Beyond Glucosamine: Improving Joint Structure and Function
Arthritis and other joint issues affect people of all ages and have a variety of causes, but the most common is osteoarthritis (OA), also known as degenerative joint disease. According to the Arthritis Foundation, “over 50 million Americans have arthritis, making it the number one cause of disability in the country.”
Age, weight, trauma and wear due to repetitious movements are common risk factors of knee OA with frequent kneeling and squatting being of particular concern. Years ago, initial research suggested that glucosamine sulfate might be effective in decreasing painful symptoms associated with OA and hence became a very popular dietary supplement, but more recent studies demonstrated that glucosamine alone does not prevent or repair cartilage damage. Cartilage is a matrix of glycosaminoglycans, proteoglycans, and collagen fibers. Glucosamine sulfate provides the raw material needed by the body to manufacture the glycosaminoglycan. Studies conducted on the efficacy of glucosamine alone versus glucosamine with chondroitin, revealed the latter combination produced more positive results1. Chondroitin is a proteoglycan. So it does make sense that providing not just one, but two elements of the cartilage matrix would allow for better results.
For over 25 years, veterinarians have known that collagen from chicken cartilage exerts an anabolic effect on cartilage tissue which repairs and helps prevent joint degeneration in horses, dogs and cats. It has taken quite a long time for this same substance also known as Collagen II, to catch on for human use, but studies are showing its efficacy in facilitating joint repair in athletes as well as adults with OA 2,3,4. Chondrocytes excrete collagen, but they must have access to the right amino acids along with Vitamin C in order for collagen production to occur, and collagen II provides the amino acids required to make the type of collagen that incorporates into the joint cartilage matrix. Now we have evidence that glucosamine, chondroitin and collagen together can help joints repair and rebuild.
Cartilage, being avascular, requires hyaluronic acid along with exercise to move nutrients in and waste out. This is the reason behind the seemingly paradoxical fact that exercise reduces the pain and stiffness of OA. Hyaluronic acid (HA) is a glycosaminoglycan (GAG) found in extracellular matrix throughout the body and its role in the synovial fluid of the joint space is to hydrate and provide lubrication.5 As endogenous HA production declines with age, so does our ability to maintain adequate joint lubrication. There seems to be a correlation between age related declines in both hyaluronic acid and proteoglycans (like chondroitin sulfate) and the development of OA. We now know that chondroitin is a proteoglycan which not only contributes to forming cartilage matrix, but also to joint lubrication and hydration by attracting and binding hyaluronic acid. The great news is that all these supplements can be incorporated into an integrative practitioner’s toolbox to support the maintenance of healthy joints.
Preventing joint damage is the key to a lifetime without pain, and athletes are at particular risk, even young athletes. It is critically important to protect the joints from damaging trauma, wear and tear, or at least to mitigate the damage and facilitate adequate repair 6. We now have some great supplement options and protocols for doing just that. In addition, paying attention to pain, seeking appropriate chiropractic, osteopathic or orthopedic care, and maintaining a healthy anti-inflammatory diet, high in protein, Omega-3 and antioxidants can also help patients in maintaining healthy joints throughout one’s lifespan.
- Raynauld JP, Pelletier JP, Abram F, Delorme P, Martel-Pelletier J. Long-term effects of glucosamine/chondroitin sulfate on the progression of structural changes in knee osteoarthritis: 6-year follow-up data from the osteoarthritis initiative. Arthritis Care Res (Hoboken). 2016 Feb 16. doi: 10.1002/acr.22866.
- Lugo JP, Saiyed ZM, Lane NE. Efficacy and tolerability of an undenatured type II collagen supplement in modulating knee osteoarthritis symptoms: a multicenter randomized, double-blind, placebo-controlled study. Nutr J. 2016 Jan 29;15(1):14. doi: 10.1186/s12937-016-0130-8.
3.Schauss AG, Stenehjem J, Park J, Endres JR, Clewell A. Effect of the novel low molecular weight hydrolyzed chicken sternal cartilage extract, BioCell Collagen, on improving osteoarthritis-related symptoms: a randomized, double-blind, placebo-controlled trial. J Agric Food Chem. 2012 Apr 25;60(16):4096-101.doi: 10.1021/jf205295u.Epub 2012 Apr 16.
4.Bello AE, Oesser S. Collagen hydrolysate for the treatment of osteoarthritis and other joint disorders: a review of the literature. Curr Med Res Opin. 2006 Nov;22(11):2221-32.
5.Mariko Oe, Toshiyuki Tashiro, Hideto Yoshida, Hiroshi Nishiyama, Yasunobu Masuda, Koh Maruyama. Oral hyaluronan relieves knee pain: a review Nutrition Journal (2016) 15:11 DOI 10.1186/s12937-016-0128-2
- KL, Sebastianelli W, Flechsenhar KR et al. 24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain. Curr Med Res Opin. 2008 May;24(5):1485-96. doi: 10.1185/030079908X291967.Epub 2008 Apr 15.0
By Lisa Murray, RND,LD