Gaining on joint pain

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FOR YOURSELF

 

Making Alternative

Medicine Work for You

 

By Elizabeth Krieger

 

Gaining on joint pain

 

 

 

 

How to ease your aches and pains-with four natural supplements

 

For more than a decade, Alice Meyers climbed the 20 stairs to her

Madison, New Jersey, apartment and winced in pain each time. Her

knees ached and her back stiffened. Her doctor finally diagnosed her

with osteoarthritis, a joint condition suffered by 20 million

Americans, and put her on a regimen of non-steroidal anti-

inflammatory drugs. The pills did little to relieve the pain, and

they also upset her stomach.

 

 

That's when the 58-year-old Meyers turned to her best friend for

help. Max, a standard poodle advanced in age, had been chowing down

on kibble fortified with glucosamine and chondroitin, two joint

supplements the veterinary field has used for years.

 

Meyers thought her beloved dog still had plenty of spring in his

step, so she did some research and started taking glucosamine

herself. Two years later, she's taking 1200 milligrams a day, and

she is feeling a lot less pain going up those stairs.

 

She's not alone. Increasing numbers of men and women with joint pain

are finding relief from natural supplements.

 

The research on alternatives to non-steroidal anti-inflammatory

drugs, or NSAIDS, which are notoriously harmful when used over long

periods of time, is mounting, and conventional and alternative

doctors alike are gaining a better understanding of which ones work

and why. Dozens of substances claim to ease joint pain, but

separating what works from what only wastes good money is key.

 

Before you fork over your money, take a good look at what you're

getting. Four supplements are worth looking at, however, and have

gotten a lot of attention, both scientifically and anecdotally:

glucosamine, chondroitin, SAM-e, and MSM.

 

Tried and true: Glucosamine and chondroitin

 

Glucosamine and chondroitin (you'll see the latter labeled as

chondroitin sulfate) are substances found naturally in our bodies.

 

Glucosamine is an amino sugar believed to play a role in cartilage

formation and repair, according to Judith Horstman, author of The

Arthritis Foundation's Guide to Alternative Therapies. Chondroitin

sulfate is part of a protein molecule that gives cartilage

elasticity.

 

The data backing up the efficacy of these two supplements is

remarkably solid, especially in the case of glucosamine, which has a

longer research history. Research on chondroitin, however, is

mounting, and the results are encouraging. One recent study in

particular showed that chondroitin was almost twice as effective as

glucosamine at both relieving pain and increasing mobility. Although

they're commonly packaged together, experts say they work just as

well on their own.

 

Studies show that some people with mild to moderate joint pain who

take either glucosamine or chondroitin experience a level of relief

similar to that of aspirin and ibuprofen, without the ill effects,

which can include ulcers and stomach bleeding.

 

Research also indicates that these supplements might slow or even

reverse cartilage damage. In fact, reports are so encouraging that

the National Institutes of Health, often slow to research natural

supplements, is conducting a $6.6 million study of the pain

relieving and cartilage rebuilding capabilities of the two

substances-the biggest study of glucosamine and chondroitin to date.

 

Glucosamine is thought to work by increasing production of new

cartilage molecules and decreasing production of enzymes that

degrade cartilage, says Jason Theodosakis, M.D., preventive medicine

specialist and author of The Arthritis Cure, the 1999 bestseller

that brought talk of glucosamine and chondroitin to the mainstream.

 

Chondroitin probably works in a similar way, he says, and it also

has an anti-inflammatory effect. While some lucky people experience

relief within a few days from glucosamine or chondroitin, for most,

it should take about three weeks to judge if the supplement is

working. The recommended dosage is 1500 milligrams per day for

glucosamine and 1200 milligrams for chondroitin.

 

For the most part, both glucosamine and chondroitin are safe. It's

the anti-inflammatory drugs that people are sucking down that drive

them to the hospital, says Marc Darrow, M.D., of the Joint

Rehabilitation and Sports Medical Center in Los Angeles.

 

More than 100,000 hospitalizations each year can be attributed to

NSAID use, and last year 13,000 people died from complications.

 

The most common side effects from glucosamine and chondroitin are

gas and softened stool. Children and pregnant women should not take

the supplements, notes Judith Horstman, since studies determining

their effects on a child or developing fetus have yet to be

conducted.

 

Because glucosamine is an amino " sugar " , people with diabetes

should check their blood sugar levels more frequently when taking

this supplement or discontinue it altogether.

