As a young adult, I’m sure you heard elders complain about stiff, aching joints or even worse, heard from your grandparents just how awful the onset of arthritis can be. With young, healthy and functioning joints, it’s often easy to forget just how much we move on a daily basis and how an imperfection in joint function can be a painful hassle. From long-term use, injury, joint repair via surgery or simply growing older, our joints break down over time and with that comes discomfort, pain and eventually restrictions in mobility due to pain and inflammation.
Now, while most only think of Senior citizens when it comes to joint support, as a healthy, active individual, it is important to take care of some of the most crucial elements in our body that allow us to be active. Intense, heavy training and repetitive usage can put wear and tear on the body beyond what it is designed for. Inflammation, longer recovery time and an overall feeling of being more ‘broken down’ can result sooner rather than later if we aren’t careful. With proper joint support supplementation, we can address this issue head on. With proper joint supplementation should address chronic inflammation and joint lubrication to provide the best possible scenario for improving joint function and comfort. To better address this, we first must understand what the popular ingredients in today’s joint support actually do and if they have the research back their effectiveness.
Joint Supplements: The Ingredients
There are so many different joint supplements on the market today, so the most logical way of approaching this subject is to take a closer look at the ingredients that make up joint supplements, covering the most popular ones as well as some of the latest and cutting-edge ones.
Classified as an aminosugar that is naturally occurring and extracted from shellfish, glucosamine is found in most of the tissues of the body with it being specifically high in joints and cartilage. It is possibly the most widely used supplement for joint support with a staggering 59% of those that take supplements for osteoarthritis reporting use of this ingredient (1). Interestingly, the most popular form of glucosamine is Glucosamine Hydrochloride, however when it comes to clinical data it appears to exert no benefit compared to supplementation with Glucosamine Sulfate (2).
Despite popular use, glucosamine has recently been shot down in many circles in its efficacy as a joint support supplement. The reason it became popular to begin with was that in vitro, it was thought to act as a substrate of collagen synthesis. However, in further research, serum levels detected that it realistically contributes to less than 2% of total synthesis in cartilage, making it less plausible that it has a benefit (3).
The bottom line when it comes to glucosamine is that there is a large division between results in research studies. Independent studies tend to show less promising results while some that have positive benefits are regarded as having a conflict of interest when it comes to the source in regard to providing joint support for existing conditions. The biggest benefits with glucosamine supplementation (specifically glucosamine sulfate) is that it appears to delay the progression of hip/kneed osteoarthritis and provide analgesic effects, though to what degree is debatable. That means that if you have a pre-existing condition, glucosamine sulfate can prevent it from getting worse, but it isn’t promising in helping alleviate or improve symptoms.
A major constituent of cartilage and connective tissues, chondroitin is a glycosaminoglycan. It is also found in the gastrointestinal tract in moderate amounts and functions to help add lubrication by retaining water. In supplemental form, it is either derived from animal cartilage or synthetically engineered. The synthetic version is the sulfate form and has mineral salts bonded to it that improve absorption (4).
Purported to help increase joint performance and reduce joint pain via increased joint lubrication, it is often found paired with glucosamine. Despite its popularity, like glucosamine, it is often regarded in modern scientific circles to have a large degree of uncertainty as to whether or not it exerts any real-world benefit. When studied independent of other compounds, results indicate that it there isn’t any significant data for improvement. Most studies reporting a benefit suffer from subpar study design or inadequate sample size to provide accurate data (5).
Methylsulfonylmethane, known commonly as MSM is an oxidized form of dimethyl sulfoxide that is naturally occurring in a variety of green vegetables and animal products. It has been shown in vitro to have anti-inflammatory properties by inhibiting cytokine secretion and in rat studies to reduce arthritic symptoms and markers of damage (6). In human trials, the results are less promising, showing results that resemble that of glucosamine in having a wide degree of variability regarding effect size with even less substantial evidence (7). In general, it can be used as a mild anti-inflammatory product or for anti-oxidant properties, but the magnitude as a joint health supplement isn’t statistically significant.
