Joint Builder ULTRA: A combination supplement for joint health

We recently heard from two NYBC members who have found Jarrow’s Joint Builder ULTRA very effective in supporting healthy joint function. Indeed, they were quite pleased with improvement in joint function within a few weeks to a month of starting to take this combination supplement. So we thought we’d review this formula a little more thoroughly.

First, here’s the list of ingredients, together with the supplier’s recommendation on dosage and how to take:

Ultra Joint Builder (Jarrow) Each bottle, 90 tablets. Each tablet, 500 mg glucosamine sulfate, 500 mg MSM, 167 mg Yucca juice extract (Yucca schidigera, 4:1), 34 mg ApresFLEX (Boswellia serrata extract, 20% 3-O-acetyl-11-keto-beta-boswellic acid); 13.3 mg hyaluronic acid, 1 mg boron (citrate). Suggested use is 3 tablets per day. Studies for inflammation suggest 1.5 grams per day. Start slowly and build up the dose over a few days.

Glucosamine is the most familiar part of this formula, and plays an important and well-documented role in the body’s production of the connective tissue around joints, and the production of synovial fluid (the lubricant in joints, basically). Glucosamine thus has the potential to offset the destructive effects of arthritis and osteoarthritis. MSM, a supplement providing sulfur, also plays a role in these joint supportive processes.

The Jarrow combination also includes two botanicals that have long been used for their anti-inflammatory effects. Yucca schidigera is a medicinal plant which may have beneficial effects in the prevention and treatment of arthritis. Boswellia serrata has a long tradition of use for arthritis in the Ayurvedic tradition; some recent Western study of its effectiveness has suggested benefit, but other research has been less clear.

Note that Vitamin C is another important joint-supporting supplement, since it is required for the synthesis of collagen and cartilage; be sure that your intake of this Vitamin is adequate.

For best results with Joint Builder ULTRA, some suggest also using Jarrow’s Biosil, containing the biologically active form of silicon.

See further information in the NYBC catalog:

JOINT BUILDER ULTRA (JARROW)

and

Biosil

Glucosamine and omega-3s for arthritis

In a study published in 2009, a combination of glucosamine and omega-3 fatty acids (such as those found in fish oil) performed the best in reducing arthritis symptoms. According to this research, while glucosamine improves cartilage metabolism, EPA and DHA (two omega-3 fatty acids) further reduce joint deterioration by suppressing inflammation, which lowers swelling and pain.

Although this seems to be the first study that looked closely at the glucosamine / omega-3 fatty acid combination for arthritis, the results are perhaps not so surprising. After all, clinical studies over the past two decades have repeatedly shown the value of omega-3 fatty acids in treating inflammatory conditions ranging from atherosclerosis to osteoarthritis. And a 2005 study found that In people who have osteoarthritis, increased use of omega-3 fatty acids and adequate intake of monounsaturated fatty acids such as olive oil (and decreased consumption of omega-6 fatty acids) can improve symptoms and even sometimes permit a reduction in the use of NSAIDs, the pain killers that can have unwanted long-term side effects (Miggiano GA et al 2005).

Reference: Advances in Therapy 2009: “Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis” Authors: J. Gruenwald, E. Petzold, R. Busch, H.-P. Petzold, H.-J. Graubaum

For further recommendations, see NYBC entries under
Glucosamine chondroitin (the most common combination used to date in arthritis management), and the fish oil/ omega-3 fatty acid supplement Max DHA.

