Supplements that help ease muscle and joint pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

From the Arthritis Foundation

There are multiple supplements that have been touted as having beneficial properties when it comes to aches and pains. This article will discuss some of the more proven ones.

Non-steroidal and-inflammatory drugs (NSAIDs) that most people use, such as Motrin, Naprosyn, Celebrex, and related medicines relieve symptoms. They also have potential side effects such as stomach ulcers, kidney and liver dysfunction, and increased risk of cardiovascular events. These drugs also may impair joint healing, which is why an increasing number of active active people are choosing alternative approaches.

Glucosamine/ Chondroitin Sulfate

These two alternatives to NSAIDs belong to a class called glycosaminoglycans, which are natural building blocks used to build and repair joint cartilage. Glucosamine and chondroitin are used to build the matrix or "ground substance" of joint cartilage, with collagen being the other major component. Because your body can make glucosamine only slowly, taking it as a supplement may effectively speed the healing of your joints after exercise. Studies have shown glucosamine and chondroitin to be effective for arthritis, making these supplements first-line treatments for most people with joint complaints.

Admittedly, the data on these two supplements is controversial. There have been studies showing these supplements are effective and other studies demonstrating no effect. Nonetheless I still recommend them.

Unlike fish oil which reduces inflammation, glucosamine and chondroitin enhance the rebuilding of cartilage. As a result, glucosamine and chondroitin are best added to a supplementation regimen that includes fish oil extracts and anti-inflammatory drugs like aspirin and ibuprofen.

Chondroitin is made up of chains of galactosamine and glucuronic acid. It isn't as well absorbed as glucosamine. It still is considered to be a good addition to glucosamine for renewal joint cartilage and reducing symptoms of arthritis.

Neither supplement works particularly quickly; they both generally take about 2-4 months to work. Take 500 mg of glucosamine or 400 mg of chondroitin three times per day for several months for best results. Side effects are rare but include stomach upset, skin rash, an increase in insulin levels in diabetics and possibly increased insulin resistance. People who are allergic to shellfish also might want to avoid these preparations.

Omega-3 Fatty Acids

Omega-3 fatty acids reduce inflammation. Because they are anti-oxidants, omega-3 fatty acids are also considered essential to good health.

One of the best omega-3 supplements for joints is fish oil, which is rich in the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Both combat joint-damaging enzymes called collagenases and reduce inflammation. As a result, fish oil is a great supplement for reducing joint pain due to inflammation. In fact, a number of excellent clinical trials have found that about 6 grams per day of 30% omega-3 fish oil reduces symptoms of rheumatoid arthritis. That's why eating fish at least twice per week -- especially oily, cold-water varieties like salmon, trout and water-packed tuna -- or taking

fish oil capsules is recommended.

Buying a more concentrated fish oil capsule reduces the pills you have to swallow to four 500 mg capsules per day. Tell your doctor if you're on blood-thinning medication or drugs for arthritis, as fish or flaxseed oils may increase risk of bruising or bleeding when taken with these drugs.


SAMe (S-adenosyl-methionine), often pronounced "Sammy," is a co-enzyme used by the body to make anything from natural mood elevators like dopamine in the brain to building blocks for joint repair like glucosamine. As a result, SAMe has been prescribed both for depression and arthritis alike. Although less vigorously investigated than glucosamine as a joint remedy, SAMe has both anti-inflammatory and joint-rebuilding effects, and shows promise as a second-rung supplement for aches and pains.

Since inflammation and the free radicals that result from it are responsible for much of the joint damage following exercise, SAMe appears to protect joints as well as help rebuild them. Studies suggest that the supplement reduces joint wear-and-tear and arthritis, and SAMe has been recommended for people with fibromyalgia, a disorder characterized by muscle pain, stiffness, fatigue and other symptoms. SAMe's ability to protect the liver from certain toxins is also noteworthy and overall this supplement is worth consideration in cases where glucosamine, fish oil and conventional medicine have failed to treat or prevent post-workout stiffness and soreness.

Normally, 800-1,200 mg of SAMe per day is used for achy joints and/or inflammation. Take it on an empty stomach as two or three 400 mg doses (morning and noon) with a B-complex vitamin, This will help prevent the rare side effects of dry mouth, restlessness and tummy trouble. Since SAMe’s effectiveness is destroyed by light, buy tablets that are individually wrapped in foil or housed in an opaque (not see-through) bottle. Avoid SAMe if you're taking antidepressants or suffering from bipolar syndrome or other psychiatric disorder SAMe is pricey.


Also called betaine or trimethylglycine, TMG is related to SAMe in that it helps reduce cartilage wear-and-tear while also having direct anti-inflammatory effects, TMG is made from beet sugar and, along with certain vitamins, it helps minimize toxicity of drugs and helps protect the liver in a fashion similar to SAMe. TMG regenerates SAMe and may help it work. It also reduces blood homocysteine levels. Elevated levels of homocysteine are associated with heart attacks and osteoporosis. TMG also reduces gastrointestinal damage resulting from the use of aspirin, and presumably other anti-inflammatory drugs like Motrin.

Roughly, 300-500 mg per day of betaine or TMG has often been taken in conjunction with SAMe. No side effects have been reported at the recommended doses. Don't take betaine if you have a urinary tract infection, as it may interfere with your doctor's prescribed medication for treating this condition.


You can try the following supplement combination for joint problems and generalized aches and pains. Allow at least three months for a noticeable benefit.

