Joint Supplements

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Knee Pain is one of the most common running problems.

The joint supplements glucosamine and chondroitin provide marginal benefit, but are considered safe. They may be worth considering if you can justify the expense. Other supplements such as Omega 3 oils and Vitamin C/E may be worth considering.

1 Glucosamine and chondroitin

Chondroitin is an important component of joint cartilage and glucosamine is building block for other joint structures. Both chondroitin and glucosamine taken orally reach the joint space[1][2][3]. There have been over 500 studies of glucosamine and chondroitin[4], and analysis of the best of the studies show only a marginal benefit[5][6][7] or provide benefit only to a subgroup of suffers[8]. These benefits do not meet the requirements to be generally considered clinically important[5]. However, given the safety of these supplements, they may be worth considering if your income is sufficient.

1.1 Dosage

Doses of less than 800 mg/day of chondroitin or less than 1500 mg/day of glucosamine are considered sub-therapeutic[5], but there is no indication of appropriate dose. The Mayo Clinic suggest 500mg Glucosamine sulfate three times a day or 20mg per Kg body weight[9] and 200-400mg chondroitin 2-3 times daily[10]. These doses are based on those commonly used in studies.

2 Cost

I found glucosamine and chondroitin available online for about $10/month. Look carefully at the ingredients to check how many capsules make up the stated dose when calculating the daily cost.

3 Food for joints

There have been over 2,000 studies of related to nutrition and Osteoarthritis, but only 53 are of sufficient quality to be useful[11]. Some options that may be worth considering include:

  • Methylsulfonylmethane (MSM) is a less well known joint supplement than glucosamine and chondroitin, with far less studies available. There is some support for MSM helping with joint pain[12][13], but not enough to give confidence as to its effectiveness or safety[14]. MSM does cross the blood/brain barrier[15][16] and may cause headaches[12]. (I believe MSM was a trigger for my migraines.)
  • The supplement "avocado/soybean unsaponifiables" has shown positive results in studies[17][18][19][20]. However, this supplement has not been widely studies for effectiveness or long term safety.
  • There is some suggestion that Omega 3 oils may help with Osteoarthritis[21][22]. Given the other health benefits of Omega 3 oils, supplementation should be considered.
  • Higher Vitamin C intake may reduce Osteoarthritis[23] and 1000mg/day of Vitamin C reduced joint pain, though by less than half what would be expected from NSAIDs[24]. Like Omega 3 there may be other benefits to Vitamin C supplementation that make this worthwhile.
  • Some[25][26][27], but not all[28][29] studies have shown benefit from Vitamin E supplementation. Like the above two supplements, Vitamin E should be considered as there may be other health benefits.
  • Devil's Claw, a South African plan extract, may help with joint pain (60mg harpagoside)[30]. However, there is little known about its safety.

4 References

  1. Biochemical and pharmacokinetic aspect... [Arzneimittelforschung. 1995] - PubMed - NCBI
  2. Anti-inflammatory activity of chond... [Osteoarthritis Cartilage. 1998] - PubMed - NCBI
  3. Synovial and plasma glucosamine con... [Osteoarthritis Cartilage. 2007] - PubMed - NCBI
  4. JAMA Network | Archives of Internal Medicine | Structural and Symptomatic Efficacy of Glucosamine and Chondroitin in Knee OsteoarthritisA Comprehensive Meta-analysis
  5. 5.0 5.1 5.2 Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis
  6. Meta-analysis: chondroitin for osteoarthritis... [Ann Intern Med. 2007] - PubMed - NCBI
  7. Glucosamine for pain in osteoarthritis: why ... [Arthritis Rheum. 2007] - PubMed - NCBI
  8. Glucosamine, chondroitin sulfate, and the two i... [N Engl J Med. 2006] - PubMed - NCBI
  9. Glucosamine: Dosing -
  10. Chondroitin sulfate: Dosing -
  11. Arthritis Research & Therapy | Full text | Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence
  12. 12.0 12.1 Efficacy of methylsulfonylmethane (... [Osteoarthritis Cartilage. 2006] - PubMed - NCBI,f1000m,isrctn
  13. Randomised, Double-Blind, Parallel, Place... [Clin Drug Investig. 2004] - PubMed - NCBI
  14. Systematic review of the nutritiona... [Osteoarthritis Cartilage. 2008] - PubMed - NCBI
  15. Detection of dimethyl sulfone in the huma... [Magn Reson Imaging. 2000] - PubMed - NCBI
  16. Accumulation of methylsulfonylmethane in the hu... [Toxicol Lett. 2001] - PubMed - NCBI
  17. Structural effect of avocado/soybean unsapon... [Arthritis Rheum. 2002] - PubMed - NCBI,f1000m,isrctn
  18. Efficacy and safety of avocado/soybean unsa... [Rev Rhum Engl Ed. 1997] - PubMed - NCBI,f1000m,isrctn
  19. Symptoms modifying effect of avocado/soybe... [Scand J Rheumatol. 2001] - PubMed - NCBI,f1000m,isrctn
  20. Symptomatic efficacy of avocado/soybean unsa... [Arthritis Rheum. 1998] - PubMed - NCBI,f1000m,isrctn
  21. Regulation of osteoarthritis by omega-3 (n-3) polyunsaturated fatty acids in a naturally occurring model of disease
  22. Association of plasma n-6 and n-3 polyunsaturated fatty acids with synovitis in the knee: the MOST study
  23. Do antioxidant micronutrients protect agains... [Arthritis Rheum. 1996] - PubMed - NCBI,f1000m,isrctn
  24. Reduced pain from osteoarthritis in hip joint... [Ugeskr Laeger. 2003] - PubMed - NCBI,f1000m,isrctn
  25. Tocopherol in Osteoarthritis: a controlled ... [J Am Geriatr Soc. 1978] - PubMed - NCBI,f1000m,isrctn
  26. Clinical effectiveness of Sp... [Z Orthop Ihre Grenzgeb. 1986 May-Jun] - PubMed - NCBI,f1000m,isrctn
  27. High dosage vitamin E therapy in patien... [Z Rheumatol. 1990 Nov-Dec] - PubMed - NCBI,f1000m,isrctn
  28. Vitamin E is ineffective for symptomatic relie... [Ann Rheum Dis. 2001] - PubMed - NCBI,f1000m,isrctn
  29. Supplementary vitamin E does not affect the loss... [J Rheumatol. 2002] - PubMed - NCBI,f1000m,isrctn
  30. Harpgophytum procumbens for osteoa... [BMC Complement Altern Med. 2004] - PubMed - NCBI,f1000m,isrctn