by Yousry Naguib, Ph.D.
Joint health issues in America cost over $100 billion annually and continue to be a common cause of disability. As the older population grows, the prevalence of joint problems is expected to increase as well.
What options do we have? A common approach is to treat symptoms with NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen.
Another option is to provide the body with what it needs to heal itself. Natural approaches may slow or halt the progression of joint degeneration, and in some cases, improve joint health. For those looking to do more than just relieve symptoms, I have provided a review of some of the most researched joint health boosting ingredients.
Glucosamine is one of the most studied and well-known joint health ingredients. It’s a constituent of glycosaminoglycans, which are found in cartilage and synovial fluid (the yolklike 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. In the same study, symptoms of joint discomfort and limitation of function significantly improved in the glucosamine group compared to placebo. The magnitude of improvement was 15% on the WOMAC (an index for joint health) for joint comfort, stiffness and physical function. My Tips:
A typical daily dose is 1,500 mg of either the sulfate or HCl form of glucosamine. It’s relatively inexpensive and should be one of your core supplements.
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 subjects with significant knee discomfort. One group of 622 subjects received either 800 mg of chondroitin or a placebo once daily for two years. The results demonstrated a significant reduction in joint space width loss in the chondroitin group compared to placebo. Furthermore, joint discomfort decreased significantly in the chondroitin group compared to placebo.
A recent systematic review from the University of Minnesota included 42 randomized control trials that assessed the effectiveness of chondroitin compared with placebo or control treatments. The authors concluded that in short term studies, chondriotin (alone or in combination with glucosamine) was superior to placebo in terms of joint discomfort. My Tips:
The most common dosage is 800-1,200 mg a day.
Methylsulfonylmethane (MSM) is made up of about 34% sulfur, the fourth most abundant mineral in the body. It supports multiple structures including the connective tissue of joints and skin, and proteins found in hair, nails and tendons. It’s also used in healing and repair processes. In one study, 49 subjects 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 symptoms of joint discomfort and physical function. In another 12-week study, 118 subjects with knee issues 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 mixture group.
In a different double-blind, placebo-controlled 12-week study on mild-to-moderate joint issues 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. My Tips:
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 is the traditional Indian spice used in curry. Research shows it can act on several proinflammatory markers such as COX-2, TNFalpha and NF-kappaB that typically rise during exercise. The active components of curcumin, curcuminoids, can fight this type of exerciseinduced inflammation, resulting in less soreness following an intense bout of exercise.
In one study, 20 healthy men who exercised regularly took 400 mg of curcumin or a placebo for four days. On the third day they performed a downhill treadmill test designed to create muscle damage. On the fifth day, compared to placebo, the curcumin group reported less thigh muscle soreness which was backed up by MRI results showing less leg muscle damage. Curcumin is poorly absorbed into the bloodstream, so manufacturers use various techniques to boost its bioavailability.
Some of the most studied forms include those combined with black pepper and those concentrated to a higher curcuminoid content (Curcumin C3 Complex®) or those bound with phosphatidylcholine (Meriva®). Once in the blood, unlike many other nutrients, curcuminoids can cross the blood-brain barrier and a study out of UCLA provided evidence that curcumin may have a potential role in supporting brain health. My Tips:
Dosages range from 200-2,000 mg a day depending on absorption qualities.
Collagen is the main structural component of the various connective tissues in humans, including tendons, ligaments, cartilage and skin. The majority of collagen in the body is type I (90% of all collagen), but type II collagen makes up 50% of all protein in cartilage. Collagen is probably most well known for its effects on skin appearance, but in recent years, type I collagen and type II collagen have been studied in relation to joint health.
BioCell Collagen® is a patented, type II collagen derived from chicken sternal cartilage. It naturally contains hyaluronic acid, chondroitin sulfate and type II collagen. BioCell has been the subject of more than 20 clinical studies (including five human clinical trials). One study evaluated 80 people with joint discomfort that took either 2g of BioCell or a placebo for 70 days. The BioCell group had significantly better results than the placebo group by day 70, and by as early as day 35, they had significantly better WOMAC scores and an improvement of physical activities as well. More recently BioCell has been studied for additional benefits on skin health.
