Historically, older adults slowed down with the passing of the years. Grandmother sitting in a rocker and grandpa with his cane, right? Today, grandmother is more likely to be hitting a yoga class while grandpa plans the holiday ski trip. "Many people in their 40s, 50s and 60s work out, play in a sports league, or take part in running or bike clubs, as well as go on action vacations," said Eileen Sheets, managing director, Bioforce USA. "With this in mind, the idea of preserving joint health is paramount so that activity and lifestyle may be maintained. It used to be only about arthritis, but now joint health is so much more than that: it's about freedom of living life to its fullest."
Seconded Micah Osborne, president, Membrell: "The Baby Boomers are aging, but do not want to look or feel older. They want to maintain their active lifestyle, and who can blame them?"
Indeed, the Baby Boomers have determined they're not going to slow down, despite what may fall to them. "Minor injuries incurred years ago are catching up to Baby Boomers as larger numbers of them march through their 50s and 60s," said Dean Mosca, president, Proprietary Nutritionals Inc. "This group is not used to being sidelined from activities, as demonstrated by the increasing number of knee- and hip-replacement surgeries."
Of course, that doesn't stop the onset of joint degeneration. The National Center for Chronic Disease Prevention and Health Promotion reports 46 million Americans—one in five—have been diagnosed by a health-care professional with arthritis or another rheumatic condition. In fact, the term "arthritis" describes more than 100 different conditions that affect joints and other parts of the body. It is one of the most chronic health problems, and one of the nation's most common causes of disability, limiting the activities of nearly 19 million adults.
The degeneration is exacerbated by the challenge of supplying adequate nutrients for the body to carry out repair and keep the joints health. "Aging also tends to be associated with reduced absorption of nutrients, forcing us to take higher amounts and better forms in order to assure adequate nutrition," noted Neil E. Levin, CCN, DANLA, nutrition education manager, NOW Foods. "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. Stomach acid and digestive enzymes also tend to decline with age, negatively affecting digestion and nutrient absorption."
It's not only the aging population that is putting more attention on nutrition for joint health. There is a movement toward preserving joint function earlier in life. "A significant number of people are leading highly active lives, regularly participating in sports and exercise programs," said David Winston, founder, Herbalist & Alchemist. "This population has a higher risk of bursitis, repetitive motion injuries, and the need for joint replacement."
Mosca concurred, "Many former and current athletes also want to preserve their mobility, and this is an exceptional opportunity for retailers to cross-promote joint-health supplements with their sports-supplements department."
There has also been increased concern about the serious side effects associated with more traditional pharma remedies for arthritis, including non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors. "Research is indicating in the treatment of osteoarthritis (OA), these drugs may be producing short-term benefit, but actually accelerating the progression of the joint destruction and causing more problems down the road," said Michael T. Murray, N.D., director of product development, Natural Factors Nutritional Products Inc. "These drugs can promote joint destruction and inhibit cartilage repair by inhibiting the formation of key compounds in cartilage known as glycosaminoglycans (GAGs). These compounds are responsible for maintaining the proper water content in the cartilage matrix, thereby helping cartilage keep its gel-like nature and shock absorbing qualities. Simply stated, aspirin and other NSAIDs appear to suppress the symptoms, but accelerate the progression of OA. They are designed to fight disease rather than promote health."
On the other side of the equation, the media is reporting on nutritional ingredients with positive research results. "Consumers are paying growing interest to joint-health dietary supplements because the currently available medicines are not a cure for degenerative joint disease, let alone their notorious side effects, costs and inconvenience," said Suhail Ishaq, vice president, BioCell Technology. "Their interest can also be justified due to recent scientific substantiation for the safety and efficacy of various natural joint-health ingredients through research including clinical trials."
The health-care debate is another contributing factor, according to Joseph Villanueva, senior account manager, Hamida Pharma (Botanical Wisdom). He said, "One might consider that the United States government is increasingly looking to supplement our lauded crisis intervention model's techniques and strategies with a preventive lifestyle that is the Euro-centric model of thinking. Consumers are looking to supplements as a cost-effective, affordable, possibly tastier (due to the taste of some functional/power foods) and safer (than the side effects one might incur from pharmaceuticals) way to address their health concerns."
