Dietary supplements for osteoarthritis (OA or degenerative joint disease) are the most underappreciated supplement category. First, let’s look at the conventional medical options for pain. Acetaminophen can increase the risk of liver toxicity; in fact, it’s the number one cause of acute liver failure in the United States.
Ibuprofen and similar drugs can increase the risk of cardiovascular disease, internal bleeding, kidney damage, gastrointestinal problems (ulcers), and now probably sexual dysfunction. Opioids, the strongest prescription pain medicines, are now the number one cause of unintentional prescription drug overdose leading to death in the United States. Not such great options, right?
Dietary supplements for OA might not work as well or as fast as over-the-counter or prescription painkillers, but they have an outstanding safety record and they may also help reduce the progression of OA. However, the American College of Rheumatology (ACR, the leading educator of health care professionals in the area of OA) recently revised its treatment guidelines for osteoarthritis and recommended against the use of chondroitin sulfate, glucosamine, and topical capsaicin for knee OA.
This is a good organization, but it continues to be enamored with expensive and potentially toxic options—and closed-minded when it comes to dietary supplements. I thought the Hippocratic oath was to “first do no harm.” Other international organizations are still recommending both conventional medicines as well as dietary supplements for the treatment of OA. (In slight defense of the ACR, they did overwhelmingly endorse exercise and weight loss for OA of the knee.)
What are Osteoarthritis and Joint Pain?
Osteoarthritis is one of the most common and disabling chronic diseases that impact us as we age. It’s the erosion or reduction of joint cartilage and eventually the underlying bone; the resulting inflammation contributes to further cartilage breakdown. Joints (and muscles) can become sore and stiff, sometimes to the point where it’s difficult to carry out daily activities or even sleep. The elbows, hips, knees, ankles, shoulders, neck, and even the tiny joints in the hands
and feet are all prone to osteoarthritis. Imaging tests or x-rays may reveal areas of bony outgrowth called osteophytes, which are created by the bone in an effort to stabilize the joint.
Age is the biggest risk factor, but others include inflammatory joint disease (gout, rheumatoid arthritis, and infection), obesity (the strongest modifiable risk factor), occupation (a job that requires repetitive knee bending, for example), and previous injury to the area (such as a torn knee ligament).
Home Remedies For Osteoarthritis and Joint Pain
1. (tie) SAM-e (S-adenosylmethionine) 600 to 1,200 milligrams a day
SAM-e is widely used in Europe as a prescription for a variety of conditions, especially osteoarthritis and depression (see the Depression section), and it’s enjoying a resurgence in the United States, too. Researchers aren’t sure how this naturally occurring compound controls pain, but it does play a primary role in several pathways in the body, including transmethylation, transsulfuration, and amino-propylation, which basically means it helps to reduce pain in multiple ways.
A recent review of numerous clinical trials comparing SAM-e to a placebo or NSAIDs (nonsteroidal anti-inflammatory drugs, such as ibuprofen, aspirin, and naproxen) concluded that SAM-e is at least as effective as NSAIDs for osteoarthritis but with fewer side effects; in fact, people taking SAM-e were almost 60 percent less likely to experience a side effect compared to NSAID users. It takes longer for SAM-e to kick in, but after a month or two, its effect is similar to NSAIDs. SAM-e may reduce morning stiffness, swelling, pain at rest and in motion, and even the popping or cracking sounds associated with OA, and it may improve range of motion and walking ability.
Effective dosages range from 600 to 1,200 milligrams per day for at least 30 to 90 days, usually on an empty stomach. Most trials tested SAM-e for between 10 days and 3 months, with the most common trial period being 30 days, so how it will perform long-term is unknown. Plus, more safety data is needed. One enduring concern with SAM-e is that it may increase blood levels of homocysteine, which might be an indirect marker of cardiovascular risk, but recent studies show this is not as much of an issue. Regardless, please talk to your doctor about using SAM-e. If a jump in your homocysteine level is observed, you may be instructed to take more B vitamins.
Be careful when you’re taking over-the-counter NSAIDs along with SAM-e; this hasn’t really been studied. In addition, most of the research with SAM-e and pain has been for knee and hip OA; that’s not to say you couldn’t try it for other types of chronic pain, but let your doctor know. Finally, the biggest side effect of SAM-e, in my experience, is on your wallet; it can be ridiculously expensive, so shop around.
