Nutritional therapists are often asked “What supplement can help my joints?” This is a more difficult question than it sounds as often there are multiple factors that affect joint function and often no one-size fits all solution. The most effective approach is to utilise perfect partners of supplements for joint health which support the structure of the joint, reduce inflammation to aid pain management and mobility, support lubrication (or synovial fluid) and maintain healthy tissue turnover.
Joint pain is a common complaint and is most often associated with osteoarthritis (OA). OA has, for a long time, been associated with wear and tear, but it is now understood that it is multi-faceted and synonymous with cartilage degradation, synovial inflammation and bone remodelling.
Cartilage is made up of specialised cells known as chondrocytes, which produce an extracellular matrix (ECM) made up of collagen (type II), proteoglycans, and elastin. This matrix acts as a shock absorber in the joint, to take strain off the end of the bone and help prevent wear and tear on the cartilage itself.
However, it has little to no blood supply driving nutrient extraction from the adjacent synovial fluid, which can make repair mechanisms inefficient. Pro-inflammatory cytokines, particularly IL-1β and TNF-α, are implicated in the destruction of cartilage and the associated extra cellular matrix.1,2 Therefore, supporting this matrix, regenerating chondrocytes and the reduction of inflammation is essential for supporting joint health.
Interventions for joint pain should include:
- Supporting structural integrity – providing nutrients which support regeneration and maintenance of tissue including cartilage and synovial fluid
- Reducing inflammation – inflammation is a major driver of pain and therefore immobility and also degradation of tissue
- Reducing oxidative stress – oxidative stress drives inflammation and tissue degradation. Free radicals have a number of negative effects in the body, including a direct reaction on the polysaccharide found in connective tissue and synovial fluid, resulting in damage and subsequent inflammation3
Therefore, combining nutrients is a more effective intervention than providing singular products in isolation.
Perfect partners for all-encompassing joint health support
Glucosamine – protecting against cartilage degradation
Glucosamine is a glycosaminoglycan. These specific structures are a combination of both protein (amino acids) and carbohydrates, allowing for branched chain molecules which are flexible, making them perfect for acting as shock absorbers within joints. They make up cartilage as well as part of synovial fluid. The degradation or disruption of both of these body tissues are associated with joint pain, in particular OA.
It has been shown that glucosamine exhibits a chondroprotective action on OA by inhibiting type II collagen degradation and maintaining type II collagen synthesis.4
A meta-analysis has identified that:5
- Administration of glucosamine was associated with a favourable effect on pain scores (visual analogue scale) compared with placebo
- There were subjective improvements to quality of life after use of glucosamine (by Japanese Knee Osteoarthritis Measure)
It is preferable to supplement glucosamine as glucosamine HCl as it has a higher purity and is better tolerated by the digestive system.
Boswellia – reducing inflammation
Boswellia is an Ayurvedic herb with anti-inflammatory properties and has been investigated for its benefits in conditions including OA.6
Boswellia has been shown to inhibit the 5-lipoxygenase pathway, thus playing a positive role in various inflammatory diseases that are perpetuated by the production of leukotrienes. It has also been shown to reduce the production of inflammatory cytokines, including IL-1β, IL-6, IFNγ, and TNFα, which are ultimately directed to cartilage destruction in OA. As well as reducing inflammation, it is thought that Boswellia’s mechanism of action on joints also includes the prevention of glycosaminoglycan (GAG) degradation and improved blood supply to joint tissue.6 These protective effects in OA have been also correlated to its antioxidant activity by suppressing ROS levels, lipid peroxidation, and decreasing oxidative DNA damage.7
It has been shown that oral Boswellia supplements can significantly suppress the pain and immobility associated with OA, with the effects being felt in as little as one week.8
A meta-analysis identified that oral supplementation with Boswellia prevents articular cartilage degradation, decreases osteophytes (bone spur) formation, and consequently improves physical mobilisation by reducing pain in OA patients compared with placebo control.8
MSM – maintaining connective tissue, such as collagen, and reducing inflammation
MSM contains high levels of sulphur which are important for maintaining normal connective tissue. It has also been demonstrated to have anti-inflammatory activities, chemoprotective properties, and free radical scavenging activity. In a pilot study MSM (3g twice a day) improved symptoms of pain and physical function during the short intervention without major adverse events.9
MSM’s anti-inflammatory properties are most significantly linked to its ability to downregulate the expression of NF-kB, which governs pro-inflammatory pathways. Thereby it also affects inflammatory pathways further downstream including:10
- Negatively affecting the expression of the NLRP3 inflammasome and/or by blocking the activation signal in the form of mitochondrial generated reactive oxygen species (ROS)
- Downregulation of mRNA for interleukin (IL)-1, IL-6, and tumour necrosis factor-α (TNF-α) – both of which are pro-inflammatory cytokines
MSM also plays a direct role in maintaining cartilage. Studies have suggested MSM significantly decreased cartilage surface degeneration.10
In addition, MSM possesses antioxidant capabilities. In humans, MSM pre-treatment prior to endurance exercise results in acute attenuation of induced protein oxidation, bilirubin, lipid peroxidation, creatine kinase, oxidized glutathione, and uric acid (all of which are associated with oxidative stress) and also an increase in total antioxidant capacity.10 This makesMSM an excellent intervention for joint pain.
