Chronic pelvic, shoulder, back and knee pain are all part of the picture of fibromyalgia and chronic fatigue syndrome (CFS). Osteoarthritis (OA) is also very common being a leading cause of chronic disability and pain in the developed world.
Osteoarthritis is thought to affect about 8 million people in the UK and nearly 27 million people in the US. It is a degenerative joint disease, in which the cartilage and underlying bone degrade. Symptoms of OA can include joint pain, tenderness, stiffness, joint locking, and sometimes an effusion.
The cause(s) of osteoarthritis are not understood by allopathic medicine and treatment usually involves taking non-steroidal anti-inflammatory drugs (NSAIDs) to suppress the pain, exercise to keep the joints mobile, and ultimately joint replacement when the joint has completely degenerated.
About a third of the 40 million Americans with chronic joint pain regularly take NSAIDs like aspirin and ibuprofen, but these have several recognised side-effects including gastric problems and hearing loss.
Over 100,000 Americans are hospitalised every year for NSAID-induced ulcers, and 16,500 die. Even when NSAIDs don't cause digestive problems, they are only ever seeking to deal with the pain, and never address the cause of the degenerative condition. In fact, they may actually make the joint problem worse by slowing the production of collagen and proteoglycans, which are the tissues that make cartilage an effective shock absorber.
It is for these reasons that people have turned to supplements such as chondroitin, MSM, glucosamine and SAMe for pain relief and also to aid regeneration of the affected joint(s). These supplements can be found either as single nutrients or combined in various proportions.
So how do these supplements work?
MSM is a natural substance which is found in fresh fruits and vegetables, milk, grains, meat, seafood and fish although it is destroyed by processing. It is also found in the human body where it supplies a biologically active form of sulphur, which promotes the intercellular transport of toxins and nutrients by making the cells more permeable. The increased efficiency of exporting toxins from the cells and importing nutrients may account for how MSM relieves joint pain.
MSM is chemically related to dimethyl sulphoxide (DMSO), of which it is less reactive metabolite. Dr Stanley W. Jacob MD has been one of the chief proponents of the use of DMSO and MSM and has successfully treated tens of thousands of patients with a variety of ailments using these products.
He suggests that we are all sulphur deficient although there is no recommended amount of dietary sulphur which is readily available through foods such as onions, garlic, cruciferous vegetables and in protein-containing foods, such as nuts, seeds, milk and eggs.
In addition to aiding transport in and out of the cell, sulphur is utilised in the body to create the proteins involved in the formation of connective tissue, skin, hair, nails, enzymes, hormones, and immunoglobulins.
To watch a documentary about DMSO click for part 1, part 2, and part 3 of DMSO: Dr Stanley W. Jacob or click the relevant link for Amazon UK or US for more about Dr Jacob's book The MSM Miracle.
DMSO is known to be an active carrier capable of crossing membranes without damage and the claims made for it include:
Stimulation of the synthesis of growth hormone and
A bacteriostatic effect.
However, whilst potent, DMSO also has a strong sulphurous odour, causes a bad taste and bad breath and can cause local skin irritation where it is applied. Whereas, methysulphonylmethane (MSM) which is a metabolite of is DMSO and which may account for the therapeutic properties of DMSO is odourless, and virtually tasteless.
The late biochemist, Robert Herschler, who worked with Dr Jacob began studying MSM in 1955 and registered a number of patents worldwide relating to the biological and cosmetic uses of MSM. Like DMSO, MSM can also cross barriers including the blood-brain barrier.
The sulphur in MSM is thought to help reduce osteoarthritis pain by strengthening collagen and as such it has been marketed for the pain and inflammation associated with:
Other conditions for which MSM has been suggested to have a therapeutic effect include:
Inflammatory conditions of the mucous-membranes.
Double blind, randomised controlled studies of MSM have yielded mixed results with some finding significant improvements in pain outcomes in the treatment group compared to comparator treatments and others finding no significant improvement. MSM has not been shown to preserve cartilage, nor to prevent joint destruction or deformity, but subjective reports are that it relieves pain. However, these effects only last as long as the MSM is taken.
MSM can be applied externally as a cream or lotion where it penetrates through the skin improving the health of the area to which it is applied, or it can be taken as a supplement in a variety of forms. The Arthritis Foundation recommends starting with 500 mg twice a day of MSM and increasing gradually to 1,000 mg twice daily. You also need to give the supplement at least a few weeks or preferably a few months before assessing its effectiveness or otherwise.
Side effects with MSM are rare but may include stomach upset, headache and diarrhoea. The safety and efficacy of MSM has only been established in trials lasting up to 12 weeks and so the long-term safety has not been established.
