Ball Joints and Sternums

To remain healthy, the cartilage in your body requires substances to attract and maintain water molecules within it. Chondroitin sulfate is one of a group of structures within healthy cartilage that, like sponges, soak water into a collagenous mesh.

In addition to assisting in the water-binding process, chondroitin sulfate appears to help diminish osteoarthritic pain. Investigations into its clinical activity in osteoarthritis, both alone and accompanied by glucosamine hydrochloride, are ongoing and encouraging.

If I hadn't begun a heavy regimen of chondrotin/glucosamine—it must be 10 years ago by now—the quarterly hip attacks, first left hip, then right, four times a year, almost like clockwork, that prevented me each time, for at least one week at a time, from walking without a cane because of pain, I am certain would have brought me, begging for relief, to re-enact my mother's dual hip-replacement surgery.

A more recent addition to this regimen is methyl-sulfonyl-methane (MSM), which in combination with glucosamine and chondroitin finally caused my husband's arthritic symptoms to decline.

Anecdotal? Admittedly, but with a scientific basis.

In 1999 a study involving 34 men from the US Navy diving and special warfare community reported encouraging results with glucosamine, chondroitin, and manganese ascorbate (Leffler et al, 1999). Designed with all the bells and whistlesThat is, it was a 16-week, randomized, double-blind, placebo-controlled, crossover pilot study. , the relatively short study saw a significant improvement in physical-examination scores for treated patients, while still-improved changes in scores of tenderness, effusion, swelling, and warmth did not reach significance. Trends toward benefit in low back pain failed to reach significance, along with other measures.

Nevertheless, this early trial was promising in that it delivered some positive results despite short treatment times and the fact that the subjects were mere babes (well, young; I didn't see their pictures), presumably relatively unencumbered by osteoarthritis.

But there is another reason that US trials of chondroitin and glucosamine sometimes do not appear as successful as equivalent European studies, and that is that they may in fact not be equivalent.

Random laboratory testing by Consumer Labs of several well-known brands of chondroitin sulfate showed that no fewer than 73% contained subpotent percentages of the quantity advertised (and tests of other substances fared similarly), with some amounts of chondroitin sulfate, in this instance, falling fall short of the label's claim.

In addition, a recent issue of Integrative Medicine: A Clinician's Journal ( pointed out that measurement variations, which can also affect conclusions as to an ingredient's potency and purity, must be taken into consideration before clinical trials of any supplement will have meaning.

So what do we do—Let regulation descend into gov'mint regulation?  I really don't know where I stand on that—FDA coverage for the supplement industry.  It would have its good aspects, being certainty, and bad aspects, being up-up-up prices. 

My guess is that eventually the supplement industry, along with every other aspect of our personal lives if allow it, will fall under the giant umbrella of gov'mint regulation, with every single one of its good and its not-good aspects.

Okay, but What's Wrong With Aspirin?

What's wrong with aspirin? It's recommended all the time, by medical practitioners conservative and fringe (well, maybe not way-far-fringe). A bit of background.

Aspirin is an NSAID—a non-steroidal anti-inflammatory drug—which basically means that it reduces swelling (swelling often causes pain) without using steroids.

Other NSAIDs include most of the non-injectable, over-the-counter available, pain relievers—acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), naproxen (Aleve®), COX-2 inhibitors (Celebrex®, Bextra®).

NSAIDs do reduce pain. But long-term use includes gastric irritation. And, when used for arthritic pain, they have one momentous, and for some reason seldom recognized, drawback.

First, they irritate the stomach lining. This impacts some people more than others. For anyone, it helps if you take something else in, something food-like, at the same time. Bread is good. (Whole wheat, of course!)

PalliativeBasically, when you see that word, read "band-aid". It does not purport to cure; it merely ameliorates the pain. treatment of arthritic pain, according to the authors of The Arthritis Cure, interferes with the homeostasis (the right-and-proper, natural, healthy regulation, if you will) of the joint itself.

What? You say that in arthritis the "healthy regulation" of the joint is impaired anyway?

Verily it is, but the chemical activity of NSAIDs, even as it relieves your pain, actually damages the joint.

This requires some explanation. No arthritis in that lucky avocet.

Inflammation occurs in the joints from arthritis, or sometimes from simple over-use of the joint. In any case, it causes discomfort—stiff-ness, swelling, difficulty bending a finger or sudden sharp pain from knocking on doors, for example. The inflammation occurs because the body is responding to tissue damage or over-use.

Inflammation is actually protective. When tissue is damaged, white blood cells are attracted to the area, where they attack invading cells, if existent, and remove damaged cells. In performing these acts the white blood cells produce leukotrienes and prostaglandins, substances that turn on a response resulting in, among other things, swelling. But as the white blood cells are releasing these chemicals they also produce free radicals.

Free radicals are somewhat like bowling balls hurled blindly within your neighborhood blown-glass shop. Unstable because they've lost an electron they careen around seeking a replacement. They usually gain their lost electron by "stealing" one from the nearest molecule. That creates another free radical, and a cascade commences. Eventually, a living cell is disrupted or worse.

This kind of thing—the flight of free radicals—happens throughout life (sometimes even instigated defensively by your own immune system), and damage slowly begins to build (or deconstruct). In the joint area, free radicals damage the cartilage. Everywhere, we age.

