Nutrient molecules are important in joint disorders, because all of the metabolic events that take place in joints require essential components only obtainable from the diet. Therefore, it is not unexpected that nutrients might be helpful in joint disorders like OA. But we also must acknowledge some of the mixed reviews on nutrients and osteoarthritis. Before we discuss nutrients and OA, we have to address one shortcoming of some studies, which is related to how joints get their nutrients.
How Joints Get Their Nutrients
Cartilage is one of the critical components of joint architecture. It is one of the key things that wears down and it is one of the toughest materials in the human body to rebuild. Cartilage has a notoriously poor blood supply. It gets its blood, oxygen, and nutrients through a process called imbibition. The blood and all its nutrients get squeezed into the cartilage via movement of the joint. It is a bit like a sponge taking up water and releasing water as you squeeze the sponge and then release it. Without movement, the cartilage has a terribel time getting nutrients.
This is why movement and exercise are so vitally important in a comprehensive joint health program. When you provide additional nutrients, you must also provide the means to deliver them to a very finicky tissue. The only way to do this adequately is through movement. Thus, in order for any nutrient program to truly work, it must be combined with a movement and exercise program. Because of this, we are not surprised when certain studies of nutrients and arthritis do not show promise. It is just tough getting nutrients to the cartilage when movement is not part of the equation.
Nutrients that May Help Joints
Having said this, there are some promising studies surrounding certain nutrients and arthritis. This section is a brief introduction into the research that suggests a range of diet-derived substances that might be helpful in OA. The more detailed discussion of nutrients and joint pain will be at the link that follows this brief introduction.
One nutrient that has gotten a great deal of attention in OA is SAMe (S-adenosylmethionine). SAMe is a compound made in the body from the dietary amino acid methionine. It is crucial to processes in the brain called methylation reactions, which help make our neurotransmitters. It is also important in joint function. In all, SAMe influences some 100 metabolic reactions in the human body.
One such study of SAMe and OA can be used as a representation of the promise of this nutrient. At the Department of Family Medicine & Geriatrics, University of California, Irvine, Medical Center, doctors compared SAMe to celecoxib (Celebrex®) in people with OA.
Fifty-six people with osteoarthritis of the knee were given either 1600 mg SAMe or 200 mg Celebrex® per day for 16 weeks. In the first month of the study, those taking Celebrex® fared better than those taking SAMe. This was not unexpected, since Celebrex® is typically used for acute pain, while SAMe is used for more long term support.
By the second month of this study, those in the SAMe group experienced relief similar to that of people in the Celebrex® group. According to the authors, “SAMe has a slower onset of action but is as effective as celecoxib in the management of symptoms of knee osteoarthritis. Longer studies are needed to evaluate the long-term effectiveness of SAMe and the optimal dose to be used.” [emphasis added]
The authors went on to make an additional observation. They wrote, “While the pain relief of celecoxib [Celebrex®] was constant throughout the study, the effect of SAMe continued to increase with time. This raises the question whether the effect of SAMe would have continued to improve had the study been for a longer period of time?”
Writing about the finding that the SAMe proved as effective as Celebrex®, the doctors wrote, “The evidence of comparable efficacy [effectiveness] between SAMe and celecoxib seems rather solid.”
[Najm, WI, Reinsch, S, Hoehler, F, et al. S-adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: a double-blind cross-over trial. BMC Musculoskelet Disord. 2004 Feb 26;5:6.]
The Agency for Health Care Research and Quality (AHCRQ) is a department of the United States Department of Health and Human Services. This agency undertook an investigation that examined the benefits of SAMe (S-adenosyl-methionine) on depression and on osteoarthritis (SAMe Treats Osteoarthritis, Depression, and Liver Disease, Agency for Healthcare Research and Quality. 2002;64:1–3).
The Agency identified 14 studies for SAMe for osteoarthritis. Ten of these studies were included in an analysis of the benefits of SAMe to decrease pain of osteoarthritis. A summary of their findings is below.
- SAMe vs. Placebo. One large randomized clinical trial showed an effect size in favor of SAMe of 0.20 compared to placebo, thus demonstrating a decrease in the pain of osteoarthritis.
- SAMe vs. Anti-inflammatory Drugs. Use of SAMe resulted in outcomes similar to that achieved by anti-inflammatory drugs (such as ibuprofen, indomethacin, aspirin, and others).
Increased oxidative stress with aging reduces chondrocyte survival: correlation with intracellular glutathione levels.
