Beneath the Skin

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Understanding Inflammation
Inflammation is defined as a defense mechanism in the body when the immune system recognizes damaged cells, pathogens and irritants (1). Inflammation is a necessary process everyone has to deal with at one point, but chronic inflammation can lead to disease and more serious conditions.

Acute inflammation has symptoms that include pain, redness, immobility, swelling and heat. However, more serious symptoms can occur with chronic inflammation including fatigue, mouth sores, chest and/or abdominal pain, fever, rash and joint pain (1).

Traditional pain relievers such as ibuprofen are made with synthetic materials and can actually cause the lining of the gut to deteriorate over time. Shailinder Sodhi, president of Ayush Herbs Inc. says, “Drugs such as ibuprofen cannot modulate their function, downregulating inflammation without any ability to decrease or cease effects.” Sodhi explains that herbs and natural ingredients change based on body chemistry and have mild (if any) side effects as opposed to conventional medications.

Recently younger generations have taken notice of joint care and preventative measures. Experts have pointed out that the mindset around this topic has shifted to maintaining a healthy lifestyle and proper supplementation. Rather than waiting until an older age to fix these issues, we can create a lifestyle to maintain health. We will explore the many natural products, remedies and trends that have been found to assist in healthy joint care.

Finding the Right Support
Antioxidants work against free radicals in the body—which can do a lot of damage. In terms of joint health, free radicals can damage cartilage, leading to joint pain and inflammation. Making sure the body gets the right dose of antioxidants through diet and supplements can reduce free radicals from oxidative stress and reduce inflammation.

Easing overall body stress is also important in regards to inflammation. Sodhi says magnesium (used in products like SupraMag) helps the nervous system function properly, in turn easing body stress. SupraMag, for example, uses elemental magnesium in the forms of dimagnesium malate, magnesium fumarate, magnesium orotate, magnesium bisglycinate and chelate buffered magnesium citrate. (Magnesium is a highly important mineral in the body that works to regulate enzymes within cells, the production and synthesis of RNA and DNA and helps balance minerals within the body.) Magnesium helps maintain energy in the body and absorption of calcium, which helps with the structural development of bones (2).

Too little of the element can lead to a deficiency, which can lead to oxidative stress. Oxidative stress can cause tissue damage, leading to inflammation and ultimately can lead to diseases like arthritis (2). Antioxidants like magnesium can help prevent oxidative stress and larger-scale issues.

A magnesium deficiency can also prevent absorption of calcium. When this happens, calcium collects in soft tissue, leading to arthritis (2). Magnesium helps the body utilize calcium properly so a balance of each is important.

Sodhi says there is a rise of magnesium and calcium supplements as studies continue to show the benefits they have on recovery of joints and muscles.

Making sure the body gets the right dose of antioxidants through diet and supplements can reduce free radicals from oxidative stress and reduce inflammation.

Ginger is a powerful anti-inflammatory with many other health benefits; it acts as an antioxidant and can boost overall immunity. Studies have shown that ginger has been effective as a pain reliever, reduces swelling and even eases joint pain from rheumatoid arthritis (3). It can be used topically, ingested through tea or in a capsule form.

Studies have shown that Boswellia acts as an anti-inflammatory and is a multi-tasking herb. By supporting a healthy inflammatory response, boswellia can reduce the severity of pain and the loss of cartilage (4). Joint support products often combine Boswellia and other efficacious ingredients together to impart the best results. Ayush Herb’s Boswelya Plus, for example, contains a proprietary blend of bromelain, glucosamine sulphate, and chondroitin sulphate sodium, with extracts of Boswellia serrata, Zingiber officinale, Withania somnifera, Curcuma longa.

Curcumin, the active constituent of turmeric is another effective and popular ingredient for supporting inflammatory response as well as pain and stiffness related to rheumatoid arthritis and osteoporosis. It has more than two dozen anti-inflammatory compounds and six different COX-2- inhibitors (5). While more research needs to be done, there is a growing body of data that supports the use of curcumin to support joint health. One single-blind, placebo-controlled study, for example, gave subjects with osteoarthritis 1,000 mg of an extract of Curcumin longa, 1,500 mg of glucosamine, a combination of both, and placebo for 42 days. Results showed that C. longa extract alone demonstrated better efficacy in improving all WOMAC subscales and total score, clinician global impression of change, joint tenderness, crepitation, effusion, and limitation to movement than the combination and placebo group (6).

A different double-blind, placebo-controlled study examined the effects of C. longa and Boswellia in combination vs. placebo on 30 outpatients with osteoarthritis for three months. Results showed that the experimental group experienced a significant improvement in pain-free walking time, pain before and after passive and active movement tenderness, and grade of knee effusion compared to placebo (6). Researchers attributed this to the reduction in inflammation and oxidative stress.

