Minimising the Impact of Age and Arthritis-Related Changes on Joint Health and Function
How the essential mineral boron, cartilage-derived proteoglycans, and a bioavailable form of curcumin may be your best allies for keeping joints healthy as you age by Dr Carrie Decker ND
Gravity. From our first days on this earth, we are combating its effects. Falls and tumbles in our youth all too fast progress to sagging skin, joints that hurt when we exercise, and our dwindling height. Our capacity for growth and the regenerative nature of our cells and tissues becomes progressively less with age, particularly in tissues such as our skin and those that form our joints. With this we see the joint changes associated with osteoarthritis and a loss of skin elasticity and wound-healing capacity.[i],[ii],[iii],[iv]
There are, however, nutritional supplements that may help us combat these challenges. The trace element boron, cartilage-derived proteoglycans and collagen, and a bioavailable format of curcumin are four tools which all may play important roles in keeping our bodies healthy and active with increasing age.
Despite the many biological functions requiring boron,[v] a recommended daily intake has not been established.[vi] In the diet, many people do not consume more than one milligram a day, which may be a clinical concern.[vii] Soils are depleted, and certain fertilisers inhibit boron absorption into plants. [viii],[ix]
Boron has considerable importance for the health of our bones, and deficiency leads to impaired growth and abnormal bone development.[x],[xi] Boron supports bone health in postmenopausal women, reducing the urinary loss of the minerals calcium, magnesium, and phosphorus which are essential for bone-building.[xii] Boron also has been shown in this population to increase blood concentrations of oestradiol and testosterone, both of which are important for strong bones. In a different study of postmenopausal women, boron supplementation was observed to decrease calcitonin levels (a hormone that decreases calcium levels) and simultaneously increase levels of calcium and vitamin D.[xiii]
Lower serum levels of boron have been shown in individuals with both rheumatoid arthritis (RA) and osteoarthritis (OA).[xiv],[xv] Low boron levels were correlated with higher levels of rheumatoid factor (RF), the antibody that causes destruction of the joints in RA, and in OA, were correlated with disease duration and severity.
Supplementation with boron at the dosage of 6 mg daily has been shown to improve symptoms of both OA and RA. In a pilot study in individuals with OA, symptoms improved in half the patients taking boron, while only one of those taking the placebo (10%) had improvements after 8 weeks of supplementation.[xvi] In a double-blind randomised placebo-controlled study of patients with RA, supplementation with 6 mg of boron as an adjunct to the drug etanercept was found to significantly improved the clinical scores and decrease serum levels of several inflammatory markers, including tumor necrosis factor-α (TNF-α).[xvii]
Proteoglycans and Collagen
Proteoglycans and collagen are essential to the health of the joints. Articular cartilage, which covers the ends of the long bones where they come together to form joints, contains high amounts of type II collagen and proteoglycans, made by the chondrocytes found within it. Proteoglycans are hydrophilic, and help to keep cartilage hydrated,[xviii] which is important because more than 65% of healthy cartilage by weight is water.[xix] Because the chondrocytes within the cartilage have minimal ability to replicate and decline in their ability to synthesize these molecules as we age, we see diminished articular tissue integrity with aging.[xx]
Supplementation with proteoglycans and/or collagen has been shown independently and in combination to support joint health. In individuals with knee discomfort, supplementation of proteoglycans at dosages ranging from 5 to 10 mg per day has been shown to improve various parameters used to evaluate osteoarthritis, reducing pain scores associated with both motion and rest and increasing the range of motion.[xxi],[xxii] Analysis of markers of collagen breakdown and synthesis showed significantly reduced collaged degradation compared to placebo in individuals taking 10 mg of proteoglycans daily for 16 weeks.[xxiii] Improvements in skin quality and appearance were also seen with oral supplementation of 5 mg of proteoglycans daily in a different study, showing the importance of this supplement for the health of the skin as well.[xxiv]
Salmon nasal cartilage, providing both 40% undenatured type II collagen and 30% proteoglycans, taken daily at a dosage of 50 mg for four weeks significantly improved both Western Ontario and McMaster Universities Osteoarthritis Index and Visual Analogue Scale pain scores in healthy subjects experiencing rigidity of the knee compared to placebo, with more significant improvements being seen than the third group receiving 1500 mg of glucosamine hydrochloride daily.[xxv]
For anyone who has been a user of supplements for even a brief period of time, curcumin is one supplement which has likely not slipped by unnoticed. PubMed-indexed research on curcumin parallels that of probiotics, increasing from 359 articles in 2007 to 1,367 in 2017. Curcumin is widely known for its anti-inflammatory properties,[xxvi] having clinical data supporting its use in joint problems and other concerns related to autoimmune disease,[xxvii],[xxviii] osteoarthritis,[xxix],[xxx] and even exercise recovery.[xxxi],[xxxii] Blogs and discussions of how to use turmeric and increase its bioavailability, which as a standalone powder is very low,[xxxiii] abound on the internet.
