Guide to joint support

If you train hard and heavy, you're exposing vour joints and connective tissue to considerable repetitive wear and tear. It may not be enough to sideline you — at least for the first few years — but it'll catch up to you. Over time. many hardcore bodybuilders end up with serious if not chronic joint aches that cut into their ability to train with gusto. What fun is that?
For years, bodybuilders and other athletes looked to aspirin and other anti-inflammatories to relieve sore and abused joints. Fortunately for us gym rats — especially the eft-injured and older ones — the times, they are changing for the better, thanks to a true success story of modern supplementation. Researchers have discovered that glucosamine, chondroitin and a few other substances can actually help rebuild connective tissue and reduce the ravages of doing tens of thousands of muscle-building reps.

What Is Connective Tissue?
Connective Tissue includes the dermis of the skin, tendons, ligaments, cartilage, bone matrix, fasciae, aponeuroses (fibrous membranes that connect muscles or muscles to bone), and the looser supporting tissues within and around organs. The main functions of connective tissue are to take the stresses of movement and to maintain the shape of the body. Connective tissue is made up of primarily collagen, but also elastin and reticulin; extracellular ground substance (basic material from which a specific type of tissue develops), also called proteoglycan, in which the protein fibers are embedded; and cells that make the ground substance — chondroblasts, fibroblasts and neuroblasts. The characteristics of substance to protein fibers.
Ground substance is composed mainly of glycosaminogtycans (these were once called mucopolysaccharides, because of their presence in mucus) and proteins. Ground substance is found in the lubricant (synovial fluid) in all joints and in tendon sheaths, bursa, corneas, spinal discs and bones.

WEAR AND TEAR ARE UNAVOIDABLE

The aspirin-takers I referred to above are not just squirrelly trainers using sloppy form. Many are masters of biomechanics, ultimate technicians who view each exercise as an art form and strive to perform every rep flawlessly according to their individual capacity and body structure. If you're ambitious and regularly use heavy weights in your major exercises, you damn well better be doing more than counting reps.

Think of heavy training as a repetitive-stress injury. Ponder the effects of serious training loads and stresses; the friction; the usual left-right and front-back asymmetries in strength; how stabilizers fatigue before prime movers, potentially decreasing your stability and altering neuromuscular firing patterns; and think of all these things as having the potential to increase your risk of injury. It's amazing that bodybuilders don't have more debilitating injuries than they do.
Injuries and the physical stress associated with heavy resistance exercise take their toll on joint structures. Consider cartilage, for example, which you might know as the glistening white coating at the ends of the bones in chicken drumsticks.
Wear and tear of cartilage leads to osteoarthritis, a potentially painful and even incapacitating medical condition that affects as many as 20 million Americans and more than half of people over the age of 60. Age is a risk factor, even without injury, as the balance in the enzymes that regulate the production of collagen— the toughest of the connective tissue proteins and the most prominent in cartilage — shifts to favor break down rather than synthesis. Once an injury or repetitive stress damages the cartilage surface, osteoarthritis can result and lead to the destruction of the cartilage structure itself.
I can personally attest to the reality of that. I'm 52 years old and a long time freak about good exercise form. When my eminent orthopedist confronted me with the results of a recent magnetic resonance imaging (MRI) scan and the fact that I have "80-year-old" shoulders — from the standpoint of the cartilage — I got the message.
I didn't stop training, and I won't, but I did start seriously hitting the joint supplements. Although only time and another MRI will tell for sure. I believe the supplements have made a big difference. I wish I had begun taking them sooner rather than later. That's a mistake you don't have to make.

Any serious bodybuilder knows you can tear yourself down at any age. Even if you have your training act together, you can't help but literally wear down some tissues, such as those between joints, doing rep after rep. Unless you suffer acute trauma or develop an inflammation from severe overuse or poor form, though, you may not know you're developing a joint problem. By the time you do notice a long-term overuse injury, you'll be faced with a long road back.

HELP HAS ARRIVED

How do you pro-tect against this potentially harsh training setback? Modern sports science has come to the rescue by developing supplements for crucial connective tissue that should be part of every serious bodybuilder's arsenal. Let's look at the three most important of these supplements: glucosamine, chondroitin sulfate (CS) and hydrolyzed collagen.

