1. A randomized, double-blinded, placebo-controlled study of the effect of a combination of lemon verbena extract and fish oil omega-3 fatty acid on joint management Christy Goff and Danielle Taylor

2. Research from article Lemon Verbena Extract Used in South America and Southern Europe for asthma, colds, fevers, flatulence, colic, diarrhea, indigestion Verbascoside – main compound with strong AOX and anti- inflammatory properties Plant phytochemicals can have significant protective effects against inflammation-related chronic diseases Fish Oil Shown to have immunomodulatory effects Reduce production of pro-inflammatory eicosanoids in RA

3. Objective To test the ability of lemon verbena extract and fish oil supplementation to improve the general condition of joints (pain, stiffness, and function) in subjects already experiencing joint pain.

4. Methods Double blind, placebo-controlled, randomized nine week intervention 45 participants enrolled 23 were given the supplement and 22 were given a placebo 14 individuals did not complete the study Weeks 1-5: Consumed 6 capsules per day of 370mg fish oil powder and 230mg of lemon verbena extract for the first five weeks Weeks 6-9: Reduced to 3 capsules daily Completed disease specific questionnaires once a week to measure pain/stiffness, function and physical activity

5. Results At baseline: No significant different between the treatment group and the placebo group (age, gender, BMI, physical characteristics) using WOMAC and Lequesne’s Functional Index After nine week intervention: A significant improvement of joint stiffness/pain after 3 weeks of supplementation and with function after 4 weeks WOMAC index in creased approximately 53% after 9 weeks in the supplementation group and did not decrease in placebo group Decrease in Lequesne’s functional index after 4 weeks, dropping 78% compared to baseline

6. Conclusion First intervention study to show improvement in joint pain management after supplementing with fish oil and herbs after 9 weeks Researches estimate the participants daily intake of lemon verbena extract was between 3000-7000 ORAC units

7. Limitations Strength : Well constructed study – double-blind, placebo controlled, randomized, weekly questionnaires, 2 week washout period Weakness : 14 participants dropped out of the study Did not separately test fish oil vs. lemon verbena Used ORAC value of lemon verbena extract as a criteria for choosing this herb

8. Comparative information from Databases Natural Medicine Comprehensive Database Lemon Verbena : Used for digestive disorders, agitation, insomnia, asthma, cold, fever, skin conditions, constipation Prepared as a tea, not extract Fish Oil : Used as a treatment for RA Possible effective: Taking fish oil orally, alone or in combination with naproxen, seems to significantly decrease the duration of morning stiffness in patients with RA Use of fish oil might also reduce non-steroidal anti-inflammatory drug (NSAID) requirements when taken together

9. Up to date : Lemon verbena - No information found Fish oil - found to be associated with low rates of coronary heart disease Natural Standard: Lemon verbena - No information found Fish Oil – Given the letter grade A for rheumatoid arthritis Significant reductions in tender joints and morning stiffness vs dietary controls Comparative information from Databases