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Bone Deep

Bone Joint Muscle
DaVinci Laboratories

Bone, joint and musculoskeletal wellness can be aided by a healthy lifestyle.

Oh those aching bones. Oh those tired muscles. Oh those swollen joints. Chances are that virtually everyone, of any age, has experienced aches and pains. These issues can be acute or, if they are not treated or do not respond to treatment, they could transition into a chronic problem.

The over-the-counter and prescription market is saturated with pills to provide pain relief. However, natural practitioners prefer to get at the underlying root of these problems and even try to engage in prevention, if at all possible.

Causes and Prevalence of Bone, Joint and Muscle Issues

The etiology of bone pain could range from organic causes, such as underlying infections; inflammation resulting in bursitis, tendonitis or arthritis; autoimmune diseases; sarcopenia; and/or acute pains from an injury or muscle strain.

Other underlying causes are perhaps not so obvious.

Evan DeMarco, chief science and marketing officer with Omax Health, a manufacturer headquartered in California, said that the prevalence of bone, joint and muscle problems is growing. “For instance, in 2015, 22 percent of Americans had been diagnosed with some form of arthritis or autoimmune disease. Sarcopenia (age-related muscle protein breakdown), something typically diagnosed in retired individuals, is now being seen in Americans in their 20s and 30s,” said DeMarco.

Serena Goldstein, ND, a naturopath based in New York, noted that the main causes of bone, muscle and joint issues are “… sedentary lifestyle, obesity, overuse, gout, autoimmune, age, genetics, poor nutrition and smoking.”

Cheryl Myers, chief of scientific affairs and education at Wisconsin-based EuroMedica, Inc. agreed that many factors contribute to musculoskeletal issues. These include, “… high levels of activity, low intakes of bone and muscle-building nutrients, genetic predisposition, aging or a combination of all of the above.”

Although younger people can experience a number of muscle issues, the aging process contributes to the risk. “Age-related loss of muscle mass and function in the elderly especially is a contributor to loss of independence and is also linked to increased risk of falls and fractures,” said Kai Man Yuen, medical and scientific affairs specialist with MitoQ Limited, headquartered in New Zealand.

“Mitochondrial oxidative stress has been suggested to be a contributing factor to these problems, and finding a way to keep the ROS (reactive oxygen species) in check is very important,” Yuen continued.

Anne Trias, product director with American River Nutrition in Massachusetts, agreed that these problems coincide with oxidative stress and added that other aging manifestations, such as inflammation, metabolic syndrome and obesity, are contributing factors. She said that diseases such as osteopenia and osteoporosis play a part as well; these diseases affect more women than men, as they are often related to menopause.

In fact, said Michael T. Murray, ND, chief science officer with the Florida-based manufacturer Enzyme Science, “The most common musculoskeletal issue is by far osteoarthritis (OA), or degenerative joint disease. This condition is characterized by joint degeneration, loss of cartilage, and alterations of the subchondral bone. It is estimated that more than 50 million Americans have OA, and OA is believed to be responsible for 25 percent of all office visits to primary care physicians. These numbers have increased slightly due to the aging Baby Boomer population. OA incidence increases dramatically with age and body-mass index, especially OA of the knee. Men and women are equally affected, but symptoms occur earlier and appear to be more severe in women,” he said.

Asma Ishaq, CEO of Modere, a manufacturer based in Utah, noted that we lose hyaluronic acid as we age, something that is responsible for holding moisture in our tissues. “Collagen synthesis rate also starts to decline sharply in our thirties. Together with age, repetitive physical activity is another contributor to the progressive deterioration of the cartilage and connective tissues in our joints, often resulting in common strains, stiffness and soreness that inhibit peak performance,” she said.

Conventional Treatments

Conventional treatments for achy joints depend on the etiology of the problem, but it often includes over-the-counter medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription medications. The problem with those has always been the potential for negative side effects. These side effects could range in severity from minor complaints like upset stomach to more serious ones such as gastrointestinal bleeding. At the very worst, there is the very real risk of addiction if patients are prescribed narcotics for joint pain.