• Glucosamine

Like chondroitin sulfate and collagen, glucosamine is produced naturally in the body. It is the most fundamental building block for many critical compounds that make up connective tissues.
Glucosamine is an essential component of cell membranes (consider the implications of that) and cell surface proteins, as well as of molecules that hold our cells together.
Arthritic and damaged tissues show a much higher than normal demand for glucosamine.
Directly or indirectly, glucosamine plays a part in the formation of cartilage, tendons, ligaments, synovial fluid, skin, bone, nails, heart valves, blood vessels and mucus secretions of the digestive, respiratory and urinary tracts. Glucosamine also has a role in the synthesis of transport molecules. immunological proteins (interferon, immunoglobulins), hormones (gonadotropins, thyroid stimulating hormone), enzymes and other important substances.
Although tested extensively in cases of osteoarthritis, and prescribed as a drug in some European countries, glucosamine has been studied only once in athletes, in which case it helped heal "jumper's knee." However, other data and our own experiences suggest that it should be very helpful for sore shoulder joints and any other joint degeneration or "creakiness."
All human studies of glucosamine sulfate have used 1.500 milligrams (mg) per day (three doses of 500 mg each).
It is best to take glucosamine in the morning and before bedtime, since it has a long half-life in serum. If faster results are desired, increase the dose by taking 1.000 mg twice daily, although true joint repair will still be a slow process.
Glucosamine hydrochloride, also on the market, has the same effects as glucosamine sulfate at a lower cost. Glucosamine sulfate turns into glucosamine hydrochloride in the stomach.
Since glucosamine has a different mechanism of action than nonsteroidal anti-inflammatories (NSAIDs like asprin and ibuprofen), it's possible that the two may have a synergistic effect in alleviating some types of inflammations. So, you may be able to significantly reduce the amount of NSAIDs you take (perhaps as much as two to three times less), with no loss of effect, if it's necessary to take them at all.

Chondroitin Sulfate

CS is one of today's most misunderstood supplements. Extracted from bovine and pork tracheas, as well as shark cartilage. CS, like glucosamine, serves as both a building block and a direct stimulus to the synthetic process for new cartilage. In addition to stimulating repair in cartilage cells, CS can block the enzymes that damage joints, doing double duty for joint health.
There have been more and better-designed human studies with CS on arthritis than there have been with glucosamine sulfate. Some of that research has lasted one to two years and has involved more than a thousand subjects. Like glucosamine, CS is used as a drug in some European countries for osteoarthritis (and for clogged arteries).
Purified CS is well-absorbed in humans, as demonstrated by numerous sophisticated investigations.
Many studies of people taking CS have shown slow-acting but long-lasting reductions in pain and improvements in joint function. Slow-acting means you may not really notice much change for several weeks (most of the research shows significant benefits after four to eight weeks, and definitely after three months of administration). However slowly, the benefits will accumulate.
Take anywhere from 800-1,200 mg of CS per day, in two divided doses (it has a 12-hour half-life). This regimen matches what's been effective in extensive human studies on arthritis, although once-a-day dosing also may be effective for you.
Scientists have emphasized that the CS used in the clinical studies has been extracted and purified to contain a high percentage of the supplement (up to 97%). It's likely that the processing and purity of the CS could significantly alter the metabolic fate and therapeutic results.
Bottom line: Some available products may have a lower percentage of actual CS, which in turn could dramatically influence the dosage required for therapeutic efficacy. Thus, if you use one brand as directed for a prolonged period and get no results, try another. Don't assume that CS has no efficacy for you; it may be the specific product that's at fault.

• Hydrolyzed Collagen

Collagen is the major protein in the body — it makes up approximately six percent of total bodyweight. It is found in all tissues and is our main structural protein, giving our bodies their shape. It literally holds us together.
Collagen is the primary nonwater component of all connective tissues, including cartilage. Cartilage contains type II collagen (which you might see listed on supplement labels), plus smaller amounts of other collagen types. Other connective tissues contain mostly types I and III collagen. Collagen may be more familiar to you as gelatin (found in gelatin desserts); it's also used as a thickening agent in many foods.
This supplement was once sold in a liquid form and promoted as pre-digested protein. A muscle-building protein supplement it's not, however, because though it is obtained from animals, its amino acid profile leaves much to be desired. However, it is a great supplement for your joints.
Hydrolyzed collagen (Arthred G) is a patented collagen that has been predigested by enzymes (not acids). Its use is supported by human studies that show significant relief of arthritic symptoms, although its effects are slower than those generated by glu-cosamine or CS.
Why take it then? Hydrolyzed collagen supplies collagen-specific peptides and amino acids that may stimulate repair differently from glu-cosamine or CS. and perhaps may inhibit some degradative enzymes. The only catch is the dose: 10 grams per day. To prepare it, mix a powdered form of the supplement into a liquid. CS is not expensive, and it doesn't have the gel-forming properties of regular gelatin.
Actually, hydrolyzed collagen should work especially well when combined with glucosamine and CS. There are no studies to confirm this, though. However, since each of these supplements has unique effects on cartilage, and since all overlap in their stimulatory effects on synthesis of joint components, it makes sense — and my observations and personal use confirm — that a combination of the three would result in greater, faster and longer-lasting effects than any one or even two of these ingredients.

