Athletes look after their joints as their performance and career depend on them, and tend to use prophylactic supplements to prevent long-term damage. The rest of us tend to take our joints for granted until they start playing up, by which time significant degenerative changes may already have occurred.
With age and over-use, synovial fluid becomes thinner and less cushioning, while articular cartilage stiffens and flakes so it is less able to withstand compressive forces. This leads to joints that are increasingly painful, stiff and restricted, with narrowing of the joint space in osteoarthritis (OA). Many other forms of arthritis exist, including autoimmune conditions such as rheumatoid arthritis, which can benefit from the same anti-inflammatory supplements.
Diet should always come first, as increasing your intake of fresh fruit, vegetables, nuts, seeds, and oily fish (eg salmon, fresh tuna, mackerel, herrings, sardines, pilchards) can reduce joint inflammation – click here to see my joint-friendly diet advice.
A variety of supplements can also reduce your need for prescribed medication, such as oral non-steroidal anti-inflammatory drugs (NSAIDs) which, while effective, can cause potentially serious side effects.
Which supplements are best?
Different people respond to joint supplements in different ways. Best advice is to try one or two for at least 6 weeks before reassessing whether you need to switch. I recommend starting with a fish oil (omega-3, cod liver oil or krill oil) plus glucosamine as a basic, joint-friendly plan. If this does not provide the relief you need, add in chondroitin and an additional anti-inflammatory such as turmeric, rose hip or MSM.
I recommend only buying products made to a pharmaceutical standard known as GMP (Good Manufacturing Practice) which ensures they are checked for quality and purity at all stages of manufacture. Some cheap products have been found to contain little glucosamine or chondroitin, for example, and will not offer the same benefits as those providing a consistent dose.
Omega-3 fish oil
Fish oils are a source of two long-chain, omega-3 fatty acids, EPA and DHA which are derived from the algae on which they feed. When you take a concentrated omega-3 supplement, these are converted into substances (series 3 prostaglandins and series 5 leukotrienes) that reduce inflammation and suppress joint pain in osteoarthritis and autoimmune conditions such as rheumatoid arthritis. A number of studies show that taking fish oil can reduce the need for prescribed painkillers. EPA may have the greater anti-inflammatory action for joints.
If you eat fish regularly, a dose of 500mg to 1g per day is ideal. If you rarely eat fish, higher doses may be needed for a good, anti-inflammatory effect. The same fish oil supplements that I recommend for heart health, cholesterol and blood pressure benefits will have beneficial anti-inflammatory effects on joints.
Cod Liver Oil
Cod liver oil typically provides three times less omega-3 fatty acids than are found in oily fish, but these can be concentrated to a similar level. Cod liver oil has the advantage of also providing vitamin A and vitamin D, which offer additional benefits for bones and joints.
Research suggests that cod liver oil supplements can reduce the need for non-steroidal anti-inflammatory drugs to treat rheumatoid arthritis by over 30% within 9 months.
Cartilage and underlying bone is sensitive to lack of vitamin D so that osteoarthritis can progress three to four times more rapidly when vitamin D deficiency is present. There is also an association between low vitamin D levels and increased risk of rheumatoid arthritis.
Vitamin D3 supplements can relieve joint pain in some people with osteoarthritis, and help strengthen quadriceps muscle strength. Not all studies have shown benefit, however, and the evidence is contradictory. Given that vitamin D deficiency is widespread, especially during autumn and winter in Northern latitudes, it’s worth taking a vitamin D3 supplement for general health benefits – any reduction in joint pain will be an added bonus
NB If taking a multivitamin as well as cod liver oil, check the total amounts of vitamin A and D do not exceed upper safe levels.
Krill oil is derived from shrimp-like crustaceans which feed on algae and acquire concentrated omega-3s plus two powerful antioxidant pigments, astaxanthin and canthaxanthin. These pigments are the same as those providing flamingos with their attractive pink plumage. The combination of omega 3s and antioxidants give krill oil an anti-inflammatory edge against joint pain and stiffness.
