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Whether you experience joint pain or not, it is prudent to address the nutritional needs of cartilage and ligaments as you age. Joint-related pain can occur from injuries, spinal disk degeneration, conditions such as osteoarthritis, exercise, weight training, carrying excess weight and just from old age.
Osteoarthritis affects more than 20 million Americans and may double over the next 10 years. Drug treatments of arthritic joints are aimed primarily at alleviating symptoms, but do little to correct the underlying cause. These include taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or taking acetominophen. However, there are serious adverse effects associated with their long-term use.
Conversly, certain dietary supplements can reduce pain and also improve the structural aspects of the joint and therefore slow or perhaps prevent and reverse disease progression.
There have been numerous studies that assess the effects of different supplements on joint health, many of which have shown efficacy. Following is an overview of the science behind the most common ingredients on the market today that may promote joint health.
The two ingredients with the most scientific support are glucosamine and chondroitin. Glucosamine and chondroitin are important structural components of joint cartilage.
Glucosamine provides the building blocks for glycosaminoglycans (GAGs). GAGs, when linked together, form proteoglycans, which are major building blocks of cartilage. Chondroitin, on the other hand, is a proteoglycan itself. The theory is that glucosamine and chondroitin from supplements can be incorporated into joint cartilage to help maintain the integrity of the joint and help repair damage. Glucosamine is also thought to stimulate cartilage-producing chondrocyte cells to make new cartilage. Glucosamine also affects how much hyaluronic acid you make. Hyaluronic acid is a main GAG secreted during tissue repair.
If you think this all seems improbable, consider the results from a study where a mixture of GAGs was ingested by animals that had joint damage intentionally induced. After 6 weeks of supplementation, the animals had a significantly higher content of GAG in the damaged knee, and microscopic images revealed enhanced healing of the cartilage and joint structure. This study provides powerful evidence for the therapeutic use of glucosamine and other GAGs in the treatment of osteoarthritis and potentially other joint-related problems.
In humans, an impressive number of studies over the last 22 years have provided relatively consistent findings on the safety and efficacy of glucosamine and chondroitin for joint health.
A recent paper published in the prestigious Archives of Internal Medicine included a comprehensive analysis of randomized, placebo-controlled clinical trials that assessed the efficacy of oral glucosamine and chondroitin on signs and symptoms associated with knee osteoarthritis. After evaluating almost 2,000 patients in these studies, it was concluded that supplementation with glucosamine and chondroitin had significant structural efficacy (joint space narrowing) and provided significant symptomatic relief as determined through several standard assessments for pain and functional outcomes. The authors wrote, “…it can be definitely stated that the oral administration of glucosamine and chondroitin decreases the symptoms of osteoarthritis.”
Another critical review came to the exact same conclusion. Both reviews concluded tolerance of both compounds is excellent and not associated with adverse side effects.
Common Dose: Glucosamine – 1,500 mg, chondroitin – 800-1,200 mg taken all at once or divided throughout the day.
Another ingredient used alone or in combination with other nutrients as a pain reliever and anti-inflammatory therapy for arthritis is MSM (methylsulfonylmethane). MSM is a naturally occurring compound rich in sulfur, which is required for maintaining many essential functions. Cellular studies indicate that MSM may work through a similar mechanism as aspirin. Results of a 12-week randomized trial in patients with knee osteoarthritis showed that compared to placebo, 3 grams twice daily (6 grams per day total) of MSM significantly decreased pain and improved physical function and activities of daily living without major adverse effects.
Common Dose: 1,000-3,000 mg daily. Higher doses can cause gas, which usually subsides after your body gets used to it. There are no other known negative side effects.
Invasive studies directly examining cartilage degeneration in experimental models of osteoarthritis have shown efficacy with glucosamine and chondroitin alone, but they are even more effective when used in combination. This is why the most popular joint formulas include combinations of glucosamine (1,500 mg) and chondroitin (1,200 mg) daily taken together. Adding MSM to the combination can make for an even more effective formula.
Since chondroitin is one of the more expensive ingredients in these combinations, about 5-10 times more expensive than glucosamine, an effective economical joint formula version is glucosamine and MSM together. A 12-week double-blind clinical trial on 118 patients with mild to moderate osteoarthritis showed excellent results. Three times a day, one group took 500 mg of glucosamine sulfate, one group took 500 mg of MSM and one group took both. In the glucosamine-only group, pain scores fell from 1.74 to 0.65; in the MSM only group, pain scores fell from 1.53 to 0.74; and in the combination group, pain scores fell from 1.7 to 0.36, equaling about twice the level of improvement in pain and inflammation compared to either glucosamine or MSM alone.
Common Dose: Glucosamine – 1,500 mg, chondroitin – 800-1,200 mg, MSM – 1,000-1,500 mg daily.
