Growing Pains

How our lifestyles can dictate the future for our bones and joints.

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Family history and aging are said to be the most common factors for joint ailments such as arthritis and osteoporosis. While they are not the only contributors, they are the only ones we have no control over. Because of this, “preparing for the natural aging process is critical to staying healthy and active for a longer period of time,” says Trisha Sugarek MacDonald, senior director of research and development, Bluebonnet Nutrition Corporation, Sugar Land, TX. With the aging process, also comes progressive bone mineral loss. Consumers can prepare for this by incorporating particular nutrients into their daily ritual to supplement the decline and slow down the process. In addition to supplementing with nutrients, MacDonald also recommends “taking the bull by the horns” by implementing the lifestyle changes
required to optimize bone quality and density — these are the contributors we do have control over — such as a good diet, maintaining a healthy weight and daily exercise. According to experts, balance is the key.

The Two Extremes
Annie Eng, CEO, HP Ingredients, Bradenton, FL, points to those who are on “both ends of the constitutional spectrum,” noting that either extreme can lead to joint problems and inflammation. These are individuals who are either, “obese or those who work out a bit too enthusiastically,” she says, adding that both groups tend to experience joint damage, notably in the knees and hips.

According to Hector Alila, partner, Avie Naturals, Baton Rouge, LA, “Carrying around too much weight for years stresses the joints, so weight control is a must.”  In fact, according to MacDonald, “Every extra pound of weight, adds 5 pounds of pressure on joints, so even individuals in their teens can benefit their joints in the long run if they maintain a healthy weight.” This is because inactivity and shrinking muscle mass actually put more strain on the joints and are pro-inflammatory, says Cheryl Myers, chief of education and scientific affairs,
EuroPharma, Inc., Green Bay, WI.

Paradoxically, people who exercise too much can also aggravate their joints to the point where they will also experience similar ailments to those who are overweight. “Athletes who engage in sports featuring repetitive motion may also have early-onset joint degradation,” asserts Alila. This is typical, says Myers, if one has been doing repetitive physical work since their teenage years or are a very active amateur athlete. Those are the ones who will notice joint pain and inflammation at an earlier age. For those who have had less physically demanding jobs, joint pain and inflammation may come as a bit of a surprise, what Myers refers to as an “Oh, I’m getting older” moment.

Dallas Clouatre, Ph.D., consultant for R&D, Jarrow Formulas, Inc., Los Angeles, CA, explains that there is little or no blood flow in some joint components, such as cartilage, therefore regular movement is required to provide nutrients and remove toxins. “Thus, on the one hand, remaining active is essential for joint health. On the other hand, excessive stress and overuse negatively affects the joint,” he states. Cloutare points to baseball catchers as a prime example because they both overstress their knees and engage in excessive use from an anatomically demanding position. “It is important to maintain a balance between activity and downtime for repair.” Clouatre asserts.

Speaking of athletes, “Traumatic injuries generally catch the attention of people because these injuries often involve dramatic scenes, like when an athlete falls to the ground clutching his or her knee,” but overuse injuries are actually more common says Richard Passwater, Jr., product education director, Bio Minerals, the maker of BioSil, a specialty line from Natural Factors, Monroe, WA. Passwater points to a 2003 study which showed 82.6% of 703 golfers reported overuse injuries while only 17.4% reported single trauma events (1).

“It’s easy for overuse injuries to develop because there are a lot of moving parts in the joints,” explains Passwater. This is because, he explains, “a team of different collagen-dependent connective tissues such as bones, cartilage, ligaments, tendons and muscles must all work together in unison to accomplish controlled and fluid movement. A failure of any tissue to perform properly can limit a person’s ability to move, cause pain during the movement and/or trigger inflammation. And even worse, the failure of one tissue to perform as expected can end up causing damage to the other tissues involved in the movement cycle. The bottom line is your ability to move is only as strong as the weakest link in the movement cycle.”

Timothy Mount, CN, CCMH, director of education, NeoCell, Irvine, CA, points to the term “runner’s knee” which develops from years of pounding the pavement. “[This] is a perfect example of how cartilage — made up of 60% collagen — can be worn away after years of damage.“

Every extra pound of weight, adds 5 pounds of pressure on joints, so even individuals in their teens can benefit their joints in the long run if they maintain a healthy weight.
— Hector Alila, partner, Avie Naturals

Like Alila, Cloutre makes it a point to bring caution to the other end of the spectrum, explaining that synovial joints are in fact meant to move and inactivity often leads to serious joint problems as well. “First, inactivity generally leads to muscle weakness, atrophy and laxity,” he explains. “The reduced muscle strength and reduced muscular tension can negatively affect the functioning of the tendons, ligaments and cartilage in the joint. Secondly, inactivity often leads to weight gain. Weight gain puts an increased physical load or burden on weight-bearing joints.”

