Nutrients for Bone and Joint Health Interview

This interview was given to Whole Foods Magazine, excerpts were published in the February 2011 issue:

Despite evidence in recent medical journals, including several review studies calling for a far higher RDA and UL (upper limit) that would be five times the previous levels, the IOM held true to its conservative bent and raised the RDA and the UL; but only by 50% by only 100%, respectively . Observers are somewhat disappointed, but not really surprised. The most controversial part of the IOM committee’s report is that the only proven role for vitamin D is in bone and calcium metabolism, combined with its finding that most Americans already get enough for those benefits. That should come as news to researchers from Mayo Clinic operating under an NIH grant who recently reported that “Vitamin D insufficiency is common globally and in the United States. Approximately 25-50% of patients seen in routine clinical practice have vitamin D levels below the optimal range…” It also should be news to European regulators that recognize vitamin D’s beneficial effects on muscles, immunity, inflammation, cellular health, and reproduction. We recognize the new increased recommendations for vitamin D and the new higher safety recommendation, but believe that these numbers are insufficient to support vitamin D’s roles that go beyond calcium and bone health.

The need for joint and bone health nutrients in general increases with age. Aging also tends to reduce absorption of nutrients, forcing us to take higher amounts and better forms in order to assure adequate nutrition. The tendency of many seniors to cut back on meals, for reasons such as loss of taste or smell or interest in cooking, may also increase the need for supplementation of essential nutrients. The major joint and bone problems increase with age, and studies have shown the ability of relevant nutrients to maintain healthy bone and joint structures during these vulnerable times of life. Older customers that are more likely to take calcium supplements also tend to have diminished stomach acid available for digesting calcium from food and non-chelated (predigested) forms, so tend to do better with the predigested forms. These include calcium as citrate, malate, ascorbate, or bonded to specific amino acids; all are weak acidic sources that form a stable bond with the alkaline calcium and the resulting compound simulates the calcium complexes formed naturally during proper digestion.

While calcium and vitamin D are known for their role in bone and calcium metabolism, there are other nutrients necessary for bone health. These include silica, boron, magnesium, vitamins C and K, etc. protein. Comprehensive bone formulas include over a dozen nutrients, which are also available singly.

Children need to get sunshine, exercise, and a variety of calcium from food sources to ensure the body’s needs for bone health. If the child does not eat ample amounts milk and dark green leafy vegetables, they may need to complement the diet with appropriate dietary supplements.

Adults need to take care of their bodies and not impact the joints too much with hard exercises or excess weight. Support the joints nutritionally with glucosamine, vitamin C, a good multivitamin, and natural substances that modulate inflammation.

One should not neglect the long-term benefits of glucosamine to maintain joint distances that may otherwise erode, for example, while seeking fast-term temporary relief of aches and pains. By providing those products in both categories as well as overlapping combination products, we can supply a more holistic and sustainable nutritional joint support program.

Many of the Joint Structural Support Products contain varying amounts of glucosamine and/or chondroitin, as well as MSM, Hyaluronic Acid, and other well-known ingredients.

