A common approach is to treat symptoms of pain with NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen. However, NSAIDs can cause significant side effects. The FDA has even pulled some off the market because the drugs’ overall risk versus benefit profile was unfavorable.
What other options does one have? Natural approaches that focus on providing the body with what it needs to heal itself may be a better option. The ultimate goal is not only to relieve symptoms, but to halt joint degeneration progression, and in some cases, improve joint health. Here’s a review of some of the most researched joint health boosting ingredients.
Glucosamine -- Cartilage building block
Glucosamine is one of the most effective of all joint health ingredients. It’s a constituent of glycosaminoglycans, which are found in cartilage and synovial fluid (the yolk-like fluid that reduces friction between joint cartilage). Glucosamine has been shown to delay the long-term progression of knee degeneration.
Measuring joint space width—the space between bones where cartilage cushions the joints—helps researchers determine the effectiveness of various treatments. In one study, joint space width increased 0.04 mm for those taking 1,500 mg of glucosamine daily for three years, and decreased 0.19 mm for the placebo group. Also, symptoms of joint discomfort and limitation of function significantly improved throughout the study in the glucosamine group compared to placebo. The magnitude of improvement was 15% on the WOMAC (Western Ontario McMaster Universities Osteoarthritis Index) for joint comfort, stiffness and physical function.
A typical daily dose is 1,500 mg of either the sulfate or HCl form. It’s relatively inexpensive and should be one of your core supplements.
Chondroitin Sulfate -- Gives cartilage compression strength
Chondroitin sulfate is a structural component of cartilage that helps it resist compression during weight-bearing movement.
The results of a meta-analysis of three 2-year clinical trials demonstrated a small but significant reduction in the rate of decline in joint space width in patients with significant knee discomfort. A group of 622 patients received either 800 mg of chondroitin or a placebo once daily for 2 years. The results demonstrated a significant reduction in joint space width loss in the chondroitin group compared to placebo. Furthermore, joint discomfort reduced significantly in the chondroitin group compared to placebo.
The results were mixed in a 24-week study in which osteoarthritis patients took either 1,200 mg of chondroitin sulfate, 1,500 mg of glucosamine HCl, their combination, the drug Celecoxib or a placebo daily. Only in the subgroup of osteoarthritis patients with moderate-to-severe pain did the glucosamine-chondroitin combination prove to be more effective in treating joint discomfort than glucosamine alone, chondroitin alone, Celecoxib alone or placebo. The combo group experienced 25% greater relief than placebo.
The most common dosage is 800-1,200 mg a day. Chondroitin costs about 6-8 times more than glucosamine, making it one of the more expensive ingredients in many joint formulas.
MSM (source of sulfur) -- Building block of connective tissue
Methylsulfonylmethane (MSM) is made up of about 34% sulfur, the fourth most abundant mineral in the body. It supports multiple functions in the body including connective tissue of joints and skin, and proteins found in hair, nails and tendons. It’s used in healing and repair processes.
In one study, 49 patients with knee problems received 1,125 mg of MSM three times daily for 12 weeks or a placebo. The MSM group showed a small improvement in joint discomfort symptoms and physical function.
In another 12-week study of 118 patients with knee problems, subjects took either 500 mg of MSM, 500 mg of glucosamine or both three times a day. Results showed joint discomfort significantly improved in both individual groups, but improved twice as much in the combination group.
In a different double-blind, placebo-controlled 12-week study on mild-to-moderate joint problems of the knee, subjects took 3,000 mg of MSM twice daily. Compared to placebo, those taking MSM experienced statistically significant reductions in joint discomfort, and they improved their ability to perform daily activities based on WOMAC scores.
Take about 1,000-3,000 mg a day for joint health. Begin at a lower dose, as it can cause gas until your body gets used to it. MSM is also good for acne, skin, hair and nails even at doses lower than 1,000 mg. Sulfur is found in foods like eggs and cruciferous vegetables like broccoli.
Curcumin (Turmeric) -- For a healthy Inflammation response
Curcumin is the active component of turmeric—the traditional Indian spice, curry. Research shows it acts as a master switch acting on several inflammatory pathways such as COX-2, LOX, TNF-alpha and NF-kappaB. Fortunately, it doesn’t appear to work on the COX-1 enzyme, which is necessary for gastrointestinal health. Non-selective drugs can affect beneficial COX-1 enzymes and cause side effects such as stomach problems (e.g. bleeding, ulcers).
Curcumin is poorly absorbed into the bloodstream, so various curcumin manufacturers concentrate the curcuminoid content or bind curcumin with phosphatidylcholine (Meriva® brand) to boost its bioavailability—some as much as 29-fold compared to regular curcumin.
In one study, those taking curcumin for three months had their global WOMAC scores go down 58%, thereby showning significant improvement. A 2008 study out of UCLA also showed curcumin’s beneficial effect on brain plaque (beta-amyloid).
Dosages range from 200-2,000 mg a day depending on absorption qualities.
Type II Collagen -- Turn off immune system attacks
The majority of cartilage in your joints is comprised of collagen. Unfortunately, most people with joint problems have an immune system that sees exposed cartilage within the synovial lining as the enemy and attacks it. Over time, the cartilage erodes, resulting in pain. Surprisingly, researchers found chicken soup stopped the attacks. Upon further study, they found undenatured type II collagen was the active agent that desensitized the immune system and prevented further attacks. It allows the body to recognize exposed cartilage as its own and not a foreign invader.