2. (tie) Glucosamine sulfate 1,500 milligrams a day and chondroitin sulfate 800 to 1,200 milligrams a day
Glucosamine is a basic building block for the production of glycosaminoglycans and proteoglycans, which are important components of joint cartilage. Although the body produces it naturally, glucosamine supplements are generally derived from crab shells or the shells of other sea creatures. (Vegetarians are in luck because there are now some corn-based sources of glucosamine; perhaps in the future the supplement will be called glucornsamine.) If you have a shellfish allergy, do not take it unless you know it comes from a nonshellfish source.
Glucosamine is often combined with chondroitin sulfate, another component of joint cartilage. It helps retain water in the cartilage and may help support the joint and slow disease progression. Chondroitin supplements usually are made from shark, pig, or cow cartilage, but now there are some algae sources as well.
Recently, the much-anticipated results of the large LEGS (Long-Term Evaluation of Glucosamine Sulfate) study from Australia—one of the largest and best supplement trials ever—came out. After 2 years, researchers found a combination of 1,500 milligrams of glucosamine sulfate and 800 milligrams of chondroitin sulfate daily significantly and favorably impacted joint space narrowing (less narrowing equals healthier joints), especially in people with mild OA. The results suggested the supplements were slowing the progression of OA compared to the placebo (half the rate—wow!).
Now, all groups reported a reduction in pain, but no group was significantly better after 2 years. Three-year trials are showing more impressive reductions in pain, though, so perhaps this trial was too short or there weren’t enough participants with moderate to severe OA (only 5 percent).
Still, the LEGS trial is remarkable in the sense that it suggests the earlier you use it, the better; it also shows that the combination of glucosamine and chondroitin sulfate is better than either alone. Another significant finding of the LEGS trial was that side effects of the supplements were similar to the placebo.
Like SAM-e, this is another supplement that you have to take for several weeks to see results. There have been reports of blood thinning (do not combine with warfarin), stomach upset, and excess gas in other studies. If you’re following a low-sodium diet, check the label on your glucosamine supplement; many contain 20 to 50 milligrams (or more) of sodium per one or two capsules.
On its own in studies, 500 to 1,500 milligrams per day of glucosamine sulfate resulted in a greater reduction in pain and a greater improvement in function than a placebo. Longer-term trials with chondroitin by itself have found it may help reduce cartilage volume loss and reduce pain (800 to 1,200 milligrams a day). So either one works on its own, but I think the combination is most powerful.
I would love to see a study of glucosamine sulfate, chondroitin sulfate, and SAM-e taken together! Of course, you could try this yourself and ask your doctor to monitor your progress. (I don’t currently recommend another form, glucosamine HCL, based on results of the Glucosamine/Chondroitin Arthritis Intervention, or GAIT, and other trials.)
3. Capsaicin cream (0.015 to 0.075 percent) applied up to four times a day
Over-the-counter joint creams or gels, such as capsaicin (an ingredient from cayenne and other hot peppers), seem to work well for hand and knee arthritis, but not so much for the hip because they just can’t penetrate that deeply. In several clinical trials, participants used 0.025 percent capsaicin four times daily for 4 to 12 weeks.
In other trials, people applied 0.015 percent capsaicin once a day for 6 weeks and 0.075 percent four times a day for 4 weeks. In all of these clinical trials, capsaicin was significantly more effective for improving pain than a placebo. The longer the study, the greater the reduction in pain severity (there was no hint that it slowed progression). Be warned, redness and a burning sensation are common because of the way this herbal topical works. You can also buy capsaicin in pill form, but there’s no research yet on how it impacts OA, so stick with the cream for now.
4. Avocado/soybean unsaponifiable (ASU) supplements
Avocado/soybean unsaponifiable (ASU) supplements, a phytosterol extract from avocados and soybeans, reduce inflammation and stimulate repair. Several clinical studies are suggesting that these may be especially helpful for knee pain (less so for the hip).
Although they are an approved prescription medication for OA in some countries, more research is still needed. Studies have looked at daily doses from 300 to 600 milligrams and both work well. Obviously, if you are allergic to avocados or soy, you should not take these.
5. Boswellia (Indian frankincense)
Boswellia (Indian frankincense), an herbal extract taken from the Boswellia serrata tree, also appears to reduce inflammation and compounds that increase joint damage. Most of the research for it has been in small studies, but the results have been consistent. In one trial, a 333-milligram dose, given three times a day, reduced pain and swelling and improved function over 8 weeks of treatment. And another study, which administered the same dosage and was conducted over 6 months, showed similar benefits.
