Scientific trials and evidence of effectiveness of joint nutrition

Although scientific information is primarily intended for professionals, the number of people who want to know more details about modern scientific findings rather than relying on advertising or medical advice is growing.

ACTIVE INGREDIENTS IN JOINT NUTRITION, THEIR STRUCTURE, EFFECT ON THE BODY AND THE RESULTS OF SELECTED CLINICAL TRIALS

Chondroitin


– Glucuronic acid + Galactosamine
– A chain of around 100 of these simple sugars with sulphate groups bonded to one or even two carbons (C2,C4,C6) in a structural ring of sugars
– Part of the GAG group (glycosaminoglycans = mucopolysaccharides) These bind to extracellular proteins and form PG (proteoglycans)
– Structural component of CARTILAGE
– Imparts compression resistance to cartilage

Chondroitin – benefits

Dozens of independent studies exist (universities and clinics from all over the world) demonstrating the action of chondroitin on the joints:

  • Alleviating joint pain
  • Improving joint function
  • Slowing joint spacing narrowing on X-rays
  • Increasing quality of life (according to the Lequesne index)(11)

E.g. : Singh JA, Noorbaloochi S, MacDonald R, Maxwell LJ. Chondroitin for osteoarthritis. Cochrane Database of Systematic Reviews 2015 (19)

Effective dose = 800mg/day

Collagen

  • The main structural protein in connective tissue
  • Depending on the level of mineralisation and the structural organisation, it is part of the tissue for bones, tendons, ligaments, cartilage, skin, muscle tissue, blood vessels, etc.
  • It is created by Fibroblasts in the body
  • Max. mass. = 300 000 Da
  • To make it easily absorbable, it should be administered after partial hydrolysis in peptide form with a max. mass of 3-5000 Da, where > 90% will be absorbed

Collagen (hydrolysate) – in the prevention and during alleviation of symptoms

A prospective, randomised, placebo-controlled, double-blind clinical trial
  (24 weeks; 10g of CH/day)

  • Indicated the positive impact of nutrients with an increased CH content on joint pain for the subpopulation with increased stress due to sport
  • All six pain parameters compared were in favour of CH.
  • Conclusion: CH enhances joint health and can reduce the risk of joint damage in people who have a higher level of joint stress.

(Clark et al,  Dptm Nutr and Sports Nutr for Athletics, Penn St. Univ., 2008 )

A comparative, double-blind, randomised, multicentre study
(6 months)

  • After 6 months: on concurrent groups of probands (1200mg CH/day, n = 200; ≥ 50 years old; ≥ 30mm VAS), showed significant reduction in joint pain in CH vs placebo
  • After 3 months: differences not yet statistically significant -> indicates need for long-term use of CH, Bruyère, 2012

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Hyaluronic acid (Hyaluronan)

  • Component of the GAG group
  • Component in connective, epithelial and nerve tissue, skin and, generally, an ECM component
  • In the body (75kg): 14g
  • Every day 1/3 of the total amount metabolises
  • In connective tissues, it is formed by chondrocytes, synoviocytes, fibroblasts

Role in the connective tissue

  1. Lubrication (as a component of synovial fluid and ECM)
  2. Elasticity (component of cartilage, subchondral bone, tendons and ligaments)
  3. Proliferation (growth, renewal) of tissue (acts as a growth factor, GF)
  4. Inhibition, elimination of free radicals (anti-inflammatory effect)
  5. Immunological interactions (immunomodulatory effect)

Hyaluronic acid – signal function

Low molecular weight HA
– potentiates viscoinduction

  • On the level of chondrocyte, fibroblast, cell in the skin, where it is transported to after absorption from the intestine,
  • And also directly in the intestine, where it activates TLC4 receptors -> a signal system triggering viscoinduction.

High molecular weight HA
– potentiates viscosuplementation

  • In joint structures it improves the sliding properties of joint cartilage and its flexibility,
  • And improves the lubricating effect of synovial fluid

Hyaluronic acid (Hyaluronan) – benefits of oral use

Oral viscosupplementation – in scientific medical literature, support for this method of administration is increasing for

  1. Pain relief (reduces your VAS score)
  2. Improves mobility and function of the joints.
  3. Sufficient absorption and the subsequent distribution via blood circulation into the joints and connective tissues (and skin)
  4. A more significant improvement of the clinical condition for osteoarthritis, when oral administration of HA follows intra-articular administration of HA (24)
  • Dose of 60-240mg/day
  • Use 3-12 months

Hyaluronic acid (Hyaluronan) – in the prevention and during alleviation of symptoms

Comparative multicentre clinical trial  (25)
(12 weeks; A = inter-articular HA 3×1, 6% vs. B = oral 300mg HA + 150mg Boswellia -> 150mg HA + /day)

  • Comparisons prior to treatment and 3 months from start of treatment, 60 patients <60 and >60 years old
  • American Knee Society Score (AKSS) improved and the VAS decreased for both therapeutic procedures
  • Treatment scheme A had better results for the under 60 subgroup, oral viscosupplementation had better results with the older subpopulation.
  • Conclusion: The comparison of intra-articular and oral administration routes of HA has shown that both are effective. The authors recommend combining them so that the intra-articular application is followed by oral administration (Ricci M et al, Orthopedic and Traumatology Unit, Univ. Verona and Hosp. Trento, Italy, 2017)

A prospective, double-blind, randomised, placebo-controlled clinical trial (21)
(12 months; n=60; >50 years, no comorbidities, no NSAID or SYSADOA, Kellgrene/Lawrence index 2 to 3 for at least one knee, assessed those worse affected; 12 months orally 4x50mg HA 0.9 MDa caps/day vs placebo daily strengthening of quadriceps in lower limbs)

  • Assessment at start and end of study using Japanese Knee Osteoarthritis Measure (JKOM; 25 elements characterising the Japanese way of life / movement)
  • Improvement with both HA and placebo, statistically significant with HA and people <70 years old.
  • Conclusion: aged up to 70, oral administration of HA may relieve OA symptoms, if combined with exercise.
  • Exercise on its own may improve the course of OA, even without medication

(Tashiro T et al, Dptm ORT Surgery, Tokyo. Scientific World J 2012)     

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Glucosamine

  • A separate monosaccharide or in the form of glucosamine sulphate
  • Participates in the biosynthesis of glycosylated proteins and lipids (a galactosamine precursor, i.e. participation in chondroitin synthesis)
  • A component of hyaluronic acid (HA)
  • Supports joint structure and function
  • Less studied in comparison with chondroitin

L-ascorbic acid (Vitamin C)

Role in connective tissues

  • 1. A cofactor in collagen synthesis
  • 2. Antioxidant (inhibiting free radicals via electron donation)

Table of GelaVis Family product ingredients

                             mg / cps (sachet)
 GelaVis Complex  GelaVis Forte  GelaVis HA
Collagen peptides 50 5000
Chondroitin sulphate 400 500
Glucosamine sulphate 100 500
Hyaluronan 20 20 100
Ascorbic acid 20 20  20
         Dose 2 caps/ day 1 sachet / day 1-3 caps/ day

Joint nutrition is not enough for everything

Despite the increasing amount of evident about the positive effects of good quality active ingredients contained in joint nutrition, there is no doubt that many more serious conditions, injuries and chronic diseases need to be addressed in more effective ways.

For instance, viscosupplementation can be used to treat arthritis in individual joints – using RenehaVis, for injuries and chronic issues with tendons, ligaments and soft tissue, products containing STABHA – SportVis and TendoVis.

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