Dissecting the Joint-Health Category
With so many contributing factors, it's no wonder the number of nutritional products, from dietary supplements to beverages to topical rubs, is booming. "The joint-support category has grown dramatically in recent years, forcing retailers to expand their shelf space and creating a large, almost unmanageable category," Levin said. One suggestion he offered, which NOW Foods has implemented in its product line, is to separate the category into two parts: long-term structural support and short-term pain and mobility aids.
In the area of structural support, the highest profile ingredients are likely glucosamine and chondroitin. A 2009 meta-analysis reviewed studies on the effects of the nutraceutical ingredients in addressing joint space width (JSW) in knee OA, reporting long-term (two to three years) daily administration may delay the progression of knee OA, reducing narrowing of joint space width.(1) Similarly, a team from the WHO Collaborating Center for Public Health Aspect of Osteoarticular Disorders, University of Liège, Belgium, noted evidence that glucosamine sulfate and chondroitin sulfate may have a structure-modifying effect and exert small-to-moderate symptomatic efficacy.(2) That research team further reported consumption of glucosamine sulfate may also prevent the need for knee replacement, with positive results seen even five years after discontinuing intervention.(3) And a two-year randomized, double blind, placebo-controlled trial in France found 800 mg/d of chondroitin sulfate significantly reduced JSW loss and improved pain levels.(4)
Hyaluronic acid (HA) is another important component in the cartilage and synovial fluid, and "viscosupplementation"—injecting HA into the joint—has been found to be effective and safe in addressing pain and joint function.(5) Research is still developing regarding the efficacy of oral HA consumption for joint health. A pilot clinical trial found 80 mg/d of Hyal-Joint, from Bioiberica, improved quality of life and reduced pain in subjects with knee OA.(6) Similar results were reported in an eight-week intervention in with patients with knee OA who received 200 mg/d of high-purity HA, as Hyabest(J)™, had a significant reduction in joint pain and stiffness.(7)
Collagen is another important component of joint cartilage; hydrolyzed collagen, also known as collagen hydrolysate (CH), is produced through hydrolysis of collagen extracted from the bones and skin of animals, reducing the peptides down to a smaller molecular weight. Reviews suggest orally administered CH is absorbed in the intestines and accumulates in cartilage, stimulating a statistically significant increase in chondrocyte synthesis of extracellular matrix molecules.(8) A recent randomized, placebo-controlled, double blind study found administering 10 g/d of CH to athletes resulted in statistically significant improvements in joint pain, possibly reducing the risk of joint deterioration in a high-risk group.(9) And Spanish researchers reported in subjects with primary knee OA, 10 g/d CH for six months significantly improved knee joint comfort and the WOMAC pain subscale, with the greatest improvements seen among the patients with the most joint deterioration.(10)
Darren Rude, vice president, NeoCell, commented on the results of studies using collagen, noting "Supplementing with collagen helps to maintain strength and flexibility of joints, ligaments, muscles, tendons and bones, in addition to other benefits."
There are four main types of collagen in the human body; type II collagen is the main one found in cartilage. BioCell Technologies supplies BioCell Collagen II®, a patented ingredient containing a naturally occurring matrix of highly bioavailable collagen type II peptides, depolymerized hyaluronic acid (HA) and chondroitin sulfate from chicken sternum cartilage. "It provides all structural constituents essential for human cartilage matrix, and can help replenish the loss of HA, a major lubricating molecule in the synovial fluid of the joint," Ishaq said. "It supports the joint from multiple angles. It may help regeneration of the cartilage via re-stimulation of senescent chondrocytes under oxidative and inflammatory stresses. It also inhibits hyaluronidase, which normally degrades HA, suggesting BioCell Collagen II may antagonize an important player in chronic joint conditions."
