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From Fellrnr.com, Running tips
Created page with "Knee pain is one of the most common running problems. The joint supplements glucosamine and chondroitin provide marginal bene..."
[[File:KneePainFigure m flip.jpg|right|thumb|400px|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.
=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<ref name="JointChAbs"/><ref name="JointChAbs2"/><ref name="JointGluAbs"/>. There have been over 500 studies of glucosamine and chondroitin<ref name="JointAIM"/>, and analysis of the best of the studies show only a marginal benefit<ref name="JointBMJ"/><ref name="JointAnnIM"/><ref name="JointArthRheum"/> or provide benefit only to a subgroup of suffers<ref name="JointNEJM"/>. These benefits do not meet the requirements to be generally considered clinically important<ref name="JointBMJ"/>. However, given the safety of these supplements, they may be worth considering if your income is sufficient.
==Dosage==
Doses of less than 800 mg/day of chondroitin or less than 1500 mg/day of glucosamine are considered sub-therapeutic<ref name="JointBMJ"/>, 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<ref name="GlucosDose"/> and 200-400mg chondroitin 2-3 times daily<ref name="ChondDose"/>. These doses are based on those commonly used in studies.
=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.
=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<ref name="JointNutra"/>. 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<ref name="JointMSM2"/><ref name="JointMSM3"/>, but not enough to give confidence as to its effectiveness or safety<ref name="JointMSM"/>. MSM does cross the blood/brain barrier<ref name="JointMSMBrain1"/><ref name="JointMSMBrain2"/> and may cause headaches<ref name="JointMSM2"/>. (I believe MSM was a trigger for my migraines.)
* The supplement "avocado/soybean unsaponifiables" has shown positive results in studies<ref name="JointASU1"/><ref name="JointASU2"/><ref name="JointASU3"/><ref name="JointASU4"/>. 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<ref name="JointO3GPig"/><ref name="JointO3Most"/>. Given the other health benefits of [[Omega 3]] oils, supplementation should be considered.
* Higher Vitamin C intake may reduce Osteoarthritis<ref name="JointVitCFraming"/> and 1000mg/day of Vitamin C reduced joint pain, though by less than half what would be expected from [[NSAIDs and Running|NSAIDs]]<ref name="JointVitC1g"/>. Like [[Omega 3]] there may be other benefits to Vitamin C supplementation that make this worthwhile.
* Some<ref name="JointVitEP1"/><ref name="JointVitEP2"/><ref name="JointVitEP3"/>, but not all<ref name="JointVitEN1"/><ref name="JointVitEN2"/> 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)<ref name="JointDevilC"/>. However, there is little known about its safety.
=References=
<references>
<ref name="ChondDose">Chondroitin sulfate: Dosing - MayoClinic.com http://www.mayoclinic.com/health/chondroitin-sulfate/NS_patient-chondroitin/DSECTION=dosing </ref>
<ref name="GlucosDose">Glucosamine: Dosing - MayoClinic.com http://www.mayoclinic.com/health/glucosamine/ns_patient-glucosamine/dsection=dosing </ref>
<ref name="JointDevilC">Harpgophytum procumbens for osteoa... [BMC Complement Altern Med. 2004] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/15369596?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitEN2">Supplementary vitamin E does not affect the loss... [J Rheumatol. 2002] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/12465157?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitEN1">Vitamin E is ineffective for symptomatic relie... [Ann Rheum Dis. 2001] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/11557651?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitEP3">[High dosage vitamin E therapy in patien... [Z Rheumatol. 1990 Nov-Dec] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/2085059?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitEP2">[Clinical effectiveness of Sp... [Z Orthop Ihre Grenzgeb. 1986 May-Jun] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/3529677?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitEP1">Tocopherol in Osteoarthritis: a controlled ... [J Am Geriatr Soc. 1978] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/350940?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitC1g">[Reduced pain from osteoarthritis in hip joint... [Ugeskr Laeger. 2003] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/12854267?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitCFraming">Do antioxidant micronutrients protect agains... [Arthritis Rheum. 1996] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/8630116?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointO3Most">Association of plasma n-6 and n-3 polyunsaturated fatty acids with synovitis in the knee: the MOST study http://www.oarsijournal.com/article/S1063-4584%2812%2900060-X/abstract </ref>
<ref name="JointO3GPig">Regulation of osteoarthritis by omega-3 (n-3) polyunsaturated fatty acids in a naturally occurring model of disease http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176911/ </ref>