According to the American Journal of Obesity and Orthopedics, a general rule is for every 5 kg weight gain, there is a 36% increased risk for developing osteoporosis (2). Another example Cloutre points to comes from the Arthritis Foundation, which states, “Every pound of excess weight exerts about 4 pounds of extra pressure on the knees. So a person who is 10 pounds overweight has 40 pounds of extra pressure on his knees; if a person is 100 pounds overweight, that is 400 pounds of extra pressure on his knees” (3).

The Joint Pain Culprits
Most experts agree that the two common culprits of joint pain, inflammatory response and cartilage degradation, are not separate at all but are symbiotic with each other in a cause and effect loop. Dr. Chris Meletis, director of science and research, Trace Minerals Research, Ogden, UT, and chief medical officer, DivineMedicine.com, states that “Inflammation increases free radical damage (Reactive Oxygen Species) ROS. Inflammation and the corresponding inflammatory markers such as cytokines alter the local micro-ecology of the joint and joint space altering the ability of the tissues to mend. Literally a catch 22, more inflammation leads to more joint damage and in turn joint damage creates an inflammatory environment.” It is because of this cycle that joint health can be so difficult to maintain. Alila confirms this when he says, “Inflammation is the body’s response to cartilage degradation. The inflammatory process involves the production of chemicals called cytokines. The cytokines cause further degradation of the joint cartilage and the cycle continues if treatment is not initiated.” Because of the relationship of these two common culprits, attempting to treat them separately will not be easily accomplished.

Foods and Nutrients
Knowing which foods and nutrients to ingest and which to avoid can also be a major solution to healing bone loss and inflammations. Alila states that, “Highly processed food contributes to increased inflammation in the body. Among these foods are high sugar, high unsaturated fat containing products, all of which are common in highly processed foods. Among anti-inflammatory foods are fruits and vegetables that contain antioxidants that reduce inflammation.”

While eating the right foods and avoiding ones that prompt inflammation can be very helpful, taking a supplement can also help. “Since intense inflammatory response is a contributing factor to discomfort caused by worn joints, the active ingredient in culinary spice turmeric (curcumin) is the go-to supplement for joint care,” continues Alila.

Stacey Littlefield, master herbalist and chief product formulator, Redd Remedies, Inc. Bradley, IL, believes that “One nutrient in particular, MenaQ7 vitamin K2 has been shown in scientific research to support not only healthy bones, but also to have anti-inflammatory properties. This food-sourced nutrient contains many of the co-factors necessary for healthy joints to include: glucosamine, chondroitin, hyaluronic acid, collagen and sulfur-based amino acids.”

Glucosamine and chondroitin have been on the market for some time as joint health supplements but newer to the market are cannabinoid compounds. “Cannabinoid compounds (e.g., found in agricultural hemp extracts) and the endocannabinoid system (ECS) have been making waves for optimizing health and restoring balance related to mood, anxiety, sleep, discomfort related to intense exercise/activity, neuroprotection, and even metabolic health.

It is important to maintain a balance between activity and downtime for repair.
— Dallas Clouatre, Ph.D., Consultant for R&D, Jarrow Formulas, Inc

However, there is emerging science paving the way for the application of cannabinoids such as CBD (cannabidiol) in the world of orthopedic joint, tendon, bone, and connective tissue health,” says Hector Lopez, MD, scientific and medical advisor, CV Sciences, San Diego, CA.
Lopez points to a recent animal, preclinical study published in a peer-reviewed scientific journal earlier this year by Kogan et al. which demonstrated for the first time that phytocannabinoids can help to regulate the biomechanical properties and structure of bone.

“Interestingly, it had previously been shown that a number of endocannabinoids (produced within the body) acted as ligands, or hormone-like compounds (‘keys’), for important receptors (‘locks’) that control how the bone repairs and remodels its mineral and protein content,” say Lopez.

In this study by Kogan, “CBD led to improvements in healing of a rat femoral fracture model and demonstrated increased load-bearing mechanical properties,” Lopez says. “In other words, the rat leg fractures of the CBD-supplemented group healed faster and more completely with a stronger callus at the injury site than the control group that received non-cannabis treatment.”

Lopez also points to recent data showing that CBD from agricultural hemp extract may also improve the viability and function of mesenchymal stem cells in tissue culture studies. “Mesenchymal stem cells are important for regenerative processes involving connective tissues such as cartilage, bone, tendon and ligaments,” he explains.