An unpublished pilot clinical trial found BioCell Collagen II reduced pain and improved quality of life parameters in adults with knee OA. Additional studies have also shown the ability of the ingredient to increase the body's levels of HA. Its safety has been affirmed in acute and subchronic tests, which showed BioCell Collagen II was safe, even at levels well above recommended dosage.(11)
Studies have also looked at the efficacy of an undenatured type II collagen ingredient (as UC-II®, from InterHealth Nutraceuticals). In two canine studies, providing arthritic dogs with UC-II alone or in combination with glucosamine and chondroitin sulfate, significantly reduced pain and lameness, with UC-II alone given for 120 days decreasing overall pain by 62 percent.(12,13) Similar results were reported in a study of horses with OA, in which 320 or 480 mg/d of UC-II reduced overall pain by 79 percent and 88 percent, respectively, while increasing mobility and joint flexibility.(14)
These results have been echoed in clinical trials. A human pilot study found 40 mg/d of UC-II significantly reduced pain, morning stiffness and stiffness following periods of rest.(15) A broader double blind study included 52 patients with knee OA, who were randomized to receive 40 mg of UC-II or glucosamine/chondroitin.(16) UC-II reduced WOMAC index scores by 33 percent, compared to a 14-percent reduction on the glucosamine/chondroitin. Further, subjects taking UC-II reported significantly reduced pain when walking, climbing stairs or at rest.
Another specialty ingredient delivering components important to joint health is Natural Eggshell Membrane (NEM®), supplied by Membrell. Osborne explained, "Membrell's JOINTHealth with NEM® is composed of naturally occurring GAGs, including chondroitin and hyaluronic acid, plus collagen and other proteins, which are all nutrients essential for proper joint health and flexibility." Two single-center, open-label pilot clinical studies were conducted to evaluate the safety and efficacy of NEM as a treatment for pain and inflexibility associated with joint and connective tissue disorders.(17) Patients received oral NEM 500 mg/d for four weeks, with general pain as primary outcome; the single-arm pilot trial also examined range of motion (ROM). In the single-arm and double-arm trials, supplementation significantly reduced pain measures at seven days and 30 days. Intervention also increased flexibility and reduced ROM-associated pain. These positive results were echoed in a follow-up, randomized, multicenter, double blind, placebo-controlled study.(18) Supplementation with 500 mg/d of NEM for eight weeks produced a statistically significant reduction in pain and stiffness and trended toward improvement for function and WOMAC scores.
The specialty compound Celadrin® has also attracted great interest for its ability to support joint health and fight inflammation. "Celadrin is an all-natural clinically tested joint-health compound developed through a proprietary process of esterifying oils," Mosca said. "The Celadrin compound represents a matrix of fatty acid carbons, which have been scientifically arranged to achieve maximum efficacy for joint mobility and health. Celadrin systematically enhances and lubricates cell membranes throughout the body, providing youthful cell fluidity and elasticity.
In an initial study, 40 patients with knee OA used a Celadrin cream or placebo for 30 days; assessments included range of motion, "up-and-go" from a chair and stair climbing.(19) Significant decreases in time were seen at 30 minutes after initial treatment and at study's end for stair climbing and up-and-go. The cream also improved knee range of motion and balance. These findings were confirmed in a second study involving 28 individuals with knee, elbow or wrist OA.(20) Use of a topical cream containing Celadrin and menthol, applied twice daily for one week, improved stair climbing and up-and-go ability, and significantly reduced pain.
Studies on oral administration of Celadrin have also reported positive results. A study conducted in 64 patients with chronic knee OA who took Celadrin (350 mg/d) for 68 days showed significant increases in knee flexion and a shift toward functional improvement.(21) In a 2007 unpublished, randomized study, 93 participants experiencing knee pain were given 894 mg/d Celadrin in a crossover, washout study. Participants, who at baseline walked an average distance of 1,183 feet, walked an average distance of 1,720 feet after intervention—an increase of 45 percent from two months earlier.
