Review of Joint-Supplements

Help for arthrititis pain?

Can joint-supplements really provide relieve for arthritis pain?

Arthritis causes pain, disability and restricted mobility in more than 40 million Americans. Until very recently, degenerative joint conditions were considered �incurable� side effects of old age - to which we were all eventually bound to succumb. Dramatic breakthroughs in nutritional biochemistry, exercise physiology and sports medicine, however, have begun to change the way health professionals, and the public at large, think about the treatment and prevention of bone and joint disease.

Right now, there are approximately 42 million Americans with arthritis. As the U.S. population ages, the total number of people with disability or functional impairment related to their bones and joints is expected to skyrocket. Over the next 15-20 years, an estimated 100-110 million people will be affected enough to lose some degree of flexibility and mobility. Sobering statistics to be sure, but when considered in light of the dramatic increase in active lifestyles and sports participation among older Americans (up nearly 60% since 1990), it is clear that many people are not quite ready to accept these �inevitable consequences of aging� as part of their future.

Causes of arthritis and conventional treatments

The most common form of arthritis, osteoarthritis, joint cartilage becomes damaged � resulting in inflammation, pain and reduced mobility and flexibility. As such, the degeneration of joint cartilage is often referred to (incorrectly) as a �wear and tear� condition in which the body�s own restorative processes cannot keep up with the breakdown events. Under normal conditions, connective tissues such as cartilage are undergoing a constant cycle of breakdown and repair referred to as �turnover� � a cycle which is normally balanced to maintain healthy cartilage. Arthritis and joint degeneration may result when this cycle becomes unbalanced in favor of the breakdown side of the equation (and repair cannot �keep up�).

As cartilage degradation outpaces restoration, pain and stiffness can result in reduced mobility. Conventional treatment typically involves analgesic and/or anti-inflammatory medications such as Tylenol, Advil, Aleve or aspirin. A frequent side effect of many anti-inflammatory medications is gastro-intestinal damage (ulcers) as well as the possibility of slowing cartilage repair processes even further (through an inhibition of certain enzymes).

Practical adviceIt makes very little sense for anybody to talk about nutrition or dietary supplementation without trying to put it back into the context of how it can help the entire body. For example, most people know that calcium is �good� for their bones, but you also need to consider your intake of other nutrients (like vitamins D and K, and minerals such as magnesium, boron and zinc).

The same goes for dietary supplements to support cartilage health. Virtually everybody who has even heard of nutraceuticals is aware of glucosamine and chondroitin as agents that may help nourish joint cartilage. Simply packing these supplements into a capsule, without considering essential cofactors required for the cartilage repair process, misses the entire point of using supplements to maintain health and well-being. Important cofactors for cartilage synthesis and maintenance, such as vitamins C and E, boron, copper, manganese and zinc, must be present in the right amounts for the cartilage repair process to operate normally. In addition, there are a wide variety of non-nutrient factors such as boswellia, bromelain, papain, white willow bark and curcumin, which may be able to enhance the process of connective tissue maintenance by reducing inflammation and improving circulation.

Recent evidence published in top arthritis and medical journals such as the Journal of Rheumatology January and JAMA, suggests that chondroitin does indeed appear to be as effective as glucosamine in alleviating joint pain and stiffness. It is important to note, however, that the combination of glucosamine and chondroitin has yet to be shown to be any more effective than either ingredient on its own. In addition, chondroitin is approximately 10 times more expensive compared to glucosamine and the quality of the raw material has been the subject of recent controversy.

Contributing factors

It is important to note that because no 2 people are exactly the same, the overall effect of a given dietary supplement can vary from person to person. Some individuals may experience dramatic results in a short period of time, some may take longer to notice any benefits and a portion of people may fail to achieve any noticeable benefits from a particular supplement (although it may be working just the same). A number of factors are known to influence the body�s ability to undergo the normal process of connective tissue (cartilage) maintenance, including:

Aging causes a number of biochemical and biomechanical changes in connective tissues such as cartilage and bones. For example, in joint cartilage, both the number of cells and their individual activity may decline with age. This means that cartilage in older joints may be less able to repair damage and less resistant to injury than cartilage in younger joints.

