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Nutraceuticals
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Nutraceuticals

Broadly speaking, ‘nutraceuticals’ are nutrients, supplements or other dietary products that are considered to have potential medicinal or physiological effects but do not fall within standard drug classifications. The term is loosely derived from ‘nutrition’ and ‘pharmaceutical’, and does not have a clear definition in the medical literature. However, it represents a series of approaches that have either established or potential benefits in the treatment of a wide range of conditions.

For arthritis (inflammation of the joints), and other conditions of the joints, cartilage or related areas, there are several nutraceuticals that can help alleviate pain and discomfort. These have the potential to replace, or at least help reduce, the use of more aggressive drug therapies. They are known for their extremely safe action, and in most cases are relatively inexpensive.

In some cases, there is now some data in the literature that suggests that several different nutraceutical approaches are beneficial in the treatment of cartilage and joint disorders. However, there remains some conflicting opinions on the efficacy of certain products, and this makes it imperative to discuss any products you are considering with your physician who will be able to offer you advice based on the current evidence available.

Nutraceuticals have the potential to compliment the other treatment options available in the toolbox for treating a broad range of cartilage and joint problems. It has the potential to be combined with non-operative intervention such as mainstream drug therapies, physical therapy, lifestyle changes (weight, diet) and management of other co-existing conditions, as well as with surgical procedures.

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about nutraceuticals, as well as anyone interested in cartilage problems.

What are the common neutraceuticals for arthritis, joint and cartilage problems?

Of the neutraceuticals currently available, glucosamine, chondroitin, S-adenosylmethionine (SAMe) and Avocado Soybean Unsaponifiables (ASU) have been the most carefully assessed with considerable amount of scientific and clinical usage data, as well as safety profile.

Glucosamine and chondroitin

Glucosamine and chondroitin are found naturally in the body and serve as important building blocks for the extracellular matrix (ECM), which is a spongy foundation that cells in the body attach to and form different tissues. Dietary supplementation for cartilage and joint disorders has therefore attracted a great deal of attention in recent years.

Glucosamine supplements themselves are usually derived from various compound forms of glucosamine (sulfate, hydrochloride, etc.) found in shellfish, which should be taken into account if you are allergic to shellfish or have other dietary restrictions. However, shellfish-free varieties have recently become available. Chondroitin is currently only derived from animal or fish products; again, it is important to consider your own dietary restrictions.

A number of studies have examined the potential benefits of both supplements, taken either individually or in combination, in reducing pain and inflammation in the joints. These studies have also tried to determine if these products provide any short- or long-term benefits in terms of pain, function and also the structural integrity of the joint. Thus far the literature has been inconsistent in terms of reported effects. Some systematic reviews and meta-analyses of high quality studies have shown that glucosamine and chondroitin, taken either individually or combined, provided significant improvements in terms of pain, function and disease modification as compared to placebo. While other studies have found no significant differences. Furthermore, one of the best studies on the effects of these neutraceuticals on people with knee osteoarthritis, “the multicenter, double-blind, placebo- and celecoxib-controlled glucosamine/chondroitin Arthritis Intervention Trial (GAIT) “ that was published in the well respected New England Journal of Medicine showed that glucosamine and chondroitin sulfate, taken alone or in combination, did not significantly reduce pain. However, subgroup analysis did show that the combination of glucosamine and chondroitin sulfate might be effective in treating patients with moderate-to-severe knee pain. The recent OARSI guidelines provided the following recommendations for glucosamine: “uncertain” for symptomatic pain relief and the “not appropriate” for diseases modification. Similarly, the guidelines for chondroitin were “uncertain” for symptomatic pain relief and “not appropriate” for disease modification.

Our understanding of these neutraceuticals continues to evolve and it is recommended that you discuss the efficacy of their use with your health care provider who will be able to provide you with individualized recommendations based of your disease process.

S-adenosylmethionine (SAMe)

Although naturally occurring in the body, dietary supplements of SAMe have been available since 1999 in the USA. Before that, SAMe was used as a prescription drug in many countries in Europe from the 1970s. Originally tested as an antidepressant, researchers noticed positive effects in osteoarthritis sufferers.

Oral supplementation with SAMe for prolonged periods of time has the potential to provide pain relief. Some, reports suggest it is as effective as NSAIDS in the treatment of osteoarthritis and similar conditions, with fewer side effects. The mechanism of action is slower than NSAIDS and it can take an extended period of time prior to it having an effect. A Cochran systematic review of its use in knee or hip osteoarthritis was inconclusive due to the lack of large trials studying its use. However, they found that SAMe may have some clinically relevant effects in terms of pain and function, but that more studies were needed due to the heterogeneity of the currently available literature.