Studies have also examined the impact of a cetylated fatty acid-creatine compound (as Kre-Celazine®, from All American Pharmaceuticals) in joint health. One recent clinical trial determined the ability of the compound to reduce site-specific chronic joint and muscle-related inflammation and pain.(22) Researchers randomized 35 subjects to receive placebo or test compound for 30 days. At study's end, the subjects receiving the active intervention reported improvements in ankle/foot pain (100-percent response), neck/shoulder/elbow/wrist/hand pain (85 percent) and knee pain (71 percent). Members in this group also experienced a modest increase in mobility. The compound appeared most effective at reducing inflammation/pain in extremities, as well as the neck and shoulder region.
It's not just cetylated fatty acids with a role to play. Not surprisingly, essential fatty acids (EFAs), particularly the omega-3s found in fish oil, appear to exert positive effects in this area. A meta-analysis out of York University, Toronto, examined the effects of omega-3 EFAs in patients with RA and other inflammatory conditions.(23) Supplementation for three to four months reduced joint pain intensity, number of painful and/or tender joints and NSAID consumption. Omega-3s, particularly eicosapentaenoic acid (EPA), may inhibit the formation of inflammatory cytokines and degrading enzymes, including cycloxygenase-2 (COX-2), possibly by balancing the body's ratio of omega-3s to pro-inflammatory arachidonic acid.(24) Research has also shown combining exercise with fish oil supplementation can provide the benefits of physical activity, while also keeping inflammation under control.(25) EPA+DHA from fish oil and glucosamine sulfate work better together than glucosamine sulfate alone.(26)
Nordic Naturals has taken this research a step further in its formulation. "By creating formulas that contain condition-specific nutrients combined with fish oil, Nordic Naturals provides the natural anti-inflammatory effects of EPA and DHA with research-backed ingredients that synergistically promote joint health," said Stuart Tomc, CNHP, national educator, Nordic Naturals. The company's Omega Joint™ includes 1,100 mg EPA and DHA, plus glucosamine sulfate and vitamin D3; its Omega Joint Xtra adds UC-II to the mix to further promote the repair of the connective tissue and cartilage.
Inflammation is also the target of systemic enzyme products, which work within the body to break down certain proteins that can stimulate inflammation.(27) Mike Smith, vice president, Specialty Enzymes, noted, "Systemic protease enzymes have been used as anti-inflammatory supplements for more than 50 years. Much of the original research was conducted on bromelain, the protease enzyme from pineapple. Today, many protease enzymes are used, including those from plant, animal, fungal and bacterial sources."
An open study conducted in Pakistan investigated the efficacy and safety of a combination of rutosid, bromelain and trypsin in patients with knee OA (n=103).(28) Enzyme therapy improved functionality and decreased pain at rest and on motion. German researchers also found a specialty enzyme therapy decreased pain and stiffness measures in patients with hip OA with a high pain level.(29) Similar results were reported in a study from India using systemic enzymes, in which patients with knee OA had reduced pain and joint tenderness and swelling after taking the enzyme therapy for three weeks.(30)
One of the best-known systemic enzyme formulations is Wobenzym®, available at retail through Garden of Life. "Wobenzym has been extensively studied clinically, and has been shown in multiple large-scale human studies to support the body's natural inflammation response," explained Dawn Jarvis, director of product support and education, Garden of Life. "Wobenzym N has been shown to increase flexibility and mobility, and support joint and tendon health and given temporary relief from aches, pains and muscle soreness due to everyday activity. The enzyme blend in Wobenzym N contains clinically studied enzymes: pancreatin, papain, bromelain, trypsin and chymotrypsin."
Several different botanicals also exert anti-inflammatory activity. "Many botanicals have been traditionally used and scientifically validated to support inflammatory pathways in the body," said Keri Marshall, N.D., medical director, Gaia Herbs.
