Nutritional Support For Joint and Bone Health

Achy joints, back pain and inflammation are not uncommon conditions in the UK. In fact, 1 in 5 people (20%) consult their GP about a musculoskeletal proem each year in the UK[1], which costs the NHS £4.7 billion annually.[2]

So what can you do to support your joints and bones either as a preventative measure or if you are already experiencing pain and inflammation?

Eat Your Greens!

Diet should be your first port of call when looking to improve joint and bone health. Vegetarian diets, rich in vegetables and some fruits have been shown to support musculoskeletal health. One particular study showed a direct correlation between animal protein consumption, where consuming more than 5 portions of red meat a week increased bone fractures in women, in part due to the higher content of acid forming sulfur-containing amino acids found in animal proteins.[3]

Green leafy vegetables are rich in calcium and also Vitamin K, which is also important for bone density. One study reported that women eating green leafy vegetables, broccoli and other green vegetables every day had almost half the amount of hip fractures compared to women eating their greens only once a week or less.

Dietary sources of calcium also includes nuts and seeds, reducing the reliance of high levels of dairy intake, as this can impact digestive health and absorption of nutrients and is low in levels of other important joint and bone supporting micronutrients. For more dietary information please read our Education Article on Osteoporosis.

Is Calcium the Answer for Healthy Bones?

There are also a wide range of supplements that can be used alongside the diet to support bone and joint health.

At all stages of life, high impact and resistance exercise in conjunction with adequate intake of nutrients involved in bone health are critical factors in maintaining a healthy skeleton and minimising bone loss. The most common nutrient, and also supplement, that springs to mind when discussing bone health is calcium. Inadequate calcium intake is likely to be harmful to bone, as this mineral is required for bone structure and density. Calcium deficiency may arise from the diet (though this is unlikely – see discussion below) or inadequate gastrointestinal absorption. Calcium deficiency in the elderly is associated with low gastric acid secretion and bone loss with studies linking defects in gastric acid secretion with bone destruction and impaired mineralisation.[4] Also remember the effects that NSAIDs and PPI medication combination have on lowering gastric acid that we discussed in a previous blog ‘How Healthy Are Your Joints and Bones? and the implications of this for calcium and nutrient absorption.

However, the recommendation for consumption of calcium over the typically recognised minimum official recommendations in the UK of 700-800 mg per day of dietary calcium for adults appears to have no substantive benefit on fracture prevention. There is currently little, if any, firm evidence that higher intakes prevent bone loss, falls, or fractures in middle aged and older women and men living in the community.[5],[6] Therefore, simply consuming more calcium (no surprise here for Nutritional Medicine Practitioners) has little or no relevant effect on the prevention of fracture development. In fact, some studies suggest that calcium intake significantly above the recommended level is not only unlikely to achieve substantive additional benefit for bone health, but may also increase the risk of cardiovascular disease.[7]

Minerals and Bone Health

This suggests exploration of other nutrient co-factors necessary for bone resorption, as well as lifestyle and behaviours that also have a direct impact on bone remineralisation. Multiple studies indicate that certain nutrients are consistent with healthy ageing including combinations of calcium, Vitamins D and K, copper, zinc, selenium, magnesium, and other vitamins and minerals are linked with better bone health (see Nutrigold Education Article on Osteoporosis for more information). In other words, bones and their durability rely on more than the presence of two nutrients, they need a range of bioavailable nutrients from differing foods, and if required from well-manufactured food supplements that use bioavailable forms. To realise lasting effects on bone, the intervention must persist throughout a lifetime.

Tocotrienols (subtypes of Vitamin E) have also been demonstrated to preserve bone health especially during menopause. They do this in several ways; quench free radicals and oxidative stress; reduce inflammation; inhibit osteoclast activity (bone cells that break down bone). They also enhance the structure and strength of normal, non-osteoporotic bone, increasing bone mass so that there is less risk of osteoporosis later in life.[8],[9]

Glucosamine and Healthy Joints

In terms of joint health, glucosamine is one of the best-known supplements to support joint structure and integrity through production of cartilage.[10] Silica (often supplement in horsetail extract), Vitamin B3, boron, sulphur and omega 3 essential fatty acids also support joint health. Of particular current interest is curcumin in managing musculoskeletal conditions – in fact it’s sometimes described as a golden remedy for joint health! Curcumin is the collective term for three bright golden-colored, lipophilic polyphenols (curcumin, demethoxycurcumin and bisdemethoxycurcumin). These curcuminoids have antioxidant and anti-inflammatory properties that may be useful in lessening the pain and inflammation of arthritis.[11] Several studies have been conducted which have confirmed the anti-arthritic effects of curcumin in humans with both osteoarthritis and rheumatoid arthritis.[12],[13]

So what can you do today to protect and improve your joint and bone health? There are lots of different ways to support musculoskeletal health through the diet, as well as lifestyle including exercise and movement. If you want to find out more then please read the Nutrigold Education Article on Osteoporosis and also Nutritional Support for the Menopause. If you need any further information about specific nutrients then please ring the Nutrigold free technical line on 0800 233 5675.

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References

1. Arthritis Research UK National Primary Care Centre, Keele University (2009), Musculoskeletal Matters.
2. NHS England 2013/14 CCG programme budgeting benchmarking tool online at https://www.england.nhs.uk/resources/resources–for–ccgs/ prog–budgeting/.
3. Willett, W. et al (1996) Protein consumption and bone fractures in women. Am J Epidemiol 143:472-479
4. Schinke T, et al. Impaired gastric acidification negatively affects calcium homeostasis and bone mass. Nature Medicine 15, 674 – 681 (2009)
5. Tai V, Leung W, Grey A, Reid IR, Bolland MJ. Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ. 2015 Sep 29;351:h4183
6. Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR. Calcium intake and risk of fracture: systematic review. BMJ. 2015 Sep 29;35
7. Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg) Heart 2012;98:920-925 doi:10.1136/heartjnl-2011-301345
8. Nizar AM, Nazrun AS, Norazlina M, Norliza M, Ima-Nirwana S. 2011. Low dose of tocotrienols protects osteoblasts against oxidative stress. La Clinica Terapeutica, 162(6):533-8. IF: 0.266, Q4.
9. Nazrun AS, Sharlina M, Norliza M, Fazalina MF, Sabarul AM, Norazlina M, Ima Nirwana S. 2011. Effects of a-tocopherol on the early phase of osteoporotic fracture healing. Journal of Orthopaedic Research, 29(11): 1732-1738. IF: 2.811, Q1.
10. Usha PR¹, Naidu MU. Randomised, Double-Blind, Parallel, Placebo-Controlled Study of Oral Glucosamine, Methylsulfonylmethane and their Combination in Osteoarthritis. Clin Drug Investig. 2004;24(6):353-63.
11. Amalraj A, Pius A, Gopi S, et al. Biological activities of curcuminoids, other biomolecules from turmeric and their derivatives – A review. J Tradit Complement Med. 2016 Jun 15;7(2):205-233. PMID 28417091
12. Daily JW, Yang M, Park S. Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Med Food. 2016 Aug 1; 19(8): 717–729. PMCID: PMC5003001
13. Henrotin Y, Priem F, Mobasheri, A. Curcumin: A new paradigm and therapeutic opportunity for the treatment of osteoarthritis: Curcumin for osteoarthritis management. SpringerPlus 2013, 2, 56. PMID 23487030