Nutrients for Joint Health

Nutrients for Joint Health By Neil E. Levin, CCN, DANLA Most people know that glucosamine sulfate and chondroitin sulfate are important components of joint health. They help to form spongy tissues (like articular cartilage) that hold moisture and cushion the body’s joints, protecting them from excessive wear and tear. But this takes time. Some people notice a change in joint function within days, but more typically over several weeks. Studies show that these substances help to maintain distances between joint structures over many months, a key measure of joint integrity as these structural components may slowly collapse if not nourished. This particular effect has been accepted as evidence-based by conventional physicians at a medical joint health center associated with a major university hospital. People with osteoarthritis typically may have low levels of glucosamine and chondroitin sulfates, as well as MSM, and may benefit by supplementing to restore normal levels of these soft tissue nutrients. MSM is a safe form of the mineral sulfur that may preserve joint function and structures. In order to affect joint health on a short-term basis, it may be useful to supplement the diet with herbs that inhibit the activity of the enzymes that are involved in normal inflammatory processes. These herbs may mediate COX-2 or 5-LOX enzymes. COX-2 is also the target of some widely used drugs. Some of these herbs are safe, common spices like turmeric, ginger, cayenne and the enzyme bromelain. While drugs may offer similar yet faster COX-2 inhibition, herbs can also modulate 5-LOX activity. The safety profiles and beneficial side effects associated with nutrients and herbs can be preferable to the known side effects of drugs. The antioxidant components in the herbs also improve the body's ability to repair tissues by stimulating collagen formation. A diet high in animal fat is implicated in joint problems, and experts frequently recommend that sufferers reduce their intake of most animal fats. It is important to take natural healthy essential fats, especially Omega-3 fats (cold water fatty fish, fish oil, flax seeds, flax oil) and Omega-6 fats CLA and GLA from vegetable oils. All fish oils are well-filtered and/or molecularly distilled to remove environmental contaminants and heavy metals. A low-fat, gluten-free vegetarian diet has been helpful if maintained for several months, but does not produce fast results and is best combined with other approaches, such as supplementation. Wheat and milk are often implicated in immune reactions, and it is sometimes best to avoid them, at least while addressing the problems. Joint problems have also been linked to leaky gut and maldigestion of food, leading to the body’s immune cells attacking undigested proteins. This trains immune cells to recognize food proteins as invasive organisms and respond to them aggressively, leading to food sensitivities that are not classic allergies. Since some undigested or partially digested proteins may be similar to body tissues, maldigestion could partially explain why the body sometimes attacks its own tissues. If so, there are aids to proper digestion that should be considered. Good digestion is a tool to prevent immune reactions to food and the human gut should serve as an immune barrier to pathogens in food. Take time to smell and think about your food before you eat. Avoid stress or distractions during meals. Carefully chew food to a liquid before swallowing, and even chew liquids to enhance contact with digestive enzymes in saliva. If necessary, take a high quality plant enzyme or a milk-digestive enzyme. In some cases, more stomach acid is needed to digest proteins (and minerals). HCl and Pepsin supplements do this, but sometimes much larger amounts of acid than normal are recommended by health professionals (600-2400 mg), which do have risks if you don’t need that much acid, so these high doses must be taken under medical supervision. A traditional home test to determine whether more acid would help digestion is to mix a tablespoon of (preferably raw and organic) apple cider vinegar into a glass of (pure) water and drink with a meal. If it helps digestion, you may need more acid. It may not noticeably help if you require very much acid, though. A tablespoon of raw honey can also be added to this beverage to enhance digestion, also making it taste more like apple juice. If it helps, this can be taken daily with meals. Some digestive enzymes like Bromelain and Serrazimes (serratopeptidase) can be taken between meals to help control substances associated with temporary joint discomfort. A protective layer of probiotics - acidophilus, bifidus and other “friendly bacteria” - actually lines healthy GI tracts like chain mail, preventing leakage of undigested food remnants from the gut that provoke immune responses. It is wise to supplement with healthy bacterial supplements such probiotic products. Fairly high doses of Vitamin E have been shown to help maintain joint health, but I recommend taking the full Vitamin E Complex containing eight forms of natural Vitamin E compounds, not just the alpha tocopherol. Other antioxidants are important to maintain joint health. These include the minerals selenium and zinc, vitamins A, C, E and many plant compounds. GliSODin® raises body levels of key antioxidant enzymes, such as SOD and glutathione. Celadrin® products may help to maintain joint mobility, taken orally or topically applied, and contain acetylated fatty acids from beef fat. MicroLactin™ is a milk protein fraction that helps prevent certain immune cells (cytokines) from overwhelming an area and maintaining a prolonged reaction. Time and patience may be required to find a program that works for any individual’s joint health. Many supplements work best over weeks, months or years. Stretching and gentle exercise often help people, so should be part of any comprehensive program. Yoga and Tai Chi, and variants such as water Ai Chi, are low-impact activities that aid posture and build muscle strength. Glucosamine, Chondroitin and MSM (methylsulphonylmethane, an organic form of sulfur found in all living organisms) are three of the most popular and effective nutrients for supporting joint health. There are other formulations of Glucosamine, including a vegetarian version from fungal fermentation. Studies have shown that these nutrients provide dietary components that support healthy joint structure and function. Look for substances, forms and potencies successfully used in clinical studies. REFERENCES: Chan PS, Caron JP, Orth MW. Effect of glucosamine and chondroitin sulfate on regulation of gene expression of proteolytic enzymes and their inhibitors in interleukin-1-challenged bovine articular cartilage explants. Am J Vet Res. 2005 Nov;66(11):1870-6. Chan PS, Caron JP, Rosa GJ, Orth MW. Glucosamine and chondroitin sulfate regulate gene expression and synthesis of nitric oxide and prostaglandin E(2) in articular cartilage explants. Osteoarthritis Cartilage. 2005 May;13(5):387-94. Deal CL, Moskowitz RW. Nutraceuticals as therapeutic agents in osteoarthritis. The role of glucosamine, chondroitin sulfate, and collagen hydrolysate. Rheum Dis Clin North Am. 1999 May;25(2):379-95. Kelly GS. The role of glucosamine sulfate and chondroitin sulfates in the treatment of degenerative joint disease. Altern Med Rev. 1998 Feb;3(1):27-39. Bijlsma JW. [Glucosamine and chondroitin sulfate as a possible treatment for osteoarthritis] Ned Tijdschr Geneeskd. 2002 Sep 28;146(39):1819-23. Ameye LG, Chee WS. Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence. Arthritis Res Ther. 2006;8(4):R127. Kim LS, Axelrod LJ, Howard P, Buratovich N, Waters RF. Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. Osteoarthritis Cartilage. 2006 Mar;14(3):286-94. Ebisuzaki K. Aspirin and methylsulfonylmethane (MSM): a search for common mechanisms, with implications for cancer prevention. Anticancer Res. 2003 Jan-Feb;23(1A):453-8. Parcell S. Sulfur in human nutrition and applications in medicine. Altern Med Rev. 2002 Feb;7(1):22-44. Bruyere O, Pavelka K, Rovati LC,et al. Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies. Menopause. 2004 Mar-Apr;11(2):138-43.

