Speaking of Boswellia, there are options here, too. One to look for: AprèsFlex, “a synergistic combination of two proprietary extracts derived from Boswellia serrata gum resin,” according to Steve Fink, VP Marketing, PLT. “It contains 20% AKBA, and was developed based on a first-generation clinically studied Boswellia serrata extract (5-LOXIN) that provided 30% AKBA along with other boswellic acids. The addition of Boswellia non-acidic resin extract to the acidic fraction using a proprietary controlled process led to the creation of AprèsFlex. The oral bioavailability of AKBA from AprèsFlex was found to be significantly higher in comparison with that of other commercially available Boswellia extracts. At AKBA equivalent dose, AprèsFlex delivers 52% more AKBA to the serum compared to conventional Boswellia serrata.”
Other considerations: size of the dose and time to efficacy. Fink says that, as per seven pre-clinical studies and three human clinical trials, “AprèsFlex has demonstrated efficacy starting at five days, at 100mg, a significantly lower dose than other joint health ingredients. A 2014 clinical trial with AprèsFlex showed a nearly 20% improvement in joint comfort over baseline at five days and a 50% improvement in joint comfort at 30 days; a previous, similar study showed a 70% improvement in joint comfort at 90 days. Beyond joint comfort and flexibility improvements, AprèsFlex also positively impacts biological markers associated with joint health and inflammation, including TNFa, CRP, and IL-6. It was also shown to significantly inhibit matrix metalloproteinase, enzymes that break down cartilage, collagen, and connective tissues.”
HP Ingredients (HPI) has another option for shutting down inflammation, this time targeting Nuclear Factor-kB, or NF-kB, via PPAR-gamma, which shuts down NF-kB. ParActin is a patented extraction of Andrographis paniculata. Annie Eng, CEO of HPI, says that “these naturally occurring phytochemicals have been shown by researchers to support healthy joints, bones, and muscles; this is so important to today’s active lifestyle.” Another important factor: scientific backing. “ParActin is braced by more than a dozen studies, including several human clinical trials that show not only efficacy in maintaining healthy bone structure, but also in supporting aging joints that emanate discomfort. Studies also show how ParActin exerts such efficacies. Primarily, it works on several distinct pathways that lead to inflammation.”
Those looking to go straight to the heart of the matter may look to collagen itself as a supplement. One consideration is type—collagen has several. Samantha Ford, MS, Director of Business Development at AIDP breaks it down: “Collagen type I, commonly available from fish sources, is most relevant to skin structure and function; collagen type II, commonly found in avian sources, targets joint and cartilage health. Collagens type I and III are most relevant to bone health, and most often come from bovine sources.” Taste and processing, she says, often separate one product from another, as does application. “AIDP offers collagens across the full spectrum—I to X—from marine, avian, and bovine sources that can suit a variety of formulation needs in supplement and food and beverage applications.”
Lonza also offers type II collagen: UC-II undenatured collagen, which, Erickson says, “is backed by extensive scientific evidence supporting its role in joint health, flexibility, and mobility.” Lonza’s DUOCAP capsule-in-capsule technology, she adds, “can facilitate innovative combination formulas. Not only does this enable consumers to achieve synergistic results from two ingredients in a single capsule, it also provides an opportunity for manufacturers in this space to create unique offerings.”
UC-II can be found in Solgar’s No. 7 Vegetable Capsules, along with vitamin C, Boswellia, curcumin, and several other bioactive joint-health ingredients. Solgar’s website notes that the product has been shown to measurably improve joint comfort within seven days.
Cannabidiol (CBD), too, falls into the joint health category. “We receive anecdotal reports from consumers struggling with common aches, pains, and inflammation that results from normal life and aging,” says Michael D. Lewis, M.D., MPH, MBA, FACPM, FACN, Colonel, U.S. Army (Retired), Medical Advisor to CV Sciences. “These consumers report satisfaction with our distilled Gold products, particularly our PlusCBD Oil Extra Strength softgels. These softgels are our most concentrated form of CBD-rich hemp extracts and are intended for people who might need to be taking more CBD; plus, they’re a convenient way to ensure consistent serving sizes.”
As with all supplements, consumers should discuss their options with a healthcare practitioner; however, should that practitioner recommend CBD, Dr. Lewis advises: “We always recommend to start low and go slow. Try the minimum amount for a week to see how it affects your system and to allow for your ECS to achieve balance. Then, begin to slowly raise the serving size until you find the optimal health outcomes you are seeking. Then stop there.” Using both a topical and an ingestible, he adds, will provide relief from both the inside and the outside.
Eggshell membrane is another trending ingredient. “NEM is the original and scientific leader for eggshell membrane, thus starting the global market furor for something new in the joint health market,” say Nena Dockery, Scientific and Regulatory Manager, Stratum Nutrition, and Chris Haynes, Senior Director of Global Sales and Marketing, Stratum. “NEM is the only eggshell membrane backed by a significant number of published research studies. Those studies encompass randomized controlled clinical trials, healthy population trials, in vitro mode-of-action, in vivo studies, and veterinary trials.”
One of recent study on NEM looked at healthy individuals: Dockery and Haynes say the primary endpoint was a change in levels of a particular biomarker of type II collagen metabolism and breakdown, which was significantly reduced with NEM supplementation, “indicating a substantial benefit to joint cartilage integrity.” The study included post-menopausal women, a demographic susceptible to joint challenges, and the women saw “noteworthy” improvements in both pain and stiffness. Dockery and Haynes add that a second study, not yet published, expanded the age and gender parameters to include men and women ages 40-75; the results were the same.