An extract of B. serrata enriched with 30 percent 3-O-acetyl-11-keto-beta-boswellic acid (called 5-Loxin) reduced pain and improved function over 90 days at 100 or 250 milligrams daily. Side effects in most studies were the same as a placebo. Overall, it improved some components of OA but not others. I don’t think it would hurt to try it for a month and see if you notice a difference; you can always go back to NSAIDs.
Omega-3 companies claim that their products—which may come from sardines, anchovies, mackerel, krill, or even the New Zealand green-lipped mussel— are somehow different than their competitors’ products, but in my opinion, it’s all BS (bogus science)!
While the dosage may vary slightly from form to form, the active ingredients EPA and DHA are going to be the same, so first give the least expensive product a try and see if it helps. Omega-3s are natural anti-inflammatories, and the research shows that the standard dose of 1,000 to 2,000 milligrams per day of EPA and DHA may reduce aches and pains in the back, knee, hip, and other joints. Higher doses might even work better, but you should discuss that with your doctor.
Warning: Prescription omega-3 oil is a big waste of money, and too many doctors push it because they don’t realize that fish oil dietary supplements have great quality control (in other words, mercury and most other contaminants aren’t an issue).
Fish oil has also shown a modest benefit for rheumatoid arthritis, a chronic inflammatory autoimmune disorder of the joints and bones. If you experience gastrointestinal problems (like nausea, diarrhea, or discomfort), skin abnormalities (itching, eruptions, allergies), or easy bleeding, then your fish oil dose is either too high or just not for you.
7. Hyaluronic acid
Hyaluronic acid is a component of joint fluid, and preliminary clinical trials are beginning to show that taking it in supplement form (80 to 200 milligrams daily) may strengthen the area around the cartilage, known as the joint matrix or joint support system, and may stimulate certain cells to produce more hyaluronic acid.
More research is still needed, but the benefit outweighs the risk right now. A word of warning for vegetarians or anyone who’s allergic to poultry: It’s usually derived from chicken cartilage.
8. MSM (methylsulfonylmethane)
MSM (methylsulfonylmethane) supplements contain sulfur, which occurs naturally in joints. A few small studies of 1,500 to 6,000 milligrams a day for 12 weeks have demonstrated a small reduction in pain and improvement in function. I think it might work best combined with glucosamine or chondroitin or both; I wouldn’t use it alone unless my top picks in this section were a bust.
Pycnogenol, an extract from the bark of the French maritime pine tree, helped reduce OA-related joint pain and stiffness by 35 to 55 percent in two clinical trials. Participants were also able to cut back on their pain medications.
The trials lasted about 3 months, and the most effective dose was 50 milligrams two or three times a day (100 to 150 milligrams total) taken after meals. It’s pricey though, and there haven’t been enough clinical trials to warrant using this before you give some of the cheaper and better studied supplements here a try.
What Supplements Are Useless For Treating Osteoarthritis and Joint Pain?
Normalizing low blood levels of vitamin D (35 to 40 ng/mL) has been shown to provide minimal relief from muscle discomfort in some people, but the same doesn’t hold true for bone. A recent 2-year study of moderate-dose vitamin D supplementation to reduce OA pain did not work better than a placebo.
There have been several weak studies with this herbal, which has shown some benefit for pain relief. The problem is that you would have to take five capsules twice a day to get the dose that was studied, and this is simply too costly and unrealistic.
This yellow coloring agent, which is derived from turmeric, is the anti-inflammatory du jour. But we need more clinical trials ASAP. Of course, I am excited about the preliminary data showing curcumin can reduce the pain of OA, but with such a crowded field of potentially beneficial supplements, you have to prove yourself. Very high doses of curcumin in some studies have caused abdominal fullness and pain, and the bio-availability (ease of absorption) of this supplement is just not that good.
An extract from pineapple, it’s been tested at 800 milligrams per day over 12 weeks in small clinical studies, but did not beat a placebo. Bromelain combined with trypsin and rutin has shown some benefit, but again, the study design and results were not exciting enough to bump this supplement into the effective category.
Eggshell protein or natural eggshell membrane (NEM)
Preliminary research with this new supplement, which is made of proteins (similar to those found in human joints) that can build and support cartilage, suggests it may reduce joint pain and improve flexibility at 500 milligrams per day. However, there are egg protein powders that are wonderful sources of protein, and they might be worth a try while the eggshell membrane supplement gets more research.
It’s better known for its ability to combat nausea, but it may also have anti-inflammatory effects. Studies have shown modest to zero benefit, though. It has a good safety record, but why experts tout it as having good human evidence is beyond me.