“I believe the public is becoming more aware of the fact that pharmaceuticals are more of a band-aid,” said Dr. Goldstein.

“The challenge in our medical culture right now is to bridge the gap between modern medicine and the more holistic alternative approach to treating patients. I believe that they can and absolutely need to coexist for the benefit of patients. While modern medicine can be effective at diagnosing and perhaps treating specific symptoms of disease, alternative medicine is grounded in treating the whole patient and transitioning them from a diseased state to a healthy state,” added DeMarco.

When it comes to osteoporosis, Trias said that traditional treatments include estrogen therapy, bisphosphonates and monoclonal antibodies, but all of these come with their own undesirable side effects. “Weight loss is the only recommendation for arthritis aside from the use of pain relievers, steroids and supportive devices. With such limited options that target symptoms rather than the actual ailment, it is not surprising that patients are looking for alternatives.”

Natural Approaches

Demarco regularly lectures about what he calls the 4 Pillars of Health and Wellness: Diet, Exercise, Supplementation and Social. “The foundation of The 4 Pillars is that there is no silver bullet for total health. Instead, we focus on small corrections that lead to big changes,” he said.

More specifically, he said that resistance training is a must for preventing and even reversing many bone, muscle and joint issues. “Loss of muscle mass is a major catalyst in the human disease state,” he said. He also recommends a microbiome test to understand food intolerances, as diet is another essential aspect of maintaining an overall healthy system. He further implicated today’s lack of human interaction as detrimental to health. “Engaging in human contact has been shown in numerous clinical settings to have an immune boosting effect.”

DeMarco is also a proponent of dietary supplements. “Now, with many of the toxic aspects of our lifestyle, lack of exercise and access to healthy natural food, supplements are becoming more and more essential to help offset many of the damaging aspects of our modern western lifestyle, which can be very pro-inflammatory,” he said.

For bone health specifically, Trias said that options have expanded far beyond the traditional calcium recommendation. “Two ingredients, vitamin D and vitamin K, ensure that calcium goes where it is needed the most. Vitamin D3 aids in the absorption of calcium from the intestine, its removal from blood vessels, and transfer to the bone. Vitamin K, on the other hand is essential in capturing calcium crystals within the bone, while preventing its build-up in arteries,” she explained.

Trias added that antioxidants are another strategy to promote bone health. “What many don’t realize is that estrogen has antioxidant properties, and the hormone’s rapid drop during menopause is at least partially responsible for the development of osteoporosis in women with its earlier onset compared to men. Interestingly, parts of the tocotrienol molecule’s antioxidant region resembles the estrogen molecule very closely, which may be one of the reasons for tocotrienol’s bone-protective effects we observed in post-menopausal women.”

Natalie Rasoulzadeh, marketing manager with Procana Laboratories, a manufacturer based in California, noted that, “natural approaches, such as supplementing cannabidiol or applications of anti-inflammatory essential oils, have been proven through multiple medical studies to be effective with and without traditional treatments. It also depends on the severity of the problem; for severe chronic pain, holistic supplements may not be strong enough on their own and strong medication may be needed.”

Still, supplements will not substitute for an unhealthy lifestyle, Dr. Goldstein pointed out. That is why she recommends an anti-inflammatory diet to facilitate healing and prevention of joint pain. “Limiting/avoiding alcohol, quitting smoking, getting quality sleep, having joy in life, are all approaches to potentially reducing the prevalence and quality of pain.”

Similarly, Myers recommends a holistic approach. “I think that a mixture of integrative treatment, with appropriate lifestyle measures under the supervision of a licensed practitioner makes the most sense. And those measures may take the form of a non-inflammatory, whole foods diet, and moderate, sensible exercise supported by regimen of clinically supported supplementation,” she explained.

Natural Supplements, Ingredients and Remedies

Recognizing the importance of mitochondria and its role in energy production and other functions, MitoQ Limited manufactures MitroQ 5 mg and MitoQ Joint, with plans to supply the practitioner market later this year.

