With all the recent media scares about the health risks of the COX-2 pain drugs, I am frequently asked questions by my personal training clients about how to treat joint pain, especially arthritis. I've assembled this list of supplements that have proven to be effective in relieving joint pain. I've cited studies that support the claims for those who want to do extra research. Not every person will respond to every supplement, so give them a try and see which ones work for you.
General:
GLUCOSAMINE is an amino-sugar that is a key component of mucopolysaccharides (a complex polysaccharide group [sugar] with an amino acid group attached, occurring primarily in joints) that diminishes as we age. Some studies show new connective tissue in as little as 30 days after taking the supplement. Only the sulfate form of glucosamine has been shown to increase the rate of cartilage repair and the reduction of tissue loss in joint diseases. Glucosamine hydrochloride, by itself, has not produced sustained benefits in multiple studies. Until more is known, the sulfate variation is the best choice.
There has been some concern that glucosamine impairs blood sugar metabolism, but according to a review of two three-year studies, glucosamine does not reduce insulin sensitivity or produce any other abnormalities in glucose metabolism. There is also no evidence that glucosamine increases cholesterol levels. However, acetaminophen use seems to inhibit the benefits of glucoasmine sulfate.
1. Current Opinion in Rheumatology. 2003 Sep; 15(5): 651-5.
2. Journal of Family Practice. 2003 Aug: 52(8); 645-7.
3. Archives of Internal Medicine. 2003 Jul 14; 163(13): 1514-22.
4. Journal of Arthroplasty. 2003 Apr; 18(3 Suppl 1): 5-9.
5. Metabolism. 2001 Jul; 50(7): 767-70.
CHONDROITIN SULFATE is a component of cartilage. The supplement is recommended in the bestseller The Arthritis Cure. It may make joint fluids more slippery and help protect cartilage from breaking down. Recent studies verify beneficial effects, seeming to indicate that CS is actually used by the body to build new cartilage. Research indicates that CS acts as a powerful antioxidant and may be of benefit to those suffering from rheumatoid arthritis.
1. Archives of Internal Medicine. 2003 Jul 14; 163(13): 1514-22.
2. Osteoarthritis Cartilage. 2003 May; 11(5): 335-42.
3. Free Radical Research. 2003 Mar; 37(3): 257-68.
4. Journal of Arthroplasty. 2003 Apr; 18(3 Suppl 1): 5-9.
5. Osteoarthritis Cartilage. 1998 May; 6 Suppl A: 31-6.
MSM powder (methyl sulfonyl methane) is bio-available sulfur in a dietary derivative of DMSO (with no odor). Research suggests anti-inflammatory properties, pain relief, allergy relief, immune system improvement, and much more. Many think MSM is an essential nutrient, and that sulfur, the primary component of MSM, is a neglected element in human health. As has been noted above, it is the sulfur component of glucosamine and chondroitin that seems to impart at least some of the therapeutic benefit.
The makers of Lignisul MSM claim the following for their product:
MSM maintains the structure of proteins in the body, helps in the formation of keratin (essential for hair and nail growth), aids in the production of immunoglobulin (which maintains the immune system), and catalyzes the chemical reactions which change food into energy.
They feel these functions often lead to
* Inhibition of pain impulses along nerve fibers (analgesia)
* Lessening of inflammation
* Increase in blood supply
* Reduction of muscle spasm
* Softening of scar tissue
1. Alternative Medicine Review. 2002 Feb; 7(1): 22-44.
2. The Miracle of MSM: The Natural Solution for Pain. Jacob, S.W., Lawrence, R.M., Zucker;
1999. New York: Penguin.
3. Annals of Internal Medicine. 1993 Nov 1; 119(9): 867-73.
4. International Journal of Anti-Aging Medicine. Summer 1998; I (I): 50.
5. Federation of American Societies for Experimental Biology. 69th Annual Meeting. April 1985, p.692.
SAMe is a combination of L-methionine and ATP and is most often used to enhance mood and brain function, but also seems to relieve osteoarthritis pain, most likely due to the sulfur component.
1. British Journal of Rheumatology. 1997 Jan; 36(1): 27-31.
2. Revista Clinica Espanola. 1990 Jun; 187(2): 74-8.
3. American Journal of Medicine. 1987 Nov 20; 83(5A): 72-7.
4. International Journal of Clinical Pharmacology Research. 1985; 5(1): 39.
CETYL MYRISTOLEATE has been studied for its effect on inflammation and pain due to osteoarthritis and various auto-immune diseases such as rheumatoid arthritis and psoriasis. CM provides lubrication to the joints and bones. The waxy substance seems to have the ability to relieve inflammation while lubricating joints by acting like an essential fatty-acid, only many times more effectively. It does not need to be taken for long periods (usually only a month) or at high doses. In clinical research, injections were superior to oral doses, but oral doses still provided relief.
1. Pharmacological Research. 2003 Jan; 47(1): 43-7.
2. Journal of Rheumatology. 2002 Aug; 29(8): 1708-12.
3. Journal of Pharmacological Science. 1994 Mar; 83(3): 296-9.
GREEN-LIPPED MUSSEL. Studies show extract of Perna canaliculus from New Zealand supports healthy, limber joint function. (Patented as Lyprinol.) Contains active anti-inflammatory proteins and chondroitin sulfate. Anti-inflammatory action of this supplement also seems to benefit those with atopic asthma. Works well with glucosamine, MSM, etc., at 1-4 grams per day in divided doses with food.