Obesity is a known risk factor for joint pain and stiffness due to the increased chronic load delivered to joints. The primary weight bearing joints of the body, the knees and hips, are particularly susceptible to damage from excessive weight bearing.

Genetic factors are thought to play a role in connective tissue metabolism and may explain some of the variation in the risk of conditions such as arthritis and osteoporosis.

Physical activity has the potential to significantly influence cartilage metabolism by enhancing transport of nutrients from the blood into the joint tissues where they can be used. Too little activity or too much mechanical stress may unbalance the cartilage repair process and impair function.

Medications, including over the counter pain relievers like aspirin, ibuprofen (Advil) and naproxen (Aleve) can interfere with the normal cartilage repair process. Although such medications are widely used for the temporary relief of pain and inflammation of arthritis and other injuries, their overall effect is to address the symptom of pain - not the underlying cause of tissue damage. Chronic use of such pain relievers may actually accelerate the very condition from which you are trying to get relief.

Dietary Supplements

Glucosamine and Chondroitin

Perhaps the most widely used joint supplements, glucosamine and chondroitin have been used separately and in combination in several European countries as a first-line treatment for osteoarthritis for over 20 years. A number of studies have clearly shown that both glucosamine and chondroitin reduce the pain and stiffness of arthritis and may even play a role in slowing the progression of the damage. In most cases, these supplements are significantly more effective than placebo and just as effective as common pain relieving medications (with fewer side effects) � though they often take longer to start working, they may continue to work for a longer period of time. Most studies suggest that 4-8 weeks of supplementation are needed at doses of 1500mg/day of glucosamine and/or 1200mg of chondroitin (the combination formula has not been shown to be any more effective than either supplement on its own).

S-adenosylmethionine (SAMe)

SAMe is the latest �darling� of the supplement world. A derivative of the amino acid, methionine, SAMe (or �Sammy� as it is called) has been shown to alleviate pain and inflammation, while improving flexibility and mobility in people suffering from arthritis. The overall effect of SAMe (200-1200mg/day) appears to be equivalent to common analgesic and anti-inflammatory medications (again, with fewer gastrointestinal side effects) � but its cost relative to glucosamine and chondroitin is prohibitive for many people (although an added benefit for SAMe is its potential to also help combat mild depression � something that neither glucosamine nor chondroitin can do).

Methylsulfonylmethionine (MSM)

MSM is another of the �newer� entries into the joint supplement category. Although there is quite a lot of hype surrounding MSM as a beneficial supplement for treating arthritis and other degenerative joint conditions, the scientific evidence is quite meager. MSM is a methylated and sulfated version of the amino acid, methionine, so as a dietary source of sulfur, it actually may have some benefits because sulfur is involved in a number of amino acid and protein metabolic pathways, including some related to cartilage synthesis and repair.

Hydrolyzed Collagen Protein (HCP)

HCP is also known as gelatin. Collagen is the chief structural protein that makes up connective tissues in the body (such as joint cartilage) and the �hydrolyzed� form is simply a modified form of the protein that has been broken down into smaller pieces by enzymes. By providing key amino acid building blocks for cartilage synthesis, HCP can help rebuild damaged cartilage. A handful of small European studies have suggested that HCP can effectively reduce the joint pain and stiffness or arthritis � but the daily dose is high at about 7-10 grams per day (good thing that it�s inexpensive).

Essential Fatty Acids (EFAs)

EFAs, such as those found in fish oil and some seed oils, may be effective in reducing inflammatory prostaglandins. For example, the omega-3 fatty acids, EPA and DHA, provide anti-inflammatory effects that may augment the overall joint benefits of �primary joint supplements such as glucosamine � and result in an ultimate reduction in those �consequences of aging� that we all thought we were destined to suffer. Dosage recommendations are typically in the 2-4 grams per day range (for EPA and DHA) � or about 8-12 grams of fish oil per day. As a �vegetarian� alternative to fish oils, essential fatty acids can be obtained from seed oils such as Evening primrose, black current seed and borage oils (about 5-10 grams per day).

Antioxidants

Findings from the decade-long Framingham Study have suggested that subjects with a high intake of antioxidants, particularly vitamins C and E, have a slower rate of cartilage degeneration and a better maintenance of overall joint function. Other studies have shown how bioflavonoids such as quercetin can help inhibit synthesis of inflammatory prostaglandins to reduce swelling and pain.

