Joint health

Category: Integrative Nutrition

Joint health

Osteoarthritis (OA), is a degenerative disease that affects millions of people worldwide. It occurs when the cartilage that lines the ends of bones wears down over time. When this happens, the bones begin to rub against each other causing pain, swelling and stiffness in the joints. OA is the most common rheumatic disease among older people. Although it can damage any joint, the disorder most commonly affects the knee, hip, hand and spine joints.

There are several factors that increase the risk of developing OA. Some of these are unchangeable such as genetic disposition, gender and age while others can be modifiable such as physical activity, diet, occupation, obesity and muscle strength.1 Awareness of modifiable factors can be a very useful tool in reducing the risk of developing OA. Maintaining a healthy weight is of utmost importance in preventing knee OA,2 being physically active, avoiding certain occupational injuries, and adapting jobs that require weight bearing and knee flexion can help prevent or delay disease progression, as well as improve joint pain and function.

Articular cartilage is avascular (no blood or lymphatic vessels), has no innervation, is not calcified and is characterised by unique biomechanical properties. Its nutrition is provided by passive diffusion of nutrients from synovial fluid (rich in HA) and subchondral bone. Physical exercise plays an important role in cartilage nutrition as nutrient diffusion increases with moderate compression and recovery movements. For this reason, physical activity is a necessary treatment to promote recovery of damaged cartilage.3

Degradation of articular hyaline cartilage is a key element in the development of OA. It is a tough, elastic tissue made up of cells called chondrocytes that are responsible for producing the extracellular matrix (ECM) composed mainly of type II collagen and proteoglycans (PGs). Collagen fibres are responsible for tissue integrity, while PGs, being viscous and hydrophobic, produce high compressive strength. The viscoelastic properties (firmness and flexibility) of the ECM are due to the bonding of its constituent components. To form the matrix, PGs bind to hyaluronic acid (HA) to form an aggrecan-HA complex. Collagen, on the other hand, binds to the side chains of glycosaminoglycans (GAGs), chondroitin sulphate being the most abundant of these.4

Treatment of OA

For this reason, there is a need to find natural, safe and effective alternative treatments to slow cartilage degradation and stabilise the disease. In this respect, physical exercise and nutrition play a very important role as they tackle the source of the problem “from within” by providing the body with the nutrients necessary to maintain good joint health.5 Many of these nutrients are found naturally in the body (glucosamine, chondroitin, HA, etc.) and are therefore completely safe substances that do not cause any adverse effects.

We will now analyse each of these nutrients in order to propose the most complete formula possible to slow the progression of osteoarthritis and improve the patient’s quality of life.


Supplementation with glucosamine sulphate and chondroitin sulphate has been used in the treatment of OA for many years. While each substance alone has a positive effect on cartilage restoration, the combination of the two has a synergistic effect, significantly improving outcomes.6 Other studies show that these nutrients provide the same pain relief as NSAIDs in certain cases of osteoarthritis of the knee. 7

Glucosamine is an aminosaccharide that is naturally manufactured by the body from glucose and glutamine. It is involved in the biosynthesis of the GAGs and HA that form the PGs of the cartilage matrix and therefore plays an important role in cartilage formation and repair. Chondroitin sulphate, on the other hand, forms part of the PGs of articular cartilage and gives it elasticity. It also provides substrates for ECM formation such as glucuronic acid and N-acetylgalactosamine.

Clinical studies in people suffering from osteoarthritis of the knee showed that a daily intake of 1,500 mg glucosamine sulphate for three years blocked the progression of the disease.8 Another study in people suffering from the same condition showed that the use of chondroitin sulphate for one year reduced the patients’ pain and slowed down the destruction of cartilage.9


Another chondroprotector commonly used in the treatment of knee osteoarthritis is sodium hyaluronate. It is a polymer of the GAG family, an important component of the extracellular matrix of hyaline cartilage. Its presence in synovial fluid provides the viscosity that allows the joint to move, minimising friction. Its administration in the form of intra-articular injection (viscosupplementation therapy) tends to improve joint function by increasing viscosity and reducing inflammation.10 Some authors consider its intervention in the tissue repair processes of articular cartilage by increasing chondrocyte density and decreasing acute pain by reducing prostaglandin E2 (PGE2) levels.

Oral administration of sodium hyaluronate also provides good results and is much more comfortable for patients than intra-articular injection. In oral HA supplementation, a low molecular weight HA is preferred as the smaller fragments facilitate absorption and delivery to the intestine. Oral HA acts by binding to the intestinal receptor TLR-4, increasing the production of anti-inflammatory cytokines such as IL-10 and decreasing pleiotrophin expression, thereby reducing pain and inflammation.11


A naturally occurring component present in the body with excellent anti-inflammatory and analgesic properties that is commonly used in the treatment of OA. Several studies have shown that its effect is enhanced when combined with other nutraceuticals such as chondroitin and glucosamine.12 Thanks to its sulphur content, MSM contributes to the maintenance of healthy connective tissues by neutralising free radicals that hinder the restoration of the cellular matrix of cartilage. Its anti-inflammatory power is due to its role as an inhibitor of the transcriptional activity of nuclear factor kappa B (NF-κB), which is responsible for the expression of genes encoding pro-inflammatory cytokines. The inhibitory effect of MSM on NF-κB results in the down-regulation of mRNA for interleukin IL-1, IL-6 and tumour necrosis factor α (TNF-α) in vitro. Moreover, MSM can also decrease the expression of the enzyme inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2), thereby decreasing the production of vasodilatory agents such as nitric oxide (NO). With the reduction of cytokines and vasodilatory agents, the influx and recruitment of immune cells to sites of local inflammation is inhibited.13


