The “kind-of-hidden” connection between neem and arthritis

 In Neem in the News, Neem Research

It’s not really hidden, it just wasn’t really clear unless you looked beyond the immediate keyword research.

Dr. Dan Sindelar, who founded the American Association for Oral Systemic Health, wrote the introduction to the most recent version of the booklet, “A Hands-On Guide to One of the World’s Most Versatile Herbs.” He’s a leader in the field of connecting gum disease with more serious issues – from dementia, heart disease, (particularly first heart attacks), stroke, diabetes, lung and esophageal cancer, low birth rates and preeclampsia, fatal brain aneurysms, and non-alcoholic fatty liver disease.

Recognizing that this is a long and complicated report, we’ve also posted a “short read” as an overview without the specific details included here.

THIS REPORT IS PROVIDED FOR EDUCATIONAL PURPOSES ONLY. THESE STATEMENTS HAVE NOT BEEN EVALUATED BY THE U.S. FOOD AND DRUG ADMINISTRATION. NEEM TREE FARMS DOES NOT SELL PRODUCTS WHICH ARE INTENDED TO DIAGNOSE, TREAT, PREVENT OR CURE ANY DISEASE.

Then Karl Rad, an Ayurvedic researcher, contacted us about neem and arthritis. He pointed out that both gum disease and arthritis are linked to the same pathogens, and have similar symptoms in that they cause bones to deteriorate, creating pain and inflammation in different parts of the body.

He sent us a copy of a 2013 report from Johns Hopkins University that links the two issues:

“Periodontal disease is characterized by the progression… to a chronic inflammatory process that begins to affect connective tissues surrounding the tooth leading to attachment loss.; in the absence of proper treatment, periodontal disease may progress to bone destruction and tooth loss.”

And the pathogens they share: “A seminal discovery that a major bacterial species involved in the development and propagation of periodontal disease, Porphyromonas gingivalis (Pg) … fueled interest and additional investigation … into a mechanistic link between the two conditions.”

In mice, the link is so clear that just feeding the animals P. gingivalis “significantly aggravated arthritis.” Controlling it should be considered a critical first step in preventing inflammatory markers that cause arthritis pain.

So Why Neem?

Neem has been used for oral care for thousands of years, with more recent research backing that traditional use. A comprehensive article published in Pharmacognosy Reviews looked at nearly 40 scientific papers published through 2014 and called neem “an herbal panacea in dentistry.”

Researchers estimate that nearly 500 potential pathogens can live in a human subgingival plaque. And as anyone who suffers with gum disease knows, there is no easy cure for all (or perhaps even most) of them.

One of the first studies, published in the Journal of Dental Research showed neem’s ability to reduce the bacteria that causes plaque and biofilm formation. In a six-week trial, neem extract was shown to be significantly more effective in reducing bleeding gums than chlorhexidine gluconate, a harsh chemical rinse with several side effects including stained teeth.

Another study, published in the Journal of Advanced Scientific Research, looks specifically at the two bacteria considered most resistant to the potent new antibiotic, ciprofloxacin. It concluded that 50mg/ml neem extract completely inhibited the growth of those selected bacterial isolates and called for neem extract to be used in the sterile periodontal pocket after gums are scaled and root planed.

Two reports look specifically at neem and the pathogen most likely implicated in both gum disease and arthritis, Porphyromonas gingivalis. The first used a non-absorbable neem chip impregnated with 10% neem oil. They placed it a pocket on one side of the mouth of 20 patients who had just had their gums scaled and root planed (ouch!) Microbiological studies were conducted when the chip was placed, on the seventh day and then again at 21 days.

Clinical parameters showed statistically valid improvements on the neem chip sites and presence of P. gingivalis strains were significantly reduced with researchers calling for ongoing studies to compare the use of neem chips with other treatments that can have significant long-term side effects.

A second, published in the peer-reviewed journal, BMC Complementary and Alternative Medicine by Israeli researchers, took a broader look at neem and P. gingivalis as well as other pathogens involved in gum disease beginning with the traditional use of neem sticks over thousands of years.

They created an alcohol-based extract and measured its antibacterial properties against key pathogens in test tubes as well as its activity in combination with other natural processes.

They found that the neem leaf extract showed prominent dose-dependent antibacterial activity against P. gingivalis, however, had no effect on the growth of another common pathogen, F. nucleatum nor on the coaggregation of the two bacteria. But at the same time, its “intense antioxidant activity” was amplified in a series of natural processes.