There are two species of this vine from the Amazon River basin that are used in South America as general anti-inflammatories, but there just haven’t been any good clinical studies. Nobody has been able to explain how it might work (the mechanism of action) to slow the progression of OA either. These supplements aren’t magic, folks.
The active ingredient in this African plant appears to be iridoid glycosides, especially something called harpagoside, but I don’t believe the mechanism of action has truly been discovered yet. Some compounds in this plant act as COX-2 inhibitors, which are heart unhealthy (remember Vioxx?). Preliminary laboratory data has been encouraging, and some of the clinical studies are also positive, but in terms of methodology they’ve been weak, which makes me question the results. Side effects have been rare, but gastrointestinal upset, diarrhea, skin reactions, and loss of taste have occurred. It would be a sin to try this until better safety and efficacy are proven.
This is obtained by extracting collagenous tissues from animals. It’s an amino acid mixture high in glycine, proline, hydroxylysine, and hydroxyproline, which are also found in human cartilage. A trial of 10 grams daily of collagen hydrolysate for 24 weeks found some reductions in pain that beat a placebo, but the average dropout rate at most of the clinical trial sites was very large. Give me more data!
DMSO (dimethyl sulfoxide)
This is a sulfur-containing compound made from wood pulp that comes in a gel, liquid, or roll-on form. There was a favorable older study using a 25 percent DMSO topical product, but it has not been replicated. Some people develop a rash or itching with it.
White willow bark
Some osteoarthritis and pain supplements contain salicin, or white willow bark, which is just a copycat of aspirin. The makers of these products may claim that their expensive product is working by some miracle or unique mechanism to reduce pain (or thin the blood), when in reality you’re just getting another version of cheap aspirin.
But aspirin has 100 times the research of white willow bark, and I always recommend spending your hard-earned money on that instead. I wish these companies would test their products against aspirin or ibuprofen or naproxen for pain if they think they’re that good (but the chances this will happen are slim to none and, really, slim just left town).
What Lifestyle Changes Can Help With Osteoarthritis and Joint Pain?
Heart healthy = joint healthy
Almost anything that reduces the risk of heart disease appears to prevent or reduce the progression of OA, too. Never forget this please.
Aerobics, resistance training, tai chi—they all help to reduce stress on the joints by strengthening the muscles around them and by helping you lose weight. The goal is to keep moving so your muscles stay strong; if they get weak, the joints take all the pressure. If you have more severe types of OA, you should work with your physician.
Apply heat or cold?
Cold reduces inflammation and swelling, and it reduces pain better than heat, but it can also cause temporary stiffening. Heat relaxes muscles and tendons and encourages circulation to the area, so I think it’s a better choice for increasing mobility. Here’s a good tip: Apply heat to a specific joint before physical activity, and use a cold pack afterward.
Excess weight is your number one modifiable risk factor for OA. (Google the ADAPT, or Arthritis, Diet, and Activity Promotion Trial.) Wow! Losing just a little weight or a few inches from your waist (if you are overweight) can take pressure off some joints and reduce pain. Research bears this out time and time again. It’s just a no-brainer (or should I say, “no-jointer”).
Take a salt bath
Using Epsom salt (magnesium sulfate) in the tub can be very effective for reducing joint or muscle pain. Magnesium penetrates skin and helps fight inflammation and relieve pain along with hot water. Just make sure that the water completely covers or surrounds the sore area for at least 10 to 15 minutes.
Eat more gelatin
Gelatin is a cheap home remedy for joint pain that is very popular and safe, but it’s also untested. It comes from the collagen inside an animal’s (cattle, pigs, and horses) skin and bones.
When you ingest it, it may reach the joint and provide some protection or lubrication. There are gelatin substitutes available—such as liquid fruit pectin or konjak (another gelatinous fiber)—that have similar gel-forming features and may work the same way. Some people think gelatin is no more than a placebo, but it’s safe, so why not try it? (If I had a dime for all the folks who told me it helps, I would have a house full of dimes and a wife who would be upset with me for leaving dimes all over the house.)
What Else to Know About Treating Osteoarthritis and Joint Pain?
- Topical rubs that heat the skin, such as Bengay, can help with joint and muscle aches. They work as counterirritants, producing a mild and localized inflammation that crowds out pain messages from nearby muscles and joints (for all its intricacies, your brain is very focused and can generally process only one primary pain signal at a time). It’s kind of like creating white noise for your brain so it doesn’t recognize what’s coming from the joint.
- My favorite over-the-counter pain reliever is naproxen because the dosage you need is so low and it may carry less cardiovascular toxicity than other over-the-counter NSAIDs. And you can use it with many OA supplements.