Your first choice should be supplementation with glucosamine, chondroitin and MSM. Other complementary ingredients are typically found as either stand-alone products or in more robust combination joint formulas.
Microlactin contains natural milk proteins in a highly concentrated encapsulated form. These milk proteins have been shown to contain bioactive nutrients that have anti-inflammatory properties. The results of one 6-week trial showed that Microlactin was beneficial in alleviating symptoms and dysfunction in subjects with osteoarthritis of both knees.
Common Dose: 2,000 mg daily for 7-10 days; 1,000 mg thereafter. There are no known negative side effects. You should experience benefits in 1-2 weeks.
Collagen hydrolysate, from gelatin, has been shown to contribute to an increase in the production of extracellular matrix macromolecules by chondrocytes. A recent review of seven clinical studies that evaluated collagen hydrolysate found this therapeutic treatment to provide improvement in some measures of pain and function in patients with arthritic conditions.
Common Dose: 1,000 mg; may be increased up to 10 grams per day.
Vitamin C is an essential co-factor for the synthesis of collagen, proteoglycans and other components of the intracellular matrix of tissues such as bones, skin, capillary walls and other connective tissues that make up joints and the surrounding structures.
In addition to these critical functions, vitamin C has powerful antioxidant and immunomodulation effects, which make it an essential supplement for joint health. Supplementation with 1 gram of vitamin C twice per day for two weeks was more effective than placebo at reducing pain.
Common Dose: 200-2,000 mg per day.
Bromelain is an enzyme from the pineapple plant and has been demonstrated to show anti-inflammatory and analgesic properties. Several clinical trials have evaluated the effects of bromelain mixed with other enzymes in patients with osteoarthritis. Most of these studies have shown very good tolerability and efficacy comparable to that of NSAID treatment.
Common Dose: 250-2,000 mg per day.
Boswellia serrata is a common tree in India. The gum from this tree has been shown to have anti-inflammatory, anti-arthritic and analgesic effects. One 8-week placebo-controlled cross-over clinical trial studied patients with osteoarthritis of the knee, where one group ingested 333 mg of the gum three times a day. Overall, the gum was more efficient than placebo in reducing pain, loss of movement and swelling scores.
Common Dose: Around 1,000 mg per day.
Ginger extract is an herbal medication commonly used to treat osteoarthritis. A well-controlled clinical study showed reduced pain in patients with osteoarthritis who ingested ginger extract (255 mg twice per day) compared to placebo.
Common Dose: 500-1,000 mg per day.
SAMe (S-adenosylmethionine) is the body’s main methyl group donor that assists in many metabolic reactions. Besides helping with symptoms of depression, SAMe is also as effective as the more common NSAIDs in treating osteoarthritis. This could be due to its ability to stimulate proteoglycan synthesis or its anti-inflammatory effects.
In one recent 16-week study, SAMe resulted in a similar reduction in pain and improvement in functional health measures compared to NSAID treatment in patients with osteoarthritis of the knee.
Common Dose: 200 mg 1-2 times daily. Most SAMe is taken in tablet form and enteric coated to bypass stomach acids.
Celadrin contains a specialized type of fatty acid derived from bovine tallow oil that decreases inflammation. Clinical trials support the use of Celadrin for patients with osteoarthritis. In one study, two months of treatment resulted in improvement in knee range of motion and overall function in patients with osteoarthritis of the knee. Interestingly, topical treatment may also be effective at reducing pain and improving functional performance in individuals with arthritis of the knee, elbow and wrist.
Common Dose: Three 350 mg softgels or three 500 mg capsules daily. Results can be seen in 30 minutes with continuous cumulative benefits with longer-term use.
Fish oil is rich in omega-3 fatty acids. These fats have widespread health-promoting effects, especially for heart disease and diabetes. Omega-3 fats reduce inflammation and therefore have therapeutic applications for a number of diseases associated with pro-inflammatory mechanisms such as rheumatoid arthritis and other joint-related diseases.
Common Dose: Effective doses are about 300-1,000 mg of EPA and DHA from fish oil. Optimal effects may require 2-3 grams per day.
There are many other natural supplements for joint health I could write about, but I’ve covered the best and most effective ones here. Even if you are not experiencing joint pain, it’s important to provide joints with some of these nutrients to keep them functioning optimally.
The body has some ability to regenerate healthy joints with many of these natural substances, but if joints are already down to bone-on-bone contact, there is not much supplements can do. That’s why prevention is key, especially if you can catch joint pain and stiffness early and halt or slow any destructive progression with good nutrition. Being able to get to the root cause of a joint problem and correct it naturally is always preferable to just masking the symptoms with pain killers.
These supplements have great promise as safe and effective options for prevention and management of pain and symptoms of arthritis and joint-related disorders.
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