The Health Benefits of Joint Pain Supplements

Promoting Joint, Cartilage, and Bone Health

Woman icing her shoulder.
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Myriad nutritional supplements for joint pain crowd the market—so many, in fact, it may be hard to separate those that may be effective from those that likely aren't.

For some of the most popular joint pain supplements, there's little evidence of effectiveness, while others you may never have heard of actually have shown more promise.

Whether it's your elbows or knees, fingers or toes, neck or low back, or you just hurt all over, if you have joint pain from arthritis or any cause and hope to find relief at the drugstore, you'll want a clear understanding of what you'll be choosing from.

You also will need to consult with your doctor before you swallow anything new, especially if you're currently on any prescription or over-the-counter (OTC) medication, or you regularly take other nutritional supplements: Even "natural" remedies can interact with these.

Glucosamine Chondroitin

Glucosamine and chondroitin are naturally occurring components of the cartilage that provides a cushion between the hard surfaces of the bones that form joints.

Glucosamine supplements often are derived from shellfish. Some chondroitin comes from the cartilage of sharks or cows, and some of it's lab-created. Both are available in supplement form, either separately or in combination.

What the research says: Some studies suggest that taking glucosamine and chondroitin supplements can improve cartilage health. However, results of studies are mixed, with some showing a benefit and others showing no benefit or even worsening joint pain.

A 2014 study says they appeared about as effective as the drug celecoxib in improving osteoarthritis (OA) of the knee, but a 2017 study found it didn't make any clinical improvements.

A 2018 study on hip and knee OA ranked glucosamine and chondroitin together as second only to celecoxib for improving physical function and said that glucosamine by itself was significantly better than placebo at relieving stiffness.

A review of literature, also published in 2018, concluded that either supplement can reduce pain in knee OA, but combining them didn't offer a greater benefit and neither improved the condition overall.

How to take it: A typical dosage for glucosamine and chondroitin, whether together or separate, is:

  • 1,500 milligrams (mg) of glucosamine
  • 400 to 800 mg of chondroitin

These dosages can be divided into two or three equal doses throughout the day, preferably taken with meals.

Side effects and interactions: Glucosamine chondroitin supplements may interact negatively with the blood-thinning drug Coumadin (warfarin).

Many of the common side effects of glucosamine are digestive in nature and so taking it with food can help to prevent them:

  • Bloating
  • Gas
  • Diarrhea
  • Constipation
  • Heartburn
  • Nausea

In rare cases, glucosamine may cause:

  • Drowsiness
  • Skin reactions
  • Vomiting
  • Headache
  • High blood pressure
  • Elevated heart rate

If You're Allergic to Shellfish...

...do not take glucosamine unless it is absolutely clear from the label that it was not derived from shellfish. You also can find this information by looking at the website associated with the brand or calling the manufacturer.

Chondroitin may cause side effects as well, including:

  • Nausea
  • Mild stomach pain
  • Constipation or diarrhea
  • Hair loss
  • Irregular heartbeat
  • Swelling (edema) in the legs or eyelids

Glucosamine chondroitin supplements may interact negatively with the blood-thinning drug Coumadin (warfarin).

Hyaluronic Acid

Hyaluronic acid is found in the fluid that lubricates joints. It sometimes is injected directly into painful joints in people with arthritis, but less is known about it as an oral supplement. Hyaluronic acid is sometimes extracted from rooster combs or produced in a laboratory using bacteria.

What the research says: A small but growing body of evidence suggests supplements may increase the amount of hyaluronic acid in joint fluids plus relieve pain and inflammation and may even improve sleep quality.

A 2016 review of studies on this supplement for knee osteoarthritis concluded that it is a safe and effective treatment for mild knee pain and maybe even for OA prevention.

How to take it: While there is no official advisable dosage of hyaluronic acid, manufacturers recommend between 200 mg and 1,000 mg per day. Clinical studies have often reported positive results with daily dosages of 240 mg less.

Side effects and interactions: When injected, hyaluronic acid can cause an allergic reaction or unpleasant side effects at the site along with some systemic effects. It's theoretically possible that oral supplements could cause similar systemic reactions:

  • Headaches
  • Dizziness
  • Temporary increase in joint pain

Boron/Calcium Fructoborate

Boron is a mineral found in some nuts, fruits, and vegetables as well as in the environment.

What the research says: Boron and boron-containing molecules, including calcium fructoborate, help the body maintain healthy levels of vitamin D, calcium, and magnesium—nutrients essential to healthy bones and joints.

It's also been shown to lower inflammation and possibly even reduce the risk of developing arthritis.

While much of the evidence is positive, though, not enough research has been done to say definitively that boron supplements are effective at improving joint health or relieving pain from arthritis.