Vitamin C
Vitamin D
[Mouyis, M, Ostor, AJ, Crisp, AJ, et al. Hypovitaminosis D among rheumatology outpatients in clinical practice. Rheumatology (Oxford) 2008;47(9):1348-51.] This is for the abstract below:
OBJECTIVES: A role for vitamin D in the pathogenesis of autoimmune and inflammatory diseases is emerging. We undertook an audit of 25-hydroxyvitamin D (25OHD) investigation and treatment in rheumatology outpatients. METHODS: Serum 25OHD requests were matched to electronic medical records from rheumatology and metabolic bone clinics (April 2006-March 2007). Data were analysed separately for two groups, 'Documented osteoporosis/osteopaenia' (Group 1) and 'General rheumatology outpatients' (Group 2, sub-divided by diagnosis). Hypovitaminosis D was defined by 25OHD levels <50 nmol/l. Values were compared with healthy adults to calculate geometric z-scores. RESULTS: A total of 263 patients were included (Group 1, n = 122; Group 2, n = 141) with an overall median 25OHD of 44 nmol/l.The 25OHD level among general rheumatology patients (median 39 nmol/l, mean z score -1.2, was statistically significantly lower than among osteoporotic/osteopaenic patients (median 49 nmol/l, mean z score of -0.9, p < 0.05 for the difference). 25OHD was lower in inflammatory arthritis and chronic pain/fibromyalgia than in other groups. Prescribing was recorded in 100 in Group 1 (of whom 95% were prescribed calcium/800 IU cholecalciferol) and 83 in Group 2 (91% calcium/800 IU). Only 31% of the patients with 25OHD <50 nmol/l would have been identified using general guidelines for screening patients at 'high risk' of hypovitaminosis D. CONCLUSIONS: Improved guidelines for managing hypovitaminosis D in rheumatology patients are needed. We found a high prevalence of hypovitaminosis D among secondary care patients in rheumatology and widespread supplementation with 800 IU cholecalciferol. Substantially reduced levels of serum 25OHD were identified among patients with inflammatory arthritis and chronic pain.
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Low vitamin D levels may worsen OA of the knee. ScienceDaily (Nov. 15, 2007) Recent studies have shown that vitamin D influences both musculoskeletal and neuromuscular function. Taking a closer look at this, in a two-year trial of vitamin D supplements on knee osteoarthritis progression, researchers tested whether vitamin D deficiency at study entry is associated with pain and physical function in OA patients. Researchers studied 65 women and 35 men in their sixties who showed signs of having knee OA by measuring blood levels of vitamin D, their baseline knee pain, the time needed for arising several times from a chair, and the time needed to walk 20 meters.
Of the 100 participants, 47 percent were vitamin D deficient, with vitamin D levels below 30 ng/ml. This deficiency contributed to increased pain and difficulty walking among the participants. However, the deficiency did not affect time need to stand and sit repeatedly.
Vitamin D promotes the absorption of calcium and phosphorus needed for bone mineralization, growth and repair. Sources of vitamin D are available to a lesser extent from dietary sources typically found in fortified margarine, oily fish, liver, fortified breakfast cereals and dairy products. Sun exposure helps vitamin D to become active.
Absorption of vitamin D from food and conversion of it to the active form is less efficient in elderly persons. For this reason, vitamin D supplements of 400-800 and calcium doses of 1,200 to 1,500 mg a day are recommended to prevent osteoporosis. The results of this study suggest that Vitamin D supplements may also help in arthritis treatment.
“These preliminary results suggest that, among people with knee osteoarthritis, having a low vitamin D level is associated with more knee pan and greater functional limitation,” said Tim McAlindon, MD, MPH; associate professor of medicine, division of rheumatology, Tufts New England Medical Center; and an investigator in the study. “Future results from this ongoing randomized, double-blinded, placebo-controlled clinical trial of vitamin D will help determine whether vitamin D is an effective disease-modifying intervention for knee osteoarthritis.”
Vitamin D improves symptoms of knee osteoarthritis
21-Oct-2004
Related topics: Research, Vitamins & premixes
Increased vitamin D levels appear to improve muscle strength and physical function for vitamin D-deficient patients with knee osteoarthritis, according to research presented this week.
While previous studies have associated vitamin D deficiencies with an increased risk for severity of knee osteoarthritis, the new study is thought to be the first look at vitamin levels in relation to pain and disability.
Speaking at the American College of Rheumatology annual meeting in San Antonio this week, the researchers said they measured changes in pain, physical function, muscle strength and serum levels of vitamin D twice or more times across a 15-and 30-month period in a group of 221 patients, aged 67 years old on average.
At the outset, the 48 per cent of patients with low levels of vitamin D (at or below the minimal 20 ng/ml needed to satisfy the body's requirements) experienced more pain and disability than those with levels above 20 ng/ml. Those with deficient serum vitamin D were also weaker, but this was not significant.
The study also found that changes in vitamin D status over time predicted changes in disability. Those with sufficient serum vitamin D that became deficient over time experienced worsening disability scores, while those with deficient serum vitamin D that became sufficient over time improved their disability scores.
Change in serum vitamin D levels also showed a similar pattern in changes in pain but this was not significant.
"Data suggests that many people may be vitamin D deficient, especially those living in the northern hemisphere and darker skinned individuals," said investigator Kristin Baker, from Boston University. "The good news is vitamin D levels are easily modifiable through safe, short-term exposure to sun and/or dietary intake, and may lessen the disability and pain of osteoarthritis."
Vitamin D, which comes primarily from exposure to sunlight, promotes the absorption of calcium and phosphorus in bone mineralization, growth and repair. Sources of vitamin D are available to a lesser extent from dietary sources typically found in fortified margarine, oily fish, liver, fortified breakfast cereals and dairy products. However, the elderly are less efficient at producing vitamin D from sunlight and absorbing it fromfood.
To address their higher risk for D deficiency, the elderly population is often directed to take a vitamin D supplement of 400-600 IU per day.
More than 7 million adults in the UK - 15 per cent of the population - have long-term health problems due to arthritis and related conditions, according to the Arthritis Research Campaign, and 550,000 have moderate to severe osteoarthritis in their knees.
Incidence is rising in ageing populations and those with increasing levels of obesity.