Turmeric yields the well-researched compound curcumin, which has been found to reduce pain levels in adults with knee OA as well as NSAIDs.(31) Another Indian botanical, boswellia, also reduces joint pain and may inhibit the activity of 5-lipoyxgenase (5-LOX).(32,33) One study on a standardized boswellia extract (5-Loxin®, from PL Thomas) found the botanical could significantly improve pain scores and physical function scores in a dose-dependent manner after seven days.(34) Ginger (Zingiber officinale) has also been traditionally used as an anti-inflammatory in Chinese and Ayurvedic medicine, and extracts using the whole herb appear to not only fight inflammation, but also protect the joints.(35)
Marshall said Gaia Herbs offers several Liquid Phyto-Caps™ products that contain single herbs and multi-herb combinations that support joint health, including Turmeric Supreme, Ginger Supreme, Joint Health and Infla-Profen. The company uses its Full Spectrum Processing technology and patented Liquid Phyto-Caps delivery system to optimize its herbal products. "The Liquid Phyto-Caps technology delivers a concentrated liquid extract, prepared from certified organic and ecologically wild-crafted herbs, in a vegetarian capsule," she said. "One Liquid Phyto-Cap equals as much as 75 drops of a Gaia Herbs Liquid Extract. And Gaia Herbs routinely extracts and concentrates its products to liquid extract strength, which is 2.5 to 5 times more concentrated than a tincture. We also use our Full Spectrum Processing technology to ensure the entirety of the plant's unique phytochemical makeup is left intact, as nature intended."
Membrell’s JOINThealth™ features NEM® (Natural Eggshell Membrane) which is clinically proven to improve joint comfort and flexibility in just 10 days with just ONE capsule per day. Please visit www.membrell.com for more information on Membrell products.
By combining the best of nature and science, Garden of Life has and always will formulate and market nutritional products that are able to deliver our mission of empowering extraordinary health. For more information www.GardenofLife.com.
Celadrin® is a natural ingredient for joint health made from a proprietary blend of special fatty acids. Several clinical studies – two of them published in the Journal of Rheumatology – have show Celadrin’s effectiveness in reducing inflammation and pain. Visit www.celadrininfo.com.
BioCell Collagen II is a branded ingredient that supports both healthier joints and younger looking skin. Human studies showed its clinical efficacy in improving joint mobility and remarkably elevated bioavailability of HA; essential for the health of both joints and skin. www.biocelltechnology.com
The unique, bioavailable curcumin BCM-95® forms the basis for several products from EuroPharma, which Cheryl Myers explained were developed to enhanced joint strength, flexibility and comfort. "The turmeric root for BCM-95 is sustainably grown and harvested using eco-friendly methods in India," she said. "It is then extracted, micronized and mixed with turmeric oils. The resulting product is up to 10 times more bioavailable than regular turmeric extracts." The foundation product in EuroPharma's line is Curamin®, a natural anti-inflammatory pain relief formula, which combines BCM-95 with a specialized boswellia extract known as BosPure.
Herbalist & Alchemist also offers several formulas and extracts that can be used for addressing joint and muscle discomfort. For example, Winston said the Muscle/Joint Tonic includes several herbs such as turmeric, ginger, devil's claw and sarsaparilla traditionally used for systemic anti-inflammatory activity. "These herbs reduce inflammation and inhibit histamine release and the production of inflammatory prostaglandins," he said. "By using different plants with differing modes of action, this unique formula produces a synergistic effect on the body." Additional offerings include Fitness Formula, containing anti-inflammatory botanicals and nutritive tonics; Aspirea compound, an herbal analgesic; and compound arnica oil, a topical preparation that addresses nerve and muscle pain.