Devil's Claw

This herb, at a daily dose of 1000-3000mg has been shown to provide pain relief in arthritic conditions. Curiously, Devil�s claw appears to be most effective for joint pain originating in the lower back.

White willow bark

As a natural source of salicin, white willow is sometimes called �Nature�s aspirin� and is frequently used for its mild anti-inflammatory effects. Raw white willow powders do not provide high enough concentrations of salicylates to provide much benefit, so be sure to look for an extract standardized to at least 10-20% total salicin content.

D-, L-phenylalanine (DLPA)

DLPA is a synthetic form of the amino acid phenylalanine. It is typically used as a dietary supplement to reduce appetite, elevate mood and reduce the sensation of pain. In the body, phenylalanine can be converted into another amino acid, tyrosine, and then into the neurotransmitters dopamine and norepinephrine (which have roles in transmitting pain signals). In addition, animal studies suggest that DLPA may increase brain levels of endorphins (the body�s �feel good� morphine-like compounds) � an effect that could potentially reduce pain.

Silicon

Like sulfur, the mineral silicon may help strengthen connective tissues such as cartilage by supporting the structural proteins that comprise the tissues. Horsetail extract is frequently used as a natural herbal source of silicon in some dietary supplements.

Boswellia Serrata

Extract from the sap of Boswellia, is a traditional Indian herbal treatment for controlling inflammation, pain, and stiffness. Its effects in controlling inflammation have been compared to conventional non-steroidal anti-inflammatory drugs (NSAIDs) � without the associated gastrointestinal side effects or progression of joint damage. Typical dosages recommendations suggest 600-1200mg/day of a 65% boswellic acid extract or 1200-2400mg/day of a 35% extract (taken in divided doses 2-4 times per day).

Turmeric (curcumin) and Ginger

Turmeric root extract is another traditional Indian remedy for controlling swelling and inflammation. Turmeric is a bright yellow spice is used in Indian curry cooking and supplies curcumin, a powerful anti-inflammatory and antioxidant. Standardized turmeric root extracts can provide as much as 95% curcumin, which can be used 2-4 times per day in doses of 200 � 400mg. Ginger also provides some mild anti-inflammatory effects in doses of 1-3 grams per day (taken in 2-3 divided doses).

Summary

There is little doubt in the minds of nutritionally oriented physicians and scientists that dietary supplements can indeed be helpful in supporting cartilage synthesis, repair and maintenance. Glucosamine is among the most popular joint supplements � and at 1500mg per day appears to be quite safe and effective � but approximately 4-8 eight weeks may be necessary before the joint benefits of glucosamine become evident. High levels of antioxidants in the diet, particularly vitamins C and E, have been reported to slow the rate of joint deterioration in the knees and reduce symptoms of pain and stiffness (compared to people who consume low levels of dietary antioxidants). Trace minerals such as boron, manganese, copper, selenium, silicon, sulfur and zinc are known to influence connective tissue metabolism, and boron supplements have been associated with relief from joint pain and stiffness (at a dose of 6mg/day for 2 months). Boswellia serrata, curcumin (from Turmeric root), ginger, Devil�s claw and white willow, have anti-inflammatory actions similar to conventional non-steroidal anti-inflammatory medications (NSAIDs) � but without the gastrointestinal side effects common to many NSAIDs.

References:

Consumerlab.com

Here's a Consumerlab approved joint-supplement :

Contact My Nutrition Coach

Please note that all fields followed by an asterisk must be filled in.

What do you need help with?

	Setting up an online account
	Scheduling an initial informational consultation
	Schedule a Resting Metabolic Rate (RMR) Measurement
	Schedule a nutrition coaching appointment
	Request group information for my school, team or company
	Ordering the Smart Moves 7-Day Nutrition Action Guide
	Request Smart Moves Executive Coaching Course Brochure
	Other

Other/Your Comments:

Requested best day(s) for appointment:

Requested best times(s) for appointment:

Best method to follow up with you:

	Phone
	Email

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Country*
Country*

Home Phone

Business Phone

School/team/company name (if applicable):

Grade level or sport level(if applicable):

How did you hear about us?

Other/Referred By:

Please enter the word that you see below.

footer for joint-supplements page