Chebulic Myrobalan Extract Improves Joint Mobility, Comfort, and Functional Capacity in New Study


The study showed improved joint mobility, comfort and functional capacity following supplementation with Natreon's AyuFlex.

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It’s common knowledge that maintaining an exercise program promotes health. But when physical activity hurts, people are less likely to stick with it. A study1 recently published in BMC Complementary and Alternative Medicine showing improved joint mobility, comfort and functional capacity following supplementation with a standardized aqueous extract of Terminalia chebula fruit-marketed as AyuFlex by Nateon (New Brunswick, NJ)-is promising.

The study, conducted at The Center for Applied Health Sciences in Ohio, was a 14-week, randomized, double blind, placebo-controlled trial involving 105 healthy overweight men and women aged 35 to 70 with exercise-related knee discomfort. For the trial’s duration, subjects received either 500 mg/day or 1,000 mg/day of the extract-a potent antioxidant previously shown to modulate oxidation and inflammation-or a placebo. (A two-week placebo lead-in period preceded the treatment to improve data quality and validity.)

Primary outcome measures included the modified-Knee Injury & Osteoarthritis Outcomes Score (mKOOS) and global & modified-Western Ontario and McMaster Universities Arthritis Index (mWOMAC) subscales of discomfort, stiffness and function. Secondary outcomes included visual analog scale (VAS) questionnaires on overall and whole-body joint health, low back health, knee mobility and willingness and ability to exercise; a 6-minute walk test for distance; and range of motion (ROM) evaluations of pain-free knee flexion/extension. Finally, tertiary outcomes measured included inflammation via high sensitivity C-reactive protein (hsCRP), tumor necrosis factor (TNF-α) and extracellular matrix (ECM)/cartilage oligomeric matrix protein (COMP) biomarkers, and tolerability via adverse event (AE)/side effect profiles.

Results showed that AyuFlex supplementation led to significant improvements in mWOMAC scores, distance covered in the 6-minute walk test and several VAS subscales. Researchers also reported improved mKOOS global scores and knee soreness following leg extension exercises, without AE. A significant reduction in COMP emerged in the 500 mg/day group relative to placebo-a finding consistent with a decrease in the net degradation of joint cartilage matrix. And data also suggest that the extract’s benefits may extend beyond the knees to include overall/whole-body joint and spine health. Finally, differences between the 500 mg/day and 1,000 mg/day groups were nonsignificant for most outcomes, pointing to the potential for a lower effective dose.

“To the best of our knowledge this is the first investigation of an aqueous extract of Terminalia chebula utilizing several unique study design aspects, including a placebo lead-in, rigorous inclusion/exclusion criteria, expanding beyond knee joint to other MSK areas as secondary endpoints, and the use of healthy subjects without joint pain at rest,” the study’s authors write. “In summary, 84 days of AyuFlex supplementation improves knee and overall joint health and functional capacity outcomes in otherwise healthy subjects with exercise/activity-dependent knee discomfort.”



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  1. Lopez HL et al. “Effects of dietary supplementation with a standardized aqueous extract of Terminalia chebula fruit (AyuFlex) on joint mobility, comfort, and functional capacity in healthy overweight subjects: a randomized placebo-controlled clinical trial.” BMC Complementary and Alternative Medicine, vol. 17 (2017): 475-492
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