By Myprotein Writer Christopher Tack: Lead clinician and owner of All Powers Rehabilitation & Conditioning Combat Sports Physiotherapy service, and works for Guys & St Thomas Hospital Private Physiotherapy Service in London.
If there’s one thing we should make sure we look after its out joints! Arter all our joints are the main components within our bone structure that allow for movement! However, many people are diagnosed every year with a condition that causes pain and inflammation in the joint- Arthritis.
What Is Arthritis?
Arthritis is a condition and medical diagnosis that can forever change your life. This condition affects the muscoskeletal system, in particularly the joints- however arthritis is not a single disease- it is actually a term that covers over 100 medical conditions. The “incurable” nature of this disease is often a real scary idea for suffering individuals to comprehend and accept. Alternatively, the fear of arthritis is what can drive us all to take better care of the joints our bodies hold dear.
In this article find out a bit more about arthritis and the best supplements for your joints which may assist your training regime.
What are the Symptoms of Arthritis?
If you have trouble moving around or tend to feel pain and stiffness and swelling in the joints you may have a good reason to be concerned about your joint health, however, the exact symptoms of arthritis depends on the type: osteoarthritis and rheumatoid arthritis. The symptoms of osteoarthritis develop over a long period of time where pain is suffered within the joints during or after use or after being inactive. This means your joints will be particularly stiff first thing in the morning, with a lack of flexibility and swelling of the joints. When suffering from rheumatoid arthritis an individual can often find painfully swollen joints on both sides of the body which appear to be inflamed and stiff. Joints become tender, red and puffy whereby weight loss and the presence of rheumatoid nodules can become common.
Osteoarthritis is the most common form of arthritis, which is a process of changes within the joints, involving a loss of smooth cartilage and remodelling of the adjacent bone. These processes can involve inflammation, and subsequently causes a degree of pain and limitations to how people can move in their daily lives. In essence osteoarthritis is a normal occurrence. Joints are put under stress and strain every day without any pain. Arthritis occurs when a small degree of innocuous trauma triggers a healing response within the joint. The automatic repair process undertaken to compensate for this injury leads to a structural alteration of the joint anatomy. Sometimes the compensation is not enough to leave the joint symptom free and then pain occurs. The further confusing part is that if we put people without any symptoms in an MRI scan, the results show that degenerative changes can be present. This has been identified in the knee (1) and the spine (2). In the spine it was actually found that 35% of an asymptomatic population between 20 and 39 years old had signs of degeneration! This indicates that changes in our joints are NORMAL and actually whether or not we feel pain is dependent on other factors.
In 2008 the National Institute for Health & Care Excellence produced guidelines as to the recommended management of arthritis based upon the available scientific literature. These guidelines are then taken on and used within the NHS. In February 2014 these guidelines were updated with any further research which had occurred since their publication (3).. They made the following recommendation:
“Do not offer glucosamine or chondroitin products for the management of osteoarthritis”
Now I am no nutritionalist, however I have very often heard in lay and scientific literature, and have even been told by my patients the benefits of joint health supplements, and that they could not live without them. That they received a new lease of life from taking these tablets when medicines and pain killers leave them only with side effects. For the guideline to be so emphatic in the dismissal of these products confuses me and makes me want to learn more about why this decision was made.
Which Supplements are best?
Health supplements (or nutraceuticals) is a term which covers food supplements which are thought to have health benefits. This is usually through testing on animal models (e.g. horses, dogs, etc.) where a disease is benefitted from their use, or in laboratory experiments. The most commonly analysed and tested are glucosamine (sulphate and hydrochloride) and more recently chondroitin. Both of these supplements have shown promise in tests for their use with joint disorders such as arthritis.
Glucosamine is an amino sugar that is naturally found around the cells of cartilage and connective tissue. Supplementation of glucosamine is considered beneficial in modifying the repair processes which occur in cartilage through gene expression (4) and by effecting the production of the extracellular matrix of cartilage (5).
The organisation NICE examined a large amount of scientific papers (25 in fact) regarding glucosamine and compared it to placebo, paracetamol, non-steroidal anti-inflammatories (NSAIDs) and even opioids. Generally the research indicated that for knee OA, pain was not benefited by glucosamine use. Although one small study did indicate a reduction of pain at 3 month follow up (6). Other studies showed a possible benefit for its use to increase function (movement and activity) beyond 3 months (7), but the level of evidence quality was potentially in doubt. Another study shows a possible clinical benefit compared to NSAIDs for pain in the long term (8); and a further low quality study indicated that glucosamine use may be effective in reducing joint space loss at three months (vs placebo)(9).
Chondroitin sulphate is a complex carbohydrate that acts to improve cartilage structure and health, and helps the cartilage to maintain water. It occurs naturally as part of a chain of sugar molecules which make up the extra cellular matrix of the cartilage. The lack of this substance in the diet may be a contributory factor in the development of OA.
Again another 22 papers were studied of which 17 studies (2335 people) with knee OA showed chondroitin was clinically more effective than placebo in reducing pain. Other studies showed no difference between these supplements and placebo in altering function but may be similarly effective as NSAIDs in reducing stiffness and increasing function (10). Reduction in pain was also shown in a hip OA population study (11).
