Strengthening the body from the inside out through nutrition is an opportunity to increase strength and flexibility for bone and joint health while helping to manage aches and pains, a concept with high consumer knowledge. In fact, the state of the market for both manufacturing (new launches) and retail sales of joint health supplements and functional beverages/foods is quite healthy. Market researcher New Nutrition Business ranked “bones and movement,” in its “10 Key Trends in Food, Nutrition & Health 2010” report for the first time, noted Dean Mosca, president of Proprietary Nutritionals, Inc. (Kearny, NJ).

According to Kevin Isely, vice president of sales with Uckele Health & Nutrition (Blissfield, MI), when the company first started manufacturing joint products, there was “an unusual paradigm in the industry,” he said. “At this point, however, it seems like everybody has a bone and joint product. From our perspective as a retailer, there was a lot of margin in these products in the beginning. However, as the market has become more competitive, the margins have gone down.

“At the same time, as the market becomes more saturated, the consumer has become better informed, more aware of the need for and benefits of bone and joint supplements, and the customer base has increased,” Isely noted. “We’ve also started manufacturing more complex formulas designed for more targeted needs and optimal Benefits using the latest advances in science and technology.” Maday Labrador, director of scientific affairs with Enzymedica (Port Charlotte, FL), pointed out that the category isn’t just about conditions such as arthritis.

“There are many men and women in their 30’s and 40’s who are experiencing aches and pains that they never felt before and are now looking in their local health food store for an effective supplement. There’s also the athlete who needs strong bones and healthy joints in order to prevent injury.” In addition, new data shows that bone density should be checked at younger ages in females, also middleaged and older men should be checking their bone density—low bone density is no longer just an issue for women, said Chris Haynes, director of sales with Membrell, LLC (Carthage, MO), maker of NEM® Natural Eggshell Membrane.

“With the population aging, soon the US will have its oldest median population in history,” Haynes added. “With the aging Baby Boomers, more consumers will be seeking out natural products to enhance their lifestyles. The category is looking for something new, something that gives the consumer a choice over some of the everyday options.” Glucosamine and Chondroitin The joint health market has been dominated by glucosamine, however, conflicting results from various studies have led to a questioning of glucosamine’s and chondroitin’s efficacy.

“Currently, there is conflicting information available on the so-called cartilage ‘building blocks,’ glucosamine and chondroitin,” said Dr. Frank Schonlau, director of scientific communications, Horphag Research (Hoboken, NJ), supplier of Pycnogenol®. “A recent British meta-analysis on studies related to MSM for osteoarthritis (OA) concluded: ‘Current evidence suggests DMSO and MSM are not clinically effective in the reduction of pain in the treatment of OA’ (Brien et al.; eCAM 2009).

“This is indeed harmful for the whole category and it will be getting increasingly important to not only use the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score to identify improvements related to joint pain and flexibility,” said Schonlau. “Studies on glucosamine and MSM did not fully succeed in explaining how these substances might contribute to joint recovery. Such knowledge would be truly interesting, last but not least, also for the marketing of joint health formulas.” Other manufacturers disagree with the meta-analysis findings. According to Jason Mitchell, ND, vice president of research, education and new product development with Country Life (Hauppauge, NY), “I can say that glucosamine and chondroitin used correctly and for the correct issue should aid in supporting joint health and comfort.

Sometimes a person will, without that proper diagnosis from a professional, use the wrong product and will be what I call a non-responder. These studies are also hard to gauge as they are based on reported scoring from the participant. The bottom line is, that if used correctly, glucosamine and chondroitin work.” Mitchell added that there are a few new materials out there that have been increasing in use over the last few years such as hyaluronic acid (HA). “This is unique in that, if the correct material is used, it can stimulate synovio cites to produce synovial fluid which is a buffer between the bones that join at a joint.

The material that we are using is a bioactive form of HA in the product BioActive Hyaluronic Acid Complex.

Bioberrica is the company that produces the ingredient called HyalJoint.

This material has been used in many studies related to joint comfort and support and has been shown to be very effective. To my knowledge this is the only bioactive form on the market and can be a tad more expensive that other forms of HA on the market.” Jack Grogan, CN chief science officer with Uckele Health & Nutrition, said he also supports the benefits of glucosamine and chondroitin. “I respectfully disagree with the findings that showed lack of efficacy for glucosamine and chondroitin and consider them key proponents for joint support; their benefits are well established,” he said. “Considerably more studies have shown positive findings than negatives. In addition, millions of doses have been used, and people typically don’t keep using a product that doesn’t work.” Proprietary Nutritionals’ Mosca also argued that glucosamine and chondroitin still have a powerful number of studies showing efficacy through the long-term. “The phrase, ‘long-term’ is essential,” Mosca said. “The pharmaCeutical mindset is a ‘quick fix’ action; it is not about long-term nourishment or fortification and protection of the structure, function and integrity of the joints as is glucosamine and chondroitin.” More Choices To enhance the effectiveness of traditional bone and joint ingredients, Grogan suggested additional options to combine with the basics:

• Methylsulfonylmethane (MSM) is found naturally in food and throughout the body. A bio-available source of sulfur, MSM is important for connective tissue production and repair and has been shown to reduce cartilage breakdown by protecting the cartilage tissue.

