by Thomas Incledon, PhD(c), RD, LD/LN, RPT, NSCA-CPT, CSCS
There are many products sold over-the-counter that promise relief from joint pain. Organizations such as The American College of Rheumatology, The Arthritis Foundation, and The National Institute of Health are currently engaged in research on many of these products and their impact on osteoarthritis (OA). This article will examine the most popular supplements that are currently in vogue as therapeutic aids for people afflicted with joint pain.
Starting Off Right
Joint pain can be due to a number of reasons: injury, inflammation, rheumatoid arthritis, and osteoarthritis, just to name a few. An important first step is finding out what exactly is causing the pain. Once a physician makes an official diagnosis, then a therapeutic strategy can be developed. This is important, as the consequences can be severe. As an example, the estimated number of people in the United States that will be afflicted with arthritis or some other rheumatic disease will reach 60 million in the near future [1]. The presence of these conditions may reduce leisure time physical activity and establish a pattern for individuals to develop other diseases such as obesity, cardiovascular disease, and diabetes. Over time, joint pain that is not resolved can set an individual up to acquire one or more of these diseases.
Advertising bombards us with information about how supplements may help reduce joint pain. After listening or reading these ads, it’s easy to get confused. It is especially easy for people to become gullible to advertising claims when they are in pain. The frustration of not being able to do what is normally easy can make one willing to try anything. Consider that if most products actually worked, then no one would have joint pain. Sometimes the solution can be simple, yet easily overlooked. For people who are overweight and have OA, there is ample evidence that just by reducing bodyfat and increasing their physical activity they can reduce joint pain [2]. In this case, only simple lifestyle modifications for diet and physical activity were needed. After finding out what is causing the problem, simple solutions like those above may be all that is needed to put an end to painful symptoms.
Sensible Nutrition Never Hurts
The media is filled with the latest buzzword: antioxidants. Antioxidants are being touted as the cure-all to many maladies. The various naturally occurring antioxidants can decrease free radical production, which is being explored as a possible way to treat certain types of joint pain. So far this approach has been largely unsuccessful against rheumatoid arthritis, while success against heart disease, cataracts, and some cancers has been reported [3]. Additionally, studies consistently report that diseases are inversely related to consumption of fruits and vegetables. Fruits and vegetables may not provide relief from joint pain directly, but they are certainly valuable tools against other diseases and symptoms. This is not a campaign for vegetarianism, and this doesn’t mean that you should get stuck eating the same foods every day. Don’t be afraid to consume dairy foods and animal meats, too, because these are excellent sources of minerals and protein. Just make sure that you control what you eat so the consumption of excess calories, saturated fat, and/or simple sugars is avoided. One cost-effective way to get lots of vitamins and minerals is by consuming fruits and vegetables, whether they are fresh or frozen. This will supply plenty of antioxidant vitamins like E and C and other healthy phytonutrients. Each day you should try to consume at least 2-3 servings of each.
Vitamin Supplements
The vitamins that are routinely sold for those suffering from joint pain are vitamins A, C, D, and E. This is based mostly on evidence that people who consumed more of these vitamins through their diet had a lower incidence of OA. These nutrients are important to the body because they allow cells to deal with oxidative stress and participate in immune responses. If you are following the dietary advice previously mentioned, then you are already getting plenty of these nutrients. The issue is whether more of these nutrients will have a therapeutic effect to reduce joint pain. Most studies address the effects of these vitamins on an individual basis for conditions such as osteoarthritic joint pain. While this may be appropriate for defining how these nutrients work, practically this tells us very little since most people consume these nutrients with other nutrients, either as part of the food they eat or as a supplement. At this time there is not enough evidence to indicate that the vitamins A, C, D, or E taken either alone or together will reduce joint pain. However, there may be other reasons for people to supplement with the above vitamins, such as decreasing cardiovascular disease risk factors (vitamin E), decreasing the harmful effects of smoking (vitamin C), and helping to prevent osteoporosis (vitamin D). A well-balanced diet will provide many of these nutrients, so the benefits of additional supplementation are questionable. There are cases where supplementation may be warranted. Older people avoiding milk and/or direct sunlight on their skin are prime candidates for vitamin D. If they are ingesting vitamin D fortified milk products and/or getting direct sunlight (to synthesize vitamin D in their skin), then supplementation would be unnecessary.