Research shows that krill oil supplements can reduce the level of circulating inflammatory markers by 19% after 7 days, and by 30% after 2 weeks. At the same time, joint symptoms showed significant improvement, with a noticeable reduction in pain and stiffness. Krill oil supplements also reduce the amount of pain-killing ‘rescue’ medication needed.
|Healthspan Elite Omega 3 Pure EPA capsules provide 1 gram of pure EPA to support post-exercise recovery and reduce inflammation. A down-loadable batch certificate confirms purity for those taking part in competitive sport and who are subject to checks for banned substances.
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|Igennus Pharmepa RESTORE capsules provide 1000 mg (1 gram) EPA from wild anchovies.
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|Nordic Naturals Arctic Cod Liver Oil is made from 100% wild Arctic Cod and flavoured with natural lemon.
Each serving of 3 softgels provides 675mg omega-3s.
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|Schiff Nutrition’s MegaRed Joint Care Krill Oil has a vanilla flavour, with no fishy odour or after-taste.
Each one-a-day capsule supplies 353mg Krill oil blended with hyaluronic acid and astaxanthin.
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Glucosamine stimulates the formation of proteoglycans that strengthen cartilage and synovial fluid to improve resistance against compression. The sulphur component of glucosamine sulphate may also contribute to the beneficial effects by stabilising connective tissues found in cartilage, tendons and ligaments. Latest research shows glucosamine also acts as a biological signal to switch on the repair of these tissues, and to suppress inflammation and the breakdown of cartilage.
A recent study involving over 600 people with severe pain due to osteoarthritis of the knee showed that taking glucosamine supplements (1500mg a day) plus chondroitin (1200mg) for 6 months was as effective as the proscribed drug, celecoxib, with both treatments reducing pain by 79%.
Chondroitin plays a structural role in joints, combining with hyaluronic acid to form ‘springy’ molecules that strengthen cartilage and increase its elasticity and resilience. Chondroitin also acts as a biological signal to inhibit the enzymes responsible for breaking down cartilage, increases the synthesis of joint collagen, and has an anti-inflammatory action. For people with moderate to severe knee pain, the combination of 1500mg glucosamine plus 1200mg chondroitin per day is as effective in the treatment of painful knee osteoarthritis as the prescribed NSAID, celecoxib.
MSM (methyl-sulphonyl-methane) is a sulfur-containing antioxidant that is naturally made in the body to reduce inflammation. A study involving 50 people with knee osteoarthritis found that MSM (3g, twice a day) significantly reduced pain and improved function, compared to placebo. Glucosamine and MSM are often taken together and research suggests they have an additive, synergistic effect.
|Solgar’s Extra Strength MSM Glucosamine Chondroitin MSM tablets are shellfish free. The recommended dose of 2 tablets provides 1500mg glucosamine hydrochloride, 1200mg chondroitin sulphate plus 735mg MSM.
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| Healthspan’s Joint Physio tablets each provide 400mg Optiflex (shellfish free) glucosamine hydrochloride, 100mg chondroitin sulphate, plus 50mg MSM and 80mg vitamin C.
Recommended dose is one tablet, three times a day.
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Rose Hip Extracts
Rose hips contain anti-inflammatory substances (polyphenols and galactolipids) plus vitamin C which are beneficial in reducing osteoarthritis, rheumatoid arthritis and back pain. Analysis of data from clinical trials involving 287 people show that it consistently reduces pain with response rates twice that of inactive placebo.
|GOPO Joint Health contains vitamin C plus the original rose hip extracts used in clinical trials.
Recommended dose is 3 capsules, twice a day for the first 3 to 5 weeks, then a maintenance dose of 2 capsules a day.