Curcuma longa is a plant that has been used in traditional Indian medicine for thousands of years for the treatment of diseases of inflammatory origin. Its active ingredient, curcumin, has a broad spectrum of pharmacological activities, with anti-inflammatory, hypoglycaemic, antioxidant, healing and antimicrobial properties. In terms of its application in OA, it has been shown to have a positive effect in reducing pain and stiffness, acting on the core of the joints to stop inflammation.14 As for its mechanism of action, it is known to act by reducing the expression of pro-inflammatory cytokines through the NF-κB pathway and inhibiting the expression of COX-2, 5-lipooxygenase (5-LO) and PGE2 synthesis, resulting in a marked reduction in pain and an improvement in joint function.15 There is also a study showing that turmeric is as effective as ibuprofen against osteoarthritis, and also has fewer side effects.16

One of the pharmacokinetic problems with curcumin is its low bioavailability, mainly due to poor absorption. Fortunately, there are much more bioavailable forms of curcumin on the market, such as Curcuma Meriva®, which is phytosome combined with soy lecithin phosphotilcholine 1:2), allowing greater absorption (up to 30 times more than Curcuma longa ES).17


Boswellia serrata extract (EBS), like Curcuma longa extract, has been and is commonly used in traditional Ayurvedic medicine for the treatment of pain and inflammation caused by arthritic diseases.18 Its anti-inflammatory effects are due to the boswellic acids present in its resin, including β-boswellic acid, 11-keto-β-boswellic acid and acetyl-11-keto-β-boswellic acid. Many authors have tried to clarify the mechanism of action of these acids and their application in the treatment of osteoarthritis. EBS is known to suppress leukotriene formation by inhibiting the enzyme (5-LO). In addition, recent studies show its role in inhibiting the proteolytic activity of cathepsin G (CATG) and the synthesis of microsomal prostaglandin E synthase (mPGES)-1, thereby blocking the synthesis of PGE2.19 Other studies indicate that EBS counteracts decreases in GAG levels and prevents the secretion and activity of metalloproteases (MMPs), which could prevent the degradation of articular cartilage. For all these reasons, the scientific community has begun to show interest in EBS for the treatment of OA, with many clinical studies showing its positive effects in reducing joint pain and inflammation and improving joint function, without the adverse effects associated with NSAIDsand corticosteroids. 20,21


Hops contain a large number of phytochemicals with a broad spectrum of biological activities. Due to its sedative effect, it has been used for many years as a natural remedy to treat insomnia and anxiety. On the other hand, the ‘cone’ flower contains 8-prenylnarigenin, one of the most potent phytoestrogens known to relieve hot flushes caused by menopause. Another characteristic of the plant is its powerful antioxidant effect, capable of combating oxidative stress generated by various free radicals. Among all its ingredients, it is worth highlighting the so-called alpha-acids, used in beer brewing for their bitter taste, which have shown great potential to help the body’s natural response to fight inflammation and pain. In terms of their mechanism of action, alpha-acids act by inhibiting iNOS, PGE2 and other key pathways in the pain process caused by inflammation.22 Studies have shown that they may be a natural alternative to NSAIDs but with fewer adverse effects. 23


Bamboo extract is important because of its high silicon content. Silicon is a mineral present in our body that is essential for the formation of connective tissue. It plays an important role in stabilising the collagen triple helix through a strong interaction with the hydroxyl groups of the fibres. An adequate supply of this nutrient ensures the maintenance of a stronger ECM and a delay in cartilage degradation.24


One of the conditions that can cause OA is injury to the nerves supplying the joint area. Uridine is an essential nucleotide in the synthesis of phospholipids in cell membranes and is necessary for the formation of the membrane of the dendrites and filament cells that make up nerves. Uridine-5′-monophosphate supplementation supports the regeneration of damaged nerves. It acts by inhibiting leukocyte recruitment at sites of local inflammation and thus helps to reduce the intensity of pain in the face of any type of inflammation.


Vitamin B6 (pyridoxine) may help relieve pain associated with OA. Its bioactive form (pyridoxal phosphate) acts as a coenzyme in the transformation of a precursor of tryptophan into serotonin and melatonin. Serotonin acts as a neurotransmitter in the hypothalamus and has relaxing and sedative effects. Good levels of vitamin B6 ensure a correct production of the “happiness hormone”, which leads to a reduction of pain in inflammatory processes.


Boron is a nutrient that plays a very important role in the development of arthritic diseases.25 A lower concentration of boron in the femoral head, bones, and synovial fluid has been observed in people with arthritis than in healthy patients. In a double-blind study with 20 osteoarthritis patients, a favorable response to a diet supplemented with 6 mg/day of boron was found in 50% of patients, compared to 10% in the placebo group. Boron works by reducing the levels of pro-inflammatory enzymes and has a powerful antioxidant and immunomodulatory effect, being an essential ingredient for maintaining good bone and joint health.


One of the main causes of OA is oxidative stress. Reactive oxygen species (ROS) act by damaging the main components of cartilage and joints, so combating the action of free radicals can be a very useful tool in the fight against the disease. In the body we have several enzymes with antioxidant properties such as superoxide dismutase, catalase, glutathione reductase and peroxidase, among others, which require various cofactors to fulfil their function. These cofactors are trace elements such as zinc, manganese, copper and selenium, which when present at acceptable levels contribute to the maintenance of normal joint function and protect cells against oxidative damage.26

It seems easy to think that, if we combine all the nutrients described in this article in the right doses and proportions in a single product, we could have a natural, effective and safe tool to combat inflammation and pain caused by arthritic conditions, helping to maintain good joint health.


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