Vegetarian Dietary Supplements

Vegetarian Dietary Supplements By Neil E. Levin, CCN, DANLA 

Most dietary supplement manufacturers use the term “vegetarian” to include “vegan” and one even recently began adding the word “vegan” to their product labels to assure users that they are offering products without any animal-derived ingredients. 

However, some products are always animal-derived. These include: Fish Oil, Gelatin, Chondroitin sulfate, Vitamin D3, Hydroxyapatite calcium, collagen, Chitosan fiber, Celadrin oils, Pancreatin, Pepsin, Trypsin, Chymotrypsin, ImmunoLin® immunoglobulin complex, Bovine or Shark Cartilage, Sea Cucumber, Sea Mussel, Liver products that contain actual liver tissue, IGF-1 deer velvet and glandular substances. Other products are sourced from milk or dairy products: Whey proteins, Casein, Colostrum, and MicroLactin™. 

Probiotics are typically made by growing bacterial cultures on dairy products. Some strains are weaned off of the dairy and are harvested with only traces of dairy protein (casein) remaining. The growers will not certify these probiotics as non-dairy, dairy free or vegetarian, but tell us that most manufacturers do label their probiotics with these claims. 

 Yet another class of products is considered non-vegan because of the honeybee source: Bee Pollen (collected by, but not made by, bees), Honey, and Royal Jelly. This is an interesting distinction because bees also are essential for pollination and increasing the yields of many fruits, vegetables and nuts eaten by vegans. 

 Some dietary supplements may come from either animal or vegetarian sources. One example is Glucosamine, a structural component of the joints normally extracted from clam shells. While most glucosamine products are from shellfish, there is a vegetarian version that can be combined with MSM to provide the sulfur needed for the body to turn glucosamine hydrochloride into glucosamine sulfate. This vegetarian form is obtained by fermentation. Still, the vast majority of glucosamine supplements on the market use the shellfish-derived form, including the supplement called NAG (N-acetyl glucosamine) that is used for GI health and as an “essential sugar”. 