Calcium fructoborate is a sugar-borate, which means the molecule contains one or two sugar molecules attached to a boron atom. Most of the borate in foods is in the form of a sugar-borate.

A 2019 review concluded that calcium fructoborate supplements offer better health benefits than regular borate and describes it as a safe, natural, and effective way to manage joint discomfort and improve mobility in older people.

How to take it: As a supplement, boron is believed to be safe at doses of 20 mg per day or less. Data suggest it's ideal to get more than 1 mg of boron per day as part of a healthy diet. Many people get less than this amount through food.

Side effects and interactions: Side effects aren't typically a problem except for at high doses, when it can cause:

  • Nausea and vomiting
  • Indigestion
  • Diarrhea
  • Headache

Boron is not considered safe for everyone.

  • Because boron may increase levels of certain sex hormones, it's not recommended for people with hormone-sensitive conditions (breast cancer, endometriosis, uterine fibroids).
  • Boron is processed primarily by the kidneys, so it's not recommended for anyone with poor kidney function or kidney disease.
  • If you're pregnant or breastfeeding, you shouldn't take boron in any form, use boric acid in any form, or use a borax cleaning solution (especially on children's items.) Children should not be exposed to these products, either.

Boron doses of more than 20 mg a day might impair male fertility. Large doses may also cause poisoning, which causes symptoms of tremors, convulsions, diarrhea, vomiting, and many other symptoms.

MSM

Supplements of methylsulfonylmethane, better known as MSM, are shown to reduce inflammation, joint pain, and muscle pain. This important source of sulfur is naturally found in plants and animals, including humans, and can be synthesized in a lab.

What the research says: A 2017 review explores the different aspects of MSM as a anti-inflammatory, antioxidant, and immune modulator, and how each one impacts your health.

  • To fight inflammation, it effects numerous cells involved in the immune system's inflammatory pathways, including interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNFα), both of which are involved in rheumatoid arthritis and many other autoimmune diseases.
  • As an antioxidant, it alleviates oxidative stress, which is involved in numerous disease processes, by stabilizing unstable molecules called free radicals that cause damage at the cellular and mitochondrial level.
  • As an immune modulator, it can help reverse the damage chronic stress inflicts on the immune system, in part through its actions on IL-6, inflammation, and oxidative stress, which allows the immune system to better protect you from disease and possibly to heal wounds.

How to take it: MSM is generally well-tolerated at a dosage of up to four grams daily.

Side effects and interactions: MSM is associated with few known side effects that are generally mild, including:

  • Upset stomach
  • Headache
  • Insomnia
  • Diarrhea

MSM contains sulfur, and other sulfur-containing molecules are known to cause adverse reactions when combined with alcohol. Studies haven't yet been done gauging the effect of combining alcohol with MSM.

Dosage

MSM is generally well-tolerated at a dosage of up to four grams daily.

Vitamin D3

You get vitamin D from food and sunlight. While the evidence is mixed, some studies show a correlation between low vitamin D and pain, as a vitamin D deficiency can lead to bone loss and fractures, weak muscles, and pain in the muscles and bones.

Vitamin D3 is often recommended because research suggests it's the most potent form, which means lower doses may achieve the desired benefits.

What the research says: A 2017 review of vitamin D for knee osteoarthritis finds evidence for it insufficient, with studies reporting no significant reduction in pain or stiffness, and no increase in ability or overall function.

A 2018 review of evidence on osteoarthritis treatments also declared vitamin D ineffective.

However, a 2017 study concluded vitamin D supplementation for six months decreased pain; improved physical performance, strength, and quality of life; and reduced damage from oxidative stress in people with OA.

How to take it: The U.S. Recommended Dietary Allowance (RDA) for adults under 70 is 600 IU (international unit) per day. For adults over 70, it's 800 IU.

Vitamin D is believed to cause harmful effects at dosages of 4,000 IU or higher. You shouldn't take large doses of vitamin D without the guidance and supervision of a doctor.

Side effects and interactions: Standard doses of vitamin D aren't associated with negative side effects. At larger amounts, it can become toxic and result in high blood calcium levels (hypercalcemia). That can cause:

  • Calcium deposits in the lungs, heart, or other soft tissues
  • Confusion
  • Kidney damage
  • Kidney stones
  • Nausea
  • Vomiting
  • Constipation
  • Weight loss
  • Poor appetitie

Tamarind

Tamarind (Tamarindus indica L. or Fabaceae) is a tropical fruit with numerous uses in traditional medicine.

What the research says: Research has shown that tamarind seed extract is a potent protector of joints because it appears to inhibit the activity of several enzymes that degrade bone and cartilage, relieve inflammation, and act as an antioxidant.

