FOR SOME ATHLETES, “NO PAIN, NO GAIN” IS THEIR PERSONAL MANTRA. HOWEVER, TOO MUCH PAIN MAY MEAN NO GAIN IF THERE ARE PROBLEMS WITH EXCESSIVE inflammation, and possibly less than optimal repair of muscle, joint and bone tissue. In such cases, prevention is definitely superior to treatment; and the best prevention may be avoiding workout routines that brutalize your body to the extent that you are incapacitated, eating a healthy diet that provides adequate protein and other macro-nutrients, and using dietary supplements to support the maintenance and repair of tissues from muscles, joints and bones; and that also may help reduce excessive inflammation. Following is a discussion of such dietary supplements.

Calcium and Vitamin D
Calcium’s role in supporting the maintenance and repair of healthy bone is well established and does not require further elucidation here. Likewise, vitamin D has a long-established role in facilitating calcium absorption; and research indicates that vitamin D supplementation can help to prevent bone loss^1,2.

SierraSil^TM
SierraSil is a naturally-occurring mineral composite found only in the high Sierra Mountains. Research has demonstrated that SierraSil suppresses cartilage degradation and inflammation.³ In an unpublished double-blind, placebo-controlled study SierraSil was evaluated in patients with osteoarthritis. Results indicated that with doses of 2000 or 3000 mg, SierraSil improved joint flexibility and quality of life.⁴ A previous unpublished pilot study on SierraSil in osteoarthritis patients demonstrated similar results.⁵ SierraSil has a patent pending for supporting joint mobility, flexibility and active lifestyles.

Paractin^TM
Spasov et al⁶ has reported that standardized extracts of Andrographis paniculata have been investigated in a number of studies, showing significant reduction of major symptoms of common cold and other upper respiratory tract infections. Paractin^TM is a patented, standardized extract of Andrographis paniculata which has been shown in preliminary research to stimulate immune response at low doses and to reduce inflammation high doses.^7,8,9 It does this by invigorating the activation of Peroxisome Proliferator-Activated Receptor gamma (PPARΥ), which in turn inhibits inflammatory chemicals in the body such as NFkappaB interferon gamma (IFNΥ), and Interleukin 2 (IL-2). By supplementing the body’s ability to naturally activate PPARΥ, Paractin^TM helps promote healthy inflammation response while maintaining normal cellular structure and activity in the joints, bones, and throughout the body.

Glucosamine Sulfate
According to the book, The Arthritis Cure, there are three requirements to keep cartilage healthy: water for lubrication and nourishment, proteoglycans to attract and hold the water, and collagen to keep the proteoglycans in place. Proteoglycans are large molecules made of protein and sugar. They trap water like a sponge and make cartilage resilient.¹⁰ Glucosamine sulfate figures into healthy cartilage since it is a major building block of the water-loving proteoglycans. In addition, glucosamine sulfate's very presence stimulates the production of more proteoglycans. The fact that glucosamine sulfate increases the synthesis of these key elements of cartilage means that it actually helps repair damaged or eroded cartilage.¹¹ In fact, for many years glucosamine sulfate has been successfully used in the therapy of osteoarthritis, and has met all standards of an efficient and well tolerated drug (albeit a natural drug). This has been demonstrated by experimental as well as clinical studies, in which glucosamine sulfate led to long-lasting pain reduction and functional improvement.¹²

Chondroitin Sulfate
Chondroitin sulfate is the perfect complement to glucosamine sulfate since chondroitin acts like a liquid magnet, attracting fluid into the proteoglycans. This fluid acts as a shock absorber and also brings nutrients with it into the cartilage. Perhaps of greater significance than its fluid-enhancing properties, chondroitin sulfate protects existing cartilage from premature breakdown by inhibiting certain cartilage-chewing enzymes. Furthermore, like glucosamine, chondroitin stimulates the production of proteoglycans and collagen that are needed for healthy new cartilage. As a matter of fact, chondroitin works synergistically with glucosamine.

Plant Based Enzymes
Research has shown that certain plant-based (fungal) enzymes were shown to have powerful effects on protein digestion at the University of Rhode Island. Specifically, 300 to 500 mg of these fungal enzymes successfully released 62,000 mg of free form amino acids from protein (in the form of beef steak)¡Xthat's 42 percent more amino acids than stomach acid and enzymes alone, without fungal enzymes. Furthermore, in the laboratory fungal enzymes release branched chain amino acids from beef steak at up to 200 percent the rate of stomach acid and enzymes alone. This is particularly important since branched chain amino acids (BCAA) make up at least 35 percent of key muscle proteins. The results of this research clearly demonstrate that these enzymes cause amino acids in protein to become more bioavailable. This can help to rebuild and repair muscle tissue.

