Glucosamine for Arthritis Arthritis and Glucosamine
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10/11/04  Brenda Adderly
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The key is in the cartilage
In the Land of Oz, the Tin Man had a very simple way of maintaining healthy joints. When his joints locked up, he simply reached for an oil can and gave them a quick lube. By contrast, our bodies are much more complex, using over 140 different joints to perform an infinite variety of movements with a fluidity the Tin Man could never dream of achieving. So, it isn't surprising that our joints need some special care.

Limb by limb, joints frequently support the equivalent of six times our body weight in repetitive cycles of movement. The rubbery, pliable cartilage pads that line them act as protective shock absorbers, so that we avoid bone-on-bone contact (ouch!) every time we move. Maintaining that cartilage is the key to reducing joint problems.

Cartilage is made up of living tissue that is continually broken down and replaced, and, in an ideal world, that process would take care of itself without any special effort on our part. However, injury, stress on joints--and the aging process itself--can harm cartilage tissue, often without any obvious signals until a lot of damage has been done. The most prevalent joint disease in this country (affecting one in seven Americans)--osteoarthritis--is the result of cartilage damage.

The silence of the joints
Pain is the most obvious way our bodies let us know when we're overdoing things. If we overuse a muscle, at the very least, it will feel a little sore. Cartilage doesn't possess such communication skills because it isn't supplied with nerves. Consequently, we can't experience soreness in cartilage that is undergoing stress, but the stress is there, just the same. By the time we feel pain or discomfort in a joint, a significant amount of injury has occurred. If this sounds terribly alarming, keep in mind that pain or discomfort you associate with a joint may, in fact, be sore muscles or tendons surrounding the area, rather than the joint itself. Getting the situation looked at by an appropriate healthcare practitioner is the best way to ease your concerns and resolve any problems.

On the bright side, it isn't as difficult to prevent joint problems as it may seem. Although genetic predisposition to diseases, such as arthritis, plays a role, it isn't the overriding factor. Luckily, you can be in control of those things that exert the most influence over your joint health, namely: getting the right nutrients; maintaining a healthy weight; exercising regularly the right way; and knowing something about biomechanics -- or, how to perform routine tasks (i.e., sitting, standing, talking on the phone, working on the computer) without injuring your joints. (More details about biomechanics, including diagrams of how to do everyday tasks correctly, are included in my book, Maximizing The Arthritis Cure.)

Do your joints need special food?
How do you know if your joints need specific nutrients they aren't already getting? There is no cut-and-dried test that detects a deficiency of nutrient X or Y in your knee joint, for example. However, there is plenty of research that illustrates which nutrients directly impact joint health.

Each nutrient's role becomes clear if we look at what makes a joint function well or poorly. We know that healthy cartilage is the key to maintaining healthy joints, but, more specifically, cartilage fluid is the critical ingredient. In addition to helping absorb shock in the joints, this fluid is the lifeblood of cartilage. Without adequate fluid, cartilage has no means of getting oxygen or nutrients, because, unlike other parts of our body, it contains no blood vessels to do the job. The right nutrients are vital for maintaining cartilage fluid, and replenishing it where damage has already set in.

Two nutrients that can defend your joint health--together
Two specific nutrients, used extensively in the easing of osteoarthritis pain, are the first line of defense against cartilage damage: glucosamine and chondroitin sulfates. Both occur naturally in the body and both improve the state of fluid in cartilage, but each one works in a slightly different way. Supplementing with a combination of the two is the most potent weapon against joint deterioration.

Here's how they work: Glucosamine is used by the body to manufacture "proteoglycans," which maintain fluid in the cartilage, and regulates the metabolism of cartilage, making sure that tissue is not unnecessarily destroyed. It also inhibits enzymes that degrade cartilage tissue, and blunts damage from certain chemicals. Chondroitin, itself an ingredient of cartilage tissue, draws in fluid and nutrients directly, since cartilage does not support vasculature. It also fights cartilage-destroying enzymes.

There has been plenty of research validating the efficacy of glucosamine and chondroitin when taken individually, especially in Europe. However, in the last few years, the medical community in this country has begun to recognize that when the two supplements are taken together, there is a definite synergy that occurs.

Last February, Military Medicine published the results of a study at the Port Smith Naval Hospital in Norfolk, Va., where over 30 Navy Seals experienced "significant pain relief" after taking a proprietary formulation of glucosamine and chondroitin for eight weeks. Larger studies are underway, including one with 350 patients at Johns Hopkins, and another, with 1,000 patients, under the auspices of the National Institutes of Health.

Bringing in the cavalry
There are other supplements that enhance the power of glucosamine and chondroitin, and themselves have proved to stimulate healthy joints. One major one is SAMe (S-Adenosylmethionine), which has been shown to reduce pain and inflammation from osteoarthritis. (Sometimes it gets confused with the amino acid methionine, but the two are not the same.) SAMe, which is found naturally in the body, helps cartilage to regenerate and protects its fluid supply.