Arnica also forms the basis of a product from Bioforce, although the company's Arnica Rub is an herbal solution—not a homeopathic one—made with an extract of fresh, organically grown Arnica Montana. "The active ingredients in arnica have been demonstrated to exert significant anti-inflammatory activity, which may be useful for helping to reduce edema," Sheets said. "Arnica inhibits the way that NF-kB works in the body, which can be compared to a switch that gets turned 'on' at the very beginning of the inflammatory cascade; by inactivating NF-kB, the inflammatory process can be stopped at the very beginning." In fact, a recent study found Arnica Rub was as effective as ibuprofen gel in relieving stiffness and pain associated with OA of the fingers.(36) A previous study found Arnica Rub could reduce pain and stiffness in OA of the knee.(37)
Companies are not only blending botanicals together, but combining well-researched ingredients for joint support across the board. Natural Factors, for example, recently launched a medicinal food powdered drink mix called RevitalX Whole Body Rejuvenation Formula. "This formula is a rich source of specialized nutritional agents, vitamins, minerals, amino acids, enzymes, antioxidants and probiotics that work together to provide maximum nutritional support during times of need and promote overall comfort in the body," Murray said. It incorporates the branded ingredient MicroLatcin™ (from Humanetics), a milk protein concentrate (MPC), comprising unique antibodies and other bioactive nutrients. In two clinical trials, MicroLactin significantly improved pain, stiffness and total disease scores in OA patients.(38,39)
NOW Foods also developed a range of combination products, both in the structural support area and to address joint pain. Levin said Joint Support™ and Extra Strength Glucosamine/Chondroitin are two of the popular choices in the joint-support category; hot offerings in the pain/mobility arena are Ache Action™ with Decursinol and Aquamin®, D-Flame™ COX-2 and 5-LOX enzyme inhibitor, Flex Mobility™ Vcaps or Liquid with Flavanflex™ and Regenasure® vegetarian glucosamine and Serrazimes® for systemic enzymatic effects.
Botanical Wisdom also offers combination products in the joint-health category, some of which are quite unique. Villanueva particularly called out Gouty Arthricare, which is formulated to help reduce uric acid levels in the blood. He said, "It helps relieve the pain of joints and muscles and increase the mobility of the affected body parts through its anti-inflammatory activities and mood-enhancement properties."
Effective Retail Promotion
As noted earlier, there are many reasons consumers are looking for natural joint support products, which bodes well for retail sales. "There is a tremendous interest from retailers in safe and effective anti-inflammatory and analgesic products," Winston said. "The good news is that most people going into the health food store already have a diagnosis from a physician. They already know they have a slight tear of the rotator cuff or they have OA or bursitis. Retailers can point out in books and the scientific literature the many herbs that have now been studied and found to provide effective and safe relief from pain and inflammation."
Myers agreed many consumers know what joint-health issues they're looking to address. "In fact, they may have already tried over-the-counter and prescription drugs for their condition, and are now seeking a natural intervention because of the severe adverse effects these drugs cause, and/or because they are not getting the relief they seek," she said.
However, it is still important for retailers to ensure they're not stepping out of bounds when discussing possible products. "Retailers can take the angle of preserving joint health for maintaining activity, and be very safe," Sheets said. "A retailer can talk about promoting a healthy inflammatory response and customers will get it. When customers ask specifically about arthritis, retailers can and should advise them to work directly with their physician for correct diagnosis."
Retailers can also discuss the science behind particular ingredients. "In many instances, store managers at the retail level are taking the initiative to learn more about the products that they sell and the ingredients that are in them," Ishaq said. "They are inquisitive and ask important questions, often directly to the ingredient supplier, making them more aware of the differences between the ingredients that are available."
Many companies also offer educational training to retailers to help further elucidate differences among ingredients and products. "Many companies spend a considerable amount of time educating their sales team about the quality and efficacy of their products so that they can relay this level of confidence to retailers who can, in turn, confidently discuss the pros and cons of various products," Marshall said.
Other companies are offering educational seminars, Webinars or whole programs discussing health issues. EuroPharma, for example, sponsors an educational Webinar series that is archived for easy access, while the A. Vogel Institute offers a 12-module certificate program—including a full module on the musculoskeletal system—that can be completed online. "This course is designed mainly for health food store and pharmacy personnel, as the course will give those who lack a science background the knowledge to better advise their customers," Sheets said.
Ultimately, it falls to the retailer to help customers navigate the research and find efficacious products that will address their needs. "Bone and joint are 'everyday' categories, and each retailer knows they have to have it on their shelves," said Chris Haynes, director of sales, Membrell. "These categories have a long history of sales and retailers have a very keen understanding of how far they are willing and able to go to help the consumer pick a product that is best for their specific conditions." And, helping them find that right product could have everyone stepping out in style.
