Despite the widespread popularity of glucosamine and chondroitin supplements for joint health, the evidence for their effectiveness in joint health is limited.
Almost a decade ago, that information was available to the public based on conclusions from the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT).
Despite the trial showing limited effectiveness for joint pain or prevention of joint degeneration, it remains one of the top-selling supplements in the United States for joint pain.
What are my observations over the past several years treating patients for joint pain and osteoarthritis in my Integrative Orthopedics practice here in Tucson?
Most patients do not feel considerable improvement in inflammation, joint pain, or joint stiffness with G/C products. Many however continue to practice what I call “hopeful supplementation” that maybe some day these products could help their current symptoms or prevent arthritis.
Over the past few years I have immersed myself in nutritional research, self- experiments (like any good scientist), and tested multiple products with patients, to determine if there is a better, more natural, way to address symptoms of joint pain – without the side effects of most “arthritis pills”.
So what is #1 nutritional deficiency, even in “healthy eaters” of the Standard American Diet (SAD) that I have found to have the greatest impact on joint pain and health?
Essential fatty acids – specifically high-quality omega-3 fatty acids, EPA and DHA.
Essential fatty acids are essential because the body cannot build them from other nutrients you consume. They are necessary for optimal human health, and must be derived from your daily nutrition.
Why do they have such great impact on joint pain and inflammation?
The nutrition you put in your body each day will have a big impact on the ratio of omega-3 to omega-6. This ratio has a lot to do with the inflammatory potential for soothing or inflaming your joints.
- An overabundance of omega-6 in you diet will promote inflammation.
- High quality omega-3 fatty acids in your diet will suppress inflammation.
That being said, omega-3, 6 and 9 fatty acids are all essential for optimal health, but again it is the ratio quantity and quality that matters.
Consensus from nutritional experts is that the omega-6 to omega-3 ratio should be no greater than 4:1, and ideally 1:1 for optimal health.
If following the Standard American Diet (SAD), the ratio may be 25:1 or higher in favor of omega-6. This imbalance promotes inflammation, pain, and will compromise your ability to quickly recover from pain or injury.
Ratio is important, but the type of omega-3 fatty acids in your diet also matters if you are to get the most benefit.
There are two major categories:
Alpha-linolenic acid (ALA) – Found in flaxseed, soybeans, pumpkin seeds, walnuts, and some green vegetables, such as Brussels sprouts, kale, spinach, and salad greens. Also derived from vegetable and seed oils – walnut, avocado, flaxseed, and soybean.
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – Found mainly from cold-water fatty fish such as salmon, mackerel, halibut, sardines, tuna and herring. They can also be obtained from krill and algae.
Your body can immediately use EPA and DHA, but it must convert ALA to DHA and EPA to be useable. Some people, particularly diabetics, may have a difficult time converting one form to the other.
According to a Harvard University study, most Americans are deficient in omega-3 fatty acids and do not get enough of either type. Even in those consuming “healthy diets” containing fish a couple of times weekly.
As you have already learned, joint inflammation and pain, and your health, is much too complicated to hinge on a single substance. To make the claim that a deficiency or abundance can be the sole source of the problem is unrealistic (that doesn’t stop supplement companies from trying to convince you of that through marketing).
Your body, as well as the way you interpret pain, is much too complex to be dumbed down to a single nutrient. However, an overabundance of omega-6 or a deficiency in high quality essential omega-3 fatty acids will promote inflammation, joint pain, and subsequent joint destruction.
Over 35 years ago, research showed that the fatty acid composition of bone and joint cartilage changes with age (deficient in omega-3), and more than 10 years ago that osteoarthritic bone and cartilage shows dramatically higher concentrations of (inflammatory) omega-6 fatty acids.
And, so why are G/C supplements recommended instead of EPA/DHA supplements?
Are there additional side benefits from omega-3 fatty acids?
Studies have shown promising health benefits of omega-3 fatty acids on several conditions:
- Improves cholesterol profile – decreased triglycerides, increased HDL
- Lowers blood pressure
- Reduced risk for heart disease
- Brain health (memory and mental sharpness)
- Systemic Lupus Erythrematosus (SLE)
- Macular Degeneration
- Colon, Breast, and Prostate Cancer
- Skin disorders such as psoriasis
Are there side effects or precautions to follow if taking omega-3 fatty acids?
Yes. You should always consult your health care provider before taking any supplement, especially if pregnant or nursing.
Most common with omega-3 fatty acids:
- Higher doses can increase risk of bleeding or have interactions with blood-thinning medications
- Patients with diabetes can see an increase in fasting blood sugar levels
The biggest issue I see with inferior supplements is contamination with heavy metals (such as mercury), pesticide residues and other chemicals such as polychlorinated biphenyls (PCBs) and dioxins.
This can wreak havoc on your health and immune system and actually trigger more inflammation and pain.
As you already know. Quality matters.
This is the only high-quality essential omega-3 fatty acid product I personally take, and recommend in my practice —> Get your EPA/DHA
The art of healing comes from nature, not from the physician. Therefore, the physician must start from nature, with an open mind. –Paracelsus
Committed to your healing and promoting open-mindedness in medicine.
- Sawitzke AD, Shi H, Finco MF, et al. The Effect of Glucosamine and/or Chondroitin Sulfate on the Progression of Knee Osteoarthritis: A Report from the Glucosamine/Chondroitin Arthritis Intervention Trial. Arthritis & Rheumatism, 2008; 58(10):3183–3191.
- Molfino A,Gioia G, Fanelli FR, Muscaritoli M, The Role for Dietary Omega-3 Fatty Acids Supplementation in Older Adults. 2014 Oct 3;6(10):4058-4072.
- Sierra S, et al. Dietary fish oil n-3 fatty acids increase regulatory cytokine production and exert anti-inflammatory effects in two murine models of inflammation. Lipids. 2006
- Mu L, et al. Erythrocyte saturated fatty acids and systemic inflammation in adults. Nutrition. 2014, Nov-Dec; 30(11-212): 1404-8.
- Lopez HL. Nutritional Interventions to Prevent and Treat Osteoarthritis. Part 1: Focus on Fatty Acids and Macronutrients. PMR 2012; 4:S145-S154.
- Bonner VM et al. Changes in the lipids of human cartilage with age. Arthritis Rheum. 1975
- Plumb MS, Aspden RM. High levels of fat and (n-6) fatty acids in cancellous bone in osteoarthritis. Lipids Health Dis. 2004