Known formally as diferuloylmethane, curcumin is the main active ingredient and predominant curcuminoid compound found in the well-known Indian spice Turmeric. By itself, it is poorly absorbed with it being noted in literature that up to 8,000mg can fail to significantly raise serum levels, so it is important that it is consumed with black pepper extract (piperidine specifically) to make it bioavailable (8).
Curcumin has been used for a long time when it comes to pain relief and appears to have acute analgesic (pain relieving) properties comparable even to 1,000mg of acetaminophen in a lecithinized form (9). It also holds promise for being used as a post-operative pain management element comparable to some reference drugs impressively (10).
Now, when it comes to improving joint health, the primary and most thoroughly studied mechanism is that of managing inflammation via cytokine modulation and suppression of macrophage activation and recruitment to inflammation sites (11). There are many inflammatory signals associated with arthritis and joint inflammation and it has been shown that it can be just as potent as indomethacin at treatment (12). It has also been demonstrated in research to reduce total symptoms of knee osteoarthritis as much as 41% compared to baseline values with improvements in pain, stiffness and overall function (13). Lastly aside from the general anti-inflammatory properties exhibited by curcumin it shines as an anti-oxidant with research indicating the markers SOD, glutathione and catalase all increased to a large degree with use (14).
The informal name of Withania somnifera is a traditional Ayurvedic herb that is further classified as rasayana due to its general use as a tonic and classification as an adaptogen (15). The active components are steroidal lactones (withanolides and withaferins) known as withanolide structures along with a variety of bioactive polysaccharides and alkaloids (isopelletierine, anaferine, cuseohygrine, anahygrine) (16). It has been traditionally used for applications including but not limited to analgesic, astringent, antispasmodic, and immunostimulant. Additionally, it has seen expanded use for applications in reducing inflammation, anxiety, stress fatigue and cardiovascular contraindications (17).
Ashwagandha has been shown in academic research to support a wide variety of beneficial applications because of its hypothesized healing properties as an anti-inflammatory and anti-oxidant catalyst (18). As an adaptogenic herb, it has demonstrated a strong efficacy in stabilizing the body’s natural stress response in both chronic and acute situations in both animal and human models (19). It has also been shown to offer pain reduction and rheumatoid arthritis for clinical populations, which has been an emphasis in studies the last few years (20). Ashwagandha has shown promise in helping treat Type II diabetes (21), reduce fatigue (22), and there is even potential evidence that it supports cancer treatment, though this is ongoing areas of research with more data on human subjects needed (23).
A traditional Ayurvedic herb used in a wide range of locations around the world, Cissus is used in a variety of applications including menopause, increasing bone mass, accelerating fracture healing, anti-ulcer and analgesia. Interestingly, there is also data indicating that there may be a sedative effect along with muscle relaxation at high doses (24).
Specifically, when looking at research indicative of joint and bone health, quite frankly the studies are limited and anecdotal but promising. One study found that there is an increase in the function of the joints that appears to occur alongside reductions in perceived pain and soreness when Cissus treats athletic joint pain. Note that while the magnitude is not remarkable (respectable compared to other supplements) the fact remains that it seems to be one of the few validated in athletes with nonpathological joint pain (25).
One of the newer ingredients to gain popularity in the realm of joint health is calcium fructoborate, a sugar-borate ester that is found in abundance in fresh fruits and vegetables and is a source of soluble boron. It includes three forms of borate: diester, monoester and boric acid with all three being biologically active. It is considered to be superior to boric acid and borate alone as it has a protective effect against the body’s natural inflammatory response (26).
They have been shown to provide support against the discomfort and lack of flexibility associated with arthritis and joint degeneration, and improves Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and McGill indexes (27). In addition, orally administered calcium fructoborate is effective in relieving symptoms of physiological response to stress, including inflammation of the mucous membranes, discomfort associated with osteoarthritis disorders, and bone loss, and also for supporting cardiovascular health (28).
Type II Collagen – Hydrolyzed & Undenatured (including UC-II)
Popular in today’s supplement word in the way of joint support, as well as hair skin and nail health, is collagen. There are two forms available to consumers and they include undenatured and hydrolyzed collagen.
