Millions of Americans suffer from joint pain related to deteriorating cartilage, and many want a magic bullet to vanish the aches and pains into thin air.

The reality is that no supplements in your store can be promoted to cure, treat or prevent illness. But, it’s safe to say that numerous nutrients can help maintain mobility and healthy joints, and your advice about them is invaluable.

Says Tim Hammond, vice president of sales and marketing for Bergstrom Nutrition, Vancouver, WA, “The question is, which products can we put our trust and money into?”

Cartilage Basics

When we talk about joint care, it’s helpful to understand the components that make up the joints and how nutrition supports their well-being. A rubbery connective tissue connects the bones and provides cushioning and support as we move around. Healthy cartilage lets the bones easily glide over each other with minimal friction and no discomfort.

“It helps to think about joint cartilage as part of your body’s shock-absorption system,” states Dan Lifton, CEO, Quality of Life Labs, Purchase, NY. “This smooth, rubbery tissue cushions the joints and helps to lessen the stress of impact as you move. Just like mechanical shocks, like those in your car, cartilage can get worn out.”

Cartilage has a mesh-like structure and contains substances that hold water. When pressure is placed on the cartilage, the fluid is squeezed out; the water returns when the pressure is lifted.

The synovium membrane produces this thick fluid, which is important for joint comfort. States Eric R. Santiago, CEO of Joint Relief Company, Port Jefferson, NY, “It has many functions, but none more than providing the elastic shock absorbing properties of the joint. Its second most important function in the joint is to carry nutrients to the cartilage and to also remove waste from the joint capsule.”

Joint cartilage can break down and cause discomfort for a variety of reasons. Says Chris D. Meletis, N.D., director of science and research at Trace Minerals Research, Ogden, UT, “Joint deterioration is always the result of excess wear and tear accompanied by insufficient repair.”

Such wear and tear can come from factors like one’s body structure (like having flat feet) or overuse from exercise. Genetic predisposition, certain autoimmune disorders and being overweight (which puts added stress on the joints) are all risk factors that contribute to the disease. “Every extra pound of weight adds five pounds of pressure on joints, so even individuals in their teens can benefit their joints in the long run if they maintain a healthy weight,” states Trisha Sugarek MacDonald, B.S., M.S., senior director of research and development/national educator at Bluebonnet Nutrition Corporation, Sugar Land, TX.

Lifton adds that diet can play a role, too. He states, “There is also increasing evidence that the inflammatory action of certain foods can worsen the pain associated with cartilage damage, according to the Physicians Committee for Responsible Medicine. In the same way, anti-inflammatory foods can reduce these problems.”

For instance, Nena Dockery, technical services manager at Stratum Nutrition, St. Charles, MO, says fatty fish, which are rich in omega-3 fatty acids “can be supportive to joint function.”

She adds that turmeric, thanks to its curcumin component, offers anti-inflammatory support, “which probably explains why persons who consume diets that include lots of this particular spice, are not as susceptible to diseases associated with chronic inflammation.”

Another issue to consider, according to Herb Joiner-Bey, N.D., medical science consultant to Barlean’s Organic Oils, Ferndale, WA, is that certain anti-inflammatory drugs can actually cause joint problems in some people. Joiner-Bey explains that these drugs can “inhibit normal functioning of chondrocytes, the cells that live within joint cartilage tissue and attempt to maintain its integrity and functionality.” To Lifton’s point, Joiner-Bey explains that poor nutrition can affect chondrocyte function, too.

The aging factor is more complicated than you might think. Dockery says, “The exact mechanisms are not completely understood; as we get older, the inflammation and subsequent damage caused by oxidative stress, as well as normal wear and tear on the joints, does not resolve as efficiently, gradually breaking down the cartilage structure.”

Suhail Ishaq, president of BioCell Technology, Newport Beach, CA, expands on this point, noting that cartilage’s deterioration over time is linked to the degradation of certain cartilage matrix molecules like collagen type II and glycosaminoglycans.

