All of our joints have a protective layer of cartilage covering the end of each bone. This thins in arthritis and becomes pitted, or wears out completely, allowing the bones to rub together. This is the main cause of pain and inflammation.

But what causes this process to happen in some and not others?

Recent research makes it very clear that joint degeneration as seen in arthritis is actually a metabolic disorder – an extension of ‘metabolic syndrome’ the driving force behind diabetes, heart disease, obesity and Alzheimer’s. This shift in thinking was made clear in an excellent review article in Nature headed ‘The Role of Metabolism

Metabolism

Metabolism is a term that is used to describe the chemical reactions that take place within the body’s cells. The body gets the energy it… in the Pathogenesis of Osteoarthritis’¹. This means that many of the very same things I’ve been recommending for other metabolic diseases are going to help recover your joint health.

Conventional treatment ignores these causes and concentrates on treating the pain with over-the-counter painkillers and anti-inflammatories. Steroid injections are not a cure, although they can bring relief for several months.

Over 150,000 people have knee and hip replacements in the UK each year when the pain becomes too unbearable. Most take Non Steroid AntiInflammatory Drugs (NSAIDs) but do they work? A review of 23 trials, including one involving 10,845 patients with arthritic knee pain, concludes: ‘NSAIDs can reduce short term pain in osteoarthritis of the knee slightly better than placebo, but the current analysis does not support long term use of NSAIDs for this condition. As serious adverse effects are associated with oral NSAIDs, only limited use can be recommended.’

What’s particularly significant about this review is that it is the only trial that looked at the long-term effects of NSAIDs versus placebo on pain, and it showed ‘no significant effect of NSAIDs compared with placebo at one to four years’.² Obviously, when you are in pain you have to have something to reduce it, so what other options do you have?

Keep your cartilage healthy too

There are two sides to bone and joint health. The first is keeping bone and the cartilage that surrounds it strong and healthy, and the second is reducing the inflammation, which is the primary cause of the cartilage destruction that makes joints painful.

Collagen

Cartilage is made up from collagen, which comes from vitamin C

What it does:

Strengthens immune system – fights infections. Makes collagen, keeping bones, skin and joints firm and strong.

Antioxidant, detoxifying pollutants and protecting against… and a sugar protein

Proteins

Proteins are large molecules consisting of chains of amino acids. Proteins are essential nutrients for the human body – they are a building block of… compound called proteoglycans that is made from glucosamine. The only dietary source of glucosamine is prawn or shrimp shells, although crunching them up is not to everybody’s taste!

Glucosamine

Glucosamine is a basic building material of your joints, while the mineral sulphur acts like the nails that hold it together. Everyone knows about the link between glucosamine and healthy joints, although you’d do better with the more absorbable form, which is glucosamine hydrochloride. The best source of sulphur, found in onions, garlic and eggs, is MSM (see below). The combination of glucosamine hydrochloride and MSM has proven particularly effective.³

Does glucosamine work?

The popularity of glucosamine for joints dates to a 2001 study published in the Lancet, where Belgian investigators reported that it actually slowed the progression of osteoarthritis of the knee⁴ while the knees of the patients taking the placebo steadily worsened. In another study, 1,500mg of glucosamine sulphate daily reduced knee pain as effectively as 1,200mg of ibuprofen and was better tolerated.⁵ It’s also been shown to be as good as NSAID painkillers for easing arthritic pain and inflammation, with less irritation to the stomach.

Not all studies have been positive, however. A placebo-controlled trial with 1,500mg a day for six months, given for back pain, found no benefit⁶ Recently, a combination of trials that involved a total of 3,800 patients found that neither glucosamine nor a type called chondroitin alone or together reduced joint pain or affected the narrowing of joint space. The authors recommended that neither product should be paid for on the NHS.⁷

Nevertheless, glucosamine may work better in combination with other anti-inflammatories, such as omega-3 fish oils for hip or knee osteoarthritis.⁸ Almost half (44 per cent) of those on the combination had a greater than 80 per cent reduction in pain, compared to (32 per cent) taking glucosamine alone. Another trial found taking it with MSM was significantly more effective than glucosamine alone.⁹

MSM – a good source of sulphur

Methylsulfonylmethane (MSM) is a source of the essential mineral sulphur that is involved in a multitude of key body functions, including pain control, detoxification and tissue building. Extraordinary results have been reported for pain relief from arthritis.¹⁰ Patients taking 2,250mg a day had an 80 per cent improvement in pain within six weeks, compared with 20 per cent for those who had taken dummy pills.¹¹ It’s available both as a balm and in capsules. The therapeutic dose appears to be 1,500–3,000mg a day. Some people experience a worsening of symptoms in the first ten days, followed by an improvement.

