Supplements used for joint and muscle 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.
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From the Arthritis Foundation
If it were possible to turn back the clock, we could prevent arthritis from developing. But we can't so let's talk about what we can do because aging will lead to gradual wear and tear on muscles and joints.
There is just no getting around it. Although the body can fix itself, damage accumulates if the rate of wear and tear is greater than the rate of repair. If your shoulders are popping, your hip joints are starting to click, lock, or grind, or you have other exercise-related aches and pains, you need to control inflammation and prevent further damage/deterioration.
Nonsteroidal and-inflammatory drugs (NSAIDs) that most people use, such as Motrin, Naprosyn, Celebrex, and related medicines work to relieve symptoms. They also have potential side effects such as stomach ulcers, kidney and liver dysfunction. These drugs also may impair joint healing and even the muscle-building process itself, which is why an increasing number of active active people are choosing alternative approaches.
Glucosamine/ Chondroitin Sulfate
These two excellent alternatives to NSAIDs belong to a class called glycosaminoglycans, which are natural building blocks used to build and repair joint cartilage and fascia, another type of connective tissue. 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.
Unlike fish oil extracts, which reduce inflammation, glucosamine and chondroitin primarily enhance the rebuilding process of cartilage, fascia, and other connective tissue. 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 (glucosamine restores the rate of cartilage healing after aspirin has suppressed it).
Chondroitin is made up of chains of galactosamine (made from glucosamine) and glucuronic acid (made from glucose). It isn't as well absorbed as glucosamine. Chondroitin is also a bit more expensive at about $1 per gram vs. approximately $0.66 per gram of glucosamine, and it's not marketed as widely. Still, evidence suggests it's good in combination with glucosamine at supporting renewal and replenishment of joint cartilage and reducing symptoms of arthritis. Buy chondroitin from a reputable manufacturer.
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. And definitely take these supplements when you're recovering from wear and tear on your joints or if you have arthritis. 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
Unlike glucosamine and chondroitin, omega-3 fatty acids don't help in the rebuilding of joints but instead reduce wear and tear by reducing inflammation. For example, clinical trials have found omega-3s to be useful for arthritis if enough is taken for several months, and they're likely to reduce wear and tear caused by exercise as well. 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 extract, which is rich in the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Both fight joint-damaging enzymes called collagenases and reduce inflammation, factors believed to play a role in arthritis as well as other aches and pains. As a result, fish oil is a great supplement for reducing joint pain and preventing wear and tear. In fact, a number of excellent clinical trials have found that about 6 grams per day of 30% omega-3 fish oil extract 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.
On the surface, fish oil has the drawback of being generally lower in omega-3 fatty acids than flaxseed oil: 30% omega-3s for most fish oil preparations vs. 55% omega-3s for flaxseed oil. Yet EPA and DHA are about 11 times more potent than alphalinolenic acid (ALA from flaxseed oil), and recent fish oil concentrates contain as much as 92% omega-3 fatty acids. 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) 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.
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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