Alila points to pizza, bacon, ice cream, candy, and fried food as the types of processed foods that promote inflammation. Choosing these types of foods and lacking in fresh fruit and vegetable intake high in antioxidants further worsens the condition and promotes inflammation, he further states. Anti-inflammatory foods like fruits and vegetables, contain antioxidants that reduce inflammation. “Green vegetables are rich in vitamin K (kale, broccoli and spinach),” he explains. “For salads, preparation of a dressing made of olive oil promotes reduction of inflammation. Whole grains and beans contain the anti-oxidant selenium, while beans promote muscle health through their proteins. Red and blue fruits such as cherries, strawberries, blue berries are high in antioxidants.” Alila also points to a study in The American Journal of Clinical Nutrition which claims the benefit of nuts and seeds were reported stating that “consumption of nuts over 15 years could reduce the risk of dying from inflammatory disease related complications by over 50%.”

Brittini Gehring, MH, chief botanical officer, Ridgecrest Herbals, Salt Lake City, UT, agrees that leafy greens and nuts — for their calcium — in addition to lean proteins and healthy fats lead to better health. Specifically,  “whole food-based sources are the best option in my opinion because they contain organic sources of calcium that are easier for the body to utilize. Vitamin D (from sunshine or supplements as a second resort) and certain types of vitamin K work in a synergistic fashion to make sure the calcium is properly utilized,” and in turn avoiding processed foods that “hinder calcium absorption.”

Easing Joint Discomfort
For ideal and comprehensive support, Mount says a product should contain all four nutrients that make up cartilage in a ratio that mimics the composition of cartilage naturally found in the body – 60% Collagen Type 2, 15% glucosamine, 15% chondroitin and 10% hyaluronic acid. “Most people think of glucosamine exclusively, but it only makes up a small percentage of cartilage and doesn’t support the structure of the cartilage tissue like Type 2 Collagen. By combining all four nutrients together both the structure of the cartilage is addressed with Collagen Type 2 and chondroitin and the cushioning and hydration of cartilage is aided with glucosamine and hyaluronic acid,” he explains.

Steve Holtby, president and CEO, Soft Gel Technologies, Hauppauge, NY, states that hyaluronic acid (HA) “is found in every tissue of the body. It is present in particularly high concentrations in the synovial fluid that lubricates the joints. HA is one of the best lubricants and shock absorbers found in nature, making it highly beneficial for joint and soft tissue disorders.” Cartilage and bone damage occurs over time with everyday wear and tear, so joint issues are uncommon at younger ages. The nutrients in these ingredients perform specific functions within the joint.

According to Clouatre, “anti-inflammatory and immunomodulatory nutrients are useful in controlling excessive catabolism. In the combination of chondroitin and glucosamine, the former primarily addresses excess catabolism. Glucosamine hyaluronic acid and collagen, to the contrary, address primarily the repair and the building of joint tissues by supplying the building blocks for the creation of new cartilage. Both sides of the equation help to ease pain and to improve mobility and the best results generally appear when, again, both factors are addressed.” The fluids around cartilage are key as they help lubricate and hydrate in order to make the joint area work effectively.

Mount advises that “cartilage has two main functions: 1) to protect the bone against wear and tear and 2) to absorb the impact placed on the joint. If hydration is inadequate, impact from movement will not be absorbed properly and could lead to structure damage. If the structure of the cartilage is compromised the joint will become unstable and inflamed leading to long term joint degradation of all surrounding connective tissues like ligaments and tendons.” When the joint is not getting the proper fluids, inflammation and irritation can occur. Unlike other parts of the body, cartilage does not benefit from some of its surrounding structures.

Says Passwater, “Cartilage is a vascular tissue meaning that it doesn’t receive direct blood supply from blood vessels. Because of this, cartilage is dependent on the quality and quantity of synovial fluid surrounding it to provide it with the nutrients it needs to survive and to carry away the waste products it produces. So nutrients such as choline-stabilized orthosilicic acid that can positively interact with and improve the condition of the glycosaminoglycans in synovial fluid are very helpful as well.”

Addressing the Anti-Inflammatory Response
In today’s society being healthy can be quite a challenge. MacDonald believes that “many individuals rely on fast food and a not-so-good-balanced diet. Plus, if you add in excessive weight and genetic predispositions, you can see how the delicate balance of physiological events can get disrupted, which influences the comfort level and natural solidification of joints and bones, respectively. It is quite important that when providing dietary supplement formulas with scientifically relevant/meaningful quantities of complementary ingredients ensures that products will work and be efficacious.” When talking about Omega-3’s Gehring believes that, “Omega-3 is always a good option to take in addition to herbal supplements or other nutrients (such as glucosamine and chondroitin) because it is easily absorbed and used by the body and can help to support joint health and comfort on a cellular level.”