The Problem with Celebrex and other NSAIDS: Another Reason to Consider Glucosamine and Chondroitin as Alternative for Osteoarthritis Pain

As Dr. Hyla Cass points out in her excellent book Supplement Your Prescription: What Your Doctor Doesn’t Know about Nutrition, NSAIDs (including older ones such as aspirin, as well as newer ones like Celebrex), which are very widely used for arthritis pain, have the unfortunate side effect of inhibiting the enzymes needed to create cartilage. “Essentially,” she writes, “this means that the drugs used to relieve arthritis-related discomfort accelerate the progression of the disease.” (p. 86)

Indeed, as Dr. Cass goes on to note, there’s a study showing that people taking NSAIDs on a regular basis to relieve knee arthritis pain actually have a greater risk of worsening the disease over time than people who take a dummy pill! Moreover, another study showed that people taking NSAIDs for knee arthritis were at higher risk for developing arthritis in the hip or in the other knee, compared to people who did not take these drugs.

Just another reason to consider use of the supplement glucosamine chondroitin to support joint health. See additional information, including dosage recommendations, at NYBC’s Glucosamine Chondroitin entry.

Adverse effects of NSAIDS (non-steroidal anti-inflammatory drugs)

As Dr. Hyla Cass points out in her excellent book Supplement Your Prescription: What Your Doctor Doesn’t Know about Nutrition, NSAIDs (including older ones such as aspirin, as well as newer ones like Celebrex), which are very widely used for arthritis pain, have the unfortunate side effect of inhibiting the enzymes needed to create cartilage. “Essentially,” she writes, “this means that the drugs used to relieve arthritis-related discomfort accelerate the progression of the disease.” (p. 86)

Indeed, as Dr. Cass goes on to note, there’s a study showing that people taking NSAIDs on a regular basis to relieve knee arthritis pain actually have a greater risk of worsening the disease over time than people who take a dummy pill! Moreover, another study showed that people taking NSAIDs for knee arthritis were at higher risk for developing arthritis in the hip or in the other knee, compared to people who did not take these drugs.

Just another reason to consider use of the supplement glucosamine chondroitin to support joint health. See additional information, including dosage recommendations, at NYBC’s Glucosamine Chondroitin entry.

UCLA Division of Geriatrics/David Geffen Medical School on “Four Supplements Seniors Should Take”

We took a look at the recent issue of the Healthy Years newsletter (Volume 4G) from the UCLA David Geffen Medical School’s Division of Geriatrics, and were pleasantly surprised to find a good balance of advice ranging from exercise, diet, medication regimens when called for…and a number of on-target recommendations for promoting long-term health with the aid of dietary supplements.

The UCLA newsletter, which is directed especially to people 60 and older, offers several general supplement recommendations to promote healthy aging: a multivitamin/mineral supplement (because diet and digestive capability tend to change as you age); Vitamin D plus calcium for bone health; fish oil supplements to keep triglyceride levels down; glucosamine and chondroitin for moderate to severe arthritis knee pain; and CoQ 10 to help keep blood cholesterol down when taking a statin drug.  

A couple of other recommendations emerge for specific conditions: non-smokers with early-stage macular degeneration may want to consider an NIH panel’s advice to supplement with zinc and the antioxidant vitamins C, E, and beta carotene. And niacin and/or a fibrate drug could be beneficial in raising HDL (the so-called “good cholesterol”) levels in a person taking a statin.

Thanks, UCLA Division of Geriatrics! It’s nice to see a general-audience publication from a mainstream medical source include balanced information about supplements, and not just fixate on prescription drugs as the only possible choice for every condition.

Arthritis Supplements reviewed in the journal “American Family Physician”

