Linda Ohr

Linda Milo Ohr

People suffering from arthritis make up a major portion of the target market for joint health. Osteoarthritis, in fact, is the most common joint disease and affects 34 million people in the United States. But it is not just those afflicted with arthritis who are concerned with joint health. Athletes, both competitive and recreational, are affected by the impact of sports and other activities on their joints.Studies have demonstrated therapeutic benefits for ailing joints from a variety of nutraceutical compounds.

Glucosamine and chondroitin sulfate are two common ingredients that promote joint health and are used in today’s bars and beverages. Other nutraceuticals are emerging as well, including omega-3 fatty acids, methylsulfonylmethane (MSM), collagen, and botanicals.

Glucosamine and Chondroitin 
Glucosamine, a molecule naturally produced in the human body, is a key building block of joint cartilage and joint fluid. It is a chemical precursor of glycosaminoglycan, a major component of joint cartilage. Information in a technical paper from Fortitech Inc., Schenectady, N.Y. (phone 518-372-5155, www.fortitech.com), details some studies related to glucosamine’s benefits. For example, in a three-year randomized placebo-controlled double-blind study of the effects of 1,500 mg of glucosamine sulfate in patients with knee osteoarthritis, Czech investigators found that glucosamine sulfate slowed the progression of the condition. A similar study in Belgium also found that glucosamine sulfate prevented joint space narrowing in postmenopausal women with knee osteoarthritis.

Another popular joint health supplement, chondroitin sulfate, is extracted from animal cartilage and helps cartilage retain water. The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), a study sponsored by the National Institutes of Health, showed that the combination of glucosamine plus chondroitin sulfate appeared to help people with moderate to severe pain from knee osteoarthritis, but not those with mild pain (Clegg et al., 2006).

MSM
Methylsulfonylmethane (MSM) is believed to aid joints by delivering sulfur to the body. Glycosaminoglycans (GAGs) are the fundamental building blocks of joint cartilage, and GAG molecules are linked together in chains by disulfide bonds.

TandemRain Innovations, a developer of enhanced applications of functional ingredients, is the exclusive marketer of ActivMSM, the only GRAS-designated MSM.

A recent clinical trial showed that MSM is rapidly absorbed, uniquely modifying sulfur metabolism, and appearing to be retained in the body for extended periods of time (TandemRain, 2009). In this study, the pharmacodynamics suggested MSM functions as a sulfur metabolism modifier, promoting the apparent retention of sulfur and rapidly altering sulfur etabolism—as evidenced in changes seen with homocysteine. In addition, the study showed a single 3 g dose of MSM could impart these effects.

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ActivMSM is ideal as an ingredient in many food products including yogurts, yogurt drinks and smoothies, nutrition bars, and sports drinks and other beverages, including adult nutritional drinks. It is odorless, dissolves rapidly in liquids, does not affect beverage color or clarity, and is heat- and pH-stable.

Omega-3 Fatty Acids
Omega-3 fatty acids are believed to possess anti-inflammatory properties, making them beneficial in joint pain. Many controlled clinical studies have reported that consuming substantial amounts of fish oil leads to significant improvements in the pain, stiffness, and swelling of arthritic joints. Information from the Fats of Life newsletter (www.fatsoflife.com) reports that doses of EPA and DHA in the range of 3–6 g/day—about 9 to 18 “common” fish oil capsules—have been beneficial in many arthritic patients over the course of 3 years or longer. Increased consumption of fish oil reduces the production of several inflammatory substances and the enzymes that degrade cartilage.

Collagen
Earlier this year, Nordic Naturals Inc., Watsonville, Calif. (phone 800-662-2544, www.nordicnaturals.com), introduced Omega Joint Xtra™, a joint health supplement that provides a synergistic blend of ingredients, including 1,100 mg of EPA and DHA, 1,500 mg of glucosamine sulfate, and 40 mg of UC-II®, an all-natural, patented undenatured type II collagen from InterHealth Nutraceuticals Inc., Benicia, Calif. (phone 707-751-2887, www.internealthusa.com).

UC-II is sourced in the U.S. from chicken cartilage and is backed by clinical data showing that 40 mg a day increases joint mobility, flexibility, and quality of life. The ingredient helps the body rebuild joint cartilage and complements omega-3’s ability to support the body’s natural anti-inflammatory response for a comprehensive joint-support approach.