References:

1. Dawson-Hughes B, et al. Ann Intern Med 1991;115:505–12.
2. Dawson-Hughes B, et al. Am J Clin Nutr 1995; 61:1140–45.
3. Miller MJS, Ahmed S, Bobrowski P, Haqqi TM. Suppression of Human Cartilage Degradation and Chondrocyte Activation by a Unique Mineral Supplement (SierraSil™) and a Cat’s Claw Etract, Vincaria®. JANA 2004; 7(2):32–39.
4. Raut V, Gala J, Dhumale R. A double-blind randomized placebo-controlled study to compare two doses of a mineral supplement and a herbo-mineral combination in alleviating the symptoms of osteoarthritis of the knee. (unpublished)
5. A pilot study to test the safety and efficacy of the mineral supplement SierraSil™ in osteoarthritis of the knee. (unpublished)
6. Spasov AA, Ostrovskij OV, Chernikov MV, Wikman G. Comparative Controlled Study of Andrographis paniculata Fixed Combination, Kan Jang® and an Echinacea Preparation as Adjuvant, in the Treatment of Uncomplicated Respiratory Disease in Children. Phytother Res 2004; 18:47–53.
7. Paractin useful for the treatment of autoimmune diseases, and alzeimer disease by activation of PPAR- Receptor. Juan L. Hancke. Instituto de Farmacologia, Universidad Austral de Chile, Valdivia Chile. Paractin interferes with T cell activation and reduces Experimental Autoimmune Encephalomyelitis in the Mouse. Iruretagoyena MI, Tobar JA, Gonzalez PA, Sepulveda SE, Figueroa CA, Burgos RA, Hancke JL, Kalergis AM. Uniersidad Austral de Chile. Journal of Pharmacology & Exp Therapeutics, August 26 2004.
8. Paractin interferes DNA binding of NF-kB in HL-60/Neutrophils cells. María A. Hidalgo, Alex Romero, Jaime Figueroa, Patricia Cortés, Ilona I. Concha, Juan L. Hancke, & Rafael A. Burgos. Uniersidad Austral de Chile.
9. Theodosakis, J., et al, The Arthritis Cure, (1997) St. Martin’s Press: New York, 203 pgs.
10. Theodosakis, J., ibid.
11. Anonymous, Fortschr Med Suppl (1998) 183:1–12.
12. Theodosakis, J., ibid.

Bone broths are highly valued for their benefits, especially for joints and the digestive tract. Name almost any major cuisine in the world and broths and stocks are essential components. In pre-late 20th Century households, these liquids provided the foundation for sauces, soups, stews and numerous other products of the kitchen. However, they went beyond this to provide the bases for nutrient rich tonic foods considered to be good for the bones, joints, digestive system, immune system and general vigor.

The traditional expectations of bone broths are given in numerous books and articles on the topic, but are unlikely to find substantiation as such on PubMed because modern medical research focuses on pure compounds and on items that can be patented. Bone broth benefits from the broths themselves generally are observations from history, not from the scientific literature. For those who are interested, a full history of gelatins and similar usage and science focusing on knowledge and use up to the end of the 19th Century can be found in Gotthoffer, NR, Gelatin in Nutrition and Medicine(Graylake IL, Grayslake Gelatin Company, 1945), which can be purchased as a Kindle edition on amazon. Another book on the topic worth reading is Nourishing Broth: An Old-Fashioned Remedy for the Modern World by Sally Fallon Morell and Kaayla T. Daniel. More history, but also modern science focusing on individual broth components is wonderfully reviewed in "Traditional Bone Broth in Modern Health and Disease," by Allison Siebecker in the Townsend Letter for Doctors and Patients (2005).¹

The benefits of traditional bone broth reflect an emphasis on the building blocks for tissues as the sources of repair. The idea is not to substitute for the body’s own mechanisms, but instead to assist the body in making its repairs. In line with this approach, collagen and gelatin components, such as chondroitin sulfate, found in bone broth support the tissues in the body that themselves are constructed or repaired from these components, for example, the joints and their cartilage, the skin, and connective tissues in general. Similarly, minerals from bone broth support or even stimulate the repair of various tissues. Keep in mind that bone broths traditionally were foods, which are to say, consumed in considerable quantity in gram amounts, not milligram amounts. Efficacy in milligrams only is important for tablets and capsules and often focuses only on the narrowest of ranges of benefits. Total Health has touched on this issue before in terms of the entourage effect (September 2015). This issue has been examined in medical circles, for instance, "Whole Food versus Supplement: Comparing the Clinical Evidence of Tomato Intake and Lycopene Supplementation on Cardiovascular Risk Factors."²

Bone Broth Nutrition Basics
Before examining one bone broth component–chondroitin sulfate–in depth, below is a short listing of the a few of the nutrients found in bone broths.