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Bromelain is a digestive enzyme derived from the stem of pineapples. It breaks down inflammatory proteins to reduce pain and inflammation and is widely used to treat arthritis and sports injuries. Research involving 77 people with acute knee pain found that bromelain significantly improved pain and stiffness after one month’s treatment. A small follow-up study involving 31 people with moderate to severe osteoarthritis of the knee found that taking bromelain for 12 weeks produced a clinically relevant improvement in disability, although results were less clear-cut for pain and stiffness, compared with placebo
Devil’s claw root extracts contain unique substances (harpagosides) shown to reduce the secretion of inflammatory chemicals within human cartilage cell cultures. Devil’s Claw is used to treat painful, inflamed joints due to osteoarthritis, rheumatoid arthritis, gout or sport’s injuries. Two high quality trials examining the effects of Devil’s Claw found strong evidence that daily doses standardized to 50 mg or 100 mg harpagoside were better than placebo for short-term improvements in low back pain and in reducing the need for additional rescue medication. A review of data suggests it is also effective for reduce pain in osteoarthritis, although further studies are needed to confirm this.
NB Do not take Devil’s Claw if you have peptic ulcers or indigestion.
|Schwabe Pharma’s FlexiHerb tablets are a traditional herbal medicine providing 600mg Devil’s Claw root extract, licensed to treat backache, muscular rheumatic and joint pain.
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Turmeric has a powerful anti-inflammatory action. Research involving 367 people with moderate to severe knee osteoarthritis showed that turmeric was as effective as ibuprofen in reducing knee pain and stiffness, but with fewer gastrointestinal side effects. Turmeric has also been used together with Devils Claw and bromelain to improve acute and chronic joint pain in 42 people with osteoarthritis in the spine, hips or knees.
Ginger contains a variety of anti-inflammatory polyphenols which help to reduce inflammation. Although traditionally used to treat nausea, it is increasingly recommended to relieve musculoskeletal pain, including rheumatoid and osteoarthritis. A review of data from 5 studies suggests that ginger reduces osteoarthritis pain by 30%, and related disability by 22%, although those taking it were twice as likely to discontinue treatment as those taking placebo.
Extracts from the New Zealand green-lipped mussel contain an omega-3 fatty acid (eicosatetraenoic acid) that inhibits the production of inflammatory cytokines, and reduces the migration and activation of white blood cells to suppress immune reactions associated with joint inflammation. It has shown benefit in treating osteoarthritis and rheumatoid arthritis and can reduce pain by as much as 89%.
|Seatone Super Strength Green Lipped Mussel Extract contains the original Biolane supplement shown to provide joint benefits. Each capsule provides 350mg raw green-lipped mussel extracts. These do have strong, natural odour but many people claim it has transformed their arthritis symptoms.
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Collagen supplements provide building blocks such as chondroitin sulphate for joint repair. Some studies show they significantly reduce pain in osteoarthritis, compared with placebo. Analysis of data from 8 studies concluded that more studies were needed to confirm their effectiveness, however. Collagen supplements remain an option if other approaches have not worked for you.
Celadrin is a mix of cetylated fatty acids (CFAs) – a waxy substance found naturally in sperm whale oil, but which is made commercially from the monounsaturated fats found in olive oil. CFAs are laid down in cell membranes to provide lubrication and improve their flexibility and resilience. CFAs also have a natural anti-inflammatory, pain-killing action. A study involving 64 people with knee osteoarthritis found that oral CFA supplements significantly improved the range of knee flexion by 10 degrees, compared with placebo (1 degree improvement).
|Celadrin is a patented mix of esterified oils available under several different brand names, but all contain the same clinically tested ingredients. Recommended dose is 2 capsules a day.
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Topical creams and gels
As well as taking oral supplements, I recommend applying anti-inflammatory creams and gels to the skin over painful joints. These sink in to provide targetted pain relief when needed.
I hope you’ve found this evidence-based overview of supplements for joint pain helpful. Which supplements have you tried to relieve arthritis? Which do you find most helpful?
Image credit: pat_guiney/flickr;