When examining each, we’ll start with hydrolyzed collagen (also known as collagen peptides). This collagen has been processed via hydrolysis and is rich in amino acids with research supporting its efficacy for promoting the health of connective tissues by supporting strength and elasticity (29). Further research has supported hydrolyzed collagen for the increase in size and strength of the collagen fibrils in the Achilles tendon, further supporting the idea of improving connective tissue health (30). Regarding joint support, the data isn’t a strong with this collagen form, however.
Undenatured collagen such as the branded UC-II is a particular type of collagen prevalent in humans and is specifically supplemented for reduction of joint pain and arthritis (31). Sources rich in this type of collagen include shark and chicken sternum (specific to UC-II). It can also be derived from bovine articular cartilage but this is a frowned upon source due to concerns with bovine spongiform encephalopathy (known commonly as Mad Cow Disease). It exerts anti-inflammatory effects in the body via the immune cells in the intestines. Through these receptors, it triggers a change in T-Cells to take on an anti-inflammatory form, resulting in less inflammatory cytokine activity (32). This also exerts an analgesic effect, specifically on joint related inflammatory pain (33).
Summarizing, between the two, if the goal is to improve joint comfort and manage symptoms of inflammation, undenatured collagen is the sounder route specifically for this purpose.
Yet another Ayurvedic herb used in traditional Chinese medicine, Boswellia Serrata (known simply as Boswellia by most), is a potent anti-inflammatory. The inflammation inhibition is thought to be accomplished through the enzyme 5-Lipoxygenase (34). Impressively, Boswellia has been shown to suppress pain and improve mobility associated with osteoarthritis in as little as a week (35). Used in supplemental form, Boswellia has some of the most impressive capabilities and has seen a spike in usage in recent years for the purpose of anti-inflammatory properties
What to Look for in A Joint Support Formula/What to Expect?
When it comes to selecting a joint supplement, there are a lot of variables that can come into play. Keeping it simple, however, your best bet is to select one with research-backed ingredients that address both inflammation and joint lubrication. Below we’ve included a summary based on ingredients we discussed earlier along with their branded ingredient names.
- Curcumin (also seen as Bio-Curcumin and CurcuWin)
- Calcium Fructoborate (also seen as Fruitex-B)
- Ashwagandha (also seen as the branded KSM-66)
- Boswellia (also seen as ApresFlex)
- Undenatured Collagen (also seen as UC II)
- Cissus Quadrangularis
- Glucosamine Sulfate
Now, no matter what joint support supplement you choose, there are a few things to keep in mind when you start using it. First and foremost is that even the most potent of the bunch take time to work. If you are in a constant state of inflammation, the body needs time to reduce that inflammation and thus have the resulting effect in alleviating joint discomfort caused by it. Typically, the longer you use the joint support supplement, the better it works and will continue to work as a byproduct of inflammation management.
The other thing to consider is that a supplement can only do so much. Joints are a high-wear area of the body and it is natural for them to break down as we age, with injury and with heavy usage. No matter how good a joint supplement is, there is the likelihood that a joint will never be 100% again. However, with supplementation and realistic expectations, joint supplements can and will help make those achy joints more comfortable and reduce the pain and stiffness associated with such conditions.
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- Is there any scientific evidence for the use of glucosamine in the management of human osteoarthritis? Henrotin, Y.1, 2012, Athritis Res Ther, Vol. 14.
- Low levels of human serum glucosamine after ingestion of glucosamine sulphate relative to capability for peripheral effectiveness. Biggee, B.2, February 2006, Ann Rheum Dis, Vol. 65, pp. 222-6.
- Biochemical and pharmacokinetic aspects of oral treatment with chondroitin sulfate. Conte, A.8, August 1995, Arzneimittelforschung, Vol. 45, pp. 918-25.
- Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. McAlindon, T.11, March 2000, JAMA, Vol. 283, p. 1469.
- Involvement of reactive oxygen intermediates in cyclooxygenase-2 expression induced by interleukin-1, tumor necrosis factor-alpha, and lipopolysaccharide. Feng, L.4, April 1995, J Clin Invest, Vol. 95, pp. 1669-75.
- Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: a randomized controlled study. Debbi, E.50, June 2011, BMC Complement Altern Med, Vol. 11.
- Dose escalation of a curcuminoid formulation. Lao, CD.10, March 2006, BMC Complement Altern Med, Vol. 6.
- Comparative evaluation of the pain-relieving properties of a lecithinized formulation of curcumin (Meriva(®)), nimesulide, and acetaminophen. Di Pierro, F.March 8, 2013, Vol. 6, pp. 201-5.
- Efficacy of turmeric (curcumin) in pain and postoperative fatigue after laparoscopic cholecystectomy: a double-blind, randomized placebo-controlled study. Agarwal, K.12, 2011, Surg Endosc, Vol. 25.
- Critical need for clinical trials: an example of a pilot human intervention trial of a mixture of natural agents protecting lymphocytes against TNF-alpha induced activation of NF-kappaB. Dominiak, K.6, 2010, Pharm Res, Vol. 27.
- Anti-inflammatory and anti-oxidant properties of Curcuma longa (turmeric) versus Zingiber officinale (ginger) rhizomes in rat adjuvant-induced arthritis. Ramadan, G.4, August 2011, Inflammation, Vol. 34, pp. 391-301.
- Efficacy and safety of Meriva®, a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients. Belcaro, G.4, 2010, Altern Med Res, Vol. 15, pp. 337-44.
- Diverse effects of a low dose supplement of lipidated curcumin in healthy middle aged people. DiSilvestro, R.79, September 26, 2012, Nutr J, Vol. 11.
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- A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Chandrasekhar, K.3, July 2012, Indian J Psychol Med, Vol. 34, pp. 255-62.
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- Effect of Withania somnifera (Ashwagandha) on the development of chemotherapy-induced fatigue and quality of life in breast cancer patients. Biswal, B.4, July 2013, Integr Cancer Ther, Vol. 12, pp. 312-22.
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- The anticonvulsant and sedative properties of stems of Cissus quadrangularis in mice. Bum, N.3, May 2008, African Journal of Pharmacy and Pharmacology, Vol. 2, pp. 42-7.
- Cissus quadrangularis reduces joint pain in exercise-trained men: a pilot study. Bloomer, R.3, September 2013, Phys Sportsmed, Vol. 41, pp. 29-35.
- Calcium Fructoborate for Bone and Cardiovascular Health. Mogosanu, G.December 2016, Biol Trace Elem Res, Vol. 172, pp. 277-81.
- Short-term Intake of Calcium Fructoborate Improves WOMAC and McGill Scores and Beneficially Modulates Biomarkers Associated with Knee Osteoarthritis: A Pilot Clinical Double-blinded Placebo-Controlled Study. Reyes-Izquierdo, T.October 2011, American Journal of Biomedical Sciences, Vol. 4, pp. 111-22.
- Oral resveratrol and calcium fructoborate supplementation in subjects with stable angina pectoris: effects on lipid profiles, inflammation markers, and quality of life. Militaru, C.1, January 2013, Nutrition, Vol. 29, pp. 178-83.
- Lodish, H.Collagen: The Fibrous Proteins of the Matrix. Molecular Biology. New York : W. H. Freeman, 2000.
- Effects of ingestion of collagen peptide on collagen fibrils and glycosaminoglycans in Achilles tendon. Minaguchi, J.3, Tokyo : s.n., June 2005, J Nutr Sci Vitaminol, Vol. 51, pp. 169-74.
- Effects of orally administered undenatured type II collagen against arthritic inflammatory diseases: a mechanistic exploration. Bagchi, D.3-4, 2002, Int J Clin Pharmacol Res, Vol. 22, pp. 101-10.
- Undenatured type II collagen (UC-II®) for joint support: a randomized, double-blind, placebo-controlled study in healthy volunteers. Lugo, J.48, 2013, J Int Soc Sports Nutr, Vol. 10.
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- A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Sengupta, K.4, 2008, Arthritis Res Ther, Vol. 10.
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