Amino Acids
Bone broths throughout history have been associated with healing, whether of the gut, the joints, or more generally in response to illness. Part of the reason for this involves immune-supporting amino acids. Depending on the broth, these include arginine, cysteine, glycine and proline. These are found in beef and chicken bones, marrow, etc. Fish broths offer different nutrient mixtures from those found in land-based animal broths. For those interested in the roles of proline and glycine in digestive health, the Weston Price Foundation has published "Why Broth is Beautiful/Essential Roles for Proline, Glycine and Gelatin."³

Collagen and Chondroitin
More specific nutrition factors include bioactive Type I and Type II collagen peptides and cartilage chondroitin sulfate. Collagen is the most abundant protein in humans, representing about 25-30 percent of total protein in the body. It is the main component of skin, cartilage, ligaments, tendons and bones. Glucosamine, chondroitin sulfate and hyaluronic acid (a component of Collagen Type II) are the chief components of the extracellular matrix.

Collagen Type I is associated with the preservation of bone mineral density; in conjunction with hydroxyapatite, it accelerates osteogenesis. There is a further association with the health of the immune system known as oral tolerance that may be important for joint health.

Collagen Type II is a low molecular weight, water-soluble glycosaminoglycan complex that supports joint health and skin hydration.

Chondroitin Sulfate acts like a biological version of a "liquid magnet," attracting fluid into proteoglycans, protein chains that form the basis of cartilage and the extracellular matrix. This fluid acts as a shock absorber and also brings nutrients with it into the cartilage. Perhaps of greater significance than its fluid-enhancing properties, chondroitin protects existing cartilage through its modulatory effects on enzymes that degrade cartilage. Furthermore, chondroitin stimulates the production of proteoglycans and collagen that are needed for healthy new cartilage.

Natural Cartilage Components Heal The Joints
A just released study in the Annals of the Rheumatic Diseases (May 2017) shows that a relatively small quantity of the supplement chondroitin sulfate is effective in improving the symptoms of osteoarthritis.⁴ Pitted against either the prescription drug celecoxib (Celebrex) or placebo in a blinded trial, 800 mg chondroitin sulfate per day led to improvements in pain and joint function that were significantly greater after six months (chondroitin sulfate) and three months (celecoxib). Joint function improved more quickly in patients taking celecoxib, but there were no overall differences in the effectiveness and the benefit-risk profile strongly favored the chondroitin sulfate treatment. These results should be viewed in light of a 2016 study that demonstrated in a 2-year randomized controlled trial that treatment with 1,200 mg per day chondroitin sulfate was superior to celecoxib in preventing cartilage volume loss.⁵

Such results offer the promise of help to large numbers of individuals. Joint pain and connective tissue injuries are amongst the most common complaints of older individuals and affect 15 percent or more Americans whom exhibit some form of arthritis. Not just the elderly, but even young and fit athletes through overuse can exceed the repair capacity of the joints. Non-steroidal anti-inflammatories (NSAIDS) can relieve pain and initially help with joint inflammation and swelling, yet at the cost of slowing healing and for some individuals causing irritation and bleeding of the stomach. This has led to a search for alternatives. The idea that natural compounds such as glucosamine and/or chondroitin sulfate might have therapeutic effects in treating osteoarthritis by providing the substrates for the repair of cartilage has been around since the mid-1950s. Major issues have included determining which forms and how much of such supplements are necessary for benefits. For instance, confirming earlier studies, research published in 2005 involving approximately 1,500 osteoarthritis patients demonstrated that a daily dose of 1,500 mg glucosamine hydrochloride in combination with 1,200 mg chondroitin sulfate was equally as effective with fewer side effects than 200 mg of prescription celecoxib in treating moderate to severe knee pain, albeit relief took longer to appear. At the same forum, it was reported that 1,500 mg glucosamine sulfate was superior to acetaminophen in relief. Both of these studies involved quite large dosages of supplements leaving open the question of whether such large amounts are necessary. The 2017 study demonstrated efficacy with a dose of chondroitin sulfate that was less than half of that which had been tested previously and shown to be effective.

Study Summary
Chondroitin sulfate is a sulfated glycosami¬noglycan composed of chains of alternating D-glu¬curonic acid and N-acetyl-Dgalactosamine.⁶ It is a major component of cartilage, a tissue in which it exists attached to proteoglycans. Proteoglycans are commonly described as looking like tree trunks with many branches to which are connected bottle brush-like bristles. Chondroitin sulfate is especially important in joint synovial fluid and for the fluid-retaining qualities of the proteoglycans.⁷ In the 2017 study, the primary issue was whether chondroitin sulfate could be effectively used for long-term treatment of osteoarthritis, in particular in an aging population.