1. Allergy and Immunology (Paris). 2003 Jun; 35(6): 212-6.
2. European Respiratory Journal. 2002 Sep; 20(3): 596-600.
3. Journal of Nutrition. June 2002; 132: 1634S-1636S.
SEA CUCUMBER extract. Mucopolysaccharides and chondroitins from this starfish relative are similar to natural substances present in healthy joints. It appears that anti-inflammatory relief from pain in many arthritic conditions and joint problems might occur from this variation of CS. Other research indicates powerful anti-tumor effects (apoptosis) in hormone-related cancers of the prostate and breast.
1. Journal of Biological Chemistry. 1991 Jul 25; 266(21): 13530-6.
2. Prostate. 2003 Jun 1; 55(4): 281-91.
3. Biochemical and Biophysical Research Communications. 2002 Aug 30; 296(4): 942-8.
Lipids:
OMEGA-3 FATTY ACIDS (particularly fish oil). The essential fatty acids EPA and DHA are found pre-formed in fish oil. They lower blood cholesterol and triglycerides, normalize blood pressure, and have anti-inflammatory properties. Most American adults have low DHA and EPA. Evidence is overwhelming that the omega-3 fats are as potent as pharmaceuticals in relieving inflammation and joint pain. When consuming higher doses of fish oil (up to 6 grams of combined DHA/EPA a day equals 20 or more 1000 milligram capsules) to combat arthritis pain, it is crucial to increase vitamin E intake (400-800 I.U. per day). It is also important to eliminate trans-fatty acids, minimize saturated fat, and reduce omega-6 fatty acids (other than GLA from evening primrose, borage, or black currant oils).
The anti-inflammatory effects of DHA and EPA also produce relief in rheumatoid arthritis sufferers, especially when reducing omega-6 fatty acids (arachidonic acid in particular). The benefits have been confirmed through a variety of studies over the years, yet NSAIDs are still the preferred first treatment by most physicians. If moderate- to high-dose fish oil treatment was initiated at first diagnosis, the patient’s quality of life would be greatly improved over the long term.
[DHA is also available in a vegan form.]
1. American Journal of Clinical Nutrition. 2000 Jan; 71(1 Suppl): 349S-51S.
2. Lipids. 1999; 34 Suppl: S191-4.
3. Seminars in Arthritis and Rheumatism. 1997; 27: 85-97.
4. Advances in Experimental Medicine and Biology. 1997; 400B: 589-97.
5. Rheumatic Diseases Clinics of North America. 1991 May; 17(2): 391-402.
6. Arthritis and Rheumatology. 1995 Aug; 38(8): 1107-14.
7. British Journal of Rheumatology. 1993 Nov; 32(11): 982-9.
FLAX OIL is the best vegetarian source of essential omega-3 fatty acids. Alpha linolenic acid in flax is the primary omega-3 lipid that converts to DHA and EPA in the body (the conversion rate is only 15 to 25 percent, which is why fish oil is a better source for DHA and EPA). However, flax oil also contains omega-9 fatty acids, which are known to inhibit one of the pro-inflammatory leukotrienes implicated in joint deterioration. As with fish oil, one should increase the intake of vitamin E when using high dose flax oil treatments (2 to 4 tablespoons a day).
1. American Journal of Clinical Nutrition. 2000 Jan; 71(1 Suppl): 343S-8S.
2. American Journal of Clinical Nutrition. 2000 Jan; 71(1 Suppl): 349S-51S.
3. American Journal of Clinical Nutrition. 1996; 63: 116-22.
GLA-Gamma linoleic acid from borage oil, evening primrose oil, or black currant seed oil. Noted for its anti-inflammatory properties, it is also a thermogenic brown-fat stimulator for fat loss. Research indicates that GLA can increase levels of the anti-inflammatory prostaglandin PGE1. Studies with its use in treating rheumatoid arthritis have been very successful. A combination approach of using GLA with fish oils, taken in alternate doses throughout the day, might prove highly beneficial.
1. Journal of Investigative Medicine. 1999 May; 47(5): 246-50.
2. Prostaglandins, Leukotriones, and Essential Fatty Acids. 1998 Oct; 59(4): 273-7.
3. Journal of Nutrition. 1997 Sep; 127(9): 1765-71.
4. Annals of Internal Medicine. 1993 Nov 1;1 19(9): 867-73.
5. British Journal of Rheumatology. 1994 Sep; 33(9): 847-52.
Herbs:
CURCUMIN extract from turmeric is a powerful antioxidant (actually prevents formation of free radicals as well), anti-viral, anti-inflammatory, and anti-carcinogenic supplement. The primary action seems to be the ability of turmeric to inhibit the metabolism of arachidonic acid, a pro-inflammatory omega-6 lipid, when blood levels are too high (this is common in the typical American diet).
1. Lipids. 1997 Nov;32(11):1173-80.
CAPSAICIN is often used as a topical analgesic for those suffering from muscle pain or arthritis. Its effectiveness seems to be enhanced by the addition of glyceryl trinitrate. Capsaicin offers no known healing properties -- only a reduction in pain through the reduction of local neurotransmitters responsible for the pain signal. There may also be mild anti-inflammatory action.
1. European Journal of Pain. 2000; 4(4): 355-60.
2. Lipids. 1997 Nov; 32(11): 1173-80.
3. Drugs Aging. 1995 Oct; 7(4): 317-28.
4. Journal of Rheumatology. 1992 Apr; 19(4): 604-7.
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