They conclude: “Neem leaf extract, containing polyphenols that adhere to oral surfaces, have the potential to provide long-lasting antibacterial as well as synergic antioxidant activities when in complex with bacteria, red blood cells and lysozyme (a natural enzyme that catalyzes the destruction of the cell walls of certain bacteria). Thus, it might be especially effective in periodontal diseases.”

Other pathogens also involved in gum disease and arthritis

Another pathogen many people are familiar with, even if they don’t think of it in terms of gum disease is the Candida albicans fungi. Neem inhibits both Candida and Streptococcus mutans in test tubes even when compared with standard antibiotic treatments, like ketoconazole, nystatin and chlorhexidine diacetate that often have long-term side effects.

A total of 216 samples were used, with two different concentrations of ketoconazole, nystatin and chlorhexidine diacetate, two concentrations of neem leaf extract, and a control group with plain tissue conditioner.

Both ketoconazole and nystatin (mixed at a concentration of 10% in 100 grams of solution) were most effective with a maximum inhibition of 32 mm and mean of 31.75. A 15% neem solution, however, showed an inhibition of 21 mm and mean of 20.67 after 24 hours against Candida albicans.

Multiple other pathogens can be involved in both gum disease and arthritis, including Treponema (which also causes syphilis) and Enterococcus faecalis (formerly known as Streptococcus faecalis, which causes up to 80% of infections in humans and is considered to be one of the most antibiotic-resistant bacteria, particularly in hospital settings).

Interestingly, these two pathogens appear to be directly involved in arthritis of the knee but not other joints, according to a report published in the Journal of Applied Biomaterials & Functional Materials based on multiple studies conducted prior to patients undergoing knee replacement surgery.

There doesn’t seem to be any clinical research on Treponemia and neem, but Ayurvedic physicians recommend its use for treating syphilis. One report, published in the Journal of Contemporary Dental Practice, compares neem leaf extract with 2% chlorhexidine and 3% sodium hypochlorite were used to assess the antimicrobial efficiency against S. faecalis following a root canal. While the two chemical treatments were more effective, all three medications showed well-defined and comparable zones of inhibition. Maximum antimicrobial activity was shown by 2% chlorhexidine (20.45), followed by 3% sodium hypochlorite and neem leaf extract (17.19).

We’re not aware of any report that specifically looks at gum disease, neem and arthritis, but multiple studies over the past 20 years document its impact on inflammation and a separate study shows significant impact on rheumatoid arthritis.

Based on anecdotal reports from customers with lupus, we’re still concerned about recommending internal neem to people with auto-immune disease, but we are far more comfortable with topical neem used to supplement good oral hygiene.

Learn more: Once you look past that “hidden link,” there is an amazing amount of research. I’ve tried to select the most pertinent, but these provide even further information on the connections between gum disease, arthritis and neem, thanks to Karl Rad.

Gum disease and arthritis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491801/

Bacterial diversity in subgingival plaque:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC95255/?report=reader

Next-generation sequencing of pathogens in osteoarthritis:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527540/

Gut bacteria involved in RA and osteoarthritis:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6155189/

Key pathogens in oral biofilms:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543615/

Candida albicans fungi in periodontitis:

https://pubmed.ncbi.nlm.nih.gov/14996281/

Treponema in periodontitis…

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144123/
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136646
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219181

Pathogens found in the joint can vary and are often pathogenic gut inhabitants too:

https://pubmed.ncbi.nlm.nih.gov/30250232/

Septic arthritis pathogenic causes, including S. aureus.  Injury increases chances of infection:

https://www.ncbi.nlm.nih.gov/books/NBK538176/

Candida albicans and  arthritis:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4742637/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978747/

Treponema in periodontitis…

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144123/
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136646
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219181

Many of these pathogens, such as F. nucleatum, are implicated in many diseases:

https://pubmed.ncbi.nlm.nih.gov/32573481/

Pathogens found in the joint can vary and are often pathogenic gut inhabitants too:

https://pubmed.ncbi.nlm.nih.gov/30250232/

Septic arthritis pathogenic causes, including S. aureus.  Injury increases chances of infection.

https://www.ncbi.nlm.nih.gov/books/NBK538176/
https://pubmed.ncbi.nlm.nih.gov/31576463/
https://pubmed.ncbi.nlm.nih.gov/26291296/