Cetyl - Myristoleate
Cetyl myristoleate is a supplement that has recently been promoted to offer relief from joint pain. The story behind this substance is as follows. Some Swiss albino mice were immune to an arthritic condition that could be induced in rats [4]. Scientists from the National Institute of Health isolated a substance called cetyl myristoleate (CM) from these mice. CM can also be synthesized from cetyl alcohol and myristoleic acid. The scientists then injected this substance into rats that were susceptible to arthritis and found they were protected. Another substances, cetyl oleate, gave less protection, while cetyl myristate and cetyl elaidate were virtually ineffective.
It doesn’t take a rocket scientist to figure out that there are numerous problems trying to apply the above research. First, this is only one study. Second, the subjects were rats, not humans. The rats were made arthritic via injections of something called Freund’s adjuvant, which causes arthritis in rats. For the rats to develop arthritis, the dose of Freund’s adjuvant and the location of injection are critical. Third, scientists don’t know if this condition is exactly what arthritic patients suffer from. The rats were protected due to injections of CM. To believe this will work in humans, you have to accept that rat injections will equate to humans ingesting capsules, and at this point in time, that is a hard story to swallow. Since scientists have no idea what will happen if people start taking this orally, it would be prudent to wait until more is known about this supplement before taking it.
Glucosamine and Chondroitin
Several scientific review articles published in respectable peer-reviewed journals have favorably reviewed glucosamine and chondroitin as working significantly better than a placebo [5-7]. However, medical groups and organizations are still hesitant to recommend glucosamine and chondroitin. The main reason is that these supplements are sold-over-the-counter and the quality and purity are not well controlled. In addition, there is still a lack of long-term data on the side effects of these agents in humans, and data from animal studies raises the concern of glucosamine inducing insulin resistance [8, 9]. Diabetics and obese people are two groups that may want to consider having their glucose levels monitored while taking glucosamine.
Most studies have used these agents separately. Recently however, the combination of 1500 mg glucosamine hydrochloride (HCl), 1200 mg chondroitin sulfate (SO4), and 228 mg manganese ascorbate was given each day for eight weeks and was shown to be effective against degenerative joint disease of the knee or low back [10]. Evidence from research on dogs indicates that lower molecular weight versions of the chondroitin may prove more beneficial [11]. If you decide to try these products, both HCl and SO4 versions are absorbed about the same. You get more glucosamine or chondroitin for the same amount of milligrams in the HCl version. This does not necessarily mean the glucosamine HCl is better than glucosamine SO4, only that a 500 mg capsule of the HCl version has more glucosamine in it.
Ginger Root or Ginger Extract
Some companies have sold ginger root products for the treatment of OA. These products are marketed as promoting joint health. There are some limited studies on animals and cell cultures. A scientific study of ginger extract in humans with OA of the hip or knee was recently published [12]. Ginger extract was compared to both a placebo and ibuprofen. Subjects were exposed to one of the three treatments for three weeks. A one-week wash-out period was followed and then subjects were crossed over (switched) to another treatment. The order of treatments was randomized and at the end of the study, the treatment periods were compared. Using a pain scale test, the results indicated that ibuprofen was better than ginger extract, which was better than a placebo. Interestingly, both ibuprofen and ginger extract worked better than a placebo during the first treatment. However after crossover, no significant effects were found for either ginger extract or the placebo. It may be wiser to hold off on ginger until there is more convincing evidence.
Methylsulfonylmethane (MSM)
MSM is a dietary sulfur supplement that has received lots of media attention. Supplement companies claim that it reduces inflammation and other symptoms associated with joint pain. A recent review of medical databases reveals that there are no scientific published studies on the effects of MSM on joint pain in humans. Long-term, double blind, placebo controlled studies involving large numbers of patients to assess the efficacy, safety, and long-term benefits need to be done on this product because it is quite popular. So the question is: why all the fuss over it? The answer lies in the fact that several patents claim that MSM can be used for a number of purposes, including the reduction of inflammation and joint pain. So far the only published evidence of this in a scientific journal is one study that used mice [13]. While MSM has a history of use with horses and appears to be safe according to patent claims, there are lots of unanswered questions. Without studies to indicate what the proper doses are, consumers are left to use trial and error. Unfortunately, this may have unforeseen consequences.