For study purposes, 604 patients diagnosed with symptomatic knee osteoarthritis were randomly assigned to one of three daily treatments in what is known as a double-blind, double-dummy design. In the chondroitin sulfate group, 199 patients were given 800 mg chondroitin sulfate; the second group made up of 200 patients received 200 mg celecoxib; the third group consisting of 205 patients received dummy tablets. Pain, joint function, and overall patient acceptability were assessed using validated scoring systems on days 30, 91 and 182. Improvements in pain and joint function were significantly greater after six months (chondroitin sulfate) and three months (celecoxib). Joint function improved more quickly in patients taking celecoxib, but there were no overall differences in the effectiveness. The benefit-risk profile favored the chondroitin sulfate treatment, meaning benefits fewer or no side effects.

The authors of the study concluded that a daily dose of 800 mg of pharmaceutical-grade chondroitin sulfate was better than a dummy product and as good as celecoxib in reducing pain and improving joint function in symptomatic knee osteoarthritis. However, the researchers advised care in selecting the form of chondroitin sulfate utilized: "Chondroitin sulfate is available as pharmaceutical-grade and nutraceutical-grade products, the latter exhibiting striking variations in preparation, composition, purity as well as clinical effects." In other words, the quality of the vendor should be the guide to choosing a product.

Chondroitin Sulfate Heals More Than The Joints
Chondroitin sulfate has many roles in the body other than in contributing to the health of the joints. Connective tissues which depend upon chondroitin sulfate are widely dispersed, which is to say that they are found not only as cartilage, but also as bone, tendon, skin, blood vessel walls, and mucous membranes. Any one or all of these tissues may benefit from supplementation with chondroitin sulfate.

Atherosclerosis (hardening of the arteries) is a case in point. Over a six-year period in a study involving one hundred and twenty subjects already suffering from diagnosed atherosclerosis and undergoing medical treatment, the group which supplemented daily with 1,500 mg of chondroitin sulfate fared strikingly better. The supplemented group had only one third as many deaths (4 versus 13) and one seventh the number of total cardiovascular incidents of types (6 versus 42). Inasmuch as this study lasted for six years, the safety of a large daily ingestion of chondroitin sulfate also was shown.

Chondroitin sulfate has a number of effects that have been demonstrated, but not always clearly explained. For instance, mucopolysaccharides in some tests have proven to be interesting immunomodulators that increased immune activity when it was too low and helped to turn it down when it was too high, such as in autoimmune conditions. Chondroitin sulfate has anti-inflammatory benefits and wound healing benefits. Some tests have indicated that chondroitin sulfate can help to regulate normal cell division. The range of benefits becomes clearer when it is realized that the following items all contain forms of chondroitin: bone broths, bovine cartilage extracts, shark cartilage extracts, extracts from sea cucumber and the green-lipped mussel.

Conclusions
Bone broths no doubt date back to prehistoric times and are staples in a number of established medical systems, such as Traditional Chinese Medicine. The principles remain the same today as in centuries past. Mineral and protein-rich broths containing the building blocks of the digestive system and connective tissues are surprisingly versatile in helping the body to heal itself. Although modern medical research typically does not examine complex food such as bone broths, research into the benefits of individual components often yields impressive results. Chondroitin sulfate is a case in point. Properly made, even seemingly small amounts can yield joint health benefits equal to those found with modern drugs along with other benefits, such as for the cardiovascular system. But why depend on pills when you can brew bone broth yourself?

References:

1. http://www.townsendletter.com/FebMarch2005/broth0205.htm
2. Burton-Freeman B, Sesso HD. Whole food versus supplement: comparing the clinical evidence of tomato intake and lycopene supplementation on cardiovascular risk factors. Adv Nutr. 2014 Sep;5(5):457–85.
3. https://www.westonaprice.org/health-topics/why-broth-is-beautifulessential-roles-for-proline-glycine-and-gelatin/
4. Reginster JY, Dudler J, Blicharski T, Pavelka K. Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT). Ann Rheum Dis. 2017 May 22. pii: annrheumdis-2016–210860. doi: 10.1136/annrheumdis-2016–210860. [Epub ahead of print]
5. Pelletier JP, Raynauld JP, Beaulieu AD, Bessette L, Morin F, de Brum-Fernandes AJ, Delorme P, Dorais M, Paiement P, Abram F, Martel-Pelletier J. Chondroitin sulfate efficacy versus celecoxib on knee osteoarthritis structural changes using magnetic resonance imaging: a 2-year multicentre exploratory study. Arthritis Res Ther. 2016 Nov 3;18(1):256.
6. Martel-Pelletier J, Farran A, Montell E, et al. Discrepancies in composition and biological effects of different formulations of chondroitin sulfate. Molecules2015;20:4277–89.
7. Crolle G, D’Este E. Glucosamine sulphate for the management of arthrosis: a controlled clinical investigation. Curr Med Res Opin. 1980;7(2):104–9.