SAM-e (pronounced Sammy) has been reported by the Scandinavian Journal of Rheumatology to reduce pain and stiffness in patients with fibromyalgia. In another trial, SAMe compared favourably to the pharmaceutical Celebrex for the management of knee osteoarthritis although it took longer to take effect.
In dozens of European trials involving thousands of patients, SAMe has performed as well as allopathic treatments for arthritis and major depression and may also help to reverse some liver conditions.
The illustration below shows how the amino acid methionine obtained from the diet can either be metabolised via SAMe into 'feel good' neurotransmitters or, how it can be metabolised into homocysteine.
If homocysteine is allowed to accumulate and not further metabolised to glutathione, heart disease may result. However, if sufficient B vitamins are present, the homocysteine can be readily metabolised on to glutathione, which has detoxifying properties in both the liver and at cellular level. So SAMe is a precursor molecule for both detoxifying glutathione and beneficial neurotransmitters.
In addition, the sulphate groups produced when homocysteine is converted into glutathione also help to generate joint-sparing proteoglycans. Other actions of SAMe may also include affecting the receptor molecules and regulation of neurotransmitter breakdown.
The methionine pathways
In over a dozen clinical trials involving tens of thousands of patients, SAMe was shown to be as effective as NSAIDs in the treatment of pain and inflammation. However, SAMe has none of the damaging side-effects on the digestive tract and instead of speeding the breakdown of cartilage (as pharmaceuticals do), SAMe may help restore it. In one German study evidence of cartilage repair was found using MRI scans.
The Arthritis Foundation recently confirmed that SAMe had been shown to provide pain relief but not that it contributes to joint health.
The other common symptom associated with the fatigue syndromes for which SAMe is said to be useful is the treatment of depression. Numerous studies over the last few decades have now confirmed this and in one study of severely depressed patients conducted at the University of California, Irvine, SAMe outperformed pharmaceutical antidepressants.
According to Columbia University psychiatrist Richard Brown who has used SAMe on several hundred patients, sometimes in combination with other drugs, he has never seen any adverse side-effects and says that "It's the best antidepressant I've ever prescribed. I've seen only benefits."
For the therapeutic effect for either depression or joint pain you need to buy full-strength SAMe which will be labelled as either tosylate or butanedisulphonate. US manufacturers such as Nature Made and GNC sell the butanedisulphonate version, and several U.S. retailers import reliable tosylate products from Europe.
Also, because SAMe is absorbed mainly in the intestines, it is best taken in an 'enteric coated' form so that it can pass through the stomach intact. These supplements may be quite expensive and are best taken twice a day on an empty stomach, with dosages starting as 400 mg a day for arthritis and rising to 1,600 mg daily for depression. Advice is to start at 400 mg per day and to increase the dose slowly.
It is also important to ensure that you are getting an adequate intake of B vitamins so as to avoid the build up of homocysteine, so taking a good quality multivitamin/mineral or a B complex is also advised.
There are few side-effects reported from the use of SAMe and these include most commonly a mild stomach upset and less commonly the possibility of triggering a manic episode in individuals with bipolar disorder (as antidepressants can do).
Glucosamine and chondroitin sulphate
Both glucosamine and chondroitin sulphate are found in cartilage and are thought to stimulate the formation of cartilage and aid in joint repair.
Chondroitin sulphate is a polysaccharide of variable length attached to a protein which is known as an aggregating preoteglycan. The polysaccharide chain can have hundreds of side chains in various pemutations making chrondroitin highly variable.
Chondroitin is one of the most abundant polysaccharides forming the exoskeletons of crustaceans and other arthropods from which supplements are usually derived.
The beneficial effects of chondroitin sulphate in patients with osteoarthritis are thought to be due to its:
Stimulation of the synthesis of proteoglycans and hyaluronic acid
Ability to decrease the destruction of articular chondrocytes (collagen forming cells)
Beneficial effects on the structure of the subchondral bone
Ability to retain water in the connective tissue
Possible blocking of the enzymes which break down cartilage and
Electrostatic repulsion between molecules which provides much of the resistance of cartilage to compression.
Again, studies of both glucosamine and chrondroitin sulphate have yielded mixed results with some studies finding a proven benefit and others finding no significant benefit to patients with osteoarthritis.
The Osteoarthritis Research Society International recommends a combination of glucosamine and chondroitin sulphate as the second most effective treatment for moderate cases of osteoarthritis. And the European League Against Rheumatism also maintains that chondroitin sulphate is well proven in the management of osteoarthritis of the knee.
There are no major dietary sources of chondroitin, so people who want to take it must take supplements. Chondroitin supplements are derived from natural animal sources such as shark, bovine or porcine cartilage, or are synthetic. If you are vegan or vegetarian, then there are also chondroitin supplements manufactured from algae.