A double-blind study of 52 people with an average age of 59 taking 40 mg of UC-II® type II chicken collagen for 90 days showed it reduced joint symptoms by 33%, whereas a combo group of glucosamine (1,500 mg) and chondroitin (1,200 mg) saw a 14% reduction.
BioCell® is another type II collagen from chicken sternal cartilage. It naturally contains hyaluronic acid, chondroitin sulfate and type II collagen. According to a recent study, 35% of subjects taking 2,000 mg of BioCell® collagen daily for 70 days had significant reductions in joint discomfort compared with only 2.5% in the placebo group.
Boswellia Serrata Extract -- Affects inflammation genes
Boswellia serrata, an ancient herb better known as frankincense, affects over 100 genes related to inflammation, including MMPs that contribute to cartilage breakdown.
In one study, a group of 30 patients were given either 1,000 mg of boswellia extract in three divided doses daily or placebo for eight weeks. The boswellia group experienced significant benefits in joint discomfort and swelling scores, and range of motion compared to placebo.
Univestin®–herb combination -- Bioflavonoids affect inflammation
Univestin is a patented blend of bioflavonoids from two herbs, Chinese skullcap and black catechu. It works on COX/LOX enzymes without gastric side effects.
In a recent clinical study, both 250 mg and 500 mg of Univestin daily were found to alleviate joint discomfort, act on stiffness and improve mobility as effectively as prescription or OTC drugs.
Systemic Enzymes / Bromelain -- Digest fibrin and bad prostaglandins
In inflamed joints, swollen tissues rub against each other and fibrin increases blood thickness and blood pressure. Systemic enzymes like bromelain (from pineapple) and trypsin, and rutosid (bioflavonoid) work by breaking down certain bad prostaglandins responsible for inflammation.
In one study, one month of 200-400 mg of bromelain supplementation resulted in significant improvement in knee discomfort and stiffness scores.
MicroLactin®–micro protein -- Affects inflammation at cellular level
MicroLactin® is a micro-protein from milk. During inflammation, blood cells that line the joints can swell and allow white blood cells to enter the joint space, causing even more inflammation and damage. This micro-protein tightens up cellular junctions to help prevent white blood cell infiltration.
In one study, 35 participants received either 2,000 mg of MicroLactin® twice daily, 500 mg of glucosamine three times daily or a placebo for six weeks. The MicroLactin® group showed significant improvement for all WOMAC scores (joint comfort, stiffness, immobility and total). The glucosamine group showed improvement in stiffness and total scores. No significant changes were noted in the placebo group.
Celadrin® (good fats)-- Cellular lubricant
Celadrin® is a patented matrix of esterified oils. It works similarly to, but much more dramatically than, fish oils by focusing on reducing pro-inflammatory fats like arachidonic acid. The specific fats in Celadrin® lubricate cell membranes, and help increase cell membrane fluidity and elasticity. It helps act on stiffened membranes.
A group of 64 patients given Celadrin® were tested after 30 days and 68 days of use. Compared to placebo, the Celadrin® group had more flexibility, fewer aches, less joint discomfort and were able to walk further distances. It has immediate and cumulative benefits.
About 1,000 mg (three softgels) of Celadrin® is an effective daily dose.
Omega-3s -- Good fats fight inflammation
Omega-3s combat inflammation in the body, while too much of certain omega-6s can increase inflammation. Therefore, the latest research suggests eating a diet rich in omega-3s. If you don't get enough omega-3s from eating fatty fish, then consider fish oil supplements.
A meta-analysis of 17 clinical trials showed that supplementation with omega-3s from fish oil for three to four months reduced joint discomfort intensity, tenderness, morning stiffness and the reliance on NSAIDs. Fish and flaxseed oils are good sources of omega-3s.
Hyaluronic Acid -- Nourishes joint fluid
Hyaluronic acid (HA) is the primary component of synovial fluid. This thick, viscous fluid lubricates joints for smooth, friction-free movement, helps absorb shock, delivers nutrients to cartilage and carries away waste.
In one study, subjects who underwent knee surgery took a combination of 20 mg of HA and 400 mg of chondroitin daily for 90 days. They experienced improved joint function and recovery time.
In another study on 20 subjects with knee problems, daily supplementation with 80 mg of HA for eight weeks appeared to be effective for decreasing joint discomfort, improving physical function, and enhancing quality of life. It’s also good for skin health and wrinkles. Typical doses are 50-100 mg a day.
More Joint Boosters
Research on other joint health ingredients has shown good results. Space doesn’t permit elaborating on them, but here are a few more.
Pycnogenol, from pine bark extract, was given to 100 patients with joint problems. After taking 150 mg for three months, they had significant improvements in joint discomfort, stiffness and function.
SAMe, in one study, when taking 400 mg three times daily for eight weeks, showed a reduction in joint discomfort equal to that of the drug nabumetone.
Tart cherries are rich in powerful antioxidants called anthocyanins. A pilot study found that half of all patients experienced significant improvement in joint discomfort and function after taking tart cherry pills for eight weeks.
Vitamin C supports collagen production.
Vitamin D deficiency has been linked with increased levels of an inflammatory marker, TNF-alpha.
I suggest taking a multi-modal approach to joint health by taking basic joint boosting building blocks with other ingredients to bring the inflammatory process back to equilibrium.