Natural Products Insider

MAY-JUN 2018

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22 INSIDER May/June 2018 which inhibited expression of metalloproteinase (MMP) enzymes that can degrade cartilage ECM, including collagen. 24 In a study of OA patients, 5-LOXIN supplementation improved joint pain and function. 25 The researchers reported an analysis of synovial fl uid revealed 5-LOXIN signifi cantly reduced levels of the pro- infl ammatory marker MMP-3. Boswellia has shown additional joint benefi ts when combined with fellow anti-infl ammatories N-acetyl-glucosamine and ginger. In a published study, this combination (as Movardol ® , from Leonardo Medica) exhibited a positive effect on joint function and pain-free walking distance after one, three and six months of supplementation. 26 Results showed WOMAC scores improved, and both infl ammatory markers and reactive oxidative species (ROS) decreased in the supplement group. Boswellia has also been combined with botanical darling curcumin (Curcuma longa), a compound found in turmeric. Three months of curcumin (as CuraMed ® , from EuroPharma USA) taken alone or with boswellia (as Curamin ® , from EuroPharma USA) lowered pain-related symptoms in OA patients, although the combination was reported as more effective due to synergistic effects. 27 Curcumin targets COX via curcuminoids that inhibit infl ammatory enzymes and signaling molecules (cytokines). In a study of OA patients with knee OA, a combination of curcuminoids (as Curcumin C3 Complex ® , from Sabinsa) and piperine (as Bioperine ® , from Sabinsa) improved joint pain and function—per WOMAC, VAS and LFI scores—compared to placebo. 28 Researchers reported in 2010 a curcumin-phosphatidylcholine complex (as Meriva ® , from Indena) was safe and effi cacious in decreasing joint pain and increasing joint function in OA patients. 29 A subsequent study revealed Meriva taken with glucosamine more quickly provided benefi ts to joint symptoms in OA patients than a combination of Meriva and chondroitin sulfate. 30 Longvida ® brand curcumin (from Verdure Sciences) was also shown to reduce infl ammatory markers, including TNF-α and IL-8. 31 In addition to boswellia and curcumin, India's traditional medicine candidates for joint health products include Terminalia chebula, the fruit of which is a key ingredient in the popular Ayurvedic formula called Triphala. T. chebula contains constituents with antioxidant and anti-infl ammatory properties helpful in joint health, especially for sports nutrition consumers. In 2017, researchers reported an ingredient derived from T. chebula (as AyuFlex ® , from Natreon) improved knee pain and function in healthy adults with knee discomfort following exercise/activity, but not at rest. 32 The study involved men and women who took either a high or low dose of AyuFlex or placebo for 84 days, and researchers measured symptoms using modifi ed-Knee Injury & Osteoarthritis Outcome Score (mKOOS) global and modifi ed-WOMAC subscales (discomfort, stiffness and function). They also looked at overall/whole-body joint health, low-back health, knee mobility, willingness and ability to exercise, and a six-minute walk test for distance and range of motion of pain-free knee fl exion/extension. Further, they analyzed infl ammatory biomarkers such as high sensitivity C-reactive protein (hsCRP) and TNF-α, and ECM/connective tissue (COMP). The mKOOS and mWOMAC scores improved signifi cantly in both AyuFlex dose groups, compared to baseline. Increased VAS scores in both supplement groups indicated improved knee discomfort from activity/exercise, whole- body joint function, and performance and recovery from a six-minute walk. VAS scores also demonstrated decreased knee joint soreness following a leg extension challenge and lower COMP levels in both supplement groups, compared to baseline. In other rese arch, AyuFlex, combined with a proprietary chromium complex (as Crominex ® 3+, from Natreon), reduced joint discomfort and swelling, compared to baseline and placebo, but not as much as AyuFlex alone. 33 Crominex is a blend of chromium III mixed with Phyllanthus emblica and shilajit, a mineral pitch. Minerals from other sources have made an impression on joint health research. A plant mineral complex, calcium fructoborate (as FruiteX-B ® , from FutureCeuticals) helped healthy, middle- aged subjects improve symptoms of self- reported knee discomfort in a 2014 study. 34 The researchers explained WOMAC and McGill Pain Questionnaire (MPQ) scores at seven and 14 days confi rmed knee benefi ts and reduction in CRP in a subgroup of supplement subjects, but not in the placebo group. Additional research on FruiteX-B found a high dose reduced CRP levels, compared to baseline measures, but a low dose of the supplement had no such effect. 35 However, both doses showed decreased infl ammatory cytokine IL-6, while the biomarker IL-1beta and pro-infl ammatory cytokine monocyte chemoattractant protein-1 (MCP-1) were reduced only in the high-dose group. A mineral complex from seaweed (Lithothamnion corallioides) containing bioactive calcium, magnesium and more than 70 other trace minerals appeared to inhibit nuclear factor kappa B (NFkB), a pro-infl ammatory regulator, and the COX-2 infl ammatory pathway, according to in vitro research. 36 The seaweed complex (as Aquamin ® , from Marigot Ltd.) was the focus of a placebo-controlled trial of patients with moderate-to-severe OA. 37 Those taking the mineral complex for 12 weeks experienced reduced pain and stiffness as measured by WOMAC and compared to placebo. A later publication compared Aquamin alone and in combination with green tea extract (as Sunphenon, from Taiyo Kagaku Co.) and pine bark extract (as Enzogenol, from Enzo Nutraceuticals) on infl ammatory biomarkers in OA patients. 38 Sports Nutrition: Joint Health

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