Our local paper, The New York Times, has just brought us a piece on “Making Sense of Arthritis Supplements” in its Jan. 21, 2008 issue.  It’s motivated by a recent medical journal review, and has already attracted a long string of reader comments.
No surprise, given that arthritis is the leading condition for which Americans use alternative therapies, including dietary supplements. At this point there has been a lot of scientific research on supplements for osteoarthritis; the review in the journal “American Family Physician,” which is the starting point for the NYT piece,  attempts to help people sort through the studies and come to some conclusions about what the best bets are.
Some of our own thoughts on the topic:
Glucosamine sulfate is the acknowledged front-runner, both for symptom relief and on account of evidence that it may have disease-modifying effects. Especially when side effects of ibuprofen or prescription medications cause concern, there’s reason to think about glucosamine sulfate as an alternative.
In 2005, results were made available for the NIH-sponsored “Glucosamine-Chondroitin Arthritis Intervention Trial” (GAIT), which looked at almost 1600 US patients with moderate-to-severe knee osteoarthritis pain. In the glucosamine-chondroitin combination group, 79.2% had pain relief, as opposed to 69.4% in the celecoxib (tradename you might know: Celebrex) group. The competition to interpret this trial to favor supplements or prescription drugs still rages pretty fiercely–see the comment from Dr Jason Theodosakis following the NYT review. (He was on oversight committee of the GAIT study, and is a well-known proponent of glucosamine.)
There is another supplement, more expensive than glucosamine, that has been extensively researched for osteoarthritis: SAM-e (S-Adenosyl-methionine). Below we simply reproduce the abstract of a frequently-cited review of this supplement, with Conclusion highlighted. (BTW, the caution raised in the NYT review about the stability of this product on the shelf is a point well taken.)
Safety and efficacy of S-adenosylmethionine (SAMe) for osteoarthritis
Soeken KL, Lee WL, Bausell RB, Agelli M, Berman BM.
University of Maryland, School of Nursing, Baltimore, MD.
OBJECTIVE: We assessed the efficacy of S-adenosylmethionine (SAMe), a dietary supplement now available in the Unites States, compared with that of placebo or nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis (OA). STUDY DESIGN: This was a meta-analysis of randomized controlled trials. DATA SOURCES: We identified randomized controlled trials of SAMe versus placebo or NSAIDS for the treatment of OA through computerized database searches and reference lists. OUTCOMES MEASURED: The outcomes considered were pain, functional limitation, and adverse effects. RESULTS: Eleven studies that met the inclusion criteria were weighted on the basis of precision and were combined for each outcome variable. When compared with placebo, SAMe is more effective in reducing functional limitation in patients with OA (effect size [ES] =.31; 95% confidence interval [CI],.099-.520), but not in reducing pain (ES =.22; 95% CI, -.247 to.693). This result, however, is based on only 2 studies. SAMe seems to be comparable with NSAIDs (pain: ES =.12; 95% CI, -.029 to.273; functional limitation: ES =.025; 95% CI, -.127 to.176). However, those treated with SAMe were less likely to report adverse effects than those receiving NSAIDs. CONCLUSIONS: SAMe appears to be as effective as NSAIDs in reducing pain and improving functional limitation in patients with OA without the adverse effects often associated with NSAID therapies.
Citation: J Fam Pract. 2002 May;51(5):425-30.

Glucosamine Chondroitin: interpreting the research

When interpreting research on dietary supplements, it sometimes pays to look between the lines and recognize that pharmaceutical companies don’t have much interest in letting people know that over-the-counter dietary supplements are at times a reasonable option for addressing a medical condition. Yes, it’s true, the pharmaceutical companies and their researchers can display, shall we say, bias in assessing the relative merits of prescrpiton drugs and supplements.

Here’s a brief case study from the NYBC archives:

…a good illustration of the dangers of the influence of The Media and Big Business on our healthcare system was recently discussed by New York Buyers’ Club’s Treatment Director, George M. Carter: this past year, the National Institutes of Health released the results of a study that the popular media interpreted as decrying the effectiveness of the popular supplement, glucosamine-chondroitin. However, read in its entirety, the study found that the combination didn’t work well specifically for mild arthritis of the knee but neither did the prescription drug Celebrex, also included in the study. It is interesting to note that many of the researchers involved had received monies from Pfizerthe makers of Celebrex. It is also worth noting that for moderate to severe arthritic pain, the glucosamine-chondroitin combination actually worked much better than Celebrex – and that the researchers didn’t even use its most potent form (glucosamine sulfate) in the study.

For more on this issue, see the NYBC website:

Interpreting the research on glucosamine chondroitin