Arthritis | Diet Supplements | Part 2

leg with knee arthritisIn Part Two of this three part series on arthritis, I am going to briefly discuss some of the more common nutrients and diet supplements that have shown at least some evidence-based benefit for helping support arthritis joint pain relief, especially in people with prediabetes and metabolic syndrome.

In Part One you learned how exercise and food can help alleviate arthritis and joint inflammation. The shiny white cartilage layer on the ends of your bones, as well as the synovial lining that makes joint lubricating fluid, depends on a regular supply of nutrients, vitamins, minerals and movement.

As you know, the foundation for good nutrition starts with eating real food. Start with a healthy prediabetes diet and exercise as discussed in Part One. If your food quality is sometimes lacking, consider using supplements to fill nutrient gaps, to help minimize arthritis and/or decrease the amount of arthritis drugs you may need – Information for you to discuss with your doctor.

Diet supplements to help arthritis inflammation with some evidence-based support

A. Polyphenols – Five common natural polyphenol phytonutrients to support arthritis relief include:

1. Curcumin (turmeric spice)
2. EGCG – epigallocatechin gallate – (green tea)
3. Resveratrol (grapes and grape seed extracts)
4. Nobiletin, naringin and hesperidin (citrus fruits)
5. Genestein (soy)

B. Discussed in Part 3

This one’s a no-brainer.  Pre-diabetics should be taking this whether they have arthritis or not.

C. Discussed in Part 3

A. Polyphenols

I wrote about this large and varied group of plant nutrient compounds in Part One. Many of the polyphenol compounds found in plants (vegetables and fruits) have anti-inflammation properties. Many of these nutrients have been isolated and can be purchased as diet supplements.

I have chosen 5 polyphenol nutrient supplements that have shown some support for healthy joints.  These polyphenol phytonutrients in general are known to influence medical conditions associated with chronic inflammation such as pre-diabetes, type 2 diabetes and rheumatoid arthritis. They have also been shown to affect the formation and action of advanced glycation end products that we often discuss at Nutrientology.

Many of the studies I have cited below were done on joints with rheumatoid arthritis as opposed to the “wear and tear” osteoarthritis I wrote about in Part One. People with rheumatoid arthritis have higher levels of chronic inflammation in their joints than people with wear and tear osteoarthritis.  Rheumatoid arthritis (RA) involves considerable inflammation leading to significant cartilage damage, bone erosions, joint destruction, joint deformity and impaired movement. Some studies mentioned below were done on experimentally caused arthritis in animals. Many polyphenols have shown great potential health benefits in the laboratory. Research into how polyphenols function in the body is continuing to positively grow.

arthritis cartilage damage in knee joint

The polyphenol supplements in the list of supplements for arthritis work by suppressing – or in some way regulating – the body’s “chemical messages” that influence inflammation to an excessive level. It is prolonged unregulated inflammation and oxidative stress over time that plays a part in many medical conditions.

These chemical messages are known as cytokines, and if I were to just even scratch the surface about how the 5 arthritis supplements I have on this list appear to influence cytokines, both of our heads would be spinning. So let’s just say and accept that the supplements on this list generally support joint heath by “influencing cytokines and/or the cells of the immune system that promote inflammation.”

If you are brave enough and want to wade into the world of cytokines and their role in inflammation, I have listed some additional arthritis supplement research studies not referenced in this post.  They can be found at the end of this article  – I warn you, read these abstracts at your own risk, while sitting down, after a good night’s sleep.

1. Curcumin

curcumin supplement from tumeric spiceCurcumin comes from the spice known as tumeric. Most people know this spice as curry. Curcumin has been used as a medicinal nutrient  for hundreds of years. Most of the research into the arthritis benefits of curcumin revolve around its property of anti-inflammation support. Several clinical trials have found that curcumin is safe and effective.