P. acnes in oral health…

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069318/

P. gingivalis in spinal fluid and brain (also contributing to Alzheimer’s)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357742/

Oral neem leaf appears effective for P. acnes bacteria (common in backaches), but I’d need to find additional research for neem and P. acnes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454980/

Neem leaf (nimba) is commonly used to treat sandhigata vata (osteoarthritis) and ama vata (rheumatoid arthritis) by Ayurvedic doctors in India.   The common prescriptions also include Boswellia serrata (Indian frankincense … https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309643/ ) resin, Commiphora wightii (Indian myrhh) resin, and triphala (a mixture of three fruits …  https://www.healthline.com/nutrition/triphala ).

Neem for arthritis…

https://pubmed.ncbi.nlm.nih.gov/25918809/

Neem for gut regeneration… various oral pathogens also infect the gut…

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139875/

Video suggesting neem leaf tea for arthritis…

Ankylosing spondylitis hypothesis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204318/

P. gingivalis and P. intermedia in ankylosing spondylitis (AS)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470850/

Tulsi leaf tea (Indian holy basil) for A. actinomycetemcomitans bacteria (an aggressive periodontitis bacteria that is also commonly found in rheumatoid arthritis…neem leaf is not effective for A. actinomycetemcomitans)

https://jisponline.com/article.asp?issn=0972-124X;year=2016;volume=20;issue=2;spage=145;epage=150;aulast=Mallikarjun;type=3

The Arthritis Foundation recommends Boswellia (Indian frankincense) for osteoarthritis and rheumatoid arthritis…

https://www.medicalnewstoday.com/articles/326599

Boswellia trial for osteoarthritis…

https://pubmed.ncbi.nlm.nih.gov/12622457/

Neem leaf extract effective for S. aureus.

https://pubmed.ncbi.nlm.nih.gov/26408045/

Neem bark effective for S. aureus, etc.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394162/

Candida albicans arthritis…

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4742637/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978747/

There’s a lot of research on RA and a couple of the periodontitis pathogens, P. gingivalis and A. actinomycetemcomitans  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384717/

Neem chewing sticks appear not to inhibit A. actinomycetemcomitans, but guava chewing stick neutralized a key toxin…

https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-5-203

Thanks for the offer of neem!  I may take you up on it.

Best wishes!

Here were a few related links I found…

There appears to be sufficient evidence to support neem for chronic backaches too… P. acnes also causes oral problems and skin problems, etc. 

https://pubmed.ncbi.nlm.nih.gov/25609421/
https://pubmed.ncbi.nlm.nih.gov/31576463/
https://pubmed.ncbi.nlm.nih.gov/26291296/

P. acnes in oral health…

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069318/

P. gingivalis in spinal fluid and brain (also contributing to Alzheimer’s)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357742/

Oral neem leaf appears effective for P. acnes bacteria (common in backaches), but I’d need to find additional research for neem and P. acnes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454980/

Neem leaf (nimba) is commonly used to treat sandhigata vata (osteoarthritis) and ama vata (rheumatoid arthritis) by Ayurvedic doctors in India.   The common prescriptions also include Boswellia serrata (Indian frankincense … https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309643/ ) resin, Commiphora wightii (Indian myrhh) resin, and triphala (a mixture of three fruits …  https://www.healthline.com/nutrition/triphala ).

Neem for arthritis…

https://pubmed.ncbi.nlm.nih.gov/25918809/

Neem for gut regeneration… various oral pathogens also infect the gut…

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139875/

Video suggesting neem leaf tea for arthritis…

Ankylosing spondylitis hypothesis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204318/

P. gingivalis and P. intermedia in ankylosing spondylitis (AS)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470850/

Tulsi leaf tea (Indian holy basil) for A. actinomycetemcomitans bacteria (an aggressive periodontitis bacteria that is also commonly found in rheumatoid arthritis…neem leaf is not effective for A. actinomycetemcomitans)

https://jisponline.com/article.asp?issn=0972-124X;year=2016;volume=20;issue=2;spage=145;epage=150;aulast=Mallikarjun;type=3

The Arthritis Foundation recommends Boswellia (Indian frankincense) for osteoarthritis and rheumatoid arthritis…

https://www.medicalnewstoday.com/articles/326599

Boswellia trial for osteoarthritis…

https://pubmed.ncbi.nlm.nih.gov/12622457/
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