Now, in all honesty, whilst I am not a nutritionalist, I was previously a researcher at NICE- in fact my job was to assess and analyse scientific studies. As such I know that in the light of all this POSITIVE research, something else must be behind the guideline not highlighting these supplements as beneficial products.
NICE guidelines are produced by getting a group of experienced professionals (doctors, physiotherapists, nutritionalists, etc.) together, and getting an independent researcher to examine the clinical and cost effectiveness of specific treatments for a condition. Recommendations are a by-product of professionals discussing and debating the results of the research, and one of their concerns can be the “quality” of the research. When examining research, in order to make a fully conclusive statement the findings must be able to be applied to the general population- which believe you me is not easy. As a result, in some cases, many positive findings from studies can be overlooked and may not receive the full attention they deserve.
Another aspect to consider is included within the full OA guideline, which explains the “concern” in recommending products whose contents are not licensed and regulated by Medicines & Healthcare Regulatory Authority (MHRA) and the British National Formulary. When purchasing supplements of any kind it is important to only purchase products whereby the company clearly adhere to the standards of the Health Analysis and Critical Control Points (HACCP) principles and Good Manufacturing Practices (GMP), whereby the quality of these products as a supplement (NOT A MEDICINE) can be considered suitable.
What else is there?
Outside of these guidelines a few other products could be considered- notably collagen hydrosylate, celadrin, methyl-sulfonyl-methane (MSM) and omega fatty acids.
Hydrolysed collagen is a naturally occurring substance which can be harvested generally from pig or cow tissue to create a supplement which may have an anabolic effect on cartilage. It also contains 8 out of 9 essential amino acids including glycine and arginine, also known to be the building blocks of muscle tissue.
In laboratory studies this substance has been shown to increase the synthesis of type II collagen in cartilage cells, as well as remain safe as measured by the US Food & Drug Administration (FDA) (12).
These experiments have led for researchers to assess its benefit in a population of OA patients. One review based between the Collagen Research institute in Germany, and the University of Illinois in Chicago, measured the effect of this supplement of patients (12). It indicated that oral collagen supplements may provide symptomatic relief to those suffering with arthritis in regards to reducing pain and improving function, although they did not measure its statistic significance.
CETYLATED FATTY ACIDS (CFAs)
CFAs, or the trademarked supplement compound Celadrin™, is a form of dietary fatty acid which is rendered from cow fat. Fish oils, and fatty acids such as this, have been identified through laboratory studies as having preventative benefits for cardiovascular health (13, 14). However, it has also been found that cetylated monosaturated fatty acid (e.g. myristoleic acid) can provide protection against rats that have been given arthritis in the laboratory (15).
In 2002 the work of Hesslink et al. (16) found that when provided as an oral supplement to 66 patients with knee arthritis, Celadrin™ caused a 15% reduction in swelling in those taking the supplement (0% change in the control group who took a placebo); and 26% more of the Celadrin group reported a reduction in pain (58% to 32%). These changes were also alongside less impressive increases in knee movement. Whilst the biochemical mechanism of this joint protection is beyond the scope of this article, it has been found that these supplements reduce joint inflammation and reducing tissue responsiveness to cytokines (a key group of cell proteins which assists inflammatory processes) (17).
Another supplement, which we will call “MSM” just to save me the trouble of pronouncing methy-sulfonyl-methane in my head, has a little less research supporting its use.
Kim et al. (18) from the College of Naturopathic Medicine in Tempe, Arizona; gave a group of individuals with knee OA 3000mg (!) of MSM for 12 weeks. Their results; using a fairly rigorous randomised, double blind, placebo controlled trial, indicated a significant reduction in pain and improvements in activity performance. Interesting, for a supplement which also reduces markers of cardiovascular disease and apparently is being added to nose drops to help combat snoring (19).
So… take your pick… It seems that whilst scientific rigour of the available research is being debated there is available evidence which points towards the use of supplements as being effective in reducing pain, improving function and making changes to joints to combat arthritis. The important thing to remember is that these products are NOT medicine and do not claim to be. They are to “supplement” correct dietary practices and an active, healthy lifestyle, and not as a cure for the dreaded arthritis.
Whether rendered from a cow or a pig it looks like products such as glucosamine, chondroitin, collagen derivatives, fatty acids or MSM, have a place in the diet of those with arthritis, especially (like most things) in combination.
Unfortunately, no studies I have found have looked at the preventative benefits of these supplements in a “normal” population, however as described even early changes in arthritis can be considered “normal” for the majority.
The other important thing is that these items generally are SAFE, and will not provide the side effects of some other medications such as anti-inflammatories, as such giving people an option of what they place in their bodies. This is especially true if you purchase them from a respected and regulated outlet, such as MyProtein.
So you may never see these items being prescribed by GPs, but when they are easily accessible, safe and effective, and you are struggling to train or get around due to arthritis, perhaps you should give them a go. I’m using them. Are you?