Nutritional Supplements For Joint Disorders

Osteoarthritis (OA) is a common source of joint pain, stiffness and swelling. It’s a leading cause of chronic disability and affects about 8 million people in the UK and 27 million in the US. OA leads to the gradual degeneration or wear and tear of joint surfaces and is often the cause of knee and hip replacements. Can nutritional supplements prevent or slow down the process? In my opinion, supplements can be separated into 2 groups: those that decrease inflammation and those that promote the regeneration of joint surfaces. I’d like to focus on the latter.

For quite a while, glucosamine, chondroitin and methylsufonylmethane (MSM) have been used to treat osteoarthritis.

Glucosamine

Glucosamine contains glycosaminoglycans which are a major component of joint cartilage. The glucosamine that is available commercially is derived from the exoskeleton of shellfish. Although inconsistent results have been reported, in 2009, a team at the University of Aberdeen led by C Black reviewed the literature on the clinical effectiveness of glucosamine in slowing or arresting the progression of OA of the knee. Only trials that met stringent criteria were used. They found that there were ‘statistically significant improvements in joint space loss, pain and function for glucosamine sulphate and in 2 studies the need for knee arthroplasty (replacement) was reduced from 14.5% to 6.3% at 8 years follow-up’ . Another study found ‘a 50 % reduction in the incidence of osteoarthritis-related surgery of the lower limbs during a 5-year period’. In 2007 a the WHO Collaborating Center for Public Health Aspect of Osteoarticular Disorders at the University of Liege conducted a review of published studies that concluded that ‘glucosamine sulphate (but not glucosamine hydrochloride) and chondroitin sulphate have small-to-moderate symptomatic efficacy in OA, although this is still debated. With respect to the structure-modifying effect, there is compelling evidence that glucosamine sulphate and chondroitin sulphate may interfere with progression of OA’ . In other words, there is compelling evidence that glucosamine sulphate and chondroitin sulphate prevent joint space narrowing by promoting the regeneration of articular cartilage. Almost all trials have found the safety of glucosamine sulphate and chondroitin sulphate to be equal to placebo.

Chondroitin

Chondroitin is also a glycosaminoglycan and a component of joint cartilage. Commercial chondroitin is derived from the cartilage of cows, pigs, shark, fish or birds. See above for results of research.

MSM

MSM occurs naturally in many primitive plants and in many foods and beverages. The mechanism of its action is uncertain but sulphur is thought to play a part. A literature review of MSM in the treatment of OA by a team at the University of Southampton showed that there was ‘positive but not definitive evidence that MSM is superior to placebo in the treatment of mild to moderate OA of the knee’. Last year an Israeli team led by EM Debbi published a study showing that, after taking MSM for 12 weeks, there was a small improvement in pain and physical function in patients with radiographic confirmed knee OA.

Recently ESM Technologies has funded research on the benefits of eggshell membranes. The eggshell membrane is just underneath the shell and surrounds the egg white. It’s interesting to note that in general, commercially funded trials show larger effects than industry independent trials.

Eggshell Membrane

Eggshell membrane or Natural Eggshell Membrane (NEM) as it is also known contains glucosamine, chondroitin and hyaluronic acid (also a glycosaminoglycan found in joints). In 2009, two papers were published (Journal of Clinical Interventions in Aging and Clinical Rheumatology) on the use of eggshell membrane to treat joint and connective tissue disorders. Both studies were led by Kevin Ruff and sponsored by ESM Technologies. The results were extremely encouraging and showed statistically significant improvements in pain, stiffness and flexibility. The positive results may be due to better bioavailability of joint sustaining compounds from eggshell membranes or possibly to researcher bias due to vested interests. This year, a study by the same author looked into the safety of NEM and concluded that it was safe for human consumption. Hopefully this will lead to independent research to look at the efficacy of NEM supplementation for joint disorders.

As we can see, there are several nutritional supplements that can aid the regeneration of joints. Here are the recommended daily dosages:

• Glucosamine Sulphate 1500 mg/day
• Chondroitin Sulphate 1200 mg/day
• NEM 500 mg/day

1 Year Already!

It’s been a year, to the day, since I started this blog. Hundreds of hours have gone into researching, reading and writing the articles. Although it’s been tough at times and even challenging just to find something to write about, I’ve enjoyed the process and learnt a lot from it. I’ve now got a lot more respect for people who update their blogs with interesting content several times a week…once a week is hard enough! Over time the blog has become a resource centre and now I often recommend that clients read certain blog posts. Whether they do or not is another question but the choice is there. Sometimes, learning something new can lead to a moment of insight that serves as a precursor for change…the little thing that ends up making the big difference!

Exercise And Testosterone Help Nerves Heal

A study by Arthur English and Nancy Thompson has found that exercise can promote the regeneration of peripheral nerve injuries. In both males and females, the effect requires the assistance of androgens such as testosterone.

“Habit is either the best of servants or the worst of masters”

Nathaniel Emmons

Pain And Emotion

Although mainly about the effects of emotion on reason, ‘Descartes’ Error‘ by Antonio Damasio contains a few fascinating nuggets on pain. He distinguishes 2 components to pain:

• Sensory perception from skin, mucosa, muscle, organ, etc. – the nerve endings stimulated in an area of the body lead to a ‘pain image’, a temporary representation  of body change in the brain. This is no different from any other kind of body perception and if it were all, we would not be inconvenienced.
• Emotion and feeling – it’s from these body-state changes that the unpleasant feeling of suffering is formed. “Suffering puts us on notice and offers us the best protection for survival, since it increases the probability that individuals will heed pain signals and act to avert their source or correct their consequences.“

Damasio’s views on emotion/feeling and pain are probably the result of his experience with the eminent Portuguese neurosurgeon Almeida Lima. Lima worked closely with Portuguese neurologist Egas Moniz. Together they developed prefrontal leucotomies, later known as lobotomies, during the 1930s. In 1949 Moniz received the Nobel Prize in medicine for his work. Damasio recalls following Lima on a pre-operative visit of a patient with trigeminal neuralgia, a condition that causes severe facial pain. “He was crouched in profound suffering, almost immobile, afraid of triggering further pain. Two days after the operation, when Lima and I visited on rounds, he was a different person. He looked relaxed, like anyone else, and was happily absorbed in a game of cards with a companion in his hospital room. Lima asked him about the pain. The man looked up and said cheerfully “Oh, the pains are the same, but I feel fine now, thank you.” Clearly, what the operation seemed to have done, then, was abolish the emotional reaction that is part of what we call pain. It had ended the man’s suffering.”

Obviously, lobotomies are extreme measures and they can cause serious side effects. This is certainly the reason fewer and fewer operations are being performed. Nowadays these operations are called psychosurgery and they have become much more precise. The important point is Damasio’s view on the link between pain and emotion. It corroborates a lot of the research being done on chronic pain. Hence, the importance of addressing the emotional part. Fortunately, there are now safer more humane ways of doing it, like relaxation, meditation, cognitive behavioural therapy, neuro-linguistic programming and hypnosis.