• Cetylated fatty acids essentially modulate and stabilize inflammation so that tissues don’t become damaged.

They operate by up-regulating or downregulating the immune system cells involved in regulating pro-inflammatory substances. This mechanism is key to controlling the amounts and effects of progressive, pro-inflammatory issues that lead to joint and tissue damage, and is front and center to improving joint health.

A more widely used form is known as cetylmyristolate (CMO), a single cetylated fatty acid. The CMO form suppresses the pro-inflammatory aspects of the immune system cells, which works well when inflammation is occurring primarily as a result of immune system up-regulation. The downside is that it can be somewhat immuno-suppressive and make people more susceptible to colds and flus.

Cetylated fatty acids as a combination is more preferred because they help to balance the pro- and anti-inflammatory aspects of the immune system without being immuno-suppressive. Cetylated fatty acids in combination modulate the immune system, while CMO is an immune system suppresser.

• Collagen proteins primarily protect joints directly by supporting the integrity of joint tissues. The mechanism by which it works is similar to those of glucosamine and chondroitin sulfate; they protect the tissues by providing structural support proteins and by protecting chondrocyte cell integrity.

Collagen proteins are becoming more widely used in part because they are natural sources of chondroitin sulfate and hyaluronic acid.

• HA is also found throughout the body, with the highest concentration in the soft connective tissue, and has really come to the forefront. It operates by protecting synovial membranes and improving the fluid buffer in joint spaces, giving elasticity to the joints by retaining water in the cellular matrix. It is important for tissue hydration, lubrication and proper cellular function.

Many products combine glucosamine, chondroitin and hyaluronic acid, however one sees a lot of free-standing products as well.

• Omega-3 fatty acids include krill and other fish oils and are widely taken for cardiovascular and brain health, forgetting that they have equally powerful joint benefit. Using the same mechanism that protects cardiovascular and brain health, they moderate or reduce inflammatory processes in the joint.

• The use of specific amino acids for pain modification, such as Dlphenylalanine (DLPA) and leucine, involves inhibiting the enzymes responsible for breaking down the pain relieving substances that the body produces itself. They also have a mood-elevating benefit and increase mental, emotional and physical energy.

Therefore, they are more widely used for mood elevating and energy improving benefits and underused for pain relieving benefit.

• The use of herbs and botanical extracts has shown great promise in supporting joint health. Plants that have shown proven value include yucca schidigera extract, devils claw extract, boswellia serrata extract, turmeric extract, cat’s claw, fever few, white willow and cayenne.

The latest from Proprietary Nutritionals for joint support are Celadrin and companion ingredient Perluxan. Celadrin is a natural compound composed of animal-sourced esterified fatty acid carbons (EFACs).

According to Mosca, clinical trials have shown it to be safe, non-toxic and effective in reducing joint discomfort and improving joint flexibility.

In October 2009, the company launched Vege-Celadrin, Mosca said.

The plant-sourced material in Vege Celadrin provides the same fatty acid composition that has been proven effective in the original Celadrin ingredient.

Perluxan is a proprietary extract of hops cones clinically shown to reduce joint discomfort. A recent clinical study of patients with knee pain showed Perluxan had a fast-acting effect on VITAMIN RETAILER vitaminretailer.com  APRIL 2010 relieving discomfort and significant improvement over placebo after only two hours following the first dose.

For another option, though enzymes are mostly known for digestion, there are certain ones that when taken on an empty stomach support the body in other ways, Enzymedica’s Labrador said.

“For example, proteolytic enzymes (those that break down protein) are being used to help maintain joint health. These enzymes break down foreign particles and debris as well as accelerate elimination of unwanted pathogens and toxins by way of the lymphatic system. This has been shown to reduce the negative effects of harmful inflammation. One proteolytic enzyme serratiopeptidase has proven to be effective in alleviating joint discomfort, improving circulation and speeding tissue repair.” Enzymedica offers two products that can be beneficial for bone and joint health. One product, SerraGold, has been formulated using the potent serratiopeptidase enzyme and Enzymedica’s Protease Thera-blend and is intended for those seeking the highest potency serratiopeptidase available, the proteolytic enzyme which has proven to be effective in alleviating joint discomfort.