 

A final warning: If you take chondroitin sulfate in addition to a

blood-thinning medication or daily aspirin therapy, have your blood

clotting time checked regularly. This supplement is similar in

structure to the blood thinner heparin, and the combination may

cause bleeding in some people.

 

A popular European import: SAM-e

 

Perhaps you've already heard of SAM-e (pleasingly

pronounced " sammy " ). Europeans have been swallowing these pills for

some time, and in the last few years, Americans have jumped on the

SAM-e bandwagon. It's often prescribed for an entirely different

sort of ache-SAM-e has shown remarkable efficacy as an

antidepressant. But doctors in Europe have been studying it as a

treatment for joint pain for more than two decades. They have

conducted dozens of studies, including controlled clinical trials,

that show it relieves joint pain just as well as non-steroidal anti-

inflammatories.

 

SAM-e is an amino acid that occurs naturally in living cells. Our

bodies usually make all the SAM-e we need, but the amount we produce

decreases with age. While the exact mechanism by which SAM-e works

has yet to be entirely delineated, scientists know that SAM-e helps

our bodies make and regulate hormones, and contributes to the

building blocks of cartilage and cell membranes.

 

SAM-e has some downsides, though, says Dr. Theodosakis. It's quite

expensive-a hefty $4 to $7 per day for the doses shown to be

effective (about 800 to 1600 milligrams).

 

It's also extremely unstable; any exposure to heat, light, or

moisture will destroy SAM-e.

 

 

Don't take SAM-e if you suffer from " bipolar disorder " , notes

Horstman, as it can cause a " manic " episode.

 

 

 

Try to choose a SAM-e product that is stabilized-look for " SAM-e

butanedisulfonate " printed on the label-and packaged in an airtight,

lightproof container. Horstman also recommends coated tablets, which

will dissolve more slowly than uncoated ones, breaking down in your

intestines rather than in your stomach. (If the SAM-e dissolves in

your stomach, your stomach acids will destroy some of it before you

can absorb it-an expensive waste.) Side effects are uncommon, but

some people experience nausea.

 

A harmless gamble: MSM

 

MSM is related to dimethyl sulfoxide, or DMSO, a solvent veterinary

product approved for human use by the Food and Drug Administration

for the bladder condition interstitial cystitis.

 

MSM is thought to help ease joint pain by supplying the body with

sulfur. Plentiful in fresh fruits and vegetables, milk, fish and

grains, sulfur is quickly destroyed when foods are processed.

According to Horstman's research, MSM's major benefit for those with

joint problems is pain relief. It has not been shown to repair or

preserve cartilage, or to modify or stop progression or joint

destruction caused by autoimmune types of arthritis, and its effects

last only as long as the supplement is taken.

 

Horstman advises a healthy dose of skepticism, as well as patience,

if you're going to try MSM. Experts suggest starting with a low

dosage (500 milligrams or less, in capsule form or dissolved in

liquid) twice a day. Gradually increase the amount until you notice

some effect. Most sources suggest working up to 1000 milligrams

twice a day. If you don't see any difference after two months, you

may never see any. The most common side effects, especially at

higher doses, are diarrhea, stomach upset, or mild cramps. Lowering

the dose may help.

 

Critics of MSM point out that there are no good human studies to

back up its claims. " Just because it helps some people isn't good

enough, " contends Theodosakis, but most consider MSM a harmless

gamble.

 

In the end, while there is a downright dizzying array of products

that claim to help ease nagging, often just plain debilitating joint

pain, patients like Alice Meyers are happy to have found something

safe and natural that works. " I feel better than I did before

starting on these supplements, " she says of her daily

glucosamine, " and that's what matters to me most. "

 

 

AM

Elizabeth Krieger is a freelance writer and editor in San Francisco.

 

Sidebar

 

Pill picking: Choosing a good supplement

 

When it comes to supplements for joint health, quality is key. The

shelves are stocked with products ranging from creams to pills to

sweet, brightly colored juice drinks, but not all are created equal.

Here are some guidelines.

 

 

- Pills are the most stable and well-regulated supplements, so don't

expect to guzzle or slather your way to relief. Drinks aren't

concentrated enough and creams don't penetrate skin. (Theodosakis

compares using joint creams to sleeping on a dictionary to increase

your vocabulary.)

 

- Since the amount of the actual substance varies widely from brand

to brand, try to find out which product a reputable study used and

take that one.

 

- Choose products sold by well-established companies that can be

held accountable.

 

- Read each product label carefully to make sure the ingredient list

makes sense to you. Seek medical advice if necessary.

 

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