Arthritis is an umbrella term for various kinds of inflammatory and painful joint degenerations. Osteoarthritis is the most common form of arthritis and is due to wear and tear on joints.
Osteoporosis refers to the process of decreasing bone density. With aging, musculoskeletal problems start affecting almost everyone. Since life expectancy has now increased to more than 80 years, osteoarthritis and osteoporosis have become classic age-related diseases.
The risk and progression of osteoarthritis and osteoporosis depend in large part on diet and exercise.
Sulfur is of central importance for the building of cartilage. Many reports suggest that we do not consume enough sulfur-containing amino acids in our daily diet 1.
The body’s sulfur requirements increase with age while, at the same time, the absorption of sulfur-containing amino acids becomes less efficient 2. The two amino acids, methionine and cysteine are good sulfur donors. Organic sulfur (MSM) is also a good option for nutritional supplementation.
Methionine: essential, sulfur donor
Methionine is an essential amino acid. This means that it cannot be synthesized by the body but must be ingested in food.
As a sulfur donor, methionine is of particular importance for people with affected joints. This is because cartilage contains three times the amount of sulfur of any other body tissue 3.
External supplementation with sulfur has been around for millennia in the form of sulfur baths. In this manner, sulfur is absorbed through the skin which provides anti-inflammatory benefits 4.
Cysteine and Methionine
There are two important sulfur-containing amino acids: methionine and cysteine. Cysteine has antioxidative properties and protects cells from oxidative stress. It also stimulates the immune system 5 and helps protect protein structures.
As an important sulfur donor, cysteine also has the ability to bind heavy metals in the body and render them harmless. The body is able to convert cysteine into methionine and vice versa. This is why the total amount of cysteine and methionine ingested is important.
MSM is also a well-researched sulfur donor. Several studies have shown that it also has anti-inflammatory properties.
In one study, American scientists found that MSM could improve joint flexibility and pain, as well as reduce wear on cartilage 8.
The effects were significantly better in the group receiving MSM than in the control group (receiving a placebo). MSM in combination with glucosamine attained better results than MSM alone.
Glucosamine and Chondroitin
Glucosamine and chondroitin are often recommended for osteoarthritis. These two amino sugars build the cartilage matrix, the basic structure of cartilage. This structure retains fluids that help absorb shock in the joints.
Because of their proven effectiveness, glucosamine and chondroitin are often prescribed as a medication. Since they are well-tolerated and generally considered to be harmless, they are also available as a nutritional supplement.
If these joint nutrients are taken as a supplement, they can also be combined with free-form amino acids, vitamins, and minerals without studies on the effectiveness of every supplement combination. As a result, the selection of products is quite extensive. There are many options in terms of dosage and composition.
Omega-3 Fatty Acids: DHA and EPA
Nutritionists, including the DGE (Deutsche Gesellschaft fuer Ernaehrung – German Nutrition Council), recommend eating fish rich in omega-3s twice a week. Fish is high in nutritional value on account of its protein and amino acid content, as well as the special omega-3 fatty acids it contains.
The two omega-3 fatty acids EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid) are important in metabolic processes, can only be found in large quantities in certain fish, and cannot be synthesized by the body.
They have positive effects on blood lipid levels, blood vessels, and the development of nerve cells (important for the eyes in aging and during pregnancy). They also have a modulating effect on the balance of fatty acids in the body.
In a study with 177 patients suffering from arthritis in the knees, it was found that the combination of omega-3 fatty acids DHA and EPA with glucosamine and chondroitin achieved 27% better results than supplementation with glucosamine and chondroitin alone 11.
While fatty acids from meats (saturated fatty acids) have an inflammatory effect, omega-3 fatty acids from fish have anti-inflammatory properties. The nutrition advice for healthy joints: eat less fatty meat (sausage and ham) and more fish rich in omega-3s.
Osteoarthritis makes itself known through pain and limited flexibility in the joints. Osteoporosis, on the other hand, is more insidious.
The loss of bone mass is unnoticeable – osteoporosis is not painful and has no symptoms. Until the bone breaks.
You may break an arm or wrist. However, often it is the head of the femur or a vertebra that breaks, resulting in months of bed rest.
Once your bones have become brittle, the damage cannot be reversed in a short period of time. It takes years of coordinated effort including exercise, diet, nutritional supplements (vitamin D, vitamin K, calcium, and magnesium), and perhaps even medication to strengthen bone tissue again.
This is why prevention is key. Osteoporosis prophylaxis should begin at age 40. Brittle bones take many years, even decades to develop. Women are more prone to osteoporosis than men and lose bone mass especially after menopause.