1. Lee YH et al. "Effect of glucosamine or chondroitin sulfate on the osteoarthritis progression: a meta-analysis." Rheumatol Int. 2009 Jun 21. [Epub ahead of print]
2. Bruyere O, Reginster JY. "Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis." Drugs Aging. 2007;24(7):573-80.
3. Bruyere O et al. "Total joint replacement after glucosamine sulphate treatment in knee osteoarthritis: results of a mean 8-year observation of patients from two previous 3-year, randomised, placebo-controlled trials." Osteoarthritis Cartilage. 2008 Feb;16(2):254-60. Epub 2007 Jul 27.
4. Kahan A et al. "Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: the study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo-controlled trial." Arthritis Rheum. 2009 Feb;60(2):524-33.
5. Bellamy N et al. "Viscosupplementation for the treatment of osteoarthritis of the knee." Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005321.
6. Kalman DS et al. "Effect of a natural extract of chicken combs with a high content of hyaluronic acid (Hyal-Joint) on pain relief and quality of life in subjects with knee osteoarthritis: a pilot randomized double-blind placebo-controlled trial." Nutr J. 2008 Jan 21;7:3.
7. Sato T, Iwaso H. "An effectiveness study of hyaluronic acid [Hyabest®(J)] in the treatment of osteoarthritis of the knee on the patients in the United States." J New Rem Clin. 2009;58(3).
8. Bello AE, Oesser S. "Collagen hydrolysate for the treatment of osteoarthritis and other joint disorders: a review of the literature." Curr Med Res Opin. 2006 Nov;22(11):2221-32.
9. Clark KL et al. "24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain." Curr Med Res Opin. 2008 May;24(5):1485-96. Epub 2008 Apr 15.
10. Benito-Ruiz P et al. "A randomized controlled trial on the efficacy and safety of a food ingredient, collagen hydrolysate, for improving joint comfort." Int J Food Sci Nutr. 2009;60 Suppl 2:99-113. Epub 2009 Feb 11.
11. Schauss AG et al. "Acute and subchronic oral toxicity studies in rats of a hydrolyzed chicken sternal collagen preparation." Food Chem Toxicol. 2007;45(2):315-21.
12. Deparle LA et al. "Efficacy and safety of glycosylated undenatured type-II collagen (UC-II) in therapy of arthritic dogs." J Vet Pharmacol Therap. 2005;28:385-90.
13. D'Altilio M et al. "Therapeutic efficacy and safety of undenatured type II collage singly or in combination with glucosamine and chondroitin in arthritic dogs." Toxicol Mech Methods. 2007;17:189-96.
14. Gupta RC et al. "Therapeutic efficacy of undenatured type-II collagen (UC-II) in comparison to glucosamine and chondroitin in arthritic horses." J Vet Pharmacol. ePub April 26, 2009. DOI: 10.1111/j.1365-2885.2009.01079.x
15. Bagchi D et al. "Effects of orally administered undenatured type II collagen against arthritic inflammatory diseases: a mechanistic exploration." Int J Clin Pharm Res. 2002;22:101-10.
16. Bagchi M, Lau FC, Bagchi D. "Beneficial effects of oral administration of undenatured type II collagen on osteoarthritis: a human clinical trial." Presented at: J Am Coll Nutr 49th Annual Meeting; Oct. 2008; Abstract No. 30.
17. Ruff KJ et al. "Eggshell membrane: A possible new natural therapeutic for joint and connective tissue disorders. Results from two open-label human clinical studies." Clin Intervention Aging. 2009;4:235-40.
18. Ruff KJ et al. "Eggshell membrane in the treatment of pain and stiffness from osteoarthritis of the knee: a randomized, multicenter, double-blind, placebo-controlled clinical study." Clin Rheumatol. 2009;28:907-14.
19. Kraemer WJ et al. "Effect of a cetylated fatty acid topical cream on functional mobility and quality of life of patients with osteoarthritis." J Rheumatol. 2004;37:767-74.