Another to add to the joint health mix: sulfur. “Sulfur is the third most abundant mineral in the human body,” says Tim Hammond, VP of Sales and Marketing at Bergstrom Nutrition, “and OptiMSM is a proven source of bioavailable sulfur. It supports the structure and flexibility of connective tissue, which includes supporting and maintaining collagen disulfide bonds. Sulfur is a necessary nutrient for the maintenance of joints, tendons, and ligaments—as well as skin, hair, and nails.” For more, check out Sulfur: The Forgotten Nutrient, a white paper from Bergstrom that shines a spotlight on this important mineral.
Sulfur plays a role in another option, as well—Aged Garlic Extract, available from Wakunaga of America as Kyolic. Jay Levy, Director of Sales, says: “Aged Garlic Extract contains compounds that have been found to help protect against osteoarthritis. A 2017 study conducted at the University of Florida found that AGE modifies inflammation in a group of obese individuals. This may help prevent or improve chronic joint issues like osteoarthritis. Earlier studies suggest that certain sulfur compounds in garlic known as diallyl disulphide may suppress the damaging enzymes that are linked with osteoarthritis. Another possible mechanism of action is the high antioxidant content found in garlic, and especially in AGE. This may play a key role in protecting joints, particularly since free radicals have been shown to undermine normal chondrocyte activity and promote cartilage damage.”
Additional benefits may come from combining AGE with curcumin and omega-3s—several studies, Levy says, have found that omega-3s inhibit COX-2 and reduce oxidative stress. “Osteoarthritis can reduce the quality of life for people with this painful and potentially disabling condition. However, these findings suggest that combining AGE with curcumin and omega-3s may provide safe and effective relief for both the pain and stiffness that can undermine an active lifestyle in those with joint issues.”
“Bones aren’t static rock-like material as you see in skeletons,” Levin says. “They’re living tissues with a matrix of collagen. As we grow and mature, especially if active and well-nourished, we accumulate bone density. This serves as a reserve later in life as various factors affect bone density, including diet, sunlight, and exercise, or the lack of any of these essentials.” He adds that those lacking these essentials between birth and the teen years may have inhibited bone growth and development.
“Bones need not only calcium, but a balance of different vitamins and minerals to remain strong,” says Audrey Ross, National Educator at Country Life Vitamins. “Ideally, people should look for a supplement that can provide a full range of vitamins and minerals that work to support bone health.” However, that doesn’t mean calcium isn’t important—and it doesn’t mean that there’s nothing there to learn. “When selecting a bone health supplement,” Ross continues, “the first step is selecting the right form of calcium. Calcium phosphate—aka hydroxyapatite—is the predominant form of calcium in the bone. A supplement such as Country Life’s Calcium Magnesium Complex contains the right balance of calcium, phosphorus, and magnesium to support bone health.”
Something else to consider: “Calcium is needed by the body for skeleton building, muscle contraction, nerve signaling, and other metabolic processes,” says AIDP’s Ford. “However, excess calcium can accumulate in blood vessels and other soft tissues. K2VITAL is an ideal solution to this paradox; it directs calcium to the right place, to the bones, supporting bone strength and circulatory health.”
Calcium, as Ross noted, isn’t enough on its own. A good choice for accompaniment: vitamin K2—not K1, stresses Kate Quackenbush, Communications Director with NattoPharma. “K vitamins are actually a family of vitamins made up of vitamin K1, phylloquinone, and vitamin K2, menaquinone,” she explains. “Think of K1 and K2 as fraternal twins. They share similarities, such as working in the liver for blood clotting, and chemically, they share a quinone ring called menadione. But that is where their similarities end. Vitamin K2 has several molecules, called menaquinones, which makes it available beyond the liver for other systems, such as the bones and the vasculature. Vitamin K2 supports bone and cardiovascular health by activating K-dependent proteins osteocalcin, which binds calcium to the bone mineral matrix, and matrix Gla protein (MGP), which inhibits calcium from depositing in arteries and soft tissues. Put simply: Vitamin K2 can do what K1 cannot.”
That isn’t the only factor to consider with vitamin K: “Adding to the K confusion: There are actually multiple forms of K2,” Quackenbush says. “The two most common forms as dietary supplements are K2 as menaquinone-4 (MK-4) and K2 as MK-7 (menaquinone-7). Due to its side chain, MK-7 has a much longer half-life in the body than MK-4, allowing it greater access to tissues beyond the liver. Further, the serum half-life of MK-4 has been shown to be just a few hours compared to a 3+ day half-life for MK-7. So, although they have the same molecular mechanism of action, MK-7 is more bioavailable than MK-4. And due to MK-4’s short half-life and poor bioavailability, it requires multiple doses per day at milligram levels—versus MK-7’s microgram levels—for measurable efficacy.”
This isn’t to say that people shouldn’t take other forms of vitamin K; it’s just that MK-7 is the most efficacious for bone health. Quackenbush notes that Nattopharma offers a Full Spectrum K2, which, in addition to MK-7, also delivers MK-6 and MK-9, “for optimal and maximal delivery of vitamin K2 with respect to absorption, half-life, and biological activity.” Why these isomers? Quackenbush says they “most closely mirror the K2 delivered in the most popular K2 food source in the West: cheese.”