B vitamins – the neglected arthritis treatment

Much less familiar than MSM and glucosamine are the B vitamins – a key element in the process of ageing. Inflammation is the root of the problem with arthritis, and inflammation is one of the symptoms found with ‘inner global warming’ which is linked to high levels of homocysteine

Homocysteine

Homocysteine is an amino acid found in the blood. Elevated levels of homocysteine have been associated with narrowing and hardening of the arteries, an increased…. These excessive levels promote the release of pro-inflammatory agents in the body.¹²

What is more, people with osteoarthritis often have other disorders marked by excess inflammation, such as diabetes, heart disease, hypertension

Hypertension is more commonly known as high blood pressure…., insulin

Insulin is a hormone made by the pancreas. It is responsible for making the body’s cells absorb glucose (sugar) from the blood…. resistance and excess weight.

Homocysteine levels are frequently found to be much higher in rheumatoid arthritis sufferers¹³ as well as those with ankylosing spondylitis, an inflammatory arthritic disease of the spine.¹⁴

Since rheumatoid arthritis is a ‘systemic’ disease – where the whole body’s chemistry is out of balance and many tissues and organs other than the joints are affected – one would suspect that homocysteine plays a leading role. And it does. Research from the Department of Biochemistry at the University Hospital in Madrid, Spain, examined the homocysteine scores of women with rheumatoid arthritis versus those without. There was a massive difference. The average homocysteine score for those with rheumatoid arthritis was a sky-high 17.3, compared to 7.6 for those without!¹⁵

Homocysteine is thought to directly damage joints¹⁶ and other tissues. All of this suggests that reducing homocysteine may well help to keep your bones and joints healthy. Yet, disappointingly, very little research has yet been done to test the homocysteine theory of arthritis. A rare exception was a study nearly 20 years ago by researchers at the American College of Nutrition in Clearwater, Florida. They gave B12 and folate supplements to 26 people who had been taking non-steroidal anti-inflammatory, pain-relieving drugs (NSAIDs) for osteoarthritis of the hands for an average of more than five years.¹⁷ The participants reported less tenderness in their hands and improved ability to grip objects but suffered none of the notorious NSAIDs side effects, which include premature death from kidney failure, ulcers and bleeding in the digestive tract.

Vitamin B12

As many as two in five people aged over 60 are B12 deficient, and supplementing 500mcg a day at least is needed to correct it. Although fish, meat, eggs and milk all contain B12, only milk and fish increase blood B12 levels. Even so, you are unlikely to get more than 3mcg of B12 from your food. To prevent a deficiency I recommend taking 10mcg a day. But even that is not enough if you have a raised homocysteine level.

Vitamin B6

Vitamin B6, another homocysteine-lowering vitamin, has also proven helpful for arthritis sufferers. Back in the 1950s, an insightful physician from Mount Pleasant in Texas, Dr John Ellis, found that giving B6 in higher daily doses of 50mg helped to control pain and restore joint mobility in his arthritic patients.¹⁸ Vitamin B6 shrinks inflamed membranes that line the weight-bearing surfaces of the joints, perhaps by helping decrease homocysteine and increasing SAMe and glutathione, both proven anti-inflammatory agents. B6 also helps to regulate production of the prostaglandins, the body’s own anti-inflammatory agents.

Case Study: Ed

Ed had always kept himself fit, by playing tennis and running, but he started to experience joint pain in his mid thirties and had operations on both knees to repair damage to the cartilage. By his mid forties he was suffering from severe arthritis, with ever-increasing pain, and he started taking a variety of anti-inflammatory drugs. But his knees just got worse, giving him excruciating pain after playing golf, his favourite leisure pursuit.

When I met him he was aged 57 and could barely walk without pain, let alone pursue his passion for golf. I told him to read and follow my book, Say No to Arthritis, and gave him a list of supplements to take; this included 1.5g of glucosamine, essential fats, high-dose niacinamide (500mg) and pantothenic acid (1,000mg), 3g of vitamin C, 250mg (400iu) of vitamin EWhat it does: Acts as an antioxidant, protecting cells from damage, including against cancer. Helps body use oxygen, preventing blood clots, thrombosis, atherosclerosis. Improves wound… and a high-potency multivitamin.

He followed the diet and took the supplements religiously every day.

Although there was little improvement in the first two months, by the third month his knees were feeling better.