“MitoQ 5 mg contains MitoQ, which is the shortened form of the antioxidant ubiquinol (or CoQ10) with an addition of a Triphenylphosphonium ion,” said Yuen, adding that this modification allows MitoQ to pass through the mitochondrial membrane, and only small doses are needed due to its bioavailability. “MitoQ Joint contains MitoQ and Green Lip Mussel Extract (GLME). GLME contains a unique blend of natural oils, esters, sterols and rich in omega-3 fatty acids.”

Omax Health supplies omega-3 fatty acids to the practitioner market with its product, Omax Ultra Pure to aid in reducing inflammation. “Omega-3 fatty acids really represent one of the valuable dietary supplements for treating these diseases. These polyunsaturated fatty acids have been proven in numerous clinical studies to support healthy inflammatory response,” noted DeMarco.

The latest product by Omax is CryoFreeze CBD. CBD is an ingredient that has garnered a lot of attention as of late. Of this product, DeMarco said, “This topical CBD uses a unique delivery system to relive pain at a cellular level, while promoting blood flow and reducing inflammation.”

Procana Laboratories is also a proponent of cannabidiol therapy. “CBD has shown to be anti-inflammatory and pain-modulating,” said Rasoulzadeh. Plus, she added, “legalizing medicinal cannabis in the USA has definitely created a buzz and has helped shape this health category.”

Procana offers several products in this vein, including CBD Balance, CBD Ultra, Hemp Spectrum and Hemp Omega. The latter, for example, contains 500 mg of cold-pressed hemp seed oil in a soft gel form and is also a source of omega-3 and omega-6 essential fatty acids.

American River Nutrition does not specifically target the practitioner market but is an ingredient supplier. Still, the company noted that health professionals are increasingly interested in the ingredient found in their product DeltaGold, a tocotrienol extract from the annatto plant that supports the decrease of bone resorption and improves bone turnover rate. Trias explained that tocotrienol is a member of the vitamin E family, and their branded DeltaGold ingredient is the only tocotrienol ingredient manufactured in the U.S.

Enzyme Science offers MyoMend, which contains mixtures of proteolytic enzymes to address the inflammation that is an underlying cause of many bone diseases. Specifically, said Dr. Murray, “MyoMend consists of a high potency, therapeutic blend of enzymes, including nattokinase and serrapeptase. When your body is overexerted due to physical stress, muscle and joint function may be compromised due to physical discomforts. Myomend contains a unique blend of proteolytic enzymes that work systemically to help break down damaged proteins, speeding up recovery and promoting flexibility and mobility. Rutin is known as a vital phytochemical which serves as an antioxidant and is associated with improvement of physical fatigue. In combination, enzymes and rutin naturally accelerate muscle and tissue repair and provide optimal wellness.”

Liquid BioCell is a collagen and hyaluronic ingredient manufactured by Modere. “Collagen and hyaluronic acid are chief components of healthy connective tissue and are especially important to knees, elbows, wrists and the spine, where they are present and responsible for joint function, lubrication, comfort and mobility,” said Ishaq. There are several products in the Liquid BioCell line: Liquid BioCell Life, Liquid BioCell Sport and Liquid BioCell Pure. In addition to the Liquid BioCell main ingredient, Liquid BioCell Life, for example, also includes 13 antioxidant phytonutrient fruits as well as resveratrol. The company’s products have won multiple industry awards.

Ishaq added that the company’s manufacturing process delivers the nutraceutical in a way that the body can easily absorb. “Unlike tablets and capsules, a liquid begins to absorb in the mouth, at which digestion begins. Additionally, a great tasting liquid is also significantly helpful in consumer-compliance to dosage and frequency requirements.”

Dr. Goldstein praised curcurmin and boswellia as wonderful herbs that help reduce inflammation, as well as white willow bark (a derivative of aspirin) and fish oil. “I also like rubbing castor oil either daily, or a few times per day, on affected joints, and recommend Epsom salt baths,” she said.

Myers said that the main goal is to stop inflammation and help build strong tissue. EuroMedica manufactures a range of formulas and products that support joints, bones, and muscles that help rebuild tissue as well as alleviate pain. These include Silica-20, Curaphen/Curaphen Extra Strength, CuraPro, ArthoMed and Strontium.

