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Keeping joints healthy is often easier said than done. The Centers for Disease Control and Prevention (CDC; Atlanta) report that one in five adults in the United States has some doctor-diagnosed form of arthritic disease, the most common joint-related health crisis.
"Arthritis is extremely common," says Sharon Kolasinski, MD, a rheumatologist at the Hospital of the University of Pennsylvania (Philadelphia). "It is very painful. It limits peoples' activities, both at work and recreationally. It is one of the major causes of work disability. Arthritis has an incredible impact on the quality of people's lives."
And with obesity on the upswing, the number of arthritis sufferers is only expected to grow.
"The population is simply getting heavier," says Lance Palumbo, director of consumer programs at Joint Juice Inc. (San Francisco), which makes ready-to-drink glucosamine supplements. "As people get heavier, that puts more pressure on weight-bearing joints. That extra pressure increases the incidence of arthritis and other joint problems."
Unfortunately, many of the more common drugs used to treat these conditions come with challenging side effects. But new research has highlighted surprising natural ingredients that may help ease the pain and inflammation caused by joint problems.
Including those as part of a healthy, well-balanced diet may be the key to maintaining optimal joint health.
The Old Standbys
Glucosamine and chondroitin are two dietary supplements that have been on the market for decades. Both compounds are naturally occurring components of joint cartilage. Glucosamine helps to thicken the fluid found in human joints, offering extra lubrication and cushioning to ultimately prevent damage and pain. Chondroitin, on the other hand, is a cartilage stimulant, helping the tissue to inhibit deterioration by encouraging production.
"Scientific evidence suggests that your body starts to make less of these things as you age," says Palumbo. "The result is dried-out cartilage and joint problems."
So the aging population must find a way to restore these lost compounds. Unfortunately, both glucosamine and chondroitin are difficult to ingest in a regular Western diet.
"There's really no dietary source," says Palumbo. "If you ate the shells of shellfish-a lot-you could get it. If you ate chicken feet, that fibrous material between the bones, there's some glucosamine and chondroitin there. But typically, you won't get it in a standard Western diet, so you need to supplement. Glucosamine and chondroitin supplements are safe, effective and, for most people, their first line of defense against joint problems."
Ancient Herb May Offer Relief for Current Health Problem
More than 20 million Americans struggle with osteoarthritis, which accounts for nearly one-fourth of all visits to primary-care physicians. Moreover, the healthcare burden is increasing as joint and knee replacement surgeries are on the rise.
One of the newest approaches to the problem could involve an ancient herb, Boswellia serrata, also known as frankincense. The herb, which has long played an important role in ayurvedic and other folk medicine traditions, may contain antiinflammatory compounds that could offer relief to people suffering from bone and joint discomfort.
According to a new study published on July 30 in the journal Arthritis Research & Therapy, an extract of the herb was shown to provide improvement in several pain and mobility scores used to evaluate arthritis patients within 7 days of administraton.
The researchers used 5-Loxin, a B. serrata extract developed by Laila Nutraceuticals (Vijayawada, India) that is enriched with 30% 3-O-acetyl-11-keto-beta boswellic acid (AKBA), one of the plant's active ingredients.
In the study, a double-blind, randomized, placebo-controlled trial, Indian researchers gave 70 osteoarthritis patients either a placebo, 100 mg of 5-Loxin, or 250 mg of 5-Loxin for 90 days. At the beginning, end, and days 7, 30, and 60 of the trial, the researchers evaluated the subjects using the Lequesne's Functional Index and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales. Moreover, the researchers also obtained synovial fluid samples from the subjects to analyze the presence of the cartilage-degrading enzyme matrix metalloproteinase-3.
While both doses of 5-Loxin appeared to have a beneficial effect, the 250-mg dose yielded statistically significant improvements as early as day 7, according to the researchers. In addition, the researchers also noted a significant reduction in the amount of matrix metalloproteinase-3 found in the synovial blood samples.
"The high incidence of adverse effects associated with currently available medications has created great interest in the search for an effective and safe alternative treatment," says Siba Raychaudhuri, a UC Davis faculty member who is one of the authors of the study. "AKBA has antiinflammatory properties, and we have shown that B. serrata enriched with AKBA can be an effective treatment for osteoarthritis of the knee."
You would need to take two to three pills to get the daily recommended dosage of these compounds. Despite the inconvenience, many are willing to add the supplements to the long list of other medications they take on a daily basis.
"In 2006, glucosamine and chondroitin sales netted out at $956 million," says David Silver, brand manager for Cargill's (Minneapolis) Elations functional beverages. "According to Drug Store News, sales of those two supplements dwarf all other single-SKU supplement sales, except perhaps multivitamins."
