By Carolyn Seber. This article originally appeared in Nutrition Industry Executive Magazine on July 21, 2014.
Traditionally targeting an older audience, the natural joint health market is expanding to meet the needs of a younger generation.
Arthritis, a condition that causes pain, swelling and stiffness in the joints, is the No. 1 cause of disability in the nation, affecting an estimated 50 million U.S. adults. This chronic condition includes more than 100 different rheumatic diseases, the most common of which is osteoarthritis, according to the Centers for Disease Control and Prevention. Other forms are rheumatoid arthritis, lupus, fibromyalgia and gout.
The joint health market has targeted aging Baby Boomers who are feeling the effects of years of wear and tear on their joints. The market for joint supplements is still strong within this group, but it is quickly expanding to meet the needs of younger generations. According to Dr. Jay Udani, founder and CEO of California-based contract researcher Medicus Research and Systemedicus, it’s no longer just the Baby Boomer generation struggling with joint pain; people can start having problems by age 30, depending on how much micro trauma they have caused themselves.
“Anybody who has been physically active—whether athletes or weekend warriors—will have episodes of micro trauma to their larger joints (such as ankles, knees, hips) that over time start to wear out and begin to show signs and symptoms of discomfort when they are exercising,” said Udani. “It’s not that they have arthritis, but they’re in a pre-arthritic state … Of course, if there’s any major traumatic event, it can result in a faster generation of the degenerative process, leading to this joint discomfort.”
Younger consumers are looking for ways to alleviate joint pain so they can keep up their normal exercise routines, said Udani. And others are looking for ways to prevent themselves from having problems down the road. “Generation X—those now predominantly in their 40s and following in the Baby Boomers indelible footsteps— folks in this age group are significantly interested in maintaining joint health and mobility,” said Dean Mosca, president of New Jersey-based Proprietary Nutritionals.
Tim Hammond, vice president of sales and marketing at Washingtonbased Bergstrom Nutrition, agreed that joint health is piquing the interest of younger people. He said recent studies on MSM (methylsulfonylmethane) suggest its effect on muscle and joint recovery, which could attract a younger consumer. “Youths tend to be more focused on products targeting energy or performance, and being bigger, stronger, faster, or more flexible,” he said. “Joint health products are viewed as products for ‘old people.’ However, it should be strongly considered as part of an overall active recovery, preventative and healthy aging supplement protocol.”
To combat joint health issues, supplements can do three things: reduce inflammation, dull pain, or help rebuild the joint by providing necessary nutrients, said Udani. The old standbys that support joint health are glucosamine, chondroitin, MSM, collagen and omega fatty acids.
Several well-designed studies have suggested that supplemental chondroitin, a major component of cartilage, may be effective in treating osteoarthritis (OA) of the knee or hip by helping to reduce pain, improve functional status and reduce joint swelling and stiffness.¹ But other studies had mixed results.
Glucosamine, another key part of cartilage, has been suggested as an effective treatment for OA, but again with some mixed results, according to a study called the 2006 Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), sponsored by the National Institutes of Health. This study of approximately 1,600 people with OA of the knee found that glucosamine alone, or in combination with chondroitin, did not reduce pain in the overall group, but did appear to lessen pain among those with moderate to severe OA of the knee.²
As mentioned earlier, MSM is another popular joint health ingredient as it helps form connective tissue such as cartilage, tendons and ligaments. It may also slow nerve impulses that transmit pain signals, thus reducing pain.³ Bergstrom Nutrition offers an MSM ingredient called OptiMSM, manufactured exclusively in the U.S.
According to Hammond, recent studies have supported that OptiMSM helps combat exercise-induced inflammation by decreasing the amount of free radicals formed as a result of intense activity, and that it decreases measures of muscle damage and soreness. “This means less recovery time and a quicker return to exercise or daily activity,” he added.