Cartilage is broken down and rebuilt throughout our lives, but the production side of the equation stops keeping pace over time. According to Timothy Mount, CN, CCMH, director of education for NeoCell Corp., Irvine, CA, “On average, collagen production declines by about 1.5% per year after the age of 25…This causes a thinning of the cartilage and can affect the stability of our joints.”

And, the end results of joint damage are not pretty, including pain, inflammation and reduced mobility.

Shoppers will be interested to know that nutrition can play a role in supporting joint health and “mitigating cartilage degradation over time,” says Ishaq.

He says supplements are key in this endeavor, and divides the category into two segments. “Most of the dietary supplements available today either work by inhibiting inflammation pathways or providing the building blocks of cartilage, which are known to stimulate cartilage renewal,” Ishaq explains.

This month, our bone and joint health series discusses the latter—supplements that support the building blocks of cartilage, as Ishaq calls them.

Next month, we will zero in on supplements that help maintain healthy inflammation levels in the joints, such as omega-3s, curcumin and many others.

Explain to shoppers there are numerous options to consider—even if they are healthy and not experiencing joint pain. “Once we enter our 40s and 50s, supporting joint health becomes important whether there is discomfort or not,” Hammond believes. Since wear-and-tear and breakdown of joint cartilage happens to everyone after a certain age, “we need to be proactive if we want to experience joint comfort and health in our golden years.”

Collagen

According to Mount, the four main components of cartilage are type-2 collagen (60%), glucosamine (15%) chondroitin (15%) and hyaluronic acid (10%). “When supporting cartilage, it makes sense to use all of these nutrients as a comprehensive support protocol,” he states.

Starting with collagen, Mount says that these interlinked protein fibers are the framework of cartilage, “much like the studs of a house.”

Dockery says there are at least 16 different types of collagen in the body, though types-1, -2 and -3 are the most prevalent. She distinguishes the three: “Most of the collagen found in the body is type-1, and it is also the main form found in bone and in the connective tissue, tendons and ligaments surrounding joint cartilage. However, cartilage tissue itself mainly contains type-2 collagen.”

Ishaq says this is an important point to stress, as there are several different types of collagens on the market. For instance, he says his company’s ingredient (BioCell Collagen) is made of 60% hydrolyzed type-2 collagen, “the bioavailable form of collagen type II that has led to several patents being awarded for its innovation.”

As for how supplemental collagen actually supports cartilage, it all goes back to Joiner-Bey’s earlier point that chondrocytes cells have the job of rebuilding cartilage after it’s broken down.

Mount explains that surface receptors on these cells look for broken fragments of type-2 collagen. “Once enough fragments of old, broken type-2 collagen stimulate the cellular receptors, the cell is ‘turned on’ to produce new cartilage,” he explains.

Over time, these collagen fragments leach out, making chondrocytes less active—and collagen produced less regularly. There’s help, though. “By taking a type-2 collagen supplement, the lost fragments are replenished and the chondrocytes are stimulated more frequently, thereby increasing the rate of new collagen production,” says Mount.

Joiner-Bey also supports this idea, noting that evidence suggests collagen may benefit people with certain degenerative joint diseases, though supplements won’t cure them. “Supplementing hydrolyzed collagen, in combination with chondroitin sulfate and hyaluronic acid, in clinical trials has reduced the joint pain of osteoarthritis,” he states.

And, Ishaq adds that some branded collagens have been found in studies to benefit those with joint discomfort. For instance, an eight-week randomized, placebo-controlled study of people with joint discomforts took 2,000 mg of BioCell Collagen daily and had as much as 40% improvement over the placebo group (1).

Another trial of 80 subjects with joint discomfort confirmed that taking 2,000 mg of BioCell Collagen daily for 10 weeks was safe and helpful for enhancing the comfort of normal movement and activity. Says Ishaq, “More than 70% of the subjects taking BioCell Collagen enjoyed a minimum of 30% decrease in joint discomfort whereas only 30% of subjects in the placebo group experienced similar results (2).”

This isn’t the only branded collagen ingredient with research support. Another undenatured type-2 collagen (UC-II from InterHealth Nutraceuticals) was recently tested in 55 individuals with joint discomfort after exercise. After 120 days of taking collagen or a placebo, researchers found that average knee extension improved and periods of comfortable exercise were extended from using the supplement; these results were not found in the placebo group (3).

