"Those who think they have no time for exercise will sooner or later have to find time for illness.” Edward Stanley
Todays article has been in the works for a while, I know I have been promising it to you for a while. It is my part of an article written with Dr. Robert Silverman, which addresses the top supplements as well as the best and worst foods for joint health. The inspiration for this piece came from Pills, Tape and Lasers, in this piece we looked at supplements, treatment and medical equipment that will help with joint health. In particular with the supplement section, I wanted to flesh out the ideas A couple of my clients have been inquiring about supplements for joint health. The truth is that joint pain is quite common in a National Health interview survey done in 2006 30% of the people interviewed complained of joint pain, with 20% of the people having knee pain, 10% had shoulder pain, and the 5% of the people had pain in the hip or finger. It goes further nearly two in three people who are obese may develop symptomatic knee osteoarthritis in their lifetime. An estimated 50 million adults in the United States reported being told by a doctor that they have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia. We all want to move without pain into the twilight of our lives, or at the very least that is my hope for me and you. Onto my top ten list:
1) Multivitamin: should be from a reputable source which is either GMP (Good Manufacturing Practice), NSF (National Sanitation Foundation) or TGA (Therapeutic Goods Administration) certified. A multivitamin/multimineral should be part of your foundation nutrition. An optimal multivitamin/multimineral will have vitamin E, carotenoids, zinc, magnesium, copper, a full complement of B vitamins, and microcrystalline calcium hydroxyapatite (MCHC) for the calcium component. MCHC has been shown to not only prevent bone loss but promote bone growth. When it comes to minerals you want them chelated, it’s not what you eat but how much makes it into the bloodstream in order to make it to the target tissues.1-3
2) Fish Oil/Omega-3: Numerous studies on Omega-3 fatty acids have shown to improve cardiovascular profiles, and that 2 grams of EPA-DHA taken daily reduced pain in almost 60% of patients with neck and low back pain4. The consumption of omega-3 may decrease chronic pain and inflammation and reduce the need for NSAIDs.
3) Proteolytic enzymes: Studies suggest that patients who received proteolytic enzymes showed reduced swelling, pain, and inflammation while also experiencing faster recovery rates.6 Proteolytic enzymes are Trypsin and Chromotrypsin they are often coupled with Bromelain. Treatment with Bromelain in studies has resulted in a clear reduction in swelling, pain at rest, pain during movement, and pain in tender areas7. The use of this supplement in a treatment plan with athletes injured within 72 hours can lead to an increase in optimal outcomes.
4) Vitamin D: Vitamin D is an essential vitamin required by the body for the proper absorption of calcium, bone development, control of cell growth, neuromuscular functioning, proper immune functioning, and alleviation of inflammation. A study performed in the Spring of 2010 found vitamin D deficiency specifically in African-American players, and players who suffered muscle injuries. It was noted that 50% of the players tested had levels consistent with vitamin D insufficiency. This lead Dr. Scott Rodeo, co-chief of the Sports Medicine and Shoulder Service at the Hospital for Special Surgery to note that, “screening and treatment of vitamin D insufficiency in professional athletes may be a simple way to help prevent injuries”. The results of this study were presented at the American Orthopedic Society for Sports Medicine (AOSSM) 2011 Annual Meeting7. A 2003 study involved vitamin D deficient and chronic low back pain subjects were given 5,000 IU for those who were less than 110 pounds, and 10,000 IUs per day for those who were over 110 pounds. After 3 months the 299 subjects who were deemed vitamin D deficient had reported a disappearance of their back pain. The result of the study was that 341 of the 360 subjects were relieved of their chronic low back pain with this vitamin D supplementation regimen8. An increase in vitamin D intake might decrease the incidence and severity of autoimmune diseases9.
5) Glucosamine & Chondroitin: Glucosamine & Chondroitin stimulates the formation and repair of articular cartilage. They have also been shown to reduce pain and inflammation and slow cartilage loss10. A 16-week randomized, double blind placebo controlled crossover trial of a combination of glucosamine HCI 1500 mg/day, chondroitin sulfate 1,200mg/day and manganese ascorbate. This combination therapy relieves symptoms of knee osteoarthritis.
6) SKRMs: To me, this is a clinical breakthrough in the natural approach to treating joint health and inflammation. SKRMs (Selective Kinase Response Modulators) are able to “flick the health switch” inside the cell. Kinases provide intercellular signal transduction, which affects processes such as inflammation can be communicated to the cell nucleus. The RIAA/THIAA prevent the translocation of (NF-кB) to the nucleus after the cell has been exposed to an inflammatory signal. This prevents NF-кB from turning on genes associated with inflammation therefore, reduces proinflammatory prostaglandins, leukotrienes and cytokines14. Two kinases are Rho-iso-alpha acids (RIAA) and tetrahydro-iso-alpha-acids (THIAA)
7) Silica: Silicate mineral comes containing a wide spectrum of minerals, such as products derived from the Sierra mountains. A key benefit of this type of mineral complex is the relatively short duration before results are seen compared to other ingredients that require longer, continuous use to see the benefits. Silica helps in the proper absorption of different essential nutrients that the body needs to function. It also helps the body to use other minerals effectively. Specifically, the consumption of calcium when levels of silica are low only leads to increased deterioration of bones. Silica helps in depositing of calcium and other minerals into necessary body organs, including the bones, teeth and skin.