Omega 3 and joint health – reducing inflammation and maintaining cellular and ECM integrity
Omega 3 (as EPA) is well known for its ability to produce anti-inflammatory prostaglandins and therefore is considered important in modulating inflammation, particularly if omega 6 intake is in excess.11 It also has direct effects on cartilage and synovial fluid.
Studies have shown omega-3 polyunsaturated fatty acids (PUFAs) reduced the expression of inflammatory markers, cartilage degradation and oxidative stress in chondrocytes. In contrast, these markers were increased upon omega-6 PUFA and saturated fatty acid stimulation. Human intervention studies with omega-3 PUFA supplementation may indicate a beneficial effect on pain and function and might be associated with less structural damage.12
PUFAs, particularly omega 3s, have been found to counteract the onset and progression of OA by reducing bone and cartilage destruction, inhibiting proinflammatory cytokine release, reactive oxygen species (ROS) generation, and the NF-κB pathway’s activation. A diet rich in omega 3 demonstrates beneficial effects on associated pain reduction.12,13
Additionally, synovial fluid contains a broad spectrum of free fatty acids. It has been shown that the fatty acid profile differs between OA and control subjects. Higher levels of omega 3 in both plasma and synovial fluid were associated with lesser pain experience.14
Omega 3 fatty acids are an effective intervention for OA reduction due to the anti-inflammatory and antioxidant properties of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids – the active forms of omega 3 fatty acids.15
Vitamin C – reducing oxidative stress and supporting collagen formation
Vitamin C is essential to produce collagen as it is a cofactor in the binding, cross-linking, and folding of collagen to provide its unique structure. Several in vitro studies have shown that vitamin C has an anabolic effect on cartilage. A threefold reduction in the risk of OA progression was found in the middle and highest tertials of vitamin C intake. Additionally, there is evidence that vitamin C is useful for pain relief, particularly of the musculoskeletal system, and vitamin C deficiency is associated with higher incidence of pain. Accumulating evidence indicates that vitamin C can exhibit analgesic properties in some clinical conditions, thus potentially mitigating suffering and improving patient quality of life.16
Vitamin C is well known as a major extracellular antioxidant and can support chondrocytes (cartilage producing cells) by ameliorating oxidative stress. In vitro studies demonstrated that chondrocytes treated with hydrogen peroxide, to induce ROS, showed enhanced proliferation when treated with vitamin C. Suggesting a protective mechanism of vitamin C on oxidative stress.17
Joint health summary
Studies have demonstrated that a combination of nutrients incorporating antioxidants, omega 3 fatty acids, anti-inflammatory supporting nutrients and supplements to support structural integrity, including glucosamine are more affective for joint health and elasticity.18 The above nutrients can work together for all aspects of joint health providing all-encompassing support.
You might like to take a look at our joint health supplements range for some inspiration.
- The most common condition associated with joint pain is osteoarthritis, which is characterised by a loss of cartilage, inflammation and bone remodelling. Multiple factors can influence these therefore interventions to support joint repair, reduce inflammation and protect against damage by oxidative stress are essential. A combination of different nutritional products can be very useful in tackling joint pain in a multifaceted approach.
- Glucosamine aids joint protection by reducing the degradation of collagen. Supplementation has improved subjective pain and quality of life scores.
- Boswellia supports joint health by reducing inflammation but has also demonstrated protection against cartilage degradation. It has been shown that oral Boswellia supplements can significantly suppress the pain and immobility associated with OA.
- MSM is a form of sulphur and supports collagen synthesis. It also possesses anti-inflammatory and antioxidant capability – thereby supporting joint health from multiple aspects.