In addition, data presented at the Scripps 12th Annual Natural Supplements Conference suggest UC-II improved joint pain and function more than a placebo or glucosamine/chondroitin group, according to the InterHealth website.

It is interesting to note that the firm has human clinical research supporting UC-II’s ability to support joint comfort, flexibility and mobility with just 40 mg/day.

Hyaluronic Acid

About 10% of cartilage is hyaluronic acid (HA), as Mount previously pointed out. Visualize what hyaluronic acid does for connective tissues as what an I-beam girder does to support a skyscraper, says Joiner-Bey.

Santiago says HA has the important job of supporting cartilage’s framework and separating and cushioning connective tissue to bear weight and withstand tension. “All of this is made possible because of the presence of the HA and its ability to form the gelatinous ground substance fluid,” he states, by binding to water.

Joiner-Bey says we should not take for granted that this nutrient will always be prevalent in our bodies. He says, “By age 70, body HA content has dropped by 80% from the level at age 40, predisposing loss of connective tissue integrity (e.g., skin and joints).”

Moreover, one industry company (Hyalogic) suggests on its website that joint fluid is sort of like oil in a car engine. With use, oil thins out and can’t protect metal surfaces from excessive wear as well as it did before. “Hyaluronic acid benefits our joints in the same way. As we age the viscosity of the joint fluid lessens. HA helps to maintain normal joint cushioning,” the firm states (4).

Joiner-Bey believes oral HA supplementation can increase the body’s HA stores, and suggests taking 80–100 mg of HA daily for eight weeks, with “significant reductions in pain scores and total symptom scores seen with the 200-mg dose.”

Meletis says he often uses HA with patients. He states, “Clinically, I use high molecular-weight HA to augment joint health. The body’s ability to make sufficient HA in both quantity and high molecular weight quality is inadequate to help offset the wear and tear of living life.”

Glucosamine and Chondroitin

Meanwhile, glucosamine and chondroitin contribute to making cartilage “spongy” and shock absorbent. With HA, “all three combined are much like a ‘goo’ between the structural collagen fibers,” Mount explains, noting that replenishing these three nutrients can “greatly improve cartilage health and function.”

According to Bruno, “glucosamine and chondroitin sulfate are involved in the structure and function of joint cartilage,” with glucosamine found in the cartilage matrix and in synovial fluid and chondroitin found in cartilaginous tissue, “serving as a substrate for healthy joint matrix.”

Glucosamine and chondroitin are widely recognized for contributing to cartilage repair. Mount says they work by stimulating chondrocyte cells in the cartilage to produce type-2 collagen at a faster rate, potentially contributing to tissue regeneration.

Aside from cartilage repair, Meletis says some researchers believe there is a glucosamine–mitochondria link. Mitochondria are cells’ source of energy. “Clinically, this is interesting as chondrocytes, cartilage-producing cells, need sufficient energy to get the job done. The research is preliminary as so far, nematodes have been the focus of this effect…yet I see this just as value added regardless for glucosamine.”

Sugarek MacDonald says that there is yet another way glucosamine may support joint health: by helping incorporate sulfur into cartilage. She states, “Sulfur is an essential nutrient for joint tissue where it functions in the stabilization of the connective tissue matrix of cartilage, tendons and ligaments.”

While all the mechanisms of action are still being studied, Sugarek MacDonald says research on people with mild to moderate osteoarthritis has found the nutrient to offer pain relief on a similar scale to that of nonsteroidal anti-inflammatory drugs (NSAIDs), though glucosamine is not a treatment for any disease.

In addition to being made of components like chondrocytes and type-2 collagen, joint cartilage is made of water, glycosaminoglycans (GAGs) and proteoglycans (GAGs with a protein core).

Glucosamine (naturally produced by the body) is needed to make important components for GAGs, once several biochemical reactions occur. Dockery says supplemental glucosamine can bypass some of these reactions “as long as the glucosamine can be absorbed; and it may be more readily absorbed through the intestinal wall in the form of N-acetylglucosamine, also available as a supplement.”

