The Best Way to Juice Your Joints

By Catherine Guthrie

If your portfolio’s gone south, you could do worse than put your money into one of the companies that make arthritis supplements. Consider the numbers: 35 million people in the United States have osteoarthritis—a term describing the wear and tear that causes aches and pains in aging joints—and they plunk down more cash for arthritis supplements than for any other malady. Last year buyers spent $790 million just on pills that contained glucosamine, chondroitin, and/or MSM, three of the most popular choices.

Figures like these mean hundreds of joint remedies will continue to jostle for shelf space in supplement aisles. So where do you start? Your sister-in-law raves about ginger capsules, but will they work for you? And a friend claims fish oil cured her dog’s arthritic limp. Bully for canines, but where does that leave an achy-kneed human?

Meet Jason Theodosakis, a physician in Tucson, Arizona, and author of The Arthritis Cure. That’s the book that put glucosamine and chondroitin on the map, and although these supplements continue to garner praise from experts and patients alike, Theodosakis isn’t done yet. A medical gumshoe, he is absolutely unrelenting in his pursuit of the best arthritis supplement. Not only does he devour the latest studies and interview scientists and supplement makers, he buys every tablet, capsule, and cream on the market to test the validity of their claims. Over the past decade, he has spent more than $60,000 of his own money putting arthritis remedies to the test.

His motivation? Disgust with standard arthritis treatments. “I was frustrated with the poor safety record of anti-inflammatories,” he says. “Sixteen thousand people die each year from these drugs alone.” Not to mention the millions who suffer from varying degrees of stomach trouble.

Also, anti-inflammatories, prescription or otherwise, don’t attack the source of the problem; all they do is alleviate the pain that comes with arthritic joints. That’s why Theodosakis continues to recommend glucosamine and chondroitin, and why he’s very excited about a newcomer called avocado/soybean unsaponifiables (ASU for short). These three, he says, are the only ones that are scientifically proven to treat the disintegration of cartilage that actually causes osteoarthritis.

Below is the latest on Theodosakis’s top picks, including information on dosage and side effects. Don’t be discouraged if your pain doesn’t disappear quickly: Because cartilage doesn’t have nerve endings, pain isn’t an accurate measure of how well cartilage-building supplements work, says Theodosakis. Indeed, in several studies, some volunteers didn’t get any pain relief, but X-rays showed that their bodies had, in fact, added cartilage.

You should feel better eventually, but in the meantime, consider adding another anti-inflammatory supplement for pain relief. Theodosakis recommends an extract of the philodendron plant, called Nexrutine; take 250 to 500 milligrams two or three times a day. Omega-3s can also be helpful, he says, though they can take from eight to 12 weeks to show any effect. He gives his patients up to 5 grams of flax oil capsules a day.

Avocado/Soybean Unsaponifiables
Avo-what? If you haven’t heard of avocado/soybean unsaponifiables (a.k.a. ASU), you’re not alone. New to the United States, the refined mixture of avocado and soybean oils has soothed the aching joints of osteoarthritis sufferers in France for nearly a decade. In 2002, the Cochrane Review, an independent health organization based in Oxford, England (think Consumer Reports for drugs), examined all herbal therapies for osteoarthritis and concluded that the most convincing evidence was behind ASU.

That same year, the American journal Arthritis and Rheumatism published one of the most compelling studies to date on ASU. Patients with mild forms of arthritis didn’t see much improvement, but among people with advanced cases of the disease, those swallowing ASU lost half as much cartilage as did those taking placebos. Dosage: Take 300 mg daily.

Side effects: Although no long-term studies are available, the French government has tracked ASU’s safety record for more than 15 years and has yet to correlate it with any significant complaints.

Glucosamine
In the body, glucosamine is made by combining glucose, a simple sugar, and glutamine, an amino acid. The body funnels most of its stash to the joints. Supplemental glucosamine, often sold in combination with chondroitin (see page 123), is made from the shells of shrimp, lobster, and crabs, and more than 150 studies and 20 clinical trials indicate that it not only relieves pain but also builds cartilage. Glucosamine also reportedly lubricates joints by keeping cartilage pliable.

