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