One common issue about curcumin is the poor bioavailability because it is fat soluble. That is why manufacturers specially formulate curcumin extracts to enhance their absorption. Typically, they will formulate with piperine, an alkaloid of black pepper because it improves bioavailability. Sodhi says, “Curcuminoids and the other constituents that make turmeric a healing herb are best absorbed with medium chain triglycerides and piperine.”

According to researchers, tart cherries have the highest anti-inflammatory content of any food and may therefore help individuals suffering from joint pain or more severe joint afflictions like osteoarthritis (7). This is due to its high antioxidant levels, specifically phenolic compounds, including cyclooxygenase inhibitory flavenoids and anthocyanids (7).

One randomized, placebo-controlled, double-blind trial found that even after running a marathon, tart cherry juice helped ameliorate soreness. In it, 54 healthy runners took either 355 mL of tart cherry juice or placebo twice daily. After seven days and competing in a long-distance relay, the treatment group experienced significantly less pain than the placebo group (8). Typically consumed in a concentrated juice, tart cherries can also be dried or frozen.

Omega-3 fatty acids, or fish oil has been shown to act as an anti-inflammatory and therefore pain reliever for those with joint pain, with minimal side effects (9). Fish oil generally is a good supplement for overall health, ranging in benefits from brain and heart health to eye and immune health. One reason so many people suffer from chronic inflammation is because of excess omega-6 consumption (from processed food rich in vegetable oils) compared to scant omega-3 consumption, creating an imbalance that fuels inflammation. Changing one’s diet, and incorporating omega-3-rich food as well as supplements into one’s diet can improve the overall state of inflammation in the body and therefore the joints.

Rose hips, the seed pod of roses, are rich in vitamin C and galactolipids, making them a natural antioxidant. Additionally, rose hips have been shown to decrease inflammation by inhibiting the production of inflammatory proteins and enzymes, including COX-1 and COX-2 (11). A 2018 meta-analysis revealed that rose hips powder reduced hip, knee and wrist pain by one-third in around 300 osteoarthritis patients and a 2010 trial of 89 patients demonstrated significant improvement of rheumatoid arthritis symptoms compared to placebo (10).

Joint Integrity
Glucosamine is a well-established ingredient that has been shown to ease joint pain and reduce joint erosion. It is a natural compound found in the body and can be used as a supplement in two forms — hydrochloride and sulfate. Glucosamine helps cartilage health, which naturally depletes with aging (11). Chondroitin sulfate is another popular ingredient with similar benefits. Glucosamine and chondroitin sulfate are also important building blocks of cartilage. Glucosamine is a precursor to glycosaminoglycans necessary for the formation of proteoglycans, an important constituent of cartilage and therefore important for the synthesis and repair of joint cartilage (6). Chondroitin sulfate, for its part is a glycosaminoglycan found in the proteoglycan of cartilage making it complementary to glucosamine.

Another important component of joint architecture is collagen. Heather Arment, marketing coordinator for North American Gelita, says that collagen comprises 30% of our total body protein. Collagen is important for joint health since it is the primary structural protein of connective tissues in the body. Arment shares that scientific studies have shown that for maximum efficacy collagen should be ingested orally — hence the popularity of collagen peptides. We are likely to see this trend continue as collagen protein has been named a 2018 hot ingredient, says Arment.

Collagen is important for joint health since it is the primary structural protein of connective tissues in the body.

Arment recognizes that collagen supplementation is not a one-size-fits-all solution, and different peptides offer solutions for different areas of the body. For example, Gelita’s Bioactive Collagen Peptides “maximize the stimulatory effects on specific cells in the body…and, the level of stimulation is different for varying collagen peptide compositions,” she explains. Specifically, Gelita’s FORTIGEL works to regenerate joint cartilage by stimulating the cell synthesis of chondrocytes. Arment explains that rather than treating the symptoms, their product works to tackle the root cause. “It stimulates the cartilage cells to increase the production of both collagen and proteoglycans — the two major components that make up almost 90% of cartilage dry mass.” When ingested orally, it absorbs into the intestines and accumulates in cartilage.

Collagen can be found in powder form, tablets, capsules, softgels and chews. There are at least 28 different types of collagen found in the human body, explains Suhail Ishaq, president of Biocell Technology, LLC. Types I and III coexist in tissues such as bone and skin, and account for 90% of the collagen in the human body. “Collagen type II comes from joint cartilage tissues, where it coexists with chondroitin sulfate and hyaluronic acid molecules,” says Ishaq. BioCell’s collagen is a proprietary hydrolyzed chicken sternal cartilage extract composed of a naturally-occurring matrix collagen type II peptides, chondroitin sulfate, and hyaluronic acid.

