Many people turn to supplements to ease joint problems. But how effective are they? And are they really safer that standard medications?
Standard medications
Interest in supplements for osteoarthritis is increased because of problems with non-steroidal anti-inflammatory drugs (NSAIDs), drugs like ibuprofen, diclofenac and naproxen, that are often used to treat the pain and inflammation associated with arthritis. These drugs increase the risk of bleeding in the stomach, particularly if the person is also taking aspirin, blood thinners or steroids (such as prednisone). They also increase the risk of kidney and heart diseases. If it is necessary to take an NSAID, naproxen has been shown to cause less risk than other drugs in this class. There is also some evidence that NSAIDs may increase the rate of progression of osteoarthritis (the “wear and tear” arthritis).
All of this has resulted in several guidelines recommending acetaminophen (Tylenol) as a first-choice treatment for osteoarthritis, although it appears to be less effective and does not address the inflammation of arthritis. Side effects of standard anti-inflammatories have also resulted in increased interest in alternatives to standard drugs for arthritis.
How safe and effective are alternatives?
The quick answer is that alternatives commonly used for symptoms of arthritis are safe to use at recommended doses, and some studies have shown that some give similar pain relief to NSAIDs, although results vary.
Medical News Today published a good review of supplements for healthy joints recently. They discussed how much evidence there is for 6 supplements that are promoted for joint problems. Here are the supplements included in their list:
1. Glucosamine – Glucosamine appears to be the supplement with the most evidence for use in osteoarthritis. There are two types available: glucosamine sulfate and glucosamine hydrochloride. Studies with positive results most often used the sulfate version, although some studies did not indicate which type was used. It is important to realize that not all natural supplements are created equal, and even the price does not always indicate quality. Patients told me that they noticed good results with a glucosamine sulfate made by Swiss Herbal company, and it was the least expensive one I had in my store! So, be sure to buy from a reputable company. Ask your pharmacist for a recommendation! The effective dose is 500mg three times daily, usually taken with meals (1500mg daily).
2. Chondroitin – The evidence is less clear for chondroitin. It has a modest ability to control pain in the joints (average of 10% improvement over placebo or “sugar pill”) but it has a lower risk of side effects than NSAIDs. This makes it an option for those who cannot or do not wish to take standard anti-inflammatories. It is often combined with glucosamine as some believe they may work well together to support the cartilage in joints, although there isn’t good evidence for this. A common dosage is 400mg three times daily (1200mg daily)
NOTE that both glucosamine and chondroitin contain types of sugar molecules that, in theory, could affect blood sugar. People with diabetes are recommended to check their blood sugar more often when starting either of these supplements. However, it appears to be a rare side effect, not noted in studies. Ordinary sugar contains 4000mg per teaspoon, as a comparison, so the 1200-1500mg of sugars in these medications would not make a difference to most diabetics with good control of their blood sugar.
3. Methylsulfonylmethane (MSM) – MSM is less studied than glucosamine and chondroitin, but has been found to improve inflammation, and joint/muscle pain, and to increase antioxidant activity in the body. It is well-tolerated by most people at doses up to 4 grams daily, with few known side effects that are mild in nature (mostly digestive upset). Since it is a general anti-inflammatory throughout the body, it is also used for other inflammatory conditions, such as interstitial cystitis, colitis, and seasonal allergies. Animal studies suggest it may reduce cartilage destruction by lowering inflammatory molecules in the joint fluid. This supplement is sold alone and in combination with glucosamine and chondroitin. Doses of 1.5 to 6 grams daily have been safely used but it appears more research is needed to determine the ideal dose. It is usually used in combination with other supplements and taken with meals.
4. Turmeric – Turmeric contains a compound called curcumin that appears to have a strong anti-inflammatory effect. Studies suggest that 1000mg per day of curcumin gives similar relief to standard anti-inflammatories such as ibuprofen, in terms of pain, morning stiffness and movement. However, studies were only short term, resulting in a recommendation of up to 1200mg daily for up to 4 months as being proven as safe (the limitation of the longest study). Note that turmeric, which contains the active compound curcumin, is commonly used in food, for example, curries.
5. Boswellia – Boswellia, or frankincense, also has an anti-inflammatory effect in the body similar to turmeric. It is usually taken in combination with other supplements, such as curcumin to reduce inflammation that leads to joint pain and destruction of cartilage. However, studies with it have been small, so do not provide enough evidence to make definite claims about its safety or effectiveness.
6. Tamarind seed – Tamarind seed contains several antioxidants that have an anti-inflammatory effect and could be beneficial for arthritic joints. One study suggests that it may protect joint cartilage by increasing protective substances while reducing destructive inflammatory molecules in the joint fluid. However, researchers are calling for further study to confirm these results.
So, from all I’ve read, glucosamine sulfate appears to have the best research to back it, but the sulfate version has shown more consistent results than the hydrochloride. A combination of supplements with different actions may give the best results, for example: glucosamine sulfate, chondroitin and MSM that is readily available in pharmacies, but more research should be done. However, as these supplements appear to be safer than traditional anti-inflammatories with less risk of side effects, they are worth trying. As with all supplements, though, discuss use of these with your doctor and pharmacist!
References:
6 supplements for healthy joints – Medical News Today
Osteoarthritis treatment update: Are NSAIDs still in the picture? – Rheumatology Network
Chondroitin for osteoarthritis – US National Library of Medicine (scroll down for plain language summary)
Methylsulfonylmethane: Applications and safety of a novel dietary supplement – US Library of Medicine
Tamarind Seed Extract Ameliorates Adjuvant-Induced Arthritis via Regulating the Mediators of Cartilage/Bone Degeneration, Inflammation and Oxidative Stress – Scientific Reports (posted on NIH)
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