1,800 mg of fish oil omega-3 fatty acids (EPA plus DI-LA), either as 6 grams of a 30% omega-3 fish oil extract (usually with 180 mg EPA and 120 tag DHA per one capsule), as 2 grams of 92% omega-3 extract.

1,500 mgs of glucosamine sulfate as three 500 tag doses throughout the day (1,200 mgs chondroitin can be used instead). Never economize on glucosamine or chondroitin.

This joint combination is perfect for an active person who likes regular running or weight training. Chondroitin or glucosamine should always be added whenever you take anti-inflammatory drugs; go off the anti-inflammatories and switch to fish oil extract with your doctor's permission as soon as symptoms diminish. It probably isn't a good idea to take fish oil at the same time as Motrin, aspirin, or other NSAIDs; this can increase bleeding in same cases.

Because they speed the healing process, glucosamine and chondroitin are great for injuries or arthritis, but maintenance is just as important. Other than injury prevention, ice and other "damage control" treatments, the importance of proper nutrition on a consistent basis cannot be overemphasized where your joints are concerned. Specifically, a good regimen for any active person should include 450 mg of magnesium, 250 mg of Vitamin C, and 1,000 mg of calcium (or two servings of fat-free dairy products). All three of these nutrients are essential for joint health and repair, and should be taken daily. In addition, 400 I.U. of Vitamin E is also very protective and works well with fish oil concentrates, for example.

Optional: If all else fails, try adding 300-500 mg of trimethylglycine (TMG or betaine), 800-1,200 mg of SAMe and a B complex vitamin that includes folic acid, Vitamin [B12] and Vitamin [B6] daily.

Another tidbit...

Diets rich in olive oil have been associated with numerous health benefits, including antiplatelet activity [1], but the mechanism behind these effects has remained obscure. A team of researchers from the Monell Chemical Senses Center (University of the Sciences, Philadelphia, PA) has discovered that oleocanthal, a component found in extra-virgin olive oil, is "a natural anti-inflammatory compound that has a potency and profile strikingly similar to that of ibuprofen" [2].

"Chronic use of associated with reduced risk of several diseases, including vascular disease (cardiac and brain), some cancers (breast, lung, colon) and dementias including Alzheimer's disease. The Mediterranean diet rich in olive oil is associated with the same reduction of disease risks. We feel that oleocanthal may be a possible bridge between the diet's and the NSAIDs' benefits," senior author Dr Paul AS Breslin says.

This discovery illustrates Pasteur's adage that "fortune favors the prepared mind" or in this instance, throat.

"We know from prior research experience on anti-inflammatory compounds that ibuprofen irritates the back of the throat but not the mouth. This is a unique experience that differs, say, from the burn of biting a chili pepper, which will irritate the mouth, lips, and tongue as well as throat," Breslin says.

While Breslin's colleague Dr Gary Beauchamp was attending a meeting in Sicily on molecular gastronomy, he sampled some freshly pressed extra-virgin olive oil and noticed this same unusual throat sting.

"He brought it back to Philadelphia and asked me to try it. I immediately knew what he was excited about: there must be something ibuprofenlike in the olive oil. This launched a research program that resulted in this paper," Breslin says.

The investigators then set out to determine what components of the olive oil caused the throat irritation and whether they had any anti-inflammatory activity. In fact, newly pressed extra-virgin olive oil contains oleocanthal, both enantiomers of which cause dose-dependent inhibition of both COX-1 and COX-2, but not of lipoxygenase.

Breslin said that oleocanthal is present in fairly high levels in extra-virgin olive oil but not in other types of olive oil and that the level of oleocanthal varies with the ripeness of the olives at harvest, the varietal of the tree, and whether the oil is from a first pressing or later pressings.

Olive oil is not, however, likely to become a substitute for ibuprofen. The investigators found that oleocanthal is about as potent as ibuprofen but occurs in such low levels in the oil that about half a liter would be required to equal the dose in two standard ibuprofen tablets.

The researchers are currently trying to learn why ibuprofen and oleocanthal cause the same throat sting even though they have different structures. "There must be a physiological connection here," Breslin says. They also suspect a link between this type of throat irritation and the anti-COX activity.


1. Togna GI, Togna AR, Franconi M, et al. Olive oil isochromans inhibit human platelet reactivity. J Nutr 2003; 133:2532-6.
2. Beauchamp GK, Keast RSJ, Morel D, et al. Ibuprofen-like activity in extra-virgin olive oil. Nature 2005; 437:45-46.


Brief, A.A., et al. Use of glucosamine and chondroitin sulfate in the management of osteoarthritis. Journal of the American Academy of Orthopsedic Surgeons 9(2):71-78, 2001.

Dingle, J.T. The effects of NSAID on the matrix of human articular cartilages. Zeitschrift fur Rheumatologie 58(3):125-129, 1999.

Fetrow, C.W., Avila, J.R. Efficacy of the dietary supplement S-adenosyl-L-methionine. Annals of Pharmacotherapy 35(11):1,414-1,425, 2001.

Tidow-Kebritchi, S., Mobarhan, S. Effects of diets containing fish oil and vitamin E on rheumatoid arthritis. Nutrition Reviews 59(10):335-338, 2001.

Trappe, T.A., et al. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. American Journal of Physiology, Endocrinology and Metabolism 282:E551-E556, 2002.

Zollei, I., et al. Betaine-palmitate reduces acetylsalicylic acid-induced gastric damage in rats. Scandinavian Journal of Gastroenterology 36(8):811-816, 2001.

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