One small clinical study randomly placed 45 rheumatoid arthritis patients into 1 of 3 groups to investigate the safety and efficacy of curcumin for patients with active rheumatoid arthritis:

  • Group 1 – curcumin (500 mg)
  • Group 2 – diclofenac (50 mg) – a prescription anti-inflammatory drug
  • Group 3 – curcumin combined with diclofenac

Patients in all three treatment groups showed statistically significant improvements. However, somewhat surprisingly, the curcumin group showed the highest percentage of improvement, and their improvement was significantly better than the patients taking the prescription drug diclofenac. Curcumin treatment was also found to be safe without any undesirable events.

The authors of this pilot study looking at the potential benefit of curcumin for arthritis support concluded,

Our study provides the first evidence for the safety and superiority of curcumin treatment in patients with active RA, and highlights the need for future large-scale trials to validate these findings in patients with RA and other arthritic conditions.

Another study looked at the anti-inflammatory effects of curcumin on the cells that make up the synovial lining in humans. This study also found some positive benefit to curcumin for the synovial lining supporting its potential use as a natural remedy for the treatment of chronic inflammation like that found in rheumatoid arthritis.

You will remember from Part One that I explained the synovial lining is what makes your joints’ lubricating fluid. You also know that these cells can become inflamed as part of arthritis. Inflamed cells do not function well, and like when your car is not lubricated well, parts wear out faster. Wear and tear problems can develop in your joints when they are not properly lubricated by a healthy synovial lining.

Click here for more information about a Curcumin Supplement at Nutrientology Store

 

cup of green tea 2. EGCG – (Epigallocatechin gallate) – green tea extract

Like curcumin, the green tea extract EGCG has also been shown to influence inflammation producing chemical messages and messengers (cytokines) in a way that decrease inflammation.

EGCG is a polyphenol nutrient found in green tea.  It has shown potent anti-inflammation effects by inhibiting “signaling events and gene expression” – those cytokine chemical messages and messengers at it again. EGCG’s potential use in arthritis appears to be related to its property of minimizing inflammation in cartilage cells.

EGCG may also benefit the synovial lining by suppressing the signals from inflammatory messengers involved in joint inflammation.

And remember in Part One when I wrote about the impact of advanced glycation end products on joint cartilage?  It appears that age-related build-up of advanced glycation end products (AGEs) can instigate your cartilage cells to make proinflammatory cytokines. Some smart researchers have used human cartilage cells from arthritic joints to study the effect of AGEs. Their work suggests that EGCG – or EGCG derived compounds – may slow down cartilage wear and tear by suppressing the ability of AGEs to start the breakdown of cartilage in your joints.

These results suggest that EGCG may have some potential therapeutic value in decreasing joint damage in arthritis. It is  a nutrient supplement with possible potential to slow arthritis wear and tear.

Click here for more information about a Green Tea EGCG Supplement at Nutrientology Store

 

grapes containing resveratrol3. Resveratrol

Resveratrol is a common polyphenol nutrient found in grapes, and therefore in red wine where most people have heard of it.

Resveratrol has natural anti-inflammatory properties and has the potential “to lend a helping hand” with inflammation. It appears to be a useful nutrient for suppressing excessive pro-inflammatory cytokines in medical conditions like arthritis.

Like curcumin and EGCG, resveratrol has also been studied in the context of rheumatoid arthritis. One study was designed to look into the effects of resveratrol on the cytokine inflammation messages that I wrote about above. Research has shown that resveratrol can suppress certain inflammation messages in a dose-dependent manner.

Some researchers have been very positive about a possible role for resveratrol in arthritis claiming,

Resveratrol plays an anti-inflammatory role and might have beneficial effects in preventing and treating RA.

A couple of resveratrol studies I came across looked at the effects on cartilage and synovial joint lining after injections of resveratrol right into the arthritic joints of rabbits.

The resveratrol joint injection group had:

  • Significantly decreased cartilage destruction
  • Less loss of matrix proteoglycan content in the cartilage
  • Less synovial inflammation after injection into the knee joint

This study suggests that joint injections of resveratrol may protect cartilage against the development of experimentally induced arthritis and inflammation. There are no studies like this on humans at this time.