Curcuminoids, often simply referred to as curcumin, are the active lipophilic polyphenols which drive the many benefits we see in studies surrounding turmeric (Curcuma longa).[xxxiv],[xxxv] Unfortunately, they only comprise 2% to 5% of the herb, so technologies to increase bioavailability abound. Often, we see studies simply comparing one technique for increasing bioavailability to the standard, non-enhanced herb, which really offers information only for that product as testing techniques and even the standard herb may vary between individual manufacturers’ tests. However, one study, published in the Nutrition Journal in 2014,[xxxvi] went beyond that, investigating three different formats marketed for their enhanced bioavailability.
The curcumin formulation that was found to be best utilises a molecular dispersion process to dissolve a highly purified powder consisting of at least 95% curcuminoids in a water-soluble base, followed by the addition of antioxidants to protect the curcumin from degradation. This product, which is now water-soluble, showed a 45.9-fold increase in oral absorption as compared with standard curcumin, a 5.8-fold increase over a popular curcumin phytosome product, and a 34.9-fold increase over a curcumin-lecithin-piperine complex.36 Additionally, with the molecular dispersion process a dramatically increased serum concentration after 12 hours was also observed, leading to an area under the curve (a parameter used to compare serum levels over time) a level of magnitude higher than the second best performer.
In a world where supplements directed at musculoskeletal health are plentiful, finding the right combination or a supplement with optimal bioavailability is often our goal. Boron, cartilage-derived proteoglycans and collagen, and curcumin each may be effective alone, or in combination, for the joint and more general musculoskeletal concerns which we encounter.
[i] Hou A, et al. Cellular senescence in osteoarthritis and anti-aging strategies. Mech Ageing Dev. 2018 Oct;175:83-87.
[ii] Carrino DA, et al. Age-related changes in the proteoglycans of human skin. Arch Biochem Biophys. 2000 Jan 1;373(1):91-101.
[iii] Röck K, Fischer JW. [Role of the extracellular matrix in extrinsic skin aging]. Hautarzt. 2011 Aug;62(8):591-7.
[iv] Maquart FX. Extracellular matrix: a major partner of wound healing. Bull Acad Natl Med. 2015 Oct;199(7):1199-1209.
[v] Bolt HM, et al. Boron and its compounds: current biological research activities. Arch Toxicol. 2017 Aug;91(8):2719-2722.
[vi] Pizzorno L. Nothing boring about boron. Integr Med (Encinitas). 2015 Aug;14(4):35-48.
[vii] Nielsen FH. The justification for providing dietary guidance for the nutritional intake of boron.
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[viii] Naghii MR, Samman S. The role of boron in nutrition and metabolism. Prog Food Nutr Sci. 1993;17(4):331-49.
[ix] Newnham RE. Mineral imbalance and boron deficiency. In: Trace Elements in Human and Animal Nutrition, 4th ed. New York: Academic Press, Inc.; 1977:400–2.
[x] Naghii MR, et al. Effects of boron and calcium supplementation on mechanical properties of bone in rats. Biofactors. 2006;28(3-4):195-201.
[xi] McCoy H, et al. Relation of boron to the composition and mechanical properties of bone. Environ Health Perspect. 1994 Nov;102 Suppl 7:49-53.
[xii] Nielsen FH, et al. Effect of dietary boron on mineral, estrogen, and testosterone metabolism in postmenopausal women. FASEB J. 1987 Nov;1(5):394-7.
[xiii] Nielsen FH. Studies on the relationship between boron and magnesium which possibly affects the formation and maintenance of bones. Magnes Trace Elem. 1990;9(2):61-9.
[xiv] Al-Rawi ZS, et al. Serum boron concentration in rheumatoid arthritis: correlation with disease activity, functional class, and rheumatoid factor. J Exper Int Med. 2013 Jan 1;3(1).