Crowley et al. (2009) recently showed that UC-II significantly reduced pain, stiffness, and immobility associated with osteoarthritis of the knee. Researchers showed that 40 mg of the undenatured type II collagen was more than twice as effective as 1,500 mg of glucosamine + 1,200 mg of chondroitin. Marone et al. (2010) demonstrated that UC-II, in amounts equivalent to up to 100 times the human recommended dose, was safe for use with no adverse events reported.

Another collagen-based ingredient, Fortigel®, from Gelita AG, Sergeant Bluff, Iowa (phone 712-943-5516, www.fortigel.com), stimulates the biosynthesis of collagen and proteoglycans, which together account for 95% of joint cartilage. Two studies presented at last year’s Osteoarthritis Research Society International in Montreal support Fortigel’s ability to regenerate cartilage tissue (Gelita, 2009). A clinical trial performed by Harvard Medical School and Tufts Medical Center demonstrated the efficacy of the collagen peptides on the basis of magnetic resonance images. The images clearly indicated that Fortigel stimulated the regeneration of damaged cartilage in patients. A study by the Collagen Research Institute in Kiel, Germany, showed that Fortigel accumulates in joint tissue and stimulates cell biosynthesis to produce collagen and proteoglycans. The cell experiments indicated that Fortigel induces the increased synthesis of aggrecan (an important component in cartilage) and type II collagen (which plays a key role in cartilage elasticity).

Olive Extract
Hydroxytyrosol, a polyphenol found mainly in olives, exhibits both cardioprotective benefits as well as anti-inflammatory benefits. Creagri Inc., Hayward, Calif. (phone 510-732-6478, www.creagri.com), offers Hidrox™ hydroxytyrosol, which is produced using a unique, patent-protected process. Bitler et al. (2007) demonstrated decreased pain and improvement in activities of daily living in patients with osteoarthritis and rheumatoid arthritis taking hydroxytyrosol. In the double-blind randomized placebo-controlled study, the treatment group received 400 mg of freeze-dried olive extract/day for 8 weeks. In addition to the joint health benefits, subjects with rheumatoid arthritis had a statistically significant decrease in serum homocysteine levels. High homocysteine levels in patients with rheumatoid arthritis have been associated with higher rates of mortality from cardiovascular events.

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Eggshell Membrane
Composed of naturally occurring glycosaminoglycans including chondroitin and hyaluronic acid, NEM® (Natural Eggshell Membrane) from ESM Technologies, Carthage, Mo. (phone 866-804-8034, www.esmingredients.com), also contains collagen and other beneficial proteins. The ingredient has been clinically shown to improve joint health and flexibility. In a double-blind, placebo-controlled study, Ruff et al. (2009) demonstrated that NEM is an effective and safe option for the treatment of pain and stiffness associated with knee osteoarthritis. Supplementation with 500 mg of NEM/day significantly reduced both joint pain and stiffness compared to a placebo at 10, 30, and 60 days.

Curcumin
A patented complex of curcumin with soy phosphatidylcholine, Meriva® from Indena Inc., Seattle, Wash. (phone 206-340-6140, www.indena.com), has been shown to reduce pain and improve mobility in patients with osteoarthritis (Indena, 2010). Curcumin is the yellow pigment of the spice turmeric (Curcuma longa L).

In the study, a total of 50 patients with osteoarthritis (confirmed by x-rays) were divided into two groups. Group A was managed using the best available treatment as defined by the patient’s general practitioner and by the specialists. Group B was managed using the best treatment in association with Meriva administered as a food supplement.

After three months of treatment, the global WOMAC score (used to evaluate osteoarthritis signs/symptoms) decreased by 58% and walking distance in the treadmill test was prolonged from 76 m to 332 m. In comparison, those in the control group experienced only a modest improvement in these parameters. In addition, the treatment costs (use of anti-inflammatory drugs, treatment, and hospitalization) were reduced significantly in those who consumed Meriva.

Shea Nut Extract
Extracts from the seed of the African shea tree Vitellaria paradoxa C.F. Gaertn have been used traditionally for the treatment of arthritic conditions. Cheras et al. (2009) recently showed that in patients with the highest levels of osteoarthritis biomarkers, a high triterpene shea nut extract, FlexNow® with 100% SheaFlex70™ from BSP Pharma Inc., Marmora, N.J. (phone 609-646-4100, www.powerofshea.com), had multiple beneficial activities consistent with slowing the disease process.