I came across another rabbit study that looked at the effects of resveratrol joint injections. Like the study mentioned above, the joints that were injected with resveratrol showed:

  • Significantly less overall cartilage destruction
  • Less loss of cartilage matrix, but
  • Inflammation of the synovial lining didn’t show any difference between joints that were injected with resveratrol and those that were not injected.

This suggests that joint injections of resveratrol at the early stages of arthritis may help protect joint cartilage against the development of experimentally induced arthritis.  This approach has not been tested in humans.  If you ask your doctor to inject your arthritic joint with resveratrol, he/she will think you’re crazy.  For now, stick with a resveratrol supplement.

Click here for more information about a Resveratrol Supplement at Nutrientology Store

 

orange4. Nobiletin and citrus fruits

Many people associate citrus with vitamin C, but there are many other health benefits of citrus found in its various phytonutrients. Vitamin C plays a role in cartilage health. Your body uses vitamin C to bind collagen molecules together to make them stronger and to function properly.

Nobiliten is another polyphenol phytonutrient that has been shown to benefit bone and joint health.  It belongs to the flavonoid family of polyphenols.

Researchers have studied the cartilage-protection effect of citrus flavonoids, especially nobiletin, using rabbit synovial lining cells and cartilage cells grown in the lab.

The results of their experiments suggest nobiletin is a good anti-inflammatory nutrient for supporting healthy cartilage by:

  • slowing cytokines
  • slowing wear and tear of the cartilage in the joint
  • slowing growth of inflamed tissue in osteoarthritis and rheumatoid arthritis.

Nobiletin seems to be a standout performer among citrus flavonoids as it has shown positive activity in multiple areas, but there are other citrus nutrients that support bone and joint health.  Naringenin and hesperidin are two other citrus flavonoid polyphenols that might be effective for treating human patients with RA.

Citrus flavonoids including nobiletin, naringenin and hesperidin are known to exert many biological actions in the lab. We need more research in humans to see how they behave, and at what dosages they may benefit bones and joints. You can also consider adding a flavonoid supplement, but try to eat some citrus fruit on a regular basis as part of a healthy diet, especially for prediabetics. Nobiletin and naringenin have also shown some positive benefit in support of healthy blood sugar and lipid levels to stop prediabetes-metabolic syndrome.

 

soybeans5. Genistein

Genistein is the major active nutrient in soybean. It has received much attention due to its potential beneficial effects on some of the degenerative diseases such as arthritis. It has been found that,

Genistein has anti-inflammatory, antiangiogenesis, antiproliferative, antioxidant, immunomodulatory, pain relief, and joint protection properties. Hence, significant advances have been made, both by in vitro and in vivo studies showing that genistein is a promising agent for RA treatment.   source

Once again this nutrient has been shown to affect the cells of the immune system that send out the cytokine chemical messages (a so-called “immunomodulatory effect”) and suppress the cytokines’ negative inflammation signalling.

One study looked at genistein, and another flavonoid from soy known as daidzein, on rheumatoid arthritis in rats. Treatment with genistein and daidzein resulted in not only a reduction in disease symptoms, but also a delay in the onset of symptoms, apparently by preventing tissue damage and joint inflammation. Granted, we are not rats, and there’s a long reach before applying this to humans. Time will tell. These researchers have speculated that joints may benefit because genistein’s chemical structure is similar to that of estrogen. Perhaps better for females. If you eat soy, it is advised that you stick with fermented soy foods.

I have listed other genistein arthritis studies below for those of you who have not yet had enough.

Don’t forget about spices!

And lastly, before we leave the polyphenol supplements for arthritis pain, stiffness, inflammation and cartilage damage, we need to think about spices again. You will recall from Part One, I wrote about the fact that many spices are actually polyphenol plant compounds with biologic activity. Many spices have shown an ability to suppress inflammation. Spice up your veggies – get more health and taste ka-bang to stop prediabetes and avoid diabetes with all its potentially devastating complications that can prevent you from living an independent functional life into your senior years!  No nursing home for you.