In many countries including some European countries, chondroitin is a prescription only or over-the-counter drug whereas in the US it is regulated as a dietary supplement by the Food and Drug Administration. This means that European products have to meet the efficacy and safety standards that have been determined by clinical trials, whereas in the US the product is much more variable. In fact, one study (Adebowale et al., 2000) found that only one in six chondroitin containing supplements were labelled correctly and that over half contained less than 40% of the stated amount.
Chondroitin supplements are generally considered to be safe, although no long-term studies have established safety beyond around 12 weeks. There are also no known drug interactions with chondroitin which makes it the substance of choice for people who are already taking possibly multiple medications.
Concerns about the use of chondroitin include:
The worsening of asthma symptoms
The possible promotion of prostate cancer. Do not take chondroitin if you have a personal or family history of prostate cancer until more is known.
The safety in pregnant and breastfeeding women has not been established.
An additive blood thinning effect if taken with anticoagulants (blood thinners).
An additive blood thinning effect if taken with supplements such as fish oil and vitamin E.
The dosage of oral chondroitin typically used in clinical trials is 400 mg twice or three times a day. Since chondroitin is not a uniform substance, and is naturally present in a wide variety of forms, the precise composition of each supplement will vary. The amount of chondroitin can also vary depending upon the source of the chondroitin (e.g., shark, porcine, or bovine) and the approximate age of the animal.
The most likely side-effect of chondroitin is a mild stomach upset and its safety at the recommended dosage for short periods of time has been established although long term safety has not.
Glucosamine is an amino sugar and a precursor in the biochemical synthesis of glycosaminoglycans which form a major component of cartilage. Glucosamine supplements are derived from shellfish, but even those who are allergic to shellfish are usually able to take the supplement since it contains little of the allergen found in the flesh.
Glucosamine is thought to:
Stimulate synovial production of hyaluronic acid
Inhibit enzymes which degrade cartilage
Only about 20-25% of both glucosamine and chondroitin supplements taken are actually bioavailable. Although, according to studies done with radioactive tracers both products have been found in the synovial fluid and cartilage. Chondroitin has been shown to exert a beneficial effect for up to 3 months after supplementation is discontinued.
Chondroitin is often combined with glucosamine and occasionally manganese which is a trace element necessary for normal bone health. Do not exceed a total of 11 mg of manganese per day from diet and supplements.
When it comes to supplementing glucosamine, it is also generally considered to be safe with occasional and mild adverse effects including gastrointestinal upsets, headache and rashes. Patients with diabetes should be aware that glucosamine can raise blood-sugar levels and there may be a further anticoagulant effect for those taking blood thinners. Taken above the recommended doses, there may be damage to pancreatic cells and an increased risk of developing diabetes.
Celadrin is a recent addition to the supplements available for joint support that is available as a cream or in soft gel form. It is an all natural mixture of esterified oils similar to the essential fatty acids EPA and DHA which have been scientifically formulated for maximum effect on joint mobility and health. Celadrin has been clinically proven to promote joint health by lubricating cell membranes and cushioning joints throughout the body.
In one study (at the University of Connecticut) all the osteoarthritic subjects on Celadrin showed significant improvement in just 30 minutes. Furthermore, all measures of joint mobility improved throughout the remaining 30 days of the study with the effects being cumulative and with no side-effects.
Celadrin prevents the deterioration in the health of the cell membrane which causes it to stiffen and become less effective. This increase in health and fluidity of the cell membrane also allows for more efficient import of nutrients and export of toxins converting it to a super membrane and enabling the cells to rapidly repair and regenerate. This restoration of cells in and around the joint aids repair of damaged joints and tissues.
Click to buy or for more about Celadrin.
The causes of joint pain and deformation
The body stores toxins including toxic metals in the joint capsules and these toxic metals can cause destruction of the articular cartilage and bone. Although the joints can become painful and deformed, this form of storage is less life threatening than storing toxins in the heart or brain, for example.
Refer to the images below of both an adult woman and child that were affected by the acute mercury poisoning at Minamata in Japan in the middle of the last century. As you can see both display signs of what we would call arthritis which I believe may in large part be chronic, low grade mercury poisoning.
Some of the joint pain experienced in fibromyalgia may also be due to muscles becoming hypertonic ie: permanently or nearly permanently in spasm. Possibly all the muscles relate to the various meridians and the associations of at least 42 paired muscles have been determined by Dr George Goodheart.
The psoas muscle, for example, runs within the pelvis and attaches to the spine and relates to the kidney meridian which is usually under immense stress with mercury poisoning. This can cause the psoas muscle to become hypertonic in turn causing the lower back and pelvic pain familiar to fibromyalgia sufferers.
With effective detoxification, both the hypertonic muscles will start to relax and the joint capsules will be detoxified. Although the supplements described above will provide symptomatic relief and may help the joints to regenerate, much pain relief will come as a result of effective detoxification as outlined in The Natural Recovery Plan book.