It is important to be cognizant of the potential side effects of its use, especially if taken alongside other antidepressants. Therefore it is strongly recommended that you consult your healthcare provider prior to starting a course treatment.

Avocado Soybean Unsaponifiables (ASUs)

While derived from avocados and soybeans, ASUs are not naturally found at high enough levels to have an effect simply from eating them. However, as a concentrated dietary supplement, there is a growing body of evidence in the literature that shows that ASUs are potentially safe and effective as anti-inflammatory that can be used to treat hip and knee arthritis. A meta-analysis of the available randomized controlled trials studying ASU’s showed that its use did provide some benefit in terms of pain relief, especially in knee arthritis. Similar to the other neutraceuticals the ORADSI guidelines have also give the use of ASUs an uncertain recommendation.

It should be noted that similar to some of the other neutraceuticals, ASUs have a relatively slow onset versus NSAIDS. A dose of approximately 300 mg of ASU has been reported to provide significant pain relief and anti-inflammatory properties in osteoarthritis sufferers after 30–60 days. It is possible that the use of this and/or some of the other neutraceuticals may allow patients to reduce their use of NSAIDs and also has the potential to delay the need for early operative intervention.

As previously mentioned, the use of intra-articular corticosteroid, over the counter anti-inflammatory (such as Ibuprofen) and prescribed anti-inflammatory pain medications (such as Meloxicam, Celebrex, Naprosyn, etc.) all still play a major role in the treatment of joint pain. Some of these can even be used to have a synergistic effect with the neutraceuticals that you may use. However, it is important for you to talk to your healthcare provider about the risk and benefits of this treatment and its appropriateness for your specific condition.

What are the advantages and disadvantages of Nutraceuticals?

What are the advantages of Nutraceuticals?

Neutraceuticals have been shown to be safe and effective. Their prolonged use in long-term osteoarthritis treatment has the potential to limit NSAID use, as well as provide effective pain relief and anti-inflammatory properties.

With a correct dosage and treatment plan, they offer a simple, relatively safe and effective therapeutic option in the overall treatment approach to cartilage arthritis and joint pain.

What are the disadvantages of Nutraceuticals?

Supplements may not work in everyone, due to difference in the way people absorb and use nutrients. In other cases, the dose may be too low for an individual to benefit, but as long as they are properly assessed by a specialist, the dose can be tailored to their needs.

Frequently Asked Questions (FAQs)

Will my doctor prescribe a neutraceuticals for me?

Current practice depends on your specific healthcare provider. It is important for you to have an open discussion with your physician about the potential risks and benefits of using any of these neutraceuticals.

Are all brand-name versions of neutraceuticals the same? Surely I can just buy the cheapest?

Absolutely not. Due to a lack of proper regulation, many neutraceuticals are marketed in extremely low, ineffective doses. Look for ‘USP’ grade supplements that recommend a dosage that is similar to the amounts used in the high level studies that have been published in peer-reviewed studies. As a quick guide the following doses (Glucosamine ?1500 mg; Chondroitin 800-1200 mg; SAMe 800–1200 mg; ASU 300-600 mg) have been used in some of the studies we have referenced for your further reading, however, it is essential that you discuss the use and dosage with you healthcare provider prior to starting any of these medications.

How long should I try neutraceuticals for?

Due to the slow mechanism of action of many neutraceuticals, it is imperative that they are given ample time to work. Speak to your physician about treatment duration. As a rough guide, a 3–6 month course should be long enough to evaluate the effects of the product on your symptoms.

Further reading
  • Theodosakis J, Buff S, et al. The Arthritis Cure. Revised Edition. New York, St. Martin’s Press, 2004. ISBN-13: 9780312990633.
  • McAlindon TE, Bannuru RR, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage 22 (2014) 363-388.
  • Rutjes AW, Nüesch E, et al. S-Adenosylmethionine for osteoarthritis of the knee or hip. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD007321.
  • Clegg DO, Reda DJ, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. New Engl J Med 2006;354(8):795e808.
  • Christensen R, Bartels EM, et al. Symptomatic efficacy of avocado-soybean unsaponifiables (ASU) in osteoarthritis (OA) patients: a meta-analysis of randomized controlled trials. Osteoarthritis and Cartilage/OARS, Osteoarthritis Research Society 2008;16(4):399e408
Broadly speaking, ‘nutraceuticals’ are…
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