[xv] Mahmood NM, et al. Relationship between serum concentrations of boron and inflammatory markers, disease duration, and severity of patients with knee osteoarthritis in Sulaimanicity. Nat J Phys, Pharm, Pharma. 2016;6(1):27-31.
[xvi] Travers RL, et al. Boron and arthritis: the results of a double-blind pilot study. J Nutri Med. 1990 Jan 1;1(2):127-32.
[xvii] Hussain SA, et al. The adjuvant use of calcium fructoborate and borax with etanercept in patients with rheumatoid arthritis: Pilot study. J Intercult Ethnopharmacol. 2016 Dec 8;6(1):58-64.
[xviii] Roughley PJ, Lee ER. Cartilage proteoglycans: structure and potential functions. Microsc Res Tech. 1994 Aug 1;28(5):385-97.
[xix] Mow VC, et al. Cartilage and diarthrodial joints as paradigms for hierarchical materials and structures. Biomaterials. 1992;13:67-97
[xx] Hou A, et al. Cellular senescence in osteoarthritis and anti-aging strategies. Mech Ageing Dev. 2018 Aug 11. pii: S0047-6374(18)30062-9.
[xxi] Kuriyama Y, Yoshida Y. Efficacy of Dietary Supplement Contained Proteoglycan Extracted from Salmon Nasal Cartilage on Knee Uncomfortableness in Healthy Volunteers. Jpn Pharmacol Ther 2017;45:1795-808.
[xxii] Najima M, et al. Usefulness of the supplement containing proteoglycan for Japanese healthy people feeling knee’s discomfort. Shinryo to Shinyaku (Med Cons New-Remed) 2016;53(3):228-36.
[xxiii] Tomonaga A, et al. Evaluation of the effect of salmon nasal proteoglycan on biomarkers for cartilage metabolism in individuals with knee joint discomfort: A randomized double-blind placebo-controlled clinical study. Exp Ther Med. 2017 Jul;14(1):115-126.
[xxiv] Takahashi T, et al. Ingestion of salmon nasal cartilage-derived proteoglycan improves skin condition: A randomized, double-blind, controlled study. Immun Endoc Metab Agents Med Chem. 2015 Aug 1;15(2):160-7.
[xxv] Kuriyama Y, et al. Effects of taking salmon nasal cartilage extract (containing undenatured type II collagen and undenatured proteoglycan) on knee joint pain. J New Rem & Clin. 2016;65(11).
[xxvi] Aggarwal BB, Harikumar KB. Potential therapeutic effects of curcumin, the anti-inflammatory agent, against neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Int J Biochem Cell Biol. 2009 Jan;41(1):40-59.
[xxvii] Amalraj A, et al. A novel highly bioavailable curcumin formulation improves symptoms and diagnostic indicators in rheumatoid arthritis patients: a randomized, double-blind, placebo-controlled, two-dose, three-arm, and parallel-group study. J Med Food. 2017 Oct;20(10):1022-30.
[xxviii] Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012 Nov;26(11):1719-25.
[xxix] Panahi Y, et al. Mitigation of Systemic Oxidative Stress by Curcuminoids in Osteoarthritis: Results of a Randomized Controlled Trial. J Diet Suppl. 2016;13(2):209-20.
[xxx] Henrotin Y, et al. Curcumin: a new paradigm and therapeutic opportunity for the treatment of osteoarthritis: curcumin for osteoarthritis management. SpringerPlus 2013 Dec;2(1):56.
[xxxi] Delecroix B, et al. Curcumin and piperine supplementation and recovery following exercise induced muscle damage: a randomized controlled trial. J Sports Sci Med. 2017 Mar 1;16(1):147-53.
[xxxii] Oliver JM, et al. Novel form of curcumin attenuates performance decrements following muscle damaging exercise. The FASEB Journal. 2017 Apr;31(1_supplement):lb415.
[xxxiii] Anand P, et al. Bioavailability of curcumin: problems and promises. Mol Pharm. 2007 Nov-Dec;4(6):807-18.
[xxxiv] Amalraj A, et al. Biological activities of curcuminoids, other biomolecules from turmeric and their derivatives – a review. J Tradit Complement Med. 2016 Jun 15;7(2):205-33.
[xxxv] Nicol LM, et al. Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS). Eur J Appl Physiol. 2015 Aug;115(8):1769-77.
[xxxvi] Jäger R, et al. Comparative absorption of curcumin formulations. Nutr J. 2014 Jan 24;13:11.
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