UC-II® is an undenatured type II collagen from chicken. In a double-blind study of 52 people with an average age of 59, participants who took 40 mg of UC-II® for 90 days reduced their joint symptoms by 33%, whereas a combo group of glucosamine (1,500 mg) and chondroitin (1,200 mg) saw a 14% reduction.
Some type I collagen preparations may benefit joints, which is usually only associated with type II collagen. A certain hydrolyzed type I collagen (Peptan® brand) has been reported to improve knee function in elderly women. Researchers performed a clinical study with women who had mild-to-moderate knee issues and showed that oral intake of 8g per day of Peptan® for 6 months significantly reduced joint discomfort and improved physical mobility.
Recently, chicken bone broth drinks have also gained popularity as a way to support joints. They can provide large doses of collagen (>10g) in only one serving and at a reasonable price. New research shows that bovine sources of collagen type I and III can also provide excellent joint health results at 5-10 grams per day. My Tips:
When it comes to collagen, the specific type matters. I recommend using forms that are clinically studied for the benefits you desire. For joint health, you could take low dose, capsule formulas like BioCell or UC-II®, or you could try out powder formulas like bone broth or bovine collagen such as Peptan®. These may also provide some positive benefits to your skin, hair and nails. If you are more concerned about the beauty of your skin, hair and nails, Verisol® Collagen Peptides (type I and III) would be the clear choice as it has solid science behind it that supports these beauty benefits.
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 issues, 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. My Tips:
Besides knee health, HA can also be good for skin health and wrinkles. Typical doses are 100-200 mg a day.
Research on other joint health ingredients has shown positive results. Space doesn’t permit me to elaborate on all of them, but here are a few more. Boswellia Serratta Extract,
an ancient herb better known as frankincense, was given at a dose of 1,000 mg daily for eight weeks. The bosewellia group experienced significant benefits in joint discomfort, swelling scores and range of motion compared to placebo. Univestin®,
a patented blend of bioflavonoids from Chinese skullcap and black catechu, works on COX/LOX enzymes without gastric side effects. As little as 250 mg daily was found in a clinical trial to alleviate joint discomfort, reduce stiffness and improve mobility. Microlactin®,
a micro protein from milk, tightens up cellular junctions to help minimize white blood cell infiltration. In one six week study, Microlactin® had an effect on WOMAC scores that was similar to 1,500 mg of glucosamine, while the placebo group had no significant changes.
Omega-3s - 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 and morning stiffness. Fish and flaxseed oils are good sources of omega-3s. Celadrin®,
a patented matrix of esterified oils, works similarly to fish oils by focusing on reducing pro-inflammatory fats like arachidonic acid. After taking Celadrin® for 30 days, subjects had more flexibility, less joint discomfort and were able to walk further distances when compared to those given a placebo. Pycnogenol,
extra-strength pine bark extract, was given to 100 subjects. After taking 150 mg for three months, they had significant improvements in joint discomfort, stiffness and function. Ginger
is a popular herb that has been used for centuries. A recent study on college-age marathon runners resulted in 40% less muscle soreness in the ginger group compared to placebo. Doctors said ginger may reduce the activity of inflammatory enzymes, helping to decrease muscle soreness as a result of exercise. SAMe
is produced in the body from the amino acid methionine. One eight-week study showed a reduction in joint discomfort when participants took 400 mg three times daily. Tart cherries
contain powerful antioxidants called anthocyanins. A pilot study found that half of all subjects experienced significant improvement in joint discomfort and function after taking tart cherry pills for eight weeks. Vitamin C
protects your joints from oxidative damage and supports collagen production. In a cohort study, risk factors for joint issues were three times higher in those who were in the lowest one-third of vitamin C intake. Vitamin D
deficiency has been linked with increased levels of an inflammatory marker, TNF-alpha. Take vitamin D3 and/or get sun exposure to prevent deficiencies. Pantothenic Acid,
also known as vitamin B5, supports adrenal function and in turn, the production of adrenal hormones – your body’s natural joint comfort soldiers.
In conclusion, I suggest taking a multi-modal approach to joint health. That means taking the basic building blocks that support joint structure, as well as other ingredients that may help to bring comfort and support your joints.
Wishing you the best of health!
Yousry Naguib, senior scientist at Nutrition Express, has a Ph.D. in chemistry (Simon Fraser University, Canada). He holds 12 patents and has published over 80 scientific papers in peer-reviewed journals and articles in health and nutrition magazines.