Another study4, conducted in 2011, looked at oxidative stress from exercise in untrained healthy males. The double blind, placebo-controlled study reviewed subjects for 10 days as they received 50 mg/kg body weight of MSM (equating to 3.75 g/day for a 75 kg person). They then completed a 14 km run. According to the study, the group treated with MSM showed favorable effects on biomarkers of oxidative stress following the exercise.
Collagen, another well-known supplement for joint health, is the basic building material of all fibrous connective tissue and is the main component of ligaments, tendons, cartilage, bones, nails and skin, said Lauren Clardy of Canada-based Nippi Collagen NA Inc. Clardy is managing director of Nutrimarketing and vice president of marketing and business development for Nippi North America, which produces the TruMarine Collagen ingredient.
“As we age, our body loses the ability to replenish natural collagen levels, leading to weakened, fracture-prone bones and stiff joints,” she said. “The beneficial effects of collagen peptides have been reported in numerous research findings for improving both bone and joint health. Supplementing our diet with collagen peptides promotes joint health by helping to repair deteriorated joint matrices, thereby improving long-term joint comfort and mobility.”
TruMarine Collagen is a highly soluble form of bioavailable type I collagen sourced from sustainable fish, according to the company. Clinical trials have shown that supplementing with TruMarine Collagen significantly reduces joint pain and discomfort because it protects against joint matrix degeneration and reduces oxidative damage, resulting in joint pain reduction and improved long-term joint comfort and mobility, Clardy said. “Osteoarthritis, the most common form of arthritis, is the result of joint and cartilage degradation. While joint degradation is most commonly found in areas such as the hips, knees and vertebra, it is a condition that can affect any and all joints in the body, leading to pain and a marked loss of mobility.”
In a 24-week, randomized, placebo controlled, double-blind test study, athletes with activity-related joint pain who were given a marine collagen peptide dietary supplement reported their joint pain at rest and during activity was considerably improved, and so was their joint comfort and mobility.
Research has also confirmed that supplementing with marine collagen’s inherently smaller molecular weight yields better bioavailability compared to other collagen products, Clardy explained. “Its small peptide molecules and low molecular weight encourages a higher level absorption through the intestinal barrier, leading to improved collagen synthesis. Fish collagen peptides are also characterized by their unique amino acid composition, with a high concentration of lysine, proline and hydroxyproline— the primary agents responsible for stimulating cell regeneration.”
Also important to the category ingredient list are omega-3 fatty acids, which are known for lubricating joints and supporting joint health. Research has found that significant concentrations of EPA (eicosapentanoic acid), as well as a relatively balanced ratio of EPA to DHA (docosahexaenoic acid), support joint health by producing hormonelike compounds that intervene with the chemical reactions that can affect joints. “Several studies also show that the lubricating benefits of EPA concentrates may increase joint mobility while reducing the joint discomfort and fatigue associated with strenuous exercise,” said Bob Green, chairman of Novel Ingredient Services, a New Jersey-based company that is the exclusive U.S. distributor of GC Rieber omega-3 concentrates.
A 2012 review of scientific literature, conducted by the National Institutes of Health’s (NIH) National Center for Complementary and Alternative Medicines (NCCAM), concluded that EPA and DHA may be helpful in supporting joint health. Many participants reported that when taking fish oil they experienced briefer morning stiffness, less joint swelling, less pain and less need for anti-inflammatory drugs, Green explained.
Further, according to Green, the omega-3 concentrates that are source from fish caught in cold, deep-sea waters offer the best quality. “Not only do they come from pristine marine habitats, they also have the highest concentrations of EPA, as well as DHA, and offer superior quality,” he said. GC Rieber is a leadership member of GOED (Global Organization for EPA and DHA Omega-3) and sources fish oils exclusively from oceans managed by international and government agencies that enforce meticulous quality assurance and sustainability programs.
Proprietary Nutritionals also offers fatty acids. The company’s Celadrin ingredient was developed through a proprietary process of esterifying fatty acids to ensure stability and prevent reactions with oxygen, Mosca noted. “Celadrin has become one of the most recognized ingredients for reducing inflammation and promoting joint health,” he said. “It is medically and clinically proven to alleviate discomfort as well as to support enhanced mobility.” The ingredient can be delivered in capsule form, as well as a topical cream.
