Rosehip (Rosa spp.) a nutritional role in arthritis
Sue McGarrigle ND DipION CNHC mBANT
Phytonutrients commonly found in whole unprocessed foods have a diverse nutritional role and influence in helping maintain human health. They may also play an important part in helping to regulate and maintain normal inflammatory responses, modulating immune function and strengthening the integrity of connective tissue throughout the body. Most phytonutrients are involved in more than one singular process and range from the more commonly identified functional activity as antioxidants, to their more complex feature as immune modulators, cell signalling regulators and cell membrane stabilisers. In principle many phytonutrients exert their nutritional influence in much the same way as vitamins, acting as bio-catalysts, initiating vital biochemical roles or supporting and maintaining normal biochemical processes.
Rosehip Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa species).
Typically they are red-to-orange, but range from dark purple to black in some species and are commonly used in soup, stew, tea, juice, jam, jelly, sauce, syrup, puree and oil. Other Names: Apothecary Rose, Cynorhodon, Cynorhodons, Cynosbatos, Dog Rose, Dog Rose Hips, Églantier, Fruit de l’Églantier, Gulab, Heps, Hip, Hip Fruit, Hip Sweet, Hipberry, Hop Fruit, Persian Rose, Phool Gulab, Pink Rose, Poire d’oiseaux, Rosa Alba, Rosa Centifolia, Rosa Damascena, Rosa de Castillo, Rosa Gallica, Rosa Mosqueta, Rosa Provincialis, Rosa Canina, Rose Hips, Rosa Lutetiana, Rosa Pomifera, Rosa Rugosa, Rosa Villosa, Satapatri, Rosae Pseudofructus cum Semen, Rosehip, Rosehips, Rose des Apothicaires, Rose de Provins, Rose Rouge de Lancaster, Rosier de Provence, Satapatrika, Shatpari, Wild Boar Fruit.
Rosehips are a storehouse of nutraceuticals which like other plants can vary with maturity and processing and have demonstrated antioxidant, antiarthritic, antiinflammatory, analgesic, antidiabetic, cardioprotective, antimicrobial, immunomodulatory, gastroprotective and skin ameliorative effects.(1)
Anti-inflammatory benefits of Rosehip The benefits of utilising nourishing foods such as rosehip which has a safe and traditional history of use with minor to no irritation to the human host are long term options against chronic inflammatory symptoms. Inflammatory abnormalities underlie a huge number of human diseases; physiological or acute inflammation is a beneficial host response to tissue damage, when resolution is delayed this can lead to immune-associated diseases such as inflammatory bowel disease (IBD) and rheumatoid arthritis.(2)
Reactive oxygen species (ROS) are key signalling molecules that play an important role in the progression of inflammatory disorders. An enhanced ROS generation by polymorphonuclear neutrophils (PMNs), a type of white blood cell at the site of inflammation, causes endothelial dysfunction and tissue injury(3). Chronic muscle and joint pain problems develop primarily from improperly managed inflammation and oxidative stress.
The lipophilic constituents in rosehip have been found to have particular anti-inflammatory activity including actions on arachidonic acid metabolism and inhibition of both cyclooxygenase-1 and 2 (4). Much of the anti-inflammatory action of rosehip shown in various studies has been attributed to high quantities of its galactolipids. Galactolipids are a class of compounds widely found in the plant kingdom, and are an important part of cell membranes. Galactolipids in plants consist mainly of monogalactosyldiacylglycerols and digalactosyldiacylglycerols containing one or two saturated and/or unsaturated fatty acids linked to the glycerol moiety. Several galactolipids have been shown to possess in vitro and/or in vivo anti-tumour promoting activity and anti-inflammatory activity. A specific galactolipid, given the trade name GOPO, has been shown in clinical observation to reduce the activity of polymorphonucleated leukocytes that is implicated in the inflammation and tissue damage that occurs in osteoarthritis (OA).(5)
Rosehip attenuates inflammatory responses in different cellular systems (macrophages, mperipheral blood lymphocytes and chondrocytes) affecting cytokine production and matrix metalloproteinase (MMP) expression, down-regulating catabolic processes associated with osteoarthritis or rheumatoid arthritis and conferring cartilage protection (6,7). Rosehip has been found to have anti-inflammatory and antinociceptive activities in several in vivo experimental models demonstrating synergistic interactions between compounds. (8)
Also in contrast to nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, rosehip has an anti-inflammatory action that does not have ulcerogenic effects, promote bleeding or disturb blood clotting mechanisms. (9) This may limit potential side effects for patients who may be at increased risk from the gastrointestinal or cardiovascular side effects of NSAIDs (10). Additionally, repeated courses of NSAIDs may actually increase the destruction of cartilage over time.
