Delivering natural ingredients that are the building blocks of connective tissue in joint space and cartilage was the first step. Now, today’s supply channel also features anti-inflammatory ingredients. For manufacturers looking to tweak joint-health supplement formulations or retailers who want to offer something new and efficacious besides the standard glucosamine and chondroitin, we unveil what’s new and validated.
A December 2008 review published in the British Medical Journal analyzed randomized clinical trials related to osteoarthritis (as well as asthma and colitis), and the reviewer found frankincense (Boswellia serrata) evidence to be “encouraging but not compelling” in treating inflammatory conditions, along with no serious safety issues. In particular, it cited a 2003 double-blind, placebo-controlled, crossover study conducted in India for eight weeks. Those receiving the frankincense extract reported decreased knee pain, increased knee flexion and increased walking distance, along with a decrease in frequency of swelling in the knee joint.
But that’s Old Testament frankincense. In the 21st century, Laila Nutraceuticals created a unique extraction process that standardizes a frankincense extract to 30 percent of what’s seen as the most potent anti-inflammatory boswellic acid, AKBA. The result is a branded ingredient called 5-Loxin, which is used in the popular joint-health supplement Osteo Bi-Flex.
A 2008 published study validated 5-Loxin’s efficacy as an anti-inflammatory. In the double-blind, randomized, placebo-controlled study, conducted in India, researchers gave 75 osteoarthritis patients either 100 mg or 250 mg of 5-Loxin for 90 days. Both doses resulted in clinically and statistically significant improvements in subjects’ pain scores and physical function scores, though the 250 mg dose was a bit more effective. Researchers said the ingredient worked not only by controlling pro-inflammatory modulators but also by reducing the enzymatic degradation of cartilage.
The researchers in India then went so far as to put a frankincense extract in a head-to-head comparison study against valdecoxib, a COX-2 inhibiting nonsteroidal anti-inflammatory drug. The six-month, randomized, prospective, open-label, comparative study analyzed 66 patients with osteoarthritis of the knee. Researchers found that patients showed statistically significant improvements with pain, stiffness and difficulty in performing daily activities after two months of taking the frankincense extract, with results that persisted for a month after the therapy was stopped.
The COX-2 inhibitor group also experienced significant results in all parameters after only one month, but the results waned rapidly immediately after stopping the treatment.
Sabinsa’s Curcumin C3 Complex, which is composed of curcuminoids from the Indian herb Curcuma longa, has been found to possess antioxidant and anti-inflammatory properties, and is also a COX-2 inhibitor. Curcuminoids also inhibit the enzymes that cause cartilage cells to degenerate. In an animal cell study, curcumin suppressed enzymatic activity between 8 percent and 100 percent, depending on the enzyme.
A recent mouse study found curcumin was able to decrease inflammation and some of the running deficits due to exercise-induced muscle trauma.
In a notable achievement for suppliers—and manufacturers—who produce ingredient blends but don’t research the finished formulation, Sabinsa conducted an unpublished study in India comparing its ArthriBlend complex, which contains its branded Boswellin along with glucosamine sulfate and its branded Curcumin C3, to glucosamine sulfate on patients with osteoarthritis of the knee. After 90 days, the patients using the combination product experienced a more than fivefold decrease in pain and morning stiffness, and a 75 percent decrease in swelling.
Vitamin D appears to relieve chronic pain. In a 2008 analysis of 22 clinical trials involving patients with chronic pain and fatigue, in almost all cases patients were deficient in vitamin D. Nothing new there—it’s now being discovered that most every demographic group is deficient. What is notable is that when the patients were supplemented with vitamin D, their pain symptoms improved significantly—in some cases, ameliorated completely.
A May 2009 study found an association between blood serum levels of vitamin D and knee-cartilage loss and joint-space narrowing. The study, conducted in Africa, found these results in women with osteoarthritis, but not in men or in those without knee pain.
In the 556-participant Framingham Study, conducted in Massachusetts, those with the highest serum vitamin D levels had three times fewer incidents of osteoarthritis compared with those with the lowest vitamin D levels. Low serum levels of vitamin D also predicted loss of cartilage.
Less well known is exactly how vitamin D produces these effects. Some evidence suggests that physiologic processes in bone are important determinants of osteoarthritis, and vitamin D is well known to promote the absorption of calcium and phosphorus needed for bone mineralization, growth and repair. Or, cumulative damage to tissues, created by oxidative stress, could also be a pathway to osteoarthritis, as this certainly appears to be a mechanism in other degenerative conditions.
When all else fails
Finally, not that ethical supplement makers should think about going this route, but a December 2008 review of 198 trials covering more than 17,000 patients found one ingredient to be effective at relieving osteoarthritis pain, improving function and ameliorating stiffness. This ingredient: placebo.