The other product is Repair Gold. This enzyme formula is designed to increase circulation and speed recovery. The enzymes in Repair Gold have been formulated to support muscle, tissue and joint recovery.

Bone and Joint Science Although it has been known for some time that calcium and vitamin D are critical in bone development, new science is suggesting a much higher level of vitamin D to be even more beneficial.

Furthermore, maintaining a neutral to slightly alkaline body pH is becoming increasingly recognized as a necessary component to both bone and joint health.

Kurt Althof, director of marketing with Coral LLC (Incline Village, NV), said the company launched a 5,000 IU vitamin D3, with 100mg of calcium product in April of 2009 to complement its flagship product Coral Complex 3 (calcium and trace minerals), and just recently launched Coral Calcium Alkalizing sachets.

For one retailer, it was her own health that sold her on the products. Sandra Ben-Joseph, owner and operator of Natural Solutions, Etc. in El Paso, TX, said she felt she wasn’t getting enough bone-building benefits from the supplements she was taking. “So when my husband, Eliezer Ben-Joseph, ND, introduced me to Coral Complex, I went on therapeutic values, taking nine to 12 capsules a day. In 10 months I had a four percent improvement in my bone density. My allopathic doctor couldn’t believe it. Without taking Fosamax!” According to Coral LLC, studies show that fossilized stony coral, or “above sea” coral, such as that found in Coral Complex, is more easily absorbed because coral calcium becomes ionic in water.

For Grogan, the new science is an expansion of existing science through committed research and discovery to advance all types of joint and bone care. “Because they typically generate very few side-effects, natural alternatives for maintaining joint health and comfort are being compared head-tohead with pharmaceutical options such as pain pills, that can cause side effects such as sleepiness and addiction or nonsteroidal anti-inflammatories, some of which have been linked to stomach, heart and blood vessel issues.

“We’re seeing the development of natural anti-inflammatories, combination products, the interaction of natural antiinflammatories with joint support nutrients, and the balance of mineral relationships for inflammatory balance,” Grogan added. “All of these formulas are providing more optimal, targeted benefit.” Uckele Health & Nutrition recently launched Celamax™, which combines ingredients with properties that reduce inflammation, can support pain relief and damaged joint, muscle and connective tissue. It contains cetylated fatty acides, L-leucine, an amino acid, DL-phenylaline and phellodendron tree extract.

Another company combining the old with the new while also using calcium, Country Life recently launched a new bone formula called Bone Solid. “We have incorporated the tried and true MCHA, which is a material that supplies a form of calcium that is consistent with what the body requires, calcium phosphate,” said Mitchell. “Ninety percent of the body’s calcium is stored in the bones in the form of calcium phosphate.

There are a great number of designer calcium forms, but the fact still remains that if the body can more easily recognize the form it will more easily utilize it for bone support. MCHA also provides collagen and many other nutrients that are also important for bone support. We included a clinically supported level of vitamin K at 1,000mcg, as this was shown to be an effective dose, and we are one of the first to use vitamin K at this level. We included a relatively new material called calcium fructoborate, which is a form of boron bio-identical to that which is found in fruits and vegetables. This form of boron has shown clinical results in supporting joint comfort and providing bone support. Other thanVitamin D3 of 1,000IU, there are several other ingredients, but this formula was designed to fuse older technology with new innovative science to pave the way for a new bone supporting formula.” Theo Kitschker, manager of Green Acres Health Foods in Piscataway, NJ, said he sees a lot of combination products.

“There used to be calcium, magnesium and a little vitamin D. Now they are adding naturally occurring trace minerals such as vitamins K and K2, calcium and boron.” Though the dosage of calcium in these newer products may be smaller, the whole food-based, calcium citrate and MCHA are more easily absorbed, he added.

Combating cartilage degeneration can also be addressed nutritionally.

“Modern active ingredients will need to demonstrate how they contribute to the end of harmful processes that degrade cartilage tissue,” said Horphag Research’s Schonlau. For example, this was done for an extract of French maritime pine bark, he noted. Several studies with human volunteers have elucidated how Pycnogenol tackles inflammatory processes and brings harmful enzymes under control that break down cartilage (MMPs) and cause pain (COX-2).

A study with arthritis patients could clearly show that pain lowering and pain medication sparing coincide with decreased inflammatory marker CRP.

“As the medical understanding of physiological processes involved in cartilage degeneration progresses, the supplement business must keep pace with ongoing research,” he added.

Ultimately, consumers want quick and easy products that work. Membrell’s Haynes noted that though NEM’s mode of action is currently under review, published clinical studies show the ingredient requires only a single 500mg dose per day to reduce pain and increase flexibility in just 10 days. “This is what consumers are looking for: convenience and effectiveness.”