Vitamin D plays a central role in calcium metabolism and is crucial to bone maintenance. It is also involved in other metabolic processes and is important for the immune system.
Vitamin D is hardly found in food. Even the strictest diet with the foods containing the highest concentrations of vitamin D possible would not provide sufficient amounts of vitamin D.
Theoretically, we could synthesize enough vitamin D in the skin – but that requires sun exposure. In the summer, exposing your arms and legs 30 minutes a day to the noon sun is sufficient. However, since most of us apply sunscreen for protection against skin cancer, the skin’s ability to produce vitamin D is reduced by 95%.
In the winter, when the sun is at a lower angle, the amount of UV light that reaches us is insufficient. This factor, combined with thick clothing, makes it basically impossible to produce enough vitamin D.
Consequently, various independent studies point to a general deficiency in vitamin D: between 60% and 90% of the population evidence significantly low levels of vitamin D in the blood and have documented vitamin D deficiency.
The DGE recommends taking 10µg daily, after age fifty, that number increases to 20µg vitamin D3 daily.
Vitamin K is a fat soluble vitamin that is a key element for bone structure. It helps regulate osteocalcin, which is responsible for bone synthesis and breakdown 12.
Vitamin K is a safe vitamin for supplementation. Even at doses of over 4,000µg per day, no toxic effects were observed. The minimum recommended daily allowance of vitamin K is 75µg.
In addition to magnesium, calcium is THE mineral that builds bone structure and determines its density. Chronic calcium deficiency, combined with a deficit in vitamin D, is the main cause of osteoporosis.
A systematic review of 59 studies to determine if supplementation with calcium leads to stronger bones brought questionable results 13. Nevertheless, milk products such as cheese are excellent calcium donors and should be part of a regular diet to reduce the chance of a calcium deficiency.
Exercise is key for the prevention of osteoarthritis and osteoporosis
Sufficient exercise is very important for the musculoskeletal system: muscles, ligaments, tendons, joints and bones are worked, trained, and strengthened. As the saying goes: “use it or lose it.” Still, we tend to hop in the car, bus, or taxi to cover even short distances and use the elevator instead of the stairs for just a few floors.
Without training, our muscles continue to deteriorate. Subsequently muscles no longer can provide adequate support to joints, and bones and joints are excessively stressed.
Cartilage receives the nutrients it needs via fluids in the joint, not via blood vessels. In order for cartilage to be able to regenerate itself, the nutrients contained in the joint fluid have to be massaged into the joint. This occurs with regular exercise.
Bones, too, suffer if they do not get exercise. Putting a little strain on the bone structure stimulates osteoblasts to build bone mass. This can be achieved with light jogging, fast walking, or exercises with small weights.
Plenty of exercise is thus the key to prevention as well as therapy for both joint issues and weak bones.
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- Young VR. Protein and amino acid metabolism with reference to aging and the elderly. Progress in Clinical and Biological Research. 1990. 326:279-300 ↩
- Ammann P, Laib A, Bonjour JP, Meyer JM, Rüegsegger P, Rizzoli R. Dietary essential amino acid supplements increase bone strength by influencing bone mass and bone microarchitecture in ovariectomized adult rats fed an isocaloric low-protein diet. Journal of Bone and Mineral Research. 2002. 12(7):1264-1272 ↩
- Sukenik S, Buskila D, Neumann L, Kleiner-Baumgarten A, Zimlichman S, Horowitz J. Sulphur bath and mud pack treatment for rheumatoid arthritis at the Dead Sea area. Annals of the Rheumatic Diseases. 1990. 49(2):99-102 ↩
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- Lands LC, Grey VL, Smountas AA: Effect of supplementation with a cysteine donor on muscular performance. Journal of Applied Physiology. 1999. 87(4):1381-1385 ↩
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- Brien S, Prescott P, Bashir N, Lewith H, Lewith G. Systematic review of the nutritional supplements dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM) in the treatment of osteoarthritis. Osteoarthritis and Cartilage. 2008. 16(11):1277-88 ↩
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- Grünwald J, Petzold E, Busch R, Petzold HP, Graubaum HJ. Effect of glucosamine sulfate with or without omega-3 fatty acids in patients with osteoarthritis. Advances in Therapy. 2009. 26:858 ↩
- Booth SL, Broe KE, Gagnon DR, Tucker KL, Hannan MT, McLean RR, Dawson-Hughes B, Wilson PWF, Cupples LA, Kiel DP. Vitamin K intake and bone mineral density in women and men. American Journal of Clinical Nutrition. 2003. 77(2):512-516 ↩
- Tai V, Leung W, Grey A, Reid IR, Bolland MJ, Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ. 2015. 351 ↩