20. Kraemer WJ et al. "A cetylated fatty acid topical cream with menthol reduces pain and improves functional performance in individuals with arthritis." J Strength Cond Res. 2005 May;19(2):475-80.
21. Hesslink R et al. "Cetylated fatty acids improve knee function in patients with osteoarthritis." J Rheumatol. 2002;29:1708-12.
22. Golini J et al. "A single-center, double-blind placebo-controlled study to evaluate the efficacy of Kre-Celazine®, an oral buffered creatine-cetylated fatty acid compound, in its ability to reduce site-specific inflammation and pain." JANA. 2009;12(1):20-25.
23. Goldberg RJ, Katz J. "A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain." Pain. 2007 May;129(1-2):210-23. Epub 2007 Mar 1.
24. Adam O. "Dietary fatty acids and immune reactions in synovial tissue." Eur J Med Res. 2003 Aug 20;8(8):381-7.
25. Calder PC. "Polyunsaturated fatty acids and inflammation." Prostaglandin Leukot Essent Fatty Acids. 2006 Sep;75(3):197-202.
26. Gruenwald J et al. "Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis." Adv Ther. 2009 Sep;26(9):858-71. Epub 2009 Sep 4.
27. Nouza K. "Outlooks of systemic enzyme therapy in rheumatoid arthritis and other immunopathological diseases." Acta Univ Carol [Med] (Praha). 1994;40(1-4):101-4.
28. Akhtar NM et al. "Oral enzyme combination versus diclofenac in the treatment of osteoarthritis of the knee--a double-blind prospective randomized study." Clin Rheumatol. 2004 Oct;23(5):410-5.
29. Klein G et al. "Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs." Clin Exp Rheumatol. 2006 Jan-Feb;24(1):25-30.
30. Tilwe GH et al. "Efficacy and tolerability of oral enzyme therapy as compared to diclofenac in active osteoarthrosis of knee joint: an open randomized controlled clinical trial." J Assoc Physicians India. 2001 Jun;49:617-21.
31. Kuptniratsaikul V et al. "Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis." J Altern Complement Med. 2009 Aug;15(8):891-7.
32. Reichling J et al. "Dietary support with Boswellia resin in canine inflammatory joint and spinal disease." Schweiz Arch Tierheilkd. 2004 Feb;146(2):71-9.
33. Ammon HP. "Boswellic acids in chronic inflammatory diseases." Planta Med. 2006 Oct;72(12):1100-16.
34. Sengupta K et al. "A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee." Arthritis Res Ther. 2008;10(4):R85. Epub 2008 Jul 30.
35. Funk JL et al. "Comparative effects of two gingerol-containing Zingiber officinale extracts on experimental rheumatoid arthritis." J Nat Prod. 2009 Mar 27;72(3):403-7.
36. Widrig R et al. "Choosing between NSAID and arnica for topical treatment of hand osteoarthritis in a randomised, double-blind study." Rheumatol Int. 2007;27:585-91.
37. Knuesel O, Weber M, Suter A. "Arnica montana gel in osteoarthritis of the knee: an open, multicenter clinical trial." Adv Ther. 2002 Sep-Oct;19(5):209-18.
38. Zenk JL, Helmer TR, Kuskowski MA. "The effects of milk protein concentrate on the symptoms of osteoarthritis in adults: An exploratory, randomized, double-blind, placebo-controlled trial." Curr Ther Res. 2002;63(7).
39. Colker CM et al. "Effects of a milk-based bioactive micronutrient beverage on pain symptoms and activity of adults with osteoarthritis: A double-blind, placebo-controlled, clinical evaluation." Nutrition. 2002;18:388-92.
To take the exam for this course, please make sure you have the course in your
nutrilearn.com profile. If you need to add the course to your profile
click
here and complete the checkout process.
If you already have the course in your profile and are ready to take the test,
click here
or visit your profile once you are logged in to the nutrilearn system. Note: To access the
available courses in your profile, click on the "courses" link at
the top of the page once you are logged in.
