Supplements for Healthy Joints

I’m frequently asked whether I recommend any dietary supplements for someone’s arthritis or other wear and tear issues. Yes! The following are some supplements that show positive effects on inflammation and healing. Most are commonly found on supermarket shelves and in the fruits and vegetable section.

Curcumin/Turmeric

The most commonly promoted anti-inflammatory supplements right now are curcumin and turmeric. Turmeric and curcumin are derived from the turmeric root with turmeric being the spice you know from Indian cooking, and curcumin one of the chemical compounds known as curcuminoids, which are believed to be biologically active. In addition, in order for curcumin to be absorbed in the gut, a black pepper extract is commonly required.

The curcuminoids also impact arthritis through anti-inflammatory pathways, down-regulating enzymes such as phospholipase A2, cyclooxygenase-2, and lipoxygenases, and reducing inflammatory cytokines like TNF-alpha-and interleukin-1ß (IL-1ß), IL-6, and IL-8 (1). All of these effects have translated into real measurable impacts on patients with knee arthritis (2,5,6). In other studies, Curcumin has been shown to be as effective as common NSAID anti-inflammatories such as Diclofenac and Ibuprofen (3,4).

Glucosamine/Chondroitin

These two supplements are commonly used in arthritis treatments and are often derived from shellfish. Hence it makes sense that glucosamine can promote mesenchymal stem cells (MSCs) to become cartilage and inhibit the breakdown of cartilage. Chondroitin can also enhance the ability of MSCs to turn into cartilage (7, 8).

Chondroitin, 800mg, also has real measurable effects on knee cartilage in actual patients. In one study, it reduced cartilage volume loss on MRI after 6 months (9). Glucosamine, 1500mg, also seemed to help cartilage quality when measured on a specialized MRI (10). In another study, glucosamine reduced cartilage breakdown products (11). Finally, when compared to prescription Celebrex, the combination of glucosamine and chondroitin were better at improving function and reducing cartilage breakdown in the knee (12).

Flavonoids

Flavonoids, found in strawberries, teas, cocoa, grapes, apples and more, are powerful antioxidants with anti-inflammatory and immune system benefits.

Studies showed that they helped stem cells become cartilage.

Two recommended flavonoids are quercetin and fisetin. Fisetin looks to have additional benefits beyond quercetin in recent studies. (13) It looks to have additional properties that may mean improved tissue healing and prevention of chronic disease and cancer.

References:

(1) Akuri MC, Barbalho SM, Val RM, Guiguer EL. Reflections about Osteoarthritis and Curcuma longa. Pharmacogn Rev. 2017;11(21):8–12. doi:10.4103/phrev.phrev_54_16

(2) Henrotin Y, Malaise M, Wittoek R, et al. Bio-optimized Curcuma longa extract is efficient on knee osteoarthritis pain: a double-blind multicenter randomized placebo controlled three-arm study. Arthritis Res Ther. 2019;21(1):179. Published 2019 Jul 27. doi:10.1186/s13075-019-1960-5

(3) Shep D, Khanwelkar C, Gade P, Karad S. Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. Trials. 2019;20(1):214. Published 2019 Apr 11. doi:10.1186/s13063-019-3327-2

(4) Kuptniratsaikul V, Dajpratham P, Taechaarpornkul W, et al. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clin Interv Aging. 2014;9:451–458. Published 2014 Mar 20. doi:10.2147/CIA.S58535

(5) Panahi Y, Rahimnia AR, Sharafi M, Alishiri G, Saburi A, Sahebkar A. Curcuminoid treatment for knee osteoarthritis: a randomized double-blind placebo-controlled trial. Phytother Res. 2014 Nov;28(11):1625-31. doi: 10.1002/ptr.5174.

(6) Rahimnia AR, Panahi Y, Alishiri G, Sharafi M, Sahebkar A. Impact of Supplementation with Curcuminoids on Systemic Inflammation in Patients with Knee Osteoarthritis: Findings from a Randomized Double-Blind Placebo-Controlled Trial. Drug Res (Stuttg). 2015 Oct;65(10):521-5. doi: 10.1055/s-0034-1384536.

(7) Derfoul A, Miyoshi AD, Freeman DE, Tuan RS. Glucosamine promotes chondrogenic phenotype in both chondrocytes and mesenchymal stem cells and inhibits MMP-13 expression and matrix degradation. Osteoarthritis Cartilage. 2007 Jun;15(6):646-55. https://www.ncbi.nlm.nih.gov/pubmed/17337215

(8) Wang T, Yang F. A comparative study of chondroitin sulfate and heparan sulfate for directing three-dimensional chondrogenesis of mesenchymal stem cells. Stem Cell Res Ther. 2017;8(1):284. Published 2017 Dec 19. doi:10.1186/s13287-017-0728-6

(9) Wildi LM, Raynauld JP, Martel-Pelletier J, et al. Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI. Ann Rheum Dis. 2011;70(6):982–989. doi:10.1136/ard.2010.140848

(10) Martí-Bonmatí L, Sanz-Requena R, Rodrigo JL, Alberich-Bayarri A, Carot JM. Glucosamine sulfate effect on the degenerated patellar cartilage: preliminary findings by pharmacokinetic magnetic resonance modeling. Eur Radiol. 2009 Jun;19(6):1512-8. doi: 10.1007/s00330-008-1286-1.

(11) Petersen SG, Saxne T, Heinegard D, Hansen M, Holm L, Koskinen S, Stordal C, Christensen H, Aagaard P, Kjaer M. Glucosamine but not ibuprofen alters cartilage turnover in osteoarthritis patients in response to physical training. Osteoarthritis Cartilage. 2010 Jan;18(1):34-40. doi: 10.1016/j.joca.2009.07.004.

(12) Zeng C, Wei J, Li H, et al. Effectiveness and safety of Glucosamine, chondroitin, the two in combination, or celecoxib in the treatment of osteoarthritis of the knee. Sci Rep. 2015;5:16827. Published 2015 Nov 18. doi:10.1038/srep16827

(13) EBioMedicine. 2018 Oct; 36: 18–28. Published online 2018 Sep 9. doi: 10.1016/j.ebiom.2018.09.015