While some of the ingredients in these formulas are well known, Myers said that one ingredient for joint, collagen and bone strength that may be under the radar is silica, found in their product Silica-20. She said that silica is valuable for stabilizing osteoporosis and osteopenia and has been shown to increase absorption of calcium into the bone by an average of 50 percent. The Curaphen products contain curcumin blended with turmeric essential oil and other pain-relieving ingredients like boswellia, providing an anti-inflammatory action.

State of the Market/Market Trends

The market for natural supplements that support bone, muscle and joint issues is on the rise. “The bone health market reached an estimated $9 billion in the U.S. in 2017. The number of reported cases of arthritis, lupus, autoimmune disease and other ailments affecting bone, joints and muscles is on the rise and that market doesn’t always account for practitioner sales as it pertains to treating more complex issues. Combine that with muscle protein ailments and you have a U.S. market estimated at over $30 billion,” said DeMarco.

Bone, joint and muscle problems closely parallel the aging process, and since the Baby Boomers make up a huge segment of the country’s population, the market will likely experience an upward trend. “Since traditional medical treatment options are limited and often accompanied by unwanted side effects, consumers in the growing aging population are seeking alternatives, leading to an increased demand for dietary supplements that support bone, joint and muscle health,” said Trias.

Myers believes that this is a product category that will always be strong, as there will always be patients who need nutrient support and natural medicines for muscle and joint pain, especially as the population ages. Plus, there is a general greater awareness overall of natural health options. “It’s not unusual for specific nutrients to have a wave of popularity that later settles in a bit for a more subdued, but steady market. Nonetheless, I would say that the categories of pain relief, joint care and bone health are about as ‘evergreen’ as you can get,” said Myers.

Practitioner Tips

Some natural practitioners choose to sell supplements at their medical offices. For those who do so, many manufacturers provide merchandising support and access to research studies. American River Nutrition provides a list of practitioner brands that carry the DeltaGold ingredient in its finished product and offers various courses on tocotrienol with CME credit. And EuroMedica noted that the company supports its practitioner partners with frequent webinars featuring well-known experts and clinical summaries.

As a naturopath, Dr. Goldstein said that most practitioners in her field try to incorporate various therapies that will help more than just joint pain.

“Naturopathic doctors are also trained in physical medicine so they can assess where pain is coming from physically, as well as discern what’s going on internally (physically and emotionally) regarding what could be contributing to inflammation overall. We also honor the therapeutic order, as there have been times I don’t even give supplements if someone has a lot of work to do around nutrition and lifestyle: I’ve literally told patients I’d rather them focus their energy on the foundational work before incorporating supplements,” she said.

Dr. Goldstein advises practitioners identify the obstacles to cure and start there. “Asking anyone to change their behavior is difficult and takes time; see if you can really get their own deep down, unrelenting reason why in order to change (aka intrinsic motivation). It will keep them consistent.”

Although lifestyle is of utmost importance, sometimes supplements do have their place in a wellness regimen. “Practitioners know their patients very well. I think that builds in a kind of ready-made way of incorporating them regardless of whether you practice as an ND, chiropractor, or an herbalist. As part of a daily regimen, or as part of a therapeutic/recovery protocol, these supplements make sense. I believe there is already a willingness on behalf of patients to listen to expertise when it comes to natural medicines—after all, they are your patients for that reason,” concluded Myers.

Healthy Take Aways:

• Bone, joint and muscle pain can affect anyone of any age, but the aging population is most at risk.
• Preventative care is of utmost importance when it comes to bones, joints and muscles.
• Supplements, though beneficial, should not substitute for a healthy lifestyle. Making lifestyle modifications goes a long way toward improving bone, joint and muscle health.

For More Information:

American River Nutrition, https://americanrivernutrition.com
Enzyme Science, https://enzyscience.com
EuroMedica, www.euromedicausa.com
Modere, www.modere.com
Omax, https://omaxhealth.com
Procana, www.procana.com