Today, companies like Cargill and Joint Juice Inc. are marketing functional beverages that feature these popular supplements. Joint Juice offers glucosamine in 8- and 12-oz beverages, while Cargill's Elations brand gives consumers both glucosamine and chondroitin in a single serving.
"Instead of having to take three pills or mix a bunch of powders, you can just drink a beverage," says Palumbo. "It has a full day's supply delivered to you in a single, good-tasting drink. It's simply easier to make a part of your daily regimen."
Phytochemicals for Joint Health
A newer line of inquiry for joint health is examining superfruits like pomegranate, acai, and mangosteen. Recent studies suggest that compounds in these fruits can help alleviate inflammation, a common side effect of arthritis and other joint diseases.
"So many aging diseases are all about inflammation," says Navindra Seeram, PhD, an assistant professor at the University of Rhode Island's (Kingston, RI) department of biomedical and pharmaceutical sciences. "Inflammation at a low level is a good thing. Low-grade inflammation is one way in which our bodies can fight infections. But extra inflammation can lead to cell damage that can result in chronic disease."
Tariq Haqqi, PhD, is a professor in the Department of Pathology, Microbiology, and Immunology at the University of South Carolina School of Medicine (Columbia, SC) who has been looking at compounds from pomegranate and green tea that may help with joint problems.
"There are no cures available for arthritis, and most current treatment approaches have serious side effects," says Haqqi. "We are looking at different phytochemicals, compounds derived from plants, that may help us find better, safer therapies for arthritis."
In a study published on June 13 in the Journal of Inflammation, Haqqi and colleagues showed that pomegranate extract inhibited inflammation in inflammatory types of arthritis. The researchers hypothesize that compounds in the pomegranate extract inhibit an enzyme called cyclo-oxygenase-2 (COX-2), which mediates inflammation and joint breakdown.
"It seems to inhibit the activity of cartilage-denigrating enzymes," says Haqqi. "But it also appears to be acting at a second level by helping produce proteins that help the joint stay healthy."
Research has also identified tart cherries, the herbs Boswellia serrata and Cissus quadrangularis, and the Indian spice turmeric (Curcuma longa) as also having joint-health properties.
"The mechanism of action here could be similar to what the pomegranates are doing," says Seeram. "I think the compounds in these plants are inhibiting the COX-2 enzyme that's been implicated in inflammation. The combination of phytochemicals present in fruit work additively. So, unlike Advil or other drugs, these vital nutrients work together in such a way to exert beneficial effects."
Even your old garden-variety oregano (Origanum vulgare) seems to have inflammation-fighting properties. A study published in the June 23 issue of the Proceedings of the Natural Academy of Sciences says that the herb has an active ingredient, beta-caryophyllin (E-BCP), that helps swelling in the joints to subside.
But experts caution that this work is preliminary and needs to be looked at with some caution.
"I think we're constantly discovering new foods that have nutrients with an antiinflammatory and antioxidant capacity that can over time be beneficial," says Christine Economos, PhD, an assistant professor at Tufts University's (Boston) Friedman School of Nutrition Science and Policy. "But that body of evidence needs to be there before you start relying on a single thing for an ailment."
Although some are looking for ways to turn these compounds into pharmaceuticals and supplements, many would argue that the first place to look for these ingredients is on your dinner plate.
"You need to comprehensively look at your diet," says Economos. "You want to eat a varied diet. You can't eat the same foods all the time. Foods like pomegranate and turmeric aren't in your basic American diet, so it pays to branch out."
"It's unrealistic that any one food item is going to be the answer," concurs Kolasinski. "If there are studies that suggest ingredients in certain foods have antiinflammatory or pain-relieving benefits, getting a representation of those foods in your diet seems like a very reasonable thing. But you can't eat just pomegranates 24 hours a day. Don't go overboard in embracing one food. You need a variety for overall health."
Haqqi is now working to identify the various compounds in the pomegranate extract and other plants to see which ones are working, and in what ways, on inflamed joints. His hope is to identify potential pharmaceutical targets for future arthritis drugs. Seeram also sees therapeutic potential in these plants.
"The power of plant medicine has been out there for centuries," he says. "All the ancient cultures resorted to plants as their source for medicines, and it makes sense to do so. Hippocrates said you are what you eat. And it is precisely so."
Cal Bewicke, president of Ethical Naturals Inc. (San Anselmo, CA), a provider of botanical extracts and supplement ingredients, including GreenGrown vegetarian glucosamine, sees a future for the newer antiinflammatory ingredients in supplements, too.
"The key ingredients in joint-care supplements are chondroitin and glucosamine," he says. "But as we learn more about antioxidants and other plant ingredients that are natural antiinflammatories, those should be added, too, for overall benefits. It's convenient for the consumer to have these things together."
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