FWIW… on topic of joint pain issues.
It is hard to translate findings from relatively healthy athletes in college to average Joe’s in other settings and in different overall health. I doubt we could find definitive studies for healthy (relatively) people.
We do, however, study diseases!! The majority of good studies of agents addressing joint health, or joint pain, will be focused either on Osteoarthritis (OA) or Rheumatoid Arthritis (RA). The American College Of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) are often part of the research studies and you can find reports on all sorts of stuff on their websites and in the abstracts and presentations from their yearly conferences.
Quick background: RA and OA are very different disorders. RA is an autoimmune disorder while OA is generally related to trauma. Think knee injuries for example. Both involve pain and inflammation but with different causes and outcomes and measures. But both hurt - often a lot. The advanced therapies which bring some relief in RA, and which can delay joint degradation, anti-TNF being the best know biologic but there are others, have not been shown to be effective in OA.
So, if we consider OA as a surrogate for painful joints, and look at the data for supplements, the very quick take home is for collagen, chondroitin, glucosamine and a few other molecules, there is very little to zero benefit demonstrated in good studies. Treating physicians and guidance essentially says, paraphrasing, there might be some benefit to some patients but probably not. The hedge is because the folks that write guidance are reluctant to make absolute negative statements. Also note that in the USA we consider these molecules as unregulated supplements. In Europe and other parts of the world they may be prescription drugs.
For athletes, I’d put this in the space of beet juice or other stuff we’ve all tried. If you try and get an amazing result that’s great for you. Might be pure placebo but as long as there is good safety data and you and your physician agree that you aren’t damaging your kidneys then make an adult decision on using a supplement or not. If you are trying it for 1% improvement in some generic descriptor like “helps joint health” though, the odds are good you are just making expensive urine while taking the risk that the supplement is not high quality and could do harm…
Here is a recent review on collagen in OA from 2020 and another from 2012. The collagen stuff started to gain traction and attention in roughly 2005-2006 and that spawned some OK research.
For folks who don’t do this stuff for a living, note the phrase “more research is required”. We always say that type of thing because even if it’s really clear, it’s polite and its a hedge that if you are somehow wrong you can say to your friends: “Well, I did write in the conclusion that more research was required”. It’s part of the game playa!!!
More seriously…
Chondroitin and Glucosamine have perhaps been better studied. The GAIT study included just shy of 1,600 patients and was meant to finish the debate on effectiveness of these molecules one way or another. It kind of did but not quite. The supplements failed to meet primary endpoint, but subgroup analysis showed some potential in one slice of patients. But that group was small (underpowered). But since everyone loves a good debate it continues still and you can find docs and clinical researchers willing to fight it out on either side of the argument… Would be huge fun to set up a table outside of ACR or EULAR conference with a sign which says: Chondroitin and Glucosamine Just Don’t Work. Change my Mind!!!
Reading should you desire:
https://www.nejm.org/doi/full/10.1056/nejmoa052771 (GAIT paper)
Summary of study: The NIH Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) - PubMed
Abstract
Americans continue to spend millions of dollars annually on glucosamine and chondroitin for symptoms of osteoarthritis. These agents are classified as dietary supplements, not as drugs, per se. Therefore, they do not meet the requirements of the FDA to be classified as drugs. This study was designed to determine if glucosamine and chondroitin are effective for osteoarthritis pain. This report was adapted from an online publication by the National Center for Complimentary and Alternative Medicine of the National Institutes of Health to inform the general public about the GAIT trial and its findings. Participants taking the positive control, celecoxib, experienced statistically significant pain relief versus placebo, about 70% of those taking celecoxib had a 20% or greater reduction in pain versus about 60% for placebo. Overall, there were no significant differences between the other treatments tested and placebo. For a subset of participants with moderate-to-severe pain, glucosamine combined with chondroitin sulfate provided statistically significant pain relief compared with placebo, about 79% had a 20% or greater reduction in pain versus about 54% for placebo. According to the researchers, because of the small size of this subgroup these findings should be considered preliminary and need to be confirmed in further studies. For participants in the mild pain subset, glucosamine and chondroitin sulfate together or alone did not provide statistically significant pain relief.
$0.02 - enjoy