S-adenosyl-methionine (SAMe)
SAMe is another naturally occurring sulfur compound. It is present in every cell of the body and is produced from methionine, a sulfur-containing amino acid, and adenosine triphosphate (ATP), an energy-producing compound. Research so far utilized intravenous delivery to study the effects on joint pain due to osteoarthritis in humans [14]. There is evidence that it can be taken orally, yet so far no studies have been published in the United States on the effects of orally administered SAMe on arthritic joint pain. In Europe, it is used as a prescription medication to treat arthritis and depression [15]. It appears safe, yet more research could help determine appropriate therapeutic dosages.
Last Minute Review
The agents reviewed in this article were selected because of their popularity. Many of them show promise to actually reduce joint pain. However, the current scientific evidence is weak for most of these products. Surely, more research is needed. Future studies need to address dosages, duration of treatment, side effects, and safety of these products. Presently there is poor quality control of these agents in the United States. Supplement companies need to establish safe and accurate methods of producing these products in accordance with current standards as defined by the US Pharmacopoeia. If you decide to use any of these products, first make sure that you have met with a physician and have discussed your options regarding the use of any of these supplements. Most importantly, remember that simple solutions like losing excess weight and exercise are very helpful in the treatment of joint pain.
References:
1. Anonymous, Update: prevalence of overweight among children, adolescents, and adults—United States, 1988-1994. MMWR - Morbidity & Mortality Weekly Report, 1997. 46(9): p. 198-202.
2. Toda, Y., et al., Change in body fat, but not body weight or metabolic correlates of obesity, is related to symptomatic relief of obese patients with knee osteoarthritis after a weight control program. Journal of Rheumatology, 1998. 25(11): p. 2181-6.
3. Ward, J., Free radicals, antioxidants and preventive geriatrics. Australian Family Physician, 1994. 23(7): p. 1297-301, 1305.
4. Diehl, H.W. and E.L. May, Cetyl myristoleate isolated from Swiss albino mice: an apparent protective agent against adjuvant arthritis in rats. Journal of Pharmaceutical Sciences, 1994. 83(3): p. 296-9.
5. Towheed, T.E. and M.C. Hochberg, A systematic review of randomized controlled trials of pharmacological therapy in osteoarthritis of the knee, with an emphasis on trial methodology. Semin Arthritis Rheum, 1997. 26(5): p. 755-70.
6. Sowers, M. and L. Lachance, Vitamins and arthritis. The roles of vitamins A, C, D, and E. Rheumatic Diseases Clinics of North America, 1999. 25(2): p. 315-32.
7. Deal, C.L. and R.W. Moskowitz, Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheumatic Diseases Clinics of North America, 1999. 25(2): p. 379-95.
8. Shankar, R.R., J.S. Zhu, and A.D. Baron, Glucosamine infusion in rats mimics the beta-cell dysfunction of non- insulin-dependent diabetes mellitus. Metabolism, 1998. 47(5): p. 573-7.
9. Rossetti, L., et al., In vivo glucosamine infusion induces insulin resistance in normoglycemic but not in hyperglycemic conscious rats. J Clin Invest, 1995. 96(1): p. 132-40.
10. Leffler, C.T., et al., Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Military Medicine, 1999. 164(2): p. 85-91.
11. Asari, A., et al., Molecular weight-dependent effects of hyaluronate on the arthritic synovium. Arch Histol Cytol, 1998. 61(2): p. 125-35.
12. Bliddal, H., et al., A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis & Cartilage, 2000. 8(1): p. 9-12.
13. Murav’ev Iu, V., et al., [Effect of dimethyl sulfoxide and dimethyl sulfone on a destructive process in the joints of mice with spontaneous arthritis]. Patologicheskaia Fiziologiia i Eksperimentalnaia Terapiia, 1991(2): p. 37-9.
14. Polli, E., et al., [Pharmacological and clinical aspects of S-adenosylmethionine (SAMe) in primary degenerative arthropathy (osteoarthrosis)]. Minerva Med, 1975. 66(83): p. 4443-59.
15. Montrone, F., et al., Double-blind study of S-adenosyl-methionine versus placebo in hip and knee arthrosis [letter]. Clin Rheumatol, 1985. 4(4): p. 484-5.
|
Resource Library HTML 