Dosage: Take 1,500 mg in two or three separate doses throughout the day (depending on how many milligrams—500 or 750—are in each dose). The body absorbs all supplement types—capsules, tablets, liquids, and powders—equally well. The supplement is sold as glucosamine hydrochloride and glucosamine sulfate, but both appear to be equally effective.

Side effects: If you have an allergy to shellfish, talk to your physician before trying glucosamine. Potential side effects include indigestion, nausea, and heartburn.

Tip: Don’t bother with topical glucosamine. “There is absolutely no evidence that glucosamine can be absorbed through the skin, even if you were to soak in a bathtub full of the stuff,” says Theodosakis.

Chondroitin
You can thank chondroitin sulfate for the bounce in your step; it’s a chain of repeating molecules that add elasticity to cartilage. Derived from animal cartilage (such as cow, shark, and pig parts), supplemental chondroitin is believed to increase collagen’s ability to absorb shock. Chondroitin also juices joints and disarms enzymes that destroy cartilage. Although it’s less thoroughly studied than glucosamine, several well-designed trials have indicated that chondroitin sulfate can ease pain and increase mobility in arthritic joints.

Dosage: Between 800 and 1,200 mg a day in capsule, tablet, or powder form. For best results, divide the dose over three meals. Remember that chondroitin takes up to four months to work completely, so you’ll need to cultivate patience.

Side effects: Stomach pain, diarrhea, and constipation. Chondroitin also has blood-thinning properties, so if you regularly take blood thinners, such as aspirin or heparin, consult with your physician before adding chondroitin to the mix.

Tip: When buying chondroitin, make sure you’re getting the real deal. “Chondroitin is ten times more expensive than glucosamine,” says Tod Cooperman, president of ConsumerLab.com, an independent testing lab, “so there’s a higher likelihood that the manufacturer will skimp on it or use a low-quality material.” The key is to look for products that contain only chondroitin sulfate and stay away from those that include “chondroitin complex or compound” on the label.

Chondroitin & Glucosamine Combo
The question of whether or not these two powerhouses fly better as a team or solo is still up in the air. Thus far, results from animal studies look promising for the combo, but human trials are lacking. Still, many experts suggest taking them together, if only for convenience’s sake.

Dosage: Follow directions for solo supplements or consider a single pill that packs a combination of the two.

Side effects: Same as with single-ingredient supplements.

Tip: Both glucosamine and chondroitin are difficult to work with and expensive to manufacture. To lower the price of the supplements, some companies use low-grade materials or bulk up the pill with superfluous ingredients. “I wouldn’t use 90 percent of the products on the market,” says Theodosakis.

So, what’s left? Theodosakis’s picks: CosaminDS, Triple Flex, and Osteo-Bi-Flex. a Catherine Guthrie is a contributing editor. She also wrote “Overcoming Pain” (page 84) in this issue.

Remedies: Beyond the Big Three
Look beyond the trinity of proven cartilage rescuers—ASU, chondroitin, and glucosamine—and dozens of other arthritis supplements vie for the public’s eye. Here’s the lowdown on three other popular remedies.

SAMe: On the supplement circuit since 1999, SAMe is a promising up-and-comer. Numerous well-designed studies show that SAMe can soothe osteoarthritis pain and swelling as well as over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can, but it won’t cause stomach trouble. At an average daily cost of $1.45, SAMe is pricier than most other osteoarthritis supplements, but if less expensive remedies don’t pan out, it’s certainly worth a shot.

Fish Oil: When it comes to omega-3 fatty acids, nature’s numero uno anti-inflammatory, no supplement serves up more than fish oil capsules. Studies have shown they’re mostly effective for rheumatoid arthritis sufferers, whose stubborn symptoms are often beyond the reach of other supplements. But many practitioners recommend them for osteoarthritis just the same.

MSM: Search the Internet or browse a bookstore and you’ll see plenty of testimonials for MSM, an organic sulfur compound found in both plants and animals. But look for science and you’ll come up empty-handed. “There’s not a single well-designed human study to support it,” says Jason Theodosakis, author of The Arthritis Cure. Nothing’s to say it won’t eventually pan out as a useful way to treat arthritis, but for now it may make more sense to stick with the proven remedies.