness of cherries simply because there aren't big pharmaceuticals profits to be had from doing so and that is the bottom line. Take that back to your pharmaceutical puppet masters.

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  26. A cursory glance using the Google scholar search engine brings up many studies. Here are a few you may want to explore
    Blau LW. Cherry diet control for gout and arthritis. Tex Rep Biol Med. 1950;8(3).

    Burkhardt S et al. Detection and quantification of the antioxidant melatonin in Montmorency and Balaton tart cherries (Prunus cerasus). J Agric Food Chem. 2001;49(10):4898-4902.

    Connolly D et al. The efficacy of a tart cherry juice blend in preventing the symptoms of muscle damage. Br J Sports Med. 2006 Jun 21.

    Jacob RA et al. Consumption of cherries lowers plasma urate in healthy women. J Nutr. 2003:133(6):1826-1829.

    Kang SY et al. Tart cherry anthocyanins inhibit tumor development in Apc(Min) mice and reduce proliferation of human colon cancer cells. Cancer Lett. 2003; 194(1):13-19.

    Kim DO et al. Sweet and sour cherry phenolics and their protective effects on neuronal cells. J Agric Food Chem. 2005;53(26):9921-9927.

    Seeram NP et al. Degradation products of cyanidin glycosides from tart cherries and their bioactivities. J Agric Food Chem. 2001;49(10):4924-4829.

    Tall JM et al. Tart cherry anthocyanins suppress inflammation-induced pain behavior in rat. Behav Brain Res. 2004;153(1):181-188.

    Wang H, Nair MG, Strasburg GM, et al. Antioxidant and antiinflammatory activities of anthocyanins and their aglycon, cyanidin, from tart cherries. J Nat Prod. 1999 Feb;62(2):294-296.

    ReplyDelete

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