THE BOTTOM LINE

There are other joint supplements available (see "The Rest of the Story: Other Joint Helpers"), but glucosamine, chondroitin and collagen should be your starting point. They offer real help for sore joints, as millions of users can readily attest. And they're all normally produced by and found in the human body in large amounts, plus they are present in many foods. They're virtually free of side effects, well-tested in humans, and are what the body uses to heal its own joints. They do work gradually, so you have to take them for a while — anywhere from four to eight weeks — before results are noticeable.
Most bodybuilders will benefit from repeated use of these supplements. Improvements obtained via glucosamine appear to be retained only for an average of six to 12 weeks following cessation of a six-week period of treatment. The situation with CS is similar. There is no evidence whatsoever of toxicity and there appear to be no contraindications to use of these in patients with circulatory disease, liver disorders, lung disorders, diabetes or depression.
If you train hard and heavy, and plan on doing it for a while, then these supplements should become a mainstay in your program sooner rather than later. Even if you've never had any connective tissue problems, we feel strongly that it would be in your best interest to begin using joint aids, if not year-round, then at least periodically, say for six to 10 weeks at a time, several times a year.

Other Joint Helpers

Several supplements are being promoted, some more aggressively than others, as joint supporters and antiarthritics. For the latest perspective, I interviewed Luke Bucci, PHD, an internationally recognized expert on connective tissue rejuvenation and author of Healing Arthritis the Natural Way (Summit Publishing Group, 1997 revised). The following are his comments.

• S-adenosylmethionine (SAMe)
SAMe really works. It has the backing of many human clinical trials and is actually an approved drug tor osteoarthritis in at least one European country. The only problem is, the effective dose is on the order of 1,500 mg per day, which is very expensive (about S5-6 daily at retail). SAMe is unique among nutrients in that it has some immediate analgesic activity. It seems to be completely sate, and it's also a good antidepressant, so people using it feel better mentally.

• Essential Fatty Acids (EFAs)
EFAs may make a modest but slow contribution to the alleviation of symptoms of rheumatoid arthritis, which makes them less interesting to bodybuilders with connective tissue injuries (rheumatoid arthritis is related to auto-immune problems rather than to wear and tear). Flax and evening primrose oils have not done well in human clinical trials, even at high doses. Eating lots of fatty fish — salmon, even sardines — is the way to go if possible. Otherwise, you need 10-12 fish-oil capsules daily. There have been a number of positive human clinical trials, but it takes eight weeks or more to see results. EFAs are good for so many other things that you should do what you can to increase intake anyway.

• Bromelain
This substance or any potent protease (papain, trypsin, chymotrypsin and fungal proteases) is very good for acute traumatic injuries or active inflammation. Since doses are not standardized and stability is poor, an individual needs to take four to six pills tour times daily tor a week, always on an empty stomach. They're not very good tor chronic conditions, but they do seem to reduce pain somewhat, and they definitely seem to enhance healing. Combinations of different enzymes appear to work better than a single enzyme. This is one supplement that can be felt overnight and merits a big thumbs up for acute injuries.

• Curcumin
Derived from the herb turmeric, which is used to make curry, curcumin does have a few human studies behind it However, the data show it to be about 10 times less potent than indomethacin (another NSAID), suggesting that 2,000 mg would be needed daily for reduction of pain and inflammation. It is a very good antioxidant, but it gets a little costly at effective doses. There are also suggestions that it's good for prevention of cancer and heart disease. Smaller amounts, such as those sprinkled in many supplement products, have unknown efficacy.

