In the past couple of years, oral forms of hyaluronic acid have become available. Oral HA is a nonprescription product that’s sold as a dietary supplement. The benefits of an oral formulation compared to injections are obvious: lower cost, no pain, lower risk, and improved convenience. The positive results for patients have vaulted this product into the limelight.
The number one cause of disability in America isn’t
heart disease or diabetes—it’s arthritis. According
to statistics from the federal Centers for Disease
Control (CDC), one in three adults is now affected
by an arthritis-related condition.
Arthritis is a general term for a group of conditions
that cause pain, stiffness, and swelling in
the joints. The most common form of arthritis is
osteoarthritis, sometimes called “wear and tear”
arthritis. Most people with arthritis have osteoarthritis—
in fact, some 21 million American adults
suffer from it.
People with arthritis often face serious reductions
in their quality of life. The pain, stiffness,
and inflammation make it hard to stay active,
but inactivity can lead to a downward spiral of
worsening health. When activity levels drop, depression,
obesity, diabetes, heart disease, and
problems with work and relationships often develop.
And inactivity actually makes sore joints
even worse, which just accelerates the downward
spiral. For most people, life just isn’t as enjoyable
with arthritis.
New Treatment Options
The good news is the high prevalence of arthritis
has led to increased awareness and increased research
efforts. The most exciting part about the
new treatment options that are now becoming
available is they don’t just relieve pain. They actually
improve function while also being very safe.
Unlike anti-inflammatories such as naproxen
(Aleve), for example, treatments such as glucosamine
and hyaluronic acid don’t cause gastric
bleeding or ulcers, and they don’t raise your risk
of a heart attack, stroke, or kidney disease.
In the 1990s, hyaluronic acid (HA) became
available as a treatment for knee osteoarthritis.
For people with severe knee arthritis, injecting
HA into the joint often provides relief. Injectable
HA is a prescription product that has to be administered
by a physician. Most patients need
a series of three to five weekly injections. Injectable
hyaluronic acid is well-established as a safe
therapy for osteoarthritis. In fact, it’s part of the
American College of Rheumatology guidelines
for treating osteoarthritis of the knee. Injectable
HA works reasonably well. After receiving the series
of injections, over half of all patients have
improvements in pain and function that can last
for up to a year. Because injectable HA provides
long-lasting relief, osteoarthritis patients can often
avoid the dangers associated with over-the-counter
or prescription anti-inflammatory drugs.
Injectable HA has some significant drawbacks,
however. Receiving an injection directly
into the joint isn’t something to take lightly. It’s
an invasive procedure that involves pain and a
small chance of introducing an infection in the
joint. It’s expensive—the series of injections can
run to $1,500 and may not be covered by health
insurance. It’s also inconvenient to keep going to
the doctor for several weeks in a row to receive
the full series of injection—or repeat injections,
if necessary.
In the past couple of years, oral forms of hyaluronic
acid have become available. Oral HA is a
nonprescription product that’s sold as a dietary
supplement. The benefits of an oral formulation
compared to injections are obvious: lower cost,
no pain, lower risk, and improved convenience.
The positive results for patients have vaulted this
product into the limelight.
Understanding HA
To appreciate what a breakthrough oral HA is, it
helps to understand the crucial role of HA in joint
health. In your body, HA is a naturally occurring
family of extremely large molecules that are contained
in many tissues, not just the joints. HA is
one of the components that give our tissues flexibility.
Your eyeballs, for instance, are “squishy”
mainly because of their high HA content. The
same goes for the cartilage in your joints.
Joint cartilage (what doctors call articular
cartilage) is a glistening, smooth, translucent,
whitish-colored living tissue found on the ends
of your bones. Joint cartilage caps the ends of the
bones in the 230 different joints found in the human
body. When it’s healthy, cartilage is extremely
smooth. It provides a low-friction environment
for easy movement and also acts as a shock absorber
to protect your bones and keep them from
fracturing with activity.
Hyaluronic acid is essential for healthy cartilage.
It’s the chemical backbone that holds together
the molecules, such as chondroitin sulfate, that
make up the cartilage and give joint cartilage its
special properties. HA is what makes joint cartilage
the smoothest and most friction-free substance in
nature. Nothing man-made can approach the performance
of this remarkable tissue.
In any joint, the whole structure of bone, cartilage,
ligaments, and tendons is surrounded, held together, and protected by a watertight, fibrous joint capsule. Specialized cells called synoviocytes line the interior portion
of the joint capsule. They produce the synovial fluid—a thick,
clear substance that looks and feels like raw egg white. Synovial
fluid fills the space within the joint. It lubricates the articular
cartilage, much as grease lubricates the ball joints of your car.
Synovial fluid also increases the effectiveness of shock absorption
in the joint, much as hydraulic shock absorbers smooth
out the ride of your car. Because joints don’t have a blood supply
of their own, the synovial fluid also carries nutrients into the
joint and carries waste products out.