<ref name="JointASU4">Symptomatic efficacy of avocado/soybean unsa... [Arthritis Rheum. 1998] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/9433873?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointASU3">Symptoms modifying effect of avocado/soybe... [Scand J Rheumatol. 2001] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/11578021?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointASU2">Efficacy and safety of avocado/soybean unsa... [Rev Rhum Engl Ed. 1997] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/9476272?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointASU1">Structural effect of avocado/soybean unsapon... [Arthritis Rheum. 2002] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/11932878?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointNutra">Arthritis Research & Therapy | Full text | Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence http://arthritis-research.com/content/8/4/R127 </ref>
<ref name="JointGluAbs">Synovial and plasma glucosamine con... [Osteoarthritis Cartilage. 2007] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/17353133 </ref>
<ref name="JointChAbs2">Anti-inflammatory activity of chond... [Osteoarthritis Cartilage. 1998] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/9743814 </ref>
<ref name="JointChAbs">Biochemical and pharmacokinetic aspect... [Arzneimittelforschung. 1995] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/7575762 </ref>
<ref name="JointMSMBrain2">Accumulation of methylsulfonylmethane in the hu... [Toxicol Lett. 2001] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/11641045?dopt=Abstract </ref>
<ref name="JointMSMBrain1">Detection of dimethyl sulfone in the huma... [Magn Reson Imaging. 2000] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/10642107?dopt=Abstract </ref>
<ref name="JointMSM3">Randomised, Double-Blind, Parallel, Place... [Clin Drug Investig. 2004] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/17516722 </ref>
<ref name="JointMSM2">Efficacy of methylsulfonylmethane (... [Osteoarthritis Cartilage. 2006] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/16309928?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointMSM">Systematic review of the nutritiona... [Osteoarthritis Cartilage. 2008] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/18417375 </ref>
<ref name="JointNEJM">Glucosamine, chondroitin sulfate, and the two i... [N Engl J Med. 2006] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/16495392 </ref>
<ref name="JointAIM">JAMA Network | Archives of Internal Medicine | Structural and Symptomatic Efficacy of Glucosamine and Chondroitin in Knee OsteoarthritisA Comprehensive Meta-analysis http://archinte.jamanetwork.com/article.aspx?volume=163&issue=13&page=1514 </ref>
<ref name="JointBMJ">Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941572/ </ref>
<ref name="JointAnnIM">Meta-analysis: chondroitin for osteoarthritis... [Ann Intern Med. 2007] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/17438317 </ref>
<ref name="JointArthRheum">Glucosamine for pain in osteoarthritis: why ... [Arthritis Rheum. 2007] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/17599746 </ref>
</references>
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.
=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<ref name="JointChAbs"/><ref name="JointChAbs2"/><ref name="JointGluAbs"/>. There have been over 500 studies of glucosamine and chondroitin<ref name="JointAIM"/>, and analysis of the best of the studies show only a marginal benefit<ref name="JointBMJ"/><ref name="JointAnnIM"/><ref name="JointArthRheum"/> or provide benefit only to a subgroup of suffers<ref name="JointNEJM"/>. These benefits do not meet the requirements to be generally considered clinically important<ref name="JointBMJ"/>. However, given the safety of these supplements, they may be worth considering if your income is sufficient.
==Dosage==
Doses of less than 800 mg/day of chondroitin or less than 1500 mg/day of glucosamine are considered sub-therapeutic<ref name="JointBMJ"/>, 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<ref name="GlucosDose"/> and 200-400mg chondroitin 2-3 times daily<ref name="ChondDose"/>. These doses are based on those commonly used in studies.
=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.
=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<ref name="JointNutra"/>. 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<ref name="JointMSM2"/><ref name="JointMSM3"/>, but not enough to give confidence as to its effectiveness or safety<ref name="JointMSM"/>. MSM does cross the blood/brain barrier<ref name="JointMSMBrain1"/><ref name="JointMSMBrain2"/> and may cause headaches<ref name="JointMSM2"/>. (I believe MSM was a trigger for my migraines.)
* The supplement "avocado/soybean unsaponifiables" has shown positive results in studies<ref name="JointASU1"/><ref name="JointASU2"/><ref name="JointASU3"/><ref name="JointASU4"/>. 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<ref name="JointO3GPig"/><ref name="JointO3Most"/>. Given the other health benefits of [[Omega 3]] oils, supplementation should be considered.
* Higher Vitamin C intake may reduce Osteoarthritis<ref name="JointVitCFraming"/> and 1000mg/day of Vitamin C reduced joint pain, though by less than half what would be expected from [[NSAIDs and Running|NSAIDs]]<ref name="JointVitC1g"/>. Like [[Omega 3]] there may be other benefits to Vitamin C supplementation that make this worthwhile.
* Some<ref name="JointVitEP1"/><ref name="JointVitEP2"/><ref name="JointVitEP3"/>, but not all<ref name="JointVitEN1"/><ref name="JointVitEN2"/> 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)<ref name="JointDevilC"/>. However, there is little known about its safety.