The company also offers Perluxan, a proprietary extract of hops clinically shown to reduce joint discomfort. A clinical study of patients with knee pain showed Perluxan had a fast-acting effect on relieving discomfort and offered a significant improvement over placebo after only two hours following the first dose, Mosca explained. Another pilot study demonstrated that Perluxan was comparable to ibuprofen in reducing pain-causing inflammatory enzymes.
New ingredients are coming onto the joint health scene, which may be of interest to open-minded younger consumers. “Younger people may be more likely to buy into alternatives to big pharma like vitamins and supplements, and with the amount of information about causes and effects of joint damage available, are definitely more concerned with prevention than their elders,” said Chelsea Thomas, marketing coordinator at Indianabased Verdure Sciences.
The company offers two joint health ingredients, WokVel and Pomella. WokVel contains boswellic acids extracted from boswellia that are known to inhibit 5-lipoxygenase (5- LO). “These are the two primary pathways impacting joint health,” Thomas said. The ingredient was shown to be comparable to more traditional pharmaceuticals, and, according to Thomas, was also clinically shown to increase joint function and flexibility compared to placebo in multiple published human trials.
Pomella Pomegranate Extract has displayed potential use in joint health. In a study done on collagen-induced arthritis (CIA) in mice, pomegranate extract was shown to delay the onset and reduce the incidence of CIA. “This suggests that pomegranate extract, or compounds derived from it, may be a useful approach for the prevention of the onset and severity of inflammatory arthritis,” Thomas said.
Pomella is available in a water-soluble form for application in beverages, powdered drink mixes and alternative dosage forms for the consumer who prefers liquid supplements to pills. And WokVel’s granular form is well suited for tablets and capsules, according to Thomas.
Another new ingredient that may not immediately come to mind for joint health is dried apple peels. Canadian company Leahy Orchards Inc. is a fruit and vegetable processing company that focuses primarily on apples. Its AppleActiv DAPP is an allnatural ingredient made from organic dried apple peel. “AppleActiv supports a wide variety of age-related conditions, and is clinically proven to support joint comfort and range of motion,” said Lorraine Leahy, nutritionist and director of division of functional foods at the company.
AppleActiv is a rich polyphenol blend with high levels of antioxidants, flavonoids, quercetin, triterpenoids, vitamins and minerals and is ideal for use in nutrition bars, shakes and drinks, smoothies, snacks, marinades, mixes and supplements.
A recent clinical study established apple peel as a joint health ingredient offering a new option and direction for a category that has long been dominated by just a few frequently used ingredients, Leahy said. “While these ingredients allowed formulators to develop products with some success, manufacturers have been waiting for something new to offer their customers. Through nutritional support, joint function can be improved, inflammation can be managed, degradation slowed and natural repair processes enhanced.”
Next Pharmaceuticals, located in Salinas, CA, offers two products for joint health— Nexrutine and Citrofen.
Nexrutine is a proprietary blend of actives from the bark of Phellodendron amurense. The product acts to indirectly inhibit the COX-2 enzyme and works to alleviate joint discomfort associated with exercise and overexertion, said Deanne Dolnick, vice president of the company.
Citrofen is a blend of patented polymethoxylated flavones and berberine. “It supports joint health by inhibiting TNF-alpha, a pro-inflammatory cytokine, thereby helping to alleviate the joint discomfort associated with osteoarthritis,” Dolnick said, adding that consumers want more than the traditional glucosamine and chondroitin—they want something that is faster acting and gives results.
According to Dolnick, Next Pharmaceuticals just completed a dose-dependent study on Citrofen and will soon be submitting it for publication. “The next step will be to conduct a double blind, placebo-controlled study on this new effective very low dose,” she added. “The subjects in the dose-dependent trial had osteoarthritis and obtained great results in alleviating the joint discomfort associated with the disease.”
4 Nakhostin-Roohi et al.