The Health Benefits of Joint Pain Supplements

Promoting Joint, Cartilage, and Bone Health

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.

A woman icing her left shoulder
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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 is lab-created. Both are available in supplement form, either separately or in combination.

What the research says: Some studies suggest 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

Hyaluronic Acid

Hyaluronic acid is a component of the fluid that lubricates joints. For treatment purposes, it sometimes is extracted from rooster combs or produced in a laboratory using bacteria. As such, it can be injected directly into joints or, with less proven results, taken as an oral supplement.

What the research says: A small but growing body of evidence suggests supplements may increase the amount of hyaluronic acid in joint fluids as well as relieve pain and inflammation. As a bonus, they may even improve sleep quality.

A 2016 review of studies of this supplement for knee osteoarthritis concluded that it is a safe and effective treatment for mild knee pain and also may help prevent OA.

How to take it: There is no medically-determined 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 or 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 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 such as 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.

Although much of the evidence is positive, more research is needed to definitively show boron supplements are effective for 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. People who should not take boron supplements are those who:

  • Have hormone-sensitive conditions (breast cancer, endometriosis, uterine fibroids), as boron may increase levels of certain sex hormones
  • Have poor kidney function or kidney disease because boron is processed primarily by the kidneys
  • Are pregnant or breastfeeding. Besides not taking boron supplements, expectant, nursing mothers, and children should not use boric acid in any form or use a borax cleaning solution.

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 explored the different aspects of MSM as an anti-inflammatory, antioxidant, and immune modulator, and how each one impacts your health.

  • To fight inflammation, it affects numerous cells involved in 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 by stabilizing unstable molecules called free radicals that cause damage at the cellular and mitochondrial level.
  • As an immune modulator, it can help reverse damage to the immune system by chronic stress, in part through its actions on IL-6, inflammation, and oxidative stress.

How to take it: MSM is generally well-tolerated at a dosage of up to 4 grams daily.

Side effects and interactions: MSM is associated with few mild side effects:

  • 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.

Vitamin D3

Vitamin D is derived 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 muscles and bones.

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

What the research says: A 2017 review of vitamin D for knee osteoarthritis found insufficient evidence that it neither significantly reduced pain or stiffness nor improved overall function.The same was true of 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 units) per day. For adults over 70, it's 800 IU.

Side effects and interactions: There are not significant side affects associated with standard doses of vitamin D. However, vitamin D is believed to cause harmful effects at dosages of 4,000 IU or higher. In large doses, it can become toxic and result in high blood calcium levels (hypercalcemia) which in turn causes:

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

Tamarind

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

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

A 2019 short-term study suggested a supplement formulation of tamarind and turmeric provided substantial relief from post-exercise knee pain not due to arthritis as well as improved 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: A primary component of turmeric's is curcumin, which research has shown to down-regulate inflammatory processes and relieve joint pain associated with arthritis.

A 2019 study of turmeric for knee osteoarthritis suggested it brought about a "rapid and significant decrease of pain." A 2014 study found it to be as effective as ibuprofen for reducing inflammation in knee OA with fewer gastrointestinal side effects.

How to take it: No official recommended dosage for turmeric has been 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 the 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 in particular 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: 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 pigment found in micro-algae and other aquatic organisms including salmon, shrimp, and krill.

What the research says: Research has shown astaxanthin 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.

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: 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 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 shopping for supplements, do so in a reputable store or website and look for well-established, respectable brands. Independent quality testing is important, so look for products certified by ConsumerLabs, The U.S. Pharmocpeial Convention, or NSF International.

In addition to heeding instructions on the bottle, talk to your doctor before adding any supplement to your regimen to make sure it's not dangerous for you and doesn't conflict with any of your medications, and to determine the best dosage for you.

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