Susan Piergeorge, nutrition education manager for Nutranext, LLC says that collagen supplementation is important especially as we age and collagen production slows. “Consequently, collagen fibers in the body become brittle and begin to break down, resulting in many of the telltale signs of aging such as wrinkles, tendon injuries, and joint pain,” she says. Supplementing with collagen can help the body produce more naturally and avoid potential joint problems.

With collagen in particular, peptides are extremely versatile and can be used to mix into foods or beverages. Arment says that Gelita’s peptides are non-allergenic and have a neutral odor and taste. “They are rapidly absorbed by the body by virtually 100% and provide high bioavailability,” says Arment.

Piergeorge talks about Neocell’s different delivery formats and how they can benefit joint health. These include Joint Bursts made with turmeric, Type II collagen and hyaluronic acid which are all associated with joint health. Along with chewables, Neocell offers Move Matrix, a capsule supplement containing Type II collagen, vitamin C, MSM, chondroitin, hyaluronic acid and a blend of curcumin C3 complex turmeric root extract, ginger root extract, boswellia extract, resveratrol, pine bark extract and BioPerine black pepper extract. Piergeorge says that in addition to the chewables and capsules, Neocell also offers powders and liquids which all promote healthy joint function.

Prevention is Key
As with anything, a healthy diet, exercise and lifestyle in general is prevention to many potential health issues. Along with a healthy lifestyle, Ayurveda and other herbs are beneficial to prevent inflammation in general. Sodhi says this maintenance is important because “reducing issues such as chronic inflammation allows the body to efficiently and appropriately respond in times of acute inflammation, such as injury or general wear and tear of the body due to exercise.”

Many people stress the joints excessively, especially with exercise. Sodhi says being mindful of our body mechanics is another key to prevention. “Exercise shouldn’t hurt or feel strange in our bodies,” he says. “If people are not sure if they are using biomechanics in their bodies, they should reach out to resources to protect the body from avoidable injury.” Injuries will always happen, but we can work to reduce the chances of one.

Besides supplements for prevention, diet can play a huge role in keeping the immune system healthy. According to Harvard Health, certain foods that inflame include refined carbs, fried foods, sweetened beverages and red meat and processed meat. Generally foods considered bad for us fall into these categories. Many of these foods also cause weight gain, which can increase inflammation as well. Anti-inflammatory foods include tomatoes, olive oil, green leafy vegetables, nuts, fatty fish and fruits. Eating a Mediterranean diet is recommended to combat inflammation (12).

Ishaq adds that consumers and brands are looking for natural alternatives backed by clinical studies. “Consumers are increasingly becoming aware of science-based ingredients, so they look for those ingredients when they shop or research ingredients online,” he says.
“What’s interesting is if you look at trends you will see that there is interest in maintaining joint health across the age span from millennial to baby boomer,” says Piergeorge.“ Consumers are also looking for quality and ingredients that are science-based,” she adds.
You can advertise healthy joint care to all age groups and stress the importance of prevention and maintenance. WF

References
1. Christian Nordqvist, “Everything you need to know about inflammation,” https://www.medicalnewstoday.com/articles/248423.php
2. Natural Arthritis Treatments, “4 Benefits of Magnesium for Arthritis,” https://www.naturalarthritistreatments.net/arthritis-in-general/magnesium-for-arthritis
3. Healthline, “Ginger for Arthritis: Should I Give It a Try?” https://www.healthline.com/health/ginger-for-arthritis
4. M.Z. Siddiqui, “Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309643/
5. Arthritis Foundation, “Turmeric,” https://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/guide/turmeric.php
6. K.Y. Chin. “The spice for joint inflammation: anti-inflammatory role of curcumin in treating osteoarthritis.” Drug Des Devel Ther. 10: 3029–3042. 2016.
7. Grace Rattue, Osteoarthritis Patients May Benefit From Drinking Tart Cherry Juice,” https://www.medicalnewstoday.com/articles/246114.php
8. K.S. Kuehl et al. “Efficacy of tart cherry juice in reducing muscle pain during running: a randomized controlled trial.” J Int Soc Sports Nutr. May 7(7). 2010.
9. Maroon JC, Bost JW, “Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain,” https://www.ncbi.nlm.nih.gov/pubmed/16531187
10. Arthritis Foundation, “Rose Hips,” https://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/guide/rose-hips.php
11. WebMD, “Is Glucosamine Good For Joint Pain?” https://www.webmd.com/vitamins-and-supplements/supplement-guide-glucosamine
12. Harvard Health Publishing, “Foods that fight inflammation,” https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation

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