Anti-oxidant activity of Rosehip Rosehips are a rich source of vitamin C and polyphenolic compounds such as proanthocyanidins and flavonoids including quercetin and catechin which protect against oxidative stress, enhance activity of antioxidant enzymes such as superoxide dismutase and catalase and demonstrate protective effects on gap junction intercellular communication (11). The vitamin C content of fresh rosehips is higher than that found in citrus fruits and when rosehip extract’s phenolic content is deprived of vitamin C it still shows considerable antioxidant activity (12). Symptoms of vitamin C deficiency may appear to be related to the weakening of blood vessels, connective tissue and bone, which all contain collagen. Not only is vitamin C essential for the maintenance and integrity of tissue but it could provide a natural method to maintain bone health without the use of pharmaceuticals in many ageing adults at risk for osteoporosis. (13)
Rosehip antioxidants may also neutralise toxic substances released by white blood cells in myofascial tissues, thereby reducing the presence of systemic inflammation (14,15). Anthocyanidins can also prevent the destruction of collagen in the muscles, a problem that has been observed in some people with fibromyalgia. Rosehip also shows remarkable content of lycopene with an unexpected isomer pattern; lycopene is mainly delivered within the human diet out of tomatoes and tomato products and is an efficient antioxidant and singlet oxygen quencher16. Rosehip is also high in folate (17) and carotenoids, betasitosterol, malic acid, tannins, ellagitannins and numerous other phytochemicals. (11,18)
Osteoarthritis Osteoarthritis usually develops with age as cartilage, the body’s natural shock absorber, worn down in hip, knee and wrist joints. It is a prevalent and chronic disabling disease mainly affecting the elderly. A primary feature of arthritis, in particular osteoarthritis, is the degradation and erosion of the rdextracellular matrix (ECM) in cartilage, resulting in impaired joint motion, severe pain and disability.The preceding alterations of collagen and proteoglycan implicate the activation of enzymatic systems, i.e. matrix metalloproteinases (MMPs) and aggrecanase. Interleukin (IL)-1β is considered a key catabolic factor that induces ECM degradation and has multiple effects on the expression of chondrocyte genes and affects matrix enzymes, chemokines and cytokines. (6)
An early study on one hundred patients (65 women, 35 men with a diagnosis of osteoarthritis of either the hip or knee, verified on radiography), participated in a randomised, placebo-controlled, double-blind study. They were divided into 2 treatment groups of 50 patients each. Half of the patients were given five 0.5g capsules of standardized rose-hip powder twice daily for 4 months, and the other half received identical placebo capsules twice daily for the same period. Mobility of the hip or knee was measured in both groups after the initial screening and again after 4 months of therapy. Hip joint mobility improved significantly in the treatment group compared with the placebo group. Similarly, pain decreased significantly in the treatment group compared with the placebo group. In this study standardised rosehip powder reduced symptoms of osteoarthritis, as 64.6% of patients reported at least some reduction of pain while receiving treatment. (19)
Daily intake of rosehip powder for four weeks by healthy male volunteers and patients suffering from osteoarthritis resulted in significantly reduced serum C-reactive protein (CRP) levels and reduced chemotaxis of peripheral blood neutrophils. The results indicate that rosehip possesses anti-inflammatory properties and might be used as a replacement or supplement for conventional drug therapies in patients with osteoarthritis. (20)
A further crossover study involved 112 patients with osteoarthritis of the hip, knee, hand, shoulder or neck and it was found that compared to those receiving placebo, patients who received 5g/day of standardised rosehip powder for 3 months experienced significant reductions in pain and stiffness, as well as significant improvements in mood, wellbeing and sleep quality. 66% of patients receiving active treatment reported improvement in pain compared to only 36% of placebo patients. Reductions in paracetamol consumption and plasma CRP along with a small but significant reduction in total cholesterol were also observed. After the treatment and placebo groups were crossed over for a further 3 months (without a washout period) no difference was seen between the two groups, suggesting that rosehip has a long duration of action with a strong carryover effect. (11)
Another placebo-controlled, double-blind crossover trial involving 94 patients with osteoarthritis of the hip or knee found treatment with rosehip resulted in a significant reduction in pain and use of medication after 3 weeks and significant reduction in disability and stiffness after 3 months of treatment. (21)
A meta-analysis of three randomised controlled trials of osteoarthritis patients included 287 patients with a median treatment period of 3 months. This meta-analysis reported that treatment with standardised rosehip powder consistently reduced pain scores and that patients were twice as likely to respond to rosehip compared to placebo.(22) A meta-analysis of six studies, involving a total of 1222 people, compared the pain reducing effect of glucosamine and rosehip powder for osteoarthritis and found rosehip is more effective than glucosamine in reducing osteoarthritic pain. (23)
Both the onset and development of OA is expected to be modulated by the effects of rosehip powder and GOPO: (1) The observed diminished nitric oxide (NO) and IL-1β production is likely to delay or prevent initial steps of the disease. (2) The homeostasis of anti- and pro-inflammatory cytokines is also modulated and thus provides a means to attenuate inflammatory processes in osteoarthritis. (3) Chemokines that predominantly direct the migration of neutrophils were less abundantly produced.
Rosehip powder and its constituents modulate cellular and molecular processes that may explain the positive effect of rosehip powder observed in clinical trials. The effects on interleukin and chemokine production as well as MMP expression indicate that rosehip powder and its constituents down-regulate catabolic processes and reduce chemotaxis related to osteoarthritis or rheumatoid arthritis. Collectively, the data provides a molecular and biochemical basis for the cartilage protection by rosehip powder. (6)
Back pain Rosehip may offer additional benefits in other conditions such as back pain. A one year surveillance of 152 patients found that rosehip provided significant pain relief for the 77 patients that completed the survey that had acute exacerbations of chronic back pain. Reductions in stiffness, painkiller use and plasma CRP levels were also observed. (24)
Rheumatoid arthritis Although studies of the effects of rosehip in rheumatoid arthritis have shown modest results, this may be due to the slow onset of the disease and the size of the studies conducted. Further, larger human studies are needed.(25) Rosehips have also been used as a traditional remedy for diabetes and in animal studies researchers have recently found that they can significantly reduce high blood glucose levels and prevent weight gain; human trials are now needed. (26,27)
Summary While further research is required to establish its clinical role, existing research (both in vitro and in vivo), many using patented extracts, suggests that rosehip may be of high nutritional and therapeutic value as a viable food or supplement in osteoarthritis and other inflammatory diseases. The growing evidence base suggests that it has a high safety profile and with its low price and ease of administration provides an attractive alternative against conventional drug therapies such as NSAIDs.
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