=References=
<references>
<ref name="ChondDose">Chondroitin sulfate: Dosing - MayoClinic.com http://www.mayoclinic.com/health/chondroitin-sulfate/NS_patient-chondroitin/DSECTION=dosing </ref>
<ref name="GlucosDose">Glucosamine: Dosing - MayoClinic.com http://www.mayoclinic.com/health/glucosamine/ns_patient-glucosamine/dsection=dosing </ref>
<ref name="JointDevilC">Harpgophytum procumbens for osteoa... [BMC Complement Altern Med. 2004] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/15369596?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitEN2">Supplementary vitamin E does not affect the loss... [J Rheumatol. 2002] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/12465157?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitEN1">Vitamin E is ineffective for symptomatic relie... [Ann Rheum Dis. 2001] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/11557651?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitEP3">[High dosage vitamin E therapy in patien... [Z Rheumatol. 1990 Nov-Dec] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/2085059?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitEP2">[Clinical effectiveness of Sp... [Z Orthop Ihre Grenzgeb. 1986 May-Jun] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/3529677?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitEP1">Tocopherol in Osteoarthritis: a controlled ... [J Am Geriatr Soc. 1978] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/350940?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitC1g">[Reduced pain from osteoarthritis in hip joint... [Ugeskr Laeger. 2003] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/12854267?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointVitCFraming">Do antioxidant micronutrients protect agains... [Arthritis Rheum. 1996] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/8630116?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointO3Most">Association of plasma n-6 and n-3 polyunsaturated fatty acids with synovitis in the knee: the MOST study http://www.oarsijournal.com/article/S1063-4584%2812%2900060-X/abstract </ref>
<ref name="JointO3GPig">Regulation of osteoarthritis by omega-3 (n-3) polyunsaturated fatty acids in a naturally occurring model of disease http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176911/ </ref>
<ref name="JointASU4">Symptomatic efficacy of avocado/soybean unsa... [Arthritis Rheum. 1998] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/9433873?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointASU3">Symptoms modifying effect of avocado/soybe... [Scand J Rheumatol. 2001] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/11578021?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointASU2">Efficacy and safety of avocado/soybean unsa... [Rev Rhum Engl Ed. 1997] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/9476272?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointASU1">Structural effect of avocado/soybean unsapon... [Arthritis Rheum. 2002] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/11932878?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointNutra">Arthritis Research & Therapy | Full text | Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence http://arthritis-research.com/content/8/4/R127 </ref>
<ref name="JointGluAbs">Synovial and plasma glucosamine con... [Osteoarthritis Cartilage. 2007] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/17353133 </ref>
<ref name="JointChAbs2">Anti-inflammatory activity of chond... [Osteoarthritis Cartilage. 1998] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/9743814 </ref>
<ref name="JointChAbs">Biochemical and pharmacokinetic aspect... [Arzneimittelforschung. 1995] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/7575762 </ref>
<ref name="JointMSMBrain2">Accumulation of methylsulfonylmethane in the hu... [Toxicol Lett. 2001] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/11641045?dopt=Abstract </ref>
<ref name="JointMSMBrain1">Detection of dimethyl sulfone in the huma... [Magn Reson Imaging. 2000] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/10642107?dopt=Abstract </ref>
<ref name="JointMSM3">Randomised, Double-Blind, Parallel, Place... [Clin Drug Investig. 2004] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/17516722 </ref>
<ref name="JointMSM2">Efficacy of methylsulfonylmethane (... [Osteoarthritis Cartilage. 2006] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/sites/entrez/16309928?dopt=Abstract&holding=f1000,f1000m,isrctn </ref>
<ref name="JointMSM">Systematic review of the nutritiona... [Osteoarthritis Cartilage. 2008] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/18417375 </ref>
<ref name="JointNEJM">Glucosamine, chondroitin sulfate, and the two i... [N Engl J Med. 2006] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/16495392 </ref>
<ref name="JointAIM">JAMA Network | Archives of Internal Medicine | Structural and Symptomatic Efficacy of Glucosamine and Chondroitin in Knee OsteoarthritisA Comprehensive Meta-analysis http://archinte.jamanetwork.com/article.aspx?volume=163&issue=13&page=1514 </ref>
<ref name="JointBMJ">Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941572/ </ref>
<ref name="JointAnnIM">Meta-analysis: chondroitin for osteoarthritis... [Ann Intern Med. 2007] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/17438317 </ref>
<ref name="JointArthRheum">Glucosamine for pain in osteoarthritis: why ... [Arthritis Rheum. 2007] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/17599746 </ref>
</references>