By six months he was virtually pain-free.

‘I would never have believed my pain could be reduced by such a large degree, and not return, no matter how much activity I do in a day or week.’

Five years on, Ed remains 95 per cent pain-free and has had no return or worsening of his symptoms – and he needs no medication. He regularly plays golf.

I’ve switched him over to a daily nutrition supplement pack, which contains

• vitamins C and E,
• omega-3 and 6 oils,
• antioxidants and
• B vitamins.
• I am also giving him 1,500mg glucosamine hydrochloride with MSM
• and a combination of the herbs boswellia,
• hop extract
• and olive pulp extract, which is a superb antioxidant

Antioxidants

Antioxidants are substances that protect cells within the body from damage caused by free radicals. They help to strengthen the body’s ability to fight infection…. I find these to be the most effective remedies for promoting comfortable joints, together with a healthy diet, low in meat and dairy produce, and high in fish, flax seeds, fruit and vegetables. Ed is living proof that the body can heal itself if you give it the right nutrients.

Oil your joints with omega-3s

Omega-3 fish oils are one of the most potent natural anti-inflammatories, because they turn into type-3 prostaglandins, which switch off pain and swelling. There have been lots of positive studies proving benefit. A meta-analysis of 17 randomised, controlled trials assessing the pain-relieving effects of omega-3s in patients with rheumatoid arthritis or joint pain concluded, ‘Supplementation with omega-3 PUFAs for 3–4 months reduces joint pain intensity by 26 per cent, the number of minutes of morning stiffness by 43 per cent, the number of painful and/or tender joints by 29 per cent, and NSAID consumption by 40 per cent.’¹⁹

I recommend both eating oily fish and supplementing omega-3 fish oils daily

Test and eliminate food intolerances

An extremely common cause of inflammation is eating foods you are unknowingly intolerant to. This is a very individual thing. But now it is possible to accurately test which foods are causing your immune symptom to react, triggering release of IgG antibodies, which in turn promote inflammation. Yorktest.com offer a hometest kit that enables you to test over a hundred foods to see how by our immune system reacts. Three out of four people who then avoid reactive foods notice a definite health improvement. If you have any kind of joint pain I recommend you become one of them. If you are a 100% Health Member you get £50 off any Yorktest test at holforddirect.com.

Stay trim and keep your body moving

If the cartilage in the joints degenerates, the joints become painful when you move. Two major causes of cartilage degeneration are too much weight on the joints and poor postural alignment. Being overweight doesn’t just stress the joints it also switches the body into an inflammatory state. So, losing weight helps ease pressure on the joints and switches off the inflammatory process.

Joints need space to move and that’s why exercises that strengthen and stretch them are so important. Exercises need to aim for mobility in the back as well as the joints. Most people don’t do these on a regular basis, however, and then suffer the consequences as they get older. That is why one of the hallmarks of unhealthy ageing is losing flexibility. Building regular – and preferably daily – joint-stretching exercises is a vital part of keeping your joints healthy.

If you have arthritis in your knees, you need to strengthen your quadriceps – the main thigh muscles. You’d be better doing it with some non-weight-bearing exercise such as cycling or swimming, but don’t make the joint pain worse. One point to remember is that if you are on cholesterol-lowering statin drugs and your muscles feel weak and painful you are advised to take a supplement of CoQ10. Statins block this essential enzyme, which is needed for energy production.

Yoga is excellent for both joint stretching and strength. You need to find a good teacher, but that shouldn’t be hard, and it’s important to join a beginner’s or mixed-ability class if you’re new to yoga. The teacher will advise you on how to tailor the postures the best way for you. Yoga, and also Pilates, are both good for flexibility and building strength, but the critical thing is finding something you enjoy and then doing it regularly.

Nature’s painkillers

Natural foods are full of potent anti-inflammatories, and our top six favourites are turmeric, containing curcumin; olives, rich in hydroxytyrosol ²⁰, onions (especially red) for their quercetin; and also lots of omega-3 fish oils. Eating an onion a day is associated with a 5 per cent increase in bone mass.²¹ Turmeric, the yellow spice in curry, has anti-cancer²² and anti-inflammatory properties.²³ Quercetin, found richly in red onions and cranberries, appears to be anti-allergenic and anti-inflammatory,²⁴ although there’s a need for clinical trials.