Encouraging, isn't it?

What is encouraging is antioxidantsNow that a pall of suspicion has been cast over Vitamin E, Vitamin C is our main man. Vitamin C, contained within fresh fruit, not-very-cooked fresh vegetables, and, of course, supplements, does not become a free radical itself upon donating an electron to a hungry free radical because an antioxidant is stable in either form. Nifty, eh? , which neutralize free radicals. If antioxidants are available, that is. Eat that C.

Back to the subject, arthritis. It's tricky in that its inflammation remains long after whatever started it is gone.

Its inflammation—actually, any inflammation—can be affected, for better or for worse, by what you eat. By your diet.

You've heard of the fatty acids that inhabit certain foods.

After you ingest fatty acids, your body makes something called prostaglandins, mentioned above, out of them.

Prostaglandins don't 'live' very long, but while they're around they are involved in inflammation. I say that in an indirect way because their involvement can be either positive or negative, depending on the flavor of prostaglandin that your body produces.

Certain prostaglandins reduce inflammation, and others increase it. Different flavors indeed.

Speaking of flavors, it is the type of food that you eat, with its resident fatty acids, that underlies much of this process.

Animal products that contain saturated fats—that would be red meat, whole cheese, whole eggs (really just the yoke), even poultry—contain a type of fatty acid called arachidonic acid. Does that awaken your arachnophobia? It shouldn't. Although its root arach- appears similar to that of the word signifying an unreasonable fear of spiders, in fact the root of arachidonic is arachidic and it refers to a groundnut. Not much to fear there. But perhaps the term arachidonic acid will not seem so foreign to you now.

An aside about physiology. Seldom can we find in the body (as elsewhere) examples of either unadulterated good or unmitigated evil. The chemicals careening around in our bodies all the while we live often play more than one role, some good, some bad, some maybe even ugly. Some fatty acids are essential. Essential fatty acids are those that are required for life and that cannot be manufactured in the body. Essential fatty acids, then, must be taken in through diet.

For some of us mammals, arachidonic acid is an essential fatty acid. Many mammals make it themselves from a precursor, in which case it is not essential; but others, such as my sweet little kitty, are unable to do so. Since plants contain little or no arachidonic acid, those unable to do it themselves are called by the evocative term obligate carnivores. (I have known obligate liars and, as well, I've known people who consider themselves, perhaps wistfully, obligate carnivores and any daughter, by logical extension, her fully owned derivative carnivore.)

Humans can make a certain amount of arachidonic acid from its precursor linoleic acid (hence, and especially with intelligent food combinations, lacto-ovo-vegetarians survive).

However, when derived from saturated fats, arachidonic acid produces an inflammatory type of prostaglandin—ones that in addition to inflammation can cause platelets to become 'sticky' and clump together, and that foment the bases of arterial hardening and strokes.

By eating meat including chicken, any dairy containing saturated fats, and egg yolks, then, we not only obtain a fatty acid that our bodies require, we assist the inflammation of arthritis.

That's irony As opposed to 'intelligent design'. for you.

But our bodies, nothing if not versatile, can make anti-inflammatory prostaglandins as well. To a certain extent, in theory anyway, we can undo inflammatory damage by eating foods (or supplements) containing alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA), and linoleic acid.

Whole grains, deep-green leafy vegetables, and especially (even as their embattled numbers ever diminish because of too many people in this world) ocean fish contain various combinations of these beneficial-prostaglandin precursors.
top Seeking arachidonic acid

We were talking about NSAIDs, remember, and specifically about what they do to interfere with the happy regulation of your arthritic joint.

What all NSAIDs do—how they work, in fact—is by slowing production of prostaglandins.

Some of these prostaglandins will have been the ones causing the pain or inflammation, and vôila, you feel better.

Unfortunately NSAIDs, and even to less extent COX-2 inhibitors, cannot distinguish between 'good' and 'bad' prostaglandins; they block 'em all.

And the longer you take NSAIDs, the more likely you are to experience such adverse effects as high blood pressure, gastric irritation, even (another irony for the headache-prone among us) headache.

There is also evidence that NSAIDs block synthesis of another substance, proteoglycans.

Proteoglycans are molecules that in effect create the sponge-like effect of water-attracting and water-softened, healthy cartilage. Without proteoglycans to attract water to cartilage, arthritis progresses.

Even as your arthritis, pain and inflammation masked, is doing more damage to your cartilage, you and, too often, your doctor believe that your arthritis is under control.

Chondroitin/glucosamine/MSM—These are all substances that help the cartilage attract water and nutrients into it, and heal.In addition to assisting in the water-binding process, chondroitin sulfate, taken regularly, appears to help diminish osteoarthritic painIt certainly did with me. . It may be the path around NSAIDs.

Keep in mind two points: Individuals react differently to different treatments.   And, on the other hand, some brands contain insufficient amounts of chondroitin and/or glucosamine. Consult your healthcare practitioner, and if he or she is unenlightened, prepare to disabuse!

It's old now, but it has been revised, and you can still get The Arthritis Cure, new or used, by Jason Theodosakis and Sheila Buff on I am much indebted to their very accessible scholarship. Read it. It's worth it.

Full o' fatty acids

 The Clock is Ticking           

 even in Boulder!