This process is part of why supplementation may take several weeks to months to see benefits, she states. The efficacy of both glucosamine and chondroitin are affected by their quality, Dockery adds, so be sure to ask manufacturers about and quality concerns.

Glucosamine and chondroitin are often paired up in supplements. But, why? Weiguo Zhang, president of Synutra Pure, Ltd., Rockville, MD, says, “Glucosamine’s possible efficacy is most often suggested in studies when it is used with chondroitin. Used alone, clinical evidence on glucosamine has remained marginally neutral.”

Zhang believes chondroitin may be even more powerful for joint support, and “is thought to work by slowing or stopping the degradation of cartilage in joints and gradually restoring lost cartilage.” In addition, it contains sulfur-containing amino acids, with are “essential building blocks for cartilage molecules in the human body.”

Sugarek MacDonald adds that chondroitin is thought to support joint strength, flexibility and shock absorption; it also supports “cartilage regeneration by providing the body with missing elements of cartilage.”

Like glucosamine, shoppers looking for instant gratification from chondroitin should be educated on the point that it needs time before benefits will be felt. States Zhang, “Naturally extracted chondroitin does not act like a chemically formulated pain killer compound to produce quick interventional bodily reactions. As all properly designed studies have shown, it takes time for chondroitin to demonstrate efficacy.”

But timing is everything, and there may be a point of no return where glucosamine won’t do much: “There must be sufficient cartilage and hence chondrocytes, cartilage-producing cells left to receive the nourishment,” Meletis states.

MSM

In discussing glucosamine, several experts mentioned that it helps put sulfur into cartilage, where it is critical for joint health. This essential nutrient stabilizes cartilage, tendons and ligaments, thus making joints strong, according to Sugarek MacDonald. “Due to the fact that the body utilizes and expends it on a daily basis, sulfur must be continually replenished for optimal nutrition and health.”

Some companies formulate with methylsufonylmethane(MSM), an organic sulfur. Lifton explains that MSM offers similar benefits to glucosamine, such as supporting collagen in joints.

Indeed, the two are interconnected. Meletis states that MSM provides 34% sulfur by weight, and this nutrient supports joint repair. “The sulfur can also be used to protect against free radical damage by supporting glutathione production,” he says.

Hammond says his firm’s branded MSM (OptiMSM) has been studied in combination with glucosamine. “The clinical trials on OptiMSM confirm what many doctors have known for well over a decade: that MSM by itself, and also when used in combination with other supplements such as glucosamine (5–7), is a safe and efficacious option for supporting joint health and is free of the side effects of drugs often used to treat the condition, such as ibuprofen or acetaminophen,” he states.

Santiago says this is the key reason why so many people take this nutrient: for pain support. “In many cases, the combination of glucosamine and MSM showed statistically significant decreases in pain and swelling compared with either single treatment alone.”

Joiner-Bey says that while MSM cannot cure diseases, the nutrient has shown much promise during clinical trials for alleviating joint pain in people with osteoarthritis and rheumatoid arthritis.

Hammond underscores this point, noting that data published in peer-reviewed medical journals suggest that MSM supports healthy joint function, joint stiffness and discomfort, supports a normal inflammation response, and supports healthy cartilage.

He believes the best evidence supporting MSM’s role in joint health comes from three independent, controlled clinical trials involving osteoarthritis of the knee. “All three demonstrated that MSM, when taken for as little as 12 weeks, may improve measures of joint function in arthritis of the knee (5–7),” he states. “The majority of the research available has been performed utilizing OptiMSM, the only MSM distilled for purity.”

Sugarek MacDonald explains that MSM must be purified, and companies either use crystallization or distillation for this purpose. “Distillation is a purification process of separating pure MSM from impurities and by-products of manufacturing through unique boiling points,” she explains.