- Omega 3s are well known for their anti-inflammatory production of prostaglandins. They support tissue regeneration and a higher amount of omega 3 fatty acids in synovial fluid is associated with reduced pain.
- Vitamin C supports collagen synthesis and is also indicated in supporting pain management. It is our major extracellular antioxidant and therefore helps to protect connective tissue from damage from free radicals.
- Studies have demonstrated that a combination of nutrients incorporating antioxidants, omega 3 fatty acids, anti-inflammatory supporting nutrients and supplements to support structural integrity, including glucosamine are more affective for joint health and elasticity. The above nutrients can work together for all aspects of joint health providing all-encompassing support.
- Sanchez-Lopez E, Coras R, Torres A, Lane NE, Guma M. Synovial inflammation in osteoarthritis progression. Nat Rev Rheumatol. 2022;18(5):258. doi:10.1038/S41584-022-00749-9
- Liu X, Machado GC, Eyles JP, Ravi V, Hunter DJ. Dietary supplements for treating osteoarthritis: a systematic review and meta-analysis. doi:10.1136/bjsports-2016-097333
- Clayton P Dr. Health Defence Accelerated Learning Systems. .; 2004.
- Nagaoka I, Tsuruta A, Yoshimura M. Chondroprotective action of glucosamine, a chitosan monomer, on the joint health of athletes. Int J Biol Macromol. 2019;132:795-800. doi:10.1016/J.IJBIOMAC.2019.03.234
- Ogata T, Ideno Y, Akai M, et al. Effects of glucosamine in patients with osteoarthritis of the knee: a systematic review and meta-analysis. Clin Rheumatol. 2018;37(9):2479. doi:10.1007/S10067-018-4106-2
- Murray JPizzornoM. Textbook of Natural Medicine. 4th Ed.; 2013.
- Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev. 2014;2014(5). doi:10.1002/14651858.CD002947.PUB2
- Yu G, Xiang W, Zhang T, Zeng L, Yang K, Li J. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complement Med Ther. 2020;20(1). doi:10.1186/S12906-020-02985-6
- Kim LS, Axelrod LJ, Howard P, Buratovich N, Waters RF. Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. Osteoarthritis Cartilage. 2006;14(3):286-294. doi:10.1016/J.JOCA.2005.10.003
- Butawan M, Benjamin RL, Bloomer RJ. Methylsulfonylmethane: Applications and Safety of a Novel Dietary Supplement. Nutrients. 2017;9(3). doi:10.3390/NU9030290
- Bland J et al. Textbook of Functional Medicine.; 2008.
- Oppedisano F, Bulotta RM, Maiuolo J, et al. The Role of Nutraceuticals in Osteoarthritis Prevention and Treatment: Focus on n-3 PUFAs. Smeriglio A, ed. Oxid Med Cell Longev. 2021;2021:1-12. doi:10.1155/2021/4878562
- Loef M, Schoones JW, Kloppenburg M, Ioan-Facsinay A. Fatty acids and osteoarthritis: different types, different effects. Joint Bone Spine. 2019;86(4):451-458. doi:10.1016/J.JBSPIN.2018.07.005
- Van de Vyver A, Clockaerts S, van de Lest CHA, et al. Synovial Fluid Fatty Acid Profiles Differ between Osteoarthritis and Healthy Patients. Cartilage. 2020;11(4):473. doi:10.1177/1947603518798891
- Moghaddami M, James M, Proudman S, Cleland LG. Synovial fluid and plasma n3 long chain polyunsaturated fatty acids in patients with inflammatory arthritis. Prostaglandins Leukot Essent Fatty Acids. 2015;97:7-12. doi:10.1016/J.PLEFA.2015.02.005
- Carr AC, McCall C. The role of vitamin C in the treatment of pain: New insights. J Transl Med. 2017;15(1):1-14. doi:10.1186/S12967-017-1179-7/FIGURES/1
- Dunlap B, Patterson GT, Kumar S, et al. Vitamin C supplementation for the treatment of osteoarthritis: perspectives on the past, present, and future. Ther Adv Chronic Dis. 2021;12. doi:10.1177/20406223211047026
- Czajka A, Kania EM, Genovese L, et al. Daily oral supplementation with collagen peptides combined with vitamins and other bioactive compounds improves skin elasticity and has a beneficial effect on joint and general wellbeing. Nutr Res. 2018;57:97-108. doi:10.1016/J.NUTRES.2018.06.001
If you have questions regarding the topics that have been raised, or any other health matters, please do contact our team of Nutritional Therapists.
Last updated on 24th May 2023 by cytoffice