A 2019 short-term study on a supplement formulation of tamarind and turmeric suggested that it can provide substantial relief from post-exercise knee pain that's not due to arthritis as well as improving joint function.

How to take it: No official dosage is established for tamarind. However, studies have reported positive results with doses between 240 mg and 400 mg.

Side effects and interactions: Tamarind seed, thus far, has not been associated with any known negative side effects. Eating the pulp of the fruit may have a laxative effect, especially in large amounts.

Turmeric

Turmeric (Curcuma longa) is a popular spice that's long been a traditional remedy for inflammation, infection, and wounds.

What the research says: Turmeric's primary ingredient is curcumin, which research has shown to down-regulate inflammatory processes and relieve joint pain associated with arthritis.

A 2019 study on turmeric for knee osteoarthritis suggested it had a "rapid and significan't decrease of pain." A 2014 study found it to be as effective as ibuprofen for reducing inflammation in knee OA and with fewer gastrointestinal side effects.

How to take it: According to some research, astaxanthin is safe and effective at doses between 2 mg and 6 mg per day.

No official recommended dosage for turmeric is established, but clinical studies report positive results with 1,000 mg per day, often divided into two equal doses.

Side effects and interactions: Side effects associated with turmeric include:

  • Nausea
  • Diarrhea
  • Heartburn
  • Increased risk of bleeding
  • Headache
  • Skin rashes
  • Yellow stool

In people who are prone to kidney stones, turmeric may increase the risk of stone formation.

Krill Oil/Omega-3

Krill oil, which comes from a crustacean called krill that's similar to shrimp, is rich in omega-3 fatty acids. Research suggests that the omega-3 in krill oil may be easier for your body to absorb than omega-3 from fish oil.

What the research says: Omega-3 is known to reduce inflammation and help reduce pain.

Animal studies suggest omega-3 from krill oil, especially, reduces levels of pro-inflammatory cytokines (specialized cells from the immune system) that trigger inflammation.

In humans, preliminary research found that it improved subjective symptoms of mild knee pain. Further research is on-going.

How to take it: According to some research, astaxanthin is safe and effective at doses between 2 mg and 6 mg per day.

No official dosage for omega-3s exist. Supplements are available with amounts ranging from about 650 mg to 1,500 mg, with instructions saying to take two or three a day.

Side effects and interactions: Common side effects of omega-3s include:

  • Upset stomach
  • Diarrhea
  • Gas and burping
  • Abdominal pain
  • Bloating
  • Heartburn and acid reflux

It may help you avoid side effects if you start with a low dose and increase it gradually.

Astaxanthin

Astaxanthin is a type of pigment found in micro-algae and other aquatic organisms including salmon, shrimp, and krill.

What the research says: Research has shown it to be valuable as a nutritional supplement for many reasons, including as an antioxidant that helps reduce oxidative stress and prevent the induction of inflammation.

It also appears to have some immune-system modifying properties. Whether it's useful for treating autoimmune diseases still is unknown.

Scientists are in the early stages of research into astaxanthin and there's much they still don't know.

How to take it: According to some research, astaxanthin is safe and effective at doses between 2 mg and 6 mg per day.

Side effects and interactions: So far, no significant side effects of astaxanthin have been reported in humans or animals.

In animal studies, high doses have led to reddening of the skin and reduction in blood pressure in hypertensive rats.

Type II Collagen

Using the same protein found in healthy cartilage, type II collagen is believed to work with the immune system to preserve cartilage. This supplement is generally derived from the sternum cartilage of chickens.

What the research says: A 2012 review concluded that evidence was insufficient to recommend this treatment for OA, but more research has been done since then.

Some studies have shown improvement in joint function and pain, including one that concluded it helped with pain from knee OA.

A 2017 review of supplements for osteoarthritis found evidence that type II collagen improved pain in the short term, but not medium or long term, in people with OA of the hand, hip, or knee.

How to take it: No standard dosage has been established. Some studies have reported good results with 40 mg per day.

Side effects and interactions: Collagen is generally well-tolerated and isn't associated with any major side effects. Possible minor side effects include:

  • Mild diarrhea
  • Upset stomach
  • Diarrhea

No negative drug interactions have been found.

Other supplements that may have benefits for your joint health include:

What to Look For

When you're buying supplements, be sure you're shopping in a reputable store or website and buying well-established, respectable brands. Independent quality testing is important, so look for products certified by ConsumerLabs, The U.S. Pharmocpeial Convention, or NSF International.

While instructions are on the bottle, always talk to your doctor before adding a supplement to your regimen to make sure it's not dangerous for you and doesn't conflict with any of your medications.

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