Go to Part Three of this series on food, exercise, and nutrient supplements for arthritis..

 

*Extra bonus references regarding the use of polyphenol nutrients and diet supplements for arthritis. Proceed at your own risk. Do not read and drive.

Curcumin Arthritis Supplement – Research Abstracts

Inhibition effect of curcumin on TNF-α and MMP-13 expression induced by advanced glycation end products in chondrocytes.

Curcumin protects against collagen-induced arthritis via suppression of BAFF production.

Advances in clinical study of curcumin.

Scientific evidence and rationale for the development of curcumin and resveratrol as nutraceutricals for joint health.

The targets of curcumin.

Curcumin inhibits pro-inflammatory mediators and metalloproteinase-3 production by chondrocytes.

EGCG Arthritis Supplement – Research Abstracts

Epigallocatechin-3-gallate suppresses the global interleukin-1beta-induced inflammatory response in human chondrocytes.

Green tea polyphenol epigallocatechin-3-gallate: inflammation and arthritis. [corrected].

Effects of (-)-epigallocatechin-3-gallate on cyclooxygenase 2, PGE(2), and IL-8 expression induced by IL-1beta in human synovial fibroblasts.

Green tea polyphenol epigallocatechin-3-gallate inhibits advanced glycation end product-induced expression of tumor necrosis factor-alpha and matrix metalloproteinase-13 in human chondrocytes

EGCG significantly decreased AGE-stimulated gene expression and production of TNF alpha and MMP-13 in human chondrocytes.

Epigallocatechin-3-gallate suppresses TNF-alpha -induced production of MMP-1 and -3 in rheumatoid arthritis synovial fibroblasts.

Regulation of interleukin-1beta-induced chemokine production and matrix metalloproteinase 2 activation by epigallocatechin-3-gallate in rheumatoid arthritis synovial fibroblasts.

Resveratrol Arthritis Supplement – Research Abstracts

Resveratrol inhibits TNF-α-induced IL-1β, MMP-3 production in human rheumatoid arthritis fibroblast-like synoviocytes via modulation of PI3kinase/Akt pathway.

Synergistic chondroprotective effects of curcumin and resveratrol in human articular chondrocytes: inhibition of IL-1beta-induced NF-kappaB-mediated inflammation and apoptosis.

Regulation of inflammation signalling by resveratrol in human chondrocytes in vitro.

Nobiletin Arthritis Supplement – Research Abstracts

Nobiletin, a citrus polymethoxy flavonoid, suppresses gene expression and production of aggrecanases-1 and -2 in collagen-induced arthritic mice.

A citrus flavonoid, nobiletin, suppresses production and gene expression of matrix metalloproteinase 9/gelatinase B in rabbit synovial fibroblasts.

Genistein Arthritis Supplement – Research Abstracts

Genistein inhibit cytokines or growth factor-induced proliferation and transformation phenotype in fibroblast-like synoviocytes of rheumatoid arthritis.

Soy protein, genistein, and daidzein improve serum paraoxonase activity and lipid profiles in rheumatoid arthritis in rats.

Genistein modulate immune responses in collagen-induced rheumatoid arthritis model.

Genistein as an anti-inflammatory agent.

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About Robert Creighton

Dr. Creighton is a podiatrist and foot surgeon with over 26 years in podiatric practice treating thousands of patients afflicted with the physiological, physical, and psychological side effects and complications of diabetes and pre-diabetes metabolic syndrome. He believes these disorders present a pressing public health concern that need to be more actively addressed in a multidisciplinary way. Dr. Creighton graduated from what is now the Temple University School of Podiatric Medicine after receiving his undergraduate degree in Biology. He is certified by the American Board of Foot and Ankle Surgery, a member of the American Public Health Association, an American College of Sports Medicine certified personal trainer and a Member of the American Nutrition Association.

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