Figure 1A: Intra-individual changes of WOMAC score in the Curcminoids (left) and placebo (right) groups. Courtesy of Sabinsa Corporation

Knowing what types of nutrients are best and what their absorption rates are is also helpful in the treatment of joint discomfort and mobility. Bioavailability is also an important factor when contemplating dosaging, especially in regards to curcumin and tumeric. “The biggest problem with most turmeric/curcumin ingredients is poor bioavailability. Consumers may realize little benefit even if they consume large amounts. Turmeric’s/curcumin’s poor bioavailability has been well documented. It is rapidly metabolized, retained in low levels in plasma and tissues, and extensively and rapidly excreted,”according to Rick Antonoff, president of Novel Ingredient Services. That is why choosing clinically tested ingredients with proven results is crucial. Lynda Doyle, vice president, Global Marketing, OmniActive Health Technologies, Inc., Morristown, NJ, states that “another important consideration is combining ingredients for a synergistic effect. Different anti-inflammatory ingredients can influence different pathways so combining ingredients can provide a more comprehensive formula to support inflammation.”
According to Shaheen Majeed, marketing director, Sabinsa, parent company of America’s Finest Inc., East Windsor, NJ, clinical trials have shown that the firm’s proprietary  curcumin (Curcumin C3 Complex) is helpful in the management of Osteoarthritis.

Figure 1B: Changes in LPFI and VAS scpres during the course of the study.
Courtesy of Sabinsa Corporation

“In a 6-week, randomized, double-blind, placebo-controlled, parallel-group pilot study carried out at the University of Medical Sciences, Tehran, Iran, 40 patients with knee OA were supplemented with Curcumin C3 Complex capsules (1,500 mg/day in 3 divided doses; or placebo). Each curcuminoid capsule contained 5 mg BioPerine (patented and clinically-validated extract from black pepper, standardized to 95% piperine) to enhance oral bioavailability of curcuminoids. Curcuminoids supplementation resulted in the reduction in the WOMAC scale (Fig. 1A) with a significant decrease in pain, physical function and stiffness; the Lequesne’s pain functional index (LPFI) and VAS scores (Fig. 1B) also showed a significant reduction,” he explains.

Another important finding of the study was an 84% decrease in the number of subjects taking naproxen in the curcuminoids group (Fig.2).

A sub-study, which was part of the randomized trial, showed that “in the presence of curcuminoids oxidative stress was reduced significantly with significant increase in serum levels of superoxide dismutase and glutathione, and concurrently there was decrease in malondialdehyde concentration and thus validated the antioxidant effects of curcuminoids in OA,”says Majeed (4).

Figure 2: Frequency of the use of NSAIDs/painkillers at baseline and at the end of study.
Courtesy of Sabinsa Corporation

Majeed also points to another randomized clinical trial in which 40 subjects with mild-to-moderate degree knee OA were supplemented with Curcumin C3 Complex and BioPerine capsules (1,500 mg/day and 5 mg/day, respectively in three divided doses). Findings showed that serum levels of inflammatory markers were analyzed and it was observed that curcumin significantly reduced interleukin-4, interleukin-6 and hs-CRP levels (5).

When would someone choose a topical application over ingestion?
Consumers may choose a topical application over ingestion because of dietary restrictions, personal preference or due to digestive sensitivity. Myers believes that using a topical application alongside a regimen of anti-inflammatory pain-fighting supplementation is a great way to get immediate relief and stop joint pain. Topical supplements are also typically used to relieve pain at the surface or to cause diminished sensitivity to an area. Majeed also explains that a “combination of use of natural compounds topically as well as orally may prove beneficial for multipronged effects.”

We all know that we cannot reverse or stop the aging process, we can however, do what is in our power to maintain balance, through what we ingest and the activities we put our bodies through. WF

References
1. Goshege et. al. Injuries and Overuse Syndromes in Golf Am J Sports Med. May 2003 vol. 31 no. 3 438-443
2. Lementowski PW, Zelicof SB. Obesity and Osteoarthritis. American Journal of Orthopedics. 2008;37(3):148–151)
3. How Fat Affects Arthritis, http://www.arthritis.org/living-with-arthritis/comorbidities/obesity-arthritis/fat-and-arthritis.php, accessed May 10, 2017
4. Panahi et al., J. Diet. Suppl. 2016; 13(2):209–20.
5. Rahimnia et al. Drug Res .(Stuttg) 2015; 65 (10), 521–5.

Published in WholeFoods Magazine June 2017

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