HA (Hyaluronic acid), used to aid the moisture-holding, cushioning ability of the joints, is often extracted from poultry. There is a vegetarian form, produced by fermentation. 

The digestive enzymes amylase, lipase and protease are found in the animal product called Pancreatin. But there are also plant-derived enzymes. These plant enzymes include amylase, lipase and protease, but they work in a much wider pH range over a longer period of time than Pancreatin enzymes, which work only in the alkaline pH of the intestine. Beginning digestion of fats and carbohydrates in the stomach can improve even good digestion. 

Look for vegetable-derived excipients such as magnesium stearate, stearic acid, rice flour, maltodextrin, etc. The stearates can also be sourced from beef fat, so it pays to check! 

Gelatin has long been the substance that capsules are made from. Originally, all capsules were gelatin caps. Two-piece capsules are normally derived from beef and pork gelatin, whereas the gelatin in softgel capsules is normally exclusively derived from beef gelatin. More recently, Vcaps have become a preferred form. In the past ten years or so there have also been Vcaps® as a vegetarian alternative, made from vegetable cellulose. A newer version, called NP Caps or Vcaps®, is made from non-GMO corn polysaccharides. Some considerations in the choice of which type of capsule to use revolve around the technical differences in filling and storing gelatin versus Vcaps. These differences include different moisture barrier characteristics, different transparency of the capsule, different speeds at which these capsules can be filled on our production line, whether only vegetarian materials are used in the formula, etc. There is a way to fill two-piece vegetarian capsules with liquids, but the resulting product has an air bubble in the capsule and is typically a much lower dose and much more expensive than softgels made from gelatin. So this form has not been fast to catch on. 

One softgel that is available in a vegetarian capsule is Vegetarian E-400. But this form is not yet widely used for other supplements. Most vitamin E softgel caps are primarily made from beef gelatin. There is often hidden gelatin (often from fish) in beta-carotene, lutein, and other oil-based ingredients. Companies should scrupulously ensure that they use only non-gelatin bases for ingredients in their vegetarian/vegan products. It is unknown how aware vegetarian shoppers are of this hidden, tricky issue. Often, these problems apply to carotene or lutein in multiple vitamin formulas, which could get mislabeled as “vegetarian” if a manufacturer does not take the care to pay attention to these important ingredient details. 

Other common names for animal-derived ingredients include Porcine (from pork/pigs), Bovine (beef/cows), and Ovine (lamb/sheep). Consumers can contact the vitamin companies directly to ask about their vegetarian products. Knowledgeable health food store personnel, especially certified nutritionists or vitamin specialists familiar with their inventory, can be very helpful. Often an employee at a store who is a vegetarian will be familiar with the products from that perspective. And please be aware that the availability of vegetarian options is always increasing! 

In many cases, there is no functional difference between differently sourced ingredients; for example, glucosamine or HA. It is only when the actual form of the active constituent is physically/chemically different that a difference in the actions and efficacy of a substance is likely. There may be some differences in efficacy between plant and animal sourced ingredients, as we have seen with plant enzymes having a wider range of action than the same types of animal enzymes. 

Fish oil is far more effective than flax oil in terms of providing the maximum EPA and DHA per serving. Flax oil contains ALA, which is poorly converted into EPA and DHA (5-10% and 2-5%, respectively). 

One good example is melatonin, usually sold as a synthesized ‘nature-identical’ molecule. It can also be extracted from the pineal gland, but considerations of Mad Cow Disease and animal ingredient issues have pretty much sunk that source, which was the original form available. While glandulars may have other, subtle effects on the body, the actual melatonin produced either way is the exact same molecule with identical actions. 

Phosphatidyl Serine (PS) is normally produced from lecithin, with additional sources more rarely available (bovine, egg). Most of the research is on the soy-derived source, so its efficacy should not be in question. In the human body PS is synthesized from phosphatidylcholine; a similar process is used commercially to produce PS.