If you have a deficiency of minerals or trace minerals, your joints will benefit if you take them. Nevertheless, more is not better when it comes to trace minerals, so be sure to stick with the dosages recommended on labels. If the recommended dosage is a range, stick to the lower end to be safe. These are the key ones for joint health: calcium, boron, chromium, copper, magnesium, manganese, selenium, silicon, and zinc, and are best taken in a multimineral combination.

Antioxidants should be part of any healthy lifestyle, and are vital for strong joints, especially vitamins A, C, E, and selenium. Vitamin C is "essential for collagen synthesis and connective tissue repair," explains Robert S. Ivker, D.O., in The Complete Self-Care Guide to Holistic Medicine (Tarcher, 1999). Vitamin E is thought to block destructive enzymes that break down cartilage, Ivker also points out.

Other vitamins and compounds are also important, including: vitamin A (at safe levels); OPCs (oligoproanthocyanidins) from grapes or French maritime pine bark; and the B vitamins -- best taken as a complex, are necessary for the body to produce SAMe. Vitamin D is also necessary to prevent osteoarthritis.

Herbs can provide relief, too, including, suggests Ivker: ginger, curcumin, devil's claw, cayenne, licorice root, yucca, and celery seed extract.

Mitigating the risks of `wear-and-tear' arthritis
Knowing which nutrients are critical for joint health is one side of the prevention story. The other is understanding what risks your joints face. The most common joint disorder, osteoarthritis, has been called "wear-and-tear" arthritis, because, literally, it is caused from wear and tear on joints, most commonly in the knee and hip areas. This tends to happen as we age, although it isn't inevitable. Where there is more stress than a joint can handle, damage occurs.

Moderate your strenuous activity. Recent research published in the American Journal of Medicine illustrates one way wear and tear its toll. The Framingham Study, in which the National Institutes of Health has tracked about 5,000 people in Massachusetts since 1948, shows that certain types of strenuous physical activity increase risk of knee osteoarthritis. Specifically, men and women doing strenuous work, such as mowing with a nonpower mower, shoveling, digging, chopping wood, or brisk cycling, for more than four hours a day, increased their risk of knee osteoarthritis by six times. That doesn't mean that everyone doing this type of work will damage their knees, but the risk is higher.

Lose extra weight. Being overweight increases the risk of joint problems, simply because joints have to bear the stress of the extra pounds. Losing weight not only cuts risk, but has been found to reverse symptoms of osteoarthritis. A study at Harvard Medical School found that women wearing high-heeled shoes increase stress on their knee joints by 23 percent, thereby putting themselves at more risk for osteoarthritis.

Exercise safely and regularly. Exercise, alone, does not put people at risk of joint injury. The Framingham Study, for example, found no increased risk of knee osteoarthritis among marathon runners. One explanation might be that the runners have developed strength in their joints over a period of time, so their joints are well-equipped to handle the task. Both aerobic and weight-bearing exercise are necessary for joint health, but they need to be done without overstraining joints.

A word about joint inflammation
Rheumatoid arthritis--an inflammation of the joints caused by an autoimmune disorder--affects about 2.5 million Americans. Although it is not related to osteoarthritis, many of the same supplements have helped those who suffer from rheumatoid arthritis, because an individual will often have osteoarthritis, or osteoarthritis-like symptoms, along with rheumatoid arthritis. In addition, enzymes with anti-inflammatory properties have been effective, especially bromelain, trypsin, chymotrypsin, papain, and rutin.

The bottom line
No one has initiated a study to find out exactly how supplements prevent joint disease among healthy people. Such an undertaking would be immense, requiring a large healthy population that is tracked for many years.

Until such a study comes to pass, common sense tells us that we should use the knowledge we do have. For when it comes to our joints, perhaps the biggest risk stems from ignoring the tools we have to live a long, flexible life.

Adderly, B., Theodosakis, J., and Fox, B. Maximizing the Arthritis Cure. New York: St. Martin's Press, 1998.
Ivker, Robert S., D.O., Anderson, Robert A., M.D., and Trivieri, Larry,, Jr. The Complete Self-Care Guide to Holistic Medicine: Treating Our Most Common Ailments. New York: Tarcher/Putnam, 1999.
Kerrigan, et al. "Knee osteoarthritis and high-heeled shoes," Lancet 351 (9113): 1399-401, May 1998.
Lesfler, C.T. "Glucosamine, Chondroitin and Manganese Ascorbate for degenerative joint disease of the knee or low back. A randomized, double-blind, placebo-controlled pilot study," Military Medicine 164:2:85-91, February 1999.
McAlindon, T., et al. "Risk of radiographic and symptomatic knee OA in the elderly," American Journal of Medicine 106:151-157, 1999