More to the Story

One way to consume several joint structure-support nutrients in one supplemental form is through formulas that include natural eggshell membrane (NEM). One such ingredient from Stratum Nutrition, says Dockery, contains proteins and peptides including three collagen types plus glycosaminoglycanslike chondroitin sulfate and hyaluronic acid. It also offers some calcium. NEM has been found in three separate studies to decrease joint pain and stiffness and improve flexibility.

And, it is said to work quickly. Dockery explains, “These studies revealed that subjects taking NEM were already feeling an improvement in joint movement and a decrease in discomfort when evaluated at day 7 and day 10.” She says that 500 mg daily is considered an efficacious dose.

There are several other nutrients known to support joint structure. Judy Gray, president of North American Herb & Spice, Buffalo Grove, IL, says vitamin C aids in cartilage renewal. “The most effective vitamin C is found in wild whole food supplements,” she believes. “Purely-C (North American Herb and Spice Co.), for instance, is this type because it is more biologically active than is the synthetic. The raw spices particularly oregano, rosemary, and sage are crucial as are their oils because they build the boney foundation for the laying down of cartilage.”

She adds that raw water extracted wild chaga drops (like Chag-O-Power from North American Herb and Spice Co.) “can be taken sublingually to provide nutrients that support cartilage. The same is true of wild ChagaCream in a beeswax base.”

According to Joiner-Bey, vitamin C can have an important positive effect on cartilage loss, and adds that vitamin D deficiency is linked to an increased risk for progression of OA of the knees, especially in people under age 60. “Low serum vitamin D predicts loss of cartilage, indicated by joint space and bone spur growth.”

Dockery adds that proper calcium levels are needed for healthy cartilage tissue and synovial fluid, which “constantly bathes healthy joints and keeps them lubricated.”

Meanwhile, Lifton speaks of a branded ingredient from his company (made with Cartilast) that’s made with avocado soy unsaponifiables. Extracted from avocado and soy oils, he believes they “could protect existing cartilage while helping to build new tissue.”

The other piece to the joint health puzzle has to do with inflammation. “Several nutrients don’t necessarily contribute to joint structure, but may help with the temporary inflammation resulting from injury, or with chronic inflammation due to damage to the joint from injury or gradual wear and tear,” says Dockery.

Many individuals are impressed with the effects that certain antioxidants and anti-inflammatory compounds have had on their lives with respect to joint comfort. Items like eggshell membrane, curcumin, boswellia, omega-3s, omega-7, wild raw spices and others fall in this category. Stay tuned for next month’s installment of this bone and joint health series for more information. WF

References

1. Data presented at the International Conference of Experimental Biology, 2004, Washington, D.C.
2. A.G. Schauss, et al., “Effect Of The Novel Low Molecular Weight Hydrolyzed Chicken Sternal Cartilage Extract, Biocell Collagen, On Improving Osteoarthritis-Related Symptoms: A Randomized, Double-Blind, Placebo-Controlled Trial,” J. Agric. Food Chem. 60 (16), 4096–4101 (2012).
3. J.P. Lugo et al., “Undenatured Type II Collagen (UC-II) For Joint Support: A Randomized, Double-Blind, Placebo-Controlled Study In Healthy Volunteers,” J. Int. Soc. Sports Nutr. 10 (1), 48 (2013).
4. Hyalogic, www.hyalogic.com/main/about_hyaluronic_acid, accessed July 2, 2015.
5. P.R. Usha and M.U. Naidu, “Randomised, Double-Blind, Parallel, Placebo-Controlled Study of Oral Glucosamine, Methylsulfonylmethane and their Combination in Osteoarthritis,” Clin. Drug Investig. 24 (6), 353-63 (2004).
6. L.S. Kim et al., “Efficacy of Methylsulfonylmethane (MSM) in Osteoarthritis Pain of the Knee: A Pilot Clinical Trial,” Osteoarthritis Cartilage. 14 (3), 286–294 (2006). Epub 2005 Nov 23.
7. T.A. Pagonis, et al., “The Effect of Methylsulfonylmethane on Osteoarthritic Large Joints and Mobility,” Int J. Orthopaedics 1(1), 19–24 (2014).

Published in WholeFoods Magazine, August 2015, (online 7/17/2015)