x-ray of arthritic ankle and foot

Last month covered the various types of arthritis, diet, and what the docs like to call “lifestyle.”  This month we focus on supplements.

If this even attempted to be a comprehensive listing, we’d be going on for pages, and pages and pages.  Instead, let’s talk about a few supplements which really work, and then cover a few that don’t really work, but which are being heavily marketed and promoted.

To make things even simpler, we’re going to divide the supplements up into three categories.

  1.  Supplements that support the structural integrity of joint cartilage.
  2. Supplements which shift the balance of inflammation over a few days to a few weeks.
  3. Supplements which jump in and intercept inflammation quickly.

Even simplifying, the list may seem overwhelming.  So where do you start?  Well, some people like to take a shotgun approach, fill their shopping basket full of pill bottles, and just go for it.  This may not be the most elegant approach, but it does tend to work.  (Although it will help to use supplements that are complementary to one another, not just redundant).

For those who want to approach things a little more methodically, a suggestion:

  • For osteoarthritis, look at glucosamine (supports joint cartilage) first.  You’re dealing with progressive breakdown of joint cartilage, so you’re going to want something which addresses that.
  • For rheumatoid arthritis, try fish oil (shifts the balance of inflammation) first.  In rheumatism, inflammation causes the joint breakdown, so addressing inflammation can get closer to the root of the problem.  Besides, any time you take something with 101 benefits (like fish oil), you ought to!
  • For most kinds of arthritis, combos work best.  Perhaps use a nutrient that supports joint integrity, combined with a slow-acting, deep anti-inflammatory; plus a quicker, herbal anti-inflammatory on hand for bad days or long hikes.


Like all tissues in the human body, joint cartilage exists in a constant state of balance between degeneration and regeneration; between wear and tear, and repair.   As we get older, however, repair slows down, and the balance shifts to breakdown. Supplements which support cartilage integrity try to shift the balance back.  Mostly, they are simply raw materials to actually (re)build joint cartilage, in the same way bricks and mortar are raw materials to build a house.

Glucosamine: 1,500 mg/day in divided doses is the standard for this consistently effective joint rejuvenator.  It takes 2-6 weeks to start working, and may take longer to plateau.  But it continues to work even if you skip a dose or two.

Glucosamine lubricates the joints.  Research shows that glucosamine taken over a number of years actually keeps joints healthier.   Glucosamine is often (but not always) derived from shellfish.  If you’re allergic, read labels!  Other than that (and the occasional upset stomach) glucosamine is very safe.

Chondroitin: traditionally paired with glucosamine (1,000-1,500 mg/day in divided doses).  We know that the combos work for most people, but it turns out, that for most people, Chondroitin is doesn’t contribute much to the combos.  And then for some, it really does.  Hard to predict.

Some people get better results using Chondroitin from sea cucumber (not a vegetable!) than the normal stuff derived from bovine tracheal cartilage.  800-1,500 mg/day is standard, in divided dose.  It takes 2-6 weeks.

MSM: stands for methylsulfonylmethane, basically a way of getting sulfur, which helps hold the joints together.  (Please note that elemental sulfur is different than the “sulfa” short for sulfonamide antibiotics that many people are allergic to).  MSM works well on its own, and in conjunction with glucosamine.

Try MSM if glucosamine is working for you just not quite well enough.  A standard dose is 3-6,000 mg/day, in divided doses (although you’ll often find less in formulas).  Give it anywhere from a few days to a full month to start working.

MSM may also hold side benefits.  It sometimes helps clear up problem skin, and can relieve sinus congestion.  Also, it’s fairly common for people to snore less when they take it.


Sometimes, inflammation is a natural and appropriate state of being.  Sprain your ankle, or poke yourself with a sharp stick, and the area should become inflamed.  Other times inflammation develops in ways that it shouldn’t chronic inflammation, fueled by an imbalance in the fatty makeup of cell membranes.  You won’t be able to shift the balance in the cell membranes overnight.  But you can over time, giving your body what it needs to regulate itself, instead of taking drugs (or herbs) which do the regulation for it.

Now, go back and read the first part under “Diet” (our November newsletter) where it talks about balancing the fats in your diet.  To continue:

Fish Oil: Well, fish oil helps just about everything, and when talking about arthritis and inflammation, it’s no exception.  A standard dose is 1,500-2,000 mg/day of EPA (which is a component of fish oil).  Divided doses aren’t necessary, but do take it with food.  You can get by with a little bit less if you eat very little meat and cheese and trans-fats; you’re going to want more if your diet contains a lot of these.

Flax oil and other vegetarian sources of omega-3 fats, including hempseed, walnuts, chia, and sacha inchi: most vegetarian omega-3s provide only precursors to the active EPA found in fish oil.  Even the most optimistic estimates say that 15% of what’s in flax, hemp, etc., gets converted into active EPA.  Flax is good, but it doesn’t pack the punch that fish oil does.

Borage, Primrose, and Black Currant Seed Oils: All sources of an anti-inflammatory fat called GLA, borage is the least expensive and most efficient source.  Although GLA can benefit anyone, look to add GLA to fish oil especially if there’s also eczema or psoriasis.  500-1,000 mg a day.  (Debra uses the liquid, and the does is ½ teaspoon daily.)

“Newfangled” anti-inflammatory fats: these include brand-name products like Celadrin, FlexNow, Lyprinol, and ASU (Avocado-Soy Unsaponifiables).  It might be hard to navigate through all these competing products, and their competing claims.  Well, despite the New York Times bestselling book behind ASU, the very clever biochemistry behind Lyprinol and the European research behind FlexNow, it has been our experience that Celadrin is the one which really shines.  It’s also the least expensive of the bunch.  Let’s call FlexNow a close second.  ASU is worth looking at, too, as the only vegetarian member of the bunch.  With any and all of these, take according to bottle directions.

Boron: this mineral, essential to life, is still left out of many multivitamins because the U.S. government hasn’t established a recommended daily allowance for it yet.  It’s necessary to convert vitamin D to its active form.  A simple 3-6 mg a day can help.  Consider this if you’re not taking a multi or bone supplement that already supplies some.


Unlike the slower-acting anti-inflammatories listed above, these don’t provide your body what it needs to self-regulate.   Instead they jump in and attempt to regulate the body by blocking the inflammatory process.

Really, the best way to do this is to reach for a formula.  Different ingredients will intercept different branches of the inflammatory cascade, hitting inflammation from different angles.  That being said, here are a few single ingredients that are especially effective.

Turmeric: Like fish oil (mentioned above) turmeric is a wonderful supplement because it protects us in so many different ways not just our joints.  A standard dose is 2,000 mg of the extract standardized to 95% curcumin, in divided doses (although it’s possible to exceed this dose significantly).

Boswellia:  This resin extracted from the frankincense bush is both a wonderful anti-inflammatory in its own right, and an ideal complement to many of the other herbs out there because it works differently than most of them.

Bromelain:  This pineapple extract might be the simplest anti-inflammatory we have.  A standard dose is 4,000 GDU/day.

Homeopathic Arnica:  This can be used after the rugby match, or whatever else has just made the arthritis worse.  It may, however, make very hot, inflamed rheumatism worse.