8) MSM (Methyl-Sulfonyl-Methane): MSM is a sulfur-containing compound normally found in many of the foods we eat, it is related to dimethyl-sulfoxide DMSO. It is a natural analgesic and anti-inflammatory agent. A double-blind parallel placebo study was performed on a combination therapy of Glucosamine 500mg, MSM 500mg, or placebo capsules taken 3 times a day for 12 weeks. The therapy combination showed better efficacy in reducing pain and swelling and in improving the functional ability of joints than the individual agents alone. The more impressive result is the onset of analgesic and anti-inflammatory activity that was found to be more rapid with the combination than with Glucosamine alone. The combination of MSM with Glucosamine provided better and more rapid improvement in patients with osteoarthritis. 11
9) ETArol: ETArol a proprietary extract of New Zealand green lipped mussels that contain the essential fatty acids eicosatetraenoicacids (ETA's), play a key role in the reduction of joint swelling due to arthritis. Studies show that ETA oils from sea mussels are more effective in reducing inflammation than aspirin or ibuprofen.
10) Nettle Leaf is an anti-inflammatory remedy that has been used in Germany for years for the safe treatment of arthritis. It has cyclooxygenase and lipooxygenase that may slow the enzymes that trigger inflammation. In a 12-week randomized double-blind crossover study on the use of nettle leaf for the base of thumb-pain in patients with osteoarthritis. The Plymouth University researchers found a reduction in pain after one week in the group using the nettle leaf12. One other reason that bolsters nettle leafs’ effectiveness is the presence of two neurotransmitters named histamine and serotonin which can affect pain transmission and perception. Those with pollen allergies are to avoid the use of nettle13.
I know that this list covers a lot of ground, it gives options to people who are suffering from different types of joint pain. Please consult your physician to see if there are any contraindications before starting with any new nutritional supplements. This coming week we will be looking at the knee specifically the ACL, what can be done to strengthen the knee and what is done in post ACL rehab. As well as an article looking at different training styles, the pros and cons and when is the best time to train in each style. As always please read and share this blog.
1. Epstein O, et al. Vitamin D, hydroxyapatite, and calcium gluconate in treatment of cortical bone thinning in postmenopausal women with primary biliary cirrhosis. AJCN 1982 Sep;36(3):426-430.
2. Ruesegger P, et al. Comparison of the treatment effects of ossein-hydroxyapatite compound and calcium carbonate in osteoporotic females. Osteo Int 1995;5:30-34.
3.Annefield M, et al. The influence of ossein-hydroxyapatite compound (“Ossopan”) on the healing of a bone defect. Cur Med Res Opin 1986;10:241-250.
4Teitelbaum et al. Effective treatment of chronic fatigue syndrome and fibromyalgia—a randomized double blind placebo-controlled intent to treat study. J Chronic Fatigue Syndrome 2001;8(2):3-28.
5 Maroon JC, Bost JW, Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.
6 Trickett P. Proteolytic enzymes in treatment of athletic injuries. Appl Ther. 1964;30:647-52.
7 American Orthopaedic Society for Sports Medicine (AOSSM) 2011 Annual Meeting: Abstract 46. Presented July 10, 2011.
8 Faraj SA, Mutairi KA, Vitamin d deficiency and chronic low back pain in Saudi Arabia 2003
9 Exp Biol Med 2004
10 Hardington, T Chondroitin Sulfate and Joint Disease. Osteo Cart 1998
11. Usha P.R., Naidu M.U.R., "Randomised, Double-Blind, Parallel, Placebo-Controlled Studyof Oral Glucosamine, Methylsulfonylmethane and their Combination in Osteoarthritis" Clinical Drug Investigation 2004
12 Randall C, Randall H, Dobbs F, Hutton C, and Sanders H,Randomized controlled trial of nettle sting for treatment of base of thumb pain JR Soc Med 2000 June 93(6) 305-309
13 Pain-Free Arthrits: A 7 step Plan for Feeling Better Again by Harris Mcilwain MD, and Debra Fulghum Bruce
14. Anuradha D et al. Comparison of Anti-inflammatory Activity of Two Selective Kinase Response Modulators (SKRMs), Rho-iso-alpha Acids (RIAA) and Tetrahydro-iso-alpha acids (THIAA), in Lipopolysaccharide (LPS) Mediated Inflammation in RAW 264.7 Macrophages. The FASEB Journal. 2007;21:702.5
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