The human trial involving 89 participants with osteoarthritis was conducted by the Australian Centre for Complementary Medicine Education and Research. It showed an average 24% reduction in inflammation in subjects taking the active study agent and a broad spectrum of other beneficial actions including preservation of cartilage, maintenance of bone integrity, and pain relief. FlexNow reduced critical inflammatory markers including TNF-alpha, IL-6, and CRP. It also reduced the cartilage breakdown marker CTX II in addition to reducing pain levels.

Boswellic Acid
Boswellia is an Ayurvedic plant that contains anti-inflammatory triterpenoids called boswellic acids. Boswellic acids are natural, selective 5-lipoxygenase inhibitors. 5-LOX inhibitors are involved in the breakdown of arachidonic acid. PL Thomas & Co. Inc., Morristown, N.J. (phone 973-984-0900, www.plthomas.com), offers 5-Loxin® boswellic acid extract, which provides a higher concentration of AKBA, standardized to 30%. Information from the company states that in a recent human study, both 100 mg and 250 mg of 5-Loxin® daily provided improvement in joint comfort and mobility within 7 days. It positively affected biological markers associated with joint and general health, including TNFa, CRP, and IL-6 and was shown to significantly inhibit matrix metalloproteinase (MMP-3), enzymes that break down cartilage, collagen, and connective tissues.

by Linda Milo Ohr,
Contributing Editor,
Denver, Colo. 
[email protected]

About the Author

Linda Milo Ohr, Contributing Editor, Nutraceuticals column
[email protected]
Linda Ohr

References

Bitler, C.M., Matta, K., Irvinga, M., Hooka, G., Yusena, J., Eagara, F., Kirschnera, K., Walker, B., and Crea, R. 2007. Olive extract supplement decreases pain and improves daily activities in adults with osteoarthritis and decreases plasma homocysteine in those with rheumatoid arthritis. Nutr. Res. 27: 470-477.

Cheras, P.A., Myers, S.P., Paul-Brent, P.-A., Outerbridge, K.H., and Nielsen, G.V.L. 2009. Randomized double-blind placebo-controlled trial on the potential modes of action of SheaFlex70™ in osteoarthritis. 2009. Phytother. Res. doi: 10.1002/ptr.3075.

Clegg, D.O., Reda, D.J., Harris, C.L., Klein, M.A., O’Dell, J.R., Hooper, M.M., Bradley, J.D., Bingham, III, C.O., Weisman, M.H., Jackson, C.G., Lane, N.E., Cush, J.J., Moreland, L.W., Schumacher, Jr., H.R., Oddis, C.V., Wolfe, F., Molitor, J.A., Yocum, D.E., Schnitzer, T.J., Furst, D.E., Sawitzke, A.D., Shi, H., Brandt, K.D., Moskowitz, R.W., and Williams, H.J. 2006. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N. Engl. J. Med. 354: 795-808.

Crowley, D.C., Lau, F.C., Sharma, P., Evans, M., Guthrie, N., Bagchi, M., Bagchi, D., Dey, D.K., and Raychaudhuri, S.P. 2009. Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: a clinical trial. Int. J. Med. Sci. 6: 312-321.

Fortitech Inc. 2010. Strategic nutrition for bone and joint health. Technical paper, Jan.

Gelita. 2009. Latest osteoarthritis research findings: objective visual evidence that Fortigel promotes the regeneration of cartilage tissue, press release, Sept. 14.

Indena. 2010. Secret for effective use of curcumin unveiled, press release, July 26.

Marone, P.A., Lau, F.C., Gupta, R.C., Bagchi, M., and Bagchi, D. 2010. Safety and toxicological evaluation of undenatured type II collagen. Toxicol. Mech. Methods 20(4): 175-189.

Ruff, K.J., Winkler, A., Jackson, R.W., DeVore, D.P., and Ritz, B.W. 2009. Eggshell membrane in the treatment of pain and stiffness from osteoarthritis of the knee: a randomized, multicenter, double-blind, placebo-controlled clinical study. Clin. Rheumatol. 28(8): 907-914.

TandemRain Innovations Inc. 2009. Novel, rapid impact upon sulfur and homocysteine metabolism, suggesting lower dosing strategies, new uses, press release, May 12.