Osteoarthritis and HA
Where does HA fit into joint health? It’s the principal functional
component of synovial fluid. HA is what makes synovial fluid
thick and viscous—and it’s these properties that are vital to
normal joint function. But when osteoarthritis strikes, the hyaluronic
acid in the joint is affected. Here’s how it happens:
The joint cartilage on the ends of the bones slowly erodes, the
bone underlying the cartilage changes (leading to bone spurs
and pain), and the synovial fluid in the joint changes in character.
Specifically, the amount of HA in the joint drops. In severe
osteoarthritis, the level of hyaluronic acid in the joint fluid may
decrease by 75 percent or more. Because HA serves as a shock
absorber and lubricator, it’s no wonder that a big decrease in
such an important molecule results in adverse consequences.
When HA levels in the knee drop, for instance, the result is a
creaking or grinding sensation, pain, and often a condition
called “movie-goers knee.” It may sound funny, but movie-goers
knee is no joke. It’s a real medical condition that occurs
after someone with knee osteoarthritis sits with the knee bent
at a sharp angle for a prolonged period of time—such as sitting
through a feature movie or driving a car for a couple of
hours. Upon arising, a sudden, sharp, stabbing pain occurs in
the knee. The pain usually goes away after walking a few steps,
as the remaining fluid in the knee coats the surfaces of the cartilage
and cuts down on the friction.
The prevailing theory of how HA works is that the molecules
attach to binding sites on cells within the joints. Once the attachment
is made, it triggers a complex cascade of events within
the cells. One of the things that seems to happen is the HA molecules
inhibit some of the enzymes that help break down the
cartilage matrix in the joint. HA also seems to inhibit some of
the natural chemicals, such as interleukin-1b and prostaglandin
E2, that create inflammation in an arthritic joint. The anti-inflammatory
mechanism of HA isn’t fully understood, but we do know
it’s quite different from that of anti-inflammatory drugs. HA molecules
also appear to disrupt some of the nerve impulses that
transmit pain signals from the joint to the brain. Importantly, HA
molecules can stimulate the cells that line the joint capsule and
trigger them to manufacture even more hyaluronic acid—something
highly desirable in osteoarthritic joints.
When there’s not enough HA in a joint, all the things it does
to maintain pain-free normal function don’t happen as well—
that’s where supplemental HA comes in.
Choosing the Best HA Supplement
As researchers learn more about the HA pathways in the joints,
they continue to discover new ways in which HA helps relieve
pain and improve function in patients with osteoarthritis. One
of the things they’ve learned is oral HA supplements can be very
effective—but only if they’re a high-quality product that closely
mimics the body’s own HA.
Today the oral forms of hyaluronic acid sold as dietary
supplements come from three general categories: low-purity
animal extractions mixed with large quantities of (relatively inactive)
collagen; fermentation from bacteria; or concentrated
extraction from avian cartilage. The original pharmaceutical
forms of injected hyaluronic acid were all derived from the
avian cartilage, so it makes sense this is also the optimal form
for dietary supplements. Low-purity animal extractions mixed
with collagen are undesirable because of two reasons. To get
an adequate quantity of hyaluronic acid from these supplements,
you’d have to take them in very large amounts. Also,
it’s questionable whether the biologic activity of this source of
hyaluronic acid compares with the others.
Hyaluronic acid derived from bacterial fermentation may
also be less functional and it doesn’t have some of the natural
active components found in the concentrated extractions from
avian cartilage. Perhaps this helps explain the results of an internal
study comparing the effectiveness of fermented HA to a
concentrated extract from avian cartilage. When a culture of
living synovial cells was exposed to the avian extract, the cells
were stimulated to produce twice as much HA as when they
were exposed to the bacterial HA—even though the concentrations
of each product was the same (200 mcg/ml ).
It’s also important to note that concentrated avian extracts
have been used in most of the important worldwide research
that has been done on HA. The concentrated extractions have
been utilized extensively in the clinic and in large human studies
(some of long duration) sponsored by the pharmaceutical
industry.
Hyal-Joint® Oral Hyaluronic Acid Supplements
Hyal-Joint oral hyaluronic acid supplements appear to be the
best available product. This product is a concentrated HA extraction
from avian cartilage and also contains other naturally
active components such as vital glycosaminoglycans. Hyal-Joint has been studied in a number of laboratory experiments,
animal studies, and in a human clinical study. Even more research
is underway. The studies suggest that Hyal-Joint raises
HA levels in the joints and, just as important, also stimulates
the body to produce more of its own natural HA. In the first
human study, the participants took only 80 mg of Hyal-Joint
a day, an amount that fits into a small capsule or tablet. This
daily dosage delivers approximately 48 to 54 mg HA, 4 to 12 mg
other glycosaminoglycans, and 16 to 24 mg collagen. A clinical
trial is underway now using a smaller dose of just 40 mg, and
some supplement manufacturers are considering adding 20
mg of Hyal-Joint to existing joint health formulations containing
other active components such as glucosamine and chondroitin
sulfate.