The best research I’ve seen relates to a highly absorbent form of curcumin in Theracurmin, derived from turmeric. This is my preferred form of curcumin, available from www.HOLFORDirect.com. It was tested in a randomised double-blind controlled trial – the gold standard – giving placebo or Theracurmin (three capsules) to 50 people with knee osteoarthritis. The Theracurmin, not the placebo, significantly lowered knee pain and use of painkiller medication. This was published in the Journal of Orthopedic Science.²⁵ A study in 2017²⁶ gave 25 people with osteoarthritis Theracurmin with or without exercise, taking three capsules a day. Those in Theracurmin plus exercise group performed aerobic training/walking for 30 minutes and weight training for increasing leg muscular strength. Both groups improved the number of steps, muscle mass, range of motion of knee, and the muscle strength in flexion and extension, and also reduced weight. Although the difference was not significant there was a trend to more improvement in the exercise plus Theracurmin group.

Of course, you can, and should, eat as many of these as possible, but the real magic, if you are suffering from joint pain, comes when you supplement concentrates of these together. Nutritional therapists give 500mg of quercetin (the equivalent of 20 red onions). The combination of glucosamine, MSM and omega-3s, together with other natural anti-inflammatories, is a winning formula if you suffer from joint aches and pains. My Glucosamine Support supplement provides five of them – glucosamine hydrochloride, MSM, hop extract, quercetin and turmeric extract.

When you put all these factors together, miracles can happen, as in the case of Ruth:

Case Study: Ruth, 77

I had osteoarthritis most of my life. When I was 45, I was diagnosed with rheumatoid arthritis. I was going downhill. In fact my fingers were clawed. I really had to bend them open in the morning, like little twigs breaking. Then I heard about Patrick Holford, and I went to the Institute for Optimum Nutrition where I learnt about diet. I changed my whole diet and lifestyle, and started taking supplements. Everything got better very quickly and, after a few years, I was so much better. I am now 77 and I feel absolutely super – no pain of any description, all due to diet, supplements and a positive mental attitude.

Summary: To keep your bones and your joints young:

• Eat more nuts, seeds and beans – high in bone-friendly minerals.
• Eat oily fish (salmon, mackerel, herring, sardines) at least three times a week for extra omega-3 and vitamin DWhat it does: Helps maintain strong and healthy bones by retaining calcium. Deficiency Signs: Joint pain or stiffness, backache, tooth decay, muscle cramps, hair loss…..
• Test and eliminate food intolerances.
• Exercise every day, including some weight-bearing, joint-stretching, back-strengthening and muscle-building exercises
• Make an effort to lose weight if you are overweight eating a low GL diet

In terms of supplements:

• Check your homocysteine level. If it is high (above 9mcmol/l) supplement high-dose B6, B12 and folic acidWhat it does: Critical during pregnancy for the development of a baby’s brain and nerves. Also essential for brain and nerve function. Needed for utilising… (eg Connect Formula)
• Check your Vitamin D level – The charity Food for the Brain now offer a Vitamin D home testing kit.
• Take a twice-daily multivitamin–mineral that provides at least 15mcg of vitamin D, 40mcg of vitamin KWhat it does: Blood clotting. Deficiency Signs: Symptoms include those of a purpuric syndrome, i.e., ecchymosis, petechiae, bruising, abdominal pain, risk of massive bleeding, cartilage…, 100–400mg of calciumWhat it does: Promotes a healthy heart, clots blood, promotes healthy nerves, contracts muscles, improves skin, bone and dental health, relieves aching muscles and bones,…, 150mg of magnesiumWhat it does: Strengthens bones and teeth, promotes healthy muscles by helping them to relax, also important for PMS, important for heart muscles and nervous… and 1mg of boron; plus 1,000mg of vitamin C and an omega-3 supplement twice a day. All these are available separately at HOLFORDirect or combined in blister strips in my Optimum Nutrition pack and 100% Health Pack
• Take Theracurmin one to three times a day
• Take a combination formula providing glucosamine, MSM, quercetin, hops (Glucosamine Support). I have created such a formula and have recently added in Theracurmin – Glucosamine with Theracurmin – available from HOLFORDirect.
• In winter months add in a high strength Vitamin D formula – my recommendation based on recent research is now 3,000iu.
• Test yourself for raised homocysteine and food intoleranceFood intolerance is not the same as a food allergy. Food intolerances tend to cause digestive symptoms such as bloating, cramps and diarrhoea, but are… at yorktest.com.

References

1. See https://www.nature.com/articles/nrrheum.2017.50#abstract.

2. J. M. Bjordal, et al., ‘Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: Meta-analysis of randomised placebo controlled trials’, British Medical Journal, 2004;329(7478):1317

3.  P.R. Ush and M.U. Naidu, ‘Randomised, double-blind, parallel, placebo-controlled study of oral glucosamine, methylsulfonylmethane and their combination in osteoarthritis’, Clinical Drug Investigation, 2004;24(6):353–63

4. J. Reginster, et al., ‘Long-term effects of glucosamine sulphate onosteoarthritis progression: A randomised, placebo-controlled clinical trial’, Lancet, 2001;357(9252), pp. 251–6

5. Results presented at the American College of Rheumatology Annual Scientific Meeting (2005). Available at http://arthritis.about.com/od/glucosamine/a/glucosaminesulf.htm

6. P. Wilkens, et al., ‘Effect of glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumbar osteoarthritis: A randomized controlled trial’, Journal of the American Medical Association, 2010;304(1):45–52

7 S. Wandel, et al., ‘Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: Network meta-analysis’, British Medical Journal, 2010;341:c4675

8. J. Gruenwald, et al., ‘Effect of glucosamine sulphate with or without omega-3 fatty acids in patients with osteoarthritis’, Advances in Therapy, 2009;26(9):858–71

9. P.R. Usha and M.U.R. Naidu., ‘Randomised, double-blind, parallel, placebo-controlled study of oral glucosamine, methylsulfonylmethane and their combination in osteoarthritis’, Clinical Drug Investigation, 2004;24(6)353–63

10. No authors listed, ‘Methylsulfonylmethane (MSM) monograph’, Alternative Medicine Review, 2003;8 (4):1514–22

11. S.W. Jacob and J. Appleton, MSM: The Definitive Guide. A comprehensive review of the science and therapeutics of methylsulfonylmethane, 2003, Freedom Press:107–21

12. M. G. Signorello, et al., ‘Effect of homocysteine on arachidonic acid release in human platelets’, European Journal of Clinical Investigation, 2002;32(4):279–84

13. R. Roubenoff, et al., ‘Abnormal homocysteine metabolism in rheumatoid arthritis’, Arthritis and Rheumatism, 1997;40(4):718–22

14. X. M. Gao, et al., ‘Homocysteine, ankylosing spondylitis and reactive arthritis: Homocysteine modification of HLA antigens and its immunological consequences’, European Journal of Immunology, 1996;26(7):1443–50

15. A. Hernanz et al., ‘Increased plasma levels of homocysteine and other thiol compounds in rheumatoid arthritis women’, Clinical Biochemistry, 1999;32 (1):65–70

16 P. E. Lazzerini, et al., ‘Homocysteine enhances cytokine production in cultured synoviocytes from rheumatoid arthritis patients’, Clinical and Experimental Rheumatology, 2006;24(4):387–93

17. M. A. Flynn, et al., ‘The effect of folate and cobalamin on osteoarthritic hands’, Journal of the American College of Nutrition, 1994;13 (4):351–6

18. For further information read, JM Ellis’s book, Free of Pain: A Proven Inexpensive Treatment for Specific Types of Rheumatism, Southwest Publishing, 1983

19. R. Goldberg and J. Katz, ‘A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain’, Pain, 2007;129(1–2):210–23

20. C. M. Bitler, et al., ‘Hydrolyzed olive vegetation water in mice has anti-inflammatory activity’, Journal of Nutrition, 2005;135(6):1475–9

21. E. M. Matheson, ‘The association between onion consumption and bone density in perimenopausal and postmenopausal non-Hispanic white women 50 years and older’, Menopause, 2009;16(4):756–9

22. R. Wilken, et al., ‘Curcumin: A review of anti-cancer properties and therapeutic activity in head and neck squamous cell carcinoma’, Molecular Cancer, 2011;10:12

23. B. White and D. Z. Judkins, ‘Clinical Inquiry. Does turmeric relieve inflammatory conditions?’, Journal of Family Practice, 2011;60(3):155–6

24. Y. B. Shaik, et al., ‘Role of quercetin (a natural herbal compound) in allergy and inflammation’, Journal of Biological Regulators and homeostatic Agents, 2006;20(3–4):47–52

25. Nakagawa Y et al., ‘Short-term effects of highly-bioavailable curcumin for treating knee osteoarthritis: a randomized, double-blind, placebo-controlled prospective study‘. J Orthop Sci. 2014 Nov;19(6):933-9.

26. Shin YA et al., ‘Short-term effects of Theracurmin dose and exercise type on pain, walking ability, and muscle function in patients with knee osteoarthritis.’ J Exerc Rehabil. 2017 Dec 27;13(6):684-692.