Nutrients for Joint Support
Joints are responsible for the movable intersection between bones. They form the connection between two bones and allow for bending, rotation, flexion, and extension of skeletal parts. Many dietary and lifestyle factors can impact the health of joints, and years of activity, injury, and impact can lead to loss of function. Fortunately, several nutrients and herbs have shown promise for supporting healthy maintenance and repair of joints.
Omega-3 Fatty Acids
Omega-3 fatty acids are well known for their multiple roles in promoting health. Studies into their benefits for joint concerns have yielded promising results, probably due to the role omega-3s play in modulating the inflammatory response. In a cross sectional study including 167 adults with osteoarthritis, the serum omega-6 to omega-3 ratio was investigated and found that a higher ratio of omega-6 to omega-3 was associated with greater pain and more functional limitations than a lower ratio.1 Additionally, a systemic review of the literature looked at 23 studies in patients with rheumatoid arthritis, finding that marine omega-3 fatty acids showed a consistent, modest benefit on joint swelling, pain, duration of morning stiffness, and assessment of disease activity, along with a reduction in use of NSAIDs.2 Results are dose dependent, and omega-3s seem to exert positive effects on joint health at intakes greater than 1.5 g/day EPA+DHA.3
Manganese is an essential trace element affecting joint health through various actions. Its role as a cofactor in the production of collagen and cartilage is important for building, maintaining, and restoring joint function. Studies indicate that cartilage may contain signaling pathways that affect the NF-Kappa B (nuclear factor kappa-B; NF-κB) transcription factors that regulate and control inflammation, and these signaling pathways are activated by mechanical forces which either activate or inhibit inflammatory processes. These signaling pathways seem to be regulated by reactive oxygen species (ROS). Super oxide dismutase (SOD) is a primary scavenger of ROS, and manganese also plays an antioxidant role as a component of SOD. A 2005 study found that individuals with osteoarthritis had four times less extracellular SOD than those who did not, suggesting that an inability to control ROS plays a role in the pathogenesis of osteoarthritis.3
Glucosamine is an amino sugar and one of the most abundant monosaccharides in the human body. It is synthesized from glucose and glutamine and is found as a component of connective tissue and cartilage, as well as other tissues. The joint-protective effects of glucosamine have received mixed reviews in human studies, possibly due to low dosing and/or duration of studies. A study that looked at markers of collagen degradation showed that effects were dose dependent, and intakes of 3,000 mg/day were most effective.4 However, many positive effects at lower doses have been shown in various controlled trials. One randomized, placebo-controlled trial found that 1,500 mg/day of glucosamine sulfate resulted in better measures of osteoarthritis (OA) progression versus placebo over a three-year period.5 Additionally, a 28-day trial looking at 1,500 mg/day glucosamine found a significant improvement compared to placebo in knee flexion and extension in patients with acute knee injuries.6
Boswellia and Other Herbs
Boswellia serrata, also known as Indian Frankincense, has been used since ancient times for the treatment of inflammatory conditions and has recently shown efficacy for use in OA. A 2014 review of the literature showed “trends of benefits” when used for OA treatment, citing reduced pain and increased functionality with a favorable adverse event profile.7 These beneficial effects of Boswellia may be due to its ability to inhibit NF-kB, which is responsible for regulating the proinflammatory cascade of cytokines such as TNF-α and IL-1β.8 Favorable joint effects are not limited to OA, however. A review of 12 controlled trials conducted in Germany and India found benefit over placebo for those suffering from rheumatoid arthritis, including results from a clinical trial involving 175 rheumatoid arthritis patients. Of this group, 14 percent reported excellent results, and 44 percent reported good results in improvement from pain, stiffness, and grip strength over a two-to-four-week period.9 Additionally, when Boswellia was compared to the non-steroidal anti-inflammatory drug Valdecoxib (a non-selective COX2 inhibitor) in the treatment of OA, the beneficial effects persisted after discontinuing Boswellia therapy but not after discontinuing Valdecoxib.10
Other herbs with anti-inflammatory properties have been studied in combination with Boswellia. Turmeric, ginger, Boswellia and Ashwagandha were studied in a double blind, randomized, placebo-controlled trial involving 99 subjects with OA. Significant improvements in pain and WOMAC score (an index used to evaluate hip and knee OA) were noted over the course of 32 weeks.11 In addition, a systematic review and meta-analysis of randomized controlled trials using turmeric alone showed turmeric to reduce arthritic symptoms as much as pain medicine, though the evidence has been limited by studies with low sample size, varying controls versus placebo, and different end points.12
Years of activity and impact can take their toll on joints, leading to discomfort and diminished range of motion. Inflammation and oxidative stress, if not managed, can add to these effects. Supporting joints with research-supported nutrients and herbs can offer relief and a return to function.
- Sibille KT, King C, Garrett TJ, et al. Omega-6: Omega-3 PUFA Ratio, Pain, Functioning, and Distress in Adults With Knee Pain. Clin J Pain. 2018;34(2):182-189. doi:10.1097/AJP.0000000000000517
- Miles EA, Calder PC. Influence of marine n-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis. Br J Nutr. 2012 Jun;107 Suppl 2:S171-84. doi: 10.1017/S0007114512001560. PMID: 22591891.
- Regan E, Flannelly J, Bowler R, et al. Extracellular superoxide dismutase and oxidant damage in osteoarthritis. Arthritis Rheum. 2005;52(11):3479-3491. doi:10.1002/art.21387
- Patel, Kamal, Glucosamine. com. 2019, Aug 14. Retrieved from: https://examine.com/supplements/glucosamine/research/#inflammation-and-joint-health_interventions-restricted-to-athletes
- Beattie KA, Duryea J, Pui M, et al. Minimum joint space width and tibial cartilage morphology in the knees of healthy individuals: a cross-sectional study. BMC Musculoskelet Disord. 2008;9:119. Published 2008 Sep 8. doi:10.1186/1471-2474-9-119
- Ostojic SM, Arsic M, Prodanovic S, Vukovic J, Zlatanovic M. Glucosamine administration in athletes: effects on recovery of acute knee injury. Res Sports Med. 2007;15(2):113-124. doi:10.1080/15438620701405248
- Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev. 2014;5(5):CD002947. Published 2014 May 22. doi:10.1002/14651858.CD002947.pub2
- Alluri VK, Kundimi S, Sengupta K, Golakoti T, Kilari EK. An Anti-Inflammatory Composition of Boswellia serrataResin Extracts Alleviates Pain and Protects Cartilage in Monoiodoacetate-Induced Osteoarthritis in Rats. Evid Based Complement Alternat Med. 2020;2020:7381625. Published 2020 May 21. doi:10.1155/2020/7381625
- Mills, S., & Bone, K. (2013). Principles and practice of phytotherapy: Modern herbal medicine. Edinburgh: Churchill Livingstone
- S Sontakke, V Thawani, S Pimpalkhute, P Kabra, S Babhulkar, L Hingorani. Open, randomized, controlled clinical trial of Boswellia serrata extract as compared to valdecoxib in osteoarthritis of knee. Indian Journal of Pharmacology. 2007;39(1):27-29.
- Chopra A, Lavin P, Patwardhan B, Chitre D. A 32-week randomized, placebo-controlled clinical evaluation of RA-11, an Ayurvedic drug, on osteoarthritis of the knees. J Clin Rheumatol. 2004 Oct;10(5):236-45. doi: 10.1097/01.rhu.0000138087.47382.6d. PMID: 17043520.
- Daily JW, Yang M, Park S. Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Med Food. 2016;19(8):717-729. doi:10.1089/jmf.2016.3705