As a consumer, it can be hard to choose which medicinal and nutritional supplements are best for you. Many, if not most, supplements do deliver on their promises; however, some are certainly better than others and knowing what to look for when choosing a supplement is extremely important.
For the purposes of this article, we will focus on one common ailment - joint pain and stiffness. Joint pain, disability, and restricted mobility affect more than 40 million Americans. As the U.S. population ages, it is expected that this number will more than double over the next decade. These symptoms, once considered an unavoidable consequence of aging, are now being successfully treated by joint support products. This is particularly true in the case of osteoarthritis.
While some people are genetically predisposed to developing this most common form of arthritis, many people will develop degenerative osteoarthritis due to injury or overuse of joints. The most commonly prescribed treatment for osteoarthritis pain is non-steroidal anti-inflammatory drugs ("NSAIDS"), which provide temporary relief from inflammation in the joints. This common treatment generally works for a while, and many people will experience no complications from the drugs. For some, however, the side effects are significant. Increased risk of stroke, heart attack, and digestive disorders are only a few of the serious risks associated with taking NSAIDS.
Nutritional supplementation offers hope for osteoarthritis suffers, without the risk of the potentially deadly side effects of NSAIDs. The acceptance of joint support products by consumers has been steadily increasing due to their proven effectiveness, as well as their ability to promote and maintain joint health with little or no side effects. Millions of people have experienced some relief and pain remediation through regular supplementation with various dietary products. Glucosamine, chondroitin, and calcium have been popular choices for regular supplementation for joint problems and bone strength, but each has drawbacks with respect to effectiveness, bioavailability, and tolerability. The often overlooked mineral silica is an attractive alternative providing similar benefits but without many of the drawbacks associated with glucosamine, chondroitin, and calcium.
Glucosamine: In general, glucosamine is an amino sugar that has shown moderate ability to relieve the pain of osteoarthritis and restore partial movement to affected joints. However, taking glucosamine derived from sea creatures may cause allergic responses in individuals who are allergic to shellfish. Individuals with diabetes may experience elevated blood sugar levels if they inject glucosamine which may even raise blood sugar for individuals who do not have diabetes. Pregnant or breastfeeding women are also advised to avoid taking glucosamine because little is known about its effects on this patient population.
During research studies, gastrointestinal complaints such as constipation, diarrhea, and nausea were attributed to taking glucosamine. Some study participants who took glucosamine sulfate also reported drowsiness or headache. In addition, glucosamine may increase the risk of excessive bleeding when it is taken in conjunction with warfarin; other anticoagulants or anti-platelet drugs; aspirin; or herbal products that reduce the blood's ability to clot. Finally, injecting it may increase blood sugar levels, thereby interfering with insulin and drugs or herbals that lower blood sugar.
Chondroitin: Chondroitin is a sulfate molecule that occurs naturally in the body and is believed to provide a different chemical from glucosamine that is important in the formation of cartilage; however, its effects are not understood as well as glucosamine's. Some people believe that it may help keep cartilage healthy by absorbing fluid into the connective tissue. However, studies have not shown conclusively that chondroitin helps repair or grow new cartilage or even helps prevent cartilage from further deterioration.
Many chondroitin supplements are made from cow cartilage. If you are a vegetarian or otherwise object to the use of animal based products, look for a supplement made from algae instead. There have been occasional reports of mild side effects which include nausea, upset stomach, diarrhea, constipation, indigestion, stomach pain, and heartburn. Chondroitin is similar in chemical composition to heparin, a drug used to thin the blood; accordingly, it is theoretically possible for chondroitin to increase the effects of blood thinners.
Chondroitin is often combined with glucosamine in many popular supplement products such as Osteo Bi-Flex, Cosamin and Estroven. The Arthritis Foundation recommends exercising caution in taking glucosamine and chondroitin for the treatment of osteoarthritis. Moreover, due to the popularity of glucosamine-chondroitin supplements and the apparent lack of reliable information about their usefulness in treating osteoarthritis,the National Institutes of Health funded a study to test the effects of chondroitin and glucosamine on osteoarthritis of the knee. This multicenter, placebo-controlled, double-blind, six month long trial found that glucosamine plus chondroitin had no statistically significant effect on symptoms of osteoarthritis in the overall group of osteoarthritis patients.
Calcium: Calcium supplements are widely popular and come in several forms including calcium carbonate and calcium citrate. The primary difference between these two types of calcium supplements is the amount of elemental (or actual) calcium they contain. Calcium carbonate contains almost twice as much as citrate, which generally makes the carbonate form less expensive. Calcium citrate is often recommended for the elderly because it may be easier for their digestive systems to absorb. A recent review of calcium and bone mass studies found that calcium citrate malate has high bioavailability in all age ranges including young girls as well as postmenopausal women.
Side effects of calcium supplementation include nausea, vomiting, loss of appetite, constipation, stomach pain, thirst, dry mouth, and increased urination. Although it is well accepted that calcium supplements reduce the risk for osteoporosis, there is concern that high calcium dosages may increase the risk for hardening of the arteries and kidney stones. High calcium intake can result in calcium deposition into soft tissue and can also impair absorption of other minerals such as magnesium, zinc, and iron. If taking calcium supplements, you should not eat large amounts of bran or whole grain cereals and breads because they may reduce absorption of calcium. Similarly, consuming alcohol, large amounts of caffeine or vitamin D, or using tobacco products may also impair the absorption of calcium.
Silica: Silica, also called silicon, is an essential mineral and potentiator of other minerals like calcium for bones; glucosamine for joints; and antioxidants for healthier arteries and cardiovascular function. Silica is a trace mineral required for the formation of healthy connective tissue, bone, skin, hair, and nails. Silica is also essential for collagen formation, healthy arteries, and regulation of calcium deposition in the bones. Absorption is critical to its effectiveness because dietary sources of silica such as those found in food, horsetail, and colloidal gel (silica) products are very poorly absorbed because of their insoluble, polymerized forms. For optimal absorption to occur, dietary silica must first be converted to organic silicon (monomethylsilanetriol). This form of silica has excellent bioavailability and is found in premium product offerings such as Orgono Living Silica. Unlike the other nutritional supplements discussed for joints, silica has no known side effects.
In addition to knowing the differences between each option available, here are a few other considerations to keep in mind when selecting a nutritional supplement.
Quality: Is the company committed to observing Good Manufacturing Practices? Does the product contain pharmaceutical-grade ingredients? Does it contain the recommended amount of each ingredient to be effective?
Delivery: Form is important. Powders, pills, tablets, and capsules all have little "extras" that can interfere with the body's ability to absorb supplements. Liquid delivery of the supplement ensures your body can absorb the active ingredients quickly and effectively, without extra binders, fillers, and additives found in powders, pills, tablets, and capsules.
Tolerability: Is the product safe? Are there any side effects associated with the product? Have there been any drug interactions reported?
Reputation: Is the company reliable? Does the company feature testimonials from satisfied customers? Does it have a negative reputation?
Customer care: This is particularly important in nutritional supplements, as many companies use independent sellers to distribute their product. Is the company you purchase your supplements from an authorized distributor? Do they stand behind their product? Do they ship quickly?
As you can see, there are many factors and options to consider when choosing a nutritional supplement for joint health. Being informed is the best way to decide which one is right for you.
McAlindon TE, et al. "Glucosamine and Chondroitin for Treatment of Osteoarthritis: A Systematic Quality Assessment and Meta-analysis". JAMA 283: 1469-1475, 2000.
Mineral Supplement
Clegg DO, et al. "Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis". New Engl J Med 354 (8): 795-808, 2006.
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