• Vitamin C
This valuable vitamin is a grossly overlooked way to slowly reverse osteoarthritis, though it does have to be used in high doses for a long time. Although there are no human studies for its use for arthritis, animal studies suggest that if humans take about four to five grams per day, it should really help connective tissue problems. Anecdotal evidence and one study in human osteoarthritis suggest that four grams per day is a threshold of effect. Test-tube work shows that vitamin C and glucosamine are the only known nutrients that can actually activate chondrocytes to produce both collagen and proteoglycans. It's cheap, it's safe, and although its efficacy is not open and shut, I would highly recommend it

• Cetyl Myristoleate (CMO)
CMO seems to be of little or no value to bodybuilders. At present, there is only one questionable human study from the inventor of the patented form of CMO and one animal study. CMO may work as a nonspecific immune adjuvant, which would make it good mostly for rheumatoid arthritis. The commercial sources do not appear to match the patented CMO material in quality, and it's very costly.

• Methylsulfonomethane (MSM)
This supplement has come and gone over and over for the last 25 years. The same old anecdotal data from Stanley W. Jacob, MD, coauthor of The Miracle of MSM. are still the only available data, and, although not worthless, are of limited value.
MSM is supposed to be a source of sulfur, which would theoretically provide increased amounts of methionine and glutathione inside of cells. This remains to be proved in humans after oral consumption. Doses used (notice 1 did not say effective doses, since there is no proof of efficacy) range from 500 mg to 10 grams.
MSM seems quite innocuous, fortunately. Many consumers have bought into the sulfur-for-chondroitin-sulfate-synthesis line of thinking, but there's no evidence this happens in humans despite the fact that some pharmaceutical companies do add sulfur groups to their CS products.MSM has been called dry DMSO, and has been given imaginary antiinflammatory properties. MSM is all fluff and no substance, but it's cheap; and with all the testimonials (reminds me of the old days of protein supplements), it apparently makes a good enough story to sell.

•Shark cartilage
Shark cartilage was actually the first kid on the block aggressively promoted as a potential joint rejuvenator for athletes. Its track record over the last half-dozen years isn't very impressive, though. Shark cartilage does contain minerals, collagen and chondroitin sulfates that can help maintain healthy connective tissue. It also contains small proteins that may educe the formation of new blood vessels — a property called antiangiogenesis. This is important for joints because the movement of new blood vessels into normally avascular cartilage leads to calcification and fragmentation, like water getting into the cracks of concrete, then freezing and eventually breaking up the cement. More recently, proprietary extracts of shark cartilage have been developed that have anticollagenase activity, meaning that they block the body's normal enzymes that break down cartilage, which give the body's synthetic enzymes an opportunity to "catch up" and get into a "positive cartilage balance." The extract is very expensive, but I can personally attest to its efficacy. The cost has so far prevented sports nutrition companies from marketing it.
The original dosing recommendation for joint pain for shark cartilage outlined in the popular book Sharks Don't Get Cancer (by 1. William Lane and Linda Comae) was a single 740/750 mg capsule per 11 pounds of bodyweight (or 20
caps for a 220-pound person), divided between three daily doses for three weeks. Once improvement is noted, the dose
can be reduced by two-thirds (to one cap per 30-33 pounds of bodyweight). If there's no improvement within 30 days, then even the original proponents of shark cartilage suggest that it's not going to help you. Shark cartilage may have beneficial immune system effects, but they would be very slow-acting.
Conclusion:
With no relevant controlled studies, the jury's still out on this supplement.

THE SHORTHAND GUIDE TO JOINT SUPPORT

• First of all, train correctly!
• Take glucosamine sulfate in dosages of 1,500 milligrams (mg) per day (three 500-mg doses, two of these in the morning and one before bedtime). For faster results, take 1,000 mg twice daily.
• Take chondroitin sulfate in total daily amounts of 800-1,200 mg divided over two doses.
• Take hydrolyzed collagen in doses of 10 grams per day in powder mixed with any liquid.
• A combination of the above three supplements should work synergistically. Try taking all three together.
• Give yourself at least eight weeks to feel benefits from these supplements.
• Use them for six to 10 weeks at a time, several times per year, or, preferably, year-round.
• Make sure your essential mineral and antioxidant intake is up to snuff.
• Give some of the other supplements listed in "The Rest